192,000 men are diagnosed with prostate cancer annually.  27,000 cases are terminal.  Currently under investigation is a new chemotherapy drug -Cabazitaxel which is being administered in conjunction with Mitoxantrone (a commonly used drug f0r prostate cancer).   Men receiving this chemo cocktail (no pun intended) had a 30% increase in survival.  [...]]]> Source:  Annual Genitourinary Cancers Symposium; Medline

192,000 men are diagnosed with prostate cancer annually.  27,000 cases are terminal.  Currently under investigation is a new chemotherapy drug -Cabazitaxel which is being administered in conjunction with Mitoxantrone (a commonly used drug f0r prostate cancer).   Men receiving this chemo cocktail (no pun intended) had a 30% increase in survival.  To you or I 15.1 months to live vs. 12.7 may not seem like a lot but if you were dying and those were your options, wouldn’t you want more time?  It is thought that giving the combination of drugs early in the diagnostic stage might translate to even greater survival times.

To that end researchers are developing better diagnostic tools for Prostate Cancer.  Showing promise is the PCA3 urine test.  Apparently overly expressed in men with prostate cancer, gene 3 is a fair predictor for advanced prostate disease.   The current complaints against the standard PSA testing is the high rate of false positives resulting in biposy.

Finally, the tried and true cystoscopy procedure (Yes, the one where they insert a catheter with a small camera into the bladder. Over the river and through the woods…Well not quite.  Cystoscopy has been found to be remarkable cost-effective.  Accordingly, look for it to be featured more in insurance schemes and offered more by urologists.  Cynical? Perhaps.  But you’ll see.

~Posted by D.M. Schwadron, Esquire

It may be still in the early lab stages -how early? Well they are still testing the technique upon mice with tumors, however, researchers have found that freezing breast cancer tumors (cryoablation) helps to stop the spread of breast cancer.

Not only did the rapid freezing, through application of a cold [...]]]> Source: Annals of Surgical Oncology; Medline

It may be still in the early lab stages -how early? Well they are still testing the technique upon mice with tumors, however, researchers have found that freezing breast cancer tumors (cryoablation) helps to stop the spread of breast cancer.

Not only did the rapid freezing, through application of a cold probe to the tumor site, kill breast cancer tumors, there was a better outcome in terms of tumor spread (metastasis) to the lungs.

All is not lab mice though.  Cryoablation is being actively used to treat actual human patients with prostate cancer, kidney cancers and cancers that have spread to the bone marrow with encouraging results.  Hopefully this will be another tool to fight breast cancer in the near future.

~Posted by D.M. Schwadron, Esquire.

Men should discuss the benefits and risks of prostate cancer screening with their doctors, according to revised prostate cancer screening guidelines from the American Cancer Society (ACS).  Yes. That’s what they said.  Not much of a guideline is it?

Okay they say a little more.  But really, only a little.  The American Cancer [...]]]> Source: American Cancer Society

Men should discuss the benefits and risks of prostate cancer screening with their doctors, according to revised prostate cancer screening guidelines from the American Cancer Society (ACS).  Yes. That’s what they said.  Not much of a guideline is it?

Okay they say a little more.  But really, only a little.  The American Cancer Society recommends that doctors more heavily involve patients in the decision of whether to get screened for prostate cancer.

ACS recommends that men with no symptoms of prostate cancer who are in relatively good health and can expect to live at least 10 more years have the opportunity to make an informed decision with their doctor about screening after learning about the uncertainties, risks, and potential benefits associated with prostate cancer screening. These talks should start at age 50. Men with no symptoms who are not expected to live more than 10 years (because of age or poor health) should not be offered prostate cancer screening. For them, the risks likely outweigh the benefits, researchers have concluded.

ACS recommends men at high risk – African-American men and men who have a father, brother, or son diagnosed with prostate cancer before age 65 – begin those conversations earlier, at age 45. Men at higher risk – those with multiple family members affected by the disease before age 65 – should start even earlier, at age 40.

