(HealthDay News) -- Ovarian cancer has long had a reputation as a silent killer, because many people believed it gave no warning signs until far advanced.
But women suffering from the disease knew differently. They knew they had certain symptoms that were common from patient to patient.
"Survivors for years have said there are symptoms for the disease, but no one listened to them," said Jane Langridge, chief executive officer for the National Ovarian Cancer Coalition.
Now, doctors have agreed with them.
A screening test has been developed that, in one study, accurately detected early stage ovarian cancer 57 percent of the time.
Based on that and similar studies, experts from the American Cancer Society, the Gynecologic Cancer Foundation and the Society of Gynecologic Oncologists have agreed on a set of symptoms that can be signs of early ovarian cancer.
"We want people to know it's not the silent killer. There are symptoms women can bring to their doctors that are important to pay attention to," said Dr. Linda Duska, a member of the National Ovarian Cancer Coalition's medical advisory board and a gynecologic oncologist at Massachusetts General Hospital Cancer Center, in Boston.
"This agreement is significant in the fact that, maybe if we pay more attention to symptoms, we can catch them sooner and have more success in treating them," she continued.
Early detection of ovarian cancer is crucial.
More than 22,000 U.S. women will be diagnosed with the disease this year, and three-fourths of them -- more than 15,000 -- will die from it, according to the National Cancer Institute.
If caught in the early stages, the five-year survival rate for ovarian cancer is 90 percent. But 75 percent of women are still diagnosed in the advanced stages, when the prognosis is poor.
Ovarian cancer is the eighth most common cancer among American women, not including skin cancer, according to the American Cancer Society. An estimated two-thirds of women with ovarian cancer are 55 or older.
"It is a disease that is detected in stage 3 and above, and that is unacceptable," said Sherry Salway Black, executive director of the Ovarian Cancer National Alliance and a survivor of the disease. "Our mortality figures are unacceptable."
The symptoms of ovarian cancer can be subtle and hard to assess, because they often mimic common digestive and gastrointestinal disorders. They include persistent swelling, bloating, pressure or pain in the abdomen, gastrointestinal upset, difficulty eating or feeling full quickly, and the frequent or urgent need to urinate.
Because these symptoms are so common, women should be careful not to assume the worst, Duska said.
"The goal of this is not to make everyone think they have ovarian cancer," she said. "If women have these symptoms, and they persist over time, they should have them investigated.
Everyone with bloating does not have ovarian cancer."
Typically, two or more symptoms occur simultaneously and increase in severity over time, according to the National Ovarian Cancer Coalition.
The screening test developed late last year involves an extensive checklist of symptoms and their frequency. It picked up early stage ovarian cancer 56.7 percent of the time, and late stage ovarian cancer 80 percent of the time. The test also produced "false-positive" findings 10 percent to 13 percent of the time.
The test searches for many of the symptoms agreed upon by cancer experts as indicative of ovarian cancer.
"When women go to their doctors and have had some of these symptoms, and they are new and have persisted for two or more weeks, perhaps a doctor now would be willing to perform some pretty simple tests to rule out ovarian cancer," Langridge said.
Women who have a family history of breast or ovarian cancer are at increased risk and should pay particular attention to the symptoms, Duska said.
Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy.
Advances in chemotherapy have made the late-stage disease more survivable, Duska said.
In a more intensive regimen recently shown to improve survival, standard intravenous chemotherapy is combined with chemotherapy injected directly into the abdominal cavity. The abdominal injection exposes hard-to-reach cancer cells to higher levels of chemotherapy than can be reached intravenously.
"That was a breakthrough, I think," Duska said.
Other treatments being explored include new chemotherapy drugs, vaccines, gene therapy and immunotherapy, which boosts the body's own immune system to help combat cancer, according to the Mayo Clinic.
More information
To learn more about ovarian cancer, visit the U.S. National Library of Medicine.
Senin, 29 Oktober 2007
Kamis, 25 Oktober 2007
FDA to Review Clotting Drug After Trial Suggests Death Risk
(HealthDay News) -- The U.S. Food and Drug Administration said Thursday that it will review the safety of the clotting drug aprotinin (Trasylol), after a major Canadian trial was stopped early due to an increase in deaths for cardiac surgery patients placed on the drug.
Trasylol, first approved by the FDA in 1993, is typically used to limit blood loss in patients undergoing cardiac surgery.
While less bleeding was noted in the aprotinin group versus patients assigned one of two other drugs, "a trend toward increased mortality in the aprotinin group had been observed throughout the study," the FDA noted in a statement released Thursday.
That elevated 30-day and overall death risk caused the Canadian study's Data Safety Monitoring Board (DSMB) to recommend stopping patient enrollment in the so-called BART trial. The trial was set to recruit about 3,000 adults who were candidates for a variety of cardiac surgeries and were at high risk of bleeding.
"The DSMB concluded that continued enrollment of patients into the aprotinin group was unlikely to significantly change the study findings," the FDA said.
Trasylol's maker, Bayer, also issued a new "guidance" to doctors on Thursday. The German company advises "that physicians use Trasylol only in accordance with approved product labeling." Bayer said it believes the drug "remains a safe and effective treatment option for physicians," but it is working with the FDA and international health authorities to see if any label changes might become necessary as new data emerges.
