Thai doctors successfully separate twins
Thu, 05 Apr 2007 17:51:05 GMTBy AMBIKA AHUJA, Associated Press Writer
BANGKOK, Thailand - Thai doctors announced Thursday that they successfully performed a rare operation to separate a pair of conjoined female infants, teasing apart their hearts and livers in the delicate procedure.
The girls, Panwad Tiyenjai and Pantawan Tiyenjai, were so-called thoracophagus twins — with their bodies joined from chest to abdomen, said an announcement from Bangkok's Siriraj Hospital.
What made their case unusual was that the upper chambers, or atriums, of their hearts were connected, with one pumping blood to the other, said Dr. Somchai Sriyoschati, a cardiac surgeon who took part in the operation.
The 12-hour operation on Feb. 20, in which 61 doctors and nurses took part, left both girls in good condition, though one has a slight heart defect which can be fixed when she gets older, he said. The girls were eight months old when they were operated on.
The hospital did not say why it delayed in announcing the operation.
Somchai told The Associated Press that a CAT scan and an MRI test before the operation clearly showed the connection between the two hearts, but doctors were unsure if one was dependent on the other.
In some cases where hearts are joined, a diagnosis results in the conclusion that the hearts cannot sustain the patients separately, and that the life of one patient might have to be sacrificed to let the other, stronger one live.
When the operation began and the hearts were exposed, doctors blocked the flow of blood at the joining point to see if each heart could operate independently, Somchai said. Only after finding that stopping the flow caused no apparent problem, did they proceed, he said.
Had stopping the flow between the two hearts caused a problem, further surgery would have been terminated and the twins left in their conjoined state, he said. Conjoined twins who share a heart are often more vulnerable to sickness and have a poor life expectancy compared to separated ones.
The hospital's claims to having performed the first successful operation of its kind — where the hearts were joined at their upper chambers — could not immediately be confirmed.
It was not clear how it differed from an operation performed in the United States in 2002 at the University of Maryland Hospital for Children, where doctors successfully separated two Ugandan girls, Loice and Christine Onziga, who also had connected livers and hearts connected by their upper chambers.
Conjoined twins form when an embryo begins to split into identical twins but stops part way, leaving the partially separated egg to mature. They occur once in every 150,000 to 200,000 live births and are three times as likely to happen to females than males.
The chances of conjoined twins surviving depends on how they are connected. About 40 to 60 percent are stillborn and 35 percent survive 24 hours or less. Those who survive longer are often plagued by medical complications due to shared organs and vital systems.
Disease underlies HatfieldMcCoy feud
Fri, 06 Apr 2007 01:08:15 GMTBy MARILYNN MARCHIONE, AP Medical Writer
The most infamous feud in American folklore, the long-running battle between the Hatfields and McCoys, may be partly explained by a rare, inherited disease that can lead to hair-trigger rage and violent outbursts.
Dozens of McCoy descendants apparently have the disease, which causes high blood pressure, racing hearts, severe headaches and too much adrenaline and other "fight or flight" stress hormones.
No one blames the whole feud on this, but doctors say it could help explain some of the clan's notorious behavior.
"This condition can certainly make anybody short-tempered, and if they are prone because of their personality, it can add fuel to the fire," said Dr. Revi Mathew, a Vanderbilt University endocrinologist treating one of the family members.
The Hatfields and McCoys have a storied and deadly history dating to Civil War times. Their generations of fighting over land, timber rights and even a pig are the subject of dozens of books, songs and countless jokes. Unfortunately for Appalachia, the feud is one of its greatest sources of fame.
Several genetic experts have known about the disease plaguing some of the McCoys for decades, but kept it secret. The Associated Press learned of it after several family members revealed their history to Vanderbilt doctors, who are trying to find more McCoy relatives to warn them of the risk.
One doctor who had researched the family for decades called them the "McC kindred" in a 1998 medical journal article tracing the disease through four generations.
"He said something about us never being able to get insurance" if the full family name was used, said Rita Reynolds, a Bristol, Tenn., woman with the disease. She says she is a McCoy descendant and has documents from the doctor showing his work on her family.
She is speaking up now so distant relatives might realize their risk and get help before the condition proves fatal, as it did to many of her ancestors.
Back then, "we didn't even know this existed," she said. "They just up and died."
