Gaps Persist in Use of Less Invasive Breast Cancer Procedure

(HealthDay News) -- The use of a less invasive form of sentinel lymph node biopsy (SLNB) during breast cancer surgery increased substantially in the United States from 1998 to 2005, researchers say. However, there are still disparities in terms of which women receive the therapy.

The study by the American Cancer Society found that non-white women, women aged 72 and older, and women living in poor areas of the country were less likely to receive the SLNB staging test than those who were white, younger, or live in more affluent areas.

In women diagnosed with breast cancer, doctors check to see if the cancer has spread from the breast tissue into neighboring lymph nodes. This can be done by removing many lymph nodes in a procedure called axillary lymph node dissection (ALND) or by removing a few lymph nodes (SLNB), which is associated with easier recovery and fewer long-term problems, according to background information in the study.

In this study, researchers analyzed national data on women who had breast cancer surgery between 1998 and 2005. Clinical care guidelines were changed in 1998 to allow surgeons to use SLNB in certain patients.

The proportion of patients who had SLNB increased from 26.8 percent in 1998 to 65.5 percent in 2005, the study found.

But the researchers also found that disparities in the use of SLNB persisted during those years. For example, in 1998, 29 percent of white women received SLNB, compared with 26 percent of black women, and 35 percent of Hispanic women. By 2005, the rates were 70 percent, 64 percent, and 67 percent, respectively.

According to clinical guidelines, SNLB should only be done in centers that have experienced teams. This study didn't examine whether the disparities in access to SLNB may be related to lack of experience at certain facilities.

"The disparities that were related to receipt of SLNB in this study are particularly important in light of the clinical advantages associated with this technique. Better outcomes have been reported for patients receiving SLNB than for patients receiving ALND," the researchers wrote.

The study was published online March 25 in the Journal of the National Cancer Institute.

"Given America's track record of disparate care, I suppose we should not be surprised that racial and ethnic minorities were disproportionately deprived of another medial advance," Dr. Stephen B. Edge, of Roswell Park Cancer Institute in Buffalo, wrote in an accompanying editorial. "However, this observation is profoundly disappointing and sobering. It is yet another call for us to redouble efforts to identify and correct the root cause of disparities."

More information
The U.S. National Cancer Institute has more about SLNB.

Heart Failure Raises Risks After Non-Cardiac Surgeries

(HealthDay News) -- Older people with heart failure face heightened odds of complications and death after non-cardiac surgeries, according to the largest study ever conducted on the issue.

"We're trying to draw attention to this major problem," said lead researcher Dr. Adrian F. Hernandez, an assistant professor of medicine at Duke University in Durham, N.C.

Heart failure, the progressive loss of the heart's ability to pump blood, is widespread among older Americans, but it sometimes is overlooked as a risk factor when surgery is needed, he said.

"Most physicians focus on whether [older patients] have coronary artery disease or have a risk of heart attack," Hernandez said. "Heart failure is by far a more important risk factor, but it doesn't usually have greater weight when they want to identify patients at risk of complications or consider how they want to treat them after surgery."

Symptoms of heart failure include shortness of breath, fatigue and swelling of the legs.

Hernandez' group published the study in the April issue of Anesthesiology. They used Medicare data on more than 159,000 people undergoing major surgery not involving the heart, such as hip replacement operations. Past estimates have put the incidence of heart failure in the older population between 5 percent and 12 percent, but the new study found the condition in almost 20 percent of those having surgery.

The study divided the participants into three groups: those with heart failure, with or without coronary artery disease; those with only coronary artery disease; and those with neither condition.

Nearly 98 percent of all those who had surgery were discharged soon afterward from the hospital. But 17.1 percent of those with heart failure had to be re-hospitalized within 30 days, compared to 10.8 percent of those with coronary artery disease and just 8.1 percent of those with neither ailment.

In the month after a surgery, 1.6 percent of those with heart failure died, compared to 0.5 percent for those with coronary artery disease and 0.3 percent of those with neither condition, the study found.

Steps can be taken to reduce the toll, Hernandez said.

