Teen girls upsidedown feet treated in NYC surgery
Thu, 01 May 2008 20:57:23 GMTBy KAREN MATTHEWS, Associated Press Writer
NEW YORK - In her 15 years, Jingle Luis has never walked on the bottoms of her feet. Born in the Philippines with feet so clubbed they twist backward and upside down, she uses crutches to hobble on what should be the tops of her feet.
"I can accept it," Jingle said Wednesday in a voice so soft it was barely audible.
But Jingle may not have to accept the condition much longer. She and her mother have journeyed from the Philippines to Montefiore Medical Center in the Bronx for surgery and follow-up treatment that will consist of slowly rotating her feet until she can walk normally.
The surgery took place Thursday and went well, hospital spokesman Steven Osborne said.
Jingle's case is more severe than those usually seen by doctors in industrialized countries.
"Generally speaking, with modern technology, it doesn't get to this point," said Dr. Terry Amaral, a pediatric orthopedic surgeon who performed the surgery at Children's Hospital at Montefiore.
Clubfoot is a relatively common deformity, occurring in about one in 1,000 births. Children are usually treated in infancy with casts or braces that gradually bring the feet into correct alignment. The condition becomes harder to treat if it is not corrected early on.
Amaral said Jingle's case was complicated by the fact that her clubfoot was associated with spina bifida, a birth defect that involves the incomplete development of the spinal cord or its coverings.
He said doctors who saw Jingle as a baby thought that her spina bifida would shorten her life span and prevent her from walking, so they did not treat the clubfoot.
"They felt it wasn't worth managing because of the life expectancy, so they decided to leave it alone," Amaral said.
But Jingle's spina bifida is relatively mild. Her bladder and bowel functions are impaired, but she has normal intelligence and can move her feet and legs.
Jingle came to the attention of Montefiore after Dr. Randall Owen, a head and neck surgeon, traveled to the Philippines in 2003 on a mission trip organized by the Tennessee-based Christian Medical and Dental Association.
Owen saw Jingle there but could not treat her clubfoot.
"She needs a multidisciplinary team," he said. "It was nothing we could do on a two-week mission trip."
Jingle and her mother arrived in New York on April 17. In Thursday's two-hour procedure, screws were inserted into the bones of her feet and attached to scaffold-like devices that will stabilize her feet while the screws are turned bit by bit. "It's like putting together an Erector Set," Amaral said during the operation. He estimated that it would take a month to rotate the feet a few degrees at a time.
The scaffolding will be replaced by casts and then by braces, which Amaral expects Jingle to wear for about a year. Then Jingle hopes she'll be wearing high-heeled shoes, said the girl's mother, Jasmine Luis.
Jingle and her mother will stay with a friend in Bergenfield, N.J., during the treatment.
Jingle's father is a corn farmer; her mother sells farm-raised fish door to door, carrying her wares on her head.
Jingle has other career goals. "I think a doctor or a nurse," she said.
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Associated Press writer Bonny Ghosh contributed to this report.
OxyContin thats harder to abuse FDA debates new version
Thu, 01 May 2008 20:36:03 GMTBy LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - The government is evaluating a new version of OxyContin — the potent painkiller sometimes called "hillbilly heroin" — designed to be harder to abuse.
A plastic-like coating fuses to the tablet, making it harder to crush — and turning into a gooey mess if abusers try to inject it, maker Purdue Pharma LP said in documents released by the Food and Drug Administration Thursday.
The FDA will ask its scientific advisers on Monday if the reformulated drug seems tamper-resistant enough to allow on the market, before the required long-term studies are done to see if the changes thwart at least some abuse.
"These are clearly difficult questions for which there are no easy answers," Dr. Bob Rappaport, FDA's chief of painkilling drugs, wrote the advisory panel.
OxyContin was hailed as a breakthrough in the treatment of severe chronic pain when it was introduced in 1996. A time-release version of the old narcotic oxycodone, it was designed to be swallowed whole and digested over 12 hours to keep a steady state of the painkiller in the bodies of seriously ill patients.
But abusers rapidly discovered the tablets can produce a heroin-like high if crushed and snorted or injected, thus dumping the dose all at once instead of letting it seep in slowly.
The U.S. Drug Enforcement Administration found the number of oxycodone-related deaths nationwide had quintupled by 2001, as OxyContin prescriptions soared. The DEA cracked down, but OxyContin abuse steadily spread across the country. And a year ago, Purdue Pharma and some of its executives pleaded guilty to misleading the public about OxyContin's risk of addiction earlier in the decade, and agreed to millions in fines to settle state complaints that it encouraged over-prescribing of the drug.
