New Heart Pump Shows Promise in Trial

(HealthDay News) -- A new kind of heart pump helped patients with heart failure so severe that their only option was a transplant, cardiologists report.

"The design is completely different from existing assist devices," said Dr. Leslie W. Miller, chief of cardiology at Washington Hospital Center, referring to the Heart Mate II that was implanted in 133 people with end-stage heart failure. "They are pulsatile, stimulating the function of the left ventricle, which injects blood into the bloodstream. This is a continuous flow device."

At six months, 75 percent of those with device were still alive, with a 12-month survival rate of 68 percent.

"The results were very positive," said Miller, lead author of a report on the trial in the Aug. 30 issue of the New England Journal of Medicine. "These patients were so sick that it was hard to get more than 75 percent survival at six months."

The device performed well mechanically, Miller said. And there was no increased incidence of blood clotting or similar problems when compared to older generations of such devices.

Data from the trial is being submitted to the U.S. Food and Drug Administration by Thoratec, the California company that plans to market the device and funded the trial. An FDA expert panel will consider whether the agency will approve the device as a bridge to heart transplants.
Another study of the device as a permanent implant for people with less severe heart failure has just been completed, and that data will also be submitted to the FDA, Miller said.

The device "looks like a flashlight," he said. "It weighs about 14 grams, and is about a fifth the size of existing devices. It is also silent in operation."

That small size "will open the door for use in more patients," said Dr. Kenneth L. Baughman, a professor of medicine and cardiology at Brigham and Women's Hospital in Boston and co-author of an accompanying editorial. "It can be used for support in women and younger adults."

The continuous flow pump "offers a different kind of support," he said. "It is smaller in size with fewer moving parts."

In fact, the device has just one moving part, the rotor that transports blood, Miller said.

The new pump does not do away with the problems that have accompanied older devices, Baughman said. "There still are problems such as thromboembolisms [clots], bleeding and infection," he said. "These are not eliminated, but they do not occur at higher levels than with current devices."

The continuous flow pump does present one difficulty -- determining blood pressure, Baughman said. Because of the way the device works, it does not provide the systolic and diastolic blood pressure reading that are a constant in heart monitoring.

"And what is not known is what happens to the body over time," when a continuous flow pump is implanted, Baughman said. "We'll just have to wait and see how it works out over time."

More information
The workings of the current generation of assist devices are described by the American Heart Association.

Heart Attack Boosts Diabetes Risk

(HealthDay News) -- After a heart attack, the risk of developing diabetes and so-called pre-diabetes rises steeply, a new study finds.

In fact, recent heart attack patients are up to four-and-a-half times more likely to develop diabetes compared with the general population and more than 15 times more likely to develop high blood sugar, according to the report in the Aug. 25 issue of The Lancet.

"Having a heart attack means that the chances of getting diabetes later are increased," said Dr. Lionel Opie, director of the Hatter Cardiovascular Research Institute at the University of Cape Town, South Africa, and author of an accompanying journal editorial. "We already know that diabetes predisposes one to heart attack, now we add that heart attacks predispose one to diabetes -- one nasty disease leads to another, and it's a two-way process."

In the study, a team led by Dr. Roberto Marchioli, from the Laboratory of Clinical Epidemiology of Cardiovascular Disease, Consorzio Mario Negri Sud, Chieti, Italy, collected data on almost 8,300 Italian patients who had suffered a recent heart attack and were not previously diabetic.

More than three and a half years after the heart attack, a third of the patients had developed diabetes or had impaired insulin resistance (a precursor to diabetes), as measured by an increase in blood sugar.

When they used a lower threshold for measuring blood sugar, 62 percent of the patients were defined as diabetic.

"These findings further tie the knot between heart attacks and high blood glucose -- each is a risk for the other, the patient thus potentially being caught in a fatal vicious circle," Opie said.
Risk markers for diabetes or high blood sugar include age, high blood pressure, and use of heart medicines such as beta-blockers, cholesterol-lowering drugs, and diuretics.

The researchers found being overweight increased the risk of diabetes. Smoking also increased the risk by 60 percent. In addition, an unhealthy diet and heavy drinking increased the risk of developing diabetes after a heart attack.

"Lifestyle factors can be particularly important in preventing disease," Marchioli said. "The reductions in risk associated with a Mediterranean-type diet suggest that diet could help reduce incidence of pre-diabetes and diabetes after a [heart attack]," he added.

Opie agreed that changing diet and exercising can help cut post-heart attack diabetes risk.

"Once you have had a heart attack, watch for new diabetes -- monitor blood sugar and keep exercising a lot," Opie advised. "This 'eats up' the blood sugar. And eat Mediterranean-style, adding olive oil and nuts -- the Mediterranean diet gives some, but not total, protection from new diabetes after a heart attack."

More information
For more on diabetes, visit the American Diabetes Association.

