May 6, 2007, 5:18 PM CT

CT colonoscopy almost as good as regular colonoscopy

Nearly 90% of colon polyps greater than or equal to 6 mm in size detected at CT colonoscopy were demonstrated to represent true polyps at subsequent optical colonoscopy (the traditional method of viewing the colon and removing premalignant growths), as per a new study by scientists from the University of Wisconsin Hospital and Clinics in Madison, WI.

"We analyzed the findings of 363 CTC-detected lesions in 244 patients who subsequently underwent optical colonoscopy," said Tyler Prout, MD, lead author of the study. The scientists observed that optical colonoscopy verified the presence of polyps in 321 of the 363 CTC-detected instances, making for an overall positive predictive value of 88.4%, he said. In addition, the combined group of polyps with either sessile or pedunculated morphology yielded a matching lesion at optical colonoscopy 91.8% of the time, Dr. Prout added.

"From a practical standpoint, this is very important, because if CTC is to be an effective screening tool it, must not only have a high sensitivity, but have sufficiently high concordance rate at subsequent optical colonoscopy to avoid unnecessary colonoscopies," said Dr. Prout.

Exact polyp size had little effect on the concordance rate, said Dr. Prout. "In our more recent experience, we do nearly as well detecting the smaller 6-7 mm polyps as those that are 1 cm or greater. Moreover, when comparing these results to our earlier experience, we find our positive predictive value at the 6-7mm polyp size threshold to be much improved; now 85%, whereas it was previously just over 50%," said Dr. Prout. "We think that this finding can be attributed to a combination of factors, some of the most important of which include colonic preparation and method of image analysis. Our colonic preparation includes both fluid and stool tagging. For image analysis, we employ a primary 3D evaluation complemented by focused review of 2D multiplanar reformats for confirmation. This is in contradistinction from a number of studies that utilize primary 2D interpretation," said Dr. Prout......... Posted by: Emily      Read more         Source

May 6, 2007, 5:16 PM CT

Use of MRI and MRS with new surgical technique proves helpful, says study

MRI and MRS can provide a roadmap of the prostate and assist in surgical planning of robotically assisted laparoscopic radical prostatectomy (RALRP), as per a recent study conducted by scientists at the University of California, Los Angeles.

"RALRP is an increasingly prevalent surgical approach which unlike a traditional, open radical prostatectomy offers no tactile feedback to the surgeon," said Mittul Gulati, MD, lead author of the study. "The surgery is intended to be a curative procedure, ideally done on patients with a life expectancy of greater than 10 years and a diagnosis of organ-confined (stage T2), or in the opinion of some, limited T3 disease," said Dr. Gulati.

The study included 16 prostate cancer patients who went on to have RALRP. Of the 16 patients, MRI/MRS correctly staged 12 of 16 patients. In three cases, MRI/MRS demonstrated extension of cancer outside the capsule and involvement of the neurovascular bundle (NVB) which allowed the surgeon to plan wide resection of the NVB on the involved side to achieve negative surgical margins.

"The MR imaging, if done accurately, can provide a 'road map' of the prostate, telling the surgeon if one of the NVB's are involved before the patient is taken to surgery, and if so, what needs to be done to provide an effective operation," said Dr. Gulati......... Posted by: Emily      Read more         Source

April 30, 2007, 9:15 PM CT

Resistant HIV quickly hides in infants' cells

New evidence shows that drug-resistant virus passed from mother-to-child can quickly establish itself in infants CD4+ T cells where it can hide for years, likely limiting their options for future therapy. The study is reported in the May 15 issue of The Journal of Infectious Diseases, now available online.

Mother-to-child transmission of HIV is an important factor in the AIDS pandemic, eventhough important strides have been made in limiting transmission with antiviral drug therapies before, during, and following birth. In the last few decades the rate of mother-to-child transmission of HIV in the United States has been reduced from 25 percent to its current rate of less than 2 percent. However, the transmission of drug-resistant strains of HIV from mother to child is still a problem, and much is unknown concerning how such transmission affects the responses of infants to various drug therapys.

The study, conducted by Deborah Persaud, MD, of Johns Hopkins University School of Medicine and his colleagues working throughout the United States, analyzed HIV-infected infants less than six months of age enrolled in a large, multi-center clinical trial covering 10 states.

