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New Procedures Save Frostbite Victims from Amputation

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The standard treatment for frostbite has not changed in decades—re-warming the affected areas, with amputation in severe cases. Radiologists can now re-open recently frozen, clotted arteries with clot-busting and anti-spasmodic drugs, using imaging to visualize areas lacking blood flow and deliver drugs via catheter.

With severely frostbitten hands and feet, subjects in a recent test would typically lose their limbs to gangrene. In this case, Angiography, an X-ray exam of the arteries and veins, was used by interventional radiologists to verify loss of blood flow to a patient’s hand or toes. Intra-arterial catheters then supplied drugs to dissolve the blood clots and relax the arteries’ muscular walls.

A study released today at the Society of Interventional Radiology’s 33rd Annual Scientific Meeting confirmed that this treatment was significantly successful in preventing amputation and saving limbs.

"Previously severe frostbite was a one-way route to limb loss. This treatment is a significant improvement. We’re opening arteries that are blocked so that tissues can heal and limbs can be salvaged. We were able to reopen even the smallest arteries, saving patients’ fingers and toes," said George R. Edmonson, M.D., interventional radiologist with St. Paul Radiology in St. Paul, Minnesota.

According to Edmonson, severe frostbite or "freezeburn" looks like a second degree heat burn with large blisters, but it’s actually body tissue that’s been frozen and-in severe cases-dead, he said. "For half our patients who received the clot-busting drug Tenectaplase, this technique worked beautifully, saving all fingers, hands, toes and feet that otherwise would have been lost," said Edmonson, who has been treating an average of 6–10 frostbite patients each year for the past 10 years.

"Overall, in about 80 percent of the cases, it significantly improved patients’ outcomes. Within one to three days of treatment, we saw improvement," noted Edmonson, explaining that patients were followed for six weeks to assess their final outcomes.

Source: Society for Interventional Radiology

Alcohol May Cause Lower Brain Volume

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According to a recent report, the more you drink the smaller your brain becomes. It is estimated that 1.9 percent decrease in brain volume per decade accompanies an increase in white matter lesions.

The progression of dementia and problems with thinking, learning and memory are accompanied by lower brain volumes and larger white matter lesions. Moderate alcohol consumption has been associated with a lower risk of cardiovascular disease; because the brain receives blood from this system, researchers have hypothesized that small amounts of alcohol may also attenuate age-related declines in brain volume. The study results were published in the October, 2008 issue of Archives of Neurology.

Members of the Framingham Offspring Study, which began in 1971 and included 1,839 adults with an average age of 60, were studied by Carol Ann Paul, M.S., of Wellesley College, Mass., and colleagues. The Study also included children of the original Framingham Heart Study participants and their spouses. Between 1999 and 2001, participants underwent magnetic resonance imaging (MRI) and a health examination. They reported the number of alcoholic drinks they consumed per week, along with their age, sex, education, height, body mass index and Framingham Stroke Risk Profile (which calculates stroke risk based on age, sex, blood pressure and other factors).

“Most participants reported low alcohol consumption, and men were more likely than women to be moderate or heavy drinkers,” the authors write. “There was a significant negative linear relationship between alcohol consumption and total cerebral brain volume.”

Although men were more likely to drink alcohol, the association between drinking and brain volume was stronger in women, they note. This could be due to biological factors, including women’s smaller size and greater susceptibility to alcohol’s effects.

“The public health effect of this study gives a clear message about the possible dangers of drinking alcohol,” the authors write. “Prospective longitudinal studies are needed to confirm these results as well as to determine whether there are any functional consequences associated with increasing alcohol consumption. This study suggests that, unlike the associations with cardiovascular disease, alcohol consumption does not have any protective effect on brain volume.”

Source: Archives of Neurology,

Protecting Yourself from the Sun to Avoid Skin Cancer

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Before leaving home for a day of outdoor activity, take appropriate precautions to ensure that your and your family’s skin is well-protected, as the majority of all skin cancers are caused by the sun.