Von Hippel-Lindau disease, which afflicts many family members, can cause tumors in the eyes, ears, pancreas, kidney, brain and spine. Roughly three-fourths of the affected McCoys have pheochromocytomas — tumors of the adrenal gland.
The small, bubbly-looking orange adrenal gland sits atop each kidney and makes adrenaline and substances called catecholamines. Too much can cause high blood pressure, pounding headaches, heart palpitations, facial flushing, nausea and vomiting. There is no cure for the disease, but removing the tumors before they turn cancerous can improve survival.
Affected family members have long been known to be combative, even with their kin. Reynolds recalled her grandfather, "Smallwood" McCoy.
"When he would come to visit, everyone would run and hide. They acted like they were scared to death of him. He had a really bad temper," she said.
Her adopted daughter, another McCoy descendant, 11-year-old Winnter Reynolds, just had an adrenal tumor removed at Vanderbilt Children's Hospital. Teachers thought the girl had ADHD — attention deficit hyperactivity disorder. Now, Winnter says, "my parents are thinking it may be the tumor" that caused the behavior. "I've been feeling great since they took it out."
Her adoptive father, James Reynolds, said of the McCoys: "It don't take much to set them off. They've got a pretty good temper.
"Before the surgery, Winnter, when we would discipline her, she'd squeeze her fists together and get real angry and start hollering back at us, screaming and crying," he said.
As for the older McCoys, "they just started dropping dead of the tumors," he said. "They didn't know what it was. A name wasn't really put on the disease until 1968. That's when one of my brothers-in-law had to have surgery, to have some tumors removed in his brain. They started to notice tumors occurring in each of the family members."
Dr. Nuzhet Atuk at the University of Virginia in Charlottesville and geneticists at the University of Pennsylvania studied the family for more than 30 years, Rita Reynolds said.
"They went back on the genealogy and all of that stuff," she said. "They called it madness disease. They said that it had to be coming from the VHL. Our family would just go off, even on the doctors."
Now 85 and retired, Atuk said he could not talk about his work because of medical confidentiality.
Rita Reynolds had two adrenal tumors removed a few years ago. Her mother and three brothers also had them. So do McCoy descendants in Oregon, Michigan and Indiana, she said.
"When you have these tumors, you're easy to get upset," said Rita's mother, Goldie Hankins, 76, of Big Rock, Va., near the Kentucky-West Virginia border. "When people get on your nerves, you just can't take it. You get angry because your blood pressure was so high."
Still, many are dubious that this condition had much of a role in the bitter feud with the Hatfields, which played out in the hill country of eastern Kentucky and West Virginia for decades.
Some say the feud dates to Civil War days, when some members of the families took opposite sides. It grew into disputes over timber rights and land in the 1870s, and gained more notoriety in 1878, when Randolph or "Old Randal" McCoy accused a Hatfield of stealing one of his pigs. The hostilities left at least a dozen dead.
"The McCoy temperament is legendary. Whether or not we can blame it on genes, I don't know," said Ron McCoy, 43, of Durham, N.C., one of the organizers of the annual Hatfield-McCoy reunion. "There are a lot of underpinnings that are probably a more legitimate source of conflict."
"There was a lot of inter-marrying" that could have played havoc with the gene pool, he conceded.
Another relative, Bo McCoy, of Waverly, Ohio, said he had never heard talk of the disease although he has been diagnosed with a different adrenal gland problem — Cushing's syndrome.
Even Reo Hatfield, who drafted the "truce" the two families famously signed in 2003 to officially end hostilities, doubted the role of the McCoys' disease in the feud.
"I would be shocked" if doctors blamed it on illness, he said.
Altina Waller, a professor of history at the University of Connecticut and author of a book about the feud, agreed.
"Medical folks like to find these kinds of explanations. Like the Salem witchcraft thing. That book came out about how that was caused by wheat that was grown that had this parasite or mold or fungus or something that caused everybody in Salem to go nuts," she said.
"How does it explain the other dozen or so feuds that I've looked at in other places?" she asked, citing disputes over coal and other issues. "The rage and violence as such was not confined to McCoys."
She acknowledges that an argument could be made for seeing the McCoys as the more aggressive of the clans.
"One of the reasons the McCoys don't like me as much in the Tug Valley as the Hatfields do is that I seem to suggest that Randal McCoy, the patriarch of the family, was sort of irrational and flamboyant and did jump to, into wanting violence more than, say, Anderson Hatfield," Waller said.
