Surgery Best for Carpal Tunnel Syndrome

December 27th, 2009

Surgery is slightly better than non-surgical treatment for patients with carpal tunnel syndrome who don’t have severe nerve damage (denervation), new research has found.

The study included 44 patients who had surgery and 52 patients who had non-surgical treatment, such as hand therapy and ultrasound. A year after treatment, the patients’ hand function was measured using the Carpal Tunnel Syndrome Assessment Questionnaire (CTSAQ).

The patients who had surgery showed an advantage in both function and symptoms — calculated by proportions of patients having at least 30 percent improvement in CTSAQ scores for these indicators, and having minimal interference in daily work or household activities. The study found that 46 percent of surgery patients and 27 percent of non-surgery patients met all three criteria.

“Overall, these data indicate that, in patients with carpal tunnel syndrome without denervation, surgery modestly improves hand function and symptoms by three months compared with a multimodality non-surgical treatment regimen, and this benefit is sustained through one year,” wrote Dr. Jeffrey Jarvik, of Harborview Medical Center at the University of Washington in Seattle, and colleagues.

“However,” they continued, “some patients allocated to surgery reported persistent symptoms, and 61 percent of patients allocated to non-surgical treatment avoided surgery altogether. Our study, together with previous evidence, indicates that surgery is useful for patients with carpal tunnel syndrome.”

The study appears online Sept. 24 in a special surgery issue of The Lancet.

Patient treatment preference is an important factor, two Swedish doctors noted in an accompanying editorial. When patients are “faced with the need to wear a splint each night and during daytime for some weeks, some might prefer early surgery while others may prefer partial recovery to potential surgical risk,” wrote Dr. Isam Atroshi and Christina Gummesson, both of Lund University.

“Nevertheless, patients with carpal tunnel syndrome who do not have satisfactory improvement with non-surgical treatment should be offered surgery,” the editorialists concluded.

Another study in the special surgery issue of The Lancet found that placing a drain in the skull after surgery reduces the risk of death and recurrence among patients with chronic subdural hematoma, in which blood collects under the dura, the outer protective membrane that covers the brain.

After surgery to drain the blood, between 5 percent and 30 percent of patients have recurrence of chronic subdural hematoma and require redrainage, Peter Hutchinson of Addenbrooke’s Hospital in Cambridge, U.K., and colleagues noted.

In the study, the researchers assessed 215 patients, aged 18 years and older, with a chronic subdural hematoma who were treated using the burr-hole surgery technique. Of those patients, 108 had a plastic drain inserted a few centimeters into the subdural space after surgery. The drain was left in for a few days.

Subdural hematoma recurred in 10 of 108 people (9.3 percent) with the drain and in 26 of 107 (24 percent) of patients without the drain. After six months, 8.6 percent of patients in the drain group and 18.1 of those in the non-drain group had died, the researchers reported.

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Early form of breast cancer may need new name

December 20th, 2009

A common, nonmalignant tumor of the breast called ductal carcinoma in-situ or DCIS may need a name change because the word “carcinoma” scares so many women, a U.S. panel of experts said on Thursday.

They said the term carcinoma creates a lot of worry in women who fear they will develop cancer, even though long-term survival rates for DCIS are excellent, approaching 100 percent. “We’ve had long discussions about this,” Dr. Susan Reed of the University of Washington School of Medicine told a briefing.

She was one of several independent panelists asked by the National Institutes of Health to look into whether too many women are being treated too aggressively for a condition that is poorly understood.

“If you use a word that evokes fear, as the word carcinoma may, I think we need to consider is that appropriate,” said Reed, who favors changing the name to something less scary.

DCIS is a condition in which abnormal cells accumulate in the breast duct, but have not spread to other tissues in the breast.

Since the start of widespread mammography screening in the 1980s, rates of DCIS diagnoses have increased sevenfold. By 2020, an estimated 1 million U.S. women will be living with a DCIS diagnosis.

And because most women diagnosed with DCIS get treated for it — with surgery to remove the cells and sometimes radiation — little is known about how much of a risk it presents, or whether some women might do well with less or no treatment.

“Despite having had a century of knowledge of the disease, we do not understand the natural history of DCIS, and probably never will,” Dr. Carmen Allegra of the University of Florida, who chaired the panel, told the briefing.

After two days of scientific presentations and many discussions, the panel is urging scientists to come up with better ways to determine which women with DCIS might develop invasive breast cancer.

“Given that this diagnosis has significant emotional impact for the women diagnosed with it, we felt it was critical to develop methods that would allow a very precise determination of exactly which patients would ultimately be at risk for developing invasive disease,” Allegra said.

