Medical Articles by Dr. Ray

May

2004

Physicians Use New Technology (GCFP) To Study Blood Flow

By Ray Schilling | Health, Heart Disease

Researchers at the Duke University Medical Center have developed a new non-invasive method of visualizing blood flow through blood vessels of patients. It is a modification of the well-known MRI scan technology where a magnetic field realigns the center of hydrogen atoms (protons) during the time of the examination and the differences of the tissue and fluid qualities are reflected in the images created by this technology. This new application depicting moving blood in blood vessels is called “global coherent free procession” (GCFP).

The principle is that the investigator can focus on an area of a blood vessel upstream of the area to be examined and tag a portion of the blood flowing through with an energy pulse. As the blood continues to flow through the area of interest, the protons give off the energy again without any changes to the body fluids or the blood cells and the MRI scanner picks up the images of the blood flow through the blood vessel.
The advantage of this technique is that it is done without any catheters (it is non-invasive), there is no need for any contrast material to be injected and there are no X-rays needed. At the present time this is the only diagnostic technology available for examining a patient’s blood flow through the heart and its vessels in real time, which is very valuable for physicians (cardiologists).
Here is a link to the Duke University publication

Physicians Use New Technology (GCFP) To Study Blood Flow

Based on an article in the April 13, 2004 issue of The Medical Post , Vol.40, No. 15, p.5.

PS. When checked on Nov. 5, 2012 this procedure has not been widely accepted in medical circles. It seems to be still more of a research tool.

Last edited December 8, 2012

Apr

2004

Sucking Bite Does Not Remove Venom

By Ray Schilling | Health, Infectious Disease, Pain

How often have you heard the story that you should suck out the venom from a snakebite or insect bite. Researchers at the University of California at San Francisco have put this to the test. They injected a “mock venom”, which mimicked the composition of a venom without the poisonous effect, into eight male volunteers. This mock venom was radioactively labelled, so it could be traced. A vacuum pump, which simulated the sucking out of the wound, was applied after a few minutes and the amount of venom extraction was calculated by measuring the radioactivity of the extracted mock venom. To the surprise of the researchers only 2% of the mock venom had been sucked out on average.

Venom alert: Attempting to suck out a bite wound will not remove enough venom to make any difference for the total body venom load. It is much more important to not waste any time by applying a tight tourniquet above the bite wound (between the bite and the heart) and to call for an ambulance to rush the patient to the nearest Emergency Department where antitoxin for the venom treatment is available. To suck out a wound would only add mouth bacteria to the wound and could result in serious infections in addition to the poison.

Sucking Bite Does Not Remove Venom

Medical Post, Vol.40, No.12, March 23, 2004 (page 66).

Last edited December 8, 2012

Apr

2004

Breast Cancer And Miscarriages; Fear-Mongering Debunked

By Ray Schilling | Cancer, Women’s Diseases

For many years there were conflicting reports about the emotionally charged topic of whether miscarriages (=spontaneous abortions) or induced abortions (also simply known as abortions) would lead to an increased risk for these women later in life. The problem was that the studies could not be directly compared because they differed in size, in age group and whether the women had one or more children or none.

The studies also differed in respect to whether they were prospective or restrospective. In this context a prospective study is one where it was known at the outset before the women developed breast cancer whether or not there was a history of a spontaneous or induced abortion in the past. A retrospective study would be one where a group of women with established breast cancer would be asked retrospectively whether or not they had a history of abortions (spontaneous or induced).

It turns out that the discrepancies between these studies in the past were largely because of the significant difference between the data of the unreliable retrospective studies and the very reliable prospective studies.

On March 27, 2004 the Lancet reported about a study that had been undertaken by the Collaborative Group on Hormonal Factors in Breast Cancer (seat of the Secretariat in Oxford, England). This study involved hundreds of scientists and clinicians from the major Cancer Clinics around the world who gathered the world-wide epidemiological evidence about breast cancer and pooled the data regarding 53 studies from 16 countries.

Breast Cancer And Miscarriages; Fear-Mongering Debunked

A total of 83,000 women with breast cancer around the world had been included in this study. The data was separated into sub-categories. For instance, 44,000 women were included in the prospective branch of the study and 33,000 in the retrospective branch. The data was carefully controlled for the factors mentioned above and many other differences to ensure that the data could be compared (rules of evidence-based medicine).

