By Phil Galewitz, The Palm Beach Post, Fla.

May 1–Here’s one way for a hospital to overcome the shortage of brain surgeons, particularly those willing to handle emergencies: Hire them and make them millionaires.

That’s what Martin Memorial Medical Center is doing.

The nonprofit Stuart hospital pays each of its two neurosurgeons $1 million a year, making them by far the institution’s highest-paid employees, according to its latest tax return.

The salaries are a reflection of the difficulty hospitals in Palm Beach County and the Treasure Coast have in finding neurosurgeons, particularly those willing to take emergency patients, local health officials say.

Drs. John Afshar and John Robinson Jr. have worked exclusively as neurosurgeons at Martin Memorial for about 10 years. The hospital also covers their medical malpractice insurance premiums, which can exceed $150,000 a year.

Dr. Lloyd Zucker, a Delray Beach neurosurgeon, said $1 million is on the high end of compensation for his profession. But, “I think the market will bear what the market will bear,” he said when asked if the pay is reasonable.

When Zucker’s group tried to recruit a neurosurgeon last year, “you could not touch somebody for less than $400,000,” he said. Job candidates wanted malpractice insurance covered and a car allowance. And those prospects were fresh out of training.

Martin Memorial makes no apologies for the seemingly high salaries. CEO Richmond Harman, who receives a $439,000 annual salary according to the hospital’s latest tax return, for 2004, says the doctors are worth every penny. “They totally deserve it,” he said. “These guys are extremely busy.”

The two doctors performed 368 surgeries in the 12 months ended July 2005, with Ashfar handling 188 cases and Robinson doing 180, according to state data compiled by Intellimed International. Together, the doctors rang up nearly $20 million in billing charges for the hospital. (Few patients pay actual charges because insurers get discounts as much as 50 percent to 60 percent.) The doctors, who both declined requests to be interviewed for this story, are well-paid by nearly any measure. Last year, the median compensation for a neurosurgeon was $542,894 nationally and $704,957 in the Southern United States, according to the Medical Group Management Association.

Most brain surgeons don’t start working until they are at least 34 years old because they have to go to college for four years, medical school for another four, complete an internship for one year and then do a five-year residency training program. Some then do a one- or two-year fellowship.

Afshar and Robinson are two of only four neurosurgeons working in Martin and St. Lucie counties. The other two do surgery at St. Lucie Medical Center in Port St. Lucie and Lawnwood Regional Medical Center & Heart Institute in Fort Pierce, but are not employed by those hospitals.

Employing its own is just one way Martin Memorial ensures it has a neurosurgeon on call.

The hospital also coordinates its emergency call system with the two St. Lucie County hospitals so there is a better chance at least one neurosurgeon is on call each night. Because the neurosurgeons typically are on call seven days out of every month, there are only two or three days a month when a neurosurgeon is not available for emergencies.

Those days patients often get sent to hospitals in Palm Beach County, where a task force of doctors, hospital administrators and the county health district is trying to form a regional call system for neurosurgery and several other specialties where doctors shun ER work.

It plans to seek state and federal approval for any proposed system to be sure to be clear of any antitrust issues.

Lawnwood spokeswoman Beth Williams said the Treasure Coast hospitals were not worried about being accused of violating antitrust laws.

Finding neurosurgeons to cover emergencies has become increasingly difficult because the doctors are trying to reduce their liability because of increased medical malpractice insurance costs.

Additionally, most doctors don’t like to work as hospital employees because they believe they can make more money on their own and don’t want to have a boss.

Afshar, half of Martin Memorial’s neurosurgery duo, graduated from Georgetown University Medical School in 1987 and did his residency at its Washington hospital until 1995.

Robinson graduated from the University of South Florida Medical School in 1988. He completed his residency training at the Cleveland Clinic in 1994, then did a one-year fellowship at Allegheny General Hospital in Pittsburgh. He followed that with a one-year fellowship.

—–

To see more of The Palm Beach Post — including its homes, jobs, cars and other classified listings — or to subscribe to the newspaper, go to http://www.palmbeachpost.com.

Copyright (c) 2006, The Palm Beach Post, Fla.

Distributed by Knight Ridder/Tribune Business News.

For information on republishing this content, contact us at (800) 661-2511 (U.S.), (213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail [email protected].

By Julia Reynolds, The Monterey County Herald, Calif.

May 01–A federal judge in Sacramento has ordered the construction of a multimillion-dollar mental health hospital inside Salinas Valley State Prison, while insisting that officials also add beds immediately to the prison’s psychiatric treatment programs.

U.S. District Court Judge Lawrence Karlton approved plans last week to build a $111 million mental health care hospital inside the walls of the prison, bringing with it jobs for doctors and health workers in Salinas Valley.

The long-range expansion plan should bring the Salinas Valley an infusion of money and jobs. Prison activists also hope the project will alleviate a decade of treatment delays for California’s 31,000 mentally ill prisoners.