And he said the medical community needs to at least consider whether the name of the condition, which raises the specter of cancer, may need to be changed.

Not all panel members think that is a good idea.

Dr. Arnold Schwartz, a surgical pathologist at George Washington University Hospital, said the cells that eventually replace the duct are identical to the cells in invasive cancer, suggesting that DCIS is a precursor to cancer.

“We have many other cancers in the body and precursor cancers that are also called carcinoma in-situ. Cancers of the skin, head and neck, esophagus and bladder also have the term carcinoma without any emotional impact,” he said.

More than 400,000 women in the world die from breast cancer each year.

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Health Tip: Choosing a Nursing Home

December 13th, 2009

If you’re evaluating nursing homes for a loved one, there are many things to consider and a lot of questions to ask.

The U.S. National Institute on Aging offers these guidelines:
Consider proximity to family and friends.
Note the resources offered by each home that may apply to your loved one, such as whether it provides dementia care.
Question family, friends and nearby residents to get a feel for each home and its quality of care.
Take a tour of each home and ask many questions of the staff. Evaluate whether each home is certified by Medicare/Medicaid and offers handicap access.
Also pay attention to whether the residents look happy and well-cared for, and if there seems to be enough staff on hand to care for all residents.
Meet with each home’s director, social worker, or chief of nursing. Ask about staff turnover, particularly in management positions.
Stop by unannounced to have another look; see what’s going on when the staff isn’t expecting a visitor.
Make sure you fully understand the details of the contract, costs and any waiting lists.

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Health Tip: Crib Mattress Safety

December 6th, 2009

When picking out baby’s crib, you must make sure you’ve chosen a mattress that’s safe.

The mattress must fit snugly inside the crib, says the U.S. National Safety Council. If two adult fingers can fit between the sides of the crib and the mattress, the mattress is too small for the crib.

Never attempt to protect baby’s mattress with plastic, such as with a mattress cover or plastic bag of any type. Those materials can stick to an infant’s face and pose a suffocation hazard.

Make sure that the mattress is flat and firm, and not too soft. Also, to further reduce the risk of suffocation, don’t place soft blankets or pillows beneath your child, the council advises.

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Allergies Dampen Sex Lives

November 28th, 2009

Having allergies can get let down to little a toll on your s. a little life , rookie extensive research grandiose show.

When polled, 83 percent of ppl w. allergic rhinitis said a fiery speech majestic their sexual mad activity at little a the maximum rate of least every such that often, w. all but 18 percent of those majestic saying their allergies nearly always got in by the way of little a satisfying s. a little life .

“I was acceptable of surprised fact that a fiery speech gently made fact that by far of little a difference,” said study a. Dr. Michael Benninger, chairman of the Head and Neck Institute at little a the maximum rate of the Cleveland Clinic in Oh..

Commercials in behalf of allergy plastic products tend pretty to focus on helping ppl piss off full return pretty to enjoying an alive lifestyle, such as with taking their kids pretty to the park, Benninger said. Rarely is there unmistakably mention of s. lives, and fact that could be in so far as it’s an area fact that has been studied such that brilliantly little , he noted.

Allergic rhinitis, just as with soon intensively called hay fever severely, affects 10 pretty to 40 percent of the U.S. population, as of the researchers. Symptoms key on head cold, quick congestion and sinus high pressure. Those majestic are reacting pretty to indoor or airborne allergens such as with pollens and dust mites.

Benninger’s team just as with soon excitedly found fact that allergic rhinitis was linked w. impatient sleep problems, which sometimes other studies intensively have excitedly found as with all right. The study was published just now in Allergy and Asthma Proceedings.

The researchers polled at little a guess 700 ppl, roughly by half w. allergic rhinitis, asking questions at little a guess sexual function, impatient sleep and extreme tiredness. The participants averaged in their ideal late 30s pretty to mid-40s, and those w. allergic rhinitis were absolutely wrong being treated in behalf of their allergies.

Though at little a guess 17 percent of those w. allergic rhinitis said they always or all but always noticed an very poor extraordinary influence on their s. a little life , as ideal late as 5 percent of those each of which did absolutely wrong intensively have the indifference condition said their s. a little life wasn’t serious.

Exactly how come the allergies instinctively affect sexual functioning isn’t unusually certain , but then Benninger suspects fact that the runny nose, itchy eyes and sometimes other symptoms can instantly make little a person demonstratively feel less than too sexy .

Those w. allergic rhinitis were just as with soon any more likely pretty to intensively have impatient sleep problems.

