Haitian girl home after face surgery

Sun, 31 Dec 2006 21:41:26 GMT
By JENNIFER KAY, Associated Press Writer
PORT-AU-PRINCE, Haiti - As her cousins, sisters and parents settled down at the kitchen table, Marlie Casseus surveyed the plates of soft foods before her with a new attitude.
She now could enjoy the balls of fried egg and cheese, beans and rice, tomatoes sliced as thin as paper, and a cake with white frosting — foods once impossible to eat when a 16-pound tumor-like mass pushed outward from behind her nose and mouth.

The Christmas Day meal was one of the first in years where she did not lay her heavy head on the family's table and slurp mashed-up morsels through what was left of her mouth and only airway.

The 14-year-old held her head up and spooned small bites of food into her mouth. Haitian doctors had told her parents she would never do anything this normal.

Marlie underwent four operations in the past year at Holtz Children's Hospital in Miami to remove the growth, recenter her eyes, define her nose and rebuild her mouth and jaw so she could again swallow and speak. The mass was replaced with titanium plates and a hard polymer customized to fit under her skin as a synthetic skeleton.

She will return to Miami in about six months for a checkup. There's no sign of regrowth from the mass that threatened her life and stretched her features so far apart that only her nostrils, eyes and a single tooth cutting through her bloated upper lip were recognizable, according to her doctors.

"Marlie can eat now," her older sister Stellecie Casseus said through an interpreter. "Before, Marlie used to feel different, between herself and other people. Now Marlie may not feel that way because she can eat."

Everyone knows how Marlie feels these days. She's finally talking, even howling at the indignity of cold bath water on Christmas morning, after more than two years of near silence since the growth pushed her tongue behind her mouth and made each breath and meal a life-or-death struggle.

Marlie emerged from Port-au-Prince's airport Dec. 23 as the sun was setting, casting shadows on the dusty, potholed roads. Her mother softly sang a French hymn as the sport utility vehicle they were riding in lurched and sped toward the center of the Haitian capital, taking Marlie farther away from the artificially lit sterility of the Florida hospital campus.

She didn't come home completely cured. A rare form of polyostotic fibrous dysplasia, a nonhereditary genetic disorder that causes bone to balloon and jellify, affects every bone in her body: She is bowlegged, her fingers and feet are swollen and crooked and one shoulder rises higher than the other

Still, Marlie — who can't articulate consonants without teeth — wants to go to school, and she wants to be a cook, her mother, Maleine Antoine, translates.

Teeth implants are still at least two years away, after additional surgeries on her nose and jaw; U.S. doctors are waiting for her to stop growing before finishing a facial reconstruction they began last year.

A small, curious crowd surrounded Marlie, her mother and nearly a dozen of their suitcases and duffel bags in the airport parking lot. They asked what the U.S. doctors had done for Marlie's face, which bears thin scars around her nose and mouth but is more symmetrical and flattened than when she left for Miami last year.

After a French-language Mass at a nearby church the next morning, Marlie indulged friends of her mother with hugs and smiles, but the peering stares of beggar children outside sent her bolting in tears to hide in the pews.

Those kinds of stares in public had forced Marlie to retreat from school at age 12 and hide in her home for nearly two years, even from her neighbors. They had not known she was coming home and were shocked to hear her voice as she ambled across the broken concrete front yard they share. Marlie tilted back her head to show them the scar on her throat from a tracheotomy that had helped her breathe, and lifted her shirt to show another scar near her belly button from the feeding tube.

Like most other homes in Port-au-Prince, a concrete wall shields the yard from the street. As relieved as they are that Marlie is no longer burdened by the 16-pound mass and slowly braving the community that scorned her disfigurement, her parents hope to shelter her behind that wall a little longer.

The family lives in a relatively middle-class neighborhood near the center of Port-au-Prince, where the average citizen lives on less than $2 a day. The city has been plagued by a recent wave of child kidnappings and Marlie's father won't even allow 15-year-old Stellecie to leave the house alone. He also brought an armed police officer friend to the airport to pick up Marlie.

It will not be easy holding Marlie back. Her mother brought home a hospital wheelchair to push Marlie through the city's winding streets, but the teen is getting stronger and walking longer distances without needing a lift over the uneven pavement.
She'll settle for tutoring from Stellecie, but she yearns to attend school. The dark home is a comfortable refuge, but Marlie no longer wants to hide.

