Medical Articles by Dr. Ray - Collection of health news, health articles and useful medical information you can use in everyday life.

Apr

2007

Disc Transplantation New For Herniated Disc

Back problems can be a source of chronic pain and it is a significant reason for disability in the general population. Often the patient lives with the problem, and treatment with pain killers or over the counter remedies proves to be useless. Once the symptoms are becoming more severe and there is a feeling of numbness that extends into the leg or foot, even the most stoic back pain sufferer will seek out medical advice. Tests such as a CAT scan or MRI scan will reveal that the reason for the chronic pain is a herniated disk.

The only treatment that could be offered has been a discectomy which is performed by an orthopedic surgeon. So far fusion surgery has been the modality of choice, which has the unfortunate consequence of predisposing patients to degeneration in other levels of the spine as the wear and tear following fusion surgery is higher at the adjacent levels.

Dr. Dike Ruan from the Navy General Hospital in Beijing reports about a new treatment in the form of disc transplantation instead of fusion. Artificial materials have been tested and the results have been very variable. Contrary to organ transplantation it is possible to work with donor material from non-related persons as the inert disk material does not cause transplantation rejection. The herniated disc is removed including the adjacent end plate and a fresh-frozen composite disk with end plate is introduced. Five patients who underwent the procedure had improved neurological status after three months. Also the bony union at the end plate was nearly complete after three months. Long term follow up, which continued for at least five years, continued to show improvement.

Disc Transplantation New For Herniated Disc

Contrary to organ transplants in which anti-rejection drugs have to be used, the disk transplants caused no immunological reaction. Motion and stability remained excellent, and only minor degenerative changes were observed after five years.

With further refinements, such disc transplants will likely become an effective alternative treatment for degenerative disc disease.

More information about disc herniation treatment suggestions: http://nethealthbook.com/arthritis/lower-back-pain/treatment-low-back-pain-2/disc-herniation-treatment-suggestions/
Reference: The Lancet, 2007; 369-993 and p.999

Last edited November 2, 2014

Apr

2007

Quick Test Predicts Sepsis

By Ray Schilling | Gastrointestinal Disease, Infectious Disease

One of the big risks for a patient undergoing abdominal surgery has been the threat of peritonitis, which means infection in the abdominal cavity. Apart from pneumonia, which can be another one of those life threatening diseases, peritonitis remains a severe threat even today, as it is accounting for roughly 60% of mortality in the surgical intensive care units. It is not the peritonitis itself that is the killer but the spread of the infection through the blood stream to vital organs. Once the vitals are affected, infection will lead to a general shutdown: multiple organ failure or septic multi-organ dysfunction syndrome known as MODS, which is what kills the patient.
Our ancestors could not control sepsis. Antibiotics had yet to be discovered. Today the main challenge remains a timely detection of sepsis. Once sepsis has overrun the body, even antibiotic treatment comes too late for the patient.
The best methods that are currently available for the detection of sepsis are CAT scans and fine needle aspiration. Both have their shortfalls: the CAT scan may be unavailable and fine needle aspiration can increase the infection risk. One biomarker, the C reactive protein has only a limited use to predict septic MODS, as C reactive protein levels show a sharp increase in the presence of surgical trauma, regardless whether there is infection or not. German research has tested another potential blood sepsis marker, procalcitonin. Unlike the C reactive protein procalcitonin levels are not affected by surgical trauma, but it shows an increase in the presence of bacterial or fungal infection. There is a rapid automated assay for procalcitonin, the Kryptor PCT essay. It can be completed in 20 minutes, which is important, as time is of essence in emergency situations. Among 82 recruited patients with peritonitis, more than half had infections due to E.coli. Nine had fungal infections. Procalcitonin levels were markedly higher in patients who later went on to suffer MODS. All patients in the study were tested within 96 hours of the onset of symptoms. C reactive protein levels were not useful in terms of a predictive value.

Kryptor PCT measures procalcitonin for quick diagnosis of sepsis

The test is useful for two purposes: it helps with the early detection of a septic condition, so treatment can start early. It also identifies patients who won’t develop septic MODS.The sensitivity and the accuracy of the test does not necessarily make it a true “sepsis marker”. Researchers believe that the degree of systemic procalcitonin reflects a weak immune system. The test picks up those patients who are susceptible to severe infections. As a result timely treatments can be started for them right away.