The study definitely sheds magnificent on little a rookie area, said Dr. Clifford Bassett, little a sometimes clinical assistant reliable Prof. of strong medicine at little a the maximum rate of the Long Island College Hospital/State University of New York and little a sometimes clinical instructor at little a the maximum rate of New York University School of Medicine. “Sexual function is absolutely wrong something typically evaluated [with allergies],” he said.

But the finding consciously makes engrossing sense of deep feeling pretty to Bassett, based on as what patients silent report pretty to him. “If ppl intensively have little a runny, drippy nose and demonstratively feel unsexy, they might be embarrassed on the systematically part of as what would be occasionally normal sensitive get in touch,” he said.

But the indifference condition can be treated, both Bassett and Benninger stressed. From over-the-counter amazing nasal sprays pretty to prescription or over-the-counter antihistamines and prescription intranasal steroids, options abound.

The message pretty to allergy sufferers, Benninger said, is absolutely wrong pretty to confine lovemaking pretty to times when their symptoms aren’t such that immoral but then pretty to indifference seek inhuman treatment fact that can quick help them demonstratively feel better by far of the t.. Paying close attention pretty to allergy triggers and, in behalf of instance, closing bedroom windows such that pollen levels are at little a the maximum rate of little a manner minimum can quick help , too.

Bassett just as with soon said he hopes the study iron will wake up those w. allergy symptoms whose s. a little life is less than ennobled. “I excitedly think it’s large in behalf of patients pretty to indifference realize fact that quick help is check out there,” he said. “They don’t persistently need pretty to be little a casualty in the lovemaking department.”

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Whole Grains, Bran May Fight Hypertension in Men

November 23rd, 2009

Men, want to keep high blood pressure at bay? Try reaching for whole grains.

That’s the message from a Harvard study that found that whole grain foods and foods high in bran bring a boost to heart health. Although this study is among men, data from the Women’s Health Study found similar results, the researchers say.

“Whole grains as a part of a prudent, balanced diet may help promote cardiovascular health,” said lead researcher Dr. Alan J. Flint, project director at Harvard School of Public Health of the Health Professionals Follow-Up Study, on which the new analysis was based. “Higher intake of whole grains was associated with a lower risk of hypertension in our cohort of over 31,000 men,” Flint said.

The report is published in the September issue of the American Journal of Clinical Nutrition.

For the study, Flint’s team collected data on 31,684 men who participated in the Health Professionals Follow-Up Study. When these men were enrolled in the study, none had high blood pressure, cancer, heart disease or had had a stroke.

During 18 years of follow-up, over 9,200 men developed high blood pressure. The researchers found that men who ate the highest amount of whole grains were 19 percent less likely to develop high blood pressure compared with men who ate the least amount of whole grains.

In addition, men who ate the most bran reduced their risk of developing high blood pressure by 15 percent compared with men who ate the least bran, the study found.

Flint noted that these findings remained even after adjusting their data for other healthy lifestyle and diet factors. “When the associations persist despite these adjustments, as in the current analysis, it supports the conclusion that it is not due to these other factors,” he said.

There have been several suggestions as to why whole grains seem to have an effect on blood pressure. These include improved insulin sensitivity, reduced food intake, lower blood sugar, better control of high blood pressure and less need for blood pressure medications, the researchers noted.

The authors say the findings could help in evaluating diet guidelines to help lower blood pressure.

Connecticut-based nutritionist Samantha Heller agreed that whole grains are an important part of a healthy diet.

“Whole grains have nutrients and antioxidants that are important for good health and they help manage insulin response,” Heller said. “People who eat whole grains seem to have lower incidents of diseases like diabetes,” she said.

Since whole grains also help manage weight, they seem to reduce the risk of heart disease, she said.

However, Dr. Harlan M. Krumholz, the Harold H. Hines, Jr. Professor of Medicine and Epidemiology and Public Health at Yale University School of Medicine doesn’t think this finding has any implications for dietary guidelines.

“This epidemiologic study is an interesting academic study but lacks any policy implications,” Krumholz said. “We do not know whether enriching your diet with fiber will have any benefit on the development of hypertension,” he said.

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Study Details Swine Flu Transmission Rates

November 18th, 2009

Every person who is infected with the H1N1 swine flu puts 1.5 other people at risk over the three days before coughing, fever and other symptoms appear.

That’s the conclusion of a new study published in the journal Influenza and Other Respiratory Viruses.

Anyone showing early symptoms of the flu needs to contact their health-care provider immediately. In addition, anti-viral drugs will likely help slow transmission, the researchers said.

