Famed Cardiologist, father of modern heart medicine, Dr. Michael DeBakey Dead At 99

Often referred to as the father of modern heart medicine, Dr. Michael DeBakey died in Houston at the age of 99. Tony Guida recounts the life of a man who helped save the lives of millions.

Hormone Replacement May Raise Women's Gallbladder Risk

(HealthDay News) -- A postmenopausal woman who uses hormone replacement therapy (HRT) may boost her risk for gallbladder disease, researchers say, although the risk appears to vary depending on how she receives the hormones.

"For women who are using HRT, their risk of gallbladder disease is less if they use a patch or gel form of HRT rather than the tablet form of HRT," noted Dr. Bette Liu, a clinical epidemiologist at the University of Oxford in the United Kingdom.

"There is evidence that is developing that the patch may have less negative effects than the pill. We need to make sure that we're talking about the menopausal hormone therapy patch, not the birth control patch -- there may be less adverse effects than when taking estrogen by mouth," said Dr. Patricia J. Sulak, professor of obstetrics/gynecology at Texas A&M Health Science Center College of Medicine and an obstetrician/gynecologist with Scott & White.

According to Sulak, who was not involved in the study, hormone therapy can be taken non-orally in several ways, including gels (rubbing it on), the patch and even spraying it on.

Not only are patches and gels given at lower doses, but they bypass having to be metabolized through the liver, thus reducing any effect on the gallbladder, the authors explained. The gallbladder stores bile produced in the liver, and less estrogen collected in the bile could explain the reduced risk, the team noted.

The findings were published this week in the online edition of the British Medical Journal.

HRT is still taken by large numbers of women to relieve the symptoms of menopause -- despite evidence of various health risks, including heightened odds for breast cancer and stroke.

The risk of developing gallbladder disease also increases when a woman hits menopause, and experts have long known that HRT contributes to this risk. To date, however, no one has analyzed whether the risk varies depending on how HRT is administered. A recent study did find that the risk of blood clots was lower in women taking HRT via skin patches as opposed to pills.

In the new study, Liu and her colleagues looked at data on more than one million women who had participated in the Million Women Study in England and Scotland. The mean age of participants was 56, and they were followed for an average of six years.

Women currently using HRT were 64 percent more likely to be hospitalized for gallbladder disease, but they were only 17 percent more likely to be admitted if they were using gels or patches.

Higher doses of estrogen were associated with a higher risk than lower doses. The risk also decreased the longer the woman had been off of HRT, although there was still some risk a decade after discontinuing.

The risk seemed mainly confined to estrogen. Adding progesterone did not have a significant impact on the risk of gallbladder disease.

Estrogen implants involved a level of risk that fell between those faced by users of oral HRT and those faced by users of patches or gels.

Among women using HRT, one cholecystectomy (removal of the gallbladder) could be avoided for every 140 women using transdermal therapy rather than oral therapy over a five-year period, the team found.

According to the study, about 1.1 percent of middle-aged women in the U.K. who have never used HRT will end up having a cholecystectomy. That proportion rises to 1.3 percent among women using patches or gel and to 2 percent for women taking HRT in pill form.

"Most people will do fine with pills, but some patients who are prone to gallbladder disease or even blood clots may do better with the patch," Sulak said. "Not all women can tolerate the patch, however. They may have skin reactions, or the patch won't stay on."

More information
There's more on hormone replacement therapy at the Women's Health Initiative.

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More Seniors Falling Victim to Escalator Injuries

(HealthDay News) -- Older Americans are being injured during slips and falls on escalators at increasing rates, a new study finds.

The rate of injuries to older adults riding escalators more than doubled from 1991 to 2005, said study lead author Dr. Joseph O'Neil, an associate professor of pediatrics at the Indiana University School of Medicine, and an expert on injury prevention.

"Escalators are a safe means of getting from one floor to another for older Americans, but you do need to be careful, especially if you have mobility, balance or vision problems," he said.

O'Neil and his colleagues published their findings in the March issue of the journal Accident Analysis and Prevention.

Reviewing records from the U.S. Consumer Product Safety Commission, the research team found that nearly 40,000 adults age 65 and older were injured on escalators between 1991 and 2005. In fact, the rate rose more than two-fold during that period: from 4.9 injuries per every 100,000 older Americans in 1991 to 11 injuries per 100,000 people by 2005.

