Category: Prior Clinic Blog
STUDY: Popular procedure may have hidden risks,studies find
JOURNAL: Obstetrics & Gynecology
AUTHORS: Dr. Evan Myers
ABSTRACT: An increasingly popular treatment promises to rid women of painful, bleeding uterine fibroids without standard surgery’s risks. But new research has some doctors questioning how long the treatment helps — and if it’s too risky for women who hope to become pregnant.
COMMENTARY: Part of the problem is that this new “uterine artery embolization” has never been fully studied to see how it compares with uterine-sparing surgical removal of fibroids.
But the controversy highlights a bigger issue: “We really don’t know very much at all about how to manage fibroids,” says Dr. Evan Myers of Duke University — even though the uterine growths plague more than a million women a year and are the leading cause of hysterectomies.
Nearly 40 percent of women in their 30s and 40s develop fibroids, non-cancerous growths of muscle fibers inside the uterus. No one knows what causes fibroids, and tiny ones usually cause no symptoms. But they can grow to cantaloupe size, causing severe pain, heavy bleeding and infertility or pregnancy complications.
More than 150,000 hysterectomies — surgical uterus removal — each year are due to fibroids.
For women who still want children, options are limited. Drugs shrink fibroids only temporarily. About 35,000 women a year undergo myomectomy, where surgeons remove fibroids while leaving the uterus intact. But it’s painful, fibroids sometimes grow back, and women who later become pregnant usually require Caesarean deliveries.
Uterine artery embolization, or UAE, is a far less invasive alternative.
Doctors squirt tiny plastic pellets into certain uterine arteries, cutting off the blood supply feeding the fibroids. Over the next three months to a year, the fibroids shrink.
About 85 percent of patients get relief, fueling UAE’s growing popularity. Some 30,000 embolizations have been performed since UAE was first tried in 1995, says Myers, who calls it a promising procedure.
But studies published this month in Obstetrics & Gynecology raise questions about how long that relief lasts — and stress that contrary to public perception, UAE isn’t risk-free.
The University of California, Los Angeles, tracked 59 UAE patients and another 38 who had a myomectomy. Three years later, 29 percent of the UAE patients needed further fibroid treatment; only 3 percent of myomectomy patients did.
Infection, bleeding and blood-vessel clots are considered serious but rare risks of UAE — at least two deaths have been reported since 1995 — although no one knows how often complications occur.
Georgetown University Hospital tracked 400 embolization patients treated there since 1997, and concluded the overall risk of side effects was a low 5 percent. Most were minor — but five patients required days of hospitalization for infection, bleeding or clots. One needed a hysterectomy four months after her UAE, for heavy bleeding when her body expelled a shrunken fibroid. Researchers at Thomas Jefferson University analyzed the 50 published cases of pregnancy after UAE and concluded those women had higher risks of miscarriage, post-delivery hemorrhage, premature birth, breech babies and Caesarean sections than do healthy women. Other researchers say infertility also may be a risk if UAE accidentally blocks blood flow to the ovaries.
Meanwhile, any of the options is reasonable for a woman no longer considering pregnancy, but know that retreatment rates for both UAE and myomectomy remain in question, Myers says.
If women want to become pregnant, they “really need to know they’re taking a chance” with UAE, he adds. Georgetown’s Spies recommends myomectomy in particular for anyone wanting a baby within two years, because UAE shrinks fibroids so slowly.
"Do a little digging” before picking a doctor, adds Cynthia Pearson of the National Women’s Health Network, which urges better fibroid research. “No matter how fabulous things were at Georgetown, a woman can’t assume her results will be the same” if her doctor hasn’t performed many UAEs.
STUDY: Elderly can think themselves into the grave, report finds
JOURNAL: the Journal of Personality and Social Psychology
AUTHORS: Becca Levy
ABSTRACT: Older people can literally think themselves into the grave by feeling bad about getting old.
