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September 2010 News Archives
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September 2: Bone drugs may raise risk of throat cancer, Associated Press
By MARIA CHENG
LONDON — People who take bone-strengthening drugs for several years may have a slightly higher risk of esophageal cancer, a new study suggests.
The findings are in contrast to another recent study that used the same database of 80,000 patients and concluded that there was no link between the drugs and esophageal cancer. That study was published last month in the Journal of the American Medical Association.
Authors of the new study say they tracked patients for nearly twice as long — nearly eight years. Other studies have been divided over whether the risk is real.
In the latest study, British researchers started with nearly 3,000 people with esophageal cancer and matched each one to five similar people who didn't have the disease. Ninety of the cancer patients and 345 people in the comparison group had been prescribed bone-building pills called bisphosphonates. These drugs, sold as Fosamax, Actonel, Boniva and other brands, are widely used after menopause to prevent or treat osteoporosis.
Normally, the risk of developing cancer of the esophagus, or throat, in people aged 60 to 79 is 1 in 1,000. The researchers estimated that with about five years use of the drugs, the risk was 2 in 1,000.
They also looked at about 10,000 people with bowel cancer and about 2,000 people with stomach cancer, and found no increased risk with use of the drugs.
The study was paid for by Britain's Medical Research Council and Cancer Research UK. It was published Friday in the medical journal, BMJ.
The study was only observational and is not the kind of evidence that can show whether such drugs cause cancer.
"Esophageal cancer is an uncommon cancer," said Jane Green, a clinical epidemiologist at the University of Oxford, one of the paper's authors. "Even a doubled risk is still a very small risk."
The chances of developing esophageal cancer after taking bisphosphonates are much smaller than from known causes like being obese, smoking or drinking.
But the disease is often caught late, as it was in actor Michael Douglas, which lowers the survival rate.
Green said the findings shouldn't affect patients taking osteoporosis drugs, but added the medicines should be watched closely.
"People are increasingly being prescribed bisphosphonates and we just don't know enough about their use over the long term," she said. The pills have other side effects including throat ulcers, abdominal pain and an irregular heartbeat.
Experts aren't sure why the drugs might lead to throat cancer, but the pills can cause inflammation in the esophagus, which could make cancer more likely.
In the U.S., the Food and Drug Administration has received reports of a few dozen people getting esophageal cancer after taking osteoporosis pills, but there is no proof the drugs caused the cancers.
"The possibility of adverse effects on the esophagus should prompt doctors who prescribe these drugs to consider risks versus benefits," wrote Diane K. Wysowski, an epidemiologist at the FDA, in an accompanying commentary.
Wysowski said patients should take the medicines carefully, like with a full glass of water before eating and not reclining for at least 30 minutes afterward.
"Doctors should tell patients to report difficulty in swallowing and throat, chest or digestive discomfort so that they can be promptly evaluated and possibly advised to discontinue the drug," she wrote.
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September 8: Lack of Sleep Linked to Distress in Young Adults, MedPage
By Nancy Walsh, Staff Writer, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
Skimping on sleep can increase the risk for common psychological problems such as low mood and anxiety, according to a large prospective study.
The study of almost 20,000 young Australian adults (ages 17 to 24) found that short sleep duration was linearly associated with psychological distress, with a relative risk of 1.14 (95% CI 1.12 to 1.15) -- or a 14% greater risk of worse distress for every missed hour of sleep, reported Nicholas Glozier, MBBS, PhD, of the University of Sydney, and colleagues.
In addition, a linear association was seen between inadequate sleep and persistent psychological distress a year later, with a relative risk of 1.08 (95% CI 1.04 to 1.13) for each hour of less sleep, Glozier and co-authors wrote in the September issue of Sleep.
In recent decades there has been an unexplained increase in the rate of psychological distress among young adults, and distress that persists can lead to depression or other serious mental health problems.
Because sleep duration among young people has also been decreasing -- likely lost to television, computer games, and the Internet -- Glozier and colleagues decided to analyze data from a prospective study that included 19,648 Australian drivers ages 17 to 24 years.
Participants answered a questionnaire that asked about risk factors for automobile crashes, including substance abuse, self-harm, and sensation seeking.
