Heart bypass best for multiple blockages
Thu, 24 Jan 2008 04:04:50 GMTBy ALICIA CHANG, AP Science Writer
LOS ANGELES - Bypass surgery remains the best option for heart patients with more than one clogged artery, according to the first big study to compare bypass with drug-coated stents. The new research dims hopes that the less drastic stent procedure would prove to be just as good for people with multiple blockages.
In the study, heart attack and death rates were lower among people who had surgery than those given artery-opening balloon angioplasty and stents — mesh cylinders oozing drugs to keep vessels from reclogging.
It is latest setback for drug-coated stents, which have revolutionized heart care and have been implanted in about 6 million people worldwide. They are far better at keeping vessels open than older bare metal stents. However, sales have been hurt in the past year by safety concerns and studies questioning the value of angioplasty itself for certain patients.
A second study gave stent makers some good news, finding that using these devices "off label," in non-approved situations, is not as dangerous as many had feared.
Both studies were published in Thursday's New England Journal of Medicine. Neither is definitive enough to resolve these issues, but they help guide doctors and patients confused about which treatment is best for whom.
The bypass study is "a sobering reality check" for people hoping that the newer drug-coated stents "would level the playing field" and make these treatments equally effective, Harvard University cardiologist Dr. Joseph Carrozza wrote in an accompanying editorial.
Blocked arteries cause chest pain by depriving the heart of needed blood, and can lead to a heart attack. One solution is bypass surgery, which reroutes blood vessels to detour around blockages. Angioplasty has emerged as a non-surgical alternative, in which a balloon is pushed into a blood vessel and inflated to flatten the clog, and stents are placed to keep the artery open.
Bypass has become less common as angioplasty has risen dramatically. In 2005, about 469,000 bypasses were performed on 261,000 patients. More than 1.2 million angioplasties were done, though many people had more than one procedure.
In 2005, Edward Hannan of the State University of New York at Albany published a study that found bypass to be better than angioplasty with bare metal stents for patients with multiple blockages. His new study makes a similar comparison, but with the newer drug-coated stents, which came out in 2003.
Researchers analyzed two state databases of 17,400 New York residents treated for multiple blockages in 2003 and 2004, and compared deaths and complications 18 months later.
Survival rates for both treatments were excellent, but bypass still showed a significant advantage after researchers took into account differences in how sick or old the patients were.
People with three clogged arteries had a survival rate of 94 percent after bypass compared with about 93 percent after stenting, which translated to a 20 percent lower risk of death. Those with two blockages had a survival rate of 96 percent after the operation compared with roughly 95 percent after stenting — about a 30 percent lower risk of death. The bypass group also needed fewer repeat procedures and suffered fewer heart attacks after treatment.
The New York State Department of Health helped pay for the study. The research covered the period in 2004 when former President Bill Clinton had quadruple bypass surgery, but it isn't known if his case was included, or if angioplasty was an option.
Stents still might be better for older patients and others who face greater risks from surgery, or for people who strongly prefer a less drastic treatment, Carrozza wrote. Some types of blockages also cannot be treated with stents.
Stent sales suffered last year after some studies suggested the drug-coated versions might lead to deadly blood clots months or years later. Danger was thought to be greater when stents were used "off label" for blockages other than types approved by the federal Food and Drug Administration.
The second study gave some reassurance that this may not be so risky. A team of U.S. and Canadian scientists looked at 6,551 patients who received either drug-coated stents or plain metal ones. Among those who received stents off-label, no difference in heart attacks or deaths was seen, though the bare-metal stent group needed more repeat procedures.
The findings "appear to validate off-label use" of drug-coated stents, but this single observational study is not enough to declare that safe, Carrozza wrote.
___
On the Net:
New England Journal: http://www.nejm.org
CDC Too few adults get their vaccines
Thu, 24 Jan 2008 04:05:02 GMTBy LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - Vaccines aren't just for kids, but far too few grown-ups are rolling up their sleeves, disappointed federal health officials reported Wednesday.
The numbers of newly vaccinated are surprisingly low, considering how much public attention a trio of new shots — which protect against shingles, whooping cough and cervical cancer — received in recent years.
Yet many seem to have missed, or forgotten, the news: A survey by the National Foundation for Infectious Diseases found that aside from the flu, most adults have trouble even naming diseases that they could prevent with a simple inoculation.
"We really need to get beyond the mentality that vaccines are for kids. Vaccines are for everybody," said Dr. Anne Schuchat of the Centers for Disease Control and Prevention, who called the new data sobering. "We obviously have a lot more work to do."
The new CDC report found:
_Only about 2 percent of Americans ages 60 and older received a vaccine against shingles in its first year of sales.
There are more than 1 million new cases a year of shingles, an excruciating rite of aging that causes a blistering skin rash. Up to 200,000 of them develop a complication, severe nerve pain that can last for months or even years. Anyone who ever had chickenpox is at risk, especially once they hit their 60s, because the chickenpox virus hibernates for decades in nerve cells until erupting again.
"Many people describe the shingles pain as the worst pain they've ever endured," said Dr. Michael Oxman of the University of California, San Diego.
