Anesthesia Technique May Affect Survival After Breast Cancer Surgery: Study

By Kathleen Doheny
HealthDay Reporter

TUESDAY, Oct. 15 (HealthDay News) — The anesthesia technique used during breast cancer surgery may affect cancer recurrence and survival, Danish researchers report.

In a small study that followed 77 breast cancer patients, researchers found the combination of a general anesthetic plus injections of a nerve block resulted in increased survival and fewer recurrences, said Dr. Palle Steen Carlsson, a researcher at the Aarhus University Hospital in Denmark.

A six-year follow-up found that 13 percent of patients who got the combination had their cancer recur versus 37 percent of those who got anesthesia alone. And 10 percent of those in the combination group died compared to 32 percent of those given anesthesia alone.

The idea that the anesthesia technique used during breast cancer surgery affects results is evolving, anesthesiologists say, and needs more study. Carlsson found a link between the two, but her study didn’t show a direct cause-and-effect relationship. She is scheduled to report her findings Oct. 15 at the American Society of Anesthesiologists’ annual meeting in San Francisco.

Carlsson acknowledged the study’s limitations. “The weakness of our study is the size,” she said.

During cancer surgery, tumor cells released into the blood can implant in lymph nodes and other organs, she said. The immune system kicks in to fight these cells, but surgery and anesthesia can impair the immune system.

Carlsson can’t say for sure why women who got the nerve block plus anesthesia tended to fare better. One theory is that better pain relief during and after surgery reduces the stress response to the procedure, she said. Or perhaps the need for fewer narcotic painkillers after surgery reduces the risk of cancer spreading.

In the study, Carlsson randomly assigned the 77 patients to general anesthesia plus injections of saline or general anesthesia plus injections of local anesthetic (this is called a paravertebral block) about an inch from the middle of the spine.

Besides differences in recurrence and survival, medical records six years later showed fewer opioids for pain relief were needed by the women who got the combination approach.

In an earlier study, researchers found that the combination of general anesthesia and regional anesthesia reduced recurrences and the spread of breast cancer four-fold, but that study looked back at medical records. Carlsson said her study is believed to be the first to follow patients forward.

The concept has been a hot topic for several years among anesthesiologists, said Dr. Michael Lew, professor and chairman of anesthesiology at the City of Hope Comprehensive Cancer Center in Duarte, Calif. Lew was not involved in the study.

“

View the Original article

Bypass May Beat Angioplasty for Diabetics With Heart Disease

By Serena Gordon
HealthDay Reporter

TUESDAY, Oct. 15 (HealthDay News) — Generally, the less invasive a surgical procedure is, the better. But, that’s not necessarily true for people with diabetes.

Recent research has found lower death rates and fewer heart attacks in people with diabetes who’ve undergone the open-heart procedure known as a coronary artery bypass graft (CABG), compared to those who had the less-invasive coronary angioplasty with stents. Angioplasty is also called percutaneous coronary intervention (PCI).

Now a new study of the same group of patients reports that they also have a better quality of life after the more-invasive bypass procedure.

“Recovery and early quality of life was better immediately with PCI, which is not surprising given the much less invasive nature of that procedure. But, between six months and two years, there was less

View the Original article

Many Doctors Ignore Guidelines, Order PSA Tests for Elderly Men

By Steven Reinberg
HealthDay Reporter

TUESDAY, Oct. 15 (HealthDay News) — A new study finds that too many doctors ignore current guidelines that advise against giving PSA tests to elderly men, subjecting many of these patients to needless worry and bother.

Even though no major medical group currently recommends prostate-specific antigen (PSA) blood tests for men older than 75, more than 40 percent of the men covered in the new study were still being screened for prostate cancer in this way.

“Depending on which primary-care physician a man sees, he will be up to seven times more likely to receive the test than if he had seen a different primary-care physician,” said lead researcher Dr. Elizabeth Jaramillo, from the department of geriatrics at the Sealy Center on Aging at the University of Texas Medical Branch in Galveston.

The findings, published in the Oct. 16 issue of the Journal of the American Medical Association, are based on Medicare records for more than 61,000 patients and close to 2,000 primary-care doctors.

PSA testing is generally not recommended for men aged 75 and older because the vast majority of prostate cancers are so slow-growing that an elderly man is much more likely to die of another condition in his lifetime than from the cancer, Jaramillo said.

“When used in elderly men, the PSA test can lead to harms, including overdiagnosis,” she said. “Overdiagnosis is when someone who will live for a long period of time will get diagnosed and treated for a condition that normally would never cause symptoms or be detected in their lifetime.”