The trend of increasing escalator accidents is likely related to shifts in lifestyle, O'Neil speculated. "Older adults are now more active at an older age than probably ever before," he noted, adding that the mean age of the accident victims in the study was 80 years old.

But while escalator accidents are an important matter of public safety for the elderly, they should not be blown out of proportion, O'Neil said. "This is a small portion of the total number of injuries that occur in older adults," he said.

Most of the injuries were not serious. Only 8 percent of the injured were admitted to a hospital after evaluation in an emergency department. The most common injuries were to the lower extremities (about 26 percent) and the head (25 percent). The leading type of injury was soft-tissue injuries (54 percent), such as sprains, followed by cuts (about 22 percent) and fractures (almost 16 percent). Women accounted for more than 73 percent of escalator injuries.

The new study does provide insight into the ways in which injuries take place on escalators among older adults, however.

The most frequent cause of escalator injury was a slip, trip or fall, which accounted for 85 percent of all injuries in the study, the researchers said.

"Most of the slip-trip-or-fall injuries happened while a person was standing on the escalator, not trying to step on or off or pass by another person," O'Neil said.

Stepping on or off the escalator only accounted for a small portion (14 percent) of slips, trips and falls. Injuries caused by walking up or down while riding an escalator were rare. Also, only 3 percent of the total injuries resulted from a garment, shoe, bag or purse becoming caught in the escalator, the study found.

The reasons that older adults slip, trip and fall on escalators are likely very similar to the causes of injuries in other situations, O'Neil said. "Factors that could contribute to a fall include poor equilibrium, decreased visual acuity, coordination problems, changes in muscle strength and balance, and lack of agility," he said.

According to Jessie VanSwearingen, associate professor of physical therapy at the University of Pittsburgh, vision problems are probably the most important cause of escalator falls.

"Older people are more reliant on vision for their balance than younger people are," she said.

Escalators are very disruptive to vision because both the escalator and the surrounding environment are moving, she added.

One way to prevent these accidents is to "stabilize your vision," VanSwearingen said, offering the following tips:

• Do not look down at the moving steps, which is disorienting.
• Find an object ahead of you and focus on it.
• Don't look side to side at distractions or displays.

"If you need a cane or walker to get around, then you should definitely use an elevator," O'Neil added.

More information : For more on preventing falls among older adults, visit the U.S. Centers for Disease Control and Prevention.

Chemotherapy After Breast Cancer Surgery Effective for Older Women, Too

HealthDay News) -- It's clear that chemotherapy after breast cancer surgery increases survival rates. But many older women aren't being offered this potentially lifesaving treatment.
But, age shouldn't be a deciding factor -- an older woman's general health appears to be a better predictor of positive results after chemotherapy, according to a study published recently in the Journal of the American Medical Association.

"Age alone should not be a contraindication to the use of optimal chemotherapy regimens in older women who are in good general health," the study authors said.

About half of all breast cancers in the United States occur in women older than 65. Past studies have shown that chemotherapy after breast cancer surgery increases the odds of disease-free survival in women between the ages of 50 and 69. But little information has been available for treating women over 70, the study authors said.

One important concern is that older women may experience more toxic side effects from chemotherapy. That's because the kidneys often function less effectively with age, and there's not as great a bone marrow reserve for generating new blood cells in older people.

"There's always been a concern that older women with breast cancer might be under-treated," said Dr. Yelena Novik, an oncologist at New York University Medical Center in New York City. "In clinical trials, the proportion of women over 70, and especially over 75, is very small, so it's hard to know the benefits and the risks. It's understood that older women are more likely to have other medical problems, such as heart disease, hypertension and diabetes, so the question is, should they be offered the same treatment as younger women?"

To answer that question, researchers from cancer centers around the country reviewed data from four previous trials that included almost 6,500 women with lymph-node positive breast cancer. Five hundred and forty-two of the women in the studies were over 65, and 159 were over age 70.

Each of the studies looked at various doses and regimens of chemotherapy, including regimens considered to be potentially more toxic than the others.

