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New Technique Shows Which Patients Will Benefit from Avastin for Brain Tumor Treatment

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The U.S. Food and Drug Administration approved the use of Avastin last month for the treatment of brain cancer. The powerful drug shrinks tumors by choking off their blood supply. However, about fifty percent of patients don’t respond to the therapy, exposing them to unnecessary side effects and medication costing up to $10,000 per month.

Now UCLA scientists have uncovered a new way to image tumors and forecast which patients are most likely to benefit from Avastin before starting a single dose of treatment. The findings are published in this month’s issue of the journal Radiology.

“Avastin is an expensive drug, yet only 50 percent of patients with recurring brain cancers respond to it,” said lead author Dr. Whitney Pope, assistant professor of radiological sciences at the David Geffen School of Medicine at UCLA. “Until now, there has been no good way to identify these patients in advance. Our work is the first to suggest that we can predict which tumors will respond before the patient ever starts therapy.”

Pope and his colleagues focused on glioblastoma, the most common and deadly form of adult brain tumor, striking 12,000 Americans a year.

The UCLA team studied 82 patients who had undergone surgery and radiation therapy to remove glioblastoma. Half of the patients received infusions of Avastin every two weeks. All underwent monthly brain scans by magnetic resonance imaging (MRI) to monitor change.

The researchers analyzed the MRI scans of the patients whose tumors returned. Explaining what the team saw requires an understanding of how the tumor creates an independent blood supply.

Cancer cells secrete a growth factor called VEGF that spurs the growth of new blood vessels to supply the tumor with oxygen and nutrients. Avastin blocks VEGF, essentially starving the tumor to death.

This process launches a chain of events that is detectable by MRI. Oxygen-starved cells produce more VEGF, which causes blood vessels to leak fluids into the tumor and surrounding tissue. This results in swelling, which boosts water’s ability to move freely in the tumor and brain tissue. As cells disintegrate, they no longer pose a physical barrier to water movement.

“We theorized that tumors with more water motion would also have higher VEGF levels,” explained Pope. “Because Avastin targets VEGF, it made sense that the drug would work better in tumors with high levels of the growth factor.”

By measuring the amount of water motion within the tumor, the researchers were able to predict with 70 percent accuracy which patients’ tumors would progress within six months and which would not. They detected greater water movement in the tumors of those persons who later responded best to Avastin.

“When we realized that high levels of VEGF are linked to greater cell death and increased water movement, we were able to predict the patients’ response to Avastin before they began treatment,” explained Pope. “We were correct 70 percent of the time. Previously, identifying which patients would respond was like flipping a coin. This is a huge improvement.”

The research finding presents clear clinical benefits to the patient, says Pope. “Knowing this information ahead of time will help doctors personalize therapy for each patient and decrease exposure to side effects,” he noted.

Pope and his colleagues plan to confirm their findings in a larger study. The team will also test the new method’s ability to identify responsive patients prior to surgical removal of their tumor.

Despite therapy with surgery, radiation and chemotherapy, the average glioblastoma patient lives only 12 to 15 months after diagnosis. Survival rates drop even lower if the tumor returns. Conventional therapies produce little benefit; only 8 to 15 percent of patients survive without tumor progression six months after treatment.

Source: University of California, Los Angeles (UCLA), Health Sciences, July 30, 2009

Tuberculosis (TB) Drug Doses Too Low for Today’s Obese Populations, Says Study

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The typical dose of a medication considered pivotal in treating tuberculosis effectively is much too low to account for modern-day physiques, UT Southwestern Medical Center researchers said.

The finding, reported online and in the August edition of Antimicrobial Agents and Chemotherapy, is particularly important for those living in societies plagued by obesity, said Dr. Tawanda Gumbo, associate professor of internal medicine at UT Southwestern and the study’s lead author.

