Category: Prior Clinic Blog
STUDY: Early treatment to reduce pressure in the eye can slow the progression of glaucoma.
JOURNAL: Archives of Ophthalmology 2002;120:1268-1279
AUTHORS: Dr. Anders Heijl
ABSTRACT: Early treatment to reduce pressure in the eye can slow the progression of glaucoma, according to a new study.
COMMENTARY: The study is the first "definite proof" that lowering intraocular pressure early in glaucoma can slow the deterioration caused by the disease.
But he cautioned that the encouraging results of the study "do not mean that all glaucoma patients should receive maximum treatment." He noted that since glaucoma did not progress for several years in some patients who did not receive treatment, it is "reasonable" to delay treatment in some low-risk patients "and instead follow them closely as long they show no worsening of their disease."
Glaucoma was less likely to progress in patients who underwent treatment, and when the disease did advance, it did so later than in untreated patients. During the study, glaucoma progressed in 45% of treated patients compared with 62% of untreated patients. On average, progression occurred 18 months later in the treatment group than in the control group.
Even though the study demonstrated the benefits of early treatment, Heijl noted that "disease progression rates vary very much between individual patients. Treatment and follow-up must therefore be tailored to the needs of the individual patient." He said that newly diagnosed patients should probably be followed for signs of progression more closely than is common today.
Talk over your treatment options with you doctor.
STUDY: Weight Loss Improves Outcome
JOURNAL: American Journal of Clinical Nutrition (2002;75(Suppl):339S).
ABSTRACT: Overweight people infected with the hepatitis C virus (HCV) may be able to limit or even reverse virus-caused liver damage by losing weight, according to recent study in the American Journal of Clinical Nutrition.
COMMENTARY: The Centers for Disease Control and Prevention estimate almost four million Americans have been infected with HCV, and that 75 to 85% of these people will develop a chronic infection due to the virus.
Hepatitis C is most often contracted through blood transfusions, intravenous drug use (sharing needles), or through other blood exposure. While most people with chronic HCV have no symptoms, infection with this virus can cause long-term liver damage and rarely is associated with liver cancer.
Men and those who consume more than 10 grams (one-third of an ounce) of alcohol per day appear to be at higher risk of developing more severe liver disease.
The success rate for conventional antiviral treatment is less than 50%, with many people experiencing only temporary remission. Common medications prescribed for HCV include alpha-interferon (Roferon A®) and ribavirin (Rebetol®, Rebetron®), which may be given for six months to one year. These treatments are expensive and have many debilitating side effects.
Researchers put 19 overweight people with HCV on a 12-week diet and exercise program, with a goal of losing about 1 pound per week. At the conclusion of the study, average weight loss was approximately 13 pounds. In addition, several markers of liver health improved, including a decrease in liver enzymes (higher numbers suggest more liver damage) and a reduction in the amount of scar tissue and fat in the liver.
These changes indicate a decrease in the severity of the liver disease. Those who continued on the weight loss program for another 12 months had sustained improvement in the health of their liver.
A surprising finding is that these improvements occurred even though the virus was not eradicated from the body. This study therefore suggests that overweight individuals may be able to improve the health of their liver, even if they continue to suffer from chronic hepatitis C.
It is important to note that going on a diet is not a substitute for medical treatment for hepatitis C, but rather an additional approach to help improve liver function. Please consult a physician or nutritionist before starting any diet or exercise program.
STUDY: Photodynamic Therapy
JOURNAL: Journal of Urology 2002;168:1427-1432.
AUTHORS: Timothy R. Nathan
ABSTRACT: Researchers may have added prostate cancer to the list of cancers that can benefit from photodynamic therapy (PDT), which combines drugs and light to treat cancer and other conditions.
COMMENTARY: Timothy R. Nathan of the University College London Hospital in the UK and his colleagues report that most patients treated with PDT, whose prostate cancer had returned following radiation treatment, appear to benefit from the new therapy.
Specifically, the authors report, more than half of treated patients experienced a decrease in their blood levels of PSA, a protein produced by the prostate gland that is often elevated in the presence of prostate cancer. In addition, more than one third of PDT-treated men showed no trace of cancer from a post-treatment biopsy.
Photodynamic therapy is a new option that could be suitable for organ confined prostate cancer recurrence after radiotherapy. These results suggest that photodynamic therapy merits further investigation.
PDT is a two-step therapy that is already being used to treat head and neck cancers, especially esophageal cancers. The first step is to give the patient a light-activated drug such as Photofrin, which tends to collect in tumors. The drug makes the abnormal tissue particularly sensitive to light. The second step is to shine a laser light on the drug-saturated tumors for a brief period of time. There are several PDT drugs available, and each is activated by different wavelengths of light.