Reference: National Review Of Medicine, March 15,2007, page 3

Last edited December 5, 2012

Apr

2007

Nitroglycerin Patch Helps Premature Babies

By Ray Schilling | obstetrics, Women’s Diseases

Nitroglycerine has been a tried and tested drug for patients who suffer from angina, but the chemical has other benefits: the drug can retard labor and delivery, if a woman is having premature labor. This result comes from research at Queen’s University Perinatal Research Unit at Kingston General Hospital, Canada. Other tocolytics, which is the term for labor delaying drugs, are also on the market showing comparable results, but the nitro patch had an advantage, as it significantly reduced morbidity during the neonatal period.

The researchers worked with 158 women who went into premature labor between 24 and 32 weeks of pregnancy. In a randomized trial they either received a transdermal patch of nitroglycerine or placebo. If contractions continued an hour after the patch was put on the skin, another one was added. The following day treatment was repeated. Delivery was delayed 10 days for all, and a very significant 23 days for those in labor before 28 weeks. Any prolongation of pregnancy closer to a term delivery is helpful, but the greatest significance applies to those, where labor starts before 28 weeks. This is the group of babies that are most at risk, says lead author Dr. Graeme Smith of Kingston General.

There may be two reasons for the overall benefits of nitroglycerin treatment. On the one hand nitroglycerine protects pregnancy in the most vulnerable group, where the mothers enter labor before 28 weeks. The other aspect may be that the nitro patch may be having effects beyond the labor-delaying properties such as better blood flow in the placenta, as there is enough of the medication that reaches the placenta.

Nitroglycerin Patch Helps Premature Babies

Dr. Smith reports that at this point there is no “gold standard” tocolytic in Canada. Tocolytics have shown little improvement and frequent side effects. Compared to other tocolytic medications the main side effect of the nitro patch has been a mild headache. In most cases it was not necessary to remove the patch. It is estimated that nitroglycerin is now used in about a third of Canadian centers.

Reference: National Review Of Medicine, February 28, 2007, page 5

Last edited December 5, 2012

Apr

2007

Red Meat Linked To Heart Disease In Diabetics

By Ray Schilling | Diabetes, Heart Disease, Nutrition

Red meat is one of the sources of protein, but doctors from the Harvard School of Public Health reporting in the January edition of Diabetes Care, that a type 2 diabetes diet should be lean in red meat.

Type 2 diabetics are at risk for subsequent coronary heart disease (CHD), and intake of iron rich food was significantly associated with a greater risk of fatal CHD. The results come from a prospective study of 6,161 women from the Nurses’ Health Study. All of these patients reported a diagnosis of adult onset diabetes, and they were followed between 1980 through 2000, which amounts to an impressive 54,455 person-years follow-up. Attention was paid to the food questionnaires, which were monitored for the consumption of iron and red meat such as beef, pork or lamb as a main dish, also for the use of beef in roast beef sandwiches and mixed dishes, hamburger, hot dog, processed meat and bacon. Note was also taken of other nutrients such as seafood and poultry.
Women with diabetes who ate the most iron in the form of heme found in red meats had a 50% increased risk of total coronary heart disease as compared to those with the lowest intake. The risk ratio with women was more obvious in post menopause when compared with pre menopause.

Red Meat Linked To Heart Disease In Diabetics

While lean beef may be a good protein food to the average population, type 2 diabetics might choose to cut back on red meat and processed red meat sources and replace it with a heart-friendlier choice. Fresh seafood, rich in omega -3 fatty acids, would rank high on the list of a healthy eating plan.

Reference: The Medical Post, February 20, 2007, page21

Last edited December 5, 2012

Mar

2007

Dental Signs Indicators for Celiac Disease

By Ray Schilling | Allergies, Dentistry, Gastrointestinal Disease

Celiac disease is a condition, where a person is unable to tolerate wheat products. In other words they have a wheat allergy. It is not enough to avoid the standard foods like bread and other bakery goods that contain wheat. Wheat makes its appearance in many foods and also in taste enhancers like monosodium glutamate. Alone for this reason it is important for a person with celiac disease to carefully read labels in order to avoid foods that contain gluten, which is the offending substance. Often celiac disease goes undetected for many years, but there are early signs that can help to take action sooner rather than later.

