Sunday, July 27, 2008

Deep brain stimulation

Deep brain stimulation is FDA approved for treating the tremor associated with Parkinson's disease. It is not approved yet for the treatment of depression, but clinical research over the last couple of years has been promising.

Clinical research trials are not available at the Mayo Clinic at this time, but are at a couple of sites both in and outside of the United States. It is not clear exactly how this "brain pacemaker" works, but it is thought that the electrical impulses generated by the stimulator reset the brain. This is theorized to return brain functioning to normal (including neurotransmitter levels, such as serotonin, norepinephrine, dopamine, etc.) and thus, treating the depression. As with electroconvulsive therapy (ECT), this is a treatment reserved for severe, debilitating depression.

Deep brain stimulation requires a neurosurgical procedure. During the surgery, electrodes are implanted deep into the brain. Wires from the stimulator are attached to a battery operated stimulator that is implanted in the chest. The battery, stimulator, wires, etc. do have the potential to malfunction. This may require replacement of parts later on. Because this is an invasive procedure, it carries definite risks, some of which are life-threatening. These include, but are not limited to:

  • Bleeding in the brain
  • Infection
  • Delirium
  • Unwanted mood changes
  • Movement disorders
  • Lightheadedness
  • Insomnia

In addition, people who have undergone deep brain stimulation to treat Parkinson's disease have reported such side effects and adverse events as panic attack, speech difficulty, movement problems and even suicide.

Since this is a relatively new treatment, long term effects are not known. As with any treatment, discussion with your physician is important so you can understand the risks, benefits and alternatives. Weighing all of the pros and cons is crucial in the decision making process. This will ensure that you are making an informed decision by putting your health care as top priority.

Thursday, June 26, 2008

Coronary artery spasm

A coronary artery spasm is a brief, temporary tightening (contraction) of the muscles in the artery wall. This can narrow and briefly decrease or even prevent blood flow to part of the heart muscle (myocardium). If the spasm lasts long enough, it can lead to chest pain (angina) and possibly a heart attack (myocardial infarction). These spasms may also be referred to as Prinzmetal angina or variant angina. Unlike typical angina, which usually occurs with exertion, coronary artery spasms often occur at rest.

Coronary artery spasms occur most often in people with risk factors for heart disease, such as tobacco use, high cholesterol and high blood pressure. They may also be associated with other diseases, such as lupus. Coronary artery spasms may be triggered by tobacco use, exposure to cold, extreme emotional stress and use of illicit stimulant drugs, such as amphetamines and cocaine.

Treatment of coronary artery spasms may include medications such as nitrates, calcium channel blockers and 1-arginine, which may reduce the risk of recurrence. You can also reduce your risk by discontinuing tobacco use and controlling high cholesterol and high blood pressure.

Wednesday, March 26, 2008

Treatment for a collapsed lung

Treatment of a collapsed lung (atelectasis) depends on the cause and severity of the collapse.

Atelectasis may be due to compression of the lung tissue or obstruction of the air passages (bronchi). The collapse may affect only a small part of the lung or the whole lung. Pneumothorax and pleural effusion can cause the lung to partially collapse without closing off any of the airway. A partially collapsed lung may slowly re-expand without treatment. But a severe collapse of a whole lung can be life-threatening and requires emergency medical attention.

Treatment of atelectasis may include:

  • Removing obstructions from the airway by suctioning mucus or bronchoscopy
  • Performing deep-breathing exercises (incentive spirometry)
  • Clapping (percussion) on the chest to loosen mucus
  • Positioning the body so that the head is lower than the chest (postural drainage) to drain mucus

If an underlying condition such as a tumor is the cause of atelectasis, treatment will also be directed at managing the condition. In the case of a tumor, for instance, treatment may include surgery, radiation or chemotherapy drugs.

If you experience the signs and symptoms of atelectasis, including shortness of breath, chest pain and cough, seek emergency medical attention.

Friday, March 07, 2008

Diet rich in certain vegetables and a decreased risk for breast cancer

Researchers with Vanderbilt-Ingram Cancer Center and the Shanghai Cancer Institute in China have discovered a possible link between a diet rich in certain vegetables and a decreased risk for breast cancer.

Corresponding author , assistant professor of Medicine at Vanderbilt-Ingram, said 3,035 women diagnosed with breast cancer were identified through the Shanghai Cancer Registry. They were closely matched with 3,037 women randomly chosen from the general population there. The women filled out questionnaires about their diet, including consumption of cruciferous vegetables like Chinese cabbage, bok choi and turnips. Americans typically eat more broccoli, kale and cauliflower in the cruciferous vegetable family.

“Cruciferous vegetables contain some compounds that may have a cancer-inhibitory effect,” explained Fowke. “Here we were able to identify a group of women who seem to particularly benefit from a high intake of these vegetables.”

While there was only a small positive relationship between a diet high in these vegetables and a reduction in breast cancer risk for the overall study population, there was a striking risk reduction – 50 percent – among women with a certain genetic profile. Researchers identified three forms of the GSTP1 genotype among the cancer patients: Ille/Ile, Ile/Val and Val/Val.

“Women who consumed more of these cruciferous vegetables and who also had the Val/Val genetic polymorphism had a lower breast cancer risk. So we cautiously interpreted this as diet being a factor that may reduce the impact of genetic susceptibility in overall breast cancer risk,” said Fowke.