Trasylol has had a checkered history since it was first approved by the FDA in 1993.
On Sept. 12, a U.S. Food and Drug Administration advisory panel recommended that aprotinin remain on the market, despite evidence that it might have serious side effects.
In February, a study published in the Journal of the American Medical Association found patients on the drug were at greater risk of dying over the next five years than those given two other medications. The same researchers linked aprotinin to an increased risk of kidney failure, heart failure and stroke in a study published in 2006.
"Our present findings deal with death," one of the JAMA study's authors, Dr. Dennis T. Mangano, said at the time. Mangano, director of the Ischemia Research and Education Foundation, a California-based nonprofit group, said that "the death rate for aprotinin patients far outstrips that for the other two drugs."
His team's study tracked the long-term survival of nearly 3,900 heart patients who underwent coronary artery bypass surgery at 62 medical centers worldwide. The researchers tabulated survival at six weeks, six months, and then annually for five years.
The five-year death rate for patients given aprotinin was 20.8 percent, compared to 15.8 percent for those given another drug, aminocaproic acid, and 14.7 percent for those given tranexamic acid. Both alternative drugs are available in generic versions.
After the 2006 report from Mangano's group, the FDA advised doctors to carefully monitor aprotinin patients for kidney, heart and brain damage -- an action taken after Bayer disclosed study data showing that it increased the risk of death, kidney damage, congestive heart failure and stroke.
The 2006 report led to a 37 percent reduction in surgeons' use of aprotinin, Mangano said. "Clinicians, more than anyone else, will decide whether this drug should be on the market or its use should be limited," he said.
Aprotinin does have its defenders.
Dr. T. Bruce Ferguson Jr., associate director of cardiothoracic and vascular surgery at East Carolina University, wrote an accompanying editorial to the JAMA study. He believes the study "was inadequate to address the question they were asking because of the way the database was designed."
"The most important factor they were unable to control was why patients got aprotinin," Ferguson said. "There were no data to address that issue, and therefore it cannot account for physician-related bias."
For example, the higher rate of death and other complications linked to the drug might be due to aprotinin being prescribed for "higher-risk patients who could be expected to have a worse outcome and higher mortality," Ferguson said. Other studies have shown that "in carefully selected patients, aprotinin is a good drug," he said.
The information used in the study was thorough and complete, Mangano countered. "In terms of the database, we had between 7,000 and 10,000 pieces of data per patient from 59 centers in 16 countries, including 23 of the 25 top cardiac centers in the United States."
"The findings speak for themselves," Mangano said. "I think they are as accurate as you can get."
He believes that aprotinin's use should be restricted to about 5 percent of patients in whom other drugs could not be used.
"And the surgeon would have to tell each patient before using this drug that there is literature out there showing that this drug is associated with renal [kidney] failure and death," Mangano said. "For the vast majority of patients, there are the two other alternatives."
More information
There's more on cardiac surgery at the U.S. National Library of Medicine.
Trasylol, first approved by the FDA in 1993, is typically used to limit blood loss in patients undergoing cardiac surgery.
While less bleeding was noted in the aprotinin group versus patients assigned one of two other drugs, "a trend toward increased mortality in the aprotinin group had been observed throughout the study," the FDA noted in a statement released Thursday.
That elevated 30-day and overall death risk caused the Canadian study's Data Safety Monitoring Board (DSMB) to recommend stopping patient enrollment in the so-called BART trial. The trial was set to recruit about 3,000 adults who were candidates for a variety of cardiac surgeries and were at high risk of bleeding.
"The DSMB concluded that continued enrollment of patients into the aprotinin group was unlikely to significantly change the study findings," the FDA said.
Trasylol's maker, Bayer, also issued a new "guidance" to doctors on Thursday. The German company advises "that physicians use Trasylol only in accordance with approved product labeling." Bayer said it believes the drug "remains a safe and effective treatment option for physicians," but it is working with the FDA and international health authorities to see if any label changes might become necessary as new data emerges.
Trasylol has had a checkered history since it was first approved by the FDA in 1993.
On Sept. 12, a U.S. Food and Drug Administration advisory panel recommended that aprotinin remain on the market, despite evidence that it might have serious side effects.
In February, a study published in the Journal of the American Medical Association found patients on the drug were at greater risk of dying over the next five years than those given two other medications. The same researchers linked aprotinin to an increased risk of kidney failure, heart failure and stroke in a study published in 2006.
"Our present findings deal with death," one of the JAMA study's authors, Dr. Dennis T. Mangano, said at the time. Mangano, director of the Ischemia Research and Education Foundation, a California-based nonprofit group, said that "the death rate for aprotinin patients far outstrips that for the other two drugs."
His team's study tracked the long-term survival of nearly 3,900 heart patients who underwent coronary artery bypass surgery at 62 medical centers worldwide. The researchers tabulated survival at six weeks, six months, and then annually for five years.
The five-year death rate for patients given aprotinin was 20.8 percent, compared to 15.8 percent for those given another drug, aminocaproic acid, and 14.7 percent for those given tranexamic acid. Both alternative drugs are available in generic versions.
After the 2006 report from Mangano's group, the FDA advised doctors to carefully monitor aprotinin patients for kidney, heart and brain damage -- an action taken after Bayer disclosed study data showing that it increased the risk of death, kidney damage, congestive heart failure and stroke.