“What really drives the variability of this particular drug is patient weight and gender, so in our simulations we took that into account,” Dr. Gumbo said. “What we found is that we’re really using doses for very skinny people – 105 to 110 pounds. I haven’t met many adults who are at that weight.”

About one-third of the world’s population is infected with Mycobacterium tuberculosis, the bacterium that causes TB, and as many as 2 million people die from the disease each year. TB, which is the leading cause of death among people infected with HIV/AIDS, kills more people than any other disease caused by a single infectious agent, according to the National Institutes of Health. Treatment usually lasts six to 12 months and includes a combination of antibiotics such as Pyrazinamide, the drug examined in this study.

Because treatment typically includes multiple drugs, introducing new ones to existing regimens has made it harder to identify which, if any, of the drugs are working at the current dosage levels. Researchers also have struggled to identify the needed dosage as well as exactly where in the body these drugs work to combat the bacterium.

The new model developed at UT Southwestern uses cultured cells to gauge the effectiveness and proper dosage of anti-tuberculosis drugs.

“With this model, we can directly test molecules that have the potential to shorten therapy and go straight to coming up with the doses that you would use in patients,” Dr. Gumbo said. “What that means is that if you have a molecule that could cure TB in one month in this model, it stands a good chance that it would do the same in patients.”

For this study, the researchers gave patients Pyrazinamide – an older drug generally used in combination with other drugs – daily for one month. The researchers then used the data collected to calculate how much bacteria the drug killed before resistance emerged. They opted to focus on Pyrazinamide because physicians once used it alone to treat the disease, so there are many studies documenting precisely how the drug behaves in patients – something that is unclear for some newer drugs.

When the UT Southwestern researchers began testing Pyrazinamide in the lab, they found that the concentration of the drug declined at a rate that matches the rate seen in patients.

“In patients, unlike in test tubes, it’s not a constant concentration. A patient given multiple drugs degrades each of them at different rates,” he said. “Using this model, we can actually copy this concentration profile of the drugs to human-like exposures.”

Dr. Gumbo said his team’s finding that the doses traditionally given to tuberculosis patients are much too low suggests that different doses are probably needed in different countries. “Most of the patients we see here in Dallas are not 110 pounds unless they have some other severe disease,” he added.

The next step, Dr. Gumbo said, is to continue researching drug combinations in order to devise the optimum treatment regimen for tuberculosis patients.

“We’ve rationally and scientifically come up with a dose that depends not just on the kinetics or the concentration time profile of patients, but also how the bug itself responds to that particular drug,” he said. “So, instead of using the average patient or a mean patient, we can now project how a drug combination will fare in actual patients. With this model, researchers can use these simulations to determine the duration of therapy, which could shorten from years to months.”

Source: Antimicrobial Agents and Chemotherapy, August, 2009.

Alternative Therapies for Eczema Treatments, With a Caveat

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Despite having access to some of the best health care in the world, many Americans with the most common form of eczema, known as atopic dermatitis, have sought relief from “alternative medicines.” However, dermatologists caution that patients seeking alternative treatments to alleviate symptoms of this common, chronic, inflammatory skin disease marked by red, itchy rashes, risk developing more severe symptoms by delaying treatment.

At the American Academy of Dermatology’s Summer Academy Meeting 2009 in Boston, dermatologist Peter A. Lio, MD, FAAD, assistant professor of dermatology and pediatrics at Northwestern University Feinberg School of Medicine in Chicago, discussed why eczema patients try alternative therapies and how certain therapies used in conjunction with clinically tested medical treatments could hold promise in further improving the condition.

“Part of the difficulty in understanding why people seek alternative medicine lies in defining this term,” said Dr. Lio. “Broadly speaking, it encompasses treatments such as acupuncture, homeopathy and holistic medicine outside of the form of medicine taught in most U.S. medical schools. But people use the term for anything from chicken soup to any lotion or potion sold on the Internet to a new dietary supplement. Unfortunately, a great deal of snake oil can hide under the umbrella of alternative medicine.”