"The first thing is to check on what the conditions are that might influence the patients outcomes," he said. "We have to identify therapies that lower the risk of a poor outcome and assure that all patients, when they have surgery, are carefully monitored."

Close attention should be paid to be sure that symptoms of heart failure are kept to a minimum, Hernandez said. Medications such as beta blockers and diuretics can be used to keep heart failure under control, he added.

But he noted that it's not certain how effective such measures might be in reducing risks -- only a rigorous, controlled study could answer that question definitively.

"We are planning to do such studies, but our planning is still in the early stages," he said. "We still need to identify sponsors of such a study."

One expert applauded the new research.

The increase in surgery risk due to heart failure has been noted before, but "this is a big study that involves a lot of people. It solidifies that the risk is real, and the risk is substantial," said Dr. Robert Hobbs, a staff cardiologist at the Cleveland Clinic whose work covers heart failure and transplant medicine.

Measures that can be taken to reduce the risk include simply not performing surgery, if possible, on someone whose life might be endangered, Hobbs said. "If surgery is necessary for someone with heart failure, there should be targeted use of heart failure medications before the operation and an effort to avoid overloading the body with intravenous fluid during the procedure," he said.

"And we would certainly watch them more carefully in the postoperative period," Hobbs added.

More information
Learn about heart failure, its symptoms and treatment, from the U.S. Library of Medicine.

Poison Prevention Tips to Protect the Most Vulnerable

(HealthDay News) -- To mark National Poison Prevention Week, which concludes Saturday, the Soap and Detergent Association offers a home safety checklist for parents with young children.

Parents and caregivers should:

• Install child-safety locks on cabinets that house cleaning supplies, medicines, cosmetics, chemicals and other poisons. Never assume a cabinet is too high for a child.
• Keep all household products in their original packaging, which includes useful first-aid information in the event of accidental exposure or ingestion. If you purchase household products in bulk, buy a smaller size of the same product and use this container for refills.
• Use child-resistant packaging properly by closing the container securely after each use.
• Keep in mind that this type of packaging is child-resistant, but not child-proof, and products must still be stored out of reach of children.
• Read and follow the directions on the product label. Pay particular attention to labels that include the words "Caution," "Warning," "Danger," or "Poison."
• When using cleaning products, take out only what's needed for the job at hand. Store the rest in a secure location.
• Don't mix household cleaning products. Doing so could release harmful vapors or cause other dangerous chemical reactions.
• Don't leave cleaning buckets unattended. If a child falls into the bucket, it may not tip over and the child could drown. If the bucket is tipped, the contents could spill and come into contact with a child's sensitive skin. Immediately clean up any spills and quickly and safely dispose of rags, paper towels and related items that you used to clean up a spill.
• Schedule house cleaning when children are having a nap, on a play date, or at school.
  If children are present while you're cleaning, avoid any distractions. If you need to answer the door, take the child with you. If the phone rings, let the answering machine get it.
• Know where to call for help. Post the Poison Control Center phone number (1-800-222-1222), along with other emergency numbers, by every land phone in your home, and enter the numbers into your cell phone's address book.

More information

The U.S. Centers for Disease Control and Prevention offers more tips to prevent poisonings.

Artery Plaque Boosts Hispanics' Odds for Stroke

(HealthDay News) -- Hispanic Americans with even a small amount of plaque build-up in their carotid artery -- the vessel that supplies blood to the brain -- are up to four times more likely to suffer or die from a stroke compared to those with clear arteries, a new study finds.

"These results are important for developing stroke and vascular prevention programs for all, but also for certain ethnic groups such as Hispanics, who represent the fastest growing minority population in the U.S.," study author Dr. Tatjana Rundek, of the Miller School of Medicine at the University of Miami in Florida, said in a prepared statement.

The research included almost 2,200 men and women who took part in the multi-ethnic Northern Manhattan Study, in New York City.

Using ultrasound, the researchers found that 58 percent of the participants had carotid artery plaque, and that 25 percent of them had maximum carotid plaque thickness (more than 1.9 millimeters of plaque).