The shingles vaccine, Merck & Co.'s Zostavax, isn't perfect, but it cuts in half the risk of shingles — and those who still get it have a much milder case.
_About 2 percent of adults ages 18 to 64 got a booster shot against whooping cough in the two years since it hit the market.
The cough so strong it can break a rib is making a big comeback, because the vaccine given to babies and toddlers starts wearing off by adolescence. Older patients usually recover, but whooping cough can cause weeks of misery. Worse, those people can easily spread the illness to not-yet-vaccinated infants, who can die from the bacterial infection, also called pertussis.
The pertussis booster was added to another long-recommended shot, a booster against tetanus and diphtheria that adults should get every 10 years. The new triple combo is called "Tdap." Sanofi-Aventis's Adacel brand is for ages 11 to 64. There also is a version for 10- to 18-year-olds, GlaxoSmithKline's Boostrix.
_About 10 percent of women ages 18 to 26 have received at least one dose of a three-shot series that protects against the human papillomavirus, or HPV, that causes cervical cancer.
There are more than 100 different types of HPV, the most prevalent sexually transmitted infection. Usually, the body gets rid of HPV without symptoms. But certain high-risk strains can persist and cause genital warts or cervical cancer.
The vaccine, Merck's Gardasil, protects against four of those high-risk types. That's not complete protection — so even the vaccinated still need regular Pap smears — but those strains are responsible for about 72 percent of cervical cancer and 90 percent of genital warts, said Dr. Stanley Gall of the American College of Obstetricians and Gynecologists.
Stay tuned: The government is considering whether even more women should get the vaccine — those up to age 45 who aren't yet infected, Gall said. And studies are under way to see if it works in men.
Price may play a role in these low vaccination rates. The shingles shot costs around $150, and the three-shot HPV vaccine about $300, and insurance coverage varies. There's no national program to guarantee access for adults who can't afford vaccines as there is for child vaccines.
But adults aren't taking full advantage of some cheap old standby vaccines, either. Among people 65 or older, a high-risk age, CDC found only 69 percent get an annual flu shot; just 66 percent have had a one-time pneumonia vaccine; and 44 percent had received a tetanus shot in the past 10 years.
It's not too late for a flu shot this year — and Oxman urged getting some of the other adult shots in the same doctor visit.
Obesity surgery seen as diabetes cure
Wed, 23 Jan 2008 23:59:31 GMTBy CARLA K. JOHNSON, Associated Press Writer
CHICAGO - A new study gives the strongest evidence yet that obesity surgery can cure diabetes. Patients who had surgery to reduce the size of their stomachs were five times more likely to see their diabetes disappear over the next two years than were patients who had standard diabetes care, according to Australian researchers.
Most of the surgery patients were able to stop taking diabetes drugs and achieve normal blood tests.
"It's the best therapy for diabetes that we have today, and it's very low risk," said the study's lead author, Dr. John Dixon of Monash University Medical School in Melbourne, Australia.
The patients had stomach band surgery, a procedure more common in Australia than in the United States, where gastric bypass surgery, or stomach stapling, predominates.
Gastric bypass is even more effective against diabetes, achieving remission in a matter of days or a month, said Dr. David Cummings, who wrote an accompanying editorial in the journal but was not involved in the study.
"We have traditionally considered diabetes to be a chronic, progressive disease," said Cummings of the University of Washington in Seattle. "But these operations really do represent a realistic hope for curing most patients."
Diabetes experts who read the study said surgery should be considered for some obese patients, but more research is needed to see how long results last and which patients benefit most. Surgery risks should be weighed against diabetes drug side effects and the long-term risks of diabetes itself, they said.
Experts generally agree that weight-loss surgery would never be appropriate for diabetics who are not obese, and current federal guidelines restrict the surgery to obese people.
The diabetes benefits of weight-loss surgery were known, but the Australian study in Wednesday's Journal of the American Medical Association is the first of its kind to compare diabetes in patients randomly assigned to surgery or standard care. Scientists consider randomized studies to yield the highest-quality evidence.
The study involved 55 patients, so experts will be looking for results of larger experiments under way.
"Few studies really qualify as being a landmark study. This one is," said Dr. Philip Schauer, who was not involved in the Australian research but leads a Cleveland Clinic study that is recruiting 150 obese people with diabetes to compare two types of surgery and standard medical care.
"This opens an entirely new way of thinking about diabetes."
Obesity is a major risk factor for diabetes, and researchers are furiously pursuing reasons for the link as rates for both climb. What's known is that excess fat can cause the body's normal response to insulin to go haywire. Researchers are investigating insulin-regulating hormones released by fat and the role of fatty acids in the blood.
In the Australian study, all the patients were obese and had been diagnosed with type 2 diabetes during the past two years. Their average age was 47. Half the patients underwent a type of surgery called laparoscopic gastric banding, where an adjustable silicone cuff is installed around the upper stomach, limiting how much a person can eat.
Both groups lost weight over two years; the surgery patients lost 46 pounds on average, while the standard-care patients lost an average of 3 pounds.