The 2006 report led to a 37 percent reduction in surgeons' use of aprotinin, Mangano said. "Clinicians, more than anyone else, will decide whether this drug should be on the market or its use should be limited," he said.
Aprotinin does have its defenders.
Dr. T. Bruce Ferguson Jr., associate director of cardiothoracic and vascular surgery at East Carolina University, wrote an accompanying editorial to the JAMA study. He believes the study "was inadequate to address the question they were asking because of the way the database was designed."
"The most important factor they were unable to control was why patients got aprotinin," Ferguson said. "There were no data to address that issue, and therefore it cannot account for physician-related bias."
For example, the higher rate of death and other complications linked to the drug might be due to aprotinin being prescribed for "higher-risk patients who could be expected to have a worse outcome and higher mortality," Ferguson said. Other studies have shown that "in carefully selected patients, aprotinin is a good drug," he said.
The information used in the study was thorough and complete, Mangano countered. "In terms of the database, we had between 7,000 and 10,000 pieces of data per patient from 59 centers in 16 countries, including 23 of the 25 top cardiac centers in the United States."
"The findings speak for themselves," Mangano said. "I think they are as accurate as you can get."
He believes that aprotinin's use should be restricted to about 5 percent of patients in whom other drugs could not be used.
"And the surgeon would have to tell each patient before using this drug that there is literature out there showing that this drug is associated with renal [kidney] failure and death," Mangano said. "For the vast majority of patients, there are the two other alternatives."
More information
There's more on cardiac surgery at the U.S. National Library of Medicine.
Senin, 22 Oktober 2007
Whole Grains Do a Heart Good
(HealthDay News) -- Diets rich in whole grains, fruits, vegetables and even a little alcohol may help ward off heart woes, new studies show.
In one study, regular consumption of whole-grain breakfast cereal cut the risk of heart failure for male American physicians.
Another study, this time from Sweden, touted the benefits of fruits, veggies and the occasional drink in helping women beat heart attack.
The American study analyzed the association between breakfast cereal intake and new cases of heart failure, in which the heart progressively loses its ability to pump blood.
The study included data on more than 21,000 participants in the Physicians' Health Study who were followed for almost 20 years.
Compared to those who ate no whole-grain cereal, men who consumed 2 to 6 servings per week saw their risk of heart failure fall by 21 percent, while those who ate 7 or more servings per week reaped a 29 percent reduction in risk, the researchers reported in the Oct. 22 issue of the Archives of Internal Medicine.
That effect is due, in part, to the high levels of magnesium, potassium and fiber in those breakfast cereals, said study co-author Dr. Luc Djousse, an associate in epidemiology at Brigham and Women's Hospital in Boston.
"Our recommendation is that a lay person consuming breakfast cereal should look at fiber," Djousse said. "At least four grams of fiber [per serving], that should be sufficient."
Fiber increases cells' sensitivity to insulin, thus reducing the risk of diabetes, while potassium and magnesium lower blood pressure, he explained.
Breakfast cereal is best taken with skim milk, Djousse said, "and if you want to add to it, a piece or half-piece of fruit would be good."
While the study included only men, there is "no reason at all" why the results shouldn't apply to women, he said.
The Swedish study, done at the Karolinska Institute, Stockholm, took a much broader approach to the food intake of more than 24,000 postmenopausal women who supplied information on how often they ate 96 common foods.
The study, published in the same issue of the journal, identified four major dietary patterns: healthy (vegetables, fruits and legumes); Western/Swedish (red meat, processed meat, poultry, rice, pasta, eggs, fried potatoes, fish); alcohol (wine, liquor, beer and some snacks); and sweets (sweet baked goods, candy, chocolate, jam and ice cream).
In an average 6.2-year follow-up period, 308 of the women had heart attacks. However, two dietary patterns, healthy and alcohol, were associated with a reduced risk of heart attack, the researchers said.
A low-risk diet is characterized by a high intake of whole grains, fish, vegetables, fruit and legumes, moderate alcohol consumption, along with not smoking and being physically active and relatively thin, the researchers concluded. "This combination of healthy behaviors -- present in 5 percent [of those studied] -- may prevent 77 percent of myocardial infarctions [heart attacks] in the study population," the team wrote.
The study was called "empowering" by Dr. Suzanne Steinbaum, director of women and heart disease at Lenox Hill Hospital in New York, because "it demonstrates that people have control over their health and can take control, eat properly and exercise and prevent onset of disease."
"This study clearly demonstrates that it is within an individual's control to change destiny and the ability to control his or her health," Steinbaum said.
"What's amazing is that a study of 24,000 women shows that a reduction of 77 percent is possible," she said. "What could be more empowering than that?"
The issue is muddied by a plethora of books urging different diets, she acknowledged. But the real road to long-term health "is not so much going on a diet as adopting a healthy lifestyle," Steinbaum said.
More information
There's more on heart-healthy lifestyles at the American Heart Association.
In one study, regular consumption of whole-grain breakfast cereal cut the risk of heart failure for male American physicians.
Another study, this time from Sweden, touted the benefits of fruits, veggies and the occasional drink in helping women beat heart attack.
The American study analyzed the association between breakfast cereal intake and new cases of heart failure, in which the heart progressively loses its ability to pump blood.