According to Susan Chon, M.D., assistant professor of dermatology at The University of Texas M. D. Anderson Cancer Center, a sunscreen with an SPF of at least 30 is a good choice for most people. One ounce of sunscreen (enough to fill a shot glass) is considered sufficient to properly cover sun-exposed areas. To get the most protection from sunscreen, generously reapply throughout the day. This is especially important because factors such as humidity, perspiration and uneven product application can cause sunscreen to lose its effectiveness.

Sun Protection Checklist
Chon recommends gathering the following items before heading outdoors.

  • Sunscreen with SPF 30 or greater
  • Lip balm with SPF 30
  • Hat with a brim or cap
  • Long-sleeved shirt (preferably sun protective clothing)
  • Sunglasses with UV protection

"These are great items to keep handy in your bag to prepare for the sun as it intensifies throughout the day," Chon said.

Application Time Line
Chon suggests the following time line for when to best use these items.

Morning: 8 – 10 a.m. Apply sunscreen with SPF 30, at least 30 minutes before sun exposure.
Reapply sunscreen every two hours.
Wear a hat, sunglasses and lip balm.

Midday: 11 a.m. – 2 p.m. (hottest time of the day)
Seek shade for extra protection.
Wear a long-sleeved shirt with a hat and sunglasses.
Reapply sunscreen and lip balm every two hours.

Afternoon: 3 – 5 p.m.
Keep wearing a hat and sunglasses.
Reapply sunscreen and lip balm every two hours.

"Remember, if you are sweating or swimming, you may need to reapply more often," Chon said. Avoid reflective surfaces such as water, sand, snow and concrete. "You can burn from indirect exposure to the sun, too," Chon said.

According to the American Cancer Society, more than one million cases of basal cell or squamous cell cancers, the most common types of skin cancer, occur annually. The most serious form of skin cancer is melanoma, of which more than 60,000 people are expected to be diagnosed in 2008.

Source: University of Texas M. D. Anderson Cancer Center

Brain Changes in Elderly Can Affect Mobility and Balance

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Changes in the brain can affect old people’s mobility and balance, according to a recent study. Particularly affecting balance and walking are white matter changes called leukoaraiosis.

The 639 men and women between the ages of 65 and 84 in the study underwent brain scans and walking and balance tests. 284 people in the group had mild age-related white matter changes, 197 moderate changes, and 158 severe changes.

People with severe white matter changes were twice as likely to score poorly on the walking and balance tests as people with mild white matter changes, the study found. The people with severe changes were also twice as likely as those with mild changes to have a history of falls. The moderate group was only one and a half times as likely as the mild group to have a history of falls.

"Walking difficulties and falls are major symptoms of people with white matter changes and a significant cause of illness and death in the elderly," said study author Hansjoerg Baezner, MD, PhD, with the University of Heidelberg in Mannheim, Germany. "Exercise may have the potential to reduce the risk of these problems since exercise is associated with improved walking and balance. We’ll be testing whether exercise has such a protective effect in our long-term study of this group."

"Mobility is one of the key determinants of independent aging," said Baezner. "Limitations in mobility often lead to hospitalization and nursing home placement. This will become a major problem for our social and economic systems in the upcoming decades."

Published in Neurology, the medical journal of the American Academy of Neurology,the 3-year study was coordinated by the Department of Neurological and Psychiatric Sciences of the University of Florence.

Source: Neurology, March 18, 2008

Vertebroplasty Shows Promise for Vertebral Compression Fracture Treatment

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Vertebroplasty, an interventional radiology treatment for vertebral compression fractures, provides patients with significant pain relief and lasting benefit, according to a 5-year follow-up study of 884 osteoporosis patients.

The procedure calls for the injection of medical-grade bone cement into a fractured vertebra, and acts like an internal cast on the fracture. It is particularly effective for painful vertebral compression fractures that do not respond to analgesics or intolerable narcotics. The average pre-treatment pain score on the 11-point Visual Analog Scale was 7.9 +/- 1.5, and it dropped significantly to an average of 1.3 +/- 1.8 after the vertebroplasty treatment.

The Oswestry Disability Questionnaire (ODQ), which measures a patient’s ability to manage everyday life, was completed by patients before, and one month after vertebroplasty, and showed greatly improved mobility—from an average of 69.3 percent +/- 13.5 to 18.8 percent +/- 6.9.