They also were asked about sleep patterns and psychological distress, which was assessed on a ten-item self-report measure of symptoms such as fatigue, nervousness, and sadness.
The researchers found that 18% of participants slept less than seven hours each night, and another 30% slept between seven and eight hours. A total of eight to nine hours of sleep per night is recommended for young adults.
Almost one-third reported considerable psychological distress.
Among those who reported five hours or less of sleep each night, the relative risk for high levels of current psychological distress was 2.22 (95% CI 2.02 to 2.44) and for those who slept between five and six hours the relative risk was 1.95 (95% CI 1.79 to 2.13).
Short sleep duration was associated with older age, having a job, using marijuana and alcohol, and recent self-harm (P<0.001 for each), while high psychological distress was associated with female sex, unemployment, drug and alcohol use, self-harm, and sensation seeking (P<0.001 for each).
A random sample of the cohort was resurveyed 12 to 18 months later, and data were available for 2,937.
Among that group, 1,992 had not reported psychological distress at baseline, but there was a linear association between shorter sleep and the new onset of distress during that year (RR 1.12, 95% CI 1.01 to 1.24).
And among the 945 who had reported high levels of psychological distress at baseline, 44% continued to experience distress a year later.
Persistent distress was associated with all durations of short sleep compared with the recommended length, reaching a relative risk of 1.65 (95% CI 1.17 to 2.32) with five hours or less each night.
In a log binomial model, the persistence of psychological distress in short sleepers remained (RR 1.05, 95% CI 1.01 to 1.10) after adjusting for multiple confounders, including the severity of distress.
The researchers noted that it has proven difficult to determine whether sleep disturbance might represent a prodrome of a mental disorder or a residual symptom of a previous disorder.
"Recent research on sleep disturbance and mental disorder has shifted the traditional view of sleep disturbance invariably being part of a mental disorder to one of comorbidity, with greater understanding of common and differential underlying biology," they observed.
Limitations of the study include potential attrition bias and confounding factors, as well as the fact that persistence of distress was assessed at only one time point and could represent a fluctuation in distress rather than true chronicity. The study also used self-reported measures of sleep duration and psychological distress.
As well, the study (though large) was conducted among Australians and thus may not be generalizable to other populations.
Short sleep duration in young people has consistently been linked with poor education, physical and social difficulties, as well as weight gain.
"The addition of another negative outcome (persistent psychological distress and thus likelihood of future psychiatric disorder) of short sleep duration adds weight to the argument for improving sleep in this age group, as well as identifying sleep duration as a marker for early intervention," they wrote.
Among possible ways of modifying the impact of inadequate sleep in young people could be starting the school day later and curtailing late-night Internet use, according to the authors.
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September 10: HPV linked to oral cancer rise, NursingTimes.net
A new report has found that the increase in certain types of oral cancer is being fuelled by the human papillomavirus, which is already the cause of millions of cases of cervical cancer.
According to a report in the journal Cancer, the root cause of the increase in oropharyngeal cancers comes from one particular strain of HPV.
It is most commonly found near the base of the tongue and around the tonsils.
Figures from the study showed that almost two-thirds (60%) of such tumours found annually in British Columbia, Canada, were as a result of the HPV infection.
The report claimed that the number of men to have tested positive with oropharyngeal cancer has increase from 30 to 60 in the last 10 years.
In women, the increase has been steady, but less dramatic. Radiation oncologist at the BC Cancer Agency, Dr John Day, believes the surge can be explained by a change in patterns of sexual behaviour and birth control over the last 30 or 40 years.
“HPV has been around for ages, but the use of oral contraceptives starting in the 1960s and 1970s led to an increase in incidents of sexually transmitted diseases,” he said.
He also pointed out that the current policy of offering vaccinations to girls between the ages of 12 and 18 failed to address the problem in boys, saying it meant “only half” the population was protected.
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September 13: Cochlear implants allow baby to hear mother's voice for the first time, ksl.com
By Shara Park
BOUNTIFUL -- Many parents revel in the moment when their child walks or talks for the first time, but an Ogden couple will never forget the moment when their 14-month-old son heard their voices for the first time.