After an average follow-up of seven years, 121 of the study participants had suffered or died from ischemic stroke (blockage of blood flow to the brain), 118 had suffered or died from heart attack, and 166 had died of other vascular causes.

The researchers found that Hispanics with the thickest amounts of carotid artery plaque were three to four times more likely to suffer a stroke, heart attack, or some other type of vascular event than Hispanics with no carotid artery plaque.

The study appears in the March 19 issue of the journal Neurology.

"More research is needed though to determine why Hispanics with even small amounts of carotid plaque are particularly susceptible to vascular events," Rundek said.

This study also showed that ultrasound measurement of carotid plaque offers doctors a simple method of determining a patient's stroke risk and guiding stroke-prevention therapies.

"It is a non-invasive marker that can help doctors identify the beginning stages of atherosclerosis, or hardening of the arteries, that is also associated with increased risk of stroke," Rundek said.

More information
The U.S. National Heart, Lung, and Blood Institute has more about atherosclerosis.

Geckos' feet inspire new high-tech bandage

CAMBRIDGE, Massachusetts (CNN) -- Lizards with hairy feet are the inspiration for a new medical product that could help surgical patients heal better and might even replace sutures some day.

Scientists at Massachusetts Institute of Technology say they have created a new kind of surgical adhesive, formed in a shape that, at the microscopic level, mimics the feet of geckos.

Gecko feet are a worthy model to imitate, because the lizards are masters of adhesion -- the force that makes two substances stick together on contact.

"The gecko has the amazing ability to walk up walls and hang from a single foot," said Jeff Karp, a researcher at Harvard-MIT Division of Health Sciences and Technology. "They have hundreds of thousands of hairs on the surface of their feet and then on each one of those hairs they have these tiny nanopillars." Watch geckos' feet in action »

The nanopillars, one hundredth as thick as a human hair, provide an enormous amount of contact surface, and that leads to remarkably strong adhesion, Karp told CNN.

By copying that structure as a shape for their glue-coated polymer, the MIT scientists think they can build a material that will cling tightly to tissue.

It will be especially useful for applications inside the body, said Dr. Bob Langer, another researcher on the project, calling it "an internal Band-Aid."

"For example, it might be used in holding tissues together that normally couldn't be held together ... say, in hernia repair," Langer said. It could also be used to prevent leaks in gastric bypass operations, Karp said.

The new product will be stretchy and will stay stuck even in wet places inside the body, according to the MIT researchers. It can be adapted to different applications and could incorporate antibiotics or other drugs, they said -- like a transdermal patch worn on the inside. It will dissolve inside the body over time, and the scientists can tweak the rate at which that happens, they said.

Karp said the new bandage material could be particularly useful in laparascopic procedures, where a surgeon operates through a very small incision.

"Our surgical collaborators think that this may even replace sutures one day," he said. "Sutures are very difficult to place within laparoscopic procedures. When working in very small spaces it's difficult to tie a knot."

There are medical glues currently in use, but they have some problems, Karp said.
"Although they provide very strong levels of adhesion, they are very difficult to work with. They have poor mechanical properties, they are very brittle, and they also induce a very strong inflammatory response," he said.

The MIT researchers said the gecko-inspired bandages could be in clinical trials within two to five years.

Don't Prescribe Antibiotics for Adult Sinus Woes

(HealthDay News) -- It's extremely difficult for doctors to tell the difference between sinus infections that can be cured by antibiotics and those that can't, a new review finds.

Given the growing problem of antibiotic resistance, the study authors urge that physicians give up using antibiotics altogether for adult patients with rhinosinusitis -- even when symptoms persist beyond a week.

"Antibiotics offer little benefit for patients with acute rhinosinusitis-like complaints," wrote the research team led by Dr. Jim Young of University Hospital Basel, Switzerland. "Antibiotics are not justified even if a patient reports symptoms for longer than 7-10 days," they added in the March 15 issue of The Lancet.

