Archive for June 21st, 2006
By: Baylor College of Medicine
By her 43rd birthday, a woman’s eggs are less efficient at being fertilized, they miscarry at a much higher rate, and the probability of her having children falls almost to zero.
In fact, the number of eggs a woman is born with decreases dramatically
at age 35, said Dr. John Buster, director of the Baylor College of Medicine Division of Reproductive Endocrinology and Infertility.
Teresa Briggs came to see Buster at age 40. She had waited to marry, and she wanted to have children with her new husband.
“After we tried for a year, I really began to become discouraged,” she said. “The reality began to sink in that maybe we won’t have kids.”
At 41, Briggs decided to try in-vitro fertilization. In that process, eggs are taken out of the ovary, fertilized in the laboratories, and returned when the embryos form three days later.
The process worked for Briggs at ages 41 and 43, producing two children. Being a full-time mom was a big adjustment from working in corporate America, but she said she wouldn’t change it for anything.
“When I married my husband I thought, `This is the most love I can have for a person.’ It was phenomenal,” she said. “Then we had kids, and it was the deepest, most indescribable kind of love and affection and emotional dimension that you could possibly have.”
Buster said another way for older women to have children is through donated eggs. Numbers show the pregnancy rates for this type of procedure are very high for women in their forties.
June 21st, 2006
By: Blackwell Publishing
Fifty years of medical studies show that sun exposure is a primary component in the development of melanoma, the most serious and deadly
type of skin cancer, report leading dermatologists in the April 2006 issue of Dermatology Surgery.
“Though genetics may play a role in the development of some melanomas, there’s overwhelming evidence that shows sun exposure adversely affects patients both with and without genetic predisposition to melanoma,” said Elisabeth K. Shim, M.D., an Associate Clinical Professor of Dermatology at Keck USC Medical School of Medicine in Los Angeles, CA.
It’s not clear what pattern of sun exposure causes melanoma or whether it’s short, intense intermittent or cumulative. Further more, it’s not clear if ultraviolet B (UVB), ultraviolet A (UVA) rays, or both are responsible for causing melanoma. “Regardless, the sun acts as an initiating and promoting agent in causing melanoma, and causes immunosuppression,” noted Dr. Shim.
With summer quickly approaching, it’s necessary to protect yourself by using sunscreen and sun protective measures to prevent melanoma, and other skin cancers, despite current controversy.
June 21st, 2006
Acne, the condition that leaves your face dotted with unsightly spots, is a real problem for teenagers.
As if the transition period from child to adult weren’t complicated enough, the onset of acne can lead an outgoing, extrovert to become withdrawn,
solemn and insecure. So, what can be done to beat acne? There are many creams on the market that may give a measure of relief. Far more effective though, is to control the problem by making an adjustment in your diet. While some people are genetically predisposed to acne, many will find that, by learning what nutrients can help with the problem and adjusting their eating accordingly, they can, indeed, find some solutions.
For many years researchers believed that acne was due to the high fat, high sugar content of many teenagers’ diets, typically composed of French fries, sodas, burgers and the like. This still appears to be partly to blame. However, recent studies would tend to indicate that the foods that are not being eaten by young people are more important in their getting acne. The typical junk food diet is glaringly deficient in several vital minerals and vitamins. Zinc, for example, is an important mineral in controlling acne. You can get more zinc in your diet by eating more of the following foods:
Lean meat
Skinless chicken
Shellfish
Nuts
Seeds
Whole Grain Cereals
Yoghurt
Skim milk
You should also endeavour to take in a good amount of beta carotene. The body will convert this into Vitamin A. Vitamin A will help maintain the health of your skin. Beta carotene can be found in dark green or orange vegetables like spinach or carrots. You can also get it from apricots and mangoes. Vitamin A can also be sourced from liver and eggs.
It has also been shown that polyunsaturated fats can help to control acne. You can source these from nuts, seed oils and oily fish. Vitamin E is also useful in helping to maintain and repair the skin.
Of course it is also recommended that you cut down on your intake of fatty foods in order to control your acne. Try to gradually replace fatty and fried foods with whole grains, vegetables and fresh fruits. Wean yourself off of those high sugar soft drinks and try to acquire a taste for water. Also try to cut out on chocolates and sweets as well as highly salted snacks.