The study included data on more than 21,000 participants in the Physicians' Health Study who were followed for almost 20 years.
Compared to those who ate no whole-grain cereal, men who consumed 2 to 6 servings per week saw their risk of heart failure fall by 21 percent, while those who ate 7 or more servings per week reaped a 29 percent reduction in risk, the researchers reported in the Oct. 22 issue of the Archives of Internal Medicine.
That effect is due, in part, to the high levels of magnesium, potassium and fiber in those breakfast cereals, said study co-author Dr. Luc Djousse, an associate in epidemiology at Brigham and Women's Hospital in Boston.
"Our recommendation is that a lay person consuming breakfast cereal should look at fiber," Djousse said. "At least four grams of fiber [per serving], that should be sufficient."
Fiber increases cells' sensitivity to insulin, thus reducing the risk of diabetes, while potassium and magnesium lower blood pressure, he explained.
Breakfast cereal is best taken with skim milk, Djousse said, "and if you want to add to it, a piece or half-piece of fruit would be good."
While the study included only men, there is "no reason at all" why the results shouldn't apply to women, he said.
The Swedish study, done at the Karolinska Institute, Stockholm, took a much broader approach to the food intake of more than 24,000 postmenopausal women who supplied information on how often they ate 96 common foods.
The study, published in the same issue of the journal, identified four major dietary patterns: healthy (vegetables, fruits and legumes); Western/Swedish (red meat, processed meat, poultry, rice, pasta, eggs, fried potatoes, fish); alcohol (wine, liquor, beer and some snacks); and sweets (sweet baked goods, candy, chocolate, jam and ice cream).
In an average 6.2-year follow-up period, 308 of the women had heart attacks. However, two dietary patterns, healthy and alcohol, were associated with a reduced risk of heart attack, the researchers said.
A low-risk diet is characterized by a high intake of whole grains, fish, vegetables, fruit and legumes, moderate alcohol consumption, along with not smoking and being physically active and relatively thin, the researchers concluded. "This combination of healthy behaviors -- present in 5 percent [of those studied] -- may prevent 77 percent of myocardial infarctions [heart attacks] in the study population," the team wrote.
The study was called "empowering" by Dr. Suzanne Steinbaum, director of women and heart disease at Lenox Hill Hospital in New York, because "it demonstrates that people have control over their health and can take control, eat properly and exercise and prevent onset of disease."
"This study clearly demonstrates that it is within an individual's control to change destiny and the ability to control his or her health," Steinbaum said.
"What's amazing is that a study of 24,000 women shows that a reduction of 77 percent is possible," she said. "What could be more empowering than that?"
The issue is muddied by a plethora of books urging different diets, she acknowledged. But the real road to long-term health "is not so much going on a diet as adopting a healthy lifestyle," Steinbaum said.
More information
There's more on heart-healthy lifestyles at the American Heart Association.
Jumat, 19 Oktober 2007
Childlessness Bothers Men More Than Women
(HealthDay News) -- Women are more comfortable with the idea of childlessness than men, new research shows, and the surprise finding might really reflect differences in how each gender views the pressures of parenthood.
"On a basic level, for men and women, parenting and parenthood mean different things," said study author Tanya Koropeckyj-Cox. "For me, it reflects that there's something important happening in the experiences of men and women where those different experiences are leading to different perceptions of family, relationships, gender and children."
Differences in socioeconomic factors such as race, age, employment, attitudes toward marriage and religion explain only part of the gender gap. "Instead, these responses indicate greater acceptance of childlessness, particularly among women, as one possible life path whether chosen or shaped by circumstances," the study concluded.
The research is published in the November issue of the Journal of Marriage and Family. The study is based on data collected in two national surveys that were conducted in 1987 to 1988 and in 1994. Over the past few decades, the number of women who are childless has varied widely, said Koropeckyj-Cox, an assistant professor of sociology at the University of Florida.
During the Baby Boom years, only about 9 percent of women were childless in their 40s. Recent statistics indicate that about 20 percent of women in their 40s are now childless, she added. "As women wait longer to have children, they may be less likely to have children," she explained.
"It's definitely a big shift," Koropeckyj-Cox said. "1962 is the tail end of the Baby Boom, and there definitely was a feeling that having children was what everybody did. The attitudes were definite and specific. Those who couldn't were regarded with pity, and those who could but didn't were disrespected."
Koropeckyj-Cox speculated that some women may not be choosing motherhood because of the burden of how difficult the dual roles of mom and working women are. "Other studies have documented that men tend to experience pretty strong economic and social rewards from being a dad, whereas women experience more of the pressures and more of the demands of the immediate day-to-day reality of parenting and juggling work."
The study argues that even though its data is at least 10 years old, that gender gap still may be pivotal in shaping attitudes toward childlessness. Conditions in terms of work and other issues for women considering parenthood don't seem to have changed much, Koropeckyj-Cox noted, but "one of my next steps would be to keep looking at it with more recent data."
At first, the findings seem "counterintuitive," said Irene Goldenberg, a professor emerita of psychiatry at University of California, Los Angeles. "People would say that women care more" about children. But, as the study implies, "women know the costs more."
The finding that women's acceptance of childlessness increases with the amount of education they have shows that "the smarter you are, the more you know about the costs," Goldenberg added. "You understand that it's difficult to do both things. The whole idea of doing both is really tough. Doing both at a high level is maybe possible for only a few women. Ordinary women can't handle it all."