For men who choose to be screened after discussing the pros and cons with their doctor, the new guidelines make the digital rectal exam (DRE) optional and offer the option of extending the time between screening for men with low PSA levels.

There it is. No specific PSA recommendations, or even whether PSA testing should be considered mandatory.  So start “talking to your doctor” about screening.  Does this sound an awful lot like the burden of screening for Prostate Cancer is being placed back upon the patient? Yeah. It sounds that way to me too.

~Posted by D.M. Schwadron, Esquire

We elaborated on just one of these but apparently March is National Salmonella month here in the U.S.  Among the products affected are dips, chips (a double whammy), spices and soup.

Just why are there so many products affected with Salmonella?  Maybe it’s time we stopped mass producing food in factories [...]]]> Source:  U.S. Food & Drug Administration

We elaborated on just one of these but apparently March is National Salmonella month here in the U.S.  Among the products affected are dips, chips (a double whammy), spices and soup.

Just why are there so many products affected with Salmonella?  Maybe it’s time we stopped mass producing food in factories and “engineering” foods genetically.  Radical concepts, I’m aware but still, click through the evidence.  The system is broken and needs some fixes.

March 2010

• March 03, 2010 – Earth Island Announces Voluntary Recall On Select Follow Your Heart Products That Contain Natural Flavor Because Of Possible Health Risk³
• March 03, 2010 – Homemade Gourmet Voluntarily Recalls “Tortilla Soup Mix” Because of Possible Health Risk⁴
• March 03, 2010 – Reser’s Fine Foods Inc Press Release⁵
• March 02, 2010 – Tim’s Cascade Snacks Recalls ‘Hawaiian^® Kettle Style Potato Chips – Sweet Maui Onion’ and ‘Hawaiian- Sweet Maui Onion Rings’ Because of Possible Health Risk⁶
• March 02, 2010 – Castella Imports, Inc. Conducts Nationwide Recall of Castella Chicken Soup Base Because of Possible Health Risk⁷
• March 01, 2010 – Heartland Foods, Inc. voluntarily recalls Coarse Ground Black Pepper because of possible Salmonella Contamination⁸
• March 01, 2010 – T. Marzetti Company Announces a Voluntary Recall of Dips Due to Possible Health Risk

~Posted by D.M. Schwadron, Esquire

T. Marzetti Company today announced as a precautionary measure that it is voluntarily recalling certain production codes of T. Marzetti Veggie Dips, Oak Lake Chip Dips and Great Value Chip Dips because an ingredient used in the product has the potential to be contaminated with Salmonella.  [...]]]> Source: U.S. Food & Drug Administration

T. Marzetti Company today announced as a precautionary measure that it is voluntarily recalling certain production codes of T. Marzetti Veggie Dips, Oak Lake Chip Dips and Great Value Chip Dips because an ingredient used in the product has the potential to be contaminated with Salmonella.  (Yeah, that would be a good precaution then).  There have been no reports of illnesses associated with the identified products, and no other types, varieties of flavors of products are affected by this recall.  Products subject to this recall that were distributed nationwide in the United States under the T. Marzetti brand in plastic tubs and sold in the produce section include:

• T. Marzetti Southwest Ranch Veggie Dip, 15.5 ounce (UPC 70200 52004)
  Best By dates: APR2010F, APR2810F, MAY1610F, MAY3110F, JUN0610F, JUN1410F, JUN1910F
• T. Marzetti Fat Free Southwest Ranch Veggie Dip, 13 ounce (UPC 70200 52033)
  Best By dates: MAY1610F, MAY3010F, JUN0810F, JUN1210F, JUN2510F
• T. Marzetti Spinach Veggie Dip, 15 ounce (UPC 70200 52059)
  Best By dates: APR1910F, MAY0910F, JUN0710F