These days, the "feud" has taken a far more civil tone and all but disappeared, members of both families say. The last time it surfaced was in January 2003. McCoy descendants sued Hatfield descendants over visitation rights to a small cemetery on an Appalachian hillside in eastern Kentucky. It holds the remains of six McCoys, some allegedly killed by the Hatfields.
___
Associated Press National Writer Allen G. Breed in Raleigh, N.C., contributed to this report.
___
On the Net:
VHL Family Alliance: http://www.vhl.org
NIH: http://www.ninds.nih.gov/disorders/von_hippel_lindau/von_hippel_lindau.htm
http://www.nlm.nih.gov/medlineplus/ency/article/000340.htm
NYC eyes circumcision push to fight AIDS
Thu, 05 Apr 2007 15:14:41 GMTNEW YORK - City health officials are considering a program to urge circumcision for men at high risk of http://www.nyc.gov/html/doh
Tsunami survivors at risk of disease
Thu, 05 Apr 2007 21:58:06 GMTBy MERAIAH FOLEY, Associated Press Writer
MUNDA, Solomon Islands - Diarrhea has broken out among children huddled in camps of tsunami survivors in the Solomon Islands, a Red Cross official said Wednesday — the first worrying sign that thousands of people who lost their homes in the waves may be at risk of disease.
International aid was slow to trickle in to survivors, particularly in the hardest-hit town of Gizo in the western Solomons. At least 2,000 people spent a third unsheltered night on a hillside near Gizo following Monday's earthquake and ocean surge.
A New Zealand military transport plane unloaded an aid package of tarps, water and food rations in the town of Munda late Tuesday, following a shipment of similar supplies delivered earlier by a police patrol boat. Six doctors and 15 nurses reached Gizo on Wednesday.
A supply boat left the capital of Honiara on Wednesday evening for the 10-hour journey to Gizo, but two others were delayed because provisions could not be found in the capital to fill them, chief government spokesman Alfred Maesulia said.
Frustrations were starting to show among survivors, many of whom fled the tsunami with whatever supplies they could carry.
"There's no water to wash, no water to drink," said Esther Zekele, who fled the tsunami waves with her husband and five children. The single sack of rice they brought to higher ground was half-empty, and no aid officials had come to their makeshift camp.
"We are just waiting, wondering why they haven't come," she said.
Getting aid to destroyed villages further afield could take at least two more days because of damaged roads, airstrips and wharves.
"We have not reached people as soon as we could ... because of the widespread nature of this particular disaster," said Fred Fakarii, chairman of the National Disaster Management Council.
Making things worse, many canoes and other boats were washed away or destroyed, and fuel was contaminated with sea water, Western Province Premier Alex Lokopio said.
At least 28 people were killed when waves up to 16 feet high smashed into the western Solomons following a magnitude-8.1 undersea quake. No significant tsunami waves were reported anywhere outside the impoverished islands, located northeast of Australia in the South Pacific.
Red Cross official Nancy Jolo said the risk of disease was rising in the largest refugee camp located near Gizo.
"What we are experiencing right now in some of the campsites is children starting to experience diarrhea," Jolo told Australian Broadcasting Corp. radio.
Fakarii said medical staff in Gizo had been overwhelmed by injuries and feared diseases such as diarrhea, cholera and malaria could break out because of the unhygienic conditions and lack of clean water and fresh food.
"The conditions at Gizo are such that these are likely things to happen unless action is taken quickly," Fakarii told The Associated Press.
Survivors terrified by the more than 50 jolts that have struck the region since Monday's quake — including several registering magnitude 6 or stronger — were afraid to come down from the hills where they had taken refuge, said deputy police commissioner Peter Marshall.
At one camp near Munda town, people perched on a hilltop peered out to sea with binoculars keeping watch for another deadly wave.
"I'm too scared to go home," said Winnie Tava, 32, whose house was nearly destroyed by the tremor. She and her husband grabbed their three small children and a few belongings and headed for higher ground, where they were joined by about 40 other families.
The family sleeps on a plastic sheet under a tarpaulin stretched between two wooden poles. They have a single aluminum pot for cooking rice, and a kerosene lantern.
"When there's no more kerosene, no more light," she said.
Authorities said they were somewhat relieved that aerial surveillance flights over the stricken coast had revealed "no evidence of mass deaths."
The quake had set off tsunami alerts from Japan to Hawaii amid fears of a repeat of the 2004 Indian Ocean tsunami that left 230,000 dead or missing in a dozen countries.