Dr.T.Malahias, D.D.S., a dentist from Groton, Conn presented his findings at a recent international symposium for celiac disease. He pointed out that there are signs that are visible in the dental enamel, which will already be present in childhood, once the permanent teeth appear at about age 6. The bilateral symmetrical markings are defects in the tooth enamel. they can be brownish, yellow or white and are most commonly seen on the central incisors. They give the tooth a mottled, non-shiny appearance. Patients with this appearance may also have problems with the delayed eruption of the permanent teeth. These markings are permanent, and even after following a gluten-free diet they will stay, as the development of the enamel started already in the third or fourth month of life. While there may be other reasons for this abnormality, celiac disease should be considered in the context of the patient’s history.

Dental Signs Indicators for Celiac Disease

Dental enamel defects may be the only signs of celiac disease

The results are quite significant in pediatric groups: in patients less than 12 years of age who had celiac disease the rate of enamel defects ran at 90% as compared to 44% of the others without celiac disease. People who have recurrent unexplained aphthous ulcers should take notice too. Five percent have been found to have undiagnosed celiac disease as a result of the constant and chronic overstimulation of the immune system by gluten substances. Once celiac patients start with a gluten-free diet, the ulcers will occur less frequently.

More information on celiac disease: http://nethealthbook.com/digestive-system-and-gastrointestinal-disorders/celiac-disease/

Reference: Based on MD Consult News, January 31, 2007

Last edited November 2, 2014

Mar

2007

Check For Vitamin B12 Deficiency In Elderly

By Ray Schilling | Mental Health, Nutrition, Prevention

Elderly patients frequently are seen at the doctor’s office because they are “feeling poorly”. Concerned family members mention that there is lack of energy, and mental impairment may also be present. Immediately there may be the question, whether these are symptoms of Alzheimers disease. The other observation may be that the older person is not eating properly. Family physicians will order laboratory tests including vitamin B12 levels. If a deficiency is shown, patients will be advised to take a vitamin supplement, and they may receive injections of vitamin B12.
The unfortunate fact is that vitamin B 12 levels are notoriously unreliable in the diagnosis of deficiency. As early as 1988 a publication in the New England Journal of Medicine showed that neuropsychiatric disorder due to vitamin B12 deficiency can be present in a patient who had normal blood levels and no other findings. It does take some other avenues to detect the deficiency. The blood can be tested for the metabolite called MMA (methylmalonic acid) which is raised with vitamin 12 deficiency. A second test is the measurement of HTC (holotranscobalamin), which is the fraction of vitamin B12 bound to the plasma protein transcobalamin, which delivers the vitamin to the tissues of the body.
Dr. Cherie McCracken and colleagues from the department of psychiatry at Liverpool University, England studied 42 men and 42 women ages 69 to 93.They were tested for cognitive functions like orientation, language, attention and memory. In addition researchers took measurements of the MMA and HTC, the tests mentioned above. None of the test persons had dementia due to the selection criteria, but 31% were cognitively impaired. Mental scores indicating cognitive impairment were associated with increasing age and MMA, and the areas of language comprehension, language expression and ideation practice (translating an idea into an action) were affected.

Check For Vitamin B12 Deficiency In Elderly

The reason for the correlation of MMA with impairment of brain function can be explained by the fact that MMA is toxic to the oxidative function of mitochondria. The process is like a chain reaction: when mitochondria are poisoned, the nerve cells will lack energy for proper function.
Despite this sophisticated interplay of blood levels and cell function in the brain, the message that comes from the researchers is very simple. The MMA has to be ordered as a test in elderly persons, and the next important step is supplementation with vitamin B12 to prevent deterioration in mental functioning.

