Prostate biopsy can cause urinary, erectile problems

NEW YORK (Reuters Health) – Biopsies taken to diagnose prostate cancer commonly cause temporary erectile dysfunction and, in some cases, lingering urinary problems, according to a new study.

The findings, reported in the Journal of Urology, highlight the fact that even the tests for diagnosing prostate cancer can have side effects.

And men who are undergoing prostate biopsies -- as well as those considering prostate cancer screening -- should be aware of those risks, experts say.

This is especially important for men facing the prospect of multiple biopsies, since the risk of side effects appears to be related to the number of needle sticks used.

For the study, German researchers followed 198 men who had been randomly assigned to undergo one of three forms of biopsy to check for suspected prostate cancer: a standard biopsy, where a needle was used to take no more than 10 tissue samples; a 10-sample biopsy along with the use of a periprostatic nerve block to lessen any pain from the procedure; or a "saturation" biopsy, where 20 tissue samples were taken.

Saturation biopsies may be done in some cases where the doctor suspects a man has a particularly elevated risk of having cancer -- such as a man who has had a negative biopsy in the past yet has persistently suspicious findings on PSA screening tests. Taking more tissue samples during the biopsy should increase the chances of finding any tumor.

But all those needle sticks may come at a cost, the study found.

Men who underwent saturation biopsies had the highest risk of developing lingering problems with urination, such as straining to pass urine and frequent nighttime trips to the bathroom.

Of that group, 10 percent reported severe symptoms before the biopsy; that figure increased to 18 percent one week after the test, and to 29 percent 12 weeks afterward.

Men who'd had a standard biopsy showed an increase in urinary symptoms only in the first week. The percentage reporting moderate symptoms increased from roughly 32 percent to 39 percent, and the proportion with severe symptoms rose from 18 percent to 20.5 percent.

Among men who'd had a biopsy with nerve block, just 0.6 percent reported severe urinary symptoms before the test. That rose to 8 percent one week afterward, and to almost 17 percent by week 12 -- though that latter finding was not statistically significant, which means it could have been due to chance.

When it came to erectile function, men in all three biopsy groups had more problems one week after the test. The side effect did, however, gradually decrease over time.

Among men in both the standard biopsy and saturation-biopsy groups, just over half reported severe erectile dysfunction one week after the test -- up from around one-quarter before. In the nerve-block group, that rate rose from 11 percent to 39 percent.

By week 12, the men's rates of erectile problems had declined to close to their baseline levels.

The findings are "not unexpected," said Dr. Paul Schellhammer, a urologist at Sentara Health System/Eastern Virginia Medical School in Norfolk who was not involved in the research.

However, he noted in an interview, there has been little study into the urinary and erectile side effects of prostate biopsies.

"This study begins to define the risks," said Schellhammer, who has studied the effects of prostate cancer treatment on men's sexual and urinary function.

Men facing repeat biopsies over time -- whatever the type of biopsy -- should be particularly aware of the chances for side effects, Schellhammer told Reuters Health, since it appears that the greater the number of needle-sticks into the prostate, the greater the odds of lingering urinary problems.

It is not clear from this study exactly why men undergoing saturation biopsy had a greater risk of longer term urinary symptoms, according to lead researcher Dr. Tobias Klein of Marienhospital Herne in Germany.

But it is possible, he told Reuters Health in an email, that damage to the "neurovascular bundle" -- a complex of nerves and blood vessels close to the prostate -- plays a role.

The fact that prostate biopsies carry some risks -- which, besides the ones seen in this study, include more-immediate problems like bleeding and infection -- also has implications for men considering prostate cancer screening, according to Schellhammer.

Routine screening with PSA testing is controversial. The tests measure concentrations of prostate-specific antigen, a protein produced by the prostate gland whose blood levels generally rise when a prostate tumor is present; however, a relatively high PSA does not necessarily mean cancer, and a biopsy must be done to confirm. And those biopsies often turn out to be negative.

In the current study, 40 percent of the men were found to have cancer after their prostate biopsy.

Much of the concern about PSA testing revolves around the fact that prostate tumors are often slow-growing, and screening may result in many men being treated for cancers that would never have caused them problems. So those treatments -- with their risks of side effects like erectile dysfunction and urinary incontinence -- can do more harm than good for some men.

But men should also be aware, Schellhammer said, that prostate biopsies can have side effects as well, and that can be considered when they are making decisions on PSA screening.

He added that the findings are also relevant to men diagnosed with prostate cancer who choose "active surveillance" -- where the doctor does not immediately treat the cancer, but instead monitors its progression. That surveillance, Schellhammer noted, might include yearly biopsies.

