Embolization for Fibroids Leads to Faster Recovery

(HealthDay News) -- Women with uterine fibroids who are treated with embolization, a minimally invasive procedure, may get out of bed and back to work faster. But after a year, their quality-of-life scores are about the same as for women who had surgery to treat the non-cancerous growths, a new study found.

In the Jan. 25 issue of the New England Journal of Medicine, Scottish researchers report that hospital stays for embolization average just a day, compared to about five days for surgical treatments.

"The choice is essentially up to the patient. Hysterectomy has a very high success rate, but longer recovery. Embolization has a slightly lower success rate, but faster recover, and you keep your uterus," said the study's lead author, Dr. Jonathan Moss, a consultant interventional radiologist at Gartnavel Hospital in Glasgow.

A fibroid is a non-cancerous growth that develops in the uterus. As many as 20 percent of women of child-bearing age have one or more fibroids, according to the U.S. National Institutes of Health. The incidence of fibroids increases with age. Most fibroids don't require treatment, but some cause excessive bleeding and may cause pain.

When fibroids cause symptoms, treatment options may include hormone therapy, surgery or uterine-artery embolization. Surgical options include hysterectomy, the surgical removal of the entire uterus, or myomectomy, which is the removal of each individual fibroid. Embolization is a minimally invasive procedure that reduces the blood supply to the fibroids, causing them to shrink. For women who may still want to have children, myomectomy is currently the recommended treatment.

Because embolization is a relatively new technique -- it was introduced in 1995 -- the researchers wanted to assess how it compares to surgical options.

For the study, 157 women were randomly assigned to undergo embolization or surgery. One hundred and six women had embolization, 43 had hysterectomies and eight had myomectomies.
The average hospital stay was one day for embolization, compared to five days for surgery. Those who underwent embolization also got back to their daily activities faster than women in the surgical group. Women in the embolization group were able to drive a car after an average of eight days, compared to 34 days for the surgical group.

The embolization group was back at work, on average, 20 days after the procedure, versus 62 days for the surgery group. And women in the embolization group were able to resume sexual activity within an average of 21 days, compared to 53 days for those who had surgery, the researchers said.

The complication rates were similar overall, with 15 percent of those in the embolization group and 20 percent of those in the surgery group reporting serious adverse events.

Yet, after one year, there were no statistically significant differences in quality-of-life scores.
"The biggest problem of surgery, whether myomectomy or hysterectomy, is the time to recover from the operation. This was much faster following embolization," Moss said. "The other problem with hysterectomy is not every woman is happy with that option. The biggest problem with embolization is that it doesn't always work. Ten to 20 percent of patients will ultimately need it repeated or to have a hysterectomy."

Dr. William Romano, an interventional radiologist at William Beaumont Hospital in Royal Oak, Mich., said he would have liked to have seen more women in the myomectomy group, because women today are often choosing between embolization and myomectomy. He said he was surprised by the larger numbers of hysterectomies in this study.

For women who know they don't want to have any more children, Romano said, "Patients should consider embolization as a first-line procedure, because, in many situations, it may be all they need."

For women who still want to have children, embolization is rarely considered because its safety for pregnancy hasn't been well-studied, he said.

"The data doesn't support embolization as a viable primary option for women interested in childbearing," Romano said.

Still, he added, it could be an option for women who are afraid to have surgery or for women with many fibroids, because myomectomy can be a more difficult procedure for multiple fibroids.

More information
To learn more about uterine fibroids and their treatment, visit the U.S. National Library of Medicine.

Love Salty Foods? You May Have Been Born With Low Blood Sodium

(HealthDay News) -- If you crave salty foods, you may have been born prematurely and lacking in sodium. And this might leave you vulnerable to weight gain, a new study suggests.

Israeli researchers analyzed 41 children born prematurely in Israel and found that the lower the level of sodium in the bloodstream at birth, the more sodium the children consumed at ages 8 to 15.

Those with low sodium levels at birth also weighed about 30 percent more than their peers by early childhood or the early teen years. The finding suggests that very low blood levels of sodium in premature and newborn infants seems to be a contributing factor for long-term sodium intake, a key risk factor for obesity, the researchers said.

The study, published in the current issue of the American Journal of Physiology -- Regulatory, Integrative, and Comparative Physiology, isn't the first to suggest such a link, said Micah Leshem, a study co-author and a researcher at the University of Haifa's psychology department.