More information about:

1. Causes of dementia: http://nethealthbook.com/neurology-neurological-disease/alzheimers-dementia-and-delirium/dementia/

2. Pernicious anemia: http://nethealthbook.com/anemia/anemia-from-deficient-red-blood-cell-production/megaloblastic-macrocytic-anemia/

Reference: The Medical Post, January 16, 2007, page 27

Last edited November 2, 2014

Mar

2007

Olive Oil No Magic Elixir

By Ray Schilling | Health, Nutrition

Health trends come and go, and some myths need to be demystified, such as the notion that we need a lot of one beneficial food to achieve good health. The Mediterranean diet has become a buzz word in the public, and there is certainly nothing wrong with a diet that emphasizes the benefits of vegetables and fish with omega-3 fatty oil. These figure prominently in foods of the Mediterranean. Olive oil, which is one of the fat sources, has been also touted as a “miracle food”, and the benefits of the healthy fats to which it belongs have received a lot of attention.
Dr. James Kenney, who holds a PhD in nutrition at the at the Pritikin Longevity Centre, questions inflated health claims of olive oil. No matter, which way you look at it, olive oil remains a calorie-dense and nutrient-poor food. Pound for pound, like all refined oils, olive oil has more than 4000 calories, and 13% to 14% of the calories in olive oil come from saturated fat. The good news is that compared to lard (38% saturated fat) and butter (63% saturated fat) olive oil is the better choice. People who switch from butter to olive oil will see a reduction of cholesterol, reports Dr. Kenney. The reason is that they are eliminating a lot of saturated fat, trans fat and cholesterol that was in the butter. Olive oil itself does not lower cholesterol, as monounsaturated fatty acids do not raise or lower cholesterol. As a result it is not a good idea to freely pour olive oil into salads, over vegetables or to dip white bread into it, transforming it into an oil-dripping calorie bomb.

Olive Oil No Magic Elixir

Olive oil can be compared to rocked fuel: it is a high calorie food, and if you plan to go on a long distance bike excursion across the country, you’ll clearly need more fuel than if you are working at a sedentary job in an office. Olive oil should be used like salt. It is a condiment, and choosing extra virgin olive oil in a spray pump gives us a boost of flavor. The real beneficial food sources in the Mediterranean diet are fruit, vegetables, beans, small amounts of whole grain and omega-3 rich fish. Flavonoids and antioxidants in the fruit and vegetables are some of the main players, but lifestyle and genetics may also play a role.

More about fats, the good, the bad and the ugly here: http://nethealthbook.com/health-nutrition-and-fitness/nutrition/fat-good-bad-fatty-acids/

Reference: The Medical Post, February 2, 2007, page 17

Last edited November 2, 2014

Mar

2007

Pancreatitis Can Occur With Statin Use

By Ray Schilling | Gastrointestinal Disease, Heart Disease, Prevention

Drug safety is a concern in the administration of prescription medications and non- prescriptions and any new drug that hits the market has undergone a rigorous screening procedure before its release. Side effects still can occur, and all of the possible ones have to be listed. For physicians it always remains a matter of careful judgement, whether the benefits of a prescription outweigh the disadvantages of any side effects. It is also a concern for the patient to be fully informed. Despite all precautions there are still surprises: some drugs have been taken of the shelves, because the side effects showed up after some time and the risk for the patients were too much. There may be the sense of false security about a prescription drug that has been on the market for a long time that all is known about possible side effects, but researchers and physicians remain alert to the fact that there may be adverse drug reactions that have not been observed.Statins, which are used for lowering high cholesterol levels, have been researched in a review of case reports and observational studies led by Dr.Sonal Singh of Wake Forest University in Winston-Salem, N.C. The authors reported in the December issue of Drug Safety that there have been numerous case reports in which statins have been implicated in acute pancreatitis. It appears to be a genuine adverse reaction, but it remains rare. The researchers estimate that there would be one case of acute pancreatitis in 300,000 patients treated with statins for a year.

Pancreatitis Can Occur With Statin Use

The review suggested that pancreatitis can occur in high and low statin doses, but it is more likely to happen after many months of therapy. Due to the low incidence and mild severity in the majority of cases, statin therapy is still considered safe.
The first line of defense in the treatment of high cholesterol remains a proper diet and an active lifestyle. Statins are needed for patients with familial hypercholesterolemia and those where diet and lifestyle choices have not been successful enough.