Readjusting your eating habits will take a great deal of discipline and accountability. Before long, however, you will have adjusted to a healthy dietary program that will benefit you for the rest of your life. And you’ll be acne free forever.
June 21st, 2006
By: American Academy of Dermatology
In this age of “instant” reality-television transformations, many consumers may have unrealistic expectations when seeking a cosmetic treatment.
Whether it’s aging skin on the face or neck, noticeable veins on the legs,
or even a few stubborn areas of fat, the desire for a quick fix should not outweigh the importance of the safety and effectiveness of the treatment. That is why a dermatologist, a doctor who specializes in treating the skin, can offer individualized advice and cosmetic treatment options to change body concerns into results.
Speaking at the American Academy of Dermatology’s (Academy) skin academy 2005, dermatologist Susan H. Weinkle, M.D., assistant clinical professor of dermatology at the University of South Florida, Tampa, Fla., discussed patients’ three most common cosmetic concerns and offered tips for maintaining healthy skin.
“While having great looking skin has a lot to do with genetics, it has even more to do with how you have protected and treated your skin over the years, especially the skin on the face,” said Dr. Weinkle. “But, a dermatologist can provide a variety of options to address concerns on any part of the body.”
Aging Skin
According to a recent Academy poll, facial rejuvenation is among the top three cosmetic procedures patients ask about at the dermatologist’s office. The type of treatment recommended by a dermatologist depends upon the appearance and location of fine lines, wrinkles and age spots. Dermatologists often recommend that patients start with over-the-counter or prescription products that contain retinoids, peptides or antioxidants, such as vitamin C.
“While most patients are seeking anti-aging benefits for their face, they can get the same anti-aging benefits by applying these products to their hands, neck and chest,” advised Dr. Weinkle. In fact, the Academy poll confirms that 40 percent of individuals consider non-facial aging skin to be one of their top skin-related health concerns.
For more help than is available at the cosmetics counter or by prescription, particularly for the face, dermatologists often recommend a skin filler to treat stubborn wrinkles and deep lines on the face. One of the newest skin fillers is hyaluronic acid, which works by pulling water into the skin, resulting in increased skin plumping and volume. The results of hyaluronic acid last approximately four to six months.
Another treatment option may be poly-L lactic acid which is considered a “dermal stimulator” because it stimulates the skin cells to make collagen – providing a slow correction over time. Patients are treated every month for four to five months until the correct results are achieved, and results typically last one to two years. “Research studies of poly-L lactic acid for approval by the Food and Drug Administration are just beginning,” said Dr. Weinkle. “If proven effective, it could be a new option for patients looking for a safe, long-lasting fix for wrinkles.”
In addition, a new filler known as calcium hydroxylapatite with a methylcellulose vehicle, which is currently FDA approved for other purposes, is being studied as an injectable skin filler. The synthetic compounds used in this filler contain beads of calcium hydroxylapatite, which is a substance used to replace missing bones. It is estimated that this filler may last about one year, but the exact duration has not been demonstrated yet.
Spider Veins
The appearance of spider veins on the legs can be cause for concern for some individuals. While there can be pain associated with spider veins, they also can cause undue emotional stress as individuals try to cover up the unsightly red, blue or green veins.
Sclerotherapy, a non-surgical procedure that permanently removes unwanted veins, is the standard treatment for spider veins. A special sclerosing solution is injected with a very fine needle into the blood vessel, which irreversibly alters the vessel wall causing it to be absorbed so that it fully and permanently disappears.
“Patients who have received sclerotherapy treatment for spider veins express great relief to be able to forgo covering up with clothes or makeup and be able to wear shorts and skirts again,” said Dr. Weinkle. “I advise patients who are predisposed to developing spider veins and even those who are not, that if you are on your feet all day, the best way to help prevent spider veins is to wear support pantyhose.” While Dr. Weinkle acknowledges that the term “support hose” conjures up images of bulky and unattractive, orange-toned nylons, she recommends that patient’s investigate today’s versions which come in lighter materials and in a variety of colors.
The Battle of the Bulge
According to the Academy poll, when diet and exercise fall short of creating a consumer’s ideal physique, liposuction is the cosmetic procedure that consumers would most seek (28 percent). Tumescent liposuction is a dermatologist-developed, safe and effective solution to eliminating unwanted fat.