COMMENTARY: People who said they had more positive views about aging lived an average 7.6 years longer than those with negative perceptions.
How one feels about getting old is more important even than having low blood pressure or cholesterol.
The effect of more positive self-perceptions of aging on survival is greater than the physiological measures of low systolic blood pressure and cholesterol, each of which is associated with a longer lifespan of four years or less.
It is also greater than the independent contributions of lower body mass index, no history of smoking, and a tendency to exercise, each of these factors has been found to contribute between one and three years of added life.
The study carries two messages. The discouraging one is that negative self-perceptions can diminish life expectancy. The encouraging one is that positive self-perceptions can prolong life expectancy.
Let's all think positive!!!!!!
STUDY: CoQ10 and Asthma
JOURNAL: Allergy 2002;57:811-814.
AUTHORS: Dr. Frantisek Gazdik
ABSTRACT: Concentrations of coenzyme Q10 are significantly lower among patients with allergic asthma compared with controls, according to the results of a study by researchers from the Slovak Republic.
COMMENTARY: Dr. Frantisek Gazdik from the Institute of Preventive and Clinical Medicine, Bratislava, and colleagues measured the levels of the antioxidants coenzyme Q10, alpha-tocopherol, and beta-carotene in 56 men and women with allergic asthma and in 25 healthy controls.
Compared with controls, the mean level of coenzyme Q10 among asthmatics was significantly lower at 0.34 mol/L versus 0.52 mol/L in plasma and 0.33 mol/L versus 0.50 mol/L in whole blood (p < 0.001), the researchers found.
The levels of alpha-tocopherol were also significantly decreased in asthmatics compared with controls, but there were no differences in levels of beta-carotene.
Dr. Gazdik's team notes that there was a positive correlation between whole blood coenzyme Q10 and alpha-tocopherol concentrations, and conclude that "the contribution of coenzyme Q10 to antioxidative dysbalance seems to be probable and could not be excluded."
The researchers say that the finding provides a rationale for coenzyme Q10 supplementation in this population.
JOURNAL: Arterioscler Thromb Vasc Biol 2003; 23:1066-1071.
AUTHORS: Dr. Helena J. Teede
ABSTRACT: Australian researchers have discovered one reason why isoflavone-rich diets appear to lower cardiovascular risks.
COMMENTARY: A randomized crossover study in which 46 healthy men and 34 post-menopausal women between the ages of 45 and 75 years took red clover-derived isoflavones and placebo for two 6-week periods.
The treatment formulations predominantly contained either formononetin or biochanin, the isoflavones synthesized by red clover. Subjects were given a total daily dose of 80 mg.
Treatment with the formononetin-enriched isoflavones "significantly reduced arterial stiffness with improved systemic arterial compliance...attributable to a reduction in total peripheral resistance...and a corresponding reduction in central pulse wave velocity," the authors discovered.
"These effects may partly explain the lower cardiovascular risk in populations eating isoflavone-rich diets," they conclude.
Eat you soy !!!!
JOURNAL: Arch Intern Med 2003;163:1448-1453.
AUTHORS: Dr. David J. Maron
ABSTRACT: Daily use of capsules containing flavonoids found in green and black tea appears to produce a significant drop in total and LDL cholesterol levels.
COMMENTARY: Flavonoid use has been shown to lower cholesterol levels in animal studies. There is also evidence from epidemiologic studies that tea consumption can lower such levels and protect against myocardial infarction.
The findings are based on a study of 240 subjects with mild to moderate hypercholesterolemia who were randomized to receive a daily capsule containing theaflavins and catechins or placebo for 12 weeks. All of the subjects were on a low-fat diet.
Treatment with the tea extracts was tied to a 11.3% and 16.4% drop in total and LDL cholesterol levels, respectively, compared with baseline values (p = 0.01 for both).
Tea extract use was also associated with a nonsignificant rise in HDL cholesterol levels and triglyceride levels. No significant change in any of these levels was noted in the placebo group.