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Age-related macular degeneration in the past meant blindness for the patient. In more recent years laser surgery could be a sight saver, but it also meant a more invasive treatment.
The arrival of new anti-angiogenic drugs that can reverse age-related macular degeneration has received a lot of attention at the recent Schepens International Society ophthalmology meeting. The new drugs Macugen (pegaptanib sodium injection) and Lucentis (ranibizumab) were showing that they stopped the disease in 95% of cases. They were injected into the vitreous of the eye, and the vision of those patients who took it, actually improved.
Macugen has been approved by Health Canada and will be launched for use in September 2005, according to Pfizer, the company behind the drug therapy.
The research goes back to the 1970's with the discovery of a process that forms new blood vessels in the body allowing tumors to thrive and metastasize. This research revolutionized the understanding of cancer. The new anti-angiogenic drugs fight a protein that induces angiotensin and is responsible for the abnormal blood vessel growth under the retina. This blood vessel growth causes macular degeneration.
Dr. Judah Folkman, a Harvard professor of cell biology, gave the presentation and he stated that this new approach would be "a lot of hope to patients."

The Medical Post, July 5, 2005, page1, 58.

Tight Blood Sugar Control In Diabetics Cuts Heart Disease

Successful treatment of type 1 diabetes in the past usually meant compliance in taking insulin shots and paying attention to a diabetic diet. Since the arrival of specific lab tests like the HbA1c levels, patient education has become more sophisticated: it is not enough to just be on shots, eat sensibly and otherwise hope for the best. As a result, it is a must for patients to monitor their glucose levels closely.
Research that was presented at the American Diabetes Association during the 65th annual scientific session spelled out the benefits very clearly: strict control of glucose levels helps patients with type 1 diabetes to decrease the risk of stroke and cardiovascular disease by 57%!

It has been known that tight glucose control helped to reduce diabetic nephropathy (kidney disease) and diabetic retinopathy (eye disease) in diabetics, but this is the first time that controlling glucose levels has been associated with cardiovascular disease, reports the main investigator, Dr.David Nathan from, director of the diabetes center at Massachusetts General Hospital in Boston. He also reported that every 1% reduction in HbA1c (glycosated hemoglobin) correlated with a 20% reduction in cardiovascular risk for the diabetes type 1 patient.
These findings are significant, as the risk reduction is larger than seen in any other trials, like administering medication (statins) or placing stents.
A similar risk reduction may also occur in patients with type 2 diabetes, but at this point no specific research on this group is available. In the meantime it is of great importance to any patient with type 1 diabetes.

The Medical Post, July 5,2005,page1, 58.

Comfort Foods Make PMS More Uncomfortable

Premenstrual depression, moodiness, insomnia, abdominal cramps and headaches are some of the symptoms that create havoc for up to 40 % of menstruating women. Premenstrual Syndrome (or PMS for short) does not just mean a" cranky" few days for the women who suffer from it, but a host of unpleasant effects. Many experience bloating and breast tenderness, and they find that their daily functioning at work and in personal relationships is impaired. Food cravings are part of the picture, and often the so-called "comfort foods" are high on the list like ice cream, chocolate, cookies, or cake. Unfortunately these are not helpful at all, whereas other foods can be beneficial. The American College of Obstetricians and Gynecologists has published recommendations already in 2000 in which a diet of complex carbohydrates was recommended and supplementation of calcium, magnesium and vitamin E. Small meals that are rich in complex carbohydrates and that also contain protein and fat are useful to keep blood sugar levels stable. Even though some women crave sugar, candy, baked goods and pop, the rapid fluctuations in blood sugar only contribute to moodiness and irritability. Caffeine can also contribute to irritability, but by the same token, quitting coffee or tea abruptly will make many feel worse. A gradual decrease would be the gentler approach.
Alcohol intake is an especially bad idea, as it is a depressant and does nothing to lift the mood. People who have bloating or edema should avoid sodium.
Trials have shown what works to control PMS. More than 400 women were enrolled in a study group and were given 1,200 mg of chewable calcium carbonate daily. Those taking the supplement benefited from a 48% decrease of symptom severity. Within the Nurses' Health Study II researchers followed up on a group of 1,057 women who got PMS and another group of 1,968 women who did not during 1991 and 2005. Women who consumed 400 IU of vitamin D a day had a lower relative risk of developing PMS. Consumption of calcium and vitamin D were measured by a food questionnaire. Calcium consumption of about four daily servings of fortified orange juice, skim-or low-fat milk or low-fat yogurt was inversely related to PMS.