The surprise finding was that there was no statistical difference regarding the risk for developing breast cancer in the prospective branch of the study between the group of women who never were pregnant, those who had one or more children and those who had miscarriages or abortions in the past. However, the retrospective studies reported a higher incidence of breast cancer because of an observer bias. The researchers and clinicians concluded that the data of the restrospective studies were unreliable because they were not carefully controlled and there likely was more reliable reporting of the women who had developed breast cancer than the control groups who likely underreported their histories thus resulting in misleading conclusions.

Summary: Women do not have a higher risk of developing breast cancer following spontaneous or induced abortions. Forget all of the fear-mongering that you may have heard in the past in the popular press.

More information about causes of breast cancer: http://nethealthbook.com/cancer-overview/breast-cancer/causes-breast-cancer/

Lancet 2004; 363: 1007-16.

Last edited October 26, 2014

Apr

2004

Lycopene Of Tomatoes Fights Cancer Cells

By Ray Schilling | Cancer, Nutrition

Dr. John Erdman Jr. from the University of Illinois has done epidemiological studies that suggest that the red color of tomatoes, which is provided by lycopenes, is only effective against prostate cancer, if the whole tomato is consumed.

The professor of food science and human nutrition found that other phytochemicals in the tomato act in concert with lycopene to protect against cancer. To prove this more conclusively, he designed an experiment involving 194 rats with prostate cancer into three groups.

Group 1 was the control group without any detectable lycopene in their diet. Group 2 was fed the control diet with purified lycopene. Group 3 was fed the control diet with ground-up tomato paste (with seeds and skins). Group 3 was the only group where the risk of dying from prostate cancer was reduced by 30%. Group 2 rats had the same high death rates as the control group. These results were recently published in the Journal of the National Cancer Institute.

Dr. Erdman concluded that taking lycopene is not as effective as eating the whole tomato to prevent cancer of the prostate. He also suggested to use whole tomato products in tomato juice, in salads, pasta and pizzas.

Lycopene Of Tomatoes Fights Cancer Cells

Based on an article in the Medical Post, Vol 40, No.8, Feb.24, 2004 (page 33).

Link to prostate cancer chapter of the Net Health Book.

Last edited December 8, 2012

Apr

2004

Acupuncture For Headaches Found Effective

By Ray Schilling | Pain, Prevention

For many years it was merely a clinical impression that some headache sufferers were helped by acupuncture. Over the years many attempted to show that acupuncture works for headaches, but the studies were done with too few patients to reach statistically meaningful results.

In a recent English study that was published by Andrew J Vickers et al. in the British Medical Journal on March 27, 2004 patients were randomly assigned to a conventional headache treatment protocol or to treatment with acupuncture. 401 patients were enrolled in this randomized study and the patients came from general practitioners in Wales and England. The patients all had similarly severe headaches or chronic headaches and had mainly migraines, but also tension type headaches. Several universities took part in the design of the study to ensure that the Cochrane criteria of evidence based medicine were adhered to. Headaches were measured according to a score that consisted of detailed standardized questionaires. Treatment with acupuncture consisted of 12 treatments over 3 months. The control headache group was treated with the usual care.

The headache sufferers were assessed at the 12 month point. There were significant differences in favor of the acupuncture treated patients. The acupuncture group had on average 22 fewer days of headaches per year than the control group. This resulted in 15% less medication use, 25% fewer doctor visits and 15% fewer sick days.

Acupuncture For Headaches Found Effective

Acupuncture treated headache sufferers felt physically more active, they had more energy and they felt a positive change in their health.

More information about causes of headaches: http://nethealthbook.com/neurology-neurological-disease/common-causes-headaches/

British Medical Journal: BMJ 2004;328:744 (27 March).

Last edited October 26, 2014

Apr

2004

Less Death Rates From Breast Cancer With Exercise

By Ray Schilling | Cancer, Fitness, Health

At the 95th annual meeting of the American Association for Cancer Research in Orlando / Fla. the results of a study regarding the effect of exercise on breast cancer survival rates was presented. Dr. Michelle D. Holmes and co-workers (Harvard University in Boston) reported about data from the Nurses’ Health Study. About 2000 patients with breast cancer were identified in the period of 1984 to 1996 who were followed until the end of 2002. At that time 209 had died from their breast cancer. The investigators were able to control the data for all the other factors such as smoking, obesity, and many other factors except for the amount of exercise per week that these women were doing. The highest risk group was the one that did not exercise and the death rate of this group was set as 100% as can be seen in this table, which I constructed based on the published data.