SOURCE: http://link.reuters.com/wew28n Journal of Urology, online August 19, 2010.


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Clinical Trials Update: Aug. 30, 2010

(HealthDay News) -- Here are the latest clinical trials, courtesy of ClinicalConnection.com:

Migraine

This study is for females who have at least two migraine attacks per month just before or during the menstrual cycle. If you qualify, the investigational medication and study exams will be provided at no cost.

The research site is in Plano, Texas.

More information

Please see http://www.clinicalconnection.com/clinical_trials/condition/migraine.aspx.

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Irritable Bowel Syndrome

This study will evaluate an investigational irritable bowel syndrome drug. You may qualify if you are aged 18 to 79, have at least 28 stools over a seven-day period, and have moderate-to-severe pain in the abdomen.

The research site is in Burbank, Calif.

More information

Please see http://www.clinicalconnection.com/clinical_trials/condition/ibs.aspx.

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Attention Deficit Hyperactivity Disorder (ADHD)

This study is for people who have attention deficit hyperactivity disorder. You may qualify if you have trouble getting organized, paying attention, finishing tasks and often feel distracted.

The research site is in Seattle, Wash.

More information

Please see http://www.clinicalconnection.com/clinical_trials/condition/adhd.aspx.

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Copyright 2010 ClinicalConnection.com. All rights reserved.

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Pediatric Group Issues New Flu Shot Guidelines

MONDAY, Aug. 30 (HealthDay News) -- All children and adolescents 6 months of age and older should receive the annual trivalent influenza vaccine this flu season, according to updated recommendations from the American Academy of Pediatrics.

The AAP also says special efforts should be made to immunize anyone who falls into the following categories: all family members, household contacts and out-of-home care providers of children younger than 5 years of age; children with high-risk conditions such as asthma, diabetes and neurological disorders; health care workers; and pregnant women.

These groups are most vulnerable to flu-related complications, the academy pointed out in a news release.

Two influenza vaccines were recommended last year but only one trivalent vaccine is being made for the 2010-11 seasonal influenza vaccine schedule. In this year's trivalent vaccine, the 2009 pandemic influenza A (H1N1) strain has replaced last year's influenza A (H1N1) strain. The new vaccine also includes two other strains of flu virus.

The seasonal flu vaccine policy statement was released online Monday and will be published in the October print issue of the journal Pediatrics.

Other recommendations included in the policy statement are as follows:


Children younger than 6 months of age should not receive influenza vaccine because they are too young.
For children 9 years of age and older, only one dose is needed.
For children younger than 9 years but older than 6 months, a minimum of two doses of 2009 pandemic H1N1 vaccine is needed. If they already received the H1N1 vaccine during last year's flu season, one dose of vaccine is needed this year, otherwise they will need two doses of seasonal influenza vaccine this year.
Those under 9 years of age who have never received the seasonal flu vaccine before will need two doses this year.
Children younger than 9 years who received seasonal flu vaccine last year for the first time, but only received one dose, should receive two doses this year.
Also, those under 9 years who received a flu vaccine last year, but for whom it is unclear whether it was a seasonal flu vaccine or the H1N1 flu vaccine, should receive two doses this year.
All children who are recommended to get two doses this year should receive the second dose at least four weeks after the first dose.

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Medicare expands coverage to help smokers quit

WASHINGTON – They've lived with the health warnings about smoking for much of their lives and doubtless seen the ill effects on friends, relatives and even themselves, yet about 4.5 million older people in the U.S. keep on lighting up. Medicare is finally catching up to most private insurers by providing counseling for anyone on the program who's trying to kick the habit.

Dr. Barry Straube, Medicare's chief medical officer, says it's never too late to quit, even for lifelong smokers.

"The elderly can respond to smoking cessation counseling even if they have been smoking for 30 years or more," says Straube. "We do know we can see a reduction in the death rate and complications from smoking-related illnesses." Not only cancer, heart disease and lung problems, which can kill, but also gastric reflux, osteoporosis and other ailments that undermine quality of life.

Smoking-related illnesses cost Medicare tens of billions a year. Straube cites a two-decade estimate of $800 billion, from 1995 through 2015.

Medicare already covers drugs used to help smokers quit, as well as counseling for those who have developed a smoking-related illness. But starting immediately, the program will expand the benefit to cover up to eight counseling sessions a year for people who want to quit.

Next year, such counseling will be free, under a provision in President Barack Obama's health care law that eliminates co-payments for preventive services.

Older smokers often don't get as much attention from doctors as do younger ones. "They just figure, 'Well, it's too late,'" said Straube, that the damage is already done. That may start to change now.