Against that contentious backdrop, the FDA had urged drug companies to develop more abuse-resistant versions of important painkillers, recognizing, in Rappaport's words, "the importance of maintaining the availability of these important drug products for the millions of patients in this country who suffer from chronic pain."
The remade OxyContin marks the first application for a reformulated painkiller that purports to do that, he wrote.
Purdue Pharma said its laboratory studies show the new OxyContin is equivalent to the original in how well the painkiller dissolves if used correctly.
If someone tries to crush it, the plastic-like coating makes the tablet more likely to break into large fragments instead of a powder, the Stamford, Conn.-based company wrote. The coating renders the drug "a gelatinous mess" when mixed with alcohol or other solvents in attempts to dissolve and inject it, the documents say.
But the FDA cited concerns, including:
_Some people who died from OxyContin abuse swallowed the drug without crushing it. Would the new version mislead doctors or patients into thinking OxyContin is less risky than it really is?
_Lower doses are set to be reformulated initially, with higher doses converted in the future. Does that increase risk from the higher doses in the meantime?
Moreover, "there is no perfect formulation that can resist all forms of tampering," FDA's Rappaport wrote. If approved, the new version's label "would have to be carefully crafted so as to avoid the publication of a road map describing how to defeat these changes."
Two other companies, Pain Therapeutics Inc. and King Pharmaceuticals, also are developing an abuse-resistant form of the drug. Called Remoxy, it would provide a thick gelatin-like version of oxycodone.
CDC 3 out of 4 new moms in US now breastfeed their infants
Thu, 01 May 2008 20:36:04 GMTBy MIKE STOBBE, AP Medical Writer
ATLANTA - More than 3 out of 4 new moms now breast-feed their infants, the highest rate in the U.S. in at least 20 years, according to a a government report released Wednesday. About 77 percent of new mothers breast-feed, at least briefly, up from 60 percent in 1993-1994, the Centers for Disease Control and Prevention said.
"It looks like it is an all-time high" based on CDC surveys since the mid-1980s, said Jeff Lancashire, a CDC spokesman.
Experts attributed the rise to education campaigns that emphasize that breast milk is better than formula at protecting babies against disease and childhood obesity. A changing culture that accommodates nursing mothers may also be a factor.
The percentage of black infants who were breast-fed rose most dramatically, to 65 percent. Only 36 percent were ever breast-fed in 1993-1994, the new study found.
For whites, the figure rose to 79 percent, from 62 percent. For Mexican-Americans, it increased to 80 percent, from 67 percent.
Former U.S. Surgeon General Dr. David Satcher celebrated the report's findings, noting that black women have historically had lower breast-feeding rates.
"It was very impressive that when it comes to beginning to breast-feed, African-American women have had the greatest progress," said Satcher, who is now an administrator at Atlanta's Morehouse School of Medicine.
The new report is based on a comprehensive federal survey involving in-person interviews as well as physical examinations. The findings are based on information for 434 infants from the years 2005 and 2006.
A telephone survey of thousands of families, released last year, found that 74 percent of infants in 2004 had been breast-fed.
At least three types of CDC surveys have shown breast-feeding rates moving upward since the early 1990s, officials said.
The latest CDC report found rates of breast-feeding were also lowest among women who are unmarried, poor, rural, younger than 20, and have a high school education or less.
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On the Net:
CDC report: http://www.cdc.gov/nchs
Audit Vets with brain injury still not getting proper care
Thu, 01 May 2008 19:05:15 GMTBy HOPE YEN, Associated Press Writer
WASHINGTON - Many Iraq war veterans with traumatic brain injury are not getting adequate health care and job assistance for their long-term recovery despite years of government pledges to do so, Veterans Affairs Department investigators say.
"Significant needs remain unmet," according to the report released Thursday by the VA's inspector general. It is the first to examine the Bush administration's long-term efforts in supporting veterans with traumatic brain injury, a leading problem among soldiers struck by roadside bombs that often causes lasting emotional and behavioral difficulties.
The study tracked a group of 52 patients who received VA treatment after sustaining brain injury during a seven-month period in 2004. An initial review by the IG in 2006 found gaps in follow-up care and family counseling 16 months after the injury and urged the VA to improve long-term case management.
The VA pledged to coordinate the necessary follow-up care with the Pentagon, but the latest audit concludes that efforts are still falling short for roughly one in four patients.
It found that 10 of the 41 veterans who agreed to be interviewed said they weren't getting needed help for health care, vocational rehabilitation, family support or housing. At least four patients specifically cited trouble in getting primary or specialty eye care, while others reported gaps with family counseling for problems such as depression and anger.