The various groups as indicated on the bottom of the table were the hours exercised per week from 0 hours to more than 15 hours per week (this was expressed as metabolic equivalent of a brisk walk). It can be seen that survival from breast cancer can be influenced by as little as 3 to 9 hours of a brisk walk per week (about 20% reduction in death rate) and reaches a plateau at 9 to 15 hours of exercise per week (around 50% reduction in death rate).

Less Death Rates From Breast Cancer With Exercise

The authors of the study said that when the data was expressed as recurrence of breast cancer, the same results were obtained. This study would indicate that even 30 minutes of exercise per day will reduce mortality in a patient with breast cancer. Also, it is known from other studies that exercise will be more effective in terms of cancer prevention in general including prevention of breast cancer.

Percentage of breast cancer death rates decreases with exercise (hours of exercise per week depicted)

Less Death Rates From Breast Cancer With Exercise1

Breast Cancer Death Rate Decreases With Exercise

Link to breast cancer chapter of the Net Health Book.

Link to Fitness: http://nethealthbook.com/health-nutrition-and-fitness/fitness/

Last edited October 26, 2014

Mar

2004

Genetic Manipulation For Terminal Cancer

By Ray Schilling | Cancer

Two publications recently highlighted the importance of the p53 gene that is located on the human chromosome 17, which has been dubbed the “guardian of the genome”.

It appears that its role is to suppress any cell that has damage of the genetic material (of the DNA). If the suppressor gene p53 is not working in a cell, it will continue to divide and become a cancer cell. Only, if the p53 gene is working properly, will the cell go through its normal life cycle, which includes cell birth, a certain period of life and cell death (“apoptosis”).

This sounds all very theoretical, but I will demonstrate with two examples from the current medical literature how this knowledge has already been used and will likely be developed further in a practical sense in cancer patients. The first paper has to do with repairing damaged p53 genes directly with genetic modifications. The second paper approaches this problem from a different angle. It deals with the other half of cancers that originate not from genetic defects of the p53 gene, but from an overproduction of inhibitors that are produced in the cell itself, particularly in many cancer cells. A new class of very promising compounds have been developed that can neutralize the action of the inhibitors and normalize p53 function.

1. The cancer treatment specialists at the M.D. Anderson Cancer Center in Houston/Texas have done several clinical trials where they have proven that with the help of gene transfers into tumor cells of lung cancer patients the survival in these previously hopeless cancer patients can be significantly improved. A summary of these studies has been published in the February 2004 edition of the Hematology/Oncology Clinics of North America.

Genetic Manipulation For Terminal Cancer

45% to 75% of these types of lung cancers have the p53 gene deficiency and for this reason are particularly difficult to treat as they are not responsive to chemotherapy or radiotherapy. These researchers and many other researchers in this field have shown that the specialist can transfer the missing p53 gene back into the cancer cells in a number of ways and this way change their growth pattern. These modified cancer cells either stop behaving like cancer and the patient is cured (a certain percentage, but not the majority). On the other hand the changed cancer cells can often be rendered more sensitive to chemotherapy and radiotherapy, which happens in about 60 to 70% of the genetically treated cases. Overall it is now possible with a combination of gene therapy and chemotherapy and/or radiotherapy to get about a 50% response rate and about 20% cures on the longterm. In the past all of these patients would have died within a few months from the initial diagnosis. The researchers of that publication stressed that these new treatment approaches are not yet routine in cancer treatment, but that with further refinements there will soon be more hope for these difficult cancer patients. This would be applicable not only for the difficult to treat lung cancer patients, but also for many other types of soft tissue cancers that often have p53 gene deficiencies and that up to now have often been untreateable.

2. The second paper that fits into this topic was published recently in the January 2, 2004 issue of the magazine Science. Researchers from the Hoffmann-La Roche labs in Nutley, New Yersey, have found that a new class of smaller molecules is able to inhibit the main group of oncoproteins known as MDM2 inhibitors that interfere with normal p53 function. The molecular oncologists at Hoffmann-La Roche under chief researcher Lyubomir Vassilev have successfully undertaken research in this complex interaction between the life saving p53 gene action and the undermining effects of various oncogene proteins and in particular the MDM2 inhibitors. There are two such substances of a new class of potential drugs that seem to be particularly promising. The new class of drugs was coined “Nutlins” in honor of the site of where they were discovered. Nutlin-1 has been tested in cultured tumor cells and was able to boost p53 activity resulting in sudden normal function. The cancer cells stopped dividing and disintegrated (due to the normal tumor fighting action of the p53 gene).