"These data provide good news for physicians and osteoporosis patients. Many osteoporosis patients with compression fractures are in terrible pain and have a greatly diminished ability to perform basic daily activities, such as dressing themselves," said Giovanni C. Anselmetti, M.D., interventional radiologist at the Institute for Cancer Research and Treatment in Turin, Italy. While vertebroplasty can improve a patient’s quality of life, the procedure is generally reserved for people for whom conventional medical management was ineffective.

"Osteoporosis patients who have persistent spinal pain lasting more than three months should consult an interventional radiologist, and those who require constant narcotic pain relief should seek help immediately," noted Anselmetti. The treatment was completed in all patients without major complications and with good clinical results. The data add to the body of evidence in the United States for the minimally invasive treatment’s safety, effectiveness and low-complication rate. The treatment is widely available in the United States at all major institutions and many smaller institutions and is generally covered by health insurance.

The study also showed that vertebroplasty does not increase the risk of fracture in nearby vertebra. "Vertebroplasty is already known to be a safe and effective treatment for osteoporotic vertebral fractures. Osteoporosis patients remain susceptible to new fractures, which often occur in the contiguous vertebra to an existing fracture. Our large-scale study shows that vertebroplasty does not increase the risk of fracture in the level contiguous to previously treated vertebra and that these new fractures occur at the same rate as they would in osteoporosis patients who did not have vertebroplasty," added Anselmetti.

The research was presented at the Society of Interventional Radiology’s 33rd Annual Scientific Meeting.

Obese Women Experience More Aggresive Breast Cancer

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Obese women with breast cancer have lower rates of survival, and suffer a more intense form of the disease, according to recently-published research.

"The more obese a patient is, the more aggressive the disease," said Massimo Cristofanilli, MD, associate professor of medicine in the Department of Breast Medical Oncology at The University of Texas M.D. Anderson Cancer Center. "We are learning that the fat tissue may increase inflammation that leads to more aggressive disease."

606 women with breast cancer were observed by Cristofanilli and colleagues, and classified by body mass index into three groups—normal/underweight (24.9 or below), overweight (at least 25 but less than 30), or obese (more than 30). At five years, overall survival was 56.8 percent among obese women, 56.3 percent among overweight women and 67.4 percent among normal weight women. The 10-year survival rate was 42.7 percent among obese women, 41.8 percent among overweight women and 56.5 percent among normal weight women. Researchers found that the rate of inflammatory breast cancer was 45% among obese women, compared with 30% in overweight women, and 15% in women with normal weight.

Obese or overweight women also displayed a higher risk of breast cancer recurrence. Obese women (50.8%) reported a recurrence after 5 years, compared with normal weight women (38.5%). After 10 years, the rate of recurrence was 58% in obese women and 45.4% in women with normal weight.

"Obesity goes far beyond just how a person looks or any physical strain from carrying around extra weight. Particular attention should be paid to our overweight patients," Cristofanilli said.

Drugs commonly used to treat cancer patients, such as tamoxifen, said Dr. Cristofanilli tend to increase weight gain during treatment – an effect physicians should note carefully. "We have actually become quite good at managing acute side effects such as nausea in our chemotherapy patients and it goes away within a couple of days," Cristofanilli said. "Following the nausea, our patients tend to overeat, which further increases their risk of weight gain. We need to implement lifestyle modifications interventions and develop better methods to follow these patients closely."

Clinical Cancer Research, March 15, 2008

Lung Damage Evident 25 Years After Workers Exposed to Legal Limits of Asbestos-Like Material (Vermiculite)

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Workers who processed vermiculite tainted with asbestos-like fibers 25 years ago show high prevalence of scarring and thickening of the membrane that lines the chest wall, including people exposed below legal levels.

In 1970 workers who had handled "Libby vermiculite" (so named after the Libby, Montana mine where the tainted fibers were first noted), exhibited a cluster of bloody pleural effusions. The Libby mine at one time produced up to 80 percent of the vermiculite used around the world.