Performed under local anesthesia, tumescent liposuction offers patients lower risk and faster recovery than other methods. “The local anesthetic technique is so safe and effective that it makes general anesthesia for liposuction virtually obsolete,” Dr. Weinkle explained.
“One of the most popular misconceptions about stubborn fat deposits is that these can be lost through diet and exercise,” said Dr. Weinkle. “While diet and exercise are important aspects in achieving a healthy body and can produce moderate weight loss results over an extended period of time, neither is effective for spot reduction, which is where liposuction can be successful.”
Another concern is the weight gain and loss associated with pregnancy that affects the abdomen. “Most women with the lower abdomen ‘roll’ don’t need a tummy tuck, even if they have stretch marks and poor elasticity,” advises Dr. Weinkle. “Rather than undergoing a surgical abdominoplasty or tummy tuck, liposuction provides women with a safer alternative that removes the fat gently and relatively pain-free to allow the skin to retract, reducing the stomach’s prominence.”
The Most Important Way to Protect the Skin
Regardless of the type of treatment a patient seeks, anyone who is serious about caring for his or her skin must wear sunscreen, stated Dr. Weinkle. “Using a sunscreen daily, preferably one with an sun-protection factor (SPF) of 15 or higher, together avoiding tanning, either outdoors or artificially at a tanning salon, can significantly decrease the damage to the skin and keep the skin’s texture and tone smooth and clear,” she remarked.
Dr. Weinkle also recommends that anyone who works or plays in the sun choose clothing that offers ultraviolet (UV) ray protection. In general, clothing made of tightly-woven fabric performs the best at protecting skin from the sun. Darker colored fabrics also are favored over lighter colors for increased sun protection.
“Patient safety is the dermatologist’s number one concern,” reminded Dr. Weinkle. Before considering any type of cosmetic procedure, it is important to consult with a dermatologist to determine if the treatment appropriately addresses the concern. “Talking with a dermatologist about a cosmetic procedure can relieve anxiety about the treatment and ensure that the results of the procedure will meet the patient’s expectations,” said Dr. Weinkle.
The consumer poll on skin-related health behaviors and attitudes was a Web-based poll fielded in September 2005 by the Segmentation Company, a Division of Yankelovich, Inc., in collaboration with the Academy. A total of 1,112 respondents age 18 and over responded to the poll.
Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org
June 21st, 2006
By: U-M News
A new procedure that stops the most common form of irregular heartbeat is expensive, but it may pay off in the long run for many patients, new
research suggests. That means it’s important for doctors to choose
carefully who receives it, and to perform further research on its long-term benefit, the authors say.
The study looks at a treatment called left atrial catheter ablation or LACA, which in the last few years has attracted tremendous attention as a new option for the 2.3 million Americans who have a heart-rhythm condition called atrial fibrillation.
LACA delivers tiny “zaps” of radiofrequency energy directly to the heart muscle to stop the electrical circuits that cause irregular heartbeats. The treatment is seen as an exciting option for atrial fibrillation, which interferes with daily life and greatly increases the risk of stroke. But like any new therapy, LACA carries costs and risks as well as benefits — and until now, no one has assessed the economics of this treatment, or compared its costs and benefits with those of drug-based treatment.
The new research, published in the Journal of the American College of Cardiology by a team from the University of Michigan Cardiovascular Center and the VA Ann Arbor Healthcare System, takes a hard look at the dollars and cents of the issue.
Using sophisticated computer modeling, the researchers tallied the cost and benefits of LACA and drugs for people of different ages and health statuses. They ran calculations based on a range of assumptions about LACA’s ability to reduce stroke risk, since the procedure is still new enough that its stroke-preventing power isn’t clear.
In general, the researchers found, it’s far more cost-effective to provide LACA to atrial fibrillation patients who are relatively younger (around 55 years of age), and who have one or more risk factors for stroke besides atrial fibrillation, compared with keeping them on traditional drug therapy to control heart rate. The advantage isn’t so clear in older patients, nor in those who don’t have other risk factors such as high blood pressure, diabetes, heart failure or prior strokes.
“Before LACA is more generally adopted as a treatment option, it’s important to ask from a societal perspective if it’s cost effective, and under what conditions,” says first author Paul Chan, M.D., M.Sc., a fellow in cardiovascular medicine at the U-M Medical School and member of the VA Health Services Research & Development Center. “This analysis provides a conservative model that could be used to assess LACA’s cost-effectiveness as more is learned about the impact of LACA on stroke risk.”