Hearing loss is the most common birth defect In Utah, about 1 in every 300 babies is born with a permanent hearing loss. -Utah Dept. of Health
Mason Loe was diagnosed deaf at birth, but because of technology he is now on his way to a hearing future.
Like most children his age, Mason likes to play with brightly-colored toys that move and make sound. But when KSL News first visited him, Mason couldn't hear the toys or any other sound.
"A lot of it is you just think: How am I going to communicate with my son?" his mother, Deanna Loe, said.
A few days after his birth, Deanna and Brian Loe knew there was a possibility Mason was deaf. While at McKay-Dee Hospital, Mason failed his newborn hearing test. Being first-time parents, it was something the Loes never expected.
"It was a little bit for me to take in," Brian said. "I had difficult time with that."
Pediatric audiologist Kurt Randall diagnosed Mason as deaf at birth. Randall is the head of Utah's Early Hearing Detection and Intervention Program, a program implemented in all hospitals around the state in an effort to catch early hearing loss in newborns.
Newborn Hearing Screening Its the law... Approximately 95% of babies now receive a hearing screen shortly after birth and most states now have statutes in place related to universal newborn hearing screening. The Utah Legislature passed a bill in 1998 requiring newborns in hospitals with over 100 births per year to have a hearing screening prior to discharge. In 1999 all births (including home births) were required to have a hearing screen. -Utah Dept. of Health
"We want to have the baby screened before one month of age. We want to diagnose the hearing loss before three months, and then have them in an early-intervention program before six months," Randall explained.
Because of an early diagnosis, Mason was wearing hearing aids at 3 months old, but they didn't help much. His parents were also fully engaged in teaching him sign language so they could communicate with him.
Doctors then determined Mason qualified for cochlear implants -- hearing devices that are surgically implanted into the inner ear.
With the help of the implant, the Loes were told Mason would likely hear and have a good shot at a speaking future.
"We're thankful for modern technology, and we know the Lord has enlightened people to have these amazing gifts to be able to hear, and we want to take advantage of it to help Mason," Deanna said.
After the surgery on both ears, and a month of healing, 14-month-old Mason went to a Primary Children's hospital rehab center in Bountiful to have his implants turned on.
It's was an emotional day for the Loes because if the implants worked, it would be the first time Mason has ever heard his mother's voice.
"I'm excited for him to hear his name," Deanna said. "That is so cool to me."
"I'm very excited," Brian said, holding back tears.
After adjusting the outer portion of the implant, which was rigged with a little hat, and adjusting a few audio levels, Mason's right implant was turned on.
What happened next was subtle. As Deanna began talking to her son, Mason turned toward her and dropped his bottle. Then he became a bit agitated. That's how audiologist Stacy Butler knew the implant was working and Mason was hearing clearly for the first time in his life.
"The fact that he turned and was reacting to sound in any way, shape or form, at this point in time, is beautiful success," Butler said.
And because Mason shifted his eyes at the sound of his mother's voice, Deanna knew the moment when her son heard his name for the first time. It's a moment she says she'll never forget.
"It's cool. It's such a blessing," Deanna managed to say through her tears. "Just a simple thing like when you want to sing your baby a lullaby, it's awesome he'll be able to hear."
Over time, the audio going into Mason's implants will need to be adjusted so that his hearing slowly progresses. By the time he enters kindergarten, with a little help from speech specialists, Butler says Mason should be hearing and speaking like many of the other kids his age.
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September 14: Like Opera Singers, Teachers Prone To Voice Stress, Medical News Today
In common with professional singers, teachers returning to the nation's classrooms this month are good candidates for severe voice problems, and Johns Hopkins throat specialists have some tips for them - and anyone whose job demands a lot of loud vocalization. "As part of their profession, teachers use their voices constantly and often in noisy rooms with poor acoustics, forced to project their voices loudly enough so that all students can hear them clearly," says Lee M. Akst, M.D., an assistant professor in the Johns Hopkins School of Medicine Department of Otolaryngology-Head and Neck Surgery and director of the Johns Hopkins Voice Center. "Unfortunately, this voice stress can lead to problems," he adds.