The European group noted that upper respiratory tract infections are responsible for a full third of doctor's appointments in the United States, and a third of those visits end in a diagnosis of rhinosinusitis. Currently, about 80 percent of patients receive a prescription for an antibiotic.

Antibiotics are only useful against bacterial disease -- they do not fight viral infections. But how good are doctors at distinguishing between the two in the typical clinical setting?

To find out, Young's group looked at data from nine trials with a total of more than 2,500 adult patients with rhinosinusitis. Doctors in the trials used a patient's medical history or symptoms -- for example, facial pain, pus-filled nasal discharge, or a prior cold -- that have been thought helpful in distinguishing a bacterial infection from a viral one.

Unfortunately, even these symptoms failed to help doctors determine whether antibiotics were appropriate. In fact, the analysis found that 15 patients with rhinosinusitis-like complaints had to be given antibiotics before one additional patient benefited from treatment, meaning that the other 14 were getting the drugs for no real purpose, the authors wrote. The result didn't change, regardless of patient age or duration or severity of symptoms.

The findings only apply to adult patients because children were not included in the study, the researchers stressed.

However, one otolaryngologist said the study goes too far in banning antibiotics for adult cases.

"This study should not convey the message that antibiotics are not indicated for all patients with sinusitis," Dr. Jordan S. Josephson, of Lenox Hill Hospital in New York City, said in a statement. He believes that while the drugs are certainly ineffective against viral sinusitis, they can offer patients with acute bacterial infections "significant symptom relief and improvement."

Josephson notes the study does not address "the 30-plus million Americans that suffer from chronic sinusitis." He said the evidence is clear that many patients with these longer-term sinus problems do benefit from antibiotic therapy.

However, the new findings mirror those of a study published last March in the Archives of Otolaryngology Head and Neck Surgery. That study found that U.S. doctors are consistently overprescribing antibiotics for sinus infections.

But even the physician who led that research doesn't see how the problem can be eliminated.

That's because when it comes to treatments for sinus trouble, antibiotics are the best of a bad lot, said Dr. Donald A. Leopold, chairman of the department of otolaryngology at the University of Nebraska Medical Center.

"We as physicians don't have very good medications for chronic rhinosinusitis," he said. "The only other drugs in contention are topical steroids, and they are not great. As a group, I suggest we are frustrated at not having good drugs. It would be great if we had better medications for this chronic inflammation."

Another factor is what patients demand, Leopold said. "Many patients call up and ask for specific antibiotics," he said. "The patients know these names. They have been marketed to them, so they know the drugs are available. And antibiotics do give some relief."

According to the Archives of Otolaryngology Head and Neck Surgery report, two national studies showed that Americans made more than 17 million visits to health-care facilities for sinus infections between 1999 and 2002. At least one antibiotic was prescribed in nearly 83 percent of cases of acute rhinosinusitis and in nearly 70 percent of cases of the chronic, longer-running version of the condition, in which symptoms persist for at least 12 weeks.

Doctors understand that overprescribing antibiotics can lead to a dangerous microbial resistance to the drugs. But it's hard to preach that wisdom to someone with a drippy, hurting sinus who wants immediate relief, Leopold acknowledged. Because more effective drugs are lacking, "patients are desperate, physicians are desperate, and it is not a happy situation," he said.

Consider the case of the working physician called on to treat such a patient, said Dr. Neil L. Kao, vice chairman of the rhinitis/sinusitis committee of the American College of Allergy, Asthma and Immunology. He happens to be just such a working physician, in private practice in Greenville, S.C.

There are ways to determine whether a sinus infection is bacterial, Kao said. One is to do endoscopy, running a tube into the nose to obtain a sample of mucus from the sinus. Another is nasal cytology, examining a swab from the lining of the nose. A third is to take an X-ray.

"The problem with all of these is that they are expensive and time-consuming," Kao said. "The differences between symptoms caused by an allergy, bacterial infection, viral infection and a common cold are few. For us, even specialist doctors, when you see someone with acute nasal symptoms, it is hard to tell the cause. And the truth is that most of the people diagnosed with sinusitis go to primary-care doctors."