Karlton, who first ordered an overhaul of prison psychiatric care 11 years ago, indicated last week that delays from the California Department of Corrections and Rehabilitation have gone on too long.

The cost of delays is not just numbers, but human life, said attorney Michael Bien, who represents mentally ill inmates in an ongoing class-action suit that began in 1990.

“People are dying because there are not enough beds,” Bien said.

Lack of crisis beds|

Documents and evidence submitted to the federal court last week described one 60-year-old man diagnosed as acutely psychotic, who had been in and out of prison on charges related to his alcoholism.

Speaking after the hearing, Bien referred to the man as Wayne, declining to give a last name.

Wayne had attempted suicide in prison more than once, according to documents submitted to the court. In and out of prison for years, Wayne was sent back inside on Nov. 17, 2005, on a psychiatric parole revocation. At Deuel Vocational Institution in Tracy, he was put on suicide watch in the prison’s Outpatient Housing Unit — what used to be called the infirmary.

“But they couldn’t get him a crisis bed,” Bien said. “There are 200 people referred to crisis beds and waiting.”

Wayne was put under suicide watch on Nov. 29. A real-time video monitor and correctional officer were assigned to keep an eye on him at all times.

“The cell had no toilet or sink, only a hole in the floor,” Bien said. “No mattress or blanket. He was only wearing what’s called a suicide smock. They found him dead in his cell at 6:45 a.m. on Nov. 30, 2005. The smock was wrapped around his neck.”

The court documents state that footage from the time of Wayne’s death is missing from the videotape provided by the prison.

In another case submitted to the court, a 28-year-old, whom Bien called Joshua, was in the OHU at San Quentin State Prison on Nov. 20, 2005.

In what Bien described as an agonizing segment of videotape, Joshua, stripped naked in his cell, is banging his head on the wall and gouging his eyes for more than an hour with no intervention from guards.

Surgeons at Marin General Hospital later tried to save Joshua’s vision, but could not.

“I don’t necessarily blame the officers,” Bien said. “He should have been in a medical facility. He was supposed to have treatment. He should have been in a crisis bed.”

Terry Thornton, spokeswoman for the California Department of Corrections and Rehabilitation, said Friday she was unfamiliar with the cases of Wayne and Joshua, but said because they are presumably under investigation, she would not be able to comment.

At the two-day hearing last week, Judge Karlton told Salinas Valley and several other prisons they must add more mental health beds right away.

Years of indifference|

Part of a plan to invest nearly $600 million in overhauling prison mental health care, the orders came 11 years after Karlton first called California’s treatment of mentally ill inmates “cruel and unusual.” He said the prison system must end its “deliberate indifference” and issued orders to improve inmate mental health programs statewide.

At least 20 percent of the state’s 169,000 inmates have diagnosed mental illnesses, Thornton said.

Salinas Valley already has a well-regarded 64-bed hospital run by the state’s Department of Mental Health that focuses on giving intermediate mental health care to maximum-security inmates.

There are 123 additional prisoners on a waiting list for those beds, according to court documents.

To handle its most urgent needs, Salinas Valley is in the process of converting regular inmate housing into 36 intermediate-care beds by summer.

But Karlton said last week that is not enough, and another 36 beds must be converted “within six to nine months,” according to Bien.

New facilities by 2011|

While the court indicated serious problems in delivering proper care in the short term, all sides appear to be in agreement about long-range plans.

The Department of Corrections and Rehabilitation’s Thornton was enthusiastic about plans that include building and staffing two new hospital facilities at Salinas Valley by 2011.

“We’ll be making every effort to hire local residents for those jobs,” Thornton said. She said she didn’t know yet how many new jobs will be created by the project, which will be phased in over five years.

The new facilities will eventually provide more than 200 new mental health beds at the prison. While the number may sound low given the tens of thousands of mentally ill prisoners in the system today, the majority of inmates requiring treatment are what’s called Triple CMS, a group that requires only medication and counseling. Triple CMS patients usually live within the general prison population.

But the most critical need is for beds for Level IV, high-security inmates with serious mental problems, and Salinas Valley is the only prison focused on serving those patients.

A study last year found more than 400 undiagnosed prisoners who had an urgent need for immediate mental health treatment, a finding that Thornton acknowledges took the department by surprise. Half of those were Level IV inmates.

Desirable area|

Thornton said Salinas Valley, which sits just north of Soledad, offers the ideal location for the state’s maximum-security inpatient hospital.

“In Salinas Valley, they already have a facility. They have licenses. And the employees have training and superior experience in providing mental health care,” she said.

Despite its high cost of living, Monterey County is also a desirable place to live, and the department hopes that will attract top doctors and psychiatric workers.

It’s an important factor, considering that a brand-new mental health facility built to treat sex offenders in Coalinga has had serious hiring problems. Planners apparently didn’t realize that professionals just weren’t attracted to the idea of living in that remote corner of Fresno County, and the facility designed to hold 1,500 houses only a smattering of patients today.