Goldenberg added that she thinks "women are not really going for childlessness, but that they are more attuned to the demands -- both economic and social demands -- of parenthood, and they carry more of these responsibilities."
Nadine Kaslow, chief psychologist at Emory Medical School in Atlanta, viewed the findings similarly, adding that "women who are successful professionals make a choice that they don't want to have children in their lives, because they have other things in their lives." Men, however, "tend to think that is what you do in life. You grow up and have a baby."
That male attitude may come from their most primal being, explained Barry Ginsberg, a Pennsylvania psychologist specializing in relationships. "For a man, the loss of having a family and carrying on the gene pool makes men helpless, because they can't give birth," Ginsberg said.
From an "evolutionary standpoint, men would go around impregnating all the women they could find, so that at least one of those women would survive" and produce a child, he explained.
More information
The National Association of Mothers' Center has support and advice for moms.
"On a basic level, for men and women, parenting and parenthood mean different things," said study author Tanya Koropeckyj-Cox. "For me, it reflects that there's something important happening in the experiences of men and women where those different experiences are leading to different perceptions of family, relationships, gender and children."
Differences in socioeconomic factors such as race, age, employment, attitudes toward marriage and religion explain only part of the gender gap. "Instead, these responses indicate greater acceptance of childlessness, particularly among women, as one possible life path whether chosen or shaped by circumstances," the study concluded.
The research is published in the November issue of the Journal of Marriage and Family. The study is based on data collected in two national surveys that were conducted in 1987 to 1988 and in 1994. Over the past few decades, the number of women who are childless has varied widely, said Koropeckyj-Cox, an assistant professor of sociology at the University of Florida.
During the Baby Boom years, only about 9 percent of women were childless in their 40s. Recent statistics indicate that about 20 percent of women in their 40s are now childless, she added. "As women wait longer to have children, they may be less likely to have children," she explained.
"It's definitely a big shift," Koropeckyj-Cox said. "1962 is the tail end of the Baby Boom, and there definitely was a feeling that having children was what everybody did. The attitudes were definite and specific. Those who couldn't were regarded with pity, and those who could but didn't were disrespected."
Koropeckyj-Cox speculated that some women may not be choosing motherhood because of the burden of how difficult the dual roles of mom and working women are. "Other studies have documented that men tend to experience pretty strong economic and social rewards from being a dad, whereas women experience more of the pressures and more of the demands of the immediate day-to-day reality of parenting and juggling work."
The study argues that even though its data is at least 10 years old, that gender gap still may be pivotal in shaping attitudes toward childlessness. Conditions in terms of work and other issues for women considering parenthood don't seem to have changed much, Koropeckyj-Cox noted, but "one of my next steps would be to keep looking at it with more recent data."
At first, the findings seem "counterintuitive," said Irene Goldenberg, a professor emerita of psychiatry at University of California, Los Angeles. "People would say that women care more" about children. But, as the study implies, "women know the costs more."
The finding that women's acceptance of childlessness increases with the amount of education they have shows that "the smarter you are, the more you know about the costs," Goldenberg added. "You understand that it's difficult to do both things. The whole idea of doing both is really tough. Doing both at a high level is maybe possible for only a few women. Ordinary women can't handle it all."
Goldenberg added that she thinks "women are not really going for childlessness, but that they are more attuned to the demands -- both economic and social demands -- of parenthood, and they carry more of these responsibilities."
Nadine Kaslow, chief psychologist at Emory Medical School in Atlanta, viewed the findings similarly, adding that "women who are successful professionals make a choice that they don't want to have children in their lives, because they have other things in their lives." Men, however, "tend to think that is what you do in life. You grow up and have a baby."
That male attitude may come from their most primal being, explained Barry Ginsberg, a Pennsylvania psychologist specializing in relationships. "For a man, the loss of having a family and carrying on the gene pool makes men helpless, because they can't give birth," Ginsberg said.
From an "evolutionary standpoint, men would go around impregnating all the women they could find, so that at least one of those women would survive" and produce a child, he explained.
More information
The National Association of Mothers' Center has support and advice for moms.
Senin, 15 Oktober 2007
Psychiatric Woes Can Postpone Weight-Loss Surgery
(HealthDay News) -- About one in every five people who were candidates for bariatric weight-loss surgery did not receive the recommended psychiatric clearance for the procedure, a U.S. study shows.
Psychiatric evaluations are part of the preoperative screening process in most bariatric surgery programs, notes a team from the Rhode Island Hospital and Brown University in Providence.
The most common reasons why patients did not receive psychiatric clearance included frequent overeating to cope with stress/emotional distress; a current eating disorder; or uncontrolled psychiatric disorders.
The researchers also found that the decision to clear candidates for bariatric surgery is made with high reliability -- meaning that a review of available information by independent psychiatrists would result in the same decision.
"The goal of psychiatric evaluation is not to keep patients from having the surgery. Rather, the goal is to determine if there are any problems that might interfere with the success of surgery, and have the patient get treatment for these problems," study author Dr. Mark Zimmerman, director of outpatient psychiatry at Rhode Island Hospital and a professor of psychiatry and human behavior at Brown University, said in a prepared statement.