Public awareness about antibiotic resistance is increasing, but most people suffering from cough, drip, lack of sleep and other sinus symptoms are likely to come in demanding an antibiotic, Kao said.

And so the physician often makes the practical choice of giving what the patient wants, with a chance of relief, over the more abstract issue of antibiotic resistance, he said.

More information
For more on sinus infections, head to the U.S. Centers for Disease Control and Prevention.

Gulf War Illness Strongly Linked to Chemical Exposure

(HealthDay News) -- A new scientific review finds a strong association between exposure to certain chemicals and the Gulf War illness suffered by many veterans.

The class of chemicals, known as acetylcholinesterase inhibitors (AChEIs), are found in pesticides, nerve agents and in pills given to soldiers to protect against nerve agents. The review, which was conducted by researchers at the University of California, San Diego, looked at 115 papers on the topic.

"Some of this has been stated for a while," said Joy Ray Miller, an assistant professor of pharmacy practice at the Irma Lerma Rangel College of Pharmacy at Texas A&M Health Science Center. "This article pulls it all together. It's definitely something to be aware of for our future veterans and for the military that's out there now. There are so many variants in the article that we can't really say as a matter of fact that [AChEIs cause the symptoms], but I think there are enough coincidences going on that we can have a pretty good understanding that maybe we should do something differently."

Veterans of the 1990-1991 Persian Gulf War have a higher rate of "chronic multi-symptom health problems" than either non-deployed military personnel or those deployed in other regions. In fact, 26 percent to 32 percent of personnel deployed to the Persian Gulf during this period have chronic health problems, a range that may actually understate the magnitude of the problem, according to the study, published in this week's issue of the Proceedings of the National Academy of Sciences.

Symptoms of the syndrome include fatigue, mood-cognition problems and musculoskeletal symptoms.

Although the exact causes remain unknown, evidence is mounting to suggest that exposure to organophosphate and carbamate acetylcholinesterase inhibitors (AChEIs), including pyridostigmine bromide (PB), pesticides and nerve agents, may be responsible.

The authors of this paper looked at epidemiological studies assessing the link between these chemicals and symptoms observed in Gulf War vets.

Many of the studies reported a link between exposure to AChEI and chronic symptoms.
An estimated 250,000 personnel received the carbamate pyridostigmine bromide (PB) as a pretreatment for potential exposure to nerve agents. Those who took more pills had a higher incidence of symptoms.

Also, an estimated 41,000 service members may have been overexposed to pesticides, which were used to control vector-borne disease, and 100,000 personnel may have been exposed to low levels of sarin nerve agent after the demolition of the Khamisiyah munitions depot in Iraq.

The symptoms are akin to those suffered by agricultural workers exposed to AChEIs, said the study authors, as well as symptoms suffered by victims of the sarin terrorist attacks in Japan.

Exposure to AChEIs could also be linked to the higher rate of amyotrophic lateral sclerosis (ALS), or Lou Gehrig's disease, in Gulf War veterans. Sporadic ALS has been associated with exposure to agricultural chemicals.

And men and women with the Gulf War symptoms were more likely to have lower concentrations and activity levels of enzymes which work to clear AChEIs from the system. Genetics may impact the way the body processes these chemicals, specifically the actions of these related enzymes.

"They're giving certain people so many of these nerve agent pills or pesticides, and [the authors] say that some people metabolize them and some not," Miller said. "Are we really giving a toxic dose apart from the genetics? What are they giving and have they really tested the amounts that they're giving? Are we overdosing?"

More information
There's more on Gulf War syndrome at the University of Chicago Medical Center.

Older Men With Low Testosterone Face Greater Depression Risk

(HealthDay News) -- Low testosterone levels in older men are associated with an increased risk of depression, an Australian study says.

Between 2001 and 2004, researchers at the University of Western Australia in Perth studied 3,987 males aged 71 to 89. The men provided demographic and health information and were tested for depression and cognitive difficulties. The researchers also checked the men's testosterone levels.