The lead author of the study was Dr. Elizabeth Bertone-Johnson PhD, from the department of public health at the University of Massachusetts in Amherst. Her colleagues agree that vitamin D and calcium is beneficial to women of all ages, since these nutrients also reduce the risk of osteoporosis. Trials of vitamin B6 in doses of up to 100 mg daily seemed to help, as reported already in 2003 in a review by American Family Physician.
For the patient it means that small, regular meals are a good idea. So are complex carbohydrates, low-glycemic fruit like apples or berries and lots of vegetables. Consume low-fat milk or low-fat yogurt. Give the calcium supplements and the vitamin B6 a try. Minimize red meat, saturated and trans fats. Avoid salt, refined carbs, sugar, salt and alcohol. All of these aspects can make a significant contribution to a reduction of PMS symptoms as well as to health and wellness.

The Medical Post, June 28.2005, page 23

Virtual Colonoscopy May Help Find Other Disease

California-based researchers reported in the August issue of the medical journal Radiology about a study involving CT colonography, also known as "virtual colonoscopy". This utilizes CT scanning. Dr.Yee, from the University of California School of Medicine, San Francisco, did a prospective study where 500 men were studied with an average age of 62.5 years.
200 of them had an average risk for colon cancer; the remainder was at a high risk for colon cancer. The surprising finding was that many disease conditions were found (315 patients or 63%) that were not related to the colon at all, such as renal cysts and hiatal hernias. These were considered to be clinically not important. However another 50 patients (8.4%) were found to have liver lesions, pulmonary nodules, aneurysms and renal tumors, which were largely unknown and were thought to be clinically very significant.
Dr. Judy Yee said that it takes a trained radiologist to interpret these CT scan findings, but that this method of screening would be very cost effective. Looking for the additional life threatening conditions in the routine virtual colonoscopy added only about 28 $ per CT examination and was considered to be very cost effective. The clinically important extra-findings were equally distributed between the high and low risks for colon cancer. Dr. Yee summed up by saying that she hopes that many more Americans would come in for virtual colonoscopy as part of colorectal cancer screening. The advantage is that this is less invasive than a conventional colonoscopy procedure, but at the same time that colon cancer is screened for the radiologist picks up clinically significant medical problems.

Radiology 2005;236:519-526.

Cognitive Therapy Useful For Suicide Prevention

A prospective study was done involving 120 adults over 18 months with evaluations at 1, 3, 6, 12, and 18 months involving patients who had attempted to commit suicide before entering the study. The purpose of the study was to find out whether cognitive therapy could make a difference in the suicide or suicide attempt rate in the months following an attempt. Several parameters were measured using scales of hopelessness, symptom of depression, frequency of suicidal thoughts and recording repeat suicidal attempts.

The results showed that there was a significant difference between the regular treatment group and the group where cognitive therapy was given. The subsequent suicide attempt rate in the regular treatment group was 1.97-fold higher than in the cognitive therapy group over the 18 months treatment and observation period. 76% of the cognitive therapy treated group did not attempt to commit suicide again (free of repeat suicide attempt), whereas in the regular treatment group this figure was down to 58%. At 6, 12 and 18 moths a depression assessment showed that the cognitive therapy group had a significantly lower (meaning "better") score than the regular treatment group. This was also reflected in the statistics showing a 50% less likely rate of repeat suicide attempts in the cognitive therapy group. Feelings of hopelessness were also significantly lower in the cognitive therapy group, but interestingly enough there was no significant difference between suicidal thoughts in the cognitive therapy group versus the regular treatment group.
The authors came to the conclusion that cognitive therapy is an effective treatment modality, which helps preventing further suicide attempts, in patients who recently have attempted to commit a suicide.

JAMA. 2005;294:563-570.

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