Dr. Lio believes there are two main reasons that patients try alternative therapies for eczema. The first reason is that since the cause of eczema is not fully understood nor why it occurs in some people and not others, treatments are
based on controlling the symptoms rather than fixing the root cause. Secondly, an increasing number of patients are looking for natural non-medical therapies that do not pose the known side effects of some of the traditional medications.

However, many non-medical therapies, especially herbal treatments, marketed for treating eczema are not governed by the U.S. Food and Drug Administration (FDA) or any agency, and contaminants could cause health problems or drug interactions could occur when used with other medications.

“The biggest risk posed by alternative medicines is worsening symptoms due to delayed treatment. In my practice, most of my patients have used some form of alternative therapy, but largely with little or no measurable improvement,” said Dr. Lio. “In fact, one large-scale study found more than half of the eczema patients participating reported using one or more forms of alternative medicine for their disease. The study concluded that the majority of patients reported no improvement or even worsening of their condition after using these alternative treatments.”

While topical corticosteroids (the mainstay in the treatment of eczema), antibacterial agents, topical calcineurin inhibitors and moisturizers are among the most effective medical treatments dermatologists prescribe to treat eczema, Dr. Lio suggested certain alternative therapies may be beneficial for some patients, perhaps by reducing stress.

For example, studies show that physical or emotional stress can worsen atopic dermatitis, and one study concluded that stress directly slows the healing of the skin barrier – or its protective outer layer. In another study, psychosocial stress and sleep deprivation were found to disrupt skin barrier function in healthy patients.

“It is possible that some forms of alternative medicine, such as hypnosis and acupuncture, may help eczema patients by reducing stress,” said Dr. Lio. “The areas of stress reduction and behavior modification are promising and deserve further exploration as a means to complement traditional medical therapies.”

In his practice, some of Dr. Lio’s patients report improvement in their condition with acupuncture, but there are no scientific studies examining this potential benefit. Currently, Dr. Lio is trying to initiate a study on the effects of acupuncture on eczema patients at his institution to examine why acupuncture reportedly benefits some patients but not others.

“I think it is important for patients to inform their dermatologist if they are using alternative therapies, as some could cause dangerous drug interactions with traditional medicine,” said Dr. Lio. “I always tell my patients that the fact that there are thousands of alternative treatments for eczema suggests that not one of them works really well. But if patients are committed to trying alternative medications, they should consult their dermatologist and not forgo their recommended medical regimen.”

Source: American Academy of Dermatology (AAD), July 29, 2009

Hormone Replacement Therapy (HRT) and Its Effects on Skin Appearance

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For many women, hormone replacement therapy (HRT) can alleviate the physical symptoms associated with the change of life. But despite the initial hype generated by post-menopausal women who noticed a marked improvement in their skin’s appearance while on HRT, dermatologists argue that scientific studies of estrogen do not show definitive improvements for skin rejuvenation of photodamaged skin and the potential risks when used long-term outweigh any potential skin benefits.

At the American Academy of Dermatology’s Summer Academy Meeting 2009 in Boston, dermatologist Margaret E. Parsons, MD, FAAD, assistant clinical professor of dermatology at the University of California at Davis in Sacramento, reviewed studies that demonstrate mixed results when examining whether or not estrogen improves the appearance of the skin and why patients should opt for tried-and-true cosmetic therapies instead.

“Based on the research conducted thus far, it does not appear that topical or oral estrogens are a viable long-term solution for improving sun-damaged or aging skin,” said Dr. Parsons. “In my practice, I do not prescribe estrogens for skin rejuvenation because of the lack of consistent data to support their use and the known risks of prolonged estrogen therapy – including an increased risk of breast cancer.”

Estrogens are a group of hormones that play a key role in regulating many aspects of a woman’s overall health, including reproduction. Certain parts of the body contain cells that are more receptive to the effects of estrogen than others, including the face. Dr. Parsons noted that estrogens benefit the skin in many ways, including an increase in collagen content, water retention and elasticity.

