Health News, Wellness, and Medical Information

Focused ultrasound is an effective way to get rid of uterine fibroids, the noncancerous but troublesome tumors that can grow inside the uterus, new research shows.

Uterine fibroids are a common condition that can lead to a host of problems, including prolonged, heavy menstrual bleeding that can be severe enough to cause anemia or require blood transfusion; severe pelvic pain and pressure; urinary frequency; pain during intercourse; problems with becoming pregnant, miscarriage and complications during pregnancy.

About 20 percent to 40 percent of women aged 35 and older have uterine fibroids. The problem is even more common among black women, about half of whom have fibroids, according to background information in the study.

There are several treatment options for fibroids, ranging from taking birth control pills to getting a hysterectomy. More recently, other techniques have been developed, including myomectomy, in which doctors surgically remove the fibroids, and uterine fibroid embolization (UFE), also called uterine artery embolization, which starves fibroids by blocking their blood supply using particles inserted into the uterus using a tube threaded through an artery in the groin.

The most recently developed — and least invasive technique — is focused ultrasound, in which interventional radiologists guided by MRI zap fibroids using tightly focused ultrasound.

In the study, researchers from the Mayo Clinic treated 119 women with focused ultrasound. One year after the treatment, 74 percent of women said their improvement of symptoms was “excellent,” while 16 percent said the improvement was “considerable.”

About 8 percent of women needed to have another form of fibroid treatment within a year, said study author Dr. Gina Hesley, an assistant professor of interventional radiology at the Mayo Clinic in Rochester, Minn.

That’s about the same percentage of women that previous studies have shown need to be re-treated after myomectomy or UFE, Hesley said.

“Focused ultrasound is another viable alternative treatment option for women who have uterine fibroids,” Hesley said.

The study is to be presented Monday at the Society of Interventional Radiology’s annual meeting in Tampa, Fla.

Researchers plan to continue following the women who received focused ultrasound. If fibroids aren’t completely destroyed, they can grow back and cause problems again. In addition, new ones can form.

Focused ultrasound was approved by the U.S. Food and Drug Administration for treating uterine fibroids in October 2004. However, the technique is only available in a limited number of hospitals nationwide, and not all insurance companies cover it, Hesley said.

Benefits of the technique are that it is minimally invasive, recovery time is quick — women can often return to their normal activities the next day — and it’s not painful. The most women usually feel is warmth from the ultrasound, Hesley noted.

Drawbacks of the technique are that it takes several hours, during which women lay on their belly in an MRI while lightly sedated.

Dr. John Lipman, director of interventional radiology and the Center for Image-Guided Medicine at Emory-Adventist Hospital in Atlanta, called the technique promising, but noted that it’s not for every woman and does not replace the techniques currently in use.

“It’s very exciting and innovative, but there are some limitations,” said Lipman, who offers focused ultrasound at his hospital. “It’s important to keep in mind this treatment can only address a small fraction of the symptomatic fibroid population.”

Because it takes two to three hours to zap each fibroid, it’s not practical to offer the technique to women who have a uterus full of larger fibroids.

Focused ultrasound can only penetrate a limited distance beneath the skin, so the location of the fibroids, the anatomy of the uterus, as well as excess weight, can make ultrasound not the best option.

One group of women who may be particularly helped by focused ultrasound is those who are having trouble getting pregnant because of fibroids, Lipman said. Myomectomy, which involves cutting into the uterus, can damage it, further compromising fertility, and there’s a small risk of a woman needing a hysterectomy afterward. These complications aren’t an issue with focused ultrasound.

Concerns about altering or damaging the uterus in some way also led many doctors to steer women who wanted to become pregnant away from UFE, Hesley added.

But a second study to be presented at the same meeting found that women who had it done were just as likely to conceive as those who underwent myomectomy.

Of the women who had UFE, 58 percent got pregnant, compared to 57 percent of those getting myomectomy, according to a study by researchers at St. Louis Hospital in Lisbon, Portugal.

SOURCES: Gina Hesley, M.D., assistant professor, interventional radiology, Mayo Clinic, Rochester, Minn.; John Lipman, M.D., director, interventional radiology and the Center for Image-Guided Medicine, Emory-Adventist Hospital, Atlanta;  presentation, Society of Interventional Radiology’s annual meeting, Tampa, Fla.

New chemotherapy agents for metastatic colon cancer improve patient survival but are costly, says a new study.