The 203 men who met the criteria for depression had significantly lower total and free (not bound to proteins) testosterone levels than those who weren't depressed. After controlling for other factors, such as cognitive scores, education level and body-mass index, the researchers concluded that men in the lowest quintile (20 percent) of free testosterone were three times more likely to have depression compared to those in the highest quintile.

The findings were published in the March issue of the Archives of General Psychiatry.
While more research is needed to determine how low hormone levels may be linked to depression risk, the study authors believe it may be caused by changes in the levels of neurotransmitters or hormones in the brain.

"A randomized controlled trial is required to determine whether reducing prolonged exposure to low free testosterone is associated with a reduction in prevalence of depression in elderly men," the researchers wrote. "If so, older men with depression may benefit from systematic screening of free testosterone concentration, and testosterone supplementation may contribute to the successful treatment of hypogonadal (with low hormone levels) older men with depression."

Between 2 percent and 5 percent of people are affected by depression at any given time, according to background information in the study. Women are more likely than men to be depressed, but that difference disappears at about age 65. A number of previous studies have suggested that sex hormones may be a factor.

More information
The U.S. National Institute of Mental Health has more about men and depression.

That 'Sex Talk' With Your Kids Should Be Ongoing

(HealthDay News) -- Parents may not want to hear this, but new research suggests it's not a good idea to just have that one big "sex talk" with your kids.

Instead, the study recommends that you encourage an ongoing dialogue about sex with your children -- even if it makes you uncomfortable -- so your kids are less likely to engage in risky sexual behaviors.

"It's important that parents set a foundation early on in talking with their kids about sex so that it becomes part of the norm in their household," said study lead author Steven Martino, a behavioral scientist at RAND in Pittsburgh. "As children grow and have experiences, you want them to feel it's natural to talk to their parents. When asked where they'd like to get their information, kids say from their parents more than anyone else."

Martino said he realizes that some parents feel uncomfortable talking about sex with their children. And, he said, it's OK to let your children know that you're uncomfortable, but explain that it's such an important topic that you need to talk about sex anyway.

Martino's study included 312 teens and their parents. Both parents and adolescents completed baseline questionnaires, and the researchers had the teens complete their surveys in private rooms and assured them that their parents would not be given any of the information they provided.

The parents were then randomly divided into two groups, with half attending an eight-week worksite-based parenting intervention class called "Talking Parents, Healthy Teens," designed to improve communication with their teens. The other parents just completed the survey and received no intervention.

Follow-up surveys were completed at one week, three months and nine months after the intervention began. The surveys were designed to assess 22 sex-related topics, such as the consequences of sex, how to make decisions about when to have sex, how to say no if you didn't want to have sex, how well condoms prevent sexually transmitted diseases, and more.

The researchers then assessed the breadth of communications -- how many of those 22 subjects the parents had discussed with their teens, and how often.

They found that when teens and their parents had more conversations -- repetition -- teens reported feeling closer to their parents and felt they could talk more openly with their parents about sex and other topics. A greater breadth of communication was associated with a perceived ease of discussing sex between parent and child, according to the study.

Results of the study were published in the March issue of Pediatrics.

"You can't just have the big sex talk once. Discussions need to be ongoing," said Dr. Lea deFrancisci Lis, a child psychiatrist at New York University's Child Study Center in New York City.

DeFrancisci Lis pointed out that, like most studies, this one didn't establish a direct cause-and-effect relationship. "We can't say that kids whose parents talk about sex openly with them will have less sex," she said. "But, research has shown an association between parents who are more open and kids who wait longer to have sex, have less teen pregnancy and less sexually transmitted diseases, so communication is really important."

Both experts recommend starting to talk about sex at a young age, properly naming the body parts. DeFrancisci Lis said that when a new sibling is on the way, that's a great time to discuss where babies come from. For parents who are really uncomfortable talking about sex, books can help open discussions, she said.

Martino added that watching TV or movies with your child can provide teaching situations and may make the dialogue feel more natural. The same goes for some of the lyrics in teen music, he said.

More information
To learn more, visit 4parents.gov.