A number of factors influenced survival rates, including smaller tumor size, fewer positive lymph nodes, having more chemotherapy, and using the breast cancer drug tamoxifen. Age alone, however, didn't appear to influence survival rates, the study authors found.

Women over 65 were more likely to die of causes other than breast cancer. And they were slightly more likely to die as a result of the treatment than younger women were. Overall treatment-related mortality was 0.5 percent, and 1.5 percent for those women over 65.
"What this study basically showed is that we shouldn't prejudice our treatment decisions based on chronological age," said Dr. Jay Brooks, chairman of hematology and oncology at Ochsner Health System in Baton Rouge, La. "We have a lot of very healthy, older individuals, and to simply preclude someone from taking potentially lifesaving therapy because they've reached some chronological age is just wrong. Would you tell someone who's 68 with coronary vessel disease not to get a bypass?"

Both Novik and Brooks said that recent advances in tailoring breast cancer treatments to the individual patient have likely made the age disparity less of an issue.

"We're hopefully getting smarter in understanding cancer behaviors, which gives us better insight into which drugs to use," Novik said.

Brooks advised older women with breast cancer to "sit down and talk with their doctor about what their individualized risk of recurrence is. We have good tools to offer individualized treatment options, whatever your age."

More information
To learn more about chemotherapy treatment for breast cancer, visit the American Cancer Society.

Scientists Turn Human Skin Cells Into Stem Cells

(HealthDay News) -- Two separate groups of scientists have succeeded in turning human skin cells into cells that are very similar -- but not identical -- to embryonic stem cells.

The two teams, one based in Japan and the other in Wisconsin, used slightly different methods to achieve essentially identical goals, researchers said.

"Embryonic stem cells can divide forever, and there has never been good evidence for such cells in adults, but this new paper shows a method to make cells essentially identical to embryonic stem cells," said James Thomson, senior author of the Wisconsin study and a professor in the departments of medicine and public health at the University of Wisconsin-Madison. "This will change the ethical debate," he said at a teleconference held Tuesday.

"We are now in a position to be able to generate patient- and disease-specific stem cells, without using human eggs or embryos," added Dr. Shinya Yamanaka, senior author of the first paper, who is affiliated with Kyoto University in Japan and the Gladstone Institute of Cardiovascular Disease in San Francisco. "These cells should be useful in understanding disease mechanisms, searching for effective and safe drugs, and treating patients with cell therapy," he said.

One outside exert agreed the achievement could shift research away from embryonic stem cells.
"Here's verification of another source of multipotent cells that could be useful for treating disease and would get around some of the ethical issues related to embryonic sources," Paul Sanberg, distinguished professor of neurosurgery and director of the University of South Florida Center for Aging and Brain Repair in Tampa, told HealthDay. "It also demonstrates that there are many cells that can be reprogrammed in the body, and this is not going to be the last time we hear of other types of cells and other ways we can make multipotent."

Multipotency or pluripotency refers to the ability of stem cells to grow into a variety of cell types.
However, the journey from laboratory to patient therapy is still a long one, experts said.
"This is a proof of principle, but, in terms of application, there are many steps in between," said Dr. Robert Tsai, assistant professor in the Center for Cancer and Stem Cell Biology at Texas A&M Health Science Center Institute of Biosciences and Technology in Houston.

The achievements followed closely on the heels of another breakthrough: Last week, U.S. scientists announced that they had created dozens of cloned embryos from a 10-year-old male macaque, a primate. This puts science one step closer to human cloning, those authors stated.

Embryonic stem cells are pluripotent, meaning they have the ability to develop into virtually any cell type in the body. The hope is that such cells may one day yield treatments or cures for diseases such as diabetes, liver failure, spinal injury, stroke, Alzheimer's disease and heart disease.

However, harvesting embryonic stem cells involves destroying a viable embryo, stirring much political debate. In the United States, embryonic stem cell research has been severely limited since August 2001, when President George W. Bush placed limits on federal funding of the field and restricted the number of embryonic stem cell lines that could be used.

Since that time, researchers have been racing to find other sources of viable stem cells. The approach documented in these two studies would circumvent the need for embryos and, thus, would bypass any controversy. The findings of Yamanaka's team are detailed in the Nov. 30 print issue of Cell, and the Wisconsin group's work was released online Tuesday by Science.