Researchers at Emory University in Atlanta analyzed data from 4,665 patients, aged 66 and older, diagnosed with metastatic colon cancer between 1995 and 2005. Compared to those who received older chemotherapy agents, patients who received one or more of the six chemotherapy agents approved in the United States between 1996 and 2004 lived an average of 6.8 months longer.

That increase in survival was associated with a lifetime cost increase of $37,100, which equates to $66,200 per year of life gained. After they made additional adjustments, the researchers calculated that the cost for each quality-adjusted life-year (a year of life in perfect health) gained was $99,100.

The study was published in the March 16 online edition of the journal Archives of Internal Medicine.

“New chemotherapeutic agents for colorectal cancer have been singled out as examples of high-cost/low-value medical care; no doubt they are the types of therapies that would receive close scrutiny if Medicare and other payers were to consider cost-effectiveness in coverage decisions,” wrote David H. Howard and colleagues.

“Our estimate of the cost per quality-adjusted life-year gained, $100,000, is below most estimates of the willingness to pay for a life-year. However, continuation of Medicare’s open-ended coverage policy for new chemotherapeutic agents and other expensive technologies will prove difficult to sustain as costs for the program continue to rise,” they concluded.

SOURCE: JAMA/Archives journals, news release.

Blood vessel function rapidly recuperates after smokers kick the habit, leading to a reduced risk of heart disease and heart attack, new research shows.

The study included more than 1,500 people taking part in a clinical trial to help them quit smoking. Before and one year after the participants stopped smoking, doctors used ultrasound to measure the patients’ flow-mediated dilation (FMD), a gauge of the health of the brachial artery, the main artery of the upper arm.

The ability of the brachial artery to relax is closely related to the ability of the heart arteries to relax, and predicts risk for future heart and blood vessel disease, explained the University of Wisconsin researchers.

They compared the FMD readings from patients who successfully quit with those who quit and then resumed smoking.

“Individuals who quit smoking had improved blood vessel function, even though they gained weight, which is a common side effect of smoking cessation,” study author Dr. James Stein, an associate professor of medicine at UW School of Medicine and Public Health, said in a university news release. “This confirms that quitting smoking is good for your blood vessels and reduces risk for heart attacks and cardiovascular disease.”

FMD improved by as much as 1 percent among patients who had quit smoking for a full year. That’s a significant improvement, according to Stein.

“It’s statistically significant, but more important, it’s also clinically relevant,” he said. “A 1 percent change in FMD is associated with an approximately 14 percent lower rate of cardiovascular disease events. That means patients who permanently quit smoking are less likely to have a heart attack and heart disease.”

The study was presented this week at the American College of Cardiology annual meeting in Atlanta and published simultaneously in the Journal of the American College of Cardiology.

Cardiovascular disease is the cause of about one-third of smoking-related premature deaths in the United States.

SOURCE: University of Wisconsin, news release.

A simple genetic test that helps doctors determine the best dose of the blood-thinner drug warfarin for individual patients could reduce hospitalizations by one-third during the early dose-adjustment phase, a new study has found.

The test identifies variations in two genes that strongly influence sensitivity to warfarin (Coumadin), which is used to prevent blood clots in people with high-risk conditions, such as atrial fibrillation, or after surgery to replace a heart valve.

“Genetic testing is a tool clinicians can use to more accurately predict the best warfarin dose early on,” Dr. Robert S. Epstein, chief medical officer and president of the Medco Research Institute in Franklin Lakes, N.J., said in a news release from the American College of Cardiology. “Patients may get to a stable dose more quickly and, therefore, have a lower risk of negative outcomes, such as excess bleeding or unwanted blood clotting.”

The findings were to be presented Tuesday at the college’s annual meeting in Atlanta.

The study included 896 people who, shortly after beginning warfarin therapy, gave a blood sample or cheek swab that was analyzed for expression of two genes — CYP2C9 and VKORC1 — that revealed sensitivity to warfarin. People with high sensitivity were put on a reduced dose of warfarin and had frequent blood tests. People with low sensitivity were given a higher dose of warfarin.

During the first six months that they took warfarin, those who underwent genetic testing were 31 percent less likely to be hospitalized for any reason and 29 percent less likely to be hospitalized for bleeding or thromboembolism than were a group that did not have genetic testing.

Epstein said that the cost of the genetic testing — $250 to $400 — would be justified by reduced hospitalization costs.

“If we reduce just two hospitalizations per 100 patients tested, that more than compensates for the cost of genotyping,” he said.

SOURCE: American College of Cardiology.