February 2, 2011, 10:50 PM CT

Migraine surgery offers good long-term outcomes

Surgery to "deactivate" migraine headaches produces lasting good results, with nearly 90 percent of patients having at least partial relief at five years' follow-up, reports a study in the recent issue of Plastic and Reconstructive Surgery�, the official medical journal of the American Society of Plastic Surgeons (ASPS).

In about 30 percent of patients, migraine headaches were completely eliminated after surgery, as per the newly released study, led by Dr. Bahman Guyuron, chairman of Plastic and Reconstructive Surgery at University Hospitals Case Medical Center and Case Western Reserve University School of Medicine in Cleveland, Ohio.



'Trigger Site' Surgery Reduces or Eliminates Migraine Headaches

Dr. Guyuron, a plastic surgeon, developed the migraine surgery techniques after noticing that some migraine patients had reduced headache activity after undergoing cosmetic forehead-lift procedures. The techniques consist of "surgical deactivation" of "trigger sites" in the muscles or nerves that produce pain.

For example, for patients with frontal migraine headaches starting in the forehead, the muscles in that area were removed, as in forehead-lift surgery. This procedure may reduce headache attacks by relieving pressure on key nerve in the frontal area. Other approaches target other migraine trigger sites......... Posted by: Daniel      Read more         Source

February 2, 2011, 10:33 PM CT

Search for better drug-addiction treatments

UT Southwestern Medical Center psychiatry scientists are leading the Texas arm of a national network that conducts clinical trials aimed at finding effective therapys for drug addiction.

More than 100 community therapy providers and academic medical centers throughout the country are funded in part through the National Institute on Drug Abuse's Clinical Trials Network (CTN). The Texas component includes partnerships between academic and community therapy providers in Dallas, El Paso, Austin and Houston. It is led by Dr. Madhukar Trivedi, professor of psychiatry at UT Southwestern.

"The effects of drugs on the brain are very clear, but we still need long-term answers that cure people who abuse drugs and prevent them from relapse," Dr. Trivedi said. "I applaud NIDA for funding the infrastructure at academic institutions to research therapies in real-world therapy centers that will lead to ready-to-launch cures. Drug abuse affects not just the person, but families and society as a whole."

Each CTN study is conducted in multiple community therapy provider sites across the country, led by a CTN substance abuse researcher and supported by the scientists in the CTN academic institutions affiliated with each participating site.

"It is critical to find new therapys in the substance abuse field where current therapys result in only modest improvements. Finding effective interventions really requires larger, multicenter therapy trials like those occurring in the CTN," Dr. Trivedi said......... Posted by: JoAnn      Read more         Source

February 2, 2011, 7:57 AM CT

PET Scans May Allow Early Prediction

Positron emission tomography (PET) can image metabolic changes following therapy with the protein kinase inhibitor vandetanib, helping to define the treatment response or the effectiveness of the therapeutic agent, as per research reported in the recent issue of The Journal of Nuclear Medicine. Currently being tested in clinical trials, vandetanib inhibits the function of the RET (rearranged-during-transfection protein) proto-oncogene and other protein kinases involved in the development and progression of cancer.

"For the most part, clinical trials have been measuring the effectiveness of vandetanib by changes in tumor size. Based on the activating effects of mutated RET and other protein kinases on numerous intracellular metabolic pathways, we hypothesized that PET imaging could play a role in the early assessment of response to vandetanib," said Martin A. Walter, MD, main author of the study "Metabolic Imaging Allows Early Prediction of Response to Vandetanib".

The study examined the usefulness of metabolic imaging to determine response to vandetanib in three ways. First, medullary thyroid cancer cells were used to create an in vitro model. After cultivation, the cells were treated with vandetanib, and changes in the metabolic profile of the cells were successfully monitored by transcriptional profiling and by radiotracer uptake studies......... Posted by: Janet      Read more         Source

February 2, 2011, 7:50 AM CT

Targeted particle fools brain's guardian to reach tumors

A targeted delivery combination selectively crosses the tight barrier that protects the brain from the bloodstream to home in on and bind to brain tumors, a research team led by researchers from The University of Texas MD Anderson Cancer Center published in the recent issue of the Journal of Clinical Investigation

In experiments with mice, the scientists demonstrated that the targeted particles guide payloads to image tumors, treat tumors, or can potentially do both to monitor therapy as it occurs. Their findings open a new research avenue for detecting and treating brain tumors in human patients.