Last year, Yamanaka's team transformed mouse skin cells into pluripotent stem cells.

This year, the researchers tried the same method in humans: using a retrovirus to activate specific transcription genes in the skin cells. Transcription genes regulate gene expression, explained Yamanaka.

Using this method, his group generated about 10 cell clones from 50,000 human facial skin cells.
The new "induced pluripotent stem" (iPS) cells were identical to embryonic stem cells in terms of appearance and behavior in cell culture. They also expressed genetic markers that were the same as those observed in embryonic stem cells.

The iPS cells could also differentiate into other tissue types, the team found.

However, a screen of more than 30,000 genes showed that the iPS cells were not actually indistinguishable from embryonic stem cells. In fact, roughly 1,000 genes were expressed differently.

"Human iPS cells are similar, but not identical, to human embryonic stem cells, Yamanaka said. "DNA microarray analyses identified differentially expressed genes between the two stem cell lines. Further studies are required to determine whether human iPS cells can replace human ES cells."

The team at the University of Wisconsin-Madison also used human skin cells, then added two of the same genes as Yamanaka's team and two different genes in their approach. The outcome was essentially the same.

"The actual combination of the factors they put in are different, the rationale is the same," Tsai explained. "There are some tiny differences between the two different combinations."

The advent of the new cells does not render embryonic stem cells unnecessary, however.

"This does not mean that it is the end of embryonic stem cell research, if only that we need a gold standard to compare to," the University of Wisconsin's Thomson told reporters. "Over time, I believe embryonic stem cells will be used by fewer and fewer labs. These new stem cells would not have been derived if it had not been for the last 10 years of research on embryonic stem cell lines. I do, nonetheless, think that the world has changed."

Can the newly designed cells be used to clone humans? "Any cell in the body can do that," Thomson said. "It's probably true of these cells, if you manipulate them enough, but not if you put them in the body as they are."

It's not clear in either of the two new studies if the cells are completely pluripotent or if one line is more efficient than the other. "Will they have the ability to fully differentiate?" Tsai asked. "There's some evidence that they can move from a differentiated state to an undifferentiated state, but will they be able to reverse back?"

"We have to be sure the cells are safe," Yamanaka said. "One of the difficulties about human embryonic stem cells is their tumorigenicity [propensity to develop tumors]. Because of the usage of retroviruses, iPS cells may be more tumorigenic than human embryonic stem cells. We will have to find a way to avoid retroviruses."

But for the more immediate purposes of drug discovery and toxicology, the use of retroviruses is not a big problem, Yamanaka added.

iPS may present their own ethical concerns, however, if they are used to generate sperm and egg cells. "This might help people with infertility problems, but it will be essential to have proper regulation regarding the generation and usage of human iPS cells to avoid misusages of this technology," Yamanaka said.

More information
Learn more about stem cells at the International Society for Stem Cell Research.

Back Pain Constipation

Defining Constipation

Constipation is a term used to describe infrequent bowel movements and affects many people every year.

However, surpassed only by cold and flu symptoms as “motivators,” having a sore back is the second most common reason people visit their doctors.

While the most obvious symptom of constipation is difficulty in having regular bowel movements, another prevalent symptom is back pain.

Most of us will experience some sort of pain or discomfort in our backs at some point in our lives, and constipation could be the cause.

Structure and Function of the Back

The back has many muscles attached to, intersecting, or covering the spine. The spine itself is made up of an elongated, curved stack of bones called vertebrae. These vertebrae are basically round and between each of them is a special disc.

These discs are composed of rubber-like tissue and provide flexibility of the spine. Without this flexibility, we wouldn’t be able to bend over, twist, sit, or walk. However, we wouldn’t want to be as flexible as a snake either. Along with the discs, we have strong ligaments spanning from vertebrae to vertebrae for more support.

The spine also has the critical job of protecting the spinal cord, which sends messages back and forth to the body and the brain, so we can see the logic of having spinal “armor” shielding it.

It’s no wonder people end up with sore back muscles, “slipped discs,” and other lower back problems because we have so many different parts to twist, pull, tear, and strain!

Back pain can be caused by lifting something too heavy, twisting too suddenly, or even sleeping in an awkward position and it can even be related to something unusual like constipation. The lower back also feels impact from walking, running, and many other everyday motions.