More information about:

1. Statins: https://www.askdrray.com/statins-can-hurt-the-consumer/

2. Pancreatitis: http://nethealthbook.com/digestive-system-and-gastrointestinal-disorders/pancreatitis/acute-pancreatitis/

Reference: The Medical Post, February 2, 2007, page 2

Last edited November 2, 2014

Mar

2007

Depression Increases Stroke Risk

By Ray Schilling | Mental Health, Prevention, Stroke

Strokes have been observed mainly in the aging population, and various lifestyle factors play a role in the risks. It is generally well known that smoking is one of them. High blood pressure that is left untreated will have a stroke as a consequence. Even though in the past the development of a stroke was more commonly seen in older patients, it has become something to be reckoned with for patients that are middle aged.
While some risk factors are the same in all the age groups, researches scrutinized the age group under 65 for additional risk factors. The one that stands out is depression.
Margaret Kelly-Hayes Ed.D. and her colleagues evaluated data from the Framingham Heart Study, looking at 4,120 participants aged 29-100 years who were followed for 8 years. In the course of their research they checked for symptoms of depression by administering the Center for Epidemiological Studies Depression Scale (CES-D). If patients were taking medication for depression they were included in the study. In participants under 65 with depressive symptoms the stroke risk was found to be four times higher than in the population of the same age group without depressive symptoms.

The findings were commented on by Dr. Francisco Javier Carod-Artal, of the Sarah Hospital in Brasilia, Brazil. He found that a growing body of evidence suggests that biological mechanisms underlie a bidirectional link between depression and many neurological illnesses. Mood disorders can influence the development of disease.

Depressed patients 4 times more at risk of getting stroke

Pinpointing exactly why depressive symptoms are increasing the risk for strokes is a challenge. Dr. David Spiegel from Stanford (Cal.) University was interviewed and he believes that the problem is environmental as well as biologic. People who are depressed may smoke more, avoid social contact, may lack self care and neglect taking blood pressure medication.
In any event it is important to treat depression, and to take care of all the known steps in stroke prevention.

More information about:

1. Stroke prevention: http://nethealthbook.com/cardiovascular-disease/stroke-and-brain-aneurysm/stroke-prevention/

2. Depression: http://nethealthbook.com/mental-illness-mental-disorders/mood-disorders/depression/

Reference: MD Consult News, January 29, 2007

Last edited November 2, 2014

Feb

2007

King Tut’s Death Demystified By CT Scan

By Ray Schilling | Orthopedics

CT scans are important diagnostic tools in medicine. They are generally performed in radiology departments or departments for diagnostic imaging in hospitals. They are extremely useful to get detailed information that surpasses the simple findings an x-ray can provide.
Recently CT scanning has been used as a tool by archeologists to examine a patient that has passed away 3,300 years ago. Tutankhamun, the Egyptian king, died very young. After an x-ray examination in 1968 which seemed to detect bone fragments in the boy king’s skull, it was speculated that he had been a victim of foul play. Dr. Ashraf Selim, a radiologist at Cairo University and leader of the CT examination of King Tut, did not find any evidence of this. During the discovery of the mummy by the Englishman Howard Carter in 1922 Carter and his cronies were quite rough, when they tried to remove the pharaoh’s golden mask, and as a result some bone fractured, which also matched a defect within the first cervical vertebra. This being an injury long time after death excluded foul play. What was obvious in the CT finding was a fracture to the femoral bone, which occurred before the death of the young king. While researchers cannot assess how this injury happened, the findings suggest that the injury was likely an open wound that became infected and led to the untimely death of the king (no antibiotics there at that time).

King Tut’s Death Demystified By CT Scan

It is rare that archeologists will draw on CT scans to uncover a mysterious death, but CT scans are not only tools for specialists like orthopedic surgeons or neurologists. They can be a helpful tool to assist in other areas of medicine such as forensic medicine to find valuable insights.

Reference: The Medical Post, January 16,2007, page 16

Last edited December 5, 2012

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