Products subject to this recall distributed in Canada and Laredo, Texas, under the T. Marzetti brand in plastic tubs and sold in the produce section include:

• T. Marzetti Spinach Veggie Dip, Epinards, Trempette A Legumes, 340 gram (UPC 70200 58843)
  Best By dates: 10AL11F, 10AL17F, 10AL24F, 10AL30F, 10MA08F, 10JN12F
• T. Marzetti Southwest Ranch Veggie Dip, Ranch style sud-ouest americain Trempette A Legumes, 340 gram (UPC 70200 58844)
  Best By dates: 10AL17F, 10AL24F, 10AL30F, 10MA08F, 10JN05F, 10JN14F

Product subject to this recall distributed in Ohio under the Oak Lake Farms Brand in plastic tubs and sold in the refrigerated case includes:

• Oak Lake Farms French Onion Chip Dip, 16 ounce (UPC 73534 43480)
  Best By dates: APR2310F, JUN1110F, JUN2610F

Product distributed in the United States under the Great Value brand in plastic tubs and sold in the refrigerated section includes:

• Great Value Ranch Chip Dip, 16 ounce (UPC 78742 43099)
  Best By dates: 042810F, 050810F, 052910F, 053010F, 053110F, 060410F, 060510F, 061110F

T. Marzetti was notified by its supplier, Basic Food Flavors, Inc., of the recall of an ingredient used in these products due to potential Salmonella contamination. Because the safety of consumers is a top priority and out of an abundance of caution, T. Marzetti has voluntarily recalled these product.

T. Marzetti is working closely with Food and Drug Administration to conduct this voluntary recall.   For more information on Salmonella, please visit the Centers for Disease Control and Prevention’s Website at http://www.cdc.gov¹.

Consumers who have purchased the recalled products are advised to discard this product or return it to the place of purchase for a refund. Consumers with questions about the recall should contact T. Marzetti Co. at 1-800-427-0147 between 8 a.m. and 9 p.m. EST or visit the company’s Website at www.marzetti.com².

~Posted by D.M. Schwadron, Esquire

It is a fact of chemotherapy (chemical treatment for cancer) that some patients simply don’t respond to medications. Or that they stop responding over time.  With more than 45,400 women diagnosed with breast cancer every year, scientists have been furiously trying to decode our genetic patterns for reasons such as [...]]]> Source: BBC Health; The Lancet Oncology

It is a fact of chemotherapy (chemical treatment for cancer) that some patients simply don’t respond to medications. Or that they stop responding over time.  With more than 45,400 women diagnosed with breast cancer every year, scientists have been furiously trying to decode our genetic patterns for reasons such as this.

Starting with 829 genes present in breast cancer cells, the focus has been drawn to just 6 genes which appear to impact the efficacy (medical effectiveness) of chemotherapy.  If they are correct then it may be possible to develop a simple test to determine whether or not certain drugs, in this case paclitaxel, will be beneficial to patients.  Another one to watch.

~Posted by D.M. Schwadron, Esquire

Seriously?  A study of over 16,000 over 7 years has been published which suggests that while people are doing their own research on the WWW, they ultimately take the information to their doctors for a discussion.  Defining the health and disease information available to the public as [...]]]> Source:  HealthDay; New England Journal of Medicine (March 4th)

Seriously?  A study of over 16,000 over 7 years has been published which suggests that while people are doing their own research on the WWW, they ultimately take the information to their doctors for a discussion.  Defining the health and disease information available to the public as “noise” the researchers from the U.S. National Cancer Institute (who produced the survey) reveal their bias.

“The doctor’s appointment is an institution that will not budge,” Affirms Susannah Fox of the Pew Research Center’s Internet & American Life Project.

Apparently there was concern that with the wealth of information now available to patients online that doctor’s visits would be supplanted in the way that the internet supplanted newspapers and travel agencies.