"There are about eight studies now that show that some form of sodium loss or deficiency [before or after birth] is associated with increased salt appetite in later childhood or adulthood," he said.

"These findings are consistent with laboratory rat studies that have produced the phenomenon experimentally -- that is, sodium-deficit before birth, as well as after it, causes greater intake of salt in adulthood."

The study participants with the lowest blood sodium at birth ate about 1,700 milligrams more sodium a day than those who didn't have low blood sodium when they were born.

The researchers analyzed each child's sodium appetite at ages 8 to 15 and gave each a physical exam. The children were tested whether they preferred a lot of salt in soup and sugar in tea. And they were invited to eat freely from a table of salty and sugary snacks.

The children with the lowest sodium levels at birth ate double the number of salty snacks years later than those who did not have low blood levels of sodium at birth.

The link may be due to self-protection, Leshem speculated. "Researchers have proposed that evolution has provided us with the ability to respond to sodium loss by increasing our avidity for it," he said.

Connie Diekman, director of university nutrition at Washington University in St Louis, called the study interesting but said it has limitations.

"The assessment of food intake was based on food frequency questionnaires as opposed to food records or food collection, leaving the accuracy of intake to recall, which is not a good tool for scientific accuracy," Diekman said.
The study also looked only at premature infants, not normal-weight babies, she said, adding that more research is needed.

Until that research is performed, parents can simply be aware of the link, according to Leshem. "In guiding the development of their child's dietary habits and preferences, our findings, together with those of others, now show that there is a cause for their child's preferences for sodium or sodium-rich foods," he said.

Your child's pediatrician can advise you on how much salt your child should be consuming daily.

More information
To learn more about how much sodium is ideal, visit the American Society for Nutrition.

Narcotics Offer Only Short-Term Relief of Back Pain

(HealthDay News) -- Potent opioid drugs, such as Oxycontin and Vicodin, may help treat chronic back pain in the short term, but it's not clear the drugs help in the long run and abuse may be common, a new review has found.

"Opioids may be effective for short-term relief," said study author Dr. Bridget A. Martell. "But all studies [reviewed] were less than four months."

Martell and her colleagues did what is known as a meta-analysis, pooling the results of 38 previously published studies. "The meta-analysis does not show statistical significance that opioids work any better than placebo," she said, although "they possibly work for short-term relief."

The new report is published in the Jan. 16 issue of the Annals of Internal Medicine.

"This is the first meta-analysis to look at opioids for chronic back pain," Martell said. She conducted the study while an associate research scientist at Yale University and wrote the report while she was associate director of the Pfizer New Haven Clinical Research Unit, part of the pharmaceutical company's Global Research and Development Division.

Martell's team found that the prescription of these drugs varied by treatment settings, with the percentage of patients prescribed the drugs for chronic back pain ranging from 3 percent to 66 percent.

Prescribing them was most likely if patients went to a specialty treatment center and least common in primary-care centers.

Included in the reviewed studies were five reports that looked at "suspicious" medication-taking behaviors that would make health-care providers suspect abuse, such as ordering refills before they are needed. These behaviors occurred in up to 24 percent of cases.

Back pain is the second leading symptom seen by physicians in the United States, according to Martell. Chronic back pain is defined as discomfort lasting more than three months. It afflicts up to 19 percent of working adults, Martell wrote.

Besides narcotic medication, physicians can treat chronic back pain in other ways, using exercise, nonsteroidal anti-inflammatory medicines (NSAIDs), tricyclic antidepressants, acupuncture and electrical stimulation.

Based on the analysis, Martell offers this advice to patients with chronic back pain: "Consider all your options carefully, weigh the risks vs. the benefits of those options, and be sure to seek specialty care from a pain specialist."

Dr. Andrew Sherman, head of spine and musculoskeletal rehabilitation at the Spine Institute at the University of Miami Miller School of Medicine, agreed. "This meta-analysis suggests that significant risks do exist with the use of opioid medicines," he said. "Patients need to consult with a board-certified expert physician in pain management."

The lack of high-quality scientific studies is another important issue, Sherman said. The researchers found 2,378 studies but discarded most because they didn't meet the standards of their meta-analysis.

More information
To learn more about chronic back pain, visit the U.S. National Institute of Neurological Disorders and Stroke.