01.03.09
Posted in Uncategorized at 1:00 am by ceo
ATLANTA (AP) -- A smoking ban in one Colorado city led to a dramatic drop in heart attack hospitalizations within three years, a sign of just how serious a health threat secondhand smoke is, government researchers said Wednesday. The study, the longest-running of its kind, showed the rate of hospitalized cases dropped 41 percent in the three years after the ban of workplace smoking in Pueblo, Colo., took effect. There was no such drop in two neighboring areas, and researchers believe it's a clear sign the ban was responsible.
The study suggests that secondhand smoke may be a terrible and under-recognized cause of heart attack deaths in this country, said one of its authors, Terry Pechacek of the U.S. Centers for Disease Control and Prevention.
At least eight earlier studies have linked smoking bans to decreased heart attacks, but none ran as long as three years. The new study looked at heart attack hospitalizations for three years following the July 1, 2003 enactment of Pueblo's ban, and found declines as great or greater than those in earlier research.
"This study is very dramatic," said Dr. Michael Thun, a researcher with the American Cancer Society.
"This is now the ninth study, so it is clear that smoke-free laws are one of the most effective and cost-effective to reduce heart attacks," said Thun, who was not involved in the CDC study released Thursday.
Smoking bans are designed not only to cut smoking rates but also to reduce secondhand tobacco smoke. It is a widely recognized cause of lung cancer, but its effect on heart disease can be more immediate. It not only damages the lining of blood vessels, but also increases the kind of blood clotting that leads to heart attacks. Reducing exposure to smoke can quickly cut the risk of clotting, some experts said.
"You remove the final one or two links in the chain" of events leading to a heart attack, Thun said.
Secondhand smoke causes an estimated 46,000 heart disease deaths and about 3,000 lung cancer deaths among nonsmokers each year, according to statistics cited by the CDC.
In the new study, researchers reviewed hospital admissions for heart attacks in Pueblo. Patients were classified by ZIP codes. They then looked at the same data for two nearby areas that did not have bans - the area of Pueblo County outside the city and for El Paso County.
In Pueblo, the rate of heart attacks dropped from 257 per 100,000 people before the ban to 152 per 100,000 in the three years afterward. There were no significant changes in the two other areas.
"The need for protection from secondhand smoke in all workplaces and public places has never been clearer," said Matthew Myers of the Campaign for Tobacco-Free Kids, in a prepared statement. He is president of the Washington, D.C.-based advocacy organization.
But the study had limitations: It assumed declines in the amount of secondhand smoke in Pueblo buildings after the ban, but did not try to measure that. The researchers also did not sort out which heart attack patients were smokers and which were not, so it's unclear how much of the decline can be attributed to reduced secondhand smoke.
One academic argued there's not enough evidence to conclude the smoking ban was the cause of Pueblo's heart attack decline.
The decline could have had more to do with a general decline in smoking in Pueblo County, from about 26 percent in 2002-2003 to less than 21 percent in 2004-2005. If there were stepped-up efforts to treat or prevent heart disease in the Pueblo area, that too could have played a role, said Dr. Michael Siegel, a professor of social and behavioral sciences at the Boston University School of Public Health.
"I don't think it's as clear as they're making it out to be," Siegel said.
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On the Net:
CDC publication: http://www.cdc.gov/mmwr
© 2008 The Associated Press.
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DETROIT (AP) -- When Dr. Trevor Banka treats cancer patients alongside Dr. Michael Mott he is working with not only his mentor, but the physician who helped save his life. "I wanted to work next to Dr. Mott and I wanted to train with him," said Banka, a 28-year-old second-year oncology resident at Detroit's Henry Ford Hospital. "We have a very special relationship." That relationship started in 1993 when a 12-year-old Banka was diagnosed with bone cancer in his right knee.
Mott and his former partner performed the surgery, removing the cancerous bone and replacing Banka's knee with a prosthetic.
Mott continued to treat his patient throughout high school, college, and even periodically while Banka attended medical school at Michigan State University.
