Hormone heart risks overstated for some
Wed, 04 Apr 2007 02:45:18 GMTBy LINDSEY TANNER, AP Medical Writer
CHICAGO - Maybe hormones aren't so bad for women's hearts after all — if the women are still in their 50s. In a postscript to a landmark study five years ago that led millions of women to abandon hormones during menopause, a new review suggests the heart risks for this group of women were overstated.
In fact, hormones probably are a reasonable short-term option for women in their 50s who need relief from hot flashes, night sweats and other symptoms, said Dr. Jacques Rossouw, the government researcher who led the original research and the new review of the high-profile Women's Health Initiative
The pills — either estrogen alone or a combination of estrogen-progestin — don't get a complete stamp of approval because of stroke risks for both and breast cancer risks for the combination pill.
But many critics of the original study feel vindicated. They had argued that the results were skewed because more than half the women in the study were well past the usual age when hormone users start treatment.
"If you go back to the original WHI results, women were too old, they had too much disease, there was no breakdown by years or time since menopause," said Dr. Debra Judelson, a Beverly Hills cardiologist. The new analysis attempts to clarify those points, she said, and "has got tremendous benefit."
"Hormone therapy is an individualized choice. This actually should help women and doctors to make that kind of decision," said Dr. Joseph Camardo of Wyeth Pharmaceuticals Inc., maker of the hormone pills studied.
The new analysis indicates the pills don't raise the risk of heart attack for women in the 50-to-59 age group. However, that age group did see a higher risk of breast cancer from the combination hormone and a higher risk for stroke from that pill and estrogen alone. The risk was even greater for older women. That's because women in their 70s or who are 20 years past menopause already face increased heart, stroke and cancer risks by virtue of age alone.
Rossouw of the National Heart, Lung and Blood Institute called the new results "somewhat reassuring."
Dr. Deborah Grady, a researcher at the University of California at San Francisco, said many women and doctors overreacted to the initial study data and the re-analysis may help temper some of the aversion to hormones that followed.
"Hormone therapy in women who are near menopause is probably not very dangerous," Grady said, noting that previous analyses of the study data also hinted at that.
However, concerns remain about the higher risk for breast cancer, which turned up in the original study of estrogen-progestin pills. So the general advice for hormones remains the same: Use them only to relieve symptoms, at the lowest effective dose for the shortest possible time, Rossouw said.
The report appears in Wednesday's http://jama.ama-assn.org
WHI: http://www.nhlbi.nih.gov
Engineers building drug filled tooth
Wed, 04 Apr 2007 05:00:03 GMTNEW YORK - Instead of settling for the bling of gold, a more practical person seeking a false tooth might eventually be able to get one that can deliver drugs.
Researchers in Europe and Israel, funded by the European Union, are working on a tiny drug-dispensing system called IntelliDrug that goes into a person's mouth — with the ultimate goal of getting the parts small enough to fit into a replacement tooth placed in the back like a molar. The device can release a specific amount of medicine at certain intervals, ensuring that the patient gets the proper dosage at the right time.
Patients, on average, follow instructions on taking drugs only half the time, even for people who need them to survive, said Dr. Andy Wolff, an Israeli dentist who initially came up with the concept. Patients often forget or find it too inconvenient to take medicine, especially in the middle of the night. He believes the device will rectify the problem by automating the process.
Wolff's company, Saliwell Ltd., and German microelectronics institute HSG-IMIT are two of 15 organizations involved with the development of the device. The project is funded by a program that promotes cooperation between EU nations and Israel. The organizations include universities, companies, research institutes and hospitals. One notable name is Spanish telephone company Telefonica SA, which is helping with the communications technology side of the development.
By placing the device in the mouth, the drug can be delivered directly into the bloodstream through the lining of the cheek and around the mouth, a surface that is porous enough to absorb the medicine. Saliva, meanwhile, mixes with the drug and carries it to the lining more consistently than just swallowing a pill every few hours.
"Why in the mouth? It's very accessible, it's very permeable, not like your skin," Wolff said.
The treatment of diabetes is one area where delivering drugs can be advantageous. People with diabetes must take regular injections of insulin to maintain low blood-glucose levels. Instead of pricking their skin, patients can wear the IntelliDrug device for a little while.
The device consists of a stainless steel housing, a pump and custom valves to regulate the drug flow, a microprocessor, batteries, and a reservoir for the drug pill. It is currently a block the size of two teeth and strapped to the side of teeth so it hugs the inside of the cheek. Developers hope to ultimately turn it into a replacement tooth.
The unit can be removed from the mouth, where a technician can refill the drug reservoir, clean the system, and replace the battery if needed.
