August 14, 2010

Less-Invasive Biopsies More Common

By Michael Smith, North American Correspondent, MedPage Today
Published: August 13, 2010
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine,
Harvard Medical School, Boston and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner Earn CME/CE credit for reading medical news.

The number of biopsies using less-invasive percutaneous methods nearly doubled over a decade, according to researchers.

And, because of the shift to image-guided procedures, radiologists are now performing half of all procedures, and 70% of lymph node biopsies, according to Sharon Kwan, MD, of the University of California San Francisco, and colleagues.

But practice patterns are still evolving and in some areas, nonradiologists are increasing their share of biopsies, Kwan and colleagues reported online in Radiology.

The first percutaneous needle biopsy of the liver was reported in 1932, but the advent of new imaging techniques in recent years suggests that image-guided percutaneous procedures -- performed by radiologists -- would have largely replaced more invasive procedures.

To investigate the issue, Kwan and colleagues analyzed Medicare claims data from 1997 through 2008, which showed that biopsies using all procedures rose from 1,380 to 1,945 procedures per 100,000 Medicare enrollees between 1997 and 2008.

That change represents a compound annual growth rate of 3%, the researchers reported.

During the study period, they found, percutaneous needle biopsies did increase -- from 59% to 67% of all biopsies (with the exception of breast biopsies, where a coding change in 2001 affected the reported distribution of open versus percutaneous procedures).

The use of percutaneous needle biopsies rose from 295,836 in 1997 to 573,397 in 2008 -- equivalent to an increase from 953 to 1,645 biopsies per 100,000 Medicare enrollees, for a compound annual growth rate of 5%.

On the other hand, the researchers reported, biopsies performed with nonpercutaneous approaches had a compound annual growth rate of minus 3% over the same time period.

But the choice of method varied widely with anatomic site, they found. On one hand, percutaneous needle biopsies were the dominant choice for kidney and liver, representing 96% and 90%, respectively, of all biopsies in these sites in 2008.

On the other hand, percutaneous needle biopsies were the minority in the superficial lymph nodes and musculoskeletal soft tissues, at 46% and 30%, respectively, they reported.

Most Current Procedural Terminology codes don't distinguish between percutaneous procedures performed with and without image guidance, the researchers noted, but for two areas that do -- percutaneous core biopsies of the breast and fine needle aspirations -- there was an increase in the use of imaging.

For breast biopsies, image guidance rose from 85% in 2002 to 95% in 2008, while for fine needle aspirations, the increase was even greater -- from 54% in 2004 to 77% in 2008, they found.

Over the study period, the top three specialties performing biopsies were radiology, general surgery, and pulmonology. Members of those specialties together performed 75% of all biopsies during the period.

Radiologists' share, however, increased steadily, from 35% in 1997 to 56% in 2008, while general surgeons and pulmonologists saw their shares decrease from 21% to 15% and 10% to 5%, respectively, Kwan and colleagues reported.

The most rapid growth, according to anatomic region, occurred in lymph node biopsies, where radiologists' share increased from 12% to 70%, for a compound annual growth rate of 22%.

Radiologists' share of fine needle aspirations also increased -- from 4% to 44%, for a compound annual growth rate of 37%.

The researchers noted that one limitation of Medicare data is that they mainly involve an elderly population, so the findings may not apply to a younger population.

Also, they reported, the precision of the analysis was limited by the "idiosyncrasies" of Current Procedural Terminology coding, which was used to calculate numbers and types of procedures.

The study was supported by the National Institute of Biomedical Imaging and Bioengineering.

The authors declared they had no financial relationships to disclose.

Primary source: Radiology

Source reference:
Kwan SW, et al "Effect of advanced imaging technology on how biopsies are done and who does them" Radiology 2010; DOI: 10.1148/radiol.10092130.

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Vietnam veteran running out of options

A bronze star awarded to Frank Tate of Drums rests next to a map of where the chemical Agent Orange was applied during the Vietnam war. Tate, who saved another Marine's life during the war, and served in areas where Agent Orange was utilized, has cirrhosis of the liver that the Department of Veterans Affairs will not acknowledge as a disease caused by the foliage-destroying chemical.

By JILL WHALEN (Staff Writer)
Published: August 9, 2010
 
Frank Tate received the prestigious Bronze Star Medal for dragging two seriously injured Marines across fire-swept terrain in Vietnam as machine gun bullets sailed past him.
 
More than 30 years later, Tate's own life needs saving.

The Drums man's liver has all but completely failed. His body is filling with fluids, and his skin has already turned yellow - a telltale sign of jaundice.

Doctors told him he needs a liver transplant, said his wife, Carol Tate. But none will attempt the procedure, saying the former Marine's health is too depleted and thus, an operation is too risky.