The Vanderbilt-Ingram researchers focused on cruciferous vegetables because they contain two chemicals called isothiocyanates and indole-3-carbinol which may affect carcinogenesis by triggering cell death or by shifting estrogen metabolism. Studies by other researchers have suggested cruciferous vegetables may reduce the risk of lung, stomach, colorectal and bladder cancers.

“We have known for some time that certain foods, like soy foods, appear to interfere with the development of breast cancer because they contain plant estrogens,” said Fowke. “The protective effect from cruciferous vegetables in this study was certainly suggestive of a risk reduction, but researchers need to replicate this finding in other studies.”

Scientists were able to isolate the specific genetic profile linked with a positive dietary impact because the women in the study submitted DNA through blood and cheek cell samples. Wei Zheng, M.D., Ph.D., professor of Medicine at Vanderbilt-Ingram is the principal investigator for the Shanghai Breast Cancer study.

“The Shanghai Breast Cancer Study is one of the largest and most comprehensive epidemiological studies conducted to date for this common cancer,” according to Zheng. “We have published over 100 research papers in this study addressing a large range of significant issues related to the etiology and survival of breast cancer. The results reported by Dr. Fowke may have significant implications in breast cancer prevention.”

While women in this study answered questionnaires about their diets, researchers want to measure more precisely the intake of cruciferous vegetables. To aid in future studies they are collecting urine samples which contain biomarkers for the beneficial chemicals.

Thursday, February 14, 2008

Synthetic form of marijuana, nabilone, Reduces Fibromyalgia Pain

Patients with fibromyalgia treated with a synthetic form of marijuana, nabilone, showed significant reductions in pain and anxiety in a first-of-its-kind study, published in The Journal of Pain .
Fibromyalgia syndrome has no cure, is difficult to diagnose, and effective pain management strategies are a must to help patients cope with the disease. An estimated 12 million Americans have fibromyalgia, which is characterized by widespread muscle and joint pain and myriad other symptoms. The condition is far more prevalent in women and the incidence increases with age, reaching 7 percent among women 65 years and older.

Forty subjects were selected for the nabilone trial, conducted by researchers at the University of Manitoba Rehabilitation Hospital. They were divided into nabilone and placebo groups and were treated for four weeks. The authors noted this was the first randomized, controlled-access trial to evaluate nabilone for pain reduction and quality-of-life improvement in fibromyalgia patients. Nabilone is one of two oral marijuana-based compounds, known as cannabinoids, available in Canada and is approved for treatment of nausea and vomiting during chemotherapy.

Results of the Manitoba study showed the nabilone group had significant reductions in pain and anxiety, measured by comparisons with baseline scores on the visual analogue scale for pain, the Fibromyalgia Impact Questionnaire (FIQ) and the FIQ anxiety score. From the data, the study concluded nabilone has significant benefits for pain relief and functional improvement in fibromyalgia patients. Although the improvement was significant, none of the nabilone-treated subjects had complete relief of their fibromyalgia symptoms.

The drug was well tolerated by treated patients, which the authors characterized as reassuring since fibromyalgia patients are sensitive to most medications and have difficulty tolerating side effects.

Wednesday, February 06, 2008

Anti-parasite drug may help stop the human immunodeficiency virus - HIV

The research, published online in the journal Retrovirology, indicates an existing drug -- miltefosine -- may promote cells being used by HIV as safe-havens to commit "cell suicide."
The drug -- miltefosine also known as Impavido, first identified in Germany in the early 1980s as a potential breast cancer treatment -- is presently used to treat a parasitic infection called leishmaniasis, or sandfly disease.

Past studies by this University of Rochester research team determined the macrophage -- a scavenger cell that normally rids the body of pathogens and other "debris" -- can actually become a "safe-haven" and provide a reservoir for HIV.

Operating from these havens, HIV can go on to make the body vulnerable to infections and progress to acquired immune deficiency syndrome, or AIDS.

Thursday, January 03, 2008

Increased Risk of Lung Disease

Here’s another reason not to smoke, especially for women: chronic obstructive pulmonary disease or COPD.
The most important risk factor for COPD is long-term cigarette smoking.
Chronic obstructive pulmonary disease is a broad term that describes any of a group of illnesses that block airflow through the lungs. The most common are emphysema and chronic bronchitis. Signs and symptoms of COPD -- persistent cough, increased mucus production, shortness of breath and frequent colds and respiratory problems -- often develop gradually, and people don’t realize they have the disease until it’s advanced.
Chronic obstructive pulmonary disease is the fourth leading cause of death in the United States. The COPD death rate for women rose much faster between 1980 and 2000 than it did for men. In 2000, the number of women dying of COPD surpassed men for the first time. According to recent research, women with the disease experience more breathlessness, higher rates of depression and lower quality of life than men with the disease -- even those women reported fewer years of smoking than men.
The increase in female rates of COPD likely reflects the increase in the number of female smokers since the 1940s, when advertisers began promoting smoking as a symbol of independence for women.
Chronic obstructive pulmonary disease can be treated, but not cured. The most important treatment is to stop smoking. For smokers with COPD, quitting smoking reduces subsequent loss of lung function by half and cuts the death rate by nearly half. And some better news for women is that those who quit smoking receive twice as great an improvement in lung function as men.