The problem with this reasoning is that as yet, people aren’t able to treat themselves online or prescribe medication on line.  Accordingly doctors should feel secure in the sense that they are still needed. Unless there is something more in the way of specific information the authors have declined to provide the issue of whether one can draw any conclusion as to trust from the data is speculative at best.

~Posted by D.M. Schwadron, Esquire

Apparently stopping death or irreparable damage from a heart attack could be as simple as inflating a blood pressure cuff.  This according to a recent Danish (The Country) study.

How does it work and why does no one seem to know about this?  Well, it is thought that a brief stoppage [...]]]> Source: U.S. National Institutes of Health

Apparently stopping death or irreparable damage from a heart attack could be as simple as inflating a blood pressure cuff.  This according to a recent Danish (The Country) study.

How does it work and why does no one seem to know about this?  Well, it is thought that a brief stoppage of blood flow improves the ability of organs to withstand stress and prevents tissue damage.  The admittedly small study of 142 patients rushed to hospital emergency rooms for heart attacks who received this treatment managed to retain 30% more of their heart tissue than those who did not.  The cuff was inflated for 4 minutes, relaxed and then inflated again.  Repeating this procedure 4 times appears to have done the trick according to the study’s author, Dr. Hans Erik Botker, a professor of cardiology.

Unfortunately it may take some time before the rest of the world adopts the European model of treatment. One group at Emory University in Atlanta is currently attempting similar treatment here in the United States.  Dr. Jacob Vinten-Johansen has added the inflation variation with a balloon catheter, slightly more invasive.  According to Dr. Vinten-Johansen, “The United States cardiology community is a bit slower to embrace these things and the regulatory situation is better in Europe.”

Regulations here in the States require a consent for what is deemed an “experimental procedure.”  Not always something easy to obtain (No, not because of trial lawyers) as patients having heart attacks aren’t necessarily able to provide a consent.  Similar techniques are being used to attempt to treat stroke as well.

~Posted by D.M. Schwadron, Esquire

Tamoxifen (an estrogen blocker) is currently the most prescribed drug to fight breast cancer recurrence.  However up to 1/3 of women do not respond to Tamoxifen.  The reasons for this are not completely known as of this post but are believed to lie in a gene -FGFR1.

Researchers are now working [...]]]> Source:  BBC Health; Journal Cancer Research

Tamoxifen (an estrogen blocker) is currently the most prescribed drug to fight breast cancer recurrence.  However up to 1/3 of women do not respond to Tamoxifen.  The reasons for this are not completely known as of this post but are believed to lie in a gene -FGFR1.

Researchers are now working on methods to “switch off” the FGFR1 gene so that the therapeutic effects of Tamoxifen may be realized in greater numbers.  1 out of every 10 breast cancer survivors have the FGFR1 gene.  There are currently a number of drugs which are known to inhibit FGFR1.

The stage is now set for clinical trials.  If the laboratory evidence is repeatable in the real world this could mean less recurrence of breast cancer for more women.  Breast cancer is the most common disease causing death for women in the US and in the UK.

~Posted by D.M. Schwadron, Esquire

Pediatric respiratory emergencies result from a variety of causes, including chronic medical conditions, infections, allergic reactions, and obstruction from foreign bodies. At the American Academy of Emergency Medicine, held February 15 to 17 in Las Vegas, Nevada, management of the pediatric patient with a respiratory emergency and [...]]]> Source:  Medscape Medical News

Pediatric respiratory emergencies result from a variety of causes, including chronic medical conditions, infections, allergic reactions, and obstruction from foreign bodies. At the American Academy of Emergency Medicine, held February 15 to 17 in Las Vegas, Nevada, management of the pediatric patient with a respiratory emergency and some of the hidden and potentially life-threatening causes of respiratory distress was one of the educational tracks.

In this interview, MedscapeEmergency Medicine discussed the topic with Karen Santucci, MD. Dr. Santucci is medical director and section chief of pediatric emergency medicine at Yale-New Haven Children’s Hospital and is associate professor of pediatrics at the Yale University School of Medicine in New Haven, Connecticut.