"This is very troubling," said Michael O'Rourke, assistant director for veterans health policy at Veterans of Foreign Wars. "The fact of the matter is from the very beginning VA and Defense went in with too little, too short , because they weren't expecting this to be a prolonged conflict of war.
"I've seen a lot of effort to correct problems that exist. But constant vigilance is required," he said. "Veterans deserve to be treated for problems they may or may not know of."
The report included a VA response in which the department acknowledged problems with case management but stated that with recent improvements it now had "systems in place to ensure that all veterans with TBI are being followed as their clinical needs require."
For example, the VA pointed to plans announced last week to start calling 570,000 recent combat veterans to make sure they know what services are available to them.
In the audit, investigators praised the new measures as "positive steps" but questioned whether the VA's latest promise to keep watch over veterans would prove to be a reality. They said that "at least 8 of 49 veterans we contacted had significant unmet needs and no evidence of VA case management in the previous year."
"We continue to be concerned that all veterans discharged after inpatient rehabilitation for TBI receive case management, unless this has been explicitly denied by the patient," investigators stated, adding that they will continue monitoring the VA to ensure Iraq war veterans are receiving the care they need.
Other findings based on the sample group:
_Eighteen of the 41 interviewed veterans with brain injury, or 44 percent, said anger was "a problem" for them.
_Twenty-one veterans, or 51 percent, reported receiving adequate counseling and support for their behavioral or emotional problems.
The report comes amid renewed scrutiny of the Bush administration's efforts in treating veterans with traumatic brain injury, which in its mild form is known as a concussion, as well as post-traumatic stress disorder in light of a prolonged Iraq war. About 19 percent — or an estimated 320,000 — of U.S. combat troops who fought in Iraq or Afghanistan may have suffered head injuries, according to a recent RAND Corp. study.
Earlier this year, the Government Accountability Office found that thousands of Iraq war veterans who could have suffered traumatic brain injury may be getting unnecessary or inadequate health care because VA officials have yet to determine whether their initial screening tests are reliable.
The VA also has faced complaints that a backlog in claims and bureaucratic hurdles have prevented some recent veterans from getting proper mental and physical care. Last week, Sens. Daniel Akaka, D-Hawaii, and Patty Murray, D-Wash., accused the VA's top mental health official of trying to cover up the number of veterans' suicides and said he should resign.
"While VA has made progress since the last investigation, the inspector general continues to find that too many veterans with TBI and their loved ones are not receiving all the assistance and support they need," said Akaka, who chairs the Senate Veterans Affairs Committee. "This does not appear to be due to a lack of funding, but rather reflects a failure to give these veterans and their loved ones the priority attention they are due."
Active-duty troops who sustain traumatic brain injury are treated for rehabilitation at one of the VA's four specialized medical centers located in Tampa, Fla., Richmond, Va., Minneapolis and Palo Alto, Calif.
"We are now in the sixth year of this war and it is clear that the VA is still struggling to meet the needs of our veterans today — it will take more than just promises to get it right," said Murray, a member of the Veterans Affairs Committee.
___
On the Net:
Veterans Affairs Department: http://www.va.gov/
VA inspector general: http://www.va.gov/oig/contacts/hotline.asp
Obesity May Worsen Impact of Asthma
Fri, 02 May 2008 03:46:50 GMTTHURSDAY, May 1 -- A study of women with a wide range of body-mass indexes found that obesity may worsen the impact of asthma and also mask its severity in standard tests.
"We have demonstrated significant differences in the changes in respiratory function that occur with asthmatic bronchoconstriction in relation to obesity," principal investigator Dr. D. Robin Taylor, of the University of Otago in New Zealand, said in a prepared statement.
The study also found that simple spirometry couldn't determine the level of pulmonary dysfunction in obese people with asthma.
The findings were published in the first issue for May of the American Journal of Respiratory and Critical Care Medicine. It's the first prospective study to find a significant comparative difference between obese and non-obese people in how the lungs and airways respond to a simulated asthma attack.
The researchers said it establishes a direct link between obesity and the development of dynamic hyperinflation -- air breathed into the lungs can't be expelled. This often occurs with acute asthma, but is more frequent in obese people.
The study included 30 asthmatic women who were divided into three groups based on their BMI: normal weight, overweight and obese. All the women breathed nebulized methacholine to induce an asthma-like attack and were then assessed for changes in lung function, including functional residual capacity (FRC -- how much air remained in the lungs after exhalation) and inspiratory capacity (IC -- how much air could be inhaled on the next breath).