Shortly after Banka joined Henry Ford, Mott transferred to the hospital. They now work together occasionally.
"He's very thorough and very meticulous," Banka said recently. "He has great technique. It's fun being on the other side of the stethoscope, being his patient and being his colleague."
It's not unusual for some patients to gravitate toward the medical field, Mott said. He said some of his former patients have gone on to become nurses or physical therapists, but Banka is the only one who moved into oncology.
"Every now and then, he would say, `I might do this stuff,'" said Mott, 45. "It certainly takes a lot of hard work and dedication, and he had to come up with that all on his own. He's a remarkable individual in that regard."
Banka said Mott had a lot to do with his decision to become a doctor.
"Going through this, I saw the ability the physicians had with, not only saving my life, but to give my life back," he said.
"I was able to keep my leg," Banka said. "He would often tell me, `Trevor, you have to treat this leg like you're a 60-year-old man.' He told me I could swim, golf and maybe bowl."
Those options weren't too appealing, so Banka took up biking and has made two cross-country trips.
"I had to balance his medical advice with being a young teen," he said.
© 2009 The Associated Press.
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TRENTON, N.J. (AP) -- Biotech company Celgene Corp. on Wednesday sent a letter to doctors warning that a study of its drug to treat dangerous blood clots suggests it may increase the risk of death in elderly patients.
The letter, posted late Wednesday on the Web site of the Food and Drug Administration, recommends that doctors consider alternatives to Innohep in patients with deep vein thrombosis, life-threatening blood clots in major veins such as in the legs.
The new warning comes after analysis of preliminary data from a study in Europe of patients 70 years old and older - a group often excluded from medical studies - who were diagnosed with deep vein thrombosis and also had failing kidneys.
The study, known by the acronym IRIS, was stopped in February 2008 after 350 of the patients had been followed for three months. By then, 13 percent in the group getting Innohep had died of various causes, versus 5 percent in a comparison group getting heparin, a widely used anticlotting drug.
"There is no clear pattern as to the causes of death," the FDA said in a statement.
The agency said available data cannot rule out the possibility that patients in the Innohep group suffered another deep vein blood clot or that there was a problem in manufacturing of the drug.
Celgene, based in Summit, N.J., one of the country's biggest biotech companies, sells Innohep, but it is manufactured by Leo Pharmaceutical Products of Denmark, according to the product's package insert.
Innohep has been sold in Europe since 1991 and was approved for U.S. sales in 2000. From early 2001 through early 2007, more than 30 million people in 60 countries were treated with the drug, which is injected just under the skin.
The FDA said it had received 383 reports of side effects and complications worldwide, including 96 deaths, as of Oct. 15, 2008.
Late last July, Celgene sent another letter to doctors warning of an elevated risk of death in patients aged 90 and older. The new letter extends the warning to all elderly patients.
The FDA statement Wednesday said the agency has asked the company to revise the package insert, or label, "to better describe the overall study results which suggest that, when compared to (heparin), Innohep increases the risk of death for elderly patients" with failing kidneys.
The agency said it expects to get a final report from the study in January and will complete its review soon after that.
© 2008 The Associated Press.
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Posted in Uncategorized at 1:00 am by ceo
NEW YORK (AP) -- It's almost New Year's Eve, a time for plunging into boisterous crowds bathed in loud music. And for some of us, that means turning to an old friend and hearing things like this: "Did you know (BOOM-da-da-BOOM) went over (Bob! You look wonder-) so she said (clink-clink) and then I (Here, have another one) what would you do?" Huh? Too noisy to hear! But wait - how come these younger people understood what she said? What's wrong with your ears? Actually, part of the problem may be your brain.
In fact, it may lie in your brain's dimmer switch for controlling the input from your ears. That bit of brain circuitry appears to falter with age, and scientists are getting some clues about why.
If you have trouble understanding conversation in a noisy room, you're experiencing what's sometimes called the cocktail party problem.