When Thornton recently visited the Salinas Valley mental health unit, she said Department of Mental Health workers there were “extremely proud” of the facility and the treatment offered.

Requests by The Herald to tour the facility went unanswered, and a prison spokesman could not be reached for comment Friday.

Frustration in short term|

Bien said that while he is basically pleased with the long-range plans ultimately carved out by both parties in the case, he is frustrated by delays in providing better mental health care now.

Thornton said the department also feels some of that frustration, saying there are forces pushing and pulling at the Department of Corrections and Rehabilitation that slow its progress. Among those are demands imposed by other court orders, legislators, and the powerful guards’ union, all factors admittedly made more difficult by poor planning years ago.

Finally, there is the severe overcrowding that Thornton said is “near crisis level,” as the system creeps perilously toward its maximum-capacity level of 172,000 inmates this year.

Yet in the last year, she said, there have been unsung efforts deep within the department to bring about real change.

Since July, meetings to reorganize the troubled organization have been held at the department’s headquarters in Sacramento. Some of the plans developed since then will unfold in coming months, said adult facilities director John Dovey, who added he and others spent “many 12-hour days” in the effort.

Thornton said she is satisfied that her department has been complying with Karlton’s orders and will continue to do so.

“I think we’ve made significant progress,” Thornton said. “They’re complex issues and they take time.”

montereyherald.com.

————

Mental health patients in Salinas Valley State Prison — Basic Outpatient Care:Diagnosed: 1,309; Capacity: 999; Percent over capacity: 31% (In general population treated with counseling and medication.) — Intermediate Care PatientsDiagnosed: 187; Capacity: 64; Percent over capacity: 190% (Intermediate care beds for maximum security inmates, with licensed mental health staff.) — Sources: California Department of Corrections and Rehabilitation, April 6, 2006; Coleman v. Schwarzenegger filings

Julia Reynolds can be reached at 648-1187 or jreynolds@

—–

Copyright (c) 2006, The Monterey County Herald, Calif.

Distributed by Knight Ridder/Tribune Business News.

For information on republishing this content, contact us at (800) 661-2511 (U.S.), (213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail [email protected].

NEW YORK (Reuters Health) – Even when they make it to the
emergency room alive, car crash victims who weren’t wearing
seatbelts are far more likely than belt users to die, study
findings show.

Researchers found that among nearly 24,000 car accident
patients who were brought to the ER, those who weren’t wearing
a seatbelt during the crash were three times more likely to die
in the hospital.

In fact, unbelted crash victims accounted for more than
two-thirds of patients who died in the ER, according to Shane
Allen and colleagues at the Medical College of Wisconsin in
Milwaukee.

In addition, the researchers found, unbelted drivers and
passengers were nearly three times more likely than belt users
to require admission to the hospital for further treatment.
Only 20 percent of unbelted patients could be successfully
treated in the ER alone.

The findings, published in the journal Academic Emergency
Medicine, come from data on 23,920 Wisconsin residents who were
treated in the ER for car accident injuries in 2002.

Almost 5,300 of these crash victims were not wearing a
seatbelt at the time of the wreck. They were more likely than
belt users to be male, or to have been drinking before the
accident.

Besides their higher fatality rate, unbelted car occupants
were at greater risk of suffering severe injuries to the head,
spine, abdomen and other body regions.

The findings, say the researchers, argue for tougher
seatbelt laws.

As of 2005, they note, only 21 U.S. states had what are
known as primary-enforcement seatbelt laws – meaning police can
pull drivers over for seatbelt violations alone. In other
states, drivers can only be cited when they are stopped for a
separate violation.

According to Allen’s team, research shows that when
jurisdictions move to primary enforcement, seatbelt use climbs
as much as 15 percent, and car crash injuries and deaths
decline.

SOURCE: Academic Emergency Medicine, online March 10, 2006.

NEW YORK (Reuters Health) – People who work rotating night
shifts appear to have a lower risk of Parkinson’s disease, the
results of a study published in the American Journal of
Epidemiology indicate. Conversely, an increased risk of
developing this condition is linked to a longer average
duration of sleep.

“Working rotating night shifts disrupts circadian rhythms
and may have a wide range of physiologic, psychological and
social effects on shift workers,” Dr. Honglei Chen, of the
National Institutes of Health, Research Triangle Park, North
Carolina, and colleagues write.

“In previous studies, shift work has been linked to higher
risks of some chronic diseases, including cardiovascular
disease and certain types of cancers,” they note, but any
effect on the risk of developing Parkinson’s disease has not
been investigated.

The researchers therefore evaluated data from the U.S.
Nurses’ Health Study, which enrolled 84,794 female nurses, to
see if there was an association between working rotating night
shifts and Parkinson’s disease risk.