Antioxidant Supplements May Raise Women's Skin Cancer Risk

(HealthDay News) -- Taking antioxidant supplements won't protect against skin cancer and may actually boost the risk, at least in women, according to a new French study.

"Taking into consideration our results, we are particularly concerned by the use of long-term supplementation, notably in sun-seekers and people wanting to look tanned [using beta-carotene]," said researcher Dr. Serge Hercberg, professor of nutrition at the Medical University of Paris.

The new findings come on the heels of a study, published in mid-August in the Archives of Internal Medicine, that found that antioxidants don't prevent heart disease risk in high-risk women.

In the new French study, published in the September issue of The Journal of Nutrition, Hercberg's team looked at the effects of antioxidant doses on skin cancer. The research was conducted as part of a larger study that looked at the effects of antioxidants on cancer and ischemic heart disease.

Antioxidant nutrients are thought to reduce disease risk by cutting down on the unhealthy effects of "free radical" molecules that damage cells.

The researchers assigned almost 7,900 women and more than 5,100 men to take either an oral daily capsule of antioxidant or a placebo that looked the same. The antioxidants included 120 milligrams of vitamin C, 30 milligrams of vitamin E, 6 milligrams of beta-carotene, 100 milligrams of selenium and 20 milligrams of zinc.

"They are not high doses," Hercberg said. "They are at a level below a lot of pills you can find to buy over the counter."

The men and women were followed for about 7.5 years. In that time, 157 cases of any form of skin cancers were reported, including 25 melanomas, the most deadly form.

The team found that, in women, the incidence of all types of skin cancer combined was actually higher in the antioxidant group, and so was their incidence of melanoma.

But the incidence of non-melanoma skin cancers, when evaluated separately, did not differ between the antioxidant and placebo groups in men or women. In men, there was no difference in any form of skin cancer (including melanoma) between the two groups.

In the antioxidant group, 51 women developed skin cancer, while 30 in the placebo group did. Among the men, 43 in the placebo group and 33 in the antioxidant group got skin cancers.

As for melanoma, the incidence did not differ significantly between the men's treatment group -- 6 in the placebo group and 3 in the antioxidant group got it. But 3 women on placebo and 13 on antioxidants got melanoma -- a significant difference, the researchers said.

Antioxidant studies have yielded mixed results, Hercberg stressed. For example, in previous studies, researchers saw a higher risk of lung cancer in heavy smokers who regularly took high doses of beta-carotene.

Studies have suggested that antioxidant supplements might protect against Prostate cancer incidence in men with low blood levels of prostate specific antigen (PSA), Hercberg said. But research has also suggested that the nutrients might increase prostate cancer risk in men with a high PSA. PSA levels are a marker for pre-existing prostate cancer risk.

That could also be happening in the women who got more skin cancers after taking antioxidants, he theorized. If their skin cancer had already been developing, taking an antioxidant might not help, Hercberg speculated.

While the study is interesting, further research is needed to confirm it, said Dr. Ariel Ostad, a spokesman for the Skin Cancer Foundation and a New York City dermatologist not involved in the study.

He said the study did have one serious limitation. "It does not take into account sunscreen use," he said. If the participants tended not to use sunscreen, that could have affected the results.
Meanwhile, Ostad added, taking care in the sun is important, and "sunscreens are by far the most powerful" weapon to prevent skin cancers.

More information
To learn more about preventing skin cancer with sunscreens, visit the Skin Cancer Foundation.

Restricting Blood Flow May Help Heart Bypass Patients

(HealthDay News) -- In a potentially significant discovery for heart bypass patients, British researchers are reporting that limiting blood flow to an arm before surgery produced better results in a small trial of patients.

Restricting blood flow before surgery reduced levels of troponin T, a cardiac protein that is released into the bloodstream after injury to the heart and is associated with poor outcomes after surgery, the researchers said.

"If you remotely precondition the heart before surgery, you get significant protection," said study researcher Dr. Derek Yellon, of University College London's Hatter Cardiovascular Institute. "You can significantly reduce troponin T in patients undergoing bypass surgery."

"Remote preconditioning is a phenomena in which, if one deprives the blood supply to an organ or tissue, other than the heart, that initiates a protective mechanism on the heart," added study lead author Dr. Derek J. Hausenloy, also from the Hatter Cardiovascular Institute.

The findings are published in the Aug. 18 issue of The Lancet.

Heart bypass surgery is done to reroute -- or "bypass" -- blood around clogged arteries to improve blood flow and oxygen to the heart, according to the American Heart Association.

In the trial, the British researchers restricted blood supply to the heart by restricting blood flow in an arm. Yellon and Hausenloy studied 57 patients undergoing coronary artery bypass surgery. Twenty-seven of the patients underwent heart preconditioning -- restrictions of blood flow -- before the operation.