IntelliDrug also has a communication port that allows the user to control the device via remote control with hopes of eventually linking it with a cellular phone or to a nearby hospital or care center.
"This approach combines dentistry with software, communication and technology," Wolff said.
Ongoing clinical trials, on pigs, have been successful. Dr. Axel Schumacher, who is helping design the pumps, said he hopes to have a prototype ready for human testing by the end of the year. Schumacher works for the research institute HSG-IMIT, which is based in southern Germany.
So far, the prototypes can only be worn for a limited period. There are hopes that when the components become small enough, they can become a permanent fixture.
The concept of IntelliDrug could solve the problem of compliance, said Dr. Charles Smith, professor of pharmacy at the Medical University of South Carolina. While he isn't familiar with the device, he said, "Having an automated delivery system might be interesting."
New study finds drugresistant flu type
Tue, 03 Apr 2007 23:10:41 GMTBy CARLA K. JOHNSON, Associated Press Writer
CHICAGO - A less common strain of flu has shown hints of resistance to two flu drugs among patients in a small study in Japan, a country known for prescribing the drugs more frequently than anywhere else in the world.
Signs of resistance to the drugs Tamiflu and Relenza turned up among a few patients who had type B influenza, normally a milder flu causing smaller outbreaks than the more common type A.
The findings were troubling to researchers because they suggested doctors will eventually need new medications to treat drug-resistant flu if the viruses become more prevalent.
Previous studies, including work by the same researchers, have found a few cases of resistance to Tamiflu in type A flu, the variety thought most likely to cause a pandemic if bird flu changes into a form that is more easily spread among people, not just poultry.
Dr. William Schaffner, an infectious-disease specialist at Vanderbilt University who was not involved in the study, said Japanese doctors prescribe anti-flu drugs frequently, perhaps too often, giving viruses a chance to evolve.
"We were afraid this might happen and, sure enough, it has," Schaffner said. The study underlines the importance of vaccination and other preventive measures, he said.
Some scientists believe Tamiflu and Relenza, which were designed to treat seasonal flu, may also be helpful in treating a global epidemic, although that is not clear.
The U.S. government's preparation for a flu pandemic includes stockpiling Tamiflu and Relenza, and funding development of new anti-flu drugs, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
Anytime doctors treat widely with an anti-viral drug, "you are going to have, sooner or later, the evolution of resistance," Fauci said. "It's critical to have a pipeline of drugs you can have available when that resistance develops."
In the new study, appearing in Wednesday's http://jama.ama-assn.org
U.S. government pandemic flu site: http://www.pandemicflu.gov
Agency Cancer cases to double by 2030
Wed, 04 Apr 2007 02:20:37 GMTBy CARLEY PETESCH, Associated Press Writer
UNITED NATIONS - The number of diagnosed cancer cases will more than double between 2000 and 2030, primarily in poorer countries, the director of the International Agency for Research on Cancer said Tuesday.
Dr. Peter Boyle said the reasons for the increase include population growth, longer life expectancy, more people smoking in the developing world and a lack of health care in poor countries.
In 2000, the agency estimated 11 million new cases of diagnosed cancer worldwide, seven million deaths from cancer and 25 million people living with cancer.
"We currently estimate that between the year 2000 and 2030, there'll be a more than doubling of the numbers of cases of cancer diagnosed each year," Boyle said. "And the great majority of this increase is going to be in the low- and medium-resource countries."
The agency, part of the World Health Organization, expects that by the year 2030, there will be 27 million cases of cancer, 17 million deaths from cancer and 75 million people living with cancer.
"We've been concentrating on cancer in high-resource countries and until essentially AIDS came along, we haven't looked too closely at what's going on in low-resource countries," Boyle told a news conference.
But he said new research shows that as time has progressed, there has been an increasing shift of cancer to poor countries.
"What's going to happen between now and 2030 is that the population is going to increase from about 6.5 billion to 8 billion in 2030," Boyle said. "So even if the risks remain constant at each five-year age group, because we've got more people around, we're going to have more cases of cancer."
An increase in life expectancy in the majority of countries, with the exception of some AIDS-ravaged countries in Africa, also is leading to a rise in cancer cases, he said.
Both China and India have continual growth in the number of people reaching older ages, Boyle said. "So if you've got more old people in the population with the same risks as the younger people, you're going to have more cases of cancer in the older population," he said.
Boyle said one of the unfortunate successes for developed countries in the last 40 years has been their export of cancer risk factors, such as cigarette smoking and alcohol consumption, to poor countries.
"These three elements are going to come together and that is going to drive up the global cancer button over the next 30 years," Boyle said.