Nurses who reported at least 15 years of night shift work
were older and more likely to be current smokers and users of
nonsteroidal antiinflammatory drugs (NSAID), such as ibuprofen
or naproxen, compared with those who never worked rotating
night shifts.

Night shift workers also tended to drink more coffee but
less alcohol and to have a higher body mass index. Women who
worked night shifts slept slightly less than non-night shift
workers.

A total of 181 cases of Parkinson’s disease were reported
between1988 and 2000. The risk of Parkinson’s disease was
50-percent lower among women who had at least 15 years of night
shift work compared with those who never worked rotating night
shifts.

After accounting for differences in age and smoking status,
the investigators found that a longer sleep duration was
associated with a higher risk of Parkinson’s disease. Compared
with nurses who slept no more than 6 hours per day, those who
slept 9 or more hours per day had a 84-percent increased risk.

Plausible biologic explanations for these results are
lacking, Chen’s team points out. They note that shift work has
been associated with modest increases in blood levels of
estradiol and uric acid, “both of which may be protective
against Parkinson’s disease.”

Conversely, they suggest that the data could be interpreted
as showing that a “low tolerance for night shift work is an
early marker of Parkinson’s disease.”

SOURCE: American Journal of Epidemiology, April 2006.

Osiris Therapeutics, Inc. announced today that it has completed enrollment in the first human clinical trial of a stem cell therapy to repair tissue in the knee. A total of 55 patients were treated in the Phase I/II double blinded, placebo-controlled trial designed to evaluate the safety and effectiveness of Chondrogen(TM), a preparation of adult stem cells formulated for direct injection into the knee.

“Over the past 15 years, there has been much laboratory research demonstrating the ability of these stem cells to regenerate orthopedic tissues. It is gratifying to now be able to move the science from the laboratory into the clinic, where the cells can be fully evaluated in humans,” said lead investigator C. Thomas Vangsness, MD, Professor of Orthopedic Surgery at University of Southern California’s Keck School of Medicine and Chief of Sports Medicine at University Hospital.

In the U.S. alone, approximately 800,000 people each year have surgery to remove damaged or torn meniscus, a cartilage-like tissue in the knee that acts as a shock absorber. While the surgery often relieves the pain associated with a torn meniscus, patients who have this surgery are at a much greater risk for developing arthritis. Chondrogen is being studied as a treatment to regenerate meniscus in these patients.

“This study is the third clinical trial for which we have completed enrollment this year. I am pleased with the continued progress we are making and am grateful to all of the members of the Osiris team for their performance,” said C. Randal Mills, Ph.D., President and CEO of Osiris. “I would especially like to thank the patients participating in this trial, as well as our other clinical trials. It is their willingness to participate that contributes to advancements in medicine.”

The Chondrogen trial is one of five Osiris stem cell clinical trials currently active in the U.S. The company also has two ongoing Phase II trials for Graft vs. Host Disease, a life threatening complication of bone marrow transplantation, a Phase II trial for Crohn’s Disease, and a Phase I trial for the repair of heart tissue following a heart attack.

“We appreciate the hard work of the investigators and coordinators at our clinical sites and we look forward to continuing to work together to complete a high quality study,” said Michelle LeRoux Williams, Ph.D., Program Director for Chondrogen. Dr. Williams leads the team at Osiris, which has been working with FDA to move Chondrogen into human clinical trials. “Treating patients with an investigational drug in a clinical trial is a tremendous responsibility that everyone at Osiris takes very seriously.”

Osiris received clearance from FDA in 2005 to begin the first clinical trial of Chondrogen. In the study, patients were either given an injection of stem cells or placebo one week after their knee surgery. Neither the patients nor the surgeons will know what was given for the duration of the study. The study was designed to assess the safety of the Osiris stem cell and to gain preliminary efficacy data on the extent of tissue regeneration using magnetic resonance imaging, or MRI. Overall changes in the joint, as well as the patients’ perception of pain and quality of life will be tracked.

“There is currently no treatment available to regenerate a damaged meniscus. The only option for these patients is to remove the damaged tissue,” said Joel Boyd, MD, an orthopedic surgeon at TRIA Orthopaedic Research Institute in Minneapolis, Minnesota, and a United States Olympic Team physician. “The ability to give patients a simple injection into the knee that could restore the meniscus and prevent the inevitable progression to osteoarthritis would be a significant advancement in the treatment of knee pain.”

About Osiris Therapeutics

Osiris(R) Therapeutics, Inc. is a leader in adult stem cell therapy. The stem cells produced by Osiris are obtained from adult volunteer donors, avoiding the technical problems and controversy surrounding other stem cell technologies. Using proprietary methods, these cells are grown in culture to very high numbers, allowing a single donor’s cells to treat thousands of patients. These cells have been used in patients unrelated to the donor, without rejection, eliminating the need for donor matching and recipient immune suppression. Once transplanted, the cells have been shown to promote healing of damaged or diseased tissues.