About one in 10 seniors smoke, compared with one in five people among the U.S. population as a whole. It turns out that smokers age 65 and older present a medical paradox.

Many started when it was fashionable to light up. They are more likely than younger smokers to be seriously hooked on nicotine and less likely to attempt quitting. But research shows that their odds of success are greater if they do try to give up the habit.

Older smokers who receive counseling are significantly more likely to quit than those who only get standard medical care. One study of elderly heart attack patients found that those who got counseling to help quit smoking were more likely to be alive five years later.

It's unclear why older people who try to quit have better luck than younger smokers.

Some experts think it's because older smokers are more motivated, perhaps from having seen a loved one die of cancer or heart disease, or by recognizing how the cigarette habit has left its mark in their own bodies, anything from wrinklier skin to shortness of breath.

Straube has his own theory: "They're under less stress," he said. "They are not working anymore, and they have more time."

Medicare's new smoking cessation benefit will also be available to younger people who are covered by the program because of a disability. About 1 million of them are smokers.

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ER visits for concussions soar among kid athletes

CHICAGO – Emergency room visits for school-age athletes with concussions has skyrocketed in recent years, suggesting the intensity of kids' sports has increased along with awareness of head injuries.

The findings in a study of national data don't necessarily mean that concussions are on the rise. However, many children aren't taken for medical treatment, so the numbers are likely only a snapshot of a much bigger problem, doctors say.

"It definitely is a disturbing trend," said lead author Dr. Lisa Bakhos, an ER physician in Neptune, N.J.

The study examined concussions in organized youth sports involving ages 8 to 19. ER visits for 14- to 19-year-olds more than tripled, from about 7,000 in 1997 to nearly 22,000 in 2007. Among ages 8 to 13, visits doubled, from 3,800 to almost 8,000.

While awareness has increased, many parents, coaches and players still don't understand how serious concussions can be, Bakhos said. Many often seem less concerned with the injury than with how soon kids can return to sports.

"They want to know if they can play tomorrow, and you're just like, 'No!'" she said. "It's not just as simple as get up, shake it off and you'll be fine.

"If they're not treated properly, with rest, then they can have long-term problems," Bakhos said. Those include learning difficulties, memory problems and chronic headaches.

The study appears in Pediatrics, published online Monday, along with a report about sports-related concussions from the American Academy of Pediatrics' sports medicine council.

A concussion means the brain has been jostled. Symptoms aren't always obvious. There usually is no loss of consciousness. And a concussion doesn't show up on an imaging scan unless there is bruising or bleeding.

Symptoms can include headache, nausea, dizziness and trouble concentrating, and may last about a week. Sometimes it can take months to recover.

Potential concussions should not be "toughed out," say the authors of the Pediatrics report. Affected athletes should always be examined by a doctor or someone else with medical expertise.

Treatment is mainly rest — both physically and mentally, avoiding activities that require concentration and focus. That may mean reducing schoolwork or staying home. Video games, computer use and TV can worsen symptoms and should be avoided, the academy report says. Some doctors advise against aspirin and similar painkillers right after a head injury because they might raise the risk for brain bleeding.

Above all, anyone with a concussion should not return to sports or other physical exertion until their symptoms have disappeared.

"If you go back in too early, that can be devastating," said Dr. Kevin Walter, co-author of the report and a concussions specialist at Children's Hospital of Wisconsin in Milwaukee. Resuming sports too soon risks another concussion that could be deadly or cause permanent brain damage, he said.

A concussion should not be dismissed as "not a big deal," Walter said. "In my mind, how the hell can a brain injury not be big deal?" he said.

Sports-related concussions have made recent headlines because of research about brain damage, depression and memory problems including Alzheimer's disease in retired NFL players who had repeat concussions.

Researchers believe young athletes may be more vulnerable than adults to lasting damage from these head injuries because their brains are still developing. Several states have adopted or are considering tougher limits on when athletes can resume play after a concussion, as have some schools, amateur leagues and the NFL.

Dr. Michael Koester, chairman of a sports medicine committee at the National Federation of State High School Associations, said young athletes increasingly are playing and practicing year-round to stay competitive, a trend that increases chances for injury.

Evan Nolte, 16, a top high school basketball player in Atlanta, says the injuries "are more serious than people think."

Evan hit his head hard on the floor during a tournament earlier this year when he dived for a ball and another player landed on top of him. He didn't think he had a concussion, and only sat out several minutes before returning to the game.

A few days later, he was elbowed in the head in another game. Evan sat out the rest of the game, feeling disoriented. His doctor diagnosed a concussion the next day and told him to avoid sports for a few weeks. When Evan had trouble focusing in class, and complained that his head was spinning, his parents took him to Children's Healthcare of Atlanta's concussion clinic.