He said a patient is "more likely to have a positive outcome from surgery that is delayed to allow time to address the problems."
The study appears in the October issue of the Journal of Clinical Psychiatry.
More information
MedlinePlus explains gastric bypass surgery.
Psychiatric evaluations are part of the preoperative screening process in most bariatric surgery programs, notes a team from the Rhode Island Hospital and Brown University in Providence.
The most common reasons why patients did not receive psychiatric clearance included frequent overeating to cope with stress/emotional distress; a current eating disorder; or uncontrolled psychiatric disorders.
The researchers also found that the decision to clear candidates for bariatric surgery is made with high reliability -- meaning that a review of available information by independent psychiatrists would result in the same decision.
"The goal of psychiatric evaluation is not to keep patients from having the surgery. Rather, the goal is to determine if there are any problems that might interfere with the success of surgery, and have the patient get treatment for these problems," study author Dr. Mark Zimmerman, director of outpatient psychiatry at Rhode Island Hospital and a professor of psychiatry and human behavior at Brown University, said in a prepared statement.
He said a patient is "more likely to have a positive outcome from surgery that is delayed to allow time to address the problems."
The study appears in the October issue of the Journal of Clinical Psychiatry.
More information
MedlinePlus explains gastric bypass surgery.
Jumat, 12 Oktober 2007
Experts Offer Answers on Colonoscopy Options
(HealthDay News) -- Two recent studies comparing the use of conventional (optical) colonoscopy and CT (virtual) colonoscopy for colorectal cancer screening may raise questions among people considering the test, says the American College of Gastroenterology (ACG).The studies included a large multi-center trial called ACRIN that was sponsored by the U.S. National Institutes of Health and a University of Wisconsin study published in the New England Journal of Medicine. Both trials compared the accuracy of CT colonoscopy to conventional colonoscopy (the current gold standard for colorectal cancer screening) in detecting polyps or cancer in the colon.
In order to help inform the public, the ACG has developed an FAQ (frequently asked questions) resource describing both colonoscopy techniques.
Conventional colonoscopy involves insertion of a flexible tube into the rectum. The tube, which carries a tiny camera, allows the doctor to directly view the entire colon and to detect and remove suspicious polyps. Three studies found that this method prevents about 80 percent of colorectal cancers from developing, according to the ACG.
In CT colonoscopy, air is pumped into the colon until it's fully distended and a CT scan is used to examine the colon. Studies suggest that between 30 percent and 50 percent of patients who have a CT colonoscopy will need a conventional colonoscopy to remove suspicious polyps.
On average, research has shown that CT colonoscopy is inferior to regular colonoscopy for detection of colon polyps, the ACG said.
Both types of colonoscopy require the same bowel-cleansing regimen.
More information
The U.S. National Cancer Institute has more about colorectal cancer screening.
Selasa, 09 Oktober 2007
Epilepsy Drug Holds Promise as Treatment for Alcoholism
(HealthDay News) -- An drug used to treat epileptic seizures could be added to the short list of medications prescribed to help alcoholics control their addiction, a new study suggests.
The drug topiramate proved measurably better than a placebo at helping alcoholics stay away from heavy drinking, the study authors said.
"Not only is there an effective new treatment, but there's a medication that you can take at the time of crisis. You can start immediately when you need help," said study author Dr. Bankole Johnson, chairman of the University of Virginia's Department of Psychiatry and Neurobehavioral Sciences.
For many alcoholics, treatment is no different than it was 50 or 60 years ago: They must rely on their own willpower, often with the help of groups like Alcoholics Anonymous. But some -- about 3 percent to 4 percent, Johnson estimates -- try to quit drinking with the help of prescription medications.
In the new study, conducted between 2004 and 2006, Johnson and his colleagues recruited 371 alcoholics between the ages of 18 and 65. The subjects, both male and female, received daily doses of topiramate -- up to 300 milligrams -- or a placebo along with a brief weekly visit with a counselor.
Both treatments seemed to help patients. Over 14 weeks, the percentage of heavy-drinking days per week dropped from 81.9 percent to 43.8 percent among those who took topiramate and from 82 percent to 51.8 percent among those who took a placebo.
Topiramate also led to a higher rate of achieving 28 or more days of continuous non-heavy drinking and 28 or more days of continuous abstinence, the researchers said.
The drug appears to work by cutting the craving for alcohol, according to Johnson.
The findings are published in the Oct. 10 issue of the Journal of the American Medical Association.
There are side effects with topiramate, Johnson said. The drug "can make you dizzy, give you headaches and the feeling of pins and needles in your fingers. Some people have difficulty naming words, which goes away after about a week."
The drug isn't cheap -- it costs about $1,000 for three months, according to Johnson. And, patients don't see benefits for two to four weeks. Still, topiramate holds promise, he said.
"We're talking about a drug that will be many times better than what is currently available," he said. "And it doesn't require you to go to rehab."
Dr. J.C. Garbutt, professor of psychiatry at the University of North Carolina at Chapel Hill, said the new research on topiramate will give doctors another option when they treat alcoholism. Since the drug is already approved for use, doctors can prescribe it immediately.
Garbutt said it's still difficult for doctors to figure out which medication to prescribe to alcoholics. But "this gives you another one you can work with," he said.