Medscape: What do you look for first when a pediatric patient presents to you in respiratory distress?

Dr. Santucci: The first thing I do is a very careful physical exam. Oddly enough, sometimes you can do your best physical starting outside the exam room. Pediatric emergency medicine is a little bit different from adult emergency medicine, in that there’s a huge anxiety component, particularly in older infants and younger toddlers. Sometimes I pause outside the exam room for 5 or 6 seconds just to get a look at the status of the child in terms of increased work of breathing, because once you walk into the room, you introduce a new variable in terms of frightening the kid to death.

You can get a good sense of their baseline respiratory rate and what their affect looks like. Are they frightened because they have a partial airway obstruction or because they are really having a lot of difficulty breathing, or are they frightened because you just walked in the room and they associate any of us in healthcare with an immunization, a needle? There’s a huge fear factor.

So standing outside the room, getting a sense of how they’re interacting in their comfort zone with their family member and whether or not they’re manifesting any head bobbing, which would be movement of their head with every respiration, which would be an indication of increased work of breathing and accessory muscle use, and if they might even have nasal flaring, which is also evidence of severe respiratory distress. The physical exam is certainly critical, but I think it starts outside the exam room.

And then doing a good lung exam and observing how they’re moving air, using all your senses in terms of whether you hear stridor. Is there evidence of congestion? Is there audible wheezing? Feeling them in terms of their capillary refill, tapping on their nail bed, seeing how long it takes to refill, feeling their distal extremities, whether or not they’re warm and well perfused or cool, because children are at increased risk of becoming dehydrated with respiratory distress because of insensible losses. Certainly, if they’re manifesting with a fever, they’ll also have increased insensible losses, and they’re more at increased risk of dehydration.

Medscape: Once you’ve gone through the physical exam findings, are there any questions or particular areas you focus on when taking the history of a pediatric patient?

Dr. Santucci: One of the major things that tends to be missed in pediatrics is asking about potential risk for a foreign-body exposure, and I probably spend half of the talk on that because it is so pediatric-specific in terms of occult exposure to a foreign body that could have been missed.

Medscape: Is there a risk of clinicians becoming complacent and missing the less common causes of obstruction?

Dr. Santucci: A lot of what we see in terms of respiratory distress is associated with more common things; for example, at this time of year — January, February — we’re seeing a lot of [respiratory syncytial virus]–related bronchiolitis, particularly in children less than 2 years of age. What I would caution the clinician about is tending to think, it’s bronchiolitis season, so if an infant or toddler is presenting with respiratory distress, it’s probably bronchiolitis. I think maintaining the possibility of it being something else is so critically important.

Increased work of breathing and some congestion, and a little bit of a wheeze . . . could also be something like an inborn error of metabolism, and the child is actually presenting with what appears to be increased work of breathing because they’re developing increased respiratory drive to compensate for a metabolic acidosis.

In one case we had, what was felt to be bronchiolitis in a 10-month old was actually a salicylate overdose secondary to a mother giving increased amounts of Maalox Extra Strength for gastroesophageal reflux. We discovered that this baby had an increased anion gap . . . and, had we not erred on the side of sending a tox screen and had not this been recognized in real time, this child would have died. . . . Ask about over-the-counter meds and ointments and preparations because they can kill an individual — so [that is] very significant information.

One of the hugest points that I’ve learned over the years is maintaining a differential diagnosis when the points don’t seem to fit, delving and asking some questions, maybe sending a few extra labs to err on the side of being overly cautious and not just accepting things at face value. Even if you can’t figure things out in the emergency department, sharing that you’re really perplexed by a patient with the accepting team upstairs when you’re admitting a patient and making sure that they follow up on the lab tests as quickly as possible and initiate a pretty comprehensive work-up can absolutely be life saving.

Medscape: What are some of the tools that physicians can use to work through and manage respiratory distress in children?

