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Medical Advances - Ladue News: Health-wellness

Medical Advances

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Posted: Thursday, December 8, 2011 12:25 pm | Updated: 12:40 pm, Thu Dec 8, 2011.

AUTISM

Having one child with autism means an increased risk that his or her siblings also will have an autistic spectrum disorder. A recent issue of the journal Pediatrics includes a study that shows 19 percent of infant siblings develop ASD by age 3.

“The risk of autistic spectrum disorders in this group is almost twice the prior estimates,” says Dr. John Constantino, the Blanche F. Ittleson Professor of Psychiatry and Pediatrics, director of the William Greenleaf Eliot Division of Child and Adolescent Psychiatry at Washington University, and one of the study authors. “The good news is some of these children may outgrow their diagnosis. The proportion of school-aged siblings who carry autism diagnoses among the 15,000 families affected by autism participating in the national volunteer registry called the IAN, or Interactive Autism Network, is actually much lower, in the 10 to 12 percent range. So some children identified very early may actually improve over time.”

Constantino and his research colleagues plan to follow the children in the study to determine how many improve over time. Tracking the children over several years may provide clues to future ASD treatments.

BREASTFEEDING & FLU SHOTS

While the consensus among medical professionals is that flu shots are a good idea for almost everyone, researchers at Saint Louis University’s Center for Vaccine Development are studying two flu vaccines in breastfeeding mothers.

The two vaccines are marketed as Fluzone, an injection of inactivated flu virus, and FluMist, a nasal spray containing weakened live virus that cannot cause flu but will create an immune response. Babies younger than 6 months do not receive a flu vaccine but can become very ill from infection of the influenza virus. Researchers hope to learn if the breastfeeding mothers in the study pass immunity to their infants.

“In some winters, 1 percent of babies younger than 6 months are hospitalized with influenza,” says Dr. Sharon Frey, clinical director of the center and the study’s principal investigator. “Both of the vaccines have been used for many years in adults. While flu shots are routinely recommended for pregnant women, there is not a lot of documented experience concerning flu vaccines in breastfeeding mothers.”

Frey and her team will compare levels of protective antibodies in the mothers’ milk following vaccination and determine whether the weakened virus found in FluMist is present in the women’s breast milk.

BRAIN STENTS

A treatment meant to decrease risk of repeat strokes has been found to have the opposite effect. According to The New England Journal of Medicine, researchers found that patients who received artery-opening brain stents experienced more than twice the rate of stroke within a month of treatment compared to those who did not receive the stents. The results were so alarming that the National Institute of Neurological Disorders and Stroke halted trial enrollment.

“The complications on the stent side of the trial were higher than we expected,” says coprincipal investigator Dr. Colin Derdeyn, professor of radiology at Washington University. “Further research may identify specific groups of patients who may benefit from these stents, but for now we seem to be able to save more lives by aggressively working to lower blood pressure and cholesterol.”

The research team is now working to determine why the patients with the stents experienced higher rates of stroke and death. Theories include blood clots forming on the stents or breaking loose from blood vessel walls and possible damage to blood vessels during stent installation. Researchers will continue to follow the patients in the study for two more years.

STROKE SURGERY

Another potential treatment for preventing repeat strokes in high-risk patients also failed in a multi-institutional clinical trial, according to a report in the Journal of the American Medical Association. The procedure, known as carotid occlusion surgery, restores blood flow to the brain using an approach similar to cardiac bypass in which an artery from elsewhere in the body is used to reroute blood flow around a blocked carotid artery.

The procedure proved no better at preventing strokes than non-surgical interventions, such as blood-pressure, cholesterol and clot-prevention medications. “We’re still thinking about surgical approaches to remedy this problem that might have less risk of complications,” says Dr. Colin Derdeyn, professor of radiology at Washington University and the study’s senior author. “For now though, non-surgical treatments are better at reducing risk.”