"After the methacholine challenge, the amount of bronchoconstriction was identical for each of the three groups, but the changes in FRC and IC were greatest in the obese group. This indicated to us that greater dynamic hyperinflation was occurring among obese individuals," Taylor said.
The greater a woman's BMI, the higher her FRC and the lower her IC.
"This means that among women with greater BMI, an asthma-like episode has the potential to cause greater breathing difficulties than in non-obese women. The greater dynamic hyperinflation means that obese individuals lose the ability to inhale as deeply or exhale as fully as normal weight individuals," Taylor said.
The findings suggest fundamental differences in the way that obese people with asthma may experience shortness of breath.
"We know that asthma in obese subjects is more likely to persist and is more likely to be perceived to be severe. These individuals often require more treatment to achieve asthma control. Our study provides an insight into why this might be happening -- the same asthma trigger produces a greater effect in obese individuals," Taylor said.
More research is needed to "confirm that the differences in dynamic hyperinflation between obese and non-obese asthmatics are sufficient to explain the differences in symptoms between the two groups. Our study was not large enough to do this," Taylor said.
More information
The U.S. National Heart, Lung, and Blood Institute has more about asthma.
UKOdd Summary
Fri, 02 May 2008 02:49:46 GMTKentucky Derby champion loses his libido
TOKYO - The Japanese owners of former Kentucky Derby winner War Emblem are struggling to explain why the American thoroughbred has lost his libido. Even a private harem and a limitless supply of Viagra have failed to pep up the love life of a stallion his handlers freely admit has some personal issues.
Blogger exposes life on the Underground
LONDON - Annie Mole's blog about the London Underground rail system began as a New Year's resolution to teach herself how to make an Internet Web site and has blossomed into a popular slice of commuter life. The criticisms, witticisms and daily observations posted on her "London Underground's Blog" www.london-underground.blogspot.com since she first began writing it in 2003 have struck a chord with commuters and the people who operate the rail system beneath the capital that is affectionately known as the "Tube".
Japan's Ganaha counts cost of garlic appeal
TOKYO - Japan striker Kazuki Ganaha is counting the cost of his bid to overturn a ban imposed for taking intravenous garlic infusions. The 27-year-old was suspended for six games last year for breaking the J-League's anti-doping rules after coming down with influenza.
Venice to fine tourists who feed pigeons
VENICE - The days when Venice tolerated tourists feeding pigeons in St. Mark's Square are over. Starting on Wednesday, it's illegal.
Ancient meteorite goes unsold in NY as dung sells
NEW YORK - Some dinosaur dung was snapped up at auction in New York even as a 4.5 billion year old meteorite which was supposed to top the sale went unsold. The two chunks of 130-million-year-old coprolite, otherwise known as fossilized dinosaur dung, fetched $960 at Bonhams in New York on Wednesday, the auction house said.
It's just not cricket! Cheerleaders shake India
NEW DELHI - Cheerleaders are taking Indian cricket by storm, but some are wondering if this conservative South Asian nation is ready for dancers with bulging breasts and gyrating bellies parading in packed stadia. Many foreign cheerleaders have been imported to India with this month's inauguration of the India Premier League , a shortened form of traditional cricket that transforms the game into a more glitzy U.S.-style sponsored sport event.
Angry mother slams writer Houellebecq
PARIS - If anyone was wondering where French avant-garde novelist Michel Houellebecq got his talent for character assassination, the answer is clear: his mother. In his seminal 1998 novel "Les particules elementaires", known in English as "Atomised", Houellebecq vented a lifetime of anger against his mother by portraying her as an egocentric, sexually promiscuous hippie who neglected her children.
What's a Roman earn? Find out on the Internet
ROME - Italians were surprised, and in some cases outraged, on Wednesday to discover that their income levels were available for public viewing on an Internet site. As part of a crack-down on tax evasion, the outgoing centre-left government made public every citizen's declared taxable income on the state's tax website, a decision attacked by consumer groups and some politicians.
Tokyo panda death a chance for China diplomacy?
TOKYO - The last giant panda at Tokyo's main zoo has died, raising the question of whether Chinese President Hu Jintao might engage in some panda diplomacy when he visits next week. Ling Ling, a 22-year-old male giant panda popular among zoo visitors, died overnight at the Ueno Zoo in Tokyo, an official at the zoo said on Wednesday.
France's Le Pen selling bullet-proof car on eBay
PARIS - French far-right leader Jean-Marie Le Pen is looking to make a bit of extra cash by putting his old bullet-proof car up for sale on eBay. Le Pen, who stunned France in the 2002 presidential election when he finished second, put his party headquarters up for sale earlier this year after humiliating defeats in presidential and legislative elections last year left his group deep in the red.