The clinic is among an increasing number of centers nationwide that use computerized or written tests to measure mental function after concussions. Evan's results showed some deficits. His scores improved after several days, but it took him about a month to feel 100 percent.

Now he's back to training. At 6-feet-7, Evan plays competitively 10 months of the year and plans to play in college. Coaches from top schools have already shown interest.

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Weight loss cuts risk of pregnancy complication

NEW YORK (Reuters Health) – Losing the weight gained during pregnancy is a real struggle for many new mothers. But dropping just 10 pounds between pregnancies may help many women diagnosed with a dangerous complication during the first pregnancy to avoid a recurrence the second time around.

Preeclampsia, which is characterized by high blood pressure, protein in the urine and swelling, occurs in about 5 percent of American pregnancies every year.

"It can be more systemic than just high blood pressure. It can affect the liver, kidneys and the body's blood clotting system," Dr. Dorothea Mostello told Reuters Health. It's one of the leading causes of maternal death in childbirth in the developed world, she added.

Mostello, based at the St. Louis School of Medicine, is lead author of a new study in the September issue of the journal Obstetrics and Gynecology.

Mostello and colleagues wanted to know if women could do anything to reduce their risk of a recurrence during a second pregnancy.

Previous research by the team showed that pre-pregnancy weight is one of the "strongest risk factors for recurrence." Because other research suggests that losing even a small amount of weight offers health benefits, such as reduced risk of heart disease, they wanted to know if it would reduce the risk of preeclampsia too.

They analyzed the medical records of nearly 18,000 Missouri women who gave birth twice between 1989 and 2005 and developed preeclampsia during the first pregnancy.

Before their second pregnancies, 1417 of the women had weighed less than before their first, 8,783 had remained about the same, and 8,798 had weighed more. The women who maintained their weights were used as the control group.

Overall, about 16 percent of these Missouri women developed preeclampsia during their second pregnancies. Of the women who had lost weight between pregnancies, 13 percent had a recurrence while 15 percent of women who maintained their weight and nearly 19 percent of those who gained weight had a recurrence.

Small changes in maternal weight between pregnancies -- as little as 10 pounds for an average height overweight woman -- "significantly alter the risk of preeclampsia recurrence," across all weight categories, the authors note.

"If you are overweight and you lose weight, your rate (of preeclampsia recurrence) is as low as someone in the normal weight category, and if you are overweight and gain weight, your rate is as high as someone in the obese category. Similarly, if normal weight people gain weight they have as high a risk as overweight people," Mostello said.

Researchers don't know why some women develop preeclampsia and others don't. Being African American appears to be a risk factor, so is being overweight or obese. While a woman can't do anything about her genetics, she may be able to reduce her risk of a recurrence by "modest, generally achievable degrees of weight loss before pregnancy," the authors conclude.

Few options exist for lowering a woman's risk of developing preeclampsia in her second pregnancy, the authors write. Losing weight between pregnancies "is the most reasonable measure to meaningfully lower the risk," they conclude.

"Most weight-loss programs can get you a 10 or 15 pound weight loss," Mostello said.

The findings also underscore the need for uninterrupted healthcare between pregnancies, Mostello said. "This is the period where we can make a real difference," she said.

SOURCE: http://link.reuters.com/cyg77n Obstetrics & Gynecology September 2010.

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Child health at risk from non-prescription drugs: study

LISBON (AFP) – Many parents give their children too large or frequent doses of non-prescription medicines for fever, coughs and colds, putting their health at risk, according to an Australian study released Monday.

"Many children are being put at risk by parents? over-use of widely-available over the counter medicines for fever, coughs and colds," concluded the study by University of Sydney researchers presented at a conference of the International Pharmaceutical Federation.

"We were surprised and concerned to find that some people thought that medicines must be safe because you can buy them without prescription", said Rebekah Moles, who headed up the study of 97 parents and day care centre employees.

"Taking all the scenarios together, 44 percent of participants would have given an incorrect dose, and only 64 percent were able to measure accurately the dose they intended to give", said Moles.

Only 14 percent managed the fever scenario correctly.

The noted that 48 percent of calls in 2008 to the New South Wales Poisons Information Centre, which receives all out of hours calls from around Australia, concerned accidental overdose in children, with 15 percent needing hospitalisation.

Australia is unlikely to be a special case, the researchers said, and they believe that the inappropriate use of children's medicines is widespread throughout the world.

"It is vital that parents worldwide should understand the proper usage of medicines so that they do not continue to put their children's health at risk," said Moles.