Neurosurgeons began using the brain bypass procedure on patients with blocked carotid arteries, a primary supplier of blood to the brain, in the 1970s. The surgery was found to be unhelpful for patients who had suffered at least one stroke or mini-stroke, a temporary episode of faintness, vision loss, weakness and other symptoms that led doctors to identify a blocked carotid artery. However, some researchers wondered if select groups of patients could be helped by the procedure and studies continued.

“If the surgical procedure went well and was free of complications, the brain had better blood flow and risk of stroke was reduced,” Derdeyn says. “But non-surgical treatment also decreased stroke risk.”

ACL

Surgery to repair a tear in the knee’s anterior cruciate ligament (ACL) is often successful—the first time. But not all patients have a successful outcome, and subsequent ACL repair attempts have a higher risk of failure. Researchers are working to figure out why.

More than 200,000 ACL reconstruction surgeries are performed each year in the U.S., and 1 percent to 8 percent fail. Patients who opt for a second attempt at repair experience a 14 percent failure rate. Washington University researchers are leading the national Multicenter ACL Revision Study, comparing surgical techniques and analyzing outcomes.

“If I reconstruct the ACL in your knee, and you go back to sports, and later you pivot on a basketball court and tear it again, that subsequent surgery often does not have results equal to the original surgery,” says Dr. Rick Wright, professor of orthopedic surgery, co-chief of Washington University’s Sports Medicine Service, and the study’s principal investigator. “In a previous study, we found that the strongest predictor for a bad outcome after ACL surgery was whether that surgery was the initial reconstruction or a subsequent procedure.”

Wright and his colleagues at 52 research sites across the country plan to enroll 1,000 patients who have a second ACL tear and follow them for at least two years. Surgeons will note the condition of the knee and how the original surgery was performed to see whether that predicts problems with a subsequent operation.

PROSTATE CANCER

Washington University and Siteman Cancer Center researchers are studying a potential link between excess dietary protein and prostate cancer.

One study targets men with prostate cancer to see whether decreasing protein intake may slow the growth of cancer prior to surgical removal of the prostate gland. A second study focuses on men who have already had prostate surgery but still have elevated levels of prostatespecific antigen (PSA), a protein produced by the prostate that is used as a possible cancer marker.

“The typical American diet includes almost twice the recommended daily allowance for protein, which should be about 10 percent of calories,” says Dr. Luigi Fontana, a research associate professor of medicine at Washington University and the studies’ principal investigator. “We don’t want to reduce protein below recommended levels, but we want to see whether cutting protein to what’s recommended may improve the health of these patients.”

Fontana notes that prostate cancer is a bigger problem in developed Western nations, and he suspects that diet may play an important role. “Past clinical studies showed that Japanese and American men typically had microscopic evidence of cancer cells in the prostate, but the American men were more likely to die of the disease,” he says. “In recent years, that gap has closed, and we think it’s possible that the lifestyle and diet that may have put American men at risk now may be increasing the risk for Japanese men.”

CEREBRAL PALSY

Scientists at Washington University have shown that a protein may help prevent the kind of brain damage that occurs in babies with cerebral palsy. Using mice, they found that high levels of the protective protein Nmnat1 substantially reduce damage that occurs when the brain is deprived of oxygen. The findings offer hope for treating cerebral palsy and neurodegenerative diseases, such as Alzheimer’s disease.

“Under normal circumstances, the brain can handle a temporary disruption of either oxygen or blood flow during birth, but when they occur together and for long enough, long-term disability and death can result,” says Dr. David Holtzman, chairman of Washington University’s department of neurology and author of the study, which was reported online in the Proceedings of the National Academy of Sciences. “If we can use drugs to trigger the same protective pathway as Nmnat1, it may be possible to prevent brain damage that occurs from these conditions.”

Researchers think that the protein Nmnat1 blocks the effects of the neurotransmitter glutamate, which is released by damaged or oxygen-deprived brain cells and can overstimulate and kill neighboring nerve cells. Five years ago, it was shown that Nmnat1 can prevent peripheral nerve damage in the extremities. Researchers now want to determine if those effects extend to the brain.