Constipation only worsens the situation as the lower back feels greater strain when natural movement is obstructed or hindered by an over-full or impacted colon.

Incredibly, even children can experience back pain constipation. You see—constipation is really just the body not getting rid of waste often enough. If waste remains in the colon too long, the body can reabsorb the water and thus the stool becomes too dry.

If a child is trying to pass a stool that is hard, dry, or very large, they have to strain to manipulate the intestinal muscles. As a result, they may experience lower back pain from all that extra effort. Children may experience additional pain in the anus from it getting stretched open for the large, dry stool to get pushed out.

When to See a Doctor

People with severe or chronic constipation can also develop a condition known as fecal impaction. This occurs when the rectum is blocked by a hardened bowel movement and it can lead to back pain and cramps, bloating, and even feelings of lethargy from the waste remaining inside the body too long.

Most people endure these types of problems without realizing a solution can be obtained; they find ways to work around any lower back pain they might be experiencing and just trudge along with the added difficulty. Nonetheless, it can be a sign that something else is wrong. If you have any of the following symptoms, consult a qualified physician:

The pain is constant and doesn’t improve by resting your back or lying down.
The pain developed suddenly and you are under 20 years old or over 55 years old.
The pain travels up the back and into the chest area.
The pain came on slowly and gradually became worse (most back pain comes on quickly from some injury or stress).

Recurrent nausea or loss of appetite affects your normal diet patterns.
You experience weakness or numbness in your legs or feet or any part of your buttock region.
You are also experiencing problems with your bladder or bowel function.

Of course, if you’re experiencing back pain constipation, once you begin having regular bowel movements again the pain should subside. But what if you’ve had back pain recently, and it feels better now, yet you are still constipated? Surprisingly, back pain constipation can also be related to medications you're taking such as painkillers or anti-inflammatory drugs.

Medications and Constipation

Stronger painkillers, like Codeine, have a tendency to constipate, as do non-steroidal anti-inflammatory drugs. Here are some medications or drugs you may not recognize as potential causes of constipation:

Antacids containing aluminum hydroxide
Anti-depressants
Anti-diarrhea products
Anti-spasmodic drugs
Diuretics
Medications for Parkinson’s disease
Iron supplements
Calcium channel blockers (high blood pressure treatments)
Decongestants and anti-histamines
Pain Relief

Helpful Hints for Reducing Back Pain Constipation

Some people are surprised to learn constipation could be causing lower back pain, but the truth is—constipation can cause all sorts of aches, pains, and general malaise. Abdominal pain pain and nausea are common symptoms, as well as a loss of appetite.

If there is fecal impaction associated with your back pain constipation, it can cause rectal cramps. Fecal impaction may occur in the elderly; and because liquid stool tends to ooze out around blockages, it can often be mistaken for diarrhea.

If you are suffering from the discomfort of back pain constipation here are some resolutions you can try:

Dehydration can be a major cause of back pain constipation. Drink lots of water, or hot teas and broths.

Begin exercising more. Easy, relaxed swimming or walking are excellent choices.

Cut back on eating refined foods and get back to the healthful basics such as fresh fruits and green, leafy vegetables.

Raise your feet with a footstool when you are sitting on the toilet. It puts the bowel at a better angle for passing the stool more easily.

Try using a natural oxygen-based intestinal cleanser, like Oxy-Powder®.

Take the time to thoroughly research your sleeping conditions. Invest in not just an “okay” bed but the best one you can afford. Getting a great night’s rest is critical to keeping the body in proper working order.

Back pain constipation is a detriment to health we may all have to face someday. If you find it’s happening more often, it's probably a good time to change your routine.

Focus on exercises strengthening both stomach and back muscles such as good old-fashioned sit-ups, rowing, back extensions, leg lifts, or the afore-mentioned aquatic activities. Be aware of potential side effects from any medication you are taking. Make sure you're sleeping well on a comfortable mattress;

some people prefer firmer and some prefer softer, but everyone should feel refreshed in the morning. And, perhaps most beneficial, begin eating a healthful, well-balanced diet with plenty of fruit, whole grains (for fiber), and vegetables.