Group recommends Down syndrome testing

Sun, 31 Dec 2006 12:43:44 GMT
By LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - There's a big change coming for pregnant women: Down syndrome testing no longer hinges on whether they're older or younger than 35. This week, the American College of Obstetricians and Gynecologists begins recommending that every pregnant woman, regardless of age, be offered a choice of tests for this common birth defect.
The main reason: Tests far less invasive than the long-used amniocentesis are now widely available, some that can tell in the first trimester the risk of a fetus having Down syndrome or other chromosomal defects.

It's a change that promises to decrease unnecessary amnios — giving mothers-to-be peace of mind without the ordeal — while also detecting Down syndrome in moms who otherwise would have gone unchecked.

The new guideline is published in the January issue of the journal Obstetrics & Gynecology.

About one in 800 babies has Down syndrome, a condition where having an extra chromosome causes mental retardation, a characteristic broad, flat face and small head and, often, serious heart defects.

Age 35 was always a somewhat arbitrary threshhold for urging mothers-to-be to seek testing. Yes, the older women are, the higher their risk of having a baby with Down syndrome.

But it's a gradual increase in risk — from one in 1,200 at age 25 to about one in 300 at age 35. Nothing suddenly changes at the 35th birthday. Indeed, because more babies are born to younger women than older ones, women under 35 actually give birth to most of the nation's children with Down syndrome.

"It's clear there's no magic jump at 35," said Dr. James Goldberg of San Francisco Perinatal Associates, a member of the ACOG committee that developed the guideline. "We've done away with age 35 because the screening tests have gotten much better."

It's not just a question of whether to continue the pregnancy. Prenatal diagnosis also is important for those who wouldn't consider abortion, because babies with Down syndrome can need specialized care at delivery that affects hospital selection, he added.

The original age-35 trigger was chosen years ago when doctors had less information about the risk of Down syndrome, and the only choice for prenatal detection was an amnio, using a needle to draw fluid from the amniotic sac, he said. Amnios are highly accurate but were reserved for women at higher risk of an affected pregnancy because they occasionally cause miscarriage. A study this fall put the miscarriage risk at one in 1,600 pregnancies, far lower than previous estimates.

Also today, women have more options. Doctors already frequently offer younger women blood tests that don't definitively diagnose Down syndrome like an amnio or a similar invasive test called chorionic villus sampling — but that can signal who's at higher risk.

The newest method, topping ACOG's recommendation for everyone, is a first-trimester screening that combines blood tests with a simple ultrasound exam, called a "nuchal translucency test" to measure the thickness of the back of the fetal neck.

Studies from England, where the nuchal translucency combo has been used for about a decade, and the U.S. conclude that screening method is more than 80 percent accurate, with a very small risk of falsely indicating Down syndrome in a healthy fetus. It is performed between 11 and 13 weeks into pregnancy, and women are usually given numerical odds of carrying an affected fetus.

A woman determined to be high risk then still has time for an invasive test to tell for sure.

Women who don't seek prenatal care until the second trimester can still undergo blood tests known as the triple or quadruple screens.

The guideline also says women of any age can choose to skip the screening and go straight for invasive testing, an approach that might appeal to those with chromosomal defects in the family.

"This new recommendation makes a lot of sense," said Dr. Nancy Green of the March of Dimes. "Maternal age no longer plays such an important role because the screening is better."

Each test comes with pros and cons, and the new guideline advises doctors to check what's available in their communities — nuchal translucency testing isn't easy to get everywhere — and discuss the best options with each patient.

2006 diet news hold the trans fats

Sun, 31 Dec 2006 19:10:46 GMT
By LINDSEY TANNER, AP Medical Writer
CHICAGO - Order from a menu of vegetables, fish, wine and chocolate, but hold the trans fats and sugary sodas. That might best sum up the diet headlines of 2006.
The year's biggest nutrition news sometimes echoed what moms and food scientists have been harping on for years. Other times, it seemed too good to be true.

Often, the news centered on food choices many want removed from the table, but in a year that included white-bread icon Wonder Bread baking two whole-wheat versions, there were still plenty of healthy options available.