Meanwhile, Johnson said, the next step is to study whether people can safely take topiramate for long periods of time.
Meanwhile, the group Public Citizen on Tuesday sent a letter to U.S. Food and Drug Administration Commissioner Andrew von Eschenbach claiming that a questionnaire that accompanied a press kit on the study violated FDA regulations that prohibit the promotion of the off-label use of a medication. Ortho-McNeil Janssen makes topiramate and funded the study.
More information
For more on alcoholism and treatment, visit the National Institute on Alcohol Abuse and Alcoholism.
The drug topiramate proved measurably better than a placebo at helping alcoholics stay away from heavy drinking, the study authors said.
"Not only is there an effective new treatment, but there's a medication that you can take at the time of crisis. You can start immediately when you need help," said study author Dr. Bankole Johnson, chairman of the University of Virginia's Department of Psychiatry and Neurobehavioral Sciences.
For many alcoholics, treatment is no different than it was 50 or 60 years ago: They must rely on their own willpower, often with the help of groups like Alcoholics Anonymous. But some -- about 3 percent to 4 percent, Johnson estimates -- try to quit drinking with the help of prescription medications.
In the new study, conducted between 2004 and 2006, Johnson and his colleagues recruited 371 alcoholics between the ages of 18 and 65. The subjects, both male and female, received daily doses of topiramate -- up to 300 milligrams -- or a placebo along with a brief weekly visit with a counselor.
Both treatments seemed to help patients. Over 14 weeks, the percentage of heavy-drinking days per week dropped from 81.9 percent to 43.8 percent among those who took topiramate and from 82 percent to 51.8 percent among those who took a placebo.
Topiramate also led to a higher rate of achieving 28 or more days of continuous non-heavy drinking and 28 or more days of continuous abstinence, the researchers said.
The drug appears to work by cutting the craving for alcohol, according to Johnson.
The findings are published in the Oct. 10 issue of the Journal of the American Medical Association.
There are side effects with topiramate, Johnson said. The drug "can make you dizzy, give you headaches and the feeling of pins and needles in your fingers. Some people have difficulty naming words, which goes away after about a week."
The drug isn't cheap -- it costs about $1,000 for three months, according to Johnson. And, patients don't see benefits for two to four weeks. Still, topiramate holds promise, he said.
"We're talking about a drug that will be many times better than what is currently available," he said. "And it doesn't require you to go to rehab."
Dr. J.C. Garbutt, professor of psychiatry at the University of North Carolina at Chapel Hill, said the new research on topiramate will give doctors another option when they treat alcoholism. Since the drug is already approved for use, doctors can prescribe it immediately.
Garbutt said it's still difficult for doctors to figure out which medication to prescribe to alcoholics. But "this gives you another one you can work with," he said.
Meanwhile, Johnson said, the next step is to study whether people can safely take topiramate for long periods of time.
Meanwhile, the group Public Citizen on Tuesday sent a letter to U.S. Food and Drug Administration Commissioner Andrew von Eschenbach claiming that a questionnaire that accompanied a press kit on the study violated FDA regulations that prohibit the promotion of the off-label use of a medication. Ortho-McNeil Janssen makes topiramate and funded the study.
More information
For more on alcoholism and treatment, visit the National Institute on Alcohol Abuse and Alcoholism.
Sabtu, 06 Oktober 2007
Health Tip: Prevent Athlete's Foot
(HealthDay News) - Athlete's foot is a fungal infection, often found in public locker rooms and showers, or anywhere else that is damp, dark and warm.
Here are suggestions to help prevent athlete's foot, courtesy of the American Podiatric Medical Association:
Here are suggestions to help prevent athlete's foot, courtesy of the American Podiatric Medical Association:
- Don't walk barefoot in public areas like pools, showers, locker rooms or dressing rooms.
- Always wear flip flops or some kind of shower shoes.
- Before putting on shoes, sprinkle the feet with talcum powder to keep them dry.
- Wear shoes that allow air to circulate so that your feet stay drier.
- Wear thick, absorbent socks that keep your feet dry, and change them at least daily.
Rabu, 03 Oktober 2007
'Virtual' Colonoscopy an Effective Option: Study
(HealthDay News) -- A new study supports the effectiveness of an innovative form of colonoscopy that relies on a CT scanner that's sent through a patient's colon.
When it comes to detecting polyps that might become malignant, this so-called "virtual colonoscopy" is just as effective as the traditional approach of using a fiber-optic device, explained study lead Dr. David Kim, assistant professor of radiology at the University of Wisconsin.
The real advantage to the technology is that "it can do it in a less invasive manner for less cost and at less risk," he said.
According to the American Cancer Society, colorectal cancer is the third most common cancer in the United States among both men and women. It's especially common among people over the age of 50. An estimated 112,000 people in the United States will be diagnosed with the disease this year, and 52,000 will die.
Colonoscopies are considered essential to preventing the disease, but many people don't get them because of the cost or because of their reputation as being uncomfortable.
Virtual colonoscopies, by contrast, offer patients less discomfort, and Kim said could cost only one-third of the price.
Just as happens with the conventional test, patients using the virtual screen must still cleanse their bowels by using laxatives beforehand and have a catheter inserted into the rectum to expand their colon with carbon dioxide, Kim said.
However, unlike the traditional procedure, the patients aren't sedated, although Kim said they may feel "crampy" until the procedure is over.