Back pain constipation can be a debilitating, painful condition but can be alleviated with a little common sense and preventative measures. Be good to your back—it’s really the foundation of a body’s strength and must be maintained for overall good health.

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Minorities Less Likely to Receive Care at High-Volume Hospitals

(HealthDay News) -- Race matters, at least when it comes to medical care received in big hospitals and Medicare managed-care plans.

Two studies in the Oct. 25 issue of the Journal of the American Medical Association found that racial minorities generally received lower quality care than whites or had less access to better care.

According to the first paper, black, Asian and Hispanic patients, as well as uninsured patients, were less likely to undergo complex surgery at high-volume hospitals that specialize in that type of surgery. These hospitals are thought to produce better results because they perform so many of the procedures.

To see who was actually using high-volume hospitals, the authors looked at the characteristics of 719,608 patients who underwent 10 inpatient procedures in California from 2000 to 2004.

The procedures were: elective abdominal aortic aneurysm repair; coronary artery bypass grafting; carotid endarterectomy; esophageal cancer resection; hip fracture repair; lung cancer resection; cardiac valve replacement; coronary angioplasty; pancreatic cancer resection; and total knee replacement.

Overall, nonwhites, Medicaid recipients and uninsured patients were less likely to receive care at high-volume hospitals and more likely to go to low-volume hospitals.

Blacks were "significantly" -- 28 percent to 60 percent -- less likely than whites to receive surgical care at high-volume hospitals for six of the 10 operations. Asians were 9 percent to 40 percent less likely to receive care at high-volume hospitals for five of the procedures, while Hispanics were 12 percent to 54 percent less likely to receive care at high-volume hospitals for nine of the procedures.

Medicaid patients were 34 percent to 78 percent less likely than Medicare patients to receive their surgical care at high-volume hospitals for seven of the operations, while uninsured patients were 19 percent to 80 percent less likely to be treated at high volume hospitals for nine of the surgeries.

Right now, the goal is to send all patients in need of a specific type of procedure to hospitals that routinely perform such procedures and have the best results. But this might not be feasible or equitable. Rather than try to refer nonwhites and Medicaid recipients to high-volume hospitals, "the question becomes how to improve the quality of low-volume hospitals, raise the tide and lift all the boats," said Dr. Clifford Ko, senior author of the study and professor of surgery and director of the center for surgical outcomes and quality at the University of California, Los Angeles.

"There is no single, perfect way to improve quality and, even though we've put a lot of stock into volume, it is not perfect," Ko continued. "We need to find additional ways that hospitals can improve quality."

The second study found that black enrollees in Medicare managed-care plans do less well when it comes to managing conditions such as high blood pressure, diabetes or high cholesterol, compared to white patients. The study authors looked at 431,573 individual-level observations in 151 Medicare health plans from 2002 to 2004. They were interested in gauging how well the plans performed on key clinical measures -- controlling blood pressure, cholesterol and blood sugar.

"If people have those measures under control, they're less likely to have heart attacks, strokes and are less likely to die prematurely," said study lead author Dr. Amal N. Trivedi, assistant professor of community health at Brown Medical School in Providence, R.I. "These are very important clinical outcomes." Trivedi started the research while at Harvard Medical School.
"There were large racial disparities in performance in the system as a whole with an absolute gap of 7 percent for blood pressure control all the way up to 14 percent for controlling cholesterol after a heart attack," Trivedi said.

The real question was whether there was any connection between these disparities and the overall quality of the plans. The answer was no, Trivedi said.

"There was basically no connection between the overall quality of the plan and how big its racial disparity, so this isn't an issue that affects just a few low-performing plans," Trivedi said. "We found that it's basically universal among Medicare managed care."

The bottom line is that managed-care plans need to start collecting this information, Trivedi said.

Stephen Thomas is director of the Center for Minority Health at the University of Pittsburgh School of Public Health. He said, "These articles tell us more of the same. The fundamental question is what are we going to do? What we need now is third generation health disparity research that is focused on solutions. Institutions need to be accountable to implementing solutions."

More information
The Kaiser Family Foundation has more on race, ethnicity and health care.