Another similar molecule, called Nutlin-3, was fed to nude mice who are deficient in their immune system and that are used by cancer researchers as a model to grow various types of tumors. In this model there was a 90% cure rate, which is unheard of as usually 100% of these nude mice would die from any transplanted tumor. There were no demonstrable side-effects in these mice that survived. Drs. Vassilev and David Heimbrook from the Hoffmann-La Roche cancer drug unit pointed out that this type of effect is much better than any cancer drugs that are presently used, however they added that it will be very difficult to predict how quickly this could be translated into the human situation with clinical trials. There is definitely a niche for treating sarcoma, which is one of the more difficult to treat cancers. Other cancers would be malignant tumors of the connective tissues, of nerves, bones, blood vessels, fat, muscles, deep skin tissues and cartilage. Many of these as well as some lung cancers produce high levels of the MDM2 protein. It is these types of tumors that would be the most likely candidates for early human trials with the Nutlins.

References: 1. February 2004 edition of the Hematology/Oncology Clinics of North America (Volume 18 • Number 1 • February 2004), published by Saunders, and entitled “Gene replacement therapy for non–small cell lung cancer: a review”. 2. January 2, 2004 issue of the magazine Science.

Comment On Oct. 26, 2014: As can be seen from this reference in 2011 nutlins persist, but likely have to be combined with other specific anti-cancer agents in the future.

Last edited October 26, 2014

Mar

2004

Ankle Blood Pressure Reveals Diabetic Problems

By Ray Schilling | Diabetes, Heart Disease, High Blood Pressure, Prevention, Stroke

One of the complications of diabetes is that ity leads to clogged arteries from peripheral artery disease and this can lead to heart attacks, strokes and circulation problems in the legs.

Recommendations were recently given to physicians in the December edition of the medical journal Diabetes Care that circulation problems in diabetics need to be monitored more stringently to avoid needless amputations.

Medically these circulation problems that affect mainly lower legs and feet are known as “peripheral vascular disease” (or PVD for short). PVD can be detected by the physician checking for ankle pulses. Another valuable and very simple test is to measure the blood pressure in the arm and at each ankle (using the stethoscope just under the inside (medial) ankle bone. If there is a major discrepancy between the arm and ankle blood pressure or if the ankle pulse is missing, this would be a sign of possible PVD. With a diabetic patient it would still be important to get the hemoglobin A1C under control through exercise, a low glycemic diet and possibly anti-diabetic medication. But the patient likely would have to be referred to a cardiovascular surgeon for further testing in order to find out whether there would be hardening of the arteries with circulation problems in the lower leg, the ankle or foot.

Ankle Blood Pressure Reveals Diabetic Problems

Dr. Peter Sheehan, the director of the Diabetes Foot & Ankle Center at the New York University school of medicine, stated that many patients and doctors overlook how frequent this condition is. About 33% of diabetic patients who are older than 50 years have PVD, but only a fraction know about it until it is too late. Once a patient has PVD in one of the legs there is a 4-fold risk of getting a heart attack or a stroke, because the hardening of the arteries is happening simultaneously in all of the body’s arteries. If the blood pressure is normal at the ankle, Dr. Sheehan recommends to check it again in 5 years.

Who should have the blood pressure check at the ankle? Here is a table that summarizes Dr. Sheehan’s recommendations.

Which diabetic needs the ankle blood pressure check?
*High risk group:*	*Remarks or more detail:*
*Anyone with leg PVD symptoms**	legs tired or hurting when walking
Young diabetics with other risks	smoking, high blood pressure, high cholesterol, diabetes present for more than 10 years are such risk factors
diabetics 50 years of age and over	particularly when the hemoblobin A1C is high and other risk factors are present

*PVD = peripheral vascular disease

Why is it so important to screen for circulation problems in the lower legs? Because this is the area where diabetics tend to get problems that often result in amputations of a foot or lower leg below the knee. With early detection of these problems and intervention by a cardiovascular surgeon often disastrous outcomes can be avoided.