During pregnancy when estrogen levels are at their highest, women experience thicker hair and glowing skin. On the other hand, post-menopausal women may
notice that their skin does not have the same elasticity as it once did and that it is drier than normal.

In order to treat the most common symptoms associated with menopause – including hot flashes, mood swings and vaginal changes – physicians often prescribe hormone replacement therapy (HRT) to boost the body’s estrogen levels that drop dramatically during this change of life. However, when the results of the Women’s Health Initiative (WHI) study were announced in 2002, the way HRT was viewed to treat post-menopausal women changed significantly. For example, the WHI study found that women on long-term HRT could be at an increased risk for breast cancer and that the overall health risks of this therapy could outweigh the possible benefits. From that point on, HRT was prescribed more conservatively with lower dosing options and individualization based on each woman’s own health history.

Since there were reports of some women on HRT noticing an improvement in their skin, studies were conducted to determine if these results could be validated. Dr. Parsons explained that results of multiple studies examining the relationship between estrogens and skin improvement were inconclusive.

For example, one study examined whether low-dose hormone therapy improved aging skin in 485 women who were on average five years post-menopausal. Published in the September 2008 issue of the Journal of the American Academy of Dermatology, the study concluded that estrogen supplementation did not provide any significant improvement in sun-damaged skin.

“Although this study found no obvious skin benefits in this particular group of women, another study that looked at women who began HRT at the onset of menopause – and did not wait to start treatment like the other group – did experience noticeable improvements in their skin,” said Dr. Parsons. “These
studies pose unanswered questions as to the timing and duration of prescribing HRT to produce skin benefits. For this reason, the jury is still out as to whether estrogens can be effective for aging skin.”

In addition, another study showed that applying topical estrogen to sun-damaged facial skin and sun-protected skin on the hip of post-menopausal women resulted in stimulated collagen production and less wrinkling in the sun-
protected hip skin, but no noticeable improvement in the sun-damaged facial skin.

Dr. Parsons added that more research will likely continue in the future to examine the possible benefits of estrogen for improving aging skin. Until then, she stressed that there are many effective therapies that dermatologists regularly use to address the common signs of aging – including retinoids, alpha-hydroxy acids and other topical therapies, as well as chemical peels, lasers, botulinum toxin and skin fillers, to name a few.

“The best advice I can offer my patients to improve their overall skin health is to wear sunscreen with a sun protection factor (SPF) of at least 30, don’t smoke and use a topical retinoid,” said Dr. Parsons. “When it comes to minimizing the cumulative effects of sun damage, an ounce of prevention really does go a long way.”

Colchicine for Acute Gout, Familial Mediterranean Fever Approved by FDA

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The U.S. Food and Drug Administration (FDA) has approved Mutual Pharmaceutical Company’s drug, Colcrys, to treat acute flairs in patients with gout, a recurrent and painful form of arthritis, and patients with familial Mediterranean fever (FMF), an inherited inflammatory disorder.

The medication’s active ingredient is colchicine, a complex compound derived from the dried seeds of a plant known as the autumn crocus or meadow saffron (Colchicum autumnale).

Colchicine has been used by healthcare practitioners for many years to treat gout but had not been approved by the FDA. The FDA has an initiative underway to bring unapproved, marketed products like colchicine under its regulatory framework. This initiative promotes the goal of assuring that all marketed drugs meet modern standards for safety, effectiveness, quality and labeling.

Physicians historically have given colchicine hourly for acute gout flares until the flare subsided or they had to stop treatment because the patient began experiencing gastrointestinal problems. A dosing study required as part of FDA approval demonstrated that one dose initially and a single additional dose after one hour was just as effective as continued hourly dosing for acute gout flares, but much less toxic. As a result, the drug is being approved for acute gout flares with the lower recommended dosing regimen.