Preconditioning consisted of three, five-minute cycles of restricting blood flow in one arm by inflating a blood pressure cuff that acted like a tourniquet. Between each cycle, the cuff was deflated.

Before and after surgery, the researchers measured the blood levels of troponin T in all patients. They found that levels of the protein were reduced by 43 percent among patients who had undergone preconditioning, compared with those who hadn't.

"If you can have a noninvasive technique that can reduce by 43 percent the amount of injury sustained by the heart during bypass surgery, then you can improve the morbidity and mortality of patients," Hausenloy said.

More study is needed to see if the technique actually improves clinical outcomes, Hausenloy said. "If this can be shown, it may warrant a change in clinical practice in all patients undergoing bypass surgery," he added.

Another heart expert agrees that if this concept is workable, it could represent a major advance in heart-bypass surgery.

"Revascularization, with angioplasty or bypass surgery, carries risk of heart muscle damage, measured in the study by troponin release," said Dr. Henry Purcell, of the Royal Brompton Hospital in London, and co-author of an accompanying editorial in the journal. "We need to minimize these risks in cardiac and non-cardiac surgery."

"We clearly need more data, and the current team is designing outcome studies to see if this protection translates into clinical benefits," Purcell said.

In another report in the same issue of the journal, South Korean researchers showed that use of the painkiller celecoxib (Celebrex) after implanting a stent to open blocked arteries in people with coronary artery disease is safe and might reduce the need for repeat procedures.

Dr Hyo-Soo Kim, of Seoul National University Hospital, and colleagues studied 274 patients, all of whom were given 100 milligrams of aspirin and 75 milligrams of Plavix -- a drug designed to prevent blood clots -- a day. In addition, 136 were randomly assigned to receive celecoxib before and after the procedure.

"These data suggest that the adjunctive use of celecoxib for six months after stent implantation in patients with coronary artery is safe," the researchers wrote.

In addition, they say that unlike another cox-2 inhibitor, Vioxx, celecoxib does not increase the risk of heart attack. "Administration of celecoxib for six months does not seem to increase the risk of adverse cardiac events in the intermediate term when used with dual anti-platelet therapy," they wrote.

However, another accompanying journal editorial warned that clinical trials suggest that long-term use of celecoxib may increase the risk of heart attack.

More information
To learn more about bypass surgery, visit the American Heart Association.

Health Tip: Reasons for Chronic Cough

(HealthDay News) -- Chronic cough is one that persists for longer than three weeks.

The cough may be caused by an illness, a behavior such as smoking, or as a side effect of a medication.

Here are common reasons for chronic cough, courtesy of the American Academy of Family Physicians:

• Smoking.
• Asthma.
• Medications, including ACE inhibitors used to treat high blood pressure, or beta blockers used to treat high blood pressure, glaucoma or migraines.
• Acid reflux (heartburn), when the acid in your stomach backs up into your throat.
• Allergies, which can trigger cough-inducing postnasal drip.

Low-Cal Sweets Might Still Make Kids Obese

(HealthDay News) -- Diet foods and drinks meant to help children control their weight may actually spur overeating and obesity, Canadian researchers say.

The study found that animals learn to associate the taste of food with the amount of caloric energy it provides. The researchers speculate that children who eat low-calorie versions of foods that normally have a high calorie content may develop distorted connections between taste and calorie content, resulting in overeating as the children grow up.

"The use of diet food and drinks from an early age into adulthood may induce overeating and gradual weight gain through the taste conditioning process that we have described," lead author and sociologist Dr. David Pierce, of the University of Alberta, said in a prepared statement.

In a series of experiments published Aug. 8 in the journal Obesity, the researchers found that young rats started to overeat when they received low-calorie food and drink. Adolescent rats did not overeat when given low-calorie items.

This may be because, unlike the younger rats, the adolescent rats didn't rely on taste-related cues to assess the caloric energy content of their food, the researchers said.

"Based on what we've learned, it is better for children to eat healthy, well-balanced diets with sufficient calories for their daily activities rather than low-calorie snacks or meals," Pierce said.

More information
The Nemours Foundation has more about children and healthy eating.

Tumor-Zapping Technique Fights Kidney Cancer

(HealthDay News) -- A heat-based technique called "CT-guided radiofrequency ablation" was almost 100 percent successful in destroying small malignant kidney tumors in a study of more than 100 patients, new research shows.

Radiofrequency ablation has been used successful in liver tumors since the early 1990s. A needle-like treatment probe, guided by computer tomography (CT), is inserted into the tumor where it emits a high-frequency alternating current. The current heats the tumor tissue and destroys it. Radiofrequency ablation is an outpatient procedure in which the patient is sedated but conscious, and a local anesthetic is used at the puncture site.