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One More Way to Avoid Diabetes: Breastfeed

New moms know that breastfeeding can be good for babies, providing them with much-needed nutrition as well as a shot of antibodies and other cells that help build immune systems. Now, evidence suggests that the practice may keep the mothers themselves healthier too.

Researchers led by Dr. Eleanor Bimla Schwarz at University of Pittsburgh found that women who breastfeed are half as likely to develop type 2 diabetes as women who do not. That's a big statistical difference, and although it's not clear what is behind the gap, scientists speculate that it has something to do with pregnancy pounds that expectant moms gain. Breastfeeding helps moms lose the abdominal fat they gain during pregnancy more efficiently. And while abdominal - or visceral - fat is important for the gestating baby's development, it can be detrimental to a mother's health if it continues to build after delivery, since it's been linked to greater risk of metabolic disorders such as insulin resistance and heart disease as well as diabetes.

"When you look at mammals, you have to consider lactation as part of the pregnancy experience," says Schwarz. "When women don't breastfeed after pregnancy, or lactation is curtailed or prematurely discontinued, women end up retaining more fat than they would have if they breastfed. Then the mother's health can suffer." (Read about mothers opting for breast-milk, not breastfeeding.)

Animal studies have helped reveal other reasons this is so. Breastfeeding, those studies found, can increase a mother's response to insulin, allowing her to break down glucose more effectively and keep sugar metabolism in check. Lactation also inhibits hormones that promote growth hormone activity, which can also affect insulin levels. In addition, studies have shown that when women do develop diabetes during pregnancy, known as gestational diabetes, breastfeeding the newborn can improve their glucose metabolism and help stabilize the condition. (See photos of pregnant belly art.)

Despite the growing body of research establishing the health benefits of breastfeeding, moms in the U.S. remain resistant.The American Academy of Pediatrics recommends that new mothers breastfeed their infants for at least six months, yet only 14% of women do. For the 86% who don't, Schwarz says lifestyle interventions such as exercise and changes in the diet can go a long way toward lowering their diabetes risk - even if it doesn't replace the health dividends the babies would be receiving if they were breastfed. "This [study] shows that perhaps counseling these women to try to reduce their personal risk of developing diabetes should be something that doctors should consider," says Schwarz. "And if you are pregnant or thinking about getting pregnant, or currently breastfeeding, then stick with it because it's important to both your baby's and your own health."

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Link Between Diabetes, Alzheimer's Disease Strengthened

WEDNESDAY, Aug. 25 (HealthDay News) -- Two of the most common and dreaded illnesses in America may share a connection, with new research suggesting that having insulin resistance or type 2 diabetes raises your risk of developing the brain plaques associated with Alzheimer's disease.

After adjusting for other risk factors, the Japanese study found that people with the highest levels of fasting insulin had nearly six times the odds of having plaque deposits between nerves in the brain, compared to people with the lowest levels of fasting insulin.

Those with the highest scores on a measure of insulin resistance (where cells become less able to use insulin effectively) had about five times the odds of having brain plaques vs. those with the lowest scores on the insulin-resistance test, the study found.

In fact, "the risk of plaque-type Alzheimer's disease pathology increases in a linear relationship with diabetes-related factors," according to one study author, Dr. Kensuke Sasaki, an assistant professor in the department of neuropathology at Kyushu University in Fukuoka, Japan.

Results of the study appear in the Aug. 25 online issue of Neurology.

Both type 2 diabetes and Alzheimer's disease have been rapidly increasing in incidence, so much so that experts worry the illnesses may overwhelm the health-care system in the coming years if nothing is done.

While numerous studies have found a link between cognitive decline and dementia in people with type 2 diabetes, the current study sought to determine the reason for that link.

Using autopsies from 135 Japanese adults, the researchers were able to compare if different indicators of insulin resistance or type 2 diabetes correlated with the development of plaque deposits between the nerves in the brain (neuritic plaques) or neurofibrillary tangles, which are found in dying cells in the brain. Plaques and tangles are thought by many to be the two main causes of the destruction of brain tissue seen in Alzheimer's disease.

All of those autopsied died between 1998 and 2003. In 1988, they had undergone numerous tests as part of an ongoing study on brain and heart health. The tests included an oral 2-hour glucose tolerance test, fasting blood sugar and insulin levels, and a measurement of insulin resistance using a test called homeostasis assessment of insulin resistance (HOMA-IR).

The researchers adjusted the data to control for age, sex, blood pressure, cholesterol, body-mass index, smoking, exercise and cerebrovascular disease.