513 former workers at a plant that processed Libby vermiculite were checked by researchers in 1980, and pleural changes or interstitial fibrosis were found in 2.2 percent of them. A team led by James Lockey, M.D., the principal investigator of this report, found that the unadjusted prevalence in the still-living members of the original cohort was 28.7 percent for pleural changes and 2.9 percent for interstitial fibrosis. The findings are published in the second issue for March of the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

"I expected to see a higher rate of x-ray changes, but was surprised at the percentage," said. Dr. Lockey. "We found that even low levels of exposure to asbestos-like fibers can cause thickening of the membrane that lines the chest wall."

280 workers of the 431 workers stlll living were interviewed for the follow-up study, to determine their lung health and work history, as well as their exposure level and the number of years worked. Chest X-rays were reviewed by professional radiologists for pleural plaques, thickening and interstitial changes.

A significant trend of increasing changes with increased exposure was detected by researchers analyzing workers with pleural changes. Those with the highest exposure levels had an average of 6 to 16 times the risk of pleural changes compared with those minimally exposed. Equally important, changes were significant at levels permitted by law.

The findings indicate that "a significant number of workers exposed at the current limit would experience pleural abnormalities," wrote Gregory Wagner, M.D., of the National Institute for Occupational Safety and Health, in an accompanying editorial. Furthermore, regulations governing legal exposure limits to hazardous materials apply only to specific fibers, not to all types of fibers that have similar and predictable biological effects.

"When humans are exposed to any mineral fibers that are long, thin and durable in human tissue and can reach the pleural membrane, these fibers can cause health problems," said Dr. Lockey. "Six types of asbestos are currently regulated, but other existing types of fibers that share similar characteristics are not."Perhaps most importantly, the research highlights the need to anticipate the health implications of occupational exposures.

"The initial Lockey investigation found a relatively modest prevalence of pleural abnormalities," wrote Dr. Wagner. But the current study "found over 10 times that level, despite the fact that contaminated vermiculite had been removed from the production process by 1980."

Consumers encountered minimal risk from most products containing Libby vermiculite, said Dr. Lockey, but advised that any home improvements that involve contact with vermiculite insulation should be left to professionals.

Source: American Journal of Respiratory and Critical Care Medicine, March, 2008 (second issue).

Appendix Removed Via the Mouth in First of its Kind Surgery in US

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Surgeons have performed one of the first removals of an appendix via the mouth in the United States. The surgery was part of a clinical trial designed to test techniques for minimally invasive surgery.

The surgery was performed on Jeff Scholz, a 42-year old California resident, at US San Diego Medical Center by Santiago Horgan, M.D., professor and director of UC San Diego’s Center for the Future of Surgery, and Talamini, president elect of the Society of American Gastrointestinal and Endoscopic Surgeons. UC San Diego Medical Center is first U.S.-based hospital to perform this procedure. India is the only other country to report such an operation.

"Only one small incision to insert a small camera in the belly button was required to complete the surgery versus three incisions required for a laparoscopic procedure," said Horgan. "The patient was discharged 20 hours after surgery and is now reporting minimal pain which is a goal for all of our patients."

"I had to have my appendix removed and the opportunity to participate in something so innovative sounded enticing. A day after surgery, I have little pain, a ‘2’ on a scale of 1 to 10," said Scholz, a resident of La Jolla. "My father had the conventional appendix removal. I didn’t want the standard issue scar on the abdomen."

The procedure, called Natural Orifice Translumenal Endoscopic Surgery (NOTES), involves passing surgical instruments, and a tiny camera, through a natural orifice, such as the mouth, to the desired organ. By avoiding major incisions through the abdomen, patients may experience a quicker recovery with less pain while reducing the risk of post operative hernias.

Horgan and Talamini used FDA-cleared EndoSurgical Operating System (EOS) developed by USGI Medical, Inc. to perform the procedure. EOS was passed through the patient’s mouth and into the stomach where a small incision was made in the stomach wall to pass the instrument through to the appendix for removal.

In addition to Horgan and Talamini, the surgical team included: John Cullen, M.D., Garth Jacobsen, M.D., Karl Limmer, M.D., John McCarren, M.D., Bryan Sandler, M.D.and Thomas Savides, M.D.