Health Tip: Symptoms of Ringworm

(HealthDay News) -- Ringworm is a fungal skin infection. It can appear almost anywhere on the body, including the hands, feet, groin and scalp. While the condition is most prevalent in children, the fungus can affect people of any age.
The National Library of Medicine says ringworm usually appears as raised, red, scaly patches. They may blister or secrete fluid, may be itchy, and are usually surrounded by a brighter red edge that looks like a ring. If the fungus spreads to the hair, it may yield bald patches. Fungus on the nails may cause them to become thick and discolored, and to disintegrate.
Ringworm spreads in areas that are damp and warm. Highly contagious, it can be passed from person to person via direct skin contact or by sharing items like combs, towels, clothing, public showers, or pool surfaces. Pets, especially cats, may pass the fungus to people.

Angioplasty Beats Bypass for High-Risk Male Patients

(HealthDay News) -- Angioplasty may be a safe and more cost-effective option for men at high risk of death from heart bypass surgery, researchers report.

Some men are at high risk for death during bypass surgery due to their age, prior open-heart surgery, recent heart attack, or decreased heart function, note researchers reporting in the Sept. 12 issue of Circulation.

This new study compared three- and five-year health outcomes and economic costs among 445 high-risk male heart patients, average age 67. Of those, 218 had angioplasty and 227 had coronary artery bypass grafting surgery.

The procedures were done between 1995 and 2000.
At the five-year mark, the average cost was 19 percent lower ($18,732 less) for angioplasty patients, and the cost difference was achieved without adversely affecting survival. Bypass offered no significant advantages over angioplasty in terms of quality of life, which further supports the use of angioplasty for high-risk male patients, the researchers said.

Previous research found that angioplasty was cheaper than bypass initially, but the difference in cost effectiveness narrowed significantly after five years.

"Since the time those studies were done, angioplasty techniques have improved and patients are getting stents, which help prevent the arteries from closing up again," lead researcher Kevin Stroupe, a health economist at the Edward Hines Jr. VA Hospital in Illinois, said in a prepared statement.

"Our study ... showed that angioplasty maintains a significant cost advantage with no adverse impact on survival rates, even after five years," he said.

More information
The Society for Vascular Surgery has more about angioplasty and stenting & EDTA.

Trimming Skin After Weight Loss?

Trimming Skin After Weight Loss?
Provided by: DrWeil.com

Q: What can prevent sagging skin when losing weight? -- A.C.

A: If you lose a lot of weight, you can end up with sagging skin that may or may not tighten up. This is less of a risk if you lose weight slowly. Your age, the length of time you've been overweight, the amount of weight you lost and the elasticity of your skin are all factors that will determine whether or not sagging skin after weight loss will stay that way or shrink down over time.

Exercise, particularly strength training, can help by toning muscles, which can shape your body and improve your appearance. However, although you can exercise muscles, you can't exercise skin - if you've dropped a lot of weight and your skin is sagging, the only alternative is plastic surgery to remove the excess. In general, plastic surgeons recommend waiting about a year after your weight loss to see to what extent your skin conforms to your new shape. (Insurance may cover the surgery if there are associated health risks, such as repeated bacterial or fungal infections in overhanging skin folds.)

The American Society of Plastic Surgeons (ASPS) recently reported a dramatic increase in patients seeking plastic surgery to remove excess, sagging skin after significant weight loss. A survey showed that plastic surgeons performed more than 52,000 body contouring procedures in 2003, and the ASPS projected a 36 percent increase for 2004. Some of these patients had undergone gastric bypass surgery to promote weight loss. At least three different operations are available to deal with overabundant skin:

Abdominoplasty (tummy tuck): Surgeons remove excess fat and skin from the abdomen and tighten the muscles of the abdominal wall. The operation takes two to five hours. You should be able to go back to work in two to four weeks and can resume exercising four to six weeks after the operation.

Breast Lift (mastopexy): With this procedure, surgeons remove redundant skin from sagging breasts and reposition tissue and nipples. The operation takes one to three hours. Plan on at least a week for recovery; you'll have to wait at least a month before resuming strenuous activity.

Upper Arm Lift (brachioplasty): Here, surgeons remove loose skin (and sometimes excess fat through liposuction) in the upper arms. The surgery takes about two hours, and recovery requires at least two weeks.
Andrew Weil, MD

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