The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) says more than one in four people in the United States reports voice disorders during their lifetime and that this is a particular problem among teachers. AAO-HNS adds that as many as47 percent of our nation's teachers experience some degree of voice abnormality on any given day,20 percent of teachers report missing work due to voice problems, and one in 10 teachers has been forced to leave the profession because of them.
Akst's advice to teachers seeking to protect their voices begins with limiting vocal over-use or abuse as much as possible, not smoking, and hydrating the vocal cords by drinking plenty of water during the day. "Do what you need to do and pay attention to how it feels," he says. "If you start to feel discomfort while talking, try to limit the use of your voice and allow your vocal cords to recover." Other tips specific for the classroom include:
- Using an amplification system for your classroom if needed so that there's no need to compete with a noisy environment.
- Moderating your speaking over the course of the school day. Find or create opportunities to rest your voice. Study halls or lunch periods, when you use your voice less, can provide a good time for the vocal cords to recover.
- Prioritizing or limiting voice use in the evenings as necessary, in order to save it for the classroom.
Akst also encourages teachers, especially those who coach teams as well, to pay attention to any signs of throat inflammation. Overuse of the vocal cords and reflux irritation, exacerbated by caffeine, carbonated drinks, alcohol and acidy foods, are the most common causes of vocal cord inflammation.
Conservative cost estimates for therapy, surgery and substitute teaching personnel top $2 billion annually in the United States alone, according to some estimates of the economic impact of voice problems among educators. Akst says any teacher - or anyone else who uses his or her voice professionally and can't meet the occupational demand, is hoarse for longer than two weeks, finds speaking painful, feels a mass in the neck or has difficulty swallowing should seek a medical evaluation by an otolaryngologist or a laryngologist who specializes in voice disorders.
Source: Johns Hopkins Medicine
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September 20: Botox Helps With Excessive Drooling, MedPage Today
By Nancy Walsh, Staff Writer, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner Earn CME/CE credit
Injecting botulinum toxin (Botox) into the submandibular glands helped to control excessive drooling in children with neurologic disorders, a Dutch prospective cohort study found.
The study of 131 patients (mean age around 11), found that two months after the injections the mean drooling quotient (a validated semiquantitative method to assess severity of drooling) fell from a baseline value of 28.8 to 15.5, which represented a change of -13.3 (P<0.001), according to Arthur R.T. Scheffer, MD, of Radboud University in Nijmegen, and colleagues.
In addition, 61 patients had a 50% reduction in their drooling quotient from baseline and thus were considered responders, the researchers reported in the September Archives of Otolaryngology–Head & Neck Surgery.
The drooling commonly experienced by children with neurological disorders such as cerebral palsy is associated with considerable morbidity -- ranging from social neglect to aspiration pneumonia.
Speech and behavioral therapy have been tried, but are only suitable in children with adequate cognitive ability.
An oral solution of glycopyrrolate (Cuvposa) was recently approved by the FDA for excessive drooling. Anticholinergics have also been used to treat the problem, but can have serious adverse effects.
To evaluate whether injections of botulinum toxin could reduce drooling without the need for surgery and how long the effects would last, Scheffer and colleagues enrolled 131 children with nonprogressive neurologic disorders and moderate to severe symptoms, for whom conservative measures were not effective or feasible.
More than two-thirds of the patients were boys (77 boys and 54 girls) with a mean age of 10.9 years; 90.1% had cerebral palsy.
The injections were done with the children under general anesthesia. Doses were 15 units per gland for children who weighed less than 15 kg, 20 units per gland for those weighing 15 kg to 25 kg, and 25 units for those weighing more than 25 kg.
The response rate at two months was 46.6%. By eight months, however, symptoms had begun to increase, although a significant difference from baseline still remained (-10, P<0.001)
A time-to-event analysis of the 61 children who were considered responders found a median duration of effect of 150 days.
On a secondary outcome measure, a caretaker visual analog scale that rated the severity of drooling during the previous two weeks, similar results were seen.
Mean scores on the visual analog scale fell from a baseline score of 80.4 to 53.9 (P<0.001).