Their results showed that five of 21 HIV-positive infants were infected with drug-resistant HIV transmitted from their mothersa surprisingly high figure. Of those five, four were resistant to non-nucleoside reverse transcriptase inhibitors (NNRTIs), a common class of antiretroviral drug used to treat HIV infection and to prevent mother-to-child transmission. All had uncommon drug-resistance mutations that some resistance tests would miss......... Posted by: Emily      Read more         Source

April 30, 2007, 8:22 PM CT

Gambia's unproven AIDS remedy

Leading HIV experts are alarmed that the government of The Gambia is encouraging citizens living with HIV to stop taking antiretroviral medications in order to try an unproven herbal remedy. The HIV Medicine Association (HIVMA) calls on President Yahya Jammeh to cease his unproven claims that the therapy "cures" AIDS.

Earlier this year, President Jammeh began applying his therapy to a handful of patients who had been doing well on antiretroviral treatment but stopped taking the drugs in order to qualify to receive his "cure."

HIVMA joins its colleagues in the International AIDS Society and the Society for AIDS in Africa in expressing great concern regarding this practice. "There currently is no cure for HIV/AIDS," said HIVMA Chair Daniel R. Kuritzkes, MD. "President Jammeh is giving people false hope, while at the same time making them stop therapy that has been demonstrated to save lives".

"Any therapy that claims to alleviate this devastating disease must be subjected to rigorous scientific scrutiny," he added. "A growing body of evidence from Africa shows the lifesaving effects of antiretroviral medicines for people living with HIV/AIDS. Conversely, the remedy President Jammeh is promoting is untested. It is highly unethical to stop a proven treatment to try an unproven one. We are extremely concerned that President Jammeh would recklessly experiment with his peoples lives"......... Posted by: Emily      Read more         Source

April 30, 2007, 7:12 PM CT

Strengthening Swallowing Rehabilitation

Just thinking about swallowing makes it harder to do.

Head and neck cancer, a stroke, brain tumor, brain injury or even a tracheostomy tube and mechanical ventilation needed to sustain life can make it impossible.

Dysphagia, or swallowing problems, can also result from aging and accompanying loss of muscle strength.

"We swallow a thousand times or more per day, just our own saliva, without even thinking about it," says Dr. Lori Burkhead, speech-language pathologist and clinical research scientist at the Medical College of Georgia Department of Otolaryngology Head and Neck Surgery. "We swallow in our sleep. Babies do it in utero. It is something we do without giving it much thought, but it's actually a very complex act that involves an intricate coordination between the brain, muscles and respiratory system".

An estimated 18 million Americans have difficulty with this routine function that, at worst, can lead to aspiration pneumonia, malnutrition, dehydration and death.

Evidence suggests that the same exercise science principles that strengthen bodies can help restore this fundamental function using mouth and throat muscles. Because swallowing muscles are not easy to access, applying the usual principles of exercise is more difficult. "Physical therapists can put a weight in someone's hand and exercise them or they can give patients external assistance and get them to complete a movement," says Dr. Burkhead. "I can't put weights on throat muscles for strengthening and I can't get at those muscles to help patients finish the movements they cannot do on their own."........ Posted by: Emily      Read more         Source

April 30, 2007, 7:08 PM CT

In Case of a Smallpox Outbreak

In the event of a smallpox outbreak in the United States, how long would it take for a vaccine to start protecting Americans by stimulating an immune response? A new national study led by Saint Louis University School of Medicine will attempt to answer this question.

General routine vaccinations for smallpox were stopped in the United States in 1971, and the world was declared free of smallpox in 1980. But because of the recent concern about biowarfare and bioterrorism throughout the world, the U.S. government is making efforts to improve its ability to protect its citizens in the event of a bioterrorist attack involving the smallpox virus (Variola major virus).

This study at Saint Louis University will look at the ability of an investigational vaccine made by Bavarian Nordic to stimulate the immune system against smallpox.

"Vaccines prevent disease by giving the body a jump-start at recognizing the infecting virus or bacteria," said Sharon Frey, M.D., the principal investigator for the study at Saint Louis University. "After successful vaccination, the body experiences a quicker fighting response to the infection, which lessens or completely avoids the symptoms of illness".

Unlike some other diseases, getting vaccinated following exposure to smallpox could provide protective effects. For example, for the flu vaccine to work, people need to get vaccinated before being exposed to influenza. The currently licensed smallpox vaccine, however, provides benefits post-exposure, and may be useful in further preventing the spread of the disease......... Posted by: Emily      Read more         Source

April 29, 2007, 7:04 PM CT

FDA approves aliskiren for hypertension

The FDA approved aliskiren, the first high blood pressure therapy that inhibits renin.

Aliskiren (Tekturna, Novartis) is also the first, new type of high blood pressure drug approved by the FDA in more than a decade, as per company officials.

Aliskiren is a once-daily tablet (150 mg and 300 mg) indicated as monotherapy or in combination with other high blood pressure medications.