The Company’s current focus includes the use of adult stem cells to improve outcomes in bone marrow recipients being treated for cancer, to treat Crohn’s Disease, to repair damage following a heart attack and prevent congestive heart failure, and to prevent and treat arthritis.

By By Judy Newman 608-252-6156, The Wisconsin State Journal

Apr. 22–You’ve probably heard the commercials and seen the ads: Healthy, nonsmoking men and women — participate in a “research study” and earn $2,200.

It’s a call for arms from Covance, one of the world’s largest drug-testing companies and one of Madison’s biggest employers. The arms they’re looking for they will prick and poke in one of hundreds of drug trials Covance conducts each year, many of them at the company’s growing campus on the East Side.

Covance is what the pharmaceutical industry calls a contract research organization, or CRO. It coordinates and collects data from early tests of drug candidates on humans and animals, records any side effects and reports the results to its customers, who range from the world’s biggest pharmaceutical companies to new academic spinoffs.

Madison is one of three sites where the human drug trials are conducted; the others are Evansville, Ind., and Leeds, England.

Overseeing those clinical research units and their 440 employees is Mary Westrick, a native of suburban Chicago (La Grange Park, Ill.) with a doctorate in pharmacology from Purdue University.

“I start where the people come in,” says Westrick, 50, global vice president and general manager of clinical pharmacology.

On a recent day at the company’s two-year-old clinical research center, several drug-test volunteers hung out in the roomy lounges, watching a wide-screen television or Web surfing at a bank of computers.

Others were sprawled on the beds of their neat, boxy rooms — four beds to a room, equipped with desks, a TV and VCR — where study technicians were taking a sample of their blood.

There’s one locked bathroom for each two rooms. Volunteers get a key and a cup from staffers; urine is collected and poured into communal jugs for tests.

Covance’s big campus near the Dane County Regional Airport already employs 1,360 (of 7,300 worldwide). Now, Covance is wrapping up a $57 million expansion that could add more than 100 jobs over the next few years.

Q: Readers may imagine Covance as a dingy place where people go if they are down on their luck. But your new clinic is bright and sunny and looks a little like a college dormitory. And the food is provided by upscale caterer Kitchen Hearth.

A: And they don’t just get food, they get the FDA (U.S. Food & Drug Administration)-mandated high-fat diet. For breakfast, that’s two eggs fried in butter, 4 ounces of hash browns, 8 ounces of whole milk, two strips of bacon and toast with butter.

Blood tests check to see how much of the drugs have been absorbed by the body. Some drugs dissolve in fat while others dissolve in water.

Q: Who are the participants?

A: The average age of volunteers is in the late 20s, and two-thirds of them are male. A lot of folks are in entry-level jobs; a lot are under-employed, working in two or three part-time jobs. We (also) get authors (and) self-employed people. We probably dose about 1,000 volunteers a year (at the three sites).

Q: The ads list tests that range from $2,200 for a five-day stay to $5,500 to two stays of up to 11 days each plus an outpatient visit.

A: We pay a standard day rate of $150 to $200. People do our trials, obviously, for money, but there usually is an altruistic component — they have a sister with (a disease, or) their mother died of multiple sclerosis. They’d like to contribute.

Q: How hard is it to get into a study?

A: It’s not as easy as you think — you’ve got to prove you’re healthy. Young men, if they’re very heavily muscled, may be over the weight limit. We do a full panel of laboratory tests, from electrolytes to blood sugar, a full physical exam, electrocardiogram and more. If you have a history of asthma — sometimes even hay fever — it can knock you out (of a test). No smoking, no alcohol or drugs. You can’t even take acetaminophen within a week of coming here. The caffeine restriction is usually 48 hours, and you can’t have chocolate, either.

Q: How often are blood samples taken?

A: The standard is 14 blood samples in the first 24 hours. It’s not as bad as it sounds. We’ve got the best phlebotomists (personnel who draw blood samples). . . . Our goal is to go in the same hole all the time so when you come out of here, you don’t have all these sticks (marks).

Q: Do you ever find health problems that people didn’t know about?

A: We found a young lady, 23 years old, with type-1 diabetes. She had no clue. We found a man with an abdominal aortic aneurysm — we got him into surgery within a day.

Q: Isn’t it potentially dangerous to take a drug that has not been prescribed and that you know nothing about?

A: There’s always the risk of the unknown. Our informed-consent form says you’re one of the first to take this drug. We test a range of products, for osteoporosis, migraines, new antibiotics, HIV drugs. But the drugs are not as toxic as levels were years ago. Volunteers may only take a single dose that usually clears out of their system in three to five days.

(A drug test conducted in England in March by Parexel International Corp., Waltham, Mass., left six volunteers seriously ill. Westrick says Covance’s Madison operation has had no such problem. “We’ve called 911 a couple of times, but it was always for our staff,” she says.)

Q: Do you also conduct food testing here?

