October 27, 2018 - November 2, 2018
Antibiotics for appendicitis? Surgery often not needed
2016 photo provided by the University of Washington, Dr. Linda Vorvick
examines Heather VanDusen at UW Neighborhood Clinic in Seattle. When
emergency tests showed the telltale right-sided pain in VanDusen’s
abdomen was appendicitis, she figured she’d be quickly wheeled into
surgery. But doctors offered her the option of antibiotics instead.
(Clare McLean/UW Medicine via AP)
Chicago (AP) -
When emergency tests showed the telltale right-sided pain in Heather
VanDusen’s abdomen was appendicitis, she figured she’d be quickly
wheeled into surgery. But doctors offered her the option of antibiotics
A new study from
Finland shows her choice is a reasonable alternative for most patients
with appendicitis. Five years after treatment with antibiotics, almost
two-thirds of patients hadn’t had another attack.
It’s a substantial
change in thinking about how to treat an inflamed appendix. For decades,
appendicitis has been considered a medical emergency requiring immediate
surgery to remove the appendix because of fears it could burst, which
can be life-threatening.
But advances in
imaging tests, mainly CT scans, have made it easier to determine if an
appendix might burst, or if patients could be safely treated without
The results suggest
that nearly two-thirds of appendicitis patients don’t face that risk and
may be good candidates for antibiotics instead.
“It’s a feasible,
viable and a safe option,” said Dr. Paulina Salminen, the study’s lead
author and a surgeon at Turku University Hospital in Finland.
Her study in adults
is the longest follow-up to date of patients treated with drugs instead
of surgery for appendicitis and the results confirm one-year findings
reported three years ago.
Research has also
shown antibiotics may work for some children with appendicitis.
The Finnish results
were published Tuesday in the Journal of the American Medical
A journal editorial
says “it’s a new era of appendicitis treatment.”
Appendix removal is
the most common emergency surgery worldwide, with about 300,000
performed each year in the United States alone, said Salminen. She said
the results from her study suggest many of those surgeries could be
U.S. doctors have
started offering antibiotics instead of surgery and Salminen says she
occasionally does too. The journal editorial says appropriate patients
should be given that option.
The study involved
about 500 Finnish adults who had CT scans to rule out severe cases.
Half were treated
with antibiotics; the others had surgery.
antibiotics patients, 100 ended up having surgery within five years of
treatment - most for a suspected recurrence of appendicitis in the first
year. Seven of them did not have appendicitis and likely could have
avoided surgery. The results suggest the success rate for antibiotic
treatment was almost 64 percent, the authors said.
About 1 in 4
surgery patients had complications, including infections around the
incision, abdominal pain and hernias, compared with only 7 percent of
antibiotics patients. Antibiotic patients had 11 fewer sick days on
average than the surgery group. In the first year, their treatment costs
were about 60 percent lower. A cost analysis for the full five years
wasn’t included in the published results.
Surgery patients in
the Finnish study all had conventional incisions rather than the less
invasive “keyhole” surgeries that are more common for appendix removal
in the United States. The non-surgery patients received three days of IV
antibiotics in the hospital, followed by seven days of pills at home.
Dr. Giana Davidson,
a University of Washington surgeon, is involved in a similarly designed
multicenter U.S. study that may answer whether similar benefits would be
seen for antibiotics versus “keyhole” surgery.
Davidson called the
Finnish study “a critical piece to the puzzle but I don’t think it
answers all of the questions.”
was treated at the University of Washington in 2016. She said she chose
antibiotic treatment partly to avoid surgery scars, and now offers
advice to patients for Davidson’s study.
“I knew the worst
case scenario was ending up back in the hospital so why not try
antibiotics first,” said VanDusen, who works in university
She said she has
done well since her treatment, but that the biggest drawback “is
wondering, with every episode of stomach or bad gas, if it could happen
Genetic glitch increases men’s risk
of impotence, study says
New York (AP) - Scientists say they’ve
located the first well-documented genetic glitch that increases a man’s
risk of impotence, a step that might someday lead to new treatments.
Most impotence isn’t caused by genetics but rather
things like obesity, diabetes, heart disease, smoking, drug and alcohol
use, stress or anxiety.
But in a study released Monday by the Proceedings
of the National Academy of Sciences, researchers say they located a spot
in human DNA where genetic variation might boost a man’s risk by about
They found statistical evidence for that by looking
in the genetic makeup of about 36,600 men, and confirmed it in a similar
study of 222,300 other men. Lab tests then suggested that variation
might affect the activity of a nearby gene that’s known to be involved
in sexual functioning.