Source: University of California, San Diego Health Sciences

Genistein in Soybeans May Halt Prostate Cancer Spread

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Genistein, an antioxidant found in soybeans, almost completely prevented the spread of human prostate cancer in mice, according to a study published in the journal Cancer Research. In the study, genistein was used in an amount equivalent to what a human being would consume in a soybean-rich diet.

Genistein decreased metastasis of prostate cancer to the lungs by 96% compared with mice that did not eat the compound, the first demonstration that genistein can stop prostate cancer metastasis in a living organism. "These impressive results give us hope that genistein might show some effect in preventing the spread of prostate cancer in patients," said the study’s senior investigator, Raymond C. Bergan, MD, director of experimental therapeutics for the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

"Diet can affect cancer and it doesn’t do it by magic," Bergan said. "Certain chemicals have beneficial effects and now we have all the preclinical studies we need to suggest genistein might be a very promising chemopreventive drug."

Bergan has already shown in prostate cell cultures that genistein slows detachment of cancer cells from a primary prostate tumor, and checks cell invasion. It does this by blocking activation of p38 MAP kinases, molecules which regulate pathways that activate proteins that loosen cancer cells from their tight hold within a tumor, pushing them to migrate. "In culture, you can actually see that when genistein is introduced, cells flatten themselves in order to spread out and stick strongly to nearby cells," he said.

Researchers implanted groups of mice with an aggressive form of prostate cancer, having first fed them genistein. The amount of the chemical in the mouses’ blood was equivalent to human blood concentrations after eating soy foods, said Bergan. Genistein stopped lung mestasis almost completely, although it did not reduce the size of the tumors that developed within the prostate. Repeating the experiment produced he same result.

The size of tumor cells’ nuclei in the animals’ tissue was checked, to see whether he cells had flattened t in rder to spread. "Within a tumor, it is hard to tell where the borders of cells stop, so one way to measure adherence is to look at the size of the nuclei in cells and see if they are wider due to cell spread," Bergan said. "And that is what we found, demonstrating that the drug is having a primary effect on metastasis."

"What we think is happening here is that the cells we put in the mice normally like to move. When genistein restricted their ability to do so, they tried to compensate by producing more protein involved in migration. But genistein prevented those proteins from being activated," he said. "This is really a lesson for researchers who depend on biomarker studies to test whether a treatment is working. They need to be aware that those biomarkers might be telling only half of the story."

Source: Cancer Research, a journal of the American Association for Cancer Research. March 15, 2008.

Alzheimer’s Disease Connection to Stroke Explained

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The risk of Alzheimer’s disease is nearly doubled among people who have had a stroke, and researchers at Columbia University Medical Center have found a process in the brain that explains the connection.

There is an increase in the production of the toxic amyloid beta (Aß) peptides after a stroke that are believed to cause Alzheimer’s disease. Results in this study showed that Aß production rises when there is an increase in production of a peptide called p25, which occurs in rodents and humans following a stroke. The Columbia team identified a pathway, known as p25/cdk5, whereby higher levels of p25 led to enhanced activity of a molecule called cdk5, which in turn led to a rise in the production of Aß

By reducing the activity of cdk5, by either an inhibitor or by genetic manipulation, lead author Karen found a decrease in Aß production in the brain, demonstrating that the p25/cdk5 pathway may be a treatment target for Alzheimer’s disease. Specifically, inhibitors of cdk5 are particular candidates for therapeutic development.

"This finding connects the dots between p25 and increased production of amyloid beta, and this p25/cdk5 pathway could explain why the risk of Alzheimer’s disease is significantly higher following a stroke," said Dr. Duff, professor of pathology (in psychiatry and in the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain) at Columbia University Medical Center and the New York State Psychiatric Institute. "However, we still need to verify that this pathway is actually set in motion after a stroke; right now the data is still circumstantial."

Dr. Duff’s laboratory is currently working on experiments to verify this pathway’s involvement using human post-mortem tissue of stroke patients. The specific pathway investigated was shown to be most active in young mice, as compared to older mice suggesting that p25/cdk5 may not be implicated in late-onset Alzheimer’s disease, the most common form of this neurodegenerative disease.

The research was published in the March 13, 2008 issue of Neuron.