Frank has seen many doctors, Carol said, and many of them agree: the 59-year-old's liver cirrhosis was caused by his exposure to Agent Orange, the name given to the herbicide used by the United States during the Vietnam War to destroy foliage that provided cover for the enemy.

What's frustrating, Frank said, is that the Department of Veterans Affairs doesn't acknowledge cirrhosis as a disease caused by Agent Orange.

"They won't admit to it," Frank said.

It's a tough pill for the Tates to swallow.

Tate said he lived a healthy life, leaving his Lattimer home in 1968 to serve during the Vietnam War with the Fox Company, 2nd Battalion, 7th Marines, First Marine Division. He was attached to a tank division and later dispatched to serve in the field, and eventually achieved the rank of lance corporal.

It was during the height of a 1969 battle in Vietnam's Que Son Valley that Tate came across two seriously wounded Marines lying in an exposed area, according to the citation accompanying Frank's military medal. He scooped up the first and carried him to a covered area, then dodged enemy fire again to drag the second Marine to a rice paddy dike. He also faced bullets again as he ran to retrieve additional medical supplies for the wounded.

A year after the heroic rescues, the 1968 Hazleton High School graduate returned home.

"Even when I came back from Vietnam, my liver count was always high. I was close to 21. My family doctor at that time - or anyone who sent me for blood work - always said that I have high liver counts," Frank recalled. "It was the only test that did not come back good."

Not a concern

Doctors, however, never seemed to press Frank to go for more tests to determine what was causing high readings of alkaline phosphatase in his liver, he said. With no reason for alarm, Frank and Carol, who have been married 36 years, never pursued the issue, they said.

Frank's health seemed mostly solid until 2000 when he needed a triple bypass. He had been working at the former Allsteel in Valmont Industrial Park for 33 years, where he served as president of the United Auto Workers union.

Then, another difficult blow came in 2007 when tests following gallbladder surgery revealed he had cirrhosis.

"I had no idea I was sick or that I had cirrhosis," he said. "It was as if all of a sudden I needed a liver."

No doctor could pinpoint what caused the disease, Frank explained.

His local doctor, Dr. Eugene Stish, Conyngham, said it's his "personal opinion" that Frank's cirrhosis was caused by Agent Orange exposure. "However, I have absolutely no proof that that is what caused it," he said.

But Stish said Frank did not have any history of alcohol abuse or exposure to other dangerous chemicals - two typical causes of the disease.

Exposure to Agent Orange is "the most logical reason" that Tate developed the disease, Stish said.

Following the diagnosis, Frank recalled each day brought more weakness. He went to Thomas Jefferson University hospitals, Philadelphia, to determine whether he was eligible for a liver transplant.

"I was down there for 11 days," Frank said of his stay earlier this year. "They did all kinds of tests on me."

Carol said it appeared her husband would be approved for a transplant until a last-minute evaluation by an anesthesiologist ruined his chances.

"They didn't think I would survive the operation, or if I did survive the operation, it wouldn't be for very long," Frank said. The unchecked liver disease caused other organs in his body - his heart, lungs and kidneys - to deteriorate and weaken.

During subsequent visits to Geisinger Medical Center, Danville, and Veterans Administration hospitals, the Tates said they were told the same bad news.

Since Frank's diagnosis, the couple have learned others who served in Vietnam have had similar problems.

"A cousin of my wife died of liver disease," Frank said. "He was in Vietnam."

As a young serviceman, Frank said he "wasn't aware" of Agent Orange. But in 1984, he received a letter from the office of Gov. Dick Thornburgh along with a map of where the toxic herbicide was applied. Frank said he served in some of those places.

The letter began with "Dear Pennsylvania Vietnam Veteran" and asked all 200,000 Vietnam-era veterans from the commonwealth to complete a questionnaire with military and health information "related to possible exposure to Agent Orange and other herbicides."

It's the only piece of correspondence Frank has received that hints at possible exposure. Carol noted that while her husband does receive disability benefits from the Veterans Administration, he does not receive Agent Orange compensation.

"The government just seems like it doesn't want to admit anything," she said.

'Thing of the past'

Steve and Lisa Krouse, the neighbors the Tates consider family, have taken the Tates to medical appointments and check on the couple daily.

At least one of the out-of-area doctors who has treated Frank gave the impression the government considers Agent Orange "a thing of the past" and as such, is not investing in research or cures for it, Steve Krouse said.

"They might feel that everyone who was exposed to it is weaning away and they're not putting too much effort into helping the people who were exposed to Agent Orange," Krouse said.

Calls to the Department of Veterans Affairs regarding Agent Orange were not returned to the Standard-Speaker. But a department-released list does not classify cirrhosis as a disease caused by exposure to the chemical.

At this point, the Tates and Krouses say they're hoping for a miracle.

"We're not giving up hope for him," Krouse said. "Western medicine might say he's done. But there is eastern medicine, there are stem cell transplants."