Now scientists want to explore how such variation
affects risk of the condition, said Eric Jorgenson, a researcher at
Kaiser Permanente Northern California in Oakland and lead author of the
paper. It may interfere with the functioning of certain brain circuits,
He said discovering a biological explanation could
give clues to developing new treatments for impotence, also known as
October 13, 2018 - October 19, 2018
80,000 people died of flu last winter in US
In this Feb. 26, 2015 photo taken through the eyepiece of a
microscope, human cells infected with the flu virus glow green
under light from a fluorescence microscope at a laboratory in
Seattle. The U.S. government estimates that 80,000 Americans
died of flu and flu complications in the winter of 2017-2018 -
the highest flu-related death toll in at least four decades. (AP
Photo/Ted S. Warren)
(AP) - An estimated 80,000 Americans
died of flu and its complications last winter - the disease’s
highest death toll in at least four decades.
director of the Centers for Disease Control and Prevention, Dr.
Robert Redfield, revealed the total in an interview last month
night with The Associated Press.
knew it was a very bad season, but at least one found the size
of the estimate surprising.
huge,” said Dr. William Schaffner, a Vanderbilt University
vaccine expert. The tally was nearly twice as much as what
health officials previously considered a bad year, he said.
years, flu-related deaths have ranged from about 12,000 to
56,000, according to the CDC.
and winter, the U.S. went through one of the most severe flu
seasons in recent memory. It was driven by a kind of flu that
tends to put more people in the hospital and cause more deaths,
particularly among young children and the elderly.
peaked in early February and it was mostly over by the end of
bad year worse, the flu vaccine didn’t work very well. Experts
nevertheless say vaccination is still worth it because it makes
illnesses less severe and save lives.
to see more people get vaccinated,” Redfield told the AP at an
event in New York. “We lost 80,000 people last year to the flu.”
officials do not have exact counts of how many people die from
flu each year. Flu is so common that not all flu cases are
reported, and flu is not always listed on death certificates. So
the CDC uses statistical models, which are periodically revised,
to make estimates.
complications from the flu can include pneumonia, stroke and
officials called the 80,000 figure preliminary, and it may be
slightly revised. But they said it is not expected to go down.
the estimates for every flu season going back to the winter of
1976-1977. Estimates for many earlier seasons were not readily
was not the worst flu season on record, however. The 1918 flu
pandemic, which lasted nearly two years, killed more than
500,000 Americans, historians estimate.
easy to compare flu seasons through history, partly because the
nation’s population is changing. There are more Americans - and
more elderly Americans - today than in decades past, noted Dr.
Daniel Jernigan, a CDC flu expert.
officials on Thursday are scheduled to hold a media event in
Washington, D.C., to stress the importance of vaccinations to
protect against whatever flu circulates this coming winter.
And how bad
is it going to be? So far, the flu that’s been detected is a
milder strain, and early signs are that the vaccine is shaping
up to be a good match, Jernigan said.
of the vaccine has been changed this year to try to better
protect against expected strains.
know what’s going to happen, but we’re seeing more encouraging
signs than we were early last year,” Jernigan said.
October 6, 2018 - October 12, 2018
UN: Excessive drinking killed over
3 million people in 2016
The World Health Organization said in a report published
Friday Sept. 21, 2018, that drinking too much alcohol killed more than 3
million people in 2016, mostly men, with Europe having the highest
global per capita alcohol consumption. (AP Photo/Alexander F. Yuan,
Geneva (AP) -
Drinking too much alcohol killed more than 3 million
people in 2016, mostly men, the World Health Organization said.
The U.N. health
agency also warned that current policy responses are not sufficient to
reverse trends predicting an increase in consumption over the next 10
In a new report Friday,
the agency said that about 237 million men and 46 million women faced
alcohol problems, with the highest prevalence in Europe and the Americas.
Europe has the highest global per capita alcohol consumption, even though it
has already dropped by 10 percent since 2010.
Around a third of
alcohol-related deaths were a result of injuries, including car crashes and
self-harm, while about one in five were due to either digestive disorders or
cardiovascular diseases. Cancers, infectious diseases, mental disorders and
other health conditions were also to blame.
“Far too many people,
their families and communities suffer the consequences of the harmful use of
alcohol through violence, injuries, mental health problems and diseases like
cancer and stroke,” said Tedros Adhanom Ghebreyesus, the director-general of
WHO. “It’s time to step up action to prevent this serious threat to the
development of healthy societies.”
The average daily
consumption of alcohol by people who consume it is about two glasses of
wine, a large bottle of beer or two shots of spirits. Globally, about 2.3
billion people are current drinkers.
The report, the third
in a series after ones in 2010 and 2014, relies on information from 2016 -
the latest data available. WHO said the trends and projections point to an
expected increase in global alcohol per capita consumption over the next
decade, particularly in Southeast Asia and the Americas.
“The policy responses
which are currently in place in countries are definitely not sufficient to
reverse the trends, which we observe in several parts of the world, or to
improve significantly this situation,” Dr. Vladimir Poznyak, coordinator of
WHO’s management of substance abuse unit, told reporters.
“When we look at the
trends of alcohol consumption in many countries from 2000, you can see ups
and downs - which are determined by different factors,” said Poznyak, citing
countries’ levels of social development, economic backdrops, policy measures
and cultural trends.