The treatment, perhaps including surgery, can be riskier than the disease and cause significant emotional stress. “We do not need to be screening elderly men for prostate cancer,” Jaramillo said.

It is estimated that more than 1 million excess prostate cancers have been identified from PSA testing, Jaramillo said.

At least one other expert disagreed with Jaramillo on the screening of elderly men, however.

Dr. Anthony D’Amico, chief of radiation oncology at Brigham and Women’s Hospital in Boston, said he thinks screening decisions should be based on a man’s overall health and life expectancy, not his age.

“According to the study, in patients with no

View the Original article

Popular Morning Sickness Drug Safe in Pregnancy, Study Finds

By Dennis Thompson
HealthDay Reporter

TUESDAY, Oct. 15 (HealthDay News) — The anti-nausea medication metoclopramide appears to be a safe and effective treatment for morning sickness, Danish researchers report.

More than 40,000 women exposed to metoclopramide while pregnant did not face any increased risk of birth defects or miscarriage, according to a study published Oct. 16 in the Journal of the American Medical Association.

“This is by far the largest study on metoclopramide safety in pregnancy, and as such it expands substantially on the published evidence,” said co-author Dr. Bjorn Pasternak of the Statens Serum Institute in Copenhagen. “It found that metoclopramide use in pregnancy was not associated with increased risk of major adverse outcomes, including major malformations and fetal death, and as such supports what is known about the safety profile of this drug.”

More than half of pregnant women experience nausea and vomiting, usually early in their pregnancy, the study authors noted.

Most women deal with these symptoms with little treatment, but about 10 percent to 15 percent eventually will require medication because they face more serious complications such as dehydration or weight loss.

But many pregnant women have grave concerns regarding any sort of nausea medication because of the horrific birth defects associated with the drug thalidomide, which was used to treat morning sickness in the late 1950s and early 1960s. Thalidomide’s tragic history led to the strengthening of the U.S. Food and Drug Administration (FDA) and the development of regulations regarding medication use during pregnancy.

“There’s a general feeling to take no medications during pregnancy,” said Dr. Siobhan Dolan, associate professor of obstetrics and gynecology at Montefiore Medical Center in New York City and medical adviser to the March of Dimes. “The truth is in the first trimester when the organs are forming we’re cautious about any medication the women take. But there’s a growing appreciation that there can be risks to not treating symptoms like nausea and vomiting.”

Metoclopramide, sold under the brand name Reglan, is one of the most commonly used prescription medications in pregnancy, the authors noted.

The drug has FDA approval for use as a treatment for patients suffering heartburn and esophagitis due to acid reflux. It’s also used to treat nausea caused by surgery or chemotherapy, and is often recommended as a treatment for morning sickness if other therapies have failed.

Pasternak said there aren’t many alternatives for the treatment of nausea and vomiting in pregnancy. “There appears to be some degree of individual variation in response to drug treatment, so some women may be helped by one drug and others by another. Therefore, different treatment alternatives are needed,” he said.

In this study, researchers reviewed more than 1.2 million pregnancies in Denmark from 1997 to 2011 and compared outcomes between women who used metoclopramide and those who did not.

The investigators compared 28,486 infants exposed to metoclopramide in the first trimester of pregnancy to 113,698 unexposed infants, and found no associations between the nausea drug and any major malformations.

The study also found no increased risk of miscarriage, stillbirth, preterm birth, low birth weight or fetal growth restriction associated with metoclopramide use in pregnancy.

Because birth defects are rare, it can be difficult to assess a drug’s safety in small-scale studies, Dolan said. A study looking at tens of thousands of pregnancies is more likely to find patterns and associations between a medication and the risk of birth defects, if such risk exists.

“We can take from this some reassurance” of metoclopramide’s safety, Dolan said. “What’s powerful about a study like this is they looked at all the births in Denmark between 1997 and 2011. That’s a lot of births.”

Regardless, Dolan said further study into the safety of this and other medications used during pregnancy will always be needed.

“We need good data to have good understanding so women can be cared for, and their symptoms can be treated and they can have successful pregnancy outcomes,” she said. “Women need to understand the risks of any medication they choose to take.”

More information

Visit the U.S. National Library of Medicine to learn more about morning sickness.

View the Original article

Snubbed? Brain Chemicals Might Comfort You

TUESDAY, Oct. 15 (HealthDay News) — Your brain releases natural painkillers when you’re rejected by other people, according to a new study.

That this painkiller system acts to ease social hurt as well as physical pain may improve understanding of depression and social anxiety, the University of Michigan Medical School researchers said.

The researchers also found that people with the highest levels of resilience — the ability to adjust to change — had the highest levels of this natural painkiller activation.