Krouse has been researching possible cures and treatments and said he learned stem cell transplants for those with liver diseases are proving successful in the United Kingdom and Germany.

And, through additional research, he's learned of an ongoing study by the University of California-San Diego and Veterans Affairs-San Diego that is proving it's possible to halt and reverse cirrhosis. There's also a drug being used successfully in a British study that nurses diseased livers back to normal, he said.

Krouse said he would love if Frank could somehow get a stem cell transplant - although it wouldn't be covered by his insurance - or be involved in one of the studies.

"He fought bravely," Krouse said, "and he's still fighting, only this time for his own life, and with only one very strong weapon - hope. And just maybe a little divine intervention too. It is what's keeping him alive right now."

Both Carol and Frank are hoping to find an answer soon, and said they wanted to share Frank's story to see if anyone else can help.

"Right now, you are reaching for time, and the time is going so fast. And I'm scared stiff," Carol said.

Frank can be contacted at greedy@ptd.net.

jwhalen@standardspeaker.com

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USM Studies Palm Oil Extract For Chronic Disease

August 10, 2010 16:58 PM

GEORGE TOWN, Aug 10 (Bernama) -- Universiti Sains Malaysia (USM) is in the midst of studying the use of the palm oil extract known as tocotrienol in the treatment of chronic diseases such as non-alcoholic fatty liver disease (NAFLD).

One of the researchers, Prof Lutfi Shuaib said the research started in 2007 and expected to be completed by the year end.

He said that 60 adults with high-cholesterol problems volunteered for the study and received 200mg of tocotrienol for a year.

"Initial finding shows that 50 per cent of the volunteers show positive results.

"The finding will be tabled soon at the meeting of the American Association for the Study of Liver Diseases in Boston, the United States," he said in a briefing for Plantation Industries and Commodities Minister Tan Sri Bernard Dompok.

Lutfi said the study was to prove that tocotrienol as a food supplement could be used to treat the NAFLD.

"Malaysia is the second biggest palm oil producer and tocotrienol production could potentially become an important economic activity," he said.

-- BERNAMA

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No science backs up 'miracle cure'

By JOE SCHWARCZ, Freelance August 14, 2010

Malaria, AIDS, hepatitis, herpes, cancer. Terrible diseases. That's why thousands and thousands of scientists around the world, armed with advanced degrees, are engaged in research projects aimed at finding a cure.

Now, ask yourself this question: What is the chance of a gold prospector, with no training in the health sciences, tackling a problem and finding an answer that has eluded the world's most renowned researchers? Furthermore, it's simple to administer, readily available and destroys the H1N1 virus, clears up acne, eliminates heavy metals and cures the common cold to boot. I can tell you what probability I would attach to this miracle solution performing as claimed. Let me see now, how does "zero" sound?

There's nothing subtle about the name of this purported wonder: "Miracle Mineral Solution (MMS)!" Well, there are no miracles to be had. Or minerals. Admittedly, however, there is a solution. Not a solution to any problem, but a solution in the sense of a substance being dissolved in water. And that substance is sodium chlorite, a common disinfectant and bleaching agent. Its chief promoter, Jim Humble, is either a brilliant inventor, a self-delusional scientifically-bewildered simpleton or a cunning scoundrel. Take your pick. I know which box I would tick off.

In a decidedly non-humble fashion, Humble claims that "this breakthrough can save your life, or the life of a loved one." He then brags that his discovery is "the answer to AIDS, hepatitis A, B and C, malaria, herpes, TB, most cancers and many more of mankind's worse diseases."

Of course you may not have heard of this revolutionary treatment, because it is being hidden from the public by those devilish pharmaceutical companies whose profits would be destroyed if the word got out about all diseases being cured in such a simple fashion.

Let's just trace how this visionary, this wonder worker, this mental colossus, discovered the gift "that would shift the course of human health history forever."

Incidentally, MMS wasn't this amazing philanthropist's first gift to humanity. That was the automatic garage door opener, which humble Humble supposedly invented, although I can't find any documented evidence for this claim.

In any case, the MMS saga begins in the South American jungle where our hero was prospecting for gold when two of his men fell ill with malaria. With no prospects for immediate medical help, Humble had to resort to his razor-sharp wits.

The sodium chlorite solution they had brought along to disinfect water obviously killed bacteria, maybe it would also destroy whatever was causing the malaria. So, he gave the men some of the solution and was stunned to see their symptoms vanish in just four hours. I bet he was!

Now Humble had a new calling: rid the world of malaria.

He started to treat sick South Americans but found that the sodium chlorite solution was only effective 70 per cent of the time. Not good enough for this dazzling mind!

He began to experiment with his concoction and discovered that when mixed with citric acid, the chlorite would be converted to chlorine dioxide, which turned out to be a superior product. Wow!