700pound woman rescued from secondfloor bathroom
Wed, 04 Apr 2007 13:03:27 GMTPHILADELPHIA - A 700-pound woman was rescued from her bathroom by firefighters who cut away part of an exterior wall and removed a window before lowering her to the ground, a fire official said on Tuesday.
The woman, identified as Patty Brown, called emergency services in Trenton, New Jersey, late on Monday after falling in the second-floor bathroom and being unable to get up.
Medical personnel were unable to move her, and so called the city's fire department, which eventually dispatched three fire engines and some 25 officers.
After removing part of the bathroom wall, cutting the window down to the floor, and taking out the toilet and radiator, firefighters moved her into a rescue basket in which she was lowered down a specially reinforced ladder to the ground outside, said Battalion Chief Qareeb Bashir.
With the help of around 10 firefighters, she was then moved on to a stretcher, transferred to an ambulance specially equipped for very large people, and taken to a local hospital.
Brown, who was only slightly injured from her fall, was conscious throughout the five-hour operation, and was &;very pleasant,&; Bashir said.
Although firefighters are trained to perform difficult rescues, this provided an unusual challenge, Bashir said.
&;This was a very unique situation,&; he said.
N.M. governor to veto vaccine bill
Wed, 04 Apr 2007 00:47:58 GMTBy DEBORAH BAKER, Associated Press Writer
SANTA FE, N.M. - The governor said Tuesday he will veto a bill that would have required girls entering sixth grade to be vaccinated against a sexually transmitted virus that can cause cervical cancer.
Gov. Bill Richardson had indicated he would sign the bill after it passed the Legislature last month, but on Tuesday said he changed his mind after parents and doctors told him their concerns about the program.
"While everyone recognizes the benefits of this vaccine, there is insufficient time to educate parents, schools and health care providers," he said.
The measure would have taken effect June 15, requiring girls entering sixth grade this fall to be vaccinated against the human papillomavirus, or HPV, before they enter public or private school.
The bill's sponsor, Republican Sen. Steve Komadina, said the governor "has the right to do what he thinks is best."
But Komadina, an obstetrician and gynecologist, said he thought the legislation was good because it required parents to be informed of the vaccine's advantages yet allowed them to opt out easily.
"It will save lives," Komadina said.
The veto will not affect a state health department program — which was in the planning stages before the legislation was passed — that will offer the vaccine to girls entering fifth grade in the fall in school districts that decide to participate.
Bills have been introduced in about 20 states to require the vaccine that protects against HPV, but some have backed off the measures because concerns over the vaccine's safety and protests from conservatives who say requiring it promotes promiscuity and erodes parents' rights.
Gardasil, a three-dose vaccine that protects against HPV for females ages 9 to 26, protects against HPV strains that cause cervical, vulvar and vaginal cancers and genital warts.
More than 500 cases of mostly minor side effects have been reported in vaccinated girls and women. Government health officials said last month that no additional warning labels are needed.
Richardson did sign a related bill, which requires that health insurance policies and plans provide coverage for the HPV vaccine.
IVF may be safe after borderline ovarian tumors
Wed, 04 Apr 2007 11:25:30 GMTBy Will Boggs, MD
NEW YORK - Infertility drugs may be safely used in women who have been treated for borderline ovarian tumors, researchers in France report.
In vitro fertilization is still an option for infertile women who have undergone conservative treatment of borderline ovarian tumors, Dr. Philippe Morice from Institut Gustave Roussy, Villejuif, told Reuters Health.
Borderline ovarian tumors are unlikely to become malignant. Only about 15 percent of this type of tumor, which is usually diagnosed at an early stage, will develop into ovarian cancer, according to the National Cancer Institute.
Morice and associates investigated the outcomes of 30 women, with a history of a borderline ovarian tumor, who underwent infertility therapy.
Three women underwent simple ovarian stimulation with the drug clomiphene and 27 underwent an IVF procedure with hyperstimulation of the ovaries, an average of 16 months after tumor treatment, the authors report.
Four patients had an ovarian tumor recurrence after infertility treatment, the investigators report in the medical journal Fertility and Sterility, and all four women were disease-free again 12 to 84 months after treatment of the recurrence.
Three of the four recurrences were in women initially treated with surgical removal of the ovarian tumor, as opposed to removal of most or all of the affected ovary, the investigators report. They suggest that the recurrences could be more associated with the surgery than the IVF procedure.
Nearly half the patients became pregnant, resulting in 11 normal pregnancies, 1 miscarriage, and 1 premature delivery .
&;Results from this study are important and a message of hope for physicians and patients,&; Morice said. &;In patients with borderline tumors,&; he added, &;the number of cycles of IVF should be reasonable, and should not exceed four.&;
SOURCE: Fertility and Sterility, March 2007.