The technique targeted tumors ranging in size from 0.6 centimeters to 8.8 centimeters in size. A total of 125 tumors in 104 patients were treated between 2000 and 2006. Of the 95 tumors that were smaller than 3.7 cm, all were completely eradicated by a single treatment, the researchers reported in the August issue of the American Journal of Roentgenology.

Seven of the remaining tumors were eradicated after a second treatment, the team added, for a total 93 percent success rate for all 125 tumors. The tumors were still gone 14 months after treatment. Of the 104 patients in the study, 101 went home the same day.

"This is the largest treatment group to date of patients with biopsy-proven renal malignancies," lead author Dr. Ronald J. Zagoria, of Wake Forest University Baptist Medical Center in Wnston-Salem, N.C., said in a prepared statement. "The results, a high cure rate and low complication rate, establish that at institutions with experience doing this procedure, this is an alternative method for treating small renal malignancies in patients who are not good surgical candidates," he said.

His team noted that the technique is best used for small tumors. Although it can be effective in larger tumors, there is always the risk of incomplete destruction. Further, tumors located near the middle of the kidney pose a particular challenge, because they are close to large blood vessels or the ureter, the tubes that transport urine from the kidney to the bladder.

Zagoria's group cautioned that surgery is still the preferred method of fighting kidney cancer in patients who are young, healthy and have two kidneys because there is no data available for long-term follow-up on the effects of radiofrequency ablation.

There are more than 51,000 new cases of kidney cancer every year in the United States and 12,000 deaths from the disease, according to the U.S. National Cancer Institute.

More information
To learn more about kidney cancer, visit the U.S. National Cancer Institute.

MRIs Spot Breast Cancers in High-Risk Women

(HealthDay News) -- MRIs caught more Breast cancers in women at high risk for the disease than either mammography or ultrasound, according to a new study that compared the three screening methods.

"This particular study supports what prior studies have shown and what the American Cancer Society recommends: that women at high risk benefit from adding MRI to mammography to screen for breast cancer," said lead researcher Dr. Constance D. Lehman, professor of radiology at the University of Washington Medical Center in Seattle.

The study "also shows that ultrasound does not have added benefit compared to MRI," added Lehman.

MRIs found all six of the breast cancers detected, while mammography spotted only two, and ultrasound found just one, among the study's sample of 171 women at high risk but without symptoms of breast cancer. A larger, earlier study of women already diagnosed with breast cancer found that MRIs also detected more cancers in the opposite breast than mammography did.

In March, the American Cancer Society published new guidelines recommending both mammography and MRI screening for women at high risk for breast cancer.

The current study, published in the August issue of Radiology, does not break new ground but does add evidence on the advantages of adding MRIs to the screening process, as well as the disadvantages of adding ultrasound, according to Dr. Daniel C. Sullivan, associate director of Duke University's Comprehensive Cancer Center in Durham, N.C.

"There has been conflicting data from other small studies about ultrasound. Some found it is effective, and some have not. This [study adds] a little more information that it is not," said Sullivan, an expert on biomedical imaging. To be more conclusive, scientists are awaiting a larger study on ultrasound that is currently under way, he said.

Based on earlier studies and supported by the current study, the "data are pretty clear" about the usefulness of adding MRI to mammography screening for premenopausal women at high risk for breast cancer, Sullivan added. Only about 1 percent to 2 percent of all women fall into the high risk category, noted Debbie Saslow, director of breast and gynecologic cancer for the American Cancer Society.

The current study included 171 women averaging about 46 years of age. About 46 percent of the women were premenopausal. The researchers defined high risk in women 25 and older as a woman who carries one of the breast cancer genes BRCA1 or BRCA2 or a 20 percent probability of carrying a mutation, or a strong family history of breast and ovarian cancer.

Further research is needed to determine whether MRI should be added to screenings for older women or a broader group of women, Sullivan said. So far, using MRIs along with mammography can be justified only with high risk women because of the higher cost of MRIs, the risk involved in injecting contrast material needed to display very small lesions, and the biopsies required to rule out false-positives, he added. In the current study, the MRIs did detect eight false-positives.

For technological reasons, MRIs are often able to detect cancers that mammography misses, Sullivan explained. However, MRIs should not be seen as a replacement for mammograms, he added. In a previous study, mammography detected a few cases that were actually missed by MRI, the expert said.

The development of a viable replacement for mammography is still some years off, according to both Saslow and Sullivan. Saslow said some work is being done with blood and saliva tests, but no conclusions about their usefulness are expected soon. Optical imaging -- which uses lasers -- and a type of mammography that doesn't use breast compression also are being explored, Sullivan added.

"Those are still quite a few years away before they could really replace mammography," he said. For women who find mammography uncomfortable, "the bad news is that for the foreseeable future, about five to 10 years, there is no likely replacement for mammography," according to Sullivan.More information

For more on the fight against breast cancer, head to the American Cancer Society.