Health Tip Risk Factors for Gestational Diabetes
Fri, 02 May 2008 03:46:59 GMT-- Gestational diabetes starts in women during pregnancy, then often disappears after the baby is born.
Women who develop the condition should be carefully monitored throughout pregnancy, and should carefully manage their diet.
Here are common risk factors for gestational diabetes, courtesy of the U.S. National Library of Medicine:
- Being of African or Hispanic descent.
- Becoming pregnant when older than 25.
- Having had a child with a birth defect.
- Having had a baby weighing more than 9 pounds.
- Being obese.
- Having frequent infections.
- Having an unexplained miscarriage, or having a newborn who died.
Alzheimer39s Disease Risk Factors May Be GenderSpecific
Fri, 02 May 2008 03:46:56 GMTTHURSDAY, May 1 -- Depression in women and stroke in men are critical factors in the development of Alzheimer's disease, French researchers report.
They analyzed data from almost 7,000 people over the age of 65 in three French cities. None of them had dementia, but about 40 percent had mild cognitive impairment at the start of the study.
They were assessed two and four years later. Of those with mild cognitive impairment at the start of the study, just over 6.5 percent developed dementia over the next four years, about half had no change, and about one-third regained normal levels of cognitive ability.
People with depression, those taking anticholinergic drugs (which influence chemical signaling in the brain), and those with a variation in the ApoE gene were more likely to progress from mild cognitive impairment to dementia.
The researchers also found that risk factors varied according to gender. Men with mild cognitive impairment were more likely to be overweight, diabetic and to have had a stroke. Men who'd suffered a stroke were almost three times more likely to progress from mild cognitive impairment to dementia.
Women with mild cognitive impairment were more likely to be in poorer general health, disabled, suffering from insomnia, and to have a poor support network. Women with depression were twice as likely to progress from mild cognitive impairment to dementia, while women unable to perform routine daily tasks were 3.5 times more likely to progress to dementia.
Stroke was not a risk factor for women, even though both women and men had similar rates of stroke.
The study was published online in the Journal of Neurology Neurosurgery & Psychiatry.
More information
The U.S. National Institute on Aging has more about Alzheimer's disease.
Complications Found in Proposed Prostate Cancer Treatment
Fri, 02 May 2008 03:46:51 GMTBy Ed Edelson
HealthDay Reporter
THURSDAY, May 1 -- The idea that prostate cancer can be treated successfully just by blocking the activity of a protein called insulin-like growth factor has been undermined by two new studies.
IGF-1 blockage is a goal being pursed by a number of drug companies and academic researchers, stimulated by studies showing an association between high levels of the protein and prostate cancer risk. Many efforts are aimed at blocking the receptors for IGF-1 in prostate cancer cells.
The new studies showing that blocking IGF-1 receptors isn't as simple a matter as might be wished are published back to back in the May 1 issue of Cancer Research.
One of the studies, by a group led by Norman Greenberg, a member of the clinical research division at the Fred Hutchinson Cancer Research Center in Seattle, found an unexpected interaction with a tumor suppressor gene, p53. The researchers created mice whose prostate cells lacked receptors for IGF-1 and crossed them with mice whose P53 gene function was crippled.
"When the function of p53 is abrogated, the cancers seem to accelerate," Greenberg said. "So when you interfere with the IGF-1 receptor, you might be taking the foot off the brake."
That wouldn't matter in human males whose p53 genes were working properly, Greenberg said. "What we are suggesting is that when p53 is compromised, patients might not respond as indicated," he said.
This might mean that a check of p53 function in someone with prostate cancer might be needed before IGF-1 blockage therapy is started, Greenberg said. That idea has to be checked out, he said.
"So we would get data on a patient's tumor before treatment and after treatment, and see if the status of p53 shows whether it would respond more or less to IGF-1 treatment," Greenberg said.
The other study, this one led by Dr. Pinchas Cohen, chief of pediatric endocrinology at the University of California, Los Angeles, also used mice bred to develop prostate cancer, with some also bred to lack IGF-1 receptors.
"The conventional wisdom was that without the IGF receptors, the tumors would fail to develop or be much smaller," Cohen said. "What happened was that they were not reduced in size. In fact, they were exactly the same size."
Low IGF-1 levels in the mice were accompanied by higher levels of growth hormone and insulin, which stimulated growth of the cancer cells, Cohen said.
"This doesn't argue against IGF-1 blockage as a treatment," he said. "But it shows the need for targeting multiple pathways. As the cancers find ways to overcome IGF-1 blockage, it should be used in conjunction with other therapies."
More information
Learn more about prostate cancer from the U.S. National Cancer Institute.