A: Yes, one day you might see them testing apples for pesticide residue; the next day you may see them slicing up a Big Mac and analyzing the fat and carbohydrate content. They test dog food. They test products covered in plastic wrap to make sure there’s no residue coming off the food.

Q: What drew you to the field?

A: Our tag line is: “Bringing miracles of medicine to market sooner,” and I really believe that. I have two brothers and a nephew with type-1 diabetes, a sister with multiple sclerosis and a sister with fibromyalgia. My father is about to start dialysis. I see up close and personal what they need. They’re more productive, for longer, (thanks to drugs).

Even if every drug didn’t make it to market, I would know I kept a lot of bad drugs off the market.

Mary Westrick Global vice president and general manager of clinical pharmacology at Covance

Company headquarters: Princeton, N.J.

Annual revenue: $1.2 billion

Industry: Drug development services

Employees: 1,360 in Madison; 7,300 worldwide

Established: 1987 as a unit of Corning

Madison operations: 3402 Kinsman Blvd. — 31 acres near the Dane County Regional Airport with more than 500,000 square feet of laboratory and office space, including three building expansions and additions in the last four years

Animal rights advocates protest Arizona land buy

Covance has been under fire in the Phoenix area after buying land in the suburb of Chandler.

Animal-rights activists have staged protests over the past few months in an effort to keep the New Jersey company from building laboratories that would conduct animal tests. And musician Paul McCartney sent a letter to the governor of Arizona saying he does not want Covance to set up an animal testing lab in the state where he owns a ranch.

“Arizona has a special place in my heart,” McCartney wrote to Gov. Janet Napolitano, because it is where his first wife, Linda Eastman, spent her last days before dying of breast cancer in 1998.

Susan LaBelle, Covance vice president of global marketing in Madison, said plans have not yet been finalized for the Chandler site.

“Covance conducts government-required medical research to find medicines for diseases like breast cancer, diabetes, heart disease, Alzheimer’s and many others,” LaBelle said. “This is the kind of life-saving research we hope to do at our proposed facility in Arizona, which ultimately benefits people like Mr. McCartney, his family, his friends and his fans around the world.”

In late March, the company said an extensive review by the U.S. Department of Agriculture of several hundred allegations by PETA (People for the Ethical Treatment of Animals) of animal mistreatment at Covance’s Vienna, Va., labs resulted in 16 citations. They ranged from “administrative issues to scope of veterinary authority,” Covance said. The company agreed to a settlement of $8,720, although it disagreed with some of the citations.

In other Covance news, the company announced last week that it will buy eight testing sites from Radiant Research, a Bellevue, Wash., drug-testing company, for $65 million.

—–

Copyright (c) 2006, The Wisconsin State Journal

Distributed by Knight Ridder/Tribune Business News.

For information on republishing this content, contact us at (800) 661-2511 (U.S.), (213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail [email protected].

NYSE:CVD, NASDAQ-NMS:PRXL,

NEW YORK (Reuters Health) – Early weaning from breast-feeding appears to be one factor that predisposes adults to alcohol abuse and hospitalization for an alcohol-related diagnosis, according to data from Denmark.

Previous research demonstrated a link between short duration of breast-feeding and alcoholism in men. Dr. Holger J. Sorenson and colleagues at Copenhagen University and the US examined this relationship in a larger population sample that included women and took into account other environmental and familial factors.

The Copenhagen Perinatal Cohort includes 3245 men and 3317 women born between 1959 and 1961. Thirty-four percent of these participants had been breast-fed for no more than a month, according to the team’s report in the American Journal of Psychiatry.

After follow-up through 1999, the researchers found that 98 men and 40 women were hospitalized with an alcohol-related diagnosis. Of the 138 cases, 63 were weaned by 1 month and 75 were breast-fed for longer periods. The researchers calculate from these numbers that early weaning increased the likelihood of alcoholism by 65 percent.

The investigators report that other factors linked to an increased risk of alcoholism were “male gender, maternal prenatal smoking, unwanted pregnancy (at the time of conception), maternal psychiatric hospitalization for alcohol abuse, maternal psychiatric hospitalization with other diagnoses, and low parental social status when the child was 1 year old.”

However, after taking all these factors into account, there was still an increased likelihood of alcohol abuse associated with early weaning.

Sorenson’s group proposes several explanations for the link. For example, decreased physical and psychological contact between the mother and the infant may increase the risk of alcoholism. Another possibility is that a decreased intake of long-chain polyunsaturated fatty acids contained in breast milk could affect brain development.

SOURCE: American Journal of Psychiatry, April 2006.

SHANGHAI — When Lao Li was a boy, sex was never discussed at home or school.

Little wonder, then, a visit to Shanghai’s Sex Culture Museum with its exhibits of 1,000-year-old dildos and Ming dynasty pornographic porcelain stunned him.