The research team focused on the mu-opioid receptor system in the brain. Their previous research on this system showed that when a person feels physical pain, the system releases opioids in order to dampen pain signals.

In this study, the researchers used brain scans to monitor the system’s response in 18 volunteers who experienced social rejection in experiments that mimicked online dating. The findings were published recently in the journal Molecular Psychiatry.

“This is the first study to peer into the human brain to show that the opioid system is activated during social rejection,” study lead author David Hsu, a research assistant professor of psychiatry, said in a university news release. “In general, opioids have been known to be released during social distress and isolation in animals, but where this occurs in the human brain has not been shown until now.”

He said participants’ personalities appeared to affect the opioid system’s response to rejection. Those with a high level of resilience tended to have greater levels of opioid release, especially in the amygdala, a region of the brain involved in processing emotions.

“This suggests that opioid release in this structure during social rejection may be protective or adaptive,” Hsu said.

The researchers are now investigating if people with depression or social anxiety have an abnormal opioid response to social rejection or acceptance.

“It is possible that those with depression or social anxiety are less capable of releasing opioids during times of social distress, and therefore do not recover as quickly or fully from a negative social experience,” Hsu said. “Similarly, these individuals may also have less opioid release during positive social interactions, and therefore may not gain as much from social support.”

More information

The U.S. National Institute of Mental Health has more about anxiety disorders.

View the Original article

Use of Donor Sperm by Lesbians Rises in Canada, Study Finds

TUESDAY, Oct. 15 (HealthDay News) — Use of donor sperm by lesbian couples increased significantly after gay marriage was legalized in the province of Ontario, Canada, a new study finds.

Researchers in Toronto analyzed data from their sperm donor program over the past 17 years and found that the proportion of lesbian couples using the program increased from 15 percent to 20 percent of their patients after gay marriage was legalized in 2003.

The number of units of donor sperm used by lesbian couples increased fourfold, from 133 to 561, according to the findings, which were scheduled for presentation Tuesday at the annual meeting of the International Federation of Fertility Societies and the American Society for Reproduction Medicine, in Boston.

“There is no question that broad social trends have a huge impact on reproduction, and on reproductive medicine,” IFFS President Joe Leigh Simpson said in a federation news release. “It is nice to have some actual data which documents how some of these trends impact our profession and, more importantly, our patients.”

The study also found that 15 percent of single women and women in heterosexual relationships used donor sperm for in vitro fertilization, compared with 7 percent of lesbian women.

Data and conclusions presented at medical meetings typically are considered preliminary until published in a peer-reviewed medical journal.

More information

The American Academy of Pediatrics offers advice for gay and lesbian parents.

View the Original article

Study Sees Link Between Psoriasis, Kidney Problems

TUESDAY, Oct. 15 (HealthDay News) — People with moderate to severe psoriasis are at increased risk for chronic kidney disease and need to be closely monitored for kidney problems, a large new study suggests.

Researchers in Philadelphia analyzed data from nearly 144,000 people, aged 19 to 90, with psoriasis, and a comparison (control) group of nearly 690,000 adults without the condition.

During seven years of follow-up, people with psoriasis were more likely to develop chronic kidney disease than those in the control group. Those with severe psoriasis had a nearly two-fold higher risk of developing kidney disease and a more than fourfold higher risk of developing kidney failure requiring dialysis, according to a journal news release

Further investigation that focused on the amount of skin area affected by psoriasis showed that people with moderate to severe psoriasis were at greater risk of developing chronic kidney disease. People with moderate psoriasis have 3 percent to 10 percent of skin area affected, while those with severe psoriasis have more than 10 percent of skin area affected.

Psoriasis is a chronic condition involving scaly skin patches that can lead to itching, cracking and bleeding. As many as 7.5 million Americans have the autoimmune condition, according to the National Psoriasis Foundation.

Moderate and severe psoriasis affect more than 20 percent of patients worldwide, according to the study, which appears Oct. 15 in the journal BMJ.

Although the study found an association between having psoriasis and a higher risk of kidney problems, it did not establish a cause-and-effect relationship.

The researchers also found that the risk of chronic kidney disease linked to psoriasis increases with age. In patients aged 40 to 50 with severe disease, psoriasis accounted for one extra case of chronic kidney disease per 134 patients yearly. In those aged 50 to 60, it accounted for one extra case yearly per 62 patients.

Further research is needed to confirm the study findings, determine how psoriasis can cause kidney disease and examine how psoriasis treatment affects the risk for kidney disease, the researchers concluded.

More information

The American Academy of Family Physicians has more about psoriasis.

View the Original article