Recent reports have suggested that PDT may also help treat cancers of the pancreas, lung and breast.
During the current study, Nathan and his team administered PDT to 14 men. All patients had prostate cancer that had returned following treatment with radiation, as indicated by an increase in PSA and results from a biopsy.
After the procedure, the researchers noted that PSA levels decreased in 9 patients, reaching undetectable levels in 2 patients. Biopsies of 5 patients showed that they were tumor-free. Scans showed that PDT had destroyed up to 91% of the prostate tissue.
A few of the patients experienced side effects after the treatment, Nathan and his team note. Four of the men reported stress incontinence, meaning they leaked urine as a result of laughing, coughing, sneezing or exercise, which began to gradually improve over time. Seven of the participants were able to have intercourse before PDT, and 4 reported a decrease in their abilities after receiving light therapy. This side effect did not appear to diminish over time, the authors report in the October issue of the Journal of Urology.
Complications were no worse among the patients than among studies of patients given surgery or cryotherapy to treat prostate tumors that had returned after treatment. And, the researchers note, complications could be reduced by dosage adjustment.
STUDY: Probiotics reduce duration of diarrheas
JOURNAL: Pediatr Infect Dis J 2002;21:411-419
AUTHORS: Dr. Vibeke Rosenfeldt
ABSTRACT: Oral bacteriotherapy with Lactobacillus rhamnosus and L. reuteri reduces the duration of diarrhea in children with mild gastroenteritis and in those with more severe disease requiring hospitalization, Danish researchers report.
COMMENTARY: The investigators conducted placebo-controlled trials in a cohort of 69 children, ages 6 to 36 months, who were hospitalized for diarrhea, and in a second group of 43 children, ages 9 to 44 months, who were attending day-care centers.
More than half the subjects in both groups were infected with rotavirus. Other pathogens isolated were Campylobacter jejuni, Salmonella typhimurium and Clostridium difficile.
By day 5 after treatment began, three of the 30 probiotic-treated hospitalized children still had loose stools, versus 13 of the 39 children given placebo (p=0.03).
Results were similar in the outpatient cohort. Probiotic-treated children spent 1.6 days in the hospital, on average, versus 2.6 days for the patients given placebo (p=0.02).
The effect of treatment was most pronounced when treatment was initiated within the first 60 hours of illness. Time to recovery was 79 to 80 hours in the early intervention treatment groups and 130 to 139 hours in the early intervention placebo groups.
L. rhamnosus had been chosen because of its ability to extensively adhere to intestinal epithelium. L. reuteri was selected because of its antimicrobial activity.
Based on comparison of their results with those of previous studies, the researchers believe that dual therapy is unnecessary, and that the ability to colonize the mucosa is the more important of the two characteristics.
STUDY: Older men's sperm is more prone to genetic defects than that of younger men, according to a new study.
JOURNAL: American Society for Reproductive Medicine
AUTHORS: Dr. Narendra Singh
ABSTRACT: Men who put their career before having a family should beware: the ticking of the biological clock is as important for fertility in men as it is in women.
COMMENTARY: American scientists have discovered that genetic damage to sperm routinely starts to cause infertility in men as young as 35.
The strongest biological evidence yet for a significant drop in male fertility in the late thirties is a warning to the increasing number of grey-haired fathers who are leaving it later to have children.
The popular worry that career women risk losing the chance to have children has long been supported by infertility research focusing on how the quality of women’s eggs deteriorates with age.
Researchers from the University of Washington in Seattle have now provided the first firm molecular explanation for why childless career men should worry too. The chances of having a baby are reduced if the man is in his late thirties or forties.
Dr Singh’s team found that, whatever the sperm count, its genetic quality was closely related to age, with a cut-off point for serious damage of about 35.
Men in the older group had higher concentrations of sperm with broken strands of DNA, more acute levels of such genetic damage and their immune systems were much less efficient at weeding out faulty sperm by programmed cell suicide, or apoptosis. The sperm of the older men were also less vigorous swimmers.
Men concerned about their fertility should avoid activities such as smoking that may damage the DNA of their sperm. While there’s nothing anyone can do about getting older, men who want to retain their own best capacity to father children should try to minimise contact with toxic agents and maintain a healthy lifestyle.
The findings do not suggest that most men who wait until after 35 to try for children will have problems, particularly if the man’s partner is in her twenties or early thirties. But the study does alert fertility doctors to another potential problem when older couples have difficulty in conceiving.