They found no association between diabetes risk factors and the development of tangles. However, higher levels of blood sugar two hours after eating, high fasting insulin levels and an elevated HOMA-IR score were associated with an increased risk of developing plaques. Fasting blood sugar levels were not associated with an increased risk of plaques, according to the study.

When the researchers compared varying levels of diabetes risk factors, such as fasting insulin, they found a linear association with the development of plaques. For example, fasting insulin was broken into three groups: low, medium and high. The low group didn't have an increased risk of plaques, while the medium group had more than twice the risk of brain plaques, and those in the high group had a six times higher risk of plaques than those in the low group.

The researchers also performed a separate analysis to see if the presence of a gene long implicated in Alzheimer's disease (ApoE4) would have an effect on the association between diabetes risk factors and the development of plaques. It did: Those with the ApoE4 gene has the strongest association between high blood sugar levels, insulin resistance and fasting insulin levels and the development of plaques.

"Research has been linking diabetes to dementia, and probably to Alzheimer's, and this study is one more bit of evidence to say that we'd better get a handle on this," said Dr. Richard Bergenstal, president of medicine and science for the American Diabetes Association.

Bergenstal said this study's findings are likely applicable to people with both type 2 and type 1 diabetes, and possibly to those with pre-diabetes, as well.

"This study fits into a body of literature looking at the relationship between diabetes and Alzheimer's disease. This area is being pretty aggressively researched for a number of reasons. Would better control of type 2 diabetes improve the cognitive fate of those with the disease, and is there some way we can intervene in glucose metabolism that might affect Alzheimer's?" said William Thies, chief medical and scientific officer for the Alzheimer's Association.

"If you have diabetes, it's certainly a good idea to keep it under control while we're sorting out the research," Bergenstal said.

"Although we don't know anything that can prevent Alzheimer's disease right now, I do think there are a lot of good reasons for people to try to prevent type 2 diabetes, much of which can potentially be avoided with regular physical activity and weight maintenance," said Thies. "Preventing or controlling diabetes is good for all kinds of reasons, and also because it might contribute to your risk of Alzheimer's disease."

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FDA releases latest list of safety issues

WASHINGTON (Reuters) – The U.S. Food and Drug Administration has released its latest list of possible drug safety concerns, citing Roche's breast cancer drug Herceptin and Sanofi Aventis' heart drug Multaq, among others.

The list, which comes out quarterly, covers safety issues that the FDA flagged between April and June and was released on the agency's website on Friday.

Other drugs listed include Merck & Co Inc's birth control Implanon, Pfizer's antibiotic Cleocin and Novartis' Afinitor.

Takeda Pharmaceutical's gout management drug Uloric, AMAG Pharmaceutical's anemia drug Feraheme and Shire Plc's phosphate binder Fosrenol were also included, among others.

In most cases, the FDA offered few clues into what the concerns were and simply said the agency "is continuing to evaluate this issue to determine the need for any regulatory action."

Merck's cholesterol drug Zocor, Genentech's HIV drug Invirase and various GnRH agonists were also listed, but the agency has already issued more specific safety alerts on those drugs. Genentech is a unit of Roche.

Johnson & Johnson's Nucynta, a pain treatment, was also listed as having a risk of convulsions, hallucinations and serotonin syndrome.

FDA also named omeprazole products, used to treat ulcers, saying there is a risk the drug could cause low levels of magnesium in the blood.

The drug manufacturers were not immediately available for comment.

The list is online at: http://link.reuters.com/myg77n

(Reporting by Susan Heavey; Editing by John Wallace and Richard Chang)


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Doctors look for orange-size lump, find 56-pounder

BUENOS AIRES, Argentina – Doctors were shocked when they looked into a woman's uterus searching for an orange-size tumor but found something that resembled a giant rock instead.

Surgeons ended up removing a 56-pound (23-kilogram) tumor from the 54-year-old woman. It was 19 inches (50 centimeters) across.

"At first sight, one could see it was going to be a big tumor, but not that big," said Dr. Oscar Lopez, leader of the surgical team that operated on the woman at Gandulfo Hospital in the city of Lomas de Zamora.

"We were totally shocked," Lopez added Thursday in discussing the procedure that was conducted earlier this year.

Stunning perhaps, but not the biggest. News stories and medical reports say that was a 303-pound (137.6-kilogram) ovarian cyst removed in 1991 in California, and other growths exceeding 100 pounds (45.5 kilograms) have been reported.

A biopsy determined the growth removed at Gandulfo Hospital was a sarcoma, a malignant tumor, and the patient is being monitored by doctors after spending five days in the hospital following the surgery.