That can be one of the first signs of an age-related hearing loss - a more general problem that can creep in during middle age, and affects one-third of adults ages 65 to 75.
Scientists are still trying to piece together why our hearing goes downhill with age, with the goal of trying to slow it or even reverse it.
When it comes to the cocktail party problem, the dimmer switch is a piece of that story, though it's not clear just how big a factor.
"I think it's a significant player," said Robert Frisina of the University of Rochester in New York, who is studying it.
Scientists have long known that the brain not only receives signals from the ears, but can also talk back to them. And when there's too much noise, this dimmer-switch brain circuitry tells the ears to reduce their flow of signals to the brain.
This helps the sensitive auditory system handle loud sounds that otherwise would overwhelm it and become distorted, as when a radio is turned up too loud for the speaker to handle. In addition, since background noise at a party tends to be lower-pitched than speech sounds, the dimmer switch probably can block out that distracting noise more than it does the speech, Frisina said.
The brain has an added trick for focusing on a particular person's speech rather than competing conversations, Frisina said. Since you're probably facing the person you want to hear, his words arrive at both your ears at the same time and at the same volume. The brain can use that, along with the dimmer switch, to home in on that person's speech, Frisina said.
Frisina and colleagues published evidence in 2002 that the dimmer switch effectiveness declines with age. The drop-off showed up in middle-aged people (ages 38 to 52) and was even worse in people past age 62.
Then they showed the same thing happens in mice, which meant they could study those animals to get clues to what's going on in people. Just last year, they found a possible cause in mice for the decline: reduced supplies of a key structure on the surfaces of the nerve cells in the dimmer-switch circuitry.
Now Frisina hopes to use genetically altered mice to focus his studies on particular parts of the dimmer switch circuitry. There is some evidence that shortcomings in this wiring harm the inner ear as well, he said.
The hope, of course, is to understand the details of the problem and find a way to intervene to slow down the age-related hearing problem, he said.
While it is not yet clear how big a role the dimmer switch plays in the cocktail party problem, Frisina's work "makes a good case that it's got to be one of the important factors," said Charles Liberman, who directs a research laboratory at the Massachusetts Eye and Ear Infirmary.
Another crucial element lies within the inner ear, where sound is converted to nerve signals. That's accomplished by cells that use delicate hairs to detect sound waves. These hair cells can be damaged by aging and by long hours in loud environments like rock concerts.
Loss of those cells makes it harder to understand speech in noisy rooms. For example, it can hinder one's hearing of high sound frequencies, like those of certain consonants. Losing those consonant sounds can make words hard to understand in noisy situations.
"What you're hearing is more of a mumbling sensation than actual clear speech," said Anne Oyler of the American Speech-Language-Hearing Association.
While scientists continue to study hearing problems, people who have trouble understanding their fellow partygoers can take some steps to help themselves. Oyler suggests facing the speaker directly to get facial cues that might fill in some blanks. And don't be shy about admitting the problem and suggesting a move to a quieter place.
"A lot of people, even some people with normal hearing, have trouble hearing with background noise," Oyler said. "You can say, `I'm sorry, I'm having trouble hearing you. I want to know what you have to say.'"
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On the Net:
Information on aging and hearing: http://www.nidcd.nih.gov/health/hearing/presbycusis.asp
How hearing works: http://www.bcm.edu/oto/research/cochlea/Hearing/
© 2008 The Associated Press.
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WASHINGTON (AP) -- Hospitals in about a dozen states are testing whether some simple steps, such as arm-strengthening exercises, could reduce the risk of one of breast cancer's troubling legacies - the painful and sometimes severe arm swelling called lymphedema. Lymphedema has long been a neglected side effect of cancer surgery and radiation: Many women say they never were warned, even though spotting this problem early improves outcomes.
And while less invasive surgical techniques mean fewer breast cancer patients today than just a few years ago should face lymphedema, it's a lingering threat for tens of thousands of survivors because it can strike two decades after their tumor was treated.