Franz Messerli, MD, director of the high blood pressure program in the division of cardiology at St. Luke's-Roosevelt Hospital, Columbia University, New York, said he is skeptical about where aliskiren fits into the antihypertensive arsenal.

"Is there a need for triple blockade of the renin angiotensin system and if so, what is the risk-benefit ratio?" Messerli, section editor of the High blood pressure and Vascular Disease section of Today in Cardiology, said. "As it is introduced now, I don't see the exact place in the therapeutic arsenal".

As per the FDA, scientists reviewed aliskiren's effectiveness through six, placebo-controlled, eight-week clinical trials involving more than 2,000 patients with mild to moderate hypertension.

The antihypertensive effect was maintained for up to one year across all demographic subgroups; however, blacks tended to have smaller reductions in BP than whites and Asians. This is generally true for drugs that affect the renin-angiotensin system, as per the FDA......... Posted by: Emily      Read more         Source

Sun, 29 Apr 2007 15:05:32 GMT

A year of paediatrics

Paediatric Grand Rounds

Clark Bartram is an American paediatrician "who takes care of newborns of all shapes, sizes, and degrees of health, and a sceptic mucking about a credulous world." He also writes Unintelligent Design (Tales from the Not So Normal Newborn Nursery), and is presenting his choice of the best contributions to Paediatric Grand Rounds over the last year.

There are some gems.

A neonatologist's (Neonatal Doc) strong and wise views on home births and the dangers thereof; Sam (Blog MD) looks at treating children with cancer; Steven Parker on treating children with antipsychotic medication, and the argument that ensued (Flea & Karoli) ; our very own Shinga (Breath Spa for Kids) looking at the use of steroids in children with asthma; Philip Gordon's (Tales from the Womb) brilliant description of Sudden Infant Death Syndrome and more, much more.

Dr Crippen was flattered to find his own article about the attempt to persuade mother's that cow's milk was poisoning their children included. This story grew out of an advertorial run by the BBC as "news" but then developed when the BBC back tracked, edited and largely re-wrote their article without acknowledging their mistake. Fortunately, the whole sordid story was tracked by the perfectly wonderful News Sniffer.

Take a look at a year of paediatrics on Unintelligent Design. Posted by: Dr John Crippen      Read more     Source

April 25, 2007, 9:39 PM CT

Strides Against Diabetic Retinopathy

Research increasingly shows promise to both slow and relieve the effects diabetic retinopathy, the most common complication of diabetes.

In its earliest stages, retinopathy often has no overt symptoms but can progress over time to a phase in which the blood vessels of the eye leak and rupture easily, eventually causing blindness. This frightening complication is caused by high blood glucose levels, and nearly all people with type 1 diabetes show some symptoms of the disorder.

An in-depth article in the spring 2007 edition of Countdown, the quarterly journal of the Juvenile Diabetes Research Foundation, details ongoing human clinical trials in this area, and important findings that have been made to date. In the article, JDRF-funded scientists share valuable insights into the causes of retinopathy, as well as the therapeutics that are being developed as a result of the identification of new biological targets.

One study mentioned within the article was led by Dr. Lloyd Aiello of the Joslin Diabetes Center, who showed that the compound ruboxistaurin slowed the progress of retinopathy by inhibiting an enzyme in the body called protein kinase C beta (PKC beta), which is believed to contribute to the blood vessel damage that leads to the disease. This is the first time a drug has been shown to protect against the complication in a human clinical trial......... Posted by: Emily      Read more         Source

April 24, 2007, 11:10 PM CT

Study Could Help Stroke Victims

A University of Leicester study could help to provide a new lease of life for patients who have suffered a stroke.

The research reported in the American Journal of High blood pressure confirms the safety of a drug, Lisinopril, that lowers their blood pressure-without reducing the blood flow to the brain.

Now a larger Leicester trial is under way to investigate the drugs benefits for victims of strokes.

Dr David Eveson, of the Department of Cardiovascular Sciences at the University of Leicester, said: "Hypertension is common immediately after a stroke. Stroke patients with hypertension tend to have a worse outcome than those with normal blood pressure and therefore it may be helpful to lower blood pressure immediately after stroke.

"However, trials to date have shown variable results, probably because therapy was either started too late or the wrong drug was used.

"The ACE inhibitor class of blood pressure lowering drugs, of which Lisinopril is a member, have been shown in studies to lower blood pressure but preserve the blood flow to the brain which may be all important after stroke. This study compared the use of blood pressure lowering with Lisinopril versus placebo therapy within a few hours of acute stroke in patients presenting to University Hospitals Leicester. The results showed that blood pressure was effectively lowered in the treated group and this did not result in any adverse outcome in comparison with placebo......... Posted by: Emily      Read more         Source