Before long, Humble claimed to have registered 75,000 successful treatments of malaria with his miracle product.

Strange, but I can't find any of these spectacular results documented in the scientific literature. Wouldn't you think that the discovery of such a simple cure for malaria would merit publication? Surely a Nobel Prize would be in the offing! Ah, I know. It must be those dastardly jealous scientists, or the evil pharmaceutical companies that are preventing publication. Yup. Must be.

As a supporter explains, "Humble had become so famous that two drug companies contacted the Minister of Health (in an unnamed country) and threatened to quit shipping drugs to the local hospitals if she didn't do something about the person claiming to be able to cure malaria."

Those fiendish companies! It's a wonder they have allowed Humble to live.

Actually, maybe they haven't. Attempts to contact him have repeatedly failed. I'm told he is "travelling" the world, busily helping people. Helping them lighten their wallets, I suspect.

If you want to know the details of his discovery -that is "how to manufacture it in your own kitchen, how to use it intravenously, how to cure colds in an hour, how to cure the worst of flu in 12 hours, how to treat cancer, AIDS and hundreds of other problems" -you have to buy his book.

I'm not sure how to describe that epic work, but "comedic" comes to mind.

Discussions about how chlorine dioxide "elongates the electron shell" of pathogens, and how its safety is confirmed by the fact that its "oxidation strength" of 0.95 volts is less than oxygen's 1.30 volts, amount to no more than mindless chemical chatter. I don't buy it. More importantly, Health Canada and the U.S. Food and Drug Administration don't buy it, either. And both urge consumers not to buy any version of Miracle Mineral Supplement.

Not only is there no evidence of efficacy for any condition, there is evidence of possible harm. Nausea, vomiting, and a life-threatening drop in blood pressure have been reported.

Humble actually maintains that nausea is a good thing because it means the body is eliminating toxins, but if bothered, he suggests it can be controlled "by eating cold apple slices that will absorb stomach toxins that have been dumped there." Like I said, comedic.

But what is decidedly not comedic is the advice on some MMS websites that AIDS patients give up their drugs and resort to intravenous MMS.

Jim Humble went out looking for gold and it seems that at least figuratively he has found it. But it is fool's gold.

MMS is not based on any reasonable science, has not been tested in any sort of randomized trials, and amounts to no more than a scheme to capitalize on the gullibility of the scientifically challenged and the desperate.

Promoting the sale of this product is criminal.

Joe Schwarcz is director of McGill University's Office for Science and Society ( http://www.oss.mcgill.ca/).
He can be heard every Sunday from 3-4 p.m. on CJAD radio.
joe.schwarcz@mcgill.ca

© Copyright (c) The Montreal Gazette

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Also See: Miracle Mineral Solution (MMS): Product as consumed produces a potent bleach
According to TransMedia, A New Syringe Is First to Have Automatic Spring Mechanism Protecting Nurses

A new safety syringe that can save lives is coming soon to a hospital near you. And one U.S. Marine combat veteran who became a nurse after wounded in Vietnam couldn't be happier.

The newly patented safety syringe from Protectus Medical Devices, Inc. (OTCQB: PTMD) will be the first to protect on-the-go healthcare workers from sometimes deadly needlestick accidents that occur all too frequently when giving injections.

And it does it automatically!

"The Protectus Automatic Self-sheathing Safety Syringe will be to nurses what seat belts and air bags are to motorists," said former Marine Marc Barbanell who has been taking the syringe on test drives and finding it incredibly safe. "Even when patients jerk their arm during an injection and send the syringe flying, it can't hurt anyone," said Barbanell, a Silver Star recipient who has since given thousands of injections to private patients.

"If a nurse were to lose control of this syringe or have it knocked out of her hands, she'd automatically be protected as a spring-activated plastic sheath instantly covers the needle, rendering it harmless and incapable of sticking anyone accidentally.

According to most recent statistics, nearly a million needlestick injuries are reported annually among U.S. healthcare workers costing healthcare system over $3 billion a year.

Workers at U.S. hospitals on average incur approximately 30 needlestick injuries per 100 beds annually. Studies show nurses sustain most of these injuries and one in seven U.S. healthcare workers is accidentally stuck by a contaminated sharp every year, while it is believed only one in three needlesticks is even reported.

From these sharps injuries there have been scores of documented cases of HIV seroconversion among healthcare personnel and 2,000 workers a year become infected with hepatitis C, and 400 contract hepatitis B. More than 20 additional types of infectious agents have been transmitted through needlesticks, including tuberculosis, syphilis, malaria, herpes, diphtheria, gonorrhea, typhus, and Rocky Mountain spotted fever.

The CDC estimates more than 80 percent of needlestick injuries can be prevented by the use of safer medical devices, such as the Protectus syringe. Needlesticks occur most in fast-paced, stressful and often understaffed facilities.

Source: TransMedia Group

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