Dr. Santucci: One specific case was a case of a 4-year-old girl presenting in the winter with some stridor, and she had some tripodding, which means she was leaning forward because she was trying to maximize airflow through the upper airway, and she was febrile to 104 degrees. This was a little girl who presented with all the classic signs and symptoms of epiglottitis. Even at a major tertiary-care center, there were specialists who just didn’t believe in epiglottitis any more. Ever since we’ve introduced Haemophilus influenzae type B vaccination, and this has become routine, we have reduced the incidence of epiglottitis so immensely that many people in healthcare don’t believe that it exists anymore.

The [attending ENT] was able to successfully intubate her in the operating room, but she clearly had epiglottitis and a near-complete airway obstruction, because the epiglottis was so inflamed and swollen, so edematous. The only way they were able to secure her airway on direct laryngoscopy was to squeeze her thorax and create a small air bubble. This could be a life-saving technique if you can’t get the child to the operating room, to squeeze the chest. While you’re doing direct laryngoscopy, there can be an air bubble, which will delineate where to pass the endotracheal tube.

Medscape: Besides H influenzae type B, are there other organisms that can cause epiglottitis?

Dr. Santucci: We almost always attribute it to H influenzae type B, but there are other types of bacteria — Staphylococcus, Streptococcus, and other serotypes of H influenzae — that can cause epiglottitis. Quite amazingly, there are other etiologies for epiglottitis — inhalational if someone is inhaling different types of illicit drugs. We’ve had a couple of cases associated with cold weather where people will take a gulp of some hot chocolate while they’re outside, and this thermal injury to the epiglottis will cause inflammation of the epiglottis.

So epiglottitis is still out there. We still need to maintain an index of suspicion for this, just like with foreign bodies. If you don’t think about it, you’re going to miss it, and someone’s going to die.

Have an index of suspicion for things like foreign bodies, and what kids are doing. They like to put stuff in their mouths, and so that’s a huge risk factor for morbidity and mortality if it’s not recognized early.

Medscape: Can a child’s activities before coming to the emergency department raise your suspicion of a foreign body?

Dr. Santucci: When you have a really sick kid, a lot of people mobilize, and they want to be at the bedside, but one thing that I’ve learned over the last couple of decades is that having a person break off from the bedside to talk to the family . . . it can be life-saving just to take a moment to go back and do a really thorough history.

Medscape: To wrap things up, can you give me a couple of bullet points that a physician should keep in mind when seeing a child in respiratory distress?

Dr. Santucci: An increased respiratory rate is not always a respiratory problem, so remember that tachypnea is not always a respiratory etiology and that sometimes that increase in respiratory rate is because of a compensatory mechanism for a metabolic problem. Propionic acidemia [propionyl-CoA carboxylase deficiency] is one example, and another would be diabetic ketoacidosis. Another thing is to remember the developmental status of children, particularly older infants and toddlers, and that whole foreign-body spectrum.

With regard to increased respiratory rate and increased work of breathing, when someone is presenting with acute anaphylaxis and severe allergic reaction, all the studies support getting epinephrine in within the first 30 minutes — it can absolutely save a life. If you delay that intramuscular injection of epinephrine, the cascade has already taken place in terms of what’s going on chemically, and you may have irreversible anaphylaxis. If you’re thinking about epinephrine, it would be better to give the epinephrine than to delay it.

We do not give the epinephrine intravenously. We give it intramuscularly. It’s going to be absorbed very nicely from an [intramuscular] route, and it’s extremely safe to give it intramuscularly.

Even in adults, giving intramuscular epinephrine is really quite safe. Anaphylaxis absolutely affects the heart as well, and if you don’t treat the anaphylaxis, someone might actually develop an acute myocardial infarct because of the anaphylaxis and the strain on the myocardium. So when you weigh all the pros and cons, you’re better off erring on the side of giving the epinephrine intramuscularly. That’s a huge critical life-saving point.