“It’s the first time I’ve seen anything like this,” said 30-something Li. “This should be taught at secondary school. Not even my parents taught me about sex.”

In pre-communist China, sex was less a taboo than it became under former leader Mao Zedong, whose own highly active — and disease-ridden — love life was chronicled by his doctor in a book banned in China.

Under Mao, sex was officially a matter of doing one’s reproductive duty for the state. He wanted a new labor force to build a new country and the state encouraged high birth rates.

Since then, the government has embarked upon a stern family planning policy to control a booming population — the world’s largest — but official attitudes toward sex remain puritan, though they are changing slowly.

They need to change faster, health experts say.

There has been a huge rise in pre-marital and teenage sex. According to state media, 70 percent of urban youth admitted to having premarital sex in 2004, up from just 15 percent in 1989.

HIV/AIDS in China is now increasingly spreading via sexual transmission, which risks exacerbating a problem that already afflicts an estimated 650,000 Chinese.

Ignorance and fear are widespread.

State media has said that some 70 percent of unmarried male migrant workers do not use condoms, and of the 6 million commercial sex workers in China, only a fifth or so use protection.

“Sixty percent of young people in China think you can get HIV by sharing chopsticks with someone,” lamented Ken Legins, head of UNICEF’s HIV/AIDS program in the country.

SEXUAL MISSION

But Liu Dalin, a retired sociology lecturer from Shanghai’s prestigious Fudan University and the curator of the city’s sex museum, has made it his mission to educate.

“Making love shows you have culture,” the sexagenarian Liu told Reuters. “People have two natures, one like an animal and the other cultural — animals have no culture.

“If you don’t teach, then people are just like animals, but if you teach then they can have culture,” he said.

“But right now sex education is a serious problem here. Even in the old days, mothers would teach daughters.”

Liu’s crusade has been a long-term ambition, yet progress has been slow.

Although he gives sex education classes in universities, Liu has yet to be allowed into schools. One Shanghai secondary school that had considered taking students to Liu’s museum decided against it after a few teachers went for a preview.

“Some of the exhibits were actually quite enlightening,” the head teacher was quoted as saying in the official China Daily, but she thought certain exhibits inappropriate for teenagers.

“People should really be learning about sex from day dot,” said Liu. “Young children need to understand that sex is a very natural and frequent activity — natural, healthy, scientific. Eating is the most natural activity, and next is sex.”

But Liu is no free-love Chinese hippie. For him, sex is best suited to marriage, or at least to monogamy, and to people over the age of 20.

“You shouldn’t pluck an apple before it is ripe, or else it tastes bad,” he said.

WHORE OF THE ORIENT

Liu’s home city of Shanghai was known in the 1920s and 1930s as the “Whore of the Orient” for its boisterous, “anything goes” brothels and lascivious night life, a past it is today slowly rediscovering as people throw off the Maoist straitjacket.

But many agree with Liu that education needs to be improved.

Organizers of a recent HIV/AIDS forum in Beijing showed a video in which a China Family Planning Association official admitted that in 27 years of working in the field, she still found it hard to talk about sex.

University student Xiao Song said her parents never taught her about sex. She said she and her classmates watched a Japanese video about sex at school aged 12, but they were given no opportunity to ask questions afterwards.

“China needs to work on the widespread misunderstanding of sex, the lack of teaching materials and on the negative approach to youngsters involved in sexual activity,” said Song.

Not all Chinese grow up with sex as a taboo. In the matriarchal Mosuo tribe in southwest China’s Yunnan province, women traditionally move into their own house — and choose between their suitors — from the age of 13.

“When you take in a man, you spend a night with him and, if he performs well, you keep one of his gifts inside the house so that he knows he can return,” said Yang Erche Namu, a Mosuo who has won fame in China as a pop star, model and writer.

MANHASSET, N.Y., April 20 /PRNewswire/ — Seeking to become a worldwide destination for patients with brain disorders, the North Shore-Long Island Jewish (LIJ) Health System today announced the establishment of the Harvey Cushing Institutes of Neuroscience, a major initiative with 12 centers of excellence planned in both neurology and neurosurgery.

“The North Shore-LIJ Health System is tremendously honored to be associated with the name of Harvey Cushing, the preeminent name in the history of neurosciences,” said Michael J. Dowling, North Shore-LIJ’s president and chief executive officer. “Because of Dr. Cushing’s unparalleled commitment to surgical excellence and patient care, it is our duty to make the Harvey Cushing Institutes of Neuroscience an international resource for patients and researchers alike.”

To date, North Shore-LIJ has invested more than $50 million in neuroscience programs, including new technologies, infrastructures and top physicians. In the next five years, another $50 million is earmarked for neuroscience. The health system has already solidified its clinical, research and education expertise to establish a Chiari Institute, Movement Disorders Institute and Brain Aneurysm Center. North Shore-LIJ also is developing other institutes to focus on epilepsy, pain, neurodegenerative disorders, brain tumors, spine diseases, neurovascular disease and stroke, neuromuscular and peripheral nerve diseases, pediatric neurosciences, neuroregenerative disorders and neurorehabilitation.