Adds senior author and cardiovascular medicine associate professor Hakan Oral, M.D., who is a member of a U-M team that has performed LACA on more than 2,000 atrial fibrillation patients and published extensive research on the procedure, “Through rigorous modeling with conservative estimates, this study provides the groundwork for the cost-effectiveness of catheter ablation in treatment of atrial fibrillation.”
He continues, “It appears that the longevity of the patient population and the ability of catheter ablation to maintain sinus rhythm and prevent future complications - primarily stroke — will be the key factors in determining cost-effectiveness of catheter ablation. However, besides cost issues, the value of improvement in the quality of life of individual patients should also be carefully considered.”
Chan, Oral and their colleagues performed the study using a computer model that took into account life expectancy at age 55 or 65, the cost of the LACA procedure, the annual cost of drugs to control heart rate or heart rhythm for the rest of a patient’s life, the potential cost of LACA complications, the potential cost of caring for a patient who had a stroke or cerebral hemorrhage, and knowledge from previous research about the stroke risk faced by atrial fibrillation patients based on age and health.
They also factored in results from research on the efficacy of rate-control and rhythm-control drugs, using atenolol and digoxin for rate control and amiodarone for rhythm control. They assumed that all patients would take blood-thinning drugs (aspirin or warfarin) to reduce the risk that blood clots would form and cause a stroke, and included the cost of monitoring for patients on warfarin or digoxin.
Most of the assumptions made in building the model, and the parameters for the different variables, were conservative, meaning they were set to give drug therapy a cost-effectiveness advantage over LACA. The model assumed that 80 percent of patients who had the LACA procedure would experience a complete return to normal heart rhythm after the first year, taking into account that some of these patients may need to receive repeat procedures in that time. The model also accounted for the fact that patients who were initially cured with LACA may re-develop atrial fibrillation over time. The researchers ran the computer simulation ten thousand times to more precisely define how much stroke-risk reduction LACA would have to provide in order to be cost-effective compared with drugs.
In the end, LACA’s cost-effectiveness prevailed over either kind of drug therapy — and rate-control drug therapy was more cost-effective than rhythm control by drug therapy in all cases.
In patients who had no other stroke risk factors besides atrial fibrillation, the model showed LACA would not be cost effective, costing an extra $98,900 per quality-adjusted life year (QALY), or year of life adjusted for quality of life during that year. The standard threshold for considering a therapy cost-effective is $50,000 per QALY. In 55-year-old patients with one or two risk factors besides atrial fibrillation, LACA’s added cost per QALY was $28,700, meaning it would be cost-effective. In 65-year-old patients with one or two more risk factors, the figure was $51,800 - not quite cost-effective.
Since the stroke-preventing power of LACA isn’t known, the researchers calculated what percentage risk reduction LACA would have to achieve in order to make it a cost-effective option for patients in different situations. For example, if LACA has an initial “cure” rate of 80 percent for patients with atrial fibrillation, it would have to result in a 42 percent reduction in annual stroke risk to be cost-effective for 65-year-olds with a moderate stroke risk — but only an 11 percent reduction in stroke risk for 55-year-olds. “This means that LACA doesn’t have to have as big an impact on stroke risk to be cost-effective for younger patients, because the benefits appreciate over their lifetime,” says Chan.
The researchers also repeated their analysis using less conservative assumptions that were not biased in favor of medical therapy. For example, when they assumed that rate-control drugs would restore only 20 percent of patients to regular rhythm at first, rather than 38 percent, LACA didn’t need to achieve as powerful a stroke-reducing effect in order to be more cost-effective than drugs. (Recent research has suggested that rate-control drugs only help about 10 to 20 percent of patients return to regular rhythm.) Similarly, when they changed the assumption about how much rate-control drugs would cost per year, from $400 to $800, LACA was more likely to be cost-effective.
In the end, says Chan, more research is needed on LACA’s long-term effect on stroke risk, quality of life and maintenance of normal heart rhythm. But as more data emerge, he hopes the U-M/VA model can be used to revisit LACA’s cost-effectiveness and guide decisions about reimbursement.
June 21st, 2006