Blood tests showed diabetes remission in 22 of the 29 surgery patients after two years. In the standard-care group, only four of the 26 patients achieved that goal. The patients who lost the most weight were the most likely to eliminate their diabetes.
Both patient groups learned about low-fat, high-fiber diets and were encouraged to exercise. Both groups could meet with a health professional every six weeks for two years.
The death rate for stomach band surgery, which can cost $17,000 to $20,000, is about 1 in 1,000. There were only minor complications in the study. Stomach stapling has a 2 percent death rate and costs $20,000 to $30,000.
In the United States, surgeons perform more than 100,000 obesity surgeries each year.
The American Diabetes Association is interested in the findings. The group revises its recommendations each fall, taking new research into account.
"There is a growing body of evidence that bariatric surgery is an effective tool for managing diabetes," said Dr. John Buse of the University of North Carolina School of Medicine in Chapel Hill, the association's president for medicine and science.
"It's just a question of how effective is it, for what spectrum of patients, over what period of time and at what cost? Not all those questions have been answered yet."
Medical devices used in the study were provided by the manufacturers, but the companies had no say over the study's design or its findings, Dixon said.
___
On the Net:
JAMA: http://jama.ama-assn.org
Incubator fire badly burns Minn. newborn
Thu, 24 Jan 2008 00:31:53 GMTBy ELIZABETH DUNBAR, Associated Press Writer
MINNEAPOLIS - Oxygen ignited inside a special hood worn by a newborn infant in a hospital, burning the boy's head and face and leaving him in critical condition.
The newborn was lying in an open-topped bassinet under a warmer at Mercy Hospital in suburban Coon Rapids on Tuesday when the accident happened, Allina Hospital and Clinics said in a statement.
The baby, just 12 hours old and named Maverick, was wearing an oxygen hood, a device that fits over the face to supply additional oxygen, when something caused the gas to ignite, the statement read.
Nurses who were with the baby immediately put out the fire, Allina said. Authorities were investigating how the fire started.
Allina spokesman David Kanihan declined to release the brand of oxygen hood and warmer, citing the investigation.
The baby, born three weeks early, was taken to the neonatal intensive care unit at Hennepin County Medical Center and is being treated by doctors from the hospital's burn center. Hospital officials said Wednesday that he was in a medically induced coma and on a ventilator, in critical but stable condition.
Dr. Leslie Smith said the infant will probably survive. But he suffered second- and third-degree burns over nearly a fifth of his body, including his head, shoulders, part of his face and the tops of his hands, Smith said.
"This is our first experience with burns at this age," said Dr. George Peltier, a plastic surgeon at the burn center.
Hospital officials and the attorney did not release the name of the baby or identify his family.
Chris Messerly, an attorney for the newborn's family, said that the fire shouldn't have happened, but that the family is focused on letting their baby heal and is not yet considering legal action. The family has one other child, a daughter, he said.
"The family is doing remarkably well under the circumstances," Messerly said.
UK to spend millions on antiobesity campaign
Wed, 23 Jan 2008 21:47:36 GMTBy Tim Castle
LONDON - The government is to spend 75 million pounds on a campaign to encourage healthy lifestyles and counter what it calls an obesity epidemic in Britain.
The campaign, to be launched in the summer, will form part of a wider strategy including aspects like food labelling, urban design and the promotion of exercise.
Department of Health officials said it will use simple messages -- such as the "five pieces of fruit and veg a day" slogan -- and be based on research into what actually works to make people change from unhealthy lifestyles.
"Tackling obesity is the most significant public and personal health challenge facing our society," said Health Secretary Alan Johnson as he launched the 372 million pound cross-government strategy.
The government says two-thirds of British adults are either obese or overweight and that on current trends the proportion could climb to nine in 10 by 2050.
A key focus for the strategy, "Healthy Weight, Healthy Lives," is to reverse rising obesity among children.
The government has set itself a target of reducing the proportion of overweight and obese children to 2000 levels by 2020.
Many children are already being weighed in their first and last years of primary school to help monitor the situation, and the government hopes to make participation universal.
It says the strategy brings together a number of existing initiatives as well as filling in gaps.
It includes 30 million pounds to support the development of healthy towns where residents are encouraged to walk or cycle rather than drive.
There will also be a "Walking into Health" campaign, aiming to get a third of the population in England walking an extra thousand steps -- around a kilometer -- every day by 2012.
The plans include a warning to the food industry that the government will consider legislating if voluntary agreements on reducing unhealthy foods are not successful.
Johnson called on retailers and food producers to end a split over health labels on food and agree to a single scheme.
He said research showed consumers were confused by the different labels used to show levels of salt, sugar and fat. Some stores use red, amber and green "traffic lights," others prefer a numerical system of guideline daily amounts.
Johnson accepted that many in the industry want to stick to their existing labelling systems, but said he hopes there will be agreement on a single scheme after a review of labelling conducted by the Food Standards Agency watchdog.
The opposition Conservatives dismissed the strategy as a repackaging of earlier announcements.
"Obesity takes a huge toll on people's lives and is set to cost the NHS tens of billions of pounds a year by 2050," said Conservative Health Spokesman Andrew Lansley.
"Is this really the best the government can come up with?"
