 Nerve-Severing Surgery Curbs Excessive Sweating: Study
TUESDAY, April 17 (HealthDay News) -- Surgery to sever the nerves that send signals to the sweat glands in the skin can help treat people who suffer from excessive sweating, called hyperhidrosis, according to new research.
People with hyperhidrosis, which affects about three percent of the world's population, or almost 197 million people, sweat three to four times the normal amount. Four areas are typically affected: the palms, the underarms, the face, and the feet.
The exact cause is not known, but it has been linked to over-activity of the nerves that send signals to the sweat glands in the skin, according to background information in the article. Treatments have included topical and oral medication, Botox injections, and iontophoresis. Surgery may be an option when these treatments prove ineffective.
This study, conducted by a team at the Barrow Neurological Institute in Phoenix, looked at the outcomes of 300 hyperhidrosis patients who had bilateral thoracoscopic sympathectomy surgery. In this minimally invasive procedure, a tiny fiber optic camera and surgical instruments are inserted through three small incisions. The surgeons identify and cut the nerves that cause the excessive sweating.
The patients in the study included 129 with excessive palm sweating, 11 with underarm sweating, and 160 with both palm and underarm sweating.
The surgery stopped palm hyperhidrosis in 99.3 percent of patients and underarm hyperhidrosis in 61 percent. Complications included: two cases of arrhythmia (irregular heartbeat); one case of postoperative depression; nine cases of postoperative pneumothorax (accumulation of air in the pleural cavity), of which five required chest tube drainage; and four cases of patients who required prophylactic chest tube drainage due to pleural adhesions.
The study also said that 16 patients experienced compensatory hyperhidrosis, where excessive sweating begins in other areas of the body, such as the chest, back or legs. Seven patients suffered Horner's syndrome, which results from inadvertent damage to nerves above those that were cut. This can lead to decreased facial sweating, eyelid drooping, and decreased pupil size on the side of the body with the nerve damage.
Six patients experienced intercostal neuralgia -- pain caused by damage to the nerves located between the ribs.
The study was to be presented Tuesday at the annual meeting of the American Association of Neurological Surgeons, in Washington, D.C.
More information
The U.S. National Library of Medicine has more about hyperhidrosis.
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 Misconceptions Linger Around Irritable Bowel Syndrome
SATURDAY, April 21 (HealthDay News) -- Irritable bowel syndrome (IBS) is a common disorder that affects 10 percent to 15 percent of people in the United States but is misunderstood by many patients and doctors, says Dr. William D. Chey, a gastroenterologist at the University of Michigan Health System.
"There are a wide spectrum of symptoms that IBS patients can experience, which can make it challenging to diagnose. While we know diet does play a role in symptoms for many patients with IBS, those 'trigger foods' often vary from person to person," Chey, director of U-M's Gastrointestinal Physiology Laboratory, said in a prepared statement.
Symptoms of IBS include cramping, abdominal pain, bloating, constipation and diarrhea. To help people with IBS gain a better understanding of the condition, Chey offered the following information about the condition:
- IBS does not exist in the patient's head. While psychological distress or stress can make IBS worse, they're not the primary cause of the condition in most cases.
- IBS occurs more frequently in women but "it's important that people know that there are many men diagnosed with IBS, and it also affects the elderly. In fact there's some early evidence to suggest that IBS affects 8 to 10 percent of older individuals," Chey said.
- Many doctors believe IBS is not an important condition because it doesn't affect a person's lifespan. But Chey said IBS can have a significant negative effect on quality of life and the ability to function on a day-to-day basis, and should be taken seriously by both doctors and patients.
- Lactose intolerance may play a role in some cases of IBS, but it's not the cause of symptoms in the vast majority of people.
- Most people with IBS don't need to limit themselves to bland diets. Chey recommended that patients keep a diary of the food they eat and IBS symptoms. "At the end of a two-week period, it's possible to get a fairly good idea about whether there are specific trigger foods associated with the onset of symptoms. Those foods then can be easily eliminated from a patient's diet," he said. Chey noted that fatty foods, milk products, chocolate, alcohol, caffeine and carbonated drinks are more likely to aggravate IBS symptoms.
- It doesn't require a lot of medical testing to diagnose IBS. "Identifying the presence of persistent recurrent abdominal pain in association with altered bowel habits, and excluding warning signs (e.g. new symptoms occurring after age 50, GI bleeding, unexplained weight loss, nocturnal diarrhea, severe or progressively worse symptoms or a family history of colon cancer, inflammatory bowel disease, colon cancer or celiac disease), is enough to accurately diagnose IBS in most patients," Chey said.
- Effective counseling, dietary and lifestyle changes, and medication can help patients effectively manage IBS.
More information
The American Medical Association has more about IBS .
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 Researchers Test Treatments for Painful Mouth Ulcers
FRIDAY, April 20 (HealthDay News) -- The drug pentoxifylline offers only limited benefit for treating one form of mouth ulcers, while a cream commonly used to treat eczema appears effective in treating another kind, according to two studies published in the April issue of the journal Archives of Dermatology.
In the first study, British researchers at the University of Sheffield found that pentoxifylline provided limited benefit to patients with mouth ulcers due to recurrent aphthous stomatitis, which is characterized by recurring mouth ulcers in otherwise healthy people. The condition affects about 20 percent of the population.