The woman, a housewife, who prefers to remain anonymous, weighed 343 pounds (140 kilograms) at the time of the surgery, which lasted four hours and involved eight surgeons — about double the time and staff usually needed.

Lopez said the woman had felt a constant growth in her abdomen for a year and a half, but just thought she was gaining weight.

Finally, she consulted doctors and it was determined she needed surgery, and the tumor was removed a couple of months ago, he said.

Lopez said that before removing tumors, surgeons generally puncture a growth in various places to remove liquid, but in this case the tumor remained solid.

"We thought the tumor could be reduced to an orange's size, but it was totally solid," he said.


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New Study: Young Children Surprisingly Perceptive

The way they weep and vomit without warning, it's tempting to think that preschoolers are incapable of rational thought. As biologist and emeritus Harvard professor Edward Wilson has written, a prevailing view - one promoted by the famed developmental theorist Jean Piaget - has long been that very young children are "reflex-dominated" and "egocentric": in other words, they see little outside themselves until they reach the age of reason (usually considered to be about 7).

But a paper published recently in the journal Psychological Science shows that very young children can be far more attuned to the "desires, preferences, beliefs [and] emotions" of others, including adults, than the Piaget theory assumes. The paper suggests that young children possess a skill many adults assume they lack: they are able to judge when a human behavior is statistically probable versus when it is unusual. Very young kids, it turns out, often know when adults are not acting as they usually do.

Three psychologists - Tamar Kushnir of Cornell; Fei Xu of the University of California, Berkeley; and Henry Wellman, who chairs the Center for Human Growth & Development at the University of Michigan - conducted the two experiments that went into the paper. For the first experiment, the scientists recruited 72 preschoolers (average age: 4 years, 1 month) from a small, unnamed Midwest city. They put the kids into a room with various boxes containing two different types of toys such as small plush baseballs and basketballs. The kids were told that a puppet that looked liked a squirrel (which was creatively called "Squirrel") liked one group of toys - either the baseballs or the basketballs - but not other.

The different boxes in the room contained different proportions of the two types of toys. The conditions of the game changed with different groups to ensure randomness, but just for purposes of explanation, let's look at the group of kids that was told that Squirrel liked to play with baseballs and not basketballs. Three boxes were opened in front of the kids. One had only 18% baseballs; another contained half baseballs and half basketballs; the last had all baseballs.

The children were then asked to pick toys for Squirrel. And something interesting happened: when the boxes containing only 18% baseballs were opened, the preschoolers usually chose to give one of the baseballs to the Squirrel. When the boxes contained half baseballs were opened, the kids would sometimes pick one for him and sometimes pick a basketball - or do nothing. And when the boxes that contained all baseballs were opened, the kids would often just sit there. Maybe they would wanly hand a baseball to Squirrel. After all, didn't Squirrel understand his own preference? He could take whatever he wanted on his own. For the researchers, this was evidence that preschoolers can understand how other people's desire works: they can take what they want.

The authors say this is the first scientific "evidence that young children can use intuitive statistical abilities to infer a psychological cause - a preference." Anyone who has ever had to mind children sharing toys in a sandbox may argue they have seen similar behavior, but this is the first time we have clear data that kids pay attention to proportions when they think about preference. Even preschoolers, in other words, can see that some people might need more help getting what they want when less is available to them.

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Girl-band star escapes jail over HIV infection

DARMSTADT, Germany (Reuters) – A German pop singer who confessed to knowingly exposing two men to the risk of HIV after finding out she had the virus herself was convicted by a court on Thursday of grievous bodily harm.

Nadja Benaissa, 28, from German girl-band No Angels was given a two-year suspended sentence. She could have faced up to 10 years in jail. Prosecutors had sought a lenient sentence because Benaissa had confessed and expressed remorse.

"I made a huge mistake," Benaissa told the Darmstadt court in western Germany at the end of the trial on Wednesday, adding she had kept it all a secret because she was afraid of what would happen if the public learned she had been HIV-positive.

"I was a coward," she said. "I'm sorry from the bottom of my heart. I wish I could turn back the clock and make it all not happen."

Benaissa was convicted of causing grievous bodily harm in one instance for infecting a 34-year-old talent agent, and attempted grievous bodily harm for another occasion when she had unprotected sex with another man between 2000 and 2004.

She was also required to perform 300 hours of community service and submit to regular counseling sessions.

The talent agent later contracted full-blown AIDS, while the other man was not infected with HIV. Benaissa said she had been aware she was HIV-positive since a routine blood test taken during her pregnancy in 1999, when she was 17.