Overweight girlhood boosts women39s asthma risk
Thu, 05 Apr 2007 19:37:19 GMTNEW YORK - Women who were overweight or obese as children face a greater risk of developing asthma as adults, a new study shows.
&;Attempts to reduce the burden of excess weight in society must be supported emphasizing the need to focus on children, perhaps young females particularly, in order to prevent asthma,&; Dr. John A. Burgess of the University of Melbourne in Australia and his colleagues conclude in the European Respiratory Journal.
Among 365 boys and 388 girls who were asthma-free at age 7, women who were in the top 25 percent weight group as 7-year-olds were nearly four times as likely to have asthma at age 32 than their peers in the lowest 25-percent category. However, this relationship between childhood weight and adulthood asthma was not seen in men.
The study participants were enrolled in the Tasmanian Asthma Study, which included 8,583 people and began in 1968, when all were 7 years old.
Women who were obese girls were 3.86 times more likely to develop asthma after age 32 than those who were in the thinnest group as children, the researchers found.
Girls who had been overweight had about triple the risk of developing asthma as adults compared with girls of normal weight. However, after factoring in the effects of other variables, such as smoking and results of lung function tests, this relationship was no longer statistically significant.
Obesity can affect lung mechanics, Burgess and colleagues note. Overweight girls tend to have their first period at an earlier age, suggesting that hormones might also play a role in increased asthma risk.
While the current study found no association between age at menstruation and asthma, they add, the study may not have been large enough to identify such a link.
The researchers also found that women who were heavier at age 32 were more likely to have developed asthma as adults. The study findings therefore suggest that the asthma risk seen at 32 years of age may have started with being overweight as a child, they conclude.
SOURCE: European Respiratory Journal, April 2007.
Treatment may fuel cancer39s spread study finds
Fri, 06 Apr 2007 02:15:30 GMTBy Maggie Fox, Health and Science Editor
WASHINGTON - Treating cancer with surgery, chemotherapy or radiation may sometimes cause tumors to spread and U.S. researchers said on Thursday they may have nailed down one of the causes -- a compound called TGF-beta.
Tests in mice show that using the chemotherapy drug doxorubicin or radiation both raised levels of TGF-beta, which in turn helped breast cancer tumors spread to the lung.
But using an antibody to block TGF-beta stopped the process, Dr. Carlos Arteaga and colleagues at Vanderbilt University in Tennessee reported.
Developing drugs that block TGF-beta might help prevent cancer from recurring, Arteaga's team reports in the May issue of the Journal of Clinical Investigation.
&;The repopulation and progression of tumors after anti-cancer therapy is a well-recognized phenomenon,&; the researchers wrote. &;It has been shown to occur following radiotherapy, chemotherapy, and surgery.&;
Cancer experts have wondered if the so-called primary tumor -- the first and biggest tumor -- might somehow suppress the growth of other tumors, and that removing or destroying the first tumor might allow other, undetectable, tumors to then grow.
TGF-beta, which is involved in both the growth and suppression of tumors, may hold part of the answer, Arteaga's team said.
When mice infected with human breast cancer cells were treated with radiation or doxorubicin, they had higher levels of TGF-beta in their blood. They also had more tiny tumor cells in their blood, and these cells metastasized, or spread, to the lungs.
When the mice were treated with an antibody that suppresses TGF-beta, the spread stopped. And this spreading process did not occur at all in mice bred to lack the TGF-beta protein.
&;We wondered then if TGF-beta induced by anti-cancer therapies can serve as a survival signal for tumor cells, thus allowing them to withstand therapy and later recur,&; Arteaga said in a statement.
His team is now testing TGF-beta levels in the blood of breast cancer patients.
&;We'll be looking to see in what proportion of patients the serum and tumor TGF-beta goes up, and whether the increase correlates with the inability of the therapy to eliminate the cancer in the breast,&; Arteaga said.
Higher levels of TGF-beta after treatment may be a way to predict which patients are likely to have their cancer come back after treatment, Arteaga said.
His team is also testing drugs that interfere with TGF-beta to see if they improve survival.
&;It probably isn't just TGF-beta that is having this effect,&; Arteaga said. Many other compounds, including some immune system signaling chemicals, are also associated with tumor spread and growth.
&;TGF-beta may be just the tip of the iceberg,&; Arteaga said.