CT scanners image the colons to look for signs of trouble. Doctors look at three-dimensional images on computers that "put you inside of the colon so you can navigate your way to look for polyps," Kim explained.
In the new study, Kim's team compared the effectiveness of traditional colonoscopies in 3,163 consecutive patients to virtual colonoscopies in 3,120 consecutive patients.
Reporting in the Oct. 4 issue of the New England Journal of Medicine, the researchers found that the two approaches were about equal in terms of detecting potentially dangerous polyps -- 123 were detected by virtual colonoscopy and 121 through the traditional approach. About eight percent of the patients who underwent the new approach had to return for traditional colonoscopies.
In the near future, doctors will need to screen patients using both approaches, he said. "The bottom line is that there's a huge number of people who should be screened but aren't -- 40 million people over age of 50 aren't screened. We're going to need both modalities to make an impact on this number."
Still, there are plenty of unanswered questions, said Dr. David Weinberg, director of gastroenterology at Fox Chase Cancer Center.
For one, he asked, "what does this do to overall colon cancer risk?" The study didn't look at that question, he said, and it's premature to declare that virtual colonoscopy should be a routine first-line screening test.
It's also unclear whether the new test is cost-effective or will be covered by insurance. Still, "it has potential to be useful because patients, when they know nothing about either, think they will prefer virtual colonoscopy," he said. That could lead to more of these potentially lifesaving screenings, Weinberg said.
But once they know the details -- particularly about how laxatives must still be used -- fewer people may think there's a huge difference between the two approaches, he said.
More information
For more about colorectal cancer screening options, visit the American Cancer Society.
more discussion: Forum· Addiction Forum · Ask the Doctors Forum · Ayurveda Forum · Ayurvedic & Thai Herbs Forum · Colon Cleansing Forum · Dental Forum · Diabetes Forum · Diet Forum · General Cleansing Forum · Hepatitis A, B. C Forum · Integrated Medicine Forum · Live Blood Analysis Forum · Ozone-Oxygen-Forum · pH - Alkaline - Acidity Forum · Weight Loss Forum
When it comes to detecting polyps that might become malignant, this so-called "virtual colonoscopy" is just as effective as the traditional approach of using a fiber-optic device, explained study lead Dr. David Kim, assistant professor of radiology at the University of Wisconsin.
The real advantage to the technology is that "it can do it in a less invasive manner for less cost and at less risk," he said.
According to the American Cancer Society, colorectal cancer is the third most common cancer in the United States among both men and women. It's especially common among people over the age of 50. An estimated 112,000 people in the United States will be diagnosed with the disease this year, and 52,000 will die.
Colonoscopies are considered essential to preventing the disease, but many people don't get them because of the cost or because of their reputation as being uncomfortable.
Virtual colonoscopies, by contrast, offer patients less discomfort, and Kim said could cost only one-third of the price.
Just as happens with the conventional test, patients using the virtual screen must still cleanse their bowels by using laxatives beforehand and have a catheter inserted into the rectum to expand their colon with carbon dioxide, Kim said.
However, unlike the traditional procedure, the patients aren't sedated, although Kim said they may feel "crampy" until the procedure is over.
CT scanners image the colons to look for signs of trouble. Doctors look at three-dimensional images on computers that "put you inside of the colon so you can navigate your way to look for polyps," Kim explained.
In the new study, Kim's team compared the effectiveness of traditional colonoscopies in 3,163 consecutive patients to virtual colonoscopies in 3,120 consecutive patients.
Reporting in the Oct. 4 issue of the New England Journal of Medicine, the researchers found that the two approaches were about equal in terms of detecting potentially dangerous polyps -- 123 were detected by virtual colonoscopy and 121 through the traditional approach. About eight percent of the patients who underwent the new approach had to return for traditional colonoscopies.
In the near future, doctors will need to screen patients using both approaches, he said. "The bottom line is that there's a huge number of people who should be screened but aren't -- 40 million people over age of 50 aren't screened. We're going to need both modalities to make an impact on this number."
Still, there are plenty of unanswered questions, said Dr. David Weinberg, director of gastroenterology at Fox Chase Cancer Center.
For one, he asked, "what does this do to overall colon cancer risk?" The study didn't look at that question, he said, and it's premature to declare that virtual colonoscopy should be a routine first-line screening test.
It's also unclear whether the new test is cost-effective or will be covered by insurance. Still, "it has potential to be useful because patients, when they know nothing about either, think they will prefer virtual colonoscopy," he said. That could lead to more of these potentially lifesaving screenings, Weinberg said.
But once they know the details -- particularly about how laxatives must still be used -- fewer people may think there's a huge difference between the two approaches, he said.
More information
For more about colorectal cancer screening options, visit the American Cancer Society.
more discussion: Forum· Addiction Forum · Ask the Doctors Forum · Ayurveda Forum · Ayurvedic & Thai Herbs Forum · Colon Cleansing Forum · Dental Forum · Diabetes Forum · Diet Forum · General Cleansing Forum · Hepatitis A, B. C Forum · Integrated Medicine Forum · Live Blood Analysis Forum · Ozone-Oxygen-Forum · pH - Alkaline - Acidity Forum · Weight Loss Forum
Langganan:
Komentar (Atom)