The FDA is alerting healthcare professionals to this new dosing regimen and also warning about the potential for severe drug interactions when patients take colchicine.

The medicinal value of using colchicum was first identified in the first century A.D. and its use for treating acute gout dates back to 1810. Physicians have prescribed the medication since then. Although single-ingredient colchicine has not been approved by the FDA until now, a combination product containing colchicine and an agent that increased the excretion of uric acid in the urine was approved by the FDA in 1939.

FMF is the most common of the hereditary periodic fever syndromes and is characterized by recurrent episodes of fever, arthritis and painful inflammation of the lining layers of the lungs and abdomen. Though rare in the United States, it is more common in Mediterranean countries. Physicians have prescribed colchicine for FMF for many years based on studies showing that it reduced the frequency of attacks but use of colchicine for FMF had never been approved. With this approval, Colcrys becomes the first drug approved to treat FMF.

Colcrys is manufactured by Mutual Pharmaceutical Company, Inc., Philadelphia.

Pilates: A Low-Impact Way to Build Core Strength, Endurance and Flexibility

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The June issue of Mayo Clinic Women’s HealthSource addresses this increasingly popular low-impact fitness technique. Pilates emphasizes mind-body connection and breath control to build strength, endurance and flexibility, particularly in the trunk muscles.

Many women opt for Pilates because it can provide a nicely toned look without adding bulk. Practiced regularly, Pilates can assist with weight loss and help alleviate low back pain.

Pilates isn’t new. In the early 20th century, Joseph Pilates, a German citizen, developed a system to help his fellow inmates at a World War I internment camp stay physically conditioned. He later opened a studio in New York where his teaching gained a following in the dance and performance arts communities.

Today, Pilates classes are widely available at health clubs, studios, community centers and senior centers. Pilates can be done on a floor mat or using specialized equipment, such as stability balls, resistance bands or most often, a Reformer. This piece of equipment consists of a sliding seat and a series of springs and pulleys that allow progressive exercises to strengthen all muscle groups.

A typical Pilates session includes a set of controlled stretches and movements, with participants concentrating on breathing, precision and flowing movements. Instead of emphasizing quantity, Pilates focuses on quality — doing a few, extremely precise repetitions.

The best way to start is to enroll in a class taught by a qualified instructor. Success with Pilates depends on precision of movement and effort. Proper instruction is key to knowing how to exercise and achieve the benefits.

Early Detection of Digestive Cancers in Multiple Organs with DNA Stool Test

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Mayo Clinic researchers have demonstrated that a noninvasive screening test can detect not only colorectal cancer but also the common cancers above the colon — including pancreas, stomach, biliary and esophageal cancers.

Gastrointestinal (GI) cancers account for approximately one in four cancer deaths. While high cure rates can be achieved with early-stage detection for each type, only colorectal cancer is currently screened at the population level. Most people associate colorectal cancer screening with invasive colonoscopy, but previous Mayo Clinic research has shown that stool DNA testing can identify both early-stage colorectal cancer and precancerous polyps. Researchers are now studying the use of noninvasive stool DNA testing to detect lesions and cancer throughout the GI tract.

“Patients are often worried about invasive tests like colonoscopies, and yet these tests have been the key to early cancer detection and prevention,” says David Ahlquist, M.D., Mayo Clinic gastroenterologist and lead researcher on the study. “Our research team continues to look for more patient-friendly tests with expanded value, and this new study reveals an opportunity for multi-organ digestive cancer screening with a single noninvasive test.”

The researchers studied 70 patients with cancers throughout the digestive tract. Besides colon cancer, the study looked at throat, esophagus, stomach, pancreatic, bile duct, gallbladder and small bowel cancers to determine if gene mutations could be detected in stool samples. Using a stool test approach developed at Mayo Clinic, researchers targeted DNA from cells that are shed continuously from the surface of these cancers. Also studied were 70 healthy patients. Stool tests were performed on cancer patients and healthy controls by technicians unaware of sample source. The stool DNA test was positive in nearly 70 percent of digestive cancers but remained negative for all healthy controls, thus demonstrating the approach’s feasibility.

