A Cost-Effective Alternative to Surgery to Treat Leg Pain
Cramplike pain while walking is a common symptom of peripheral artery disease, caused by hardening and narrowing of blood vessels in the legs. The disease affects as many as 10 million Americans, and the pain is typically treated with bypass surgery to circumvent the narrowed arteries.
But a new study has found that using angioplasty and stents to treat such leg pain, called claudication, is as effective as surgical approaches, costs only half as much and is much easier on patients.
Dr. Michael A. Bettmann and his colleagues at the Dartmouth-Hitchcock Medical Center in Lebanon, N.H., performed bypass surgery on 33 patients with claudication and used angioplasty with stents to treat 64 others. The cost of the latter procedure averaged $6,502, compared to an average of $12,422 for surgery, they reported last week at a Chicago meeting of the Radiological Society of North America. Those receiving the angioplasty had much shorter recovery times, and, one year later, follow-up tests showed they were as healthy as those who had surgery.
New Treatments Inhibit Excess Growth Hormone
A new category of drugs may provide better treatment for acromegaly, a rare condition in which the pituitary gland produces excessive amounts of a growth hormone called insulinlike growth factor-1, or IGF-1.
An estimated 40 to 60 of every 1million Americans suffer from the disease, which is marked by the abnormal growth of hands and feet, bone growth in the face, headaches, arthritis and nerve damage. The mortality rate in victims is two to four times the normal rate, primarily from heart disease.
A new drug called pegvisomant (trade-named Somavert) binds to receptors for IGF-1 in tissues, preventing the hormone itself from binding and stimulating growth. Dr. Michael O. Thorner and his colleagues at the University of Virginia Health System in Charlottesville treated 152 patients with acromegaly with daily injections of the new drug. They reported in the Nov. 24 Lancet that 97% of those who had been treated for at least a year had normal concentrations of IGF-1 in their blood stream, ameliorating symptoms. The study was funded by Pharmacia Corp., which manufactures the drug.
Elevated Selenium May Cut Prostate Cancer Risk
Higher levels of selenium in the blood are associated with a reduced risk of prostate cancer, according to researchers from Stanford University. Dr. James D. Brooks and colleagues reported in the December issue of the Journal of Urology that men with low levels of the element--found in many foods and certain dietary supplements--are four to five times more likely to develop the disease. Because selenium levels diminish with age, supplementation may be more important in older men, but no studies have shown that supplements actually raise levels of selenium in the blood, Brooks said.
Adult Soccer Balls Increase Injuries in Children
Perhaps not surprisingly, using adult-size soccer balls increases the injury rate among children playing the game, British researchers report. An adult (size 5) soccer ball weighs 450 grams (about a pound) and can be kicked at speeds of up to 25 yards per second. The impact from a stitched ball, particularly when wet, is greater than that from a molded ball and significantly greater than that from a junior (size 4) ball.
Dr. Kevin Boyd and his colleagues at the Queen’s Medical Centre in Nottingham monitored soccer-related fracture injuries at one hospital for 17 months. They recorded 29 wrist fractures in 28 goalies who had been trying to “make a save.” One goalie suffered two injuries in separate accidents.
The average age of the players was just under 11, and more than three-quarters of the injuries involved an adult-size ball, they reported in the December British Journal of Sports Medicine.
Scientists Link Hormone Imbalances to Migraines
Hormonal imbalances may underlie chronic migraine headaches, Brazilian researchers have found.
Dr. Mario Peres and his colleagues at the Sao Paulo Headache Center took hourly blood samples from 17 chronic migraine sufferers and compared them with hourly samples from nine healthy people of similar age. They studied the levels of four hormones produced by the hypothalamus, which regulates basic body functions, such as body temperature and hunger.
The researchers reported in the December issue of the Journal of Neurology, Neurosurgery and Psychiatry that the migraine sufferers had hormonal irregularities compared to the healthy people.
Peak melatonin levels were delayed in half the migraine sufferers, and peaks were abnormally low in those with insomnia, which is common in migraine sufferers. Melatonin helps regulate sleep cycles. Levels of cortisol, the stress hormone, were higher in migraine victims, while prolactin levels were lower. Prolactin normally counterbalances a neurotransmitter called dopamine. Previous studies have shown that suppression of dopamine can treat migraines.
Study Offers Insight Into Compulsive Drug Use
New imaging studies of the brain in methamphetamine users may help explain why drug addicts take drugs compulsively, according to researchers at Brookhaven National Laboratory in Upton, N.Y.
Dr. Nora Volkow and her colleagues used positron emission tomography (PET) imaging to study brain activity in 15 methamphetamine abusers and in 20 people who didn’t use drugs.
They reported in the December issue of the American Journal of Psychiatry that the methamphetamine users had abnormally low levels of dopamine D2 receptors, which are normally associated with pleasure and reward responses. They also found that the reduced receptor levels were present in the orbitofrontal cortex of the brain. Disruption of the cortex is associated with obsessive and compulsive behaviors.
“We hypothesized that disruption of this brain region, resulting from depletion of dopamine receptors, could lead to compulsive [drug] intake,” Volkow said. Similar results have been found in cocaine abusers.
Reduced dopamine D2 receptor levels blunt the ability of normal stimuli to trigger a reward response in the brain, Volkow said. “Ordinary stimuli are not strong enough to activate the circuits,” she said. Administration of methamphetamine, in contrast, floods the brain with dopamine, producing a favorable response. This makes it very hard for the addict to resist the drug, she said.
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Medical writer Thomas H. Maugh II can be reached at thomas.maugh@latimes.com.