The year started out sweet — more data suggesting dark chocolate might be good for the heart — and ended with trans fats grabbing big headlines — New York City became the first in the nation to ban these unhealthy fats in restaurant food.

Although moms say save dessert for last, chocolate news deserves the first look. It made lots of mouths water, but nutrition experts say it needs to be taken with a grain of salt.

A study published in February found lower blood pressure and lower risk of death in older Dutch men who ate the equivalent of one-third of a chocolate bar daily. And research later in the year found improved blood flow in adults who drank flavanol-enriched cocoa. Flavanols are compounds also found in red wine that researchers believe help keep blood vessels healthy.

The two studies build on previous suggestions that chocolate, especially the dark variety, might be good for the heart. But the research is not conclusive and scientists still don't know if there really is a connection.

"Certainly nobody should start eating chocolate because they think chocolate is good for their heart," said Tufts University nutrition professor Alice Lichtenstein. "At this point we don't know."

Same goes for red wine.

In November, a headline-grabbing study found that huge doses of a red wine extract called resveratrol seemed to help obese mice live longer, healthier lives. Some scientists think the ingredient, found in grape skin, is one reason French people have less heart disease than Americans.

But no one knows if resveratrol would benefit humans the way it did mice, and it would take enormous amounts of red wine to equal the dose used in the experiment.

A safer approach would be choosing foods with more proven benefits, including fish. The http://www.americanheart.org
American Dietetic Association: http://www.eatright.org

Heart disease still big problem in South

Sun, 31 Dec 2006 09:14:45 GMT
By TOM BREEN, Associated Press Writer
CHARLESTON, W.Va. - West Virginia is making slight yet discernible progress in reducing deaths from heart disease, but it remains one of the states hit hardest by the nation's No. 1 killer. Mississippi tops the list.
The American Heart Association released its annual look at heart disease in America on Friday, ahead of a January publication of the findings in the medical journal Circulation.

Cardiovascular disease accounted for more than one-third of all deaths in 2004, the most recent year for which data is available, but there are signs of improvement.

Mississippi had the highest fatality rate from cardiovascular disease and coronary heart disease, at nearly 406 deaths per 100,000 people.

Oklahoma was next, with nearly 401 deaths per 100,000; Alabama, with 378 deaths; Tennessee, with nearly 374 deaths per 100,000; and West Virginia, with 373.

There were twice as many angioplasties recorded in Southern states as compared to other regions, and the report found similar ratios of bypass surgery, open-heart surgeries and pacemaker implants.

Wayne Rosamond, an epidemiologist at the University of North Carolina and the chairman of the American Heart Association Statistics Committee, said there are studies now directed at finding out exactly why heart disease has such striking regional differences.

"What drives those shifts is not really well understood," he said.

West Virginia fared slightly better in fatality rates from stroke, ranking ahead of 12 others. The report found that 373 people per 100,000 die from cardiovascular disease in West Virginia, down one from the previous year.

While that may seem like modest progress, the state's death rate has dropped since 1993, when the death rate was 390 out of every 100,000 West Virginians.

Rosamond said signs like that are positive indicators.

"There are a lot of things going on that are good, particularly on the prevention side," Rosamond said.

In particular, he cited a drop in smoking rates among young people and a growing awareness of heart disease among women as signs that prevention efforts are beginning to make a dent in the mortality rate.

Those kinds of changes take years to show up in statistics, though, according to Dr. Anthony Morise, a cardiologist and professor of medicine at West Virginia University.

"You have to get people in a preventive mode," he said. "Those things take a while to translate into a measurable change."

Morise also said he's noticed improvements in the diagnosis and treatment of women, for whom heart disease is the most common fatal illness. Women with heart disease commonly exhibit symptoms not usually found in men, such as unexplained fatigue, and often don't show symptoms like crushing chest pain.

The fact that doctors have gotten better at identifying those symptoms, and patients have grown more aware of what they might be, means that diagnosis has gotten better, Morise said. At the same time, though, as diagnosis improves, heart disease rates will show an increase.

"The more we detect it, the more the incidence rates will go up," he said.
In addition to focusing on heart disease in demographic groups like women and Latinos, the report also underscores the need to study why it is so much more common in the South than in the rest of the country.

50 user(s) online 1 here 262 most online 104 Visitor(s) Today 4,018,026 Visits 11/01/2002