Response rates, defined as a reduction of two standard deviations from baseline scores on the visual analog scale, were 51% at two months and 26% at eight months.
In general, the injections were well tolerated, but many of the children had changes in saliva viscosity.
A total of 41.2% had thickening of the saliva at some point, while 12.2% had a reduction in viscosity.
Changes in saliva rarely resulted in serious problems, however, possibly because caretakers provided only mashed or melted foods in the days following the injections.
Transient dysphagia was reported by four patients, which may have been related to changes in consistency of the saliva, "although diffusion of toxin into surrounding tissue cannot be excluded as a cause," the researchers noted.
Feeding deteriorated in 6.1% of the patients but improved in 6.9%.
Secondary benefits included better oral hygiene in four children and improved speech in another four.
The researchers were unable to identify predictors of response to the botulinum toxin injections, noting that they did not have data on factors such as posture and oral motor function that could contribute to a response.
"It thus remains unclear why some patients benefit so much more or so much longer from botulinum toxin than others," they wrote.
Another concern that remains unknown is the effect of repeated injections. Some suggest that repeated injections could lead to atrophy of the salivary glands and a permanent reduction in drooling, but one recent report found a secondary nonresponse with multiple injections, Scheffer and co-authors noted.
"Until evidence for a cumulative effect appears, botulinum toxin should therefore be considered a temporary solution to relieve drooling, as the current study underscores," they wrote.
Furthermore, although some increased efficacy has been noted when the parotid glands also are injected, Scheffer's group did not give combined injections to children fed orally.
The parotid glands secrete saliva during mastication, and injections of botulinum into these glands for children who chew might interfere with swallowing.
"Although the 46.6% success rate might appear low, its safety and efficacy make botulinum toxin a useful first-line invasive treatment if conservative measures have failed," Scheffer and colleagues concluded.
The response rate might increase if patient selection improved, they added.
The authors declared no financial conflicts of interest.
Primary source: Archives of Otolaryngology–Head & Neck Surgery
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September 21: Gentler surgery for hay fever shows promise, Reuters
By Frederik Joelving
NEW YORK (Reuters Health) - Radiofrequency surgery appears to help people with hay fever when drugs fail -- even up to five years after the procedure, a new study shows.
Hay fever causes stuffy and runny nose, among other symptoms, because the mucous membrane inside the nose swells when it gets irritated, for instance by pollen or dust.
Drugs such as antihistamines and corticosteroid nasal sprays are typically used to alleviate the symptoms, but they fail to work for many people, experts say.
Some may choose to undergo surgery to reduce the size of the swollen mucosal membranes, but procedures such as cold knife surgery and electrocautery often cause pain, bleeding and other side effects.
Writing in the Archives of Otolaryngology--Head & Neck Surgery, researchers say radiofrequency surgery is becoming increasingly popular, because it is painless and causes few side effects.
It works by heating up the tissue underneath the mucous membrane, reducing its size and killing the small blood vessels that would otherwise lead extra blood to the irritated area.
In the new study, researchers followed patients for five years after they had been treated by Dr. Hsin-Ching Lin at Chang Gung University College of Medicine in Kaohsiung, Taiwan.
Seventeen of 119 patients - about 14 percent -- didn't respond to the procedure and went on to have more invasive surgeries. Of the rest, however, more than three-quarters felt at least one of their symptoms -- including sneezing, stuffy nose and itchy eyes -- had improved when evaluated half a year later.
At five years, about six in 10 said they continued to experience improvements and no one reported any side effects. All symptoms showed decreases when rated by the patients, and 57 percent said they would have the procedure done again.
The researchers didn't include a control group, but a shorter study from 2004 found radiofrequency surgery was better than a sham procedure at reducing congestion and easing breathing.
Dr. Lino Di Rienzo Businco, an ear, nose and throat specialist who was not involved in the study, said he would definitely recommend the procedure to patients who don't respond to medications.
Di Rienzo Businco, of Ospedale C.T.O A. Alesini in Rome, added in an e-mail to Reuters Health that the cost of the procedure was about the same as six months of medical treatment.
SOURCE: link.reuters.com/cyb64p Archives of Otolaryngology--Head & Neck Surgery, September, 2010.
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