"We've identified an iron-mimic peptide that can hitch a ride on a protein complex that transports iron across the blood-brain barrier," said co-senior author Wadih Arap, M.D., Ph.D., professor in the David H. Koch Center at MD Anderson. "Employing the iron transport system selectively opens the blood-brain barrier for tumor imaging and therapy while keeping it otherwise intact to play its protective role".

The barrier thwarts drug delivery because its tight layering of blood vessel cells and certain types of brain cells forms a nearly impenetrable wall against most blood-borne compounds, which can harm the brain. The iron-transporting transferrin protein and receptor complex is a potential path to therapy, the authors noted, because its receptor gene is the most overexpressed in human glioblastomas......... Posted by: Scott      Read more         Source

February 2, 2011, 7:47 AM CT

Teens with HIV at high risk for pregnancy

Teenage girls and young women infected with HIV get pregnant more often and suffer pregnancy complications more frequently than their HIV-negative peers, as per new research led by Johns Hopkins investigators.

A report on the multi-center study, based on an analysis of records from 181 patients with HIV, ages 13 to 24, treated at four hospitals over 12 years, would be reported in the Feb. 2 issue of the Journal of the American Medical Association

The findings are alarming for at least two reasons, the researchers say. First, teen pregnancies � planned or not � put these already vulnerable patients and their fetuses in grave danger for complications. Second, the findings signal that HIV-infected teens and young women continue to practice unsafe sexual behaviors and to have unprotected sex, the scientists say.

Pregnancy rates were particularly high in one subgroup of HIV-infected youth � teens who acquired the virus behaviorally rather than during birth. Behaviorally infected teens had five times the number of pregnancies in comparison to their HIV-negative counterparts and were more prone to premature births and spontaneous abortions than their HIV-negative peers.

Because of its retrospective nature, the study did not capture why the patients got pregnant. The answer to this question, the scientists say, would supply critical information for future pregnancy-counseling and risk-reduction efforts......... Posted by: Mark      Read more         Source

February 2, 2011, 7:47 AM CT

Safety checklist use yields 10 percent drop in hospital deaths

A Johns Hopkins-led safety checklist program that virtually eliminated bloodstream infections in hospital intensive-care units throughout Michigan appears to have also reduced deaths by 10 percent, a newly released study suggests. Eventhough previous research showed a major reduction in central-line related bloodstream infections at hospitals using the checklist, the newly released study is the first to show its use directly lowered mortality.

"We knew that when we applied safety science principles to the delivery of health care, we would dramatically reduce infections in intensive care units, and now we know we are also saving lives," says Peter J. Pronovost, M.D., Ph.D., a professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine and leader of the study published in BMJ, the British medical journal. "Thousands of people are believed to have survived because of this effort to reduce bloodstream infections".

Pronovost's prior research has shown that coupling a cockpit-style, infection-control checklist he developed with a work environment that encourages nurses to speak up if safety rules aren't followed reduced ICU central-line bloodstream infections to nearly zero at The Johns Hopkins Hospital and at hospitals throughout the states of Michigan and Rhode Island. Experts say an estimated 80,000 patients a year with central lines get infected, some 31,000 die � nearly as a number of as die from breast cancer annually � and the cost of treating them appears to be as high as $3 billion nationally......... Posted by: Janet      Read more         Source

February 2, 2011, 7:45 AM CT

More doctors must join nurses, administrators

Efforts to keep hospital patients safe and continually improve the overall results of health care can't work unless medical centers figure out a way to get physicians more involved in the process.

"Physicians' training and perspectives on patient care make their contributions to improvement efforts essential," says Peter J. Pronovost, M.D., Ph.D., a Johns Hopkins patient safety expert and co-author of a commentary reported in the Feb. 2 Journal of the American Medical Association "But the work of improving quality currently rests primarily with hospital administrators and nurses, with physicians taking a peripheral volunteer role, often questioning the wisdom of these efforts".

The major obstacle to recruiting doctor leaders to the safety movement, he says, is the failure of medical centers to professionally and financially compensate and reward physicians for spending time on quality-improvement projects. "Such projects take away from the time physicians spend treating patients � and generating revenue," he says. "What's needed is a system that would support a portion of a doctor's time spent managing and standardizing quality of care on a particular unit, in a role similar to what now happens with nurse managers."