Stool DNA testing detected cancers at each organ site, including 65 percent of esophageal cancers, 62 percent of pancreatic cancers, and 75 percent of bile duct and gallbladder cancers. In this series, 100 percent of both stomach and colorectal cancers were detected. Importantly, stool test results did not differ by cancer stage; early-stage cancers were just as likely to be detected as late-stage cancers.

“It’s very exciting to see this level of sensitivity for digestive cancer detection in our first look at this test application,” says Dr. Ahlquist, “Historically, we’ve approached cancer screening one organ at a time. Stool DNA testing could shift the strategy of cancer screening to multi-organ, whole-patient testing and could also open the door to early detection of cancers above the colon which are currently not screened. The potential impact of this evolution could be enormous.”

In October 2008, this Mayo Clinic research team published results of a multicenter study using first-generation stool DNA testing. In the seven-year, multicenter study (Ann Intern Med 2008;149:441-50), researchers found that the first-generation stool DNA tests were better than fecal blood tests for detecting cancer and precancerous polyps of the colon.

In January 2009 (Gastroenterology 2009;136:459-70), Mayo researchers published some technical improvements that nearly doubled the sensitivity of stool DNA testing for detecting premalignant polyps and increased cancer detection to about 90 percent, which is the approximate rate of detection observed for CT colonography.

Researchers hope that the next generation tests will have significant improvements in accuracy, processing speed, ease of patient use and affordability. “We anticipate that next generation tests will also be able to predict the tumor site, which will help physicians direct diagnostic studies and minimize unnecessary procedures,” says Dr. Ahlquist.

Source: Mayo Clinic, June 2, 2009

Researchers Develop DNA Compounds that May Help Treat Lupus

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A research team led by a University of Iowa investigator has generated DNA-like compounds that effectively inhibit the cells responsible for systemic lupus erythematosus — the most common and serious form of lupus. There currently is no cure for this chronic autoimmune condition that damages the skin, joints and internal organs and affects an estimated one million Americans.

The team, which included researchers at Boston University School of Medicine, demonstrated the anti-inflammatory effects of class R inhibitory oligonucleotides in laboratory experiments. The findings, which could eventually lead to new treatments, appear May 28 in BioMed Central’s open access journal Arthritis Research and Therapy.

“The increased potency of class R inhibitory oligonucleotides for certain cells involved in lupus flare-ups could help patients by providing specific inhibition, yet allowing them to generate a protective immune response when needed,” said the study’s lead author, Petar Lenert, M.D., Ph.D., assistant professor of internal medicine at the University of Iowa Roy J. and Lucille A. Carver College of Medicine.

During periodic flare-ups in people with lupus, the immune system overreacts and mistakenly attacks cells and tissues throughout the body, resulting in a range of symptoms including inflammation, pain and a characteristic “butterfly rash” across the cheeks.

Using human cell lines and isolated mouse cells, Lenert and his colleagues showed that the DNA-like compounds were able to selectively reduce the activity of two types of immune cells called autoreactive B cells and dendritic cells. When given to mice with lupus, the compounds delayed death and reduced kidney damage, proving their effectiveness.

“With further testing, we hope that class R inhibitory oligonucleotides may become another weapon in the fight against lupus,” Lenert said.

Lupus prevalence varies by country and ethnicity. It is much more common in women than men; nine out of 10 people with lupus are female. Lupus also is three times more common in African-American women than in Caucasian women and is more prevalent in women of Latino, Asian and Native American descent.

The study received grants from the National Institutes of Health and the Alliance for Lupus Research.