More info is available at:

Diabetes: http://nethealthbook.com/hormones/diabetes/type-2-diabetes/

High blood pressure: http://nethealthbook.com/cardiovascular-disease/high-blood-pressure-hypertension/

Last edited October 26, 2014

Mar

2004

Vitamins C And E – A Weapon Against Alzheimers

By Ray Schilling | Alzheimer’s disease, Nutrition, Vitamins and supplements

A study in a recent edition of the Archives of Neurology reports about 4740 patients from Cache County, Utah, who were 65 years or older and were followed over 5 years. At the start it was found that those who had taken vitamin C and E on a regular basis as separate supplements had a 78% lesser risk of developing Alzheimers (correct medical term: “Alzheimer’s disease”).

5 years later out of 3227 survivors who were at risk 104 more people had developed Alzheimers, but 64% of those who combined vitamin C and E as a supplement did not develop Alzheimers. Dr. Peter Zandi from the Department of Mental Health, Bloomberg School of Public Health, The Johns Hopkins University/ Baltimore, Md was the lead author of this study. He stated that this was only an observational study, but that the data was convincing enough to warrant a full-scale controlled trial to examine the value of anti-oxidant agents (such as vitamin C and E) as a preventative against Alzheimers. There were a number of built-in controls such as vitamin C alone, vitamin E alone and multiple vitamins (including vitamin C and E in smaller dosages) that were all ineffective in preventing Alzheimers. The daily dosages that were necessary for the protective effect were vitamin C 500mg to 1000 mg or more per day as well as 400 IU to 1000 IU of vitamin E per day. The U.S. recommended daily allowance was insufficient for the protective effect. These dosages typically are in the order of 22 IU of vit. E and 75 to 90 mg of vit. C. Vitamin B complex alone was also ineffective in protecting against Alzheimers.

Vitamins C And E – A Weapon Against Alzheimers

Comments: There are many unanswered questions about Alzheimers, but this paper gives valuable hints in terms of the protective effect of two vitamins (vitamin C and E taken as separate supplements daily). There are other factors such as genetic ones and perhaps a dysregulation of the cholesterol brain metabolism that lead to the production of a glue-like substance, called “beta-amyloid” ,that causes memory loss in Alzheimers patients. Testosterone has recently also been noticed to be important in the prevention of Alzheimers disease. In addition to these vitamin supplements a low glycemic, low fat diet would likely be very beneficial together with a regular exercise program and calorie restriction to prevent Alzheimers disease in many patients (prevention of the metabolic disease).

More info on Alzheimer’s disease: http://nethealthbook.com/neurology-neurological-disease/alzheimers-dementia-and-delirium/

Arch Neurol – 01-JAN-2004; 61(1): 82-8

Last edited October 26, 2014

Mar

2004

Less Diabetes With Coffee

By Ray Schilling | Diabetes, Nutrition, Prevention

A Dutch Study has shown previously that coffee consumption was reducing the risk for developing diabetes. Now Dr. Salazar-Martinez and co-workers have confirmed this in a study involving even larger numbers of both men and women. This was published in the Annals of Internal Medicine and the research team is from the Harvard School of Public Health, Channing Laboratory, Harvard Medical School, and the Brigham and Women’s Hospital, Boston, Massachusetts. A total of 41,000 men and 84,000 women from the Nurses’ Health Study and the Health Professionals’ Followup Study were followed between 12 and 18 years. 1,333 men and 4,085 women developed diabetes during the time of observation. All of the data was analyzed carefully by controlling for other factors such as obesity, smoking, high blood pressure etc. to be certain that the only difference in the observed groups was the amount of coffee consumed.

According to the authors the gender differences are probably unimportant and may have to do with the different sample sizes. However, as the graph shows clearly, with the consumption of around 4-5 cups of coffee per day there is a significant 30 % drop in risk to develop diabetes.

The Dutch Study showed a 50% drop in risk with 7 cups or more per day and the study here suggests a similar drop with 6 cups or more.

Less Diabetes With Coffee

Dr. Frank Hu, associate professor of nutrition and epidemiology at Harvard School of Public Health, who co-authored this study stated that physicians should still recommend to patients first to exercise and to loose weight to control diabetes. It would be premature to recommend heavy coffee consumption to patients for diabetes control.

Diabetes risk decreases with coffee consumption (%reduction)

This beneficial effect was also observed to a lesser extent with decaffeinated coffee, but not with tea. According to Dr. Hu caffeine, chlorogenic acid and magnesium likely play a role in the protective effect with regard to diabetes prevention. Further studies will be done to see whether diabetes patients who drink coffee have a better outcome when they develop a heart attack.

Reference: Ann Intern Med – 6-JAN-2004; 140(1): 1-8

Last edited December 8, 2012

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