Pronovost, a professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine, and Jill A. Marsteller, an assistant professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health, note that studies show little evidence that hospital quality-improvement programs have improved patient outcomes, despite buy-in from top administrators and a push for accountability. "Hospitals will only begin to see progress if they get physicians to not just participate more but to assume leadership roles in quality improvement," Pronovost says......... Posted by: Janet      Read more         Source

February 2, 2011, 7:41 AM CT

Painful hip fractures strike breast cancer survivors

A hip fracture is not common in a 54-year-old woman, unless she is a 54-year-old breast cancer survivor, as per a new Northwestern Medicine study. Scientists observed that a combination of early menopause due to breast cancer therapy and common drugs used to treat breast cancer, could be weakening the bones of breast cancer survivors once they hit middle age, leading to hip fractures.

Results of the study are reported in the February 2011 issue of Clinical Cancer Research

Hip fractures are rare in people under 70. Yet, Northwestern Medicine doctor Beatrice Edwards, M.D., observed that several breast cancer survivors in their early 50s were coming to her for therapy of hip fractures.

Edwards is director of the Bone Health and Osteoporosis program and associate professor of medicine and of orthopaedic surgery at Northwestern University Feinberg School of Medicine. She also is a doctor at Northwestern Memorial Hospital and a member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

Scientists studied six of these women over one year and assessed the type of breast cancer they had, the therapy they underwent and a hip fracture's effect on quality of life, said Edwards, main author of the study.

"One year after the fracture the women still reported difficulty with climbing stairs, shopping and heavy housekeeping," Edwards said. "Their health care costs may increase and their fractures contribute to losing some independence"......... Posted by: Janet      Read more         Source

February 2, 2011, 7:40 AM CT

Wide geographic disparities in children's health care

Two years after the reauthorization and expansion of the Children's Health Insurance Program (CHIP), a new Commonwealth Fund state-by-state scorecard evaluating how the health care system is working for children finds that federal and state action on behalf of children has helped preserve, and even expand, health coverage for this group, despite the severe recession. Yet wide differences persist among states when it comes to health insurance coverage, affordability of health care for families, children's receipt of preventive care and therapy, and the opportunity for children to lead healthy lives. Children living in the five top-ranked states�Iowa, Massachusetts, Vermont, Maine, and New Hampshire�are more likely to be insured and to receive recommended medical and dental check-ups than children living in poorer-performing states like Florida, Texas, Arizona, Mississippi, or Nevada.

The report finds good evidence for the value of federal and state policies aimed at improving rates of health insurance coverage. Early expansions of Medicaid at the start of the decade, Medicaid stabilization funds from the American Recovery and Reinvestment Act (the stimulus bill), and the expansion and reauthorization of CHIP in February 2009 allowed states to continue to provide and, in some cases, expand health insurance for children during the economic downturn. While coverage rates for parents have declined in 41 states over the past decade, children have fared dramatically better, with rates increasing in 35 states over the same period......... Posted by: JoAnn      Read more         Source

February 1, 2011, 8:03 AM CT

Computer-assisted diagnosis tools

Scientists are leveraging Ohio Supercomputer Center resources to develop computer-assisted diagnosis tools that will provide pathologists grading Follicular Lymphoma samples with quicker, more consistently accurate diagnoses.

"The advent of digital whole-slide scanners in recent years has spurred a revolution in imaging technology for histopathology," as per Metin N. Gurcan, Ph.D., an associate professor of Biomedical Informatics at The Ohio State University Medical Center. "The large multi-gigapixel images produced by these scanners contain a wealth of information potentially useful for computer-assisted disease diagnosis, grading and prognosis".

Follicular Lymphoma (FL) is one of the most common forms of non-Hodgkin Lymphoma occurring in the United States. FL is a cancer of the human lymph system that commonly spreads into the blood, bone marrow and, eventually, internal organs.

A World Health Organization pathological grading system is applied to biopsy samples; doctors commonly avoid prescribing severe therapies for lower grades, while they commonly recommend radiation and chemotherapy regimens for more aggressive grades.

Accurate grading of the pathological samples generally leads to a promising prognosis, but diagnosis depends solely upon a labor-intensive process that can be affected by human factors such as fatigue, reader variation and bias. Pathologists must visually examine and grade the specimens through high-powered microscopes......... Posted by: Janet      Read more         Source