The 60-day study included 26 people, average age 33, who took either one 400-milligram tablet of pentoxifylline three times a day or three placebo pills per day.
"Patients taking pentoxifylline had less pain and reported smaller and fewer ulcers compared with baseline," the study authors wrote. "Patients taking placebo reported no improvement in these variables. Patients taking pentoxifylline also reported more ulcer-free days than those taking placebo. However, the differences were small and, with the exception of median ulcer size, did not reach statistical significance."
Sixty days after they stopped taking the drug, all patients reported ulcers similar to those they had before the start of the trial. Dizziness, headaches, stomach upset, and increased heart rate were among the side effects reported by those who took the drug.
"Pentoxifylline did not prevent the ulcer episodes from occurring or result in a long-term cure. Thus, given the potential for significant adverse effects and the small benefits of the drug demonstrated in this clinical trial, we cannot recommend pentoxifylline as the drug of first choice for treatment of recurrent aphthous stomatitis, although it may have a second-line role in the management of patients unresponsive to other treatments or as an adjunct to other treatments," the researchers concluded.
The second study found that one percent pimecrolimus cream was effective against oral erosive lichen planus, a severe inflammatory condition that causes painful mouth ulcers. People with the condition, which affects about one percent of the population, may even lose weight because of the mouth pain they experience when eating.
The study, by French researchers at the University of Nice, included six patients who applied pimecrolimus cream on mouth sores twice a day for four weeks and six patients who applied a placebo cream without any active ingredient.
The patients were assessed at the start of the study and again at 14 and 28 days. After 28 days, the average clinical score in the pimecrolimus group decreased from 6.83 to 3.33 and from 4.67 to 3.33 in the placebo group. There were few side effects in either group.
"In the pimecrolimus group, all the patients but one reported a moderate to important improvement of their symptoms and were satisfied by the treatment. This improvement was observed from the first week of treatment, usually within the first two days, and most notably, patients reported less pain when eating," the study authors wrote.
However, all the patients who improved during the study had a relapse within a month after treatment.
Larger studies are needed to better evaluate the safety and efficacy of pimecrolimus cream compared to other treatments, the authors wrote.
More information
The MedlinePlus Medical Encyclopedia has more about mouth ulcers.
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 Multiple Sclerosis Drug Combats Vision Loss
TUESDAY, April 17 (HealthDay News) -- A controversial multiple sclerosis drug called Tysabri also reduces vision loss associated with the disease by 47 percent, a new study found.
"Vision loss is probably one of the most disabling things that happens to people with MS," said lead researcher Dr. Laura J. Balcer, an associate professor of neurology at the University of Pennsylvania School of Medicine. "The exciting thing is, first, that we now have an eye-chart test that can pick that up and can show if treatments help vision. Second, this particular drug appears to help prevent vision loss."
In the study, Balcer's group looked at the results of two trials -- called AFFIRM and SENTINEL -- that included 2,138 people with relapsing MS. More than half the patients received Tysabri (generic name natalizumab) every four weeks for two years.
To evaluate eyesight, the researchers used a specially developed eye chart of low contrast letters. They found vision loss was reduced by as much as 47 percent among the people taking Tysabri, compared with those taking a placebo.
"Vision is one more dimension of MS that the drug helps," Balcer said. "It has already been shown that the drug reduces the rates of relapses and disability."
Balcer thinks that other MS drugs may have similar effects on vision, and there is now a test that can be included in trials to evaluate this. "Now, we can get to see how these other medications may help vision," she said.
The findings are published in the April 17 issue of the journal Neurology.
Tysabri's history has been marked by some controversy.
It received U.S. Food and Drug Administration approval in November 2004, only to be pulled from the market three months later after several patients in clinical trials developed a rare but deadly viral infection of the brain called progressive multifocal leukoencephalopathy. In June 2006, the FDA allowed the drug to return to the mart, but with strict conditions. According to the new guidelines, Tysabri can only be administered by approved doctors, infusion sites and pharmacies that register and comply with a patient-safety program designed by Biogen-IDEC, the maker of Tysabri, and approved by the FDA.
One expert thinks that despite the vision benefit, Tysabri should be reserved for patients with aggressive MS or those who failed other medications.
"This study confirms the benefits of this particular MS drug in relapsing MS patients," said Dr. Anne H. Cross, a professor of neurology at Washington University School of Medicine, in St. Louis. "In addition, it validates the use of a new vision test which is relevant to MS."
But the benefit to vision doesn't negate the risks associated with the drug, Cross said. "I don't think I will change my prescribing habits based upon this paper," she said. "I will probably continue to use it in the same type of patients I have been using it in in the past."
However, Nicholas LaRocca, the director of health care delivery and policy research at the National Multiple Sclerosis Society, said the new study provides additional insight into the benefits of the drug and may influence the decision whether to start using it or not.
"For patients who are on natalizumab or considering natalizumab, this gives them another piece of information to consider as they are trying to make their decision," he said.
According to the U.S. National Institutes of Health, multiple sclerosis is an unpredictable disease of the central nervous system that can range from relatively benign to somewhat disabling to devastating, as communication between the brain and other parts of the body is disrupted. Many researchers believe MS to be an autoimmune disease -- one in which the body, through its immune system, launches a defensive attack against its own tissues. In the case of MS, it is the nerve-insulating myelin that comes under assault.
More information
The National Multiple Sclerosis Society can tell you more about multiple sclerosis .
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