Both state prosecutor Peter Liesenfeld and her defense attorney Oliver Wallasch had sought a suspended sentence. Liesenfeld told reporters her full confession and expression of regret were the main reasons for the leniency.

Born in Frankfurt to a German mother and a Moroccan father, Benaissa and four others formed No Angels in 2000 after taking part in a television casting show.

The band became of the most successful girl-groups in Germany with hits such as "Daylight in Your Eyes" that were popular across Europe.

Benaissa, who has also worked as an actress in Germany, was initially arrested on the charge in April last year and spent 10 days in detention.

Prosecutors' publication of her medical condition sparked criticism that she had been unfairly treated.

(Writing by Erik Kirschbaum; Editing by Steve Addison)


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Older Diabetes Patients Still Sexually Active, Study Finds

FRIDAY, Aug. 27 (HealthDay News) -- Most older adults with diabetes are sexually active but the disease does cause some problems with intimacy, a new study found.

U.S. researchers surveyed 1,993 people, aged 57 to 85, and found that nearly 70 percent of partnered men with diabetes and 62 percent of partnered women with diabetes had sex two or three times a month, which is comparable to people the same age without diabetes.

However, compared with men without diabetes, diabetic men were more likely to lack interest in sex and to experience erectile dysfunction. Men and women with diabetes reported a higher rate of orgasm problems, such as climaxing too soon (men) or not at all (men and women).

The study, published in the September issue of the journal Diabetes Care, also found that 47 percent of men with diabetes had discussed sexual problems with a doctor, compared with only 19 percent of diabetic women. Men were much more likely than women to initiate this type of discussion.

"Patients and doctors need to know that most middle-age and older adults with partners are still sexually active despite their diabetes. However, many people with diabetes have sexual problems that are not being addressed," study lead author Dr. Stacy Lindau, an associate professor of obstetrics and gynecology and of medicine at the University of Chicago, said in a university news release.

"Failure to recognize and address sexual issues among middle-age and older adults with diabetes may impair quality of life and adaptation to the disease," added senior author Dr. Marshall Chin, a professor of medicine at the University of Chicago. "Sexual problems are common in patients with diabetes, and many patients are not discussing these issues with their physicians."


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'Thirdhand Smoke' Especially Harmful For Asthma Sufferers

Components in cigarette smoke that linger long after the cigarette has been extinguished can pose their own health risks, especially for asthma sufferers, according to a new study.

"Thirdhand smoke" - the residue that can persist for months after a cigarette is put out - can react with pollutant ozone to form tiny, potentially harmful particles.

These "ultrafine" particles, less than 100 nanometers wide, can make their way deep into a person's lungs and could present a bigger threat to asthma sufferers than nicotine itself, said study researcher Mohamad Sleiman, a chemist at Lawrence Berkeley National Laboratory. (A nanometer is 1 billionth of a meter. The diameter of a human hair is about 80,000 nanometers.)

"Ultrafine particles have the capacity to carry and deposit potentially harmful organic chemicals deep into the lower respiratory tract," Sleiman said. "It's been well established by others that the elderly and the very young are at greatest risk" from these types of particles.

Thirdhand smoke

The dangers of firsthand and secondhand tobacco smoke, which contain several thousand chemical toxins distributed as particles or gases, have been well documented. Then, in February, a study conducted by Sleiman and his colleagues revealed the potential health hazards of thirdhand smoke from cigarettes. It was shown to react with nitrous acid, a common indoor air pollutant, to produce dangerous carcinogens.

Until now, however, no studies have looked at the reaction of nicotine with ozone.

Released as a vapor by the burning of tobacco, nicotine is a strong and persistent adsorbent onto indoor surfaces that can be released back into the indoor air for a period of months after smoking has ceased. Ozone is a common urban pollutant that infiltrates from outdoor air through ventilation and has been linked to health problems, including asthma and respiratory ailments.

The researchers found that when nicotine reacts with ozone, some of the products place higher up on a scale of particles hazardous to asthma sufferers than nicotine itself, said study researcher Lara Gundel, also of Berkeley National Laboratory.

Backfiring purifiers

The findings suggest using air purifiers that emit ozone to clear out the smell of tobacco smoke may not be such a good idea.

The researchers caution that the levels of both ozone and nicotine in their study were at the high end of typical indoor conditions.

"In addition, we need to do further investigations to verify that the formation of ultrafine particles occurs under a range of real-world conditions," Sleiman said. "However, given the high levels of nicotine measured indoors when smoking takes place regularly and the significant yield of ultrafine particles formation in our study, our findings suggest [a] new link between asthma and exposure to secondhand and thirdhand smoke."

The study was published online in the July 29 journal Atmospheric Environment.

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