Treadmill Test May Predict Hidden Heart Disease

Treadmill testing is sometimes ordered when a person has a warning sign of heart trouble, such as chest pain. The idea is to see how the heart responds to the stepped-up demands of pumping harder and faster when exercising. Recently, researchers announced at the annual meeting of the American College of Cardiology in Atlanta that treadmill tests may also predict hidden heart disease in people with no symptoms.

Reviewing data from a 1970s study, the researchers looked at treadmill tests done when the study began and death rates and cause of death among the nearly 5,800 participants during the ensuing 20 years or so. Though none of the men and women had symptoms of heart trouble when the original study began, 10% of the men, whose average age was then 45, had abnormal test results. Thirty percent of the women, whose average age was 53, had abnormal results.

Over the following years, those who had abnormal results on the treadmill tests were twice as likely to die of heart or vascular disease as those whose tests were normal. Despite the predictive value of the treadmill testing in this study, researcher Samia Mora, a cardiologist at Johns Hopkins Hospital in Baltimore, is not suggesting that middle-aged people with no symptoms jump on the treadmill to test their hearts just yet. She and her colleagues are now looking at the value of exercise testing for high-risk people.

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Value of Talking About Loss Is Questioned

Ever since Sigmund Freud wrote about the value of grief work, many experts have believed that people who can express their emotions are able to come to terms with death more readily than those who keep a stiff upper lip. Now European researchers have found that talking or writing about one’s grief wasn’t especially helpful.

In one study, the Dutch and Belgium researchers asked more than 100 recently widowed people to respond to questionnaires at intervals over two years. Researchers asked the study participants whether they talked about their feelings with others and also about their general psychological health. The scientists found that sharing thoughts and feelings with others didn’t appear to reduce symptoms of depression or make the adjustment any easier.

The authors point out, however, that the kind of sharing that these people did differed from earlier studies in which bereaved people wrote about their feelings, a more active way of getting in touch with one’s feelings. So they did another study involving asking about 100 other people. At four and eight months after the death, the volunteers were asked to write about their loss or the problems of day-to-day life that had resulted, or both. The researchers found that expressing emotions on paper was of little benefit and that the writers were no better off than the control group that didn’t do the essays. People who have trouble adjusting to their loss may be different from these volunteers, but, the researchers write, those whose bereavement is uncomplicated “will cope with their loss in their own time and their own way.” (Journal of Consulting and Clinical Psychology 2002, 70 (1), pp. 169-178.)

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Pancreatic Cancer Responds to Laser Light Therapy

One of the newer weapons used to fight the war on cancer is photodynamic therapy, or PDT. The treatment involves injecting a drug that is absorbed more readily by cancer cells than healthy ones. When light hits the photosensitized cells, they self-destruct.

The U.S. Food and Drug Administration has approved PDT for esophageal cancer, a type of lung cancer, and precancerous lesions on the skin. Clinical trials to treat several other malignancies are underway.

Now, PDT has shown promising results in fighting one of the most formidable malignancies, pancreatic cancer. Researchers at the National Medical Laser Center in London gave 16 people with inoperable cancer Foscan, a photosensitizer used in Europe for advanced oral cancer.

Three days later, several needles were inserted through the patient’s skin into the tumor. A laser light was beamed into the tumor in the pancreas along an optical fiber running through each needle. As the needle was pulled back, another blast of light was delivered until the entire tumor was covered. The light therapy shrank tumors in all the patients initially, and they were able to go home within 10 days of treatment.

Seven of the patients were alive a year after treatment; two patients lived two years, which is longer than the average survival rate of six to 10 months when the disease has not spread. All of them were able to spend at least some of their last days at home with their families, and only three spent more than 20% of their survival time in the hospital.

PDT has a long way to go from this small study to being an approved treatment for pancreatic cancer, says Steve Bown, a professor at the Royal Free and University College Medical School in London. He says the next step would be a study comparing the effectiveness of PDT to conventional treatment, probably chemotherapy. (Gut 2002: 50:549-557)

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Study Takes the Knife to Plastic Surgeon Ads

The smart way to go about finding a plastic surgeon is to first make a list of candidates, then check their credentials. You might ask your friends, your family doctor or an operating room nurse you happen to know for the recommendations. Then again, you might just scan the ads in the Yellow Pages.

That’s what doctors who pay a steep price for space in the phone book are hoping you will do. But many of the doctors who advertise this way may be treading a thin line between informing the public of their services and deceptive advertising, according to research in the Journal of Plastic and Reconstructive Surgery.

University of Michigan researchers asked 50 men and women to look at 104 ads from the Yellow Pages in 10 cities, including Los Angeles and San Diego, and answer questions about them. In their opinion, one in four of the ads included images that were deceptive and created unrealistic expectations. They felt that about one in five of the ads appealed to a person’s fears, anxieties or emotional vulnerabilities. In general, the participants found 18% of the ads objectionable.

The American Society of Plastic Surgeons does have a code of ethics. But Edward Luce, president of the ASPS, said the code “doesn’t set the bar high enough for what we’d like to see.” One thing to watch for, he says, are ads that claim the surgeon has some superior skill. Then, trust your instincts.

“If an ad raises a question in a person’s mind, they should listen to that part of their brain,” Luce says. (Journal of Plastic and Reconstructive Surgery, 2002: 109 (3): pp. 1,181-1,186.)

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Dianne Partie Lange can be reached by e-mail at diannelange@cs.com.