"I have ladies tell me the lymphedema is much worse than their cancer because the cancer's cured," says Dr. Electra Paskett, an epidemiologist at Ohio State University who is leading the first-of-its-kind research into possible protective steps.
Among them: Wearing elastic sleeves to counter temporary swelling during things like airplane flight or heavy lifting, and doing special exercises with light weights designed to help keep open the lymph channels that allow fluid to drain through the body.
"The theory is building up muscles in your arm acts as a natural pneumatic pump to move the fluid," explains Paskett, herself a breast cancer survivor who developed lymphedema.
When lymph nodes under a breast cancer patient's arm are removed or damaged by biopsy, surgery or radiation, lymph fluid can build up and cause anything from mild swelling to a ballooning of the arm.
Lymphedema isn't just a legacy of breast cancer treatment. The leg can swell if groin nodes are damaged from other cancers, including gynecologic cancer. Melanoma treatment left former presidential candidate John McCain with facial swelling. Occasionally, rare diseases can trigger a different form of lymphedema.
But lymphedema among breast cancer survivors may be most common. It's been estimated to affect between 20 percent and 30 percent of patients who have 10 or more under-the-arm nodes examined, called an "axillary lymph node dissection."
A surprising study published in November's Journal of Clinical Oncology suggests few such women may be diagnosed. University of Minnesota researchers analyzed records from the huge Iowa Women's Health study, to cull more than 1,200 patients who'd had breast cancer between 1986 and 2003. Eight percent had been formally diagnosed with lymphedema yet another 37 percent of the women suffered persistent lymphedema symptoms, including a swollen arm.
Today, some women have far fewer nodes examined in a "sentinel node biopsy," and separate research suggests those women are far less likely to get later lymphedema - possibly as low as 5 percent, Paskett notes - although many don't qualify for the smaller surgery because of large tumors or other factors.
But perhaps most concerning from the Iowa data, only 40 percent of the women with swollen arms but no diagnosis had heard of lymphedema and less than 2 percent had sought care for their arm symptoms.
Yet early care is key, as Anne Holman of Washington, D.C., can attest. In 2006, doctors found cancer in eight of 18 lymph nodes. She was undergoing chemotherapy to shrink her tumor before an eventual mastectomy when one day her arm turned red and itchy. Come in right away, said Minna Manalo, a nurse practitioner at Georgetown University Hospital's breast cancer unit.
Along with a skin inflammation, Manalo diagnosed lymphedema - Holman's arm was just starting to swell. Daily for two weeks, she underwent what's called complete decongestive therapy, where a machine massaged fluid from her arm and it then was tightly bandaged to counter swelling. Once her arm shrank, Holman was prescribed a lifelong therapy: A tight elastic sleeve and fingerless glove to wear regularly, especially during her job as an international flight attendant, plus arm exercises to help push out returning fluid.
"I'm trying to stay ahead of the game," says Holman, 61. "You can't cure this, but you can manage it."
Paskett's study - now recruiting participants at Ohio State, Georgetown and a growing number of other hospitals - tests whether milder versions of those techniques could prevent lymphedema in the first place. Women recovering from a large node removal are randomly assigned to either a regimen including personalized arm exercises, or just lymphedema education.
Results aren't due until 2012. Meanwhile, cancer groups advise:
-Be alert for subtle swelling. Don't ignore a tight ring or watch, or clothes suddenly not fitting.
-See a certified lymphedema specialist, who has proper training in fitting compression garments and proper use of decongestive therapy. Improper use of either can worsen the condition.
-Obesity and arm injuries are additional risk factors. So watch your weight; avoid injections in the affected arm; clean cuts and seek care for infections promptly; wear gardening gloves and oven mitts; and avoid temperature extremes, such as hot tubs.
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EDITOR'S NOTE - Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
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On the Net:
Study info: http://www.cancer.gov/clinicaltrials/CALGB-70305#ContactInfo-CDR0000494652
National Lymphedema Network: http://www.lymphnet.org
© 2008 The Associated Press.
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