SPINE SURGERY

Many patients undergoing spine surgery have low levels of vitamin D, which may delay recovery, according to a new study. Researchers at Washington University found that of 313 patients undergoing spinal fusion surgery, more than half were vitamin D deficient and a fourth of the entire group had extremely low levels of the nutrient.

“Our findings suggest it may be worthwhile to screen surgery patients for vitamin D,” says Dr. Jacob Buchowski, professor of orthopedic and neurological surgery and the study’s principal investigator. “We think those with insufficient levels of vitamin D may benefit from taking 50,000 international units of the vitamin once a week for eight weeks before surgery, as this may help the recovery after spinal fusion surgery.”

Vitamin D helps with calcium absorption, and patients with a deficiency can have difficulty producing new bone. In spinal fusion surgery, disks between two or more vertebrae are removed. The bones in the spine are then attached with hardware and treated with growth factors. As the spine heals, new bone forms and the vertebrae fuse together.

“We rarely think about deficiency in younger patients,” Buchowski says. “More of the older patients in this study had a history of taking supplements, and as a result, they had less risk for vitamin D deficiency than younger patients.” He recommends that patients having orthopedic surgery ensure that they are getting enough vitamin D through fortified dairy products, sun exposure and supplementation.

PREVENTING BREAST CANCER

According to the National Institutes of Health (NIH), one in every eight women will be diagnosed with breast cancer in her lifetime—making them 100 times more likely than men. While there are factors beyond our control that can contribute to the possibility of cancer— family history, genetics, age and gender—there are many other ways to reduce the risk. Here are five ways to help prevent breast cancer:

◆ Maintain a healthy weight.

◆ Limit your intake of processed and red meat.

◆ Eat plenty of fruits and vegetables.

◆ Have no more than one alcoholic drink per day.

◆ Get at least 30 minutes of moderate-intensity exercise five days a week.

“Prevention is the first step toward taking care of our own health,” says Pam McCullough, the director of the nursing program at Stratford University’s Woodbridge campus. “There are some factors that we cannot do much to change, like our genes, but there are many lifestyle choices that we can make. It is important to take them seriously and apply them to our lives.”

ALZHEIMER’S ANTIBODY

With Alzheimer’s disease affecting approximately 30 million people worldwide, researchers are intently focused on the search for a treatment. In a new study, Saint Louis University School of Medicine researchers are focusing on the drug bapineuzumab, to learn if it can help those suffering from the neurodegenerative disorder. “Because the disease can span more than a decade, Alzheimer’s creates a vast social and financial burden on society,” says Dr. George Grossberg, director of geriatric psychiatry and principal investigator for the study.

Bapineuzumab works as an antibody against amyloid beta, a key component of plaques found in the brain that are implicated in Alzheimer’s. Investigators will give the drug or a placebo once a month to 120 study participants who are suffering from mild to moderate forms of Alzheimer’s to see if it will reduce or stabilize the progression of the disease. Because the drug is given subcutaneously (under the skin), if the approach proves to be safe and effective, doctors hope that it will be more accessible and convenient for patients. The trial is expected to last 28 months.

KUFS GENE DISCOVERY

Often mistaken for Alzheimer’s, Kufs disease is a rare disorder that causes memory loss, motor impairments and early death, mainly affecting adults, but able to strike anyone from age 6 to 60. The recent discovery of the gene that causes Kufs by researchers at Washington University School of Medicine in St. Louis may help develop genetic tests and therapies for the condition. “We think this Kufs-causing gene may open up a new avenue of research for these kinds of disorders because it may provide new information about dementia in general,” says Dr. Bruno Benitez, who worked together with researcher Carlos Cruchaga to identify the gene.

The study involved two Kufs disease patients from the same family, whose symptoms were originally thought to be Alzheimer’srelated. By sequencing DNA from the patients, then comparing the results to DNA from other healthy family members, Cruchaga and Benitez were able to narrow down the variants until they found the DNAJC5 gene responsible. The discovery also may help physicians diagnose related disorders that affect young children.

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