He said the data
showed, for example, that alcohol consumption tends to drop in countries
facing an economic crisis.
Poznyak said it was
“imperative for the governments to put in place measures that can mitigate
the harms associated with this increase.”
The Distilled Spirits
Council, which advocates for the industry in the U.S., said in a statement
it supports the WHO’s goal to reduce the harmful use of alcohol.
“However, we are
concerned that some policy recommendations such as increasing alcohol taxes
are misguided and don’t effectively address harmful consumption,” it said.
Ultrasound jiggles open brain barrier,
a step to better care
In this March 23, 2017 photo provided by the
Sunnybrook Health Sciences Centre, patient Rick Karr is prepared for
treatment at the facility in Toronto, Canada. Karr was the first Alzheimer’s
patient treated with focused ultrasound to open the blood-brain barrier.
(Kevin Van Paassen/Sunnybrook Health Sciences Centre via AP)
Washington (AP) -
A handful of Alzheimer’s patients signed up for a bold
experiment: They let scientists beam sound waves into the brain to
temporarily jiggle an opening in its protective shield.
The so-called blood-brain barrier
prevents germs and other damaging substances from leaching in through the
bloodstream - but it can block drugs for Alzheimer’s, brain tumors and other
neurologic diseases, too.
Canadian researchers on Wednesday
reported early hints that technology called focused ultrasound can safely
poke holes in that barrier - holes that quickly sealed back up - a step
toward one day using the non-invasive device to push brain treatments
“It’s been a major goal of neuroscience
for decades, this idea of a safe and reversible and precise way of breaching
the blood-brain barrier,” said Dr. Nir Lipsman, a neurosurgeon at Toronto’s
Sunnybrook Health Sciences Centre who led the study. “It’s exciting.”
The findings were presented at the
Alzheimer’s Association International Conference in Chicago and published in
This first-step research, conducted in
just six people with mild to moderate Alzheimer’s, checked if patients’
fragile blood vessels could withstand the breach without bleeding or other
side effects - it didn’t test potential therapies.
More safety testing is needed but “it’s
definitely promising,” said Dr. Eliezer Masliah of the National Institute on
Aging, who wasn’t involved with the study. “What is remarkable is that they
could do it in a very focused way, they can target a very specific brain
Alzheimer’s isn’t the only target. A
similar safety study is underway in Lou Gehrig’s disease. And researchers
are testing if the tool helps more chemotherapy reach the right spot in
people with a deadly brain tumor called glioblastoma.
“We don’t want to broadly open the
blood-brain barrier everywhere. We want to open the blood-brain barrier
where we want the treatment to be delivered,” explained Dr. Graeme Woodworth
of the University of Maryland Medical Center, who will lead a soon-to-begin
brain tumor study.
Scientists have long tried different
strategies to overcome the blood-brain barrier with little success. The
brain’s blood vessels are lined with cells that form tight junctions, almost
like a zipper. The barrier lets in select small molecules. Often, treatments
for brain diseases are too big to easily pass.
The new approach: Scientists inject
microscopic bubbles into the bloodstream. Through an MRI scanner, they aim
at a precise brain area. Then they beam ultrasound waves through a
helmet-like device to that spot. The pulses of energy make the microbubbles
vibrate, loosening those zipper-like junctions in hopes that medications
could slip inside.
Within minutes, Lipsman’s team saw a
medical dye appear on the Alzheimer’s patients’ brain scans - proof the
barrier opened. A repeat scan the next day showed it was closed again.
Patients repeated the procedure a month later.
Researchers reported no serious side
effects, and no worsening of cognitive function. The study was funded by the
non-profit Focused Ultrasound Foundation.
“It’s not painful or anything,” said
Rick Karr of Everett, Ontario, the study’s first participant.
A retired truck driver and amateur
musician, Karr was diagnosed with Alzheimer’s in 2011. Doctors made clear
the study wouldn’t treat his memory problems, but “I feel privileged,” Karr
said in an interview. “I could help somebody else down the road.”
A French company, CarThera, is testing
a different ultrasound technique for brain tumors, using an implant attached
to the skull during surgery.
For the non-invasive ultrasound, device
maker InSightec has Food and Drug Administration permission to begin the
Maryland tumor trial and a small U.S. Alzheimer’s study.
This time, scientists will aim deeper
into Alzheimer’s-affected brains to a key memory region, said lead
researcher Dr. Ali Rezai of West Virginia University’s Rockefeller
Neuroscience Institute. And they’ll measure if simply opening the barrier
could help the body clear away sticky plaques that are a hallmark of
Alzheimer’s, after mouse studies suggested that’s a possibility.
But by far the bigger interest is in
using ultrasound to deliver drugs - if the next-step studies conclude it’s
safe to try.
“The blood-brain barrier’s no longer
off-limits,” Rezai said.