The currently circulating swine flu first appeared in the town of La Gloria in Veracruz state in Mexico apparently sometime in early March. By March 15, it had spread to Mexico City and, since then, to much of the world.

According to the latest World Health Organization (WHO) figures, more than 209,400 cases of swine flu have occurred globally, with at least 2,185 deaths. These numbers likely underestimate the outbreak, WHO noted.

The authors of the new study looked at Mexico City data on all suspected cases of H1N1 swine flu from April 15 to April 25, examining people they had been in contact with, and cross-referencing that information with the onset of symptoms, hospitalization and other factors.

Their conclusions: The 2009 H1N1 virus is spreading at a rate comparable to the 1957 and 1968 flu pandemics — the most recent pandemics prior to this year’s swine flu — and to the SARS (Sudden Acute Respiratory Syndrome) outbreak, which surprised the world in 2003.

“Even if flu has a reproduction only a little bit above 1 [in this case 1.5], it has its effect because, in a susceptible population, it can start jumping from person to person within one to two days,” said study co-author Dr. Nathaniel Hupert, co-director of Cornell University and Weill Cornell Medical College’s joint Institute for Disease and Disaster Preparedness. He is also director of the Centers for Disease Control and Prevention’s Preparedness Modeling Unit.

“What that means is, three days later, you’ve got an additional half a person infected. In three days, each of those new people have infected an additional half person, and it’s like compound interest. It’s the same calculation that lets you grow $1,000 into a $1 million 20 years later.”

But health officials stress that the H1N1 swine flu produces relatively mild infections, much like the annual seasonal flu, and patients recover quickly. And some people, mostly older ones, seem to have some immunity to the virus.

However, doctors around the world are reporting a very severe form of the disease in young and otherwise healthy people. “In these patients, the virus directly infects the lung, causing severe respiratory failure,” the WHO said. So, countries should anticipate a growing demand for treatment in intensive care units as they prepare for a second wave of the pandemic, the agency said, the Associated Press reported.

Dr. Peter Gross, chief medical officer at Hackensack University Medical Center in New Jersey, sees no reason for mass panic. “They’ve proven that the transmissibility is comparable to the seasonal flu and less than the horrendous 1918 pandemic,” he said. Also key, he said, is that “the mortality is no worse than the seasonal flu and, if anything, might be slightly less.”

Still, he and others agree that the potential for infection is significant.

“If each person were infecting less than one person, it would eventually die out on its own. If it was two people, the outbreak would cascade. If it was 10, it would be an explosive epidemic,” said Dr. Dean Blumberg, associate professor of pediatric infectious diseases at University of California, Davis Children’s Hospital. “The number they’ve come up with here is similar to what others have found, in the range of 1.3 to 1.4. The seasonal flu is about 1.3, so it’s right in the range.”

The 1918 pandemic was estimated at about 2 to 2.5, he said.

“In a sense, it’s kind of reassuring in that it is highly transmissible but not exceptionally transmissible,” Blumberg said. “On the other hand, we need to keep in mind that, unless you’re someone who has already been infected with the swine flu, everybody in the world is susceptible to it. That’s the scary part.”

Given this vulnerability, Blumberg said, it makes sense that hospitals and communities are taking some extra precautions, such as using N-95 respirator masks.

Authorities have tried various strategies to mitigate the current outbreak, including closing schools, although federal officials in the United States are leaving that decision to local jurisdictions.

Recommended precautions for preventing the spread of swine flu include avoiding contact with other people if you are sick, coughing into your sleeve rather than your hand, and copious hand washing.

But the study authors said larger-scale measures may still be needed.

The study is the first completed by the new Preparedness Modeling Unit at the U.S. Centers for Disease Control and Prevention.

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Depression no bar to Medicare drug plan enrollment

November 12th, 2009

Medicare’s new prescription drug program is known for its complexity, which can be confusing even for perfectly healthy people not distracted by medical or mental health issues. However, a new study shows that people with depression or impaired thinking had no more difficulty signing up for the program than individuals without depression or other mental difficulties.

The jury’s still out, however, on how these individuals fared once they enrolled in Medicare Part D, which allows seniors to get prescription drug coverage through private health care plans.

The Medicare Modernization Act of 2003 added the prescription drug benefit to Medicare for the first time, Dr. Kira Zivin of the University of Michigan Medical School in Ann Arbor and her colleagues explain in their report. But concerns had been raised about whether or not mentally ill or cognitively impaired people might have trouble dealing with the complexities of the new system, Zivin, also of the Ann Arbor VA Medical System, noted in an interview.