Source: University of Iowa Health Sciences, May 27, 2009

Experimental Therapy Uses Body’s Immune System to Increase Cure Rate in Neuroblastoma Patients

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A multicenter research team has announced encouraging results for an experimental therapy using elements of the body’s immune system to improve cure rates for children with neuroblastoma, a challenging cancer of the nervous system.

John M. Maris, M.D., chief of Oncology at The Children’s Hospital of Philadelphia, co-authored the phase 3 clinical trial, which was led by Alice Yu, M.D., Ph.D., of the University of California, San Diego. Maris chairs the committee supervising the trial for the Children’s Oncology Group, a cooperative organization that pools resources from leading medical centers to study and devise new treatments for pediatric cancers.

Neuroblastoma, a cancer of the peripheral nervous system, usually appears as a solid tumor in the chest or abdomen. Neuroblastoma accounts for 7 percent of all childhood cancers, but due to its often aggressive nature, causes 15 percent of all childhood cancer deaths.

Yu will present the neuroblastoma study results on June 2 at the annual meeting of the American Society of Clinical Oncology (ASCO) in Orlando, Fla. In advance of the meeting, ASCO published the findings online on May 14.

Maris explained that immunotherapy for cancer involves triggering the body’s immune system to attack cancer cells. Monoclonal antibodies are molecules customized to target particular cancers, while cytokines are naturally occurring signaling proteins that regulate the body’s immune responses.

In the current study, Children’s Oncology Group researchers studied 226 children with high-risk neuroblastoma. Half received the immunotherapy, while half received standard therapy (chemotherapy and stem cell transplantation). The patients who received the immunotherapy were 20 percent more likely than those in the standard therapy group to live disease-free two years after treatment. “This 20 percent improvement in preventing relapse led to a greater cure rate—the first substantial increase in cure rate for neuroblastoma for more than a decade,” said Maris.

The researchers halted the trial earlier than expected after early results showed the benefits of immunotherapy. “This experimental immunotherapy is poised to become part of the new standard of care for children with the aggressive form of neuroblastoma,” said Maris.

Maris added that the supply of the antibodies and cytokines used in the trial was limited, and that pediatric oncologists were seeking biotechnology companies to move the biological agents into commercial production to make the treatment readily available to children with neuroblastoma.

The Children’s Hospital of Philadelphia has one of the nation’s largest clinical and research programs in neuroblastoma. In 2008, Maris led a study that was the first to identify the gene location at which neuroblastoma originates. His laboratory continues to investigate how genes contribute to the disease, using that knowledge to devise new treatments.

Maris served as an oncologist for Alex Scott, the child with neuroblastoma who started a lemonade stand in 2000 to raise money for programs in childhood cancer. Now operated through the Scott family, the Alex’s Lemonade Stand Foundation supports ongoing research by members of the Children’s Oncology Group.

Source: American Society of Clinical Oncology, May 14, 2009

Children’s Behavioral Problems May Be the Result of Sleep Apnea

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Sleep apnea, not attention deficit disorder, may be the real reason for thousands of kids’ behavioral problems. Obstructive sleep apnea due to enlarged tonsils can cause repeated night-time arrestation of breathing resulting in sleep deprivation, according to ear, nose and throat physicians.

“If kids aren’t sleeping at night it can affect their school work and mental development,” says Stephen Landers, M.D., ear, nose and throat physician on the medical staff at Our Children’s House at Baylor. And kids so affected are sometimes misdiagnosed with learning disabilities. “If children are allowed to sleep properly a lot of these behavioral issues are improved,” adds Dr. Landers.

Parents needing top know whether their children’s ADD or ADHO is actually the result of sleep apnea are encouraged to watch their child sleeping at night. If they snore loudly or make gasping or snorting noises, these could be signs of sleep apnea and the family phyisician should be advised immediately.

In adults, sleep apnea is often caused by excess weight, but in 90 percent of pediatric cases, it is caused by enlarged tonsils. Fortunately, a tonsillectomy can usually treat obstructive sleep apnea in children.