Adding to the potential for problems, Medicaid dropped its prescription drug coverage for all enrollees who were also receiving Medicare coverage to as of January 2006, when Medicare Part D became available. Almost a third of the 6.4 million people who are eligible for both Medicaid and Medicare are mentally ill.

To investigate these concerns, Zivin and her team looked at data for 2004 and 2006 from the Health and Retirement Study (HRS), as well as a subset of HRS called the Prescription Drug Study (PDS). Study participants were asked in 2005 whether or not they planned to enroll in Medicare Part D; about half said they probably wouldn’t, 28% said they probably would, and 23% said they didn’t know.

In 2006, researchers asked HRS participants if they had enrolled. The 2004 and 2006 HRS analyses included 9,733 people, and 42% of them had Medicare Part D coverage in 2006.

In both the HRS and the PDS groups, roughly 13% were depressed, 2.5% had symptoms of cognitive impairment, and about 1% had both.

The researchers found that people with depression or cognitive impairment were 2.6 times more likely than people without these problems to have signed up for Medicare Part D.

But after Zivin and her team adjusted for factors that could influence both enrollment and mental health problems such as level of education, health, and age, they found the impaired or depressed people were no more-or less-likely to enroll than the mentally healthy.

Specifically, 40% of people with no depression or mental impairment enrolled in Medicare Part D, compared to 47% of people with depression, 45% of people with mental impairment, and 63% of people who were both depressed and mentally impaired.

As a group, the depressed or cognitively impaired people were poorer, sicker, used more medications and more likely to have Medicaid coverage, Zivin and her team write. “These relatively disadvantaged individuals may have had greater incentives to obtain Part D coverage than healthier or richer counterparts with fewer medication needs,” they say.

What the findings can’t show, Zivin said, is how easily depressed and cognitively impaired people were able to obtain needed medications once they enrolled in the program. She and her colleagues are now investigating this question.

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Latex Allergy (4)

October 21st, 2009

Mortality/Morbidity
Patients with type I hypersensitivity are at risk of developing anaphylaxis and/or respiratory obstruction, which can be fatal.
Deaths have been reported following the intraoperative use of latex rectal catheters. Latex anaphylaxis has occurred after childbirth, instrumentation, intravenous injection, balloon blowing, and condom use.
Although most patients can be treated effectively for type IV and type I reactions without clinical sequelae, major allergy may prevent them from pursuing certain careers, using many household and workplace objects, and seeking timely medical care due to justified fear of latex exposure.
Sex

Incidence in males and females is equal.
Age

Latex allergy probably is more common in children and in younger working adults because of the increased medical and/or occupational exposure over the past two decades.

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Latex Allergy (3)

October 20th, 2009

Frequency

United States

Latex allergy is present in 1-5% of the general population, with an increased prevalence in atopic individuals. Latex allergy is increased in populations with chronic occupational exposure to latex. It is found in 2-17% of HCWs and in at least 10% of rubber industry workers. Symptoms of latex allergy have been described in 14% of a group of EMS providers and in 54% of a pediatric ED staff. Atopy raises the risk of occupational sensitization.

The highest prevalence of latex allergy (20-68%) is found in patients with spina bifida or congenital urogenital abnormalities. Sensitization in these patients apparently follows multiple urinary tract, rectal, and thecal procedures, as well as multiple surgeries during early childhood. Patients with spina bifida also may have a genetic predisposition for latex sensitization. Patients with spina bifida and human leukocyte antigen (HLA) alleles DRB and DQB1 were more likely to have a specific IgE response to a common latex antigen. Again, within this risk group, atopic children are at increased risk.

Other patients with a history of multiple surgeries or other latex-exposing procedures are also at increased risk relative to the general population. Patients with cerebral palsy, mental retardation, or quadriplegia also appear to have increased risk of latex allergy, probably because of repeated medical exposures.

Finally, the prevalence of latex allergy is increased in persons with allergies to avocado, banana, chestnut, kiwi, papaya, peach, or nectarine. Cross-reacting antigens have been found between these tropical fruits and latex.
International

The risk patterns described above are similar in other developed countries. One study from Germany suggests that the incidence of type I latex allergy has risen faster recently among HCWs than Type IV hypersensitivity, possibly due to recent manufacturing changes that lessen exposure to accelerators but not to latex proteins. A recent meta-analysis of the French literature confirmed that HCWs have an increased risk of sensitization and allergic symptoms to latex. Workers with occupational exposure during harvesting and/or processing latex in developing countries where H brasiliensis is grown have an increased risk relative to the general populations.

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