Featuring the most advanced technologies, including the Novalis radiosurgery system, an intraoperative magnetic resonance imaging (MRI) system and a biplane procedure suite used for endovascular surgery, the health system’s neurosurgical programs are carried out primarily at North Shore University Hospital in Manhasset and LIJ Medical Center in New Hyde Park. However, many other North Shore-LIJ facilities, including community hospitals and their community-based physicians, are also an integral part of the Cushing initiative. For instance, nine hospitals within the North Shore-LIJ Health System, including six community hospitals, are New York State-designated stroke centers. In addition, spinal surgery, pain management and neurorehabilitation services are also available at various facilities across the health system.

North Shore-LIJ’s neurosciences initiative carries on the legacy of Dr. Cushing (1869-1939), regarded as the greatest neurosurgeon of the 20th century. In 1951, his daughter, Betsey, and her husband, John Hay Whitney, donated the land on which North Shore University Hospital was built. The Whitney’s daughters, Sara Wilford and Kate Whitney, who have long supported medical causes, agreed to lend the name of their legendary grandfather to North Shore-LIJ’s new Harvey Cushing Institutes of Neuroscience.

It is estimated that one in five Americans suffer from a neurological disorder such as Parkinson’s disease, Alzheimer’s or chronic pain. As the population ages and lives longer, the incidence of neurological disease is expected to rise, with older adults facing the loss of independence, productivity and quality of life. The Harvey Cushing Institutes of Neuroscience will be developed to be a premiere resource for patients in the region and elsewhere seeking the latest treatments in neurology and neurosurgery.

Each institute will offer a comprehensive, multidisciplinary program focused on developing state-of-the-art diagnostic and therapeutic solutions particular to its own unique disease cluster. Each new institute will be staffed by healthcare professionals who are recognized leaders in their neurological/ neurosurgical subspecialties.

“I am proud to be leading such a bold and comprehensive effort in the field of neuroscience,” said Thomas H. Milhorat, MD, chairman of neurosurgery of North Shore University Hospital (NSUH) and LIJ Medical Center, and director of the Harvey Cushing Institutes of Neuroscience. “I am grateful for the confidence that the Cushing family has bestowed on our institution, allowing us to be linked and inspired by the standards set by Dr. Harvey Cushing.”

Dr. Milhorat, who joined the North Shore-LIJ Health System in 2002, received his MD degree in 1961 from Cornell University. While an intern and assistant resident at the New York Hospital-Cornell Medical Center, he was mentored by and began neurological surgery training with Bronson Ray, MD, the last in a prestigious line of neurosurgeons trained by Dr. Harvey Cushing.

Dr. Milhorat is widely regarded as one of the world’s foremost experts on Chiari malformation, a condition in which excess brain tissue pushes against the cerebellum and spinal cord at the base of the skull, disturbing the flow of cerebrospinal fluid. Surgery is the only intervention for this debilitating and painful condition.

For more information on the Harvey Cushing Institutes for Neuroscience, contact: (516) 562-3822, or http://www.harveycushinginstitutes.com/

North Shore-Long Island Jewish (LIJ) Health System

CONTACT: Betty Olt, or Terry Lynam, both for North Shore-Long IslandJewish (LIJ) Health System, +1-516-465-2600

Web site: http://www.harveycushinginstitutes.com/

Immunicon Corporation (NASDAQ-NM:IMMC), announced today that its CellTracks(R) Analyzer II received a 2006 Medical Design Excellence Award in the category of In Vitro Diagnostics. The CellTracks Analyzer II is a semi-automated fluorescence microscope used to count and characterize fluorescently labeled cells that are immuno-magnetically selected and aligned. It is currently used by clinicians and research settings in conjunction with the CellTracks(R) AutoPrep system and specific reagent kits in the diagnosis of patients with metastatic breast cancers.

The Medical Design Excellence Awards competition is organized and presented by Canon Communications LLC of Los Angeles, and is the only awards program that exclusively recognizes contributions and advances in the design of medical products. Entries are evaluated on the basis of their design and engineering features, including innovative use of materials, user-related functions that improve healthcare delivery and change traditional medical attitudes or practices, features that provide enhanced benefits to the patient, and the ability of the product development team to overcome design and engineering challenges so the product meets its clinical objectives.

Byron Hewett, President and Chief Executive Officer for Immunicon, said: “We are gratified that this award recognizes the relevance of our technology for oncologists and researchers. Previously, they could monitor the status of metastatic cancers and response to treatment only through subjective interpretation of imaging scans which are conducted typically every three to six months. The CellTracks(R) Analyzer II is part of a suite of products that determines the presence of Circulating Tumor Cells in a patient’s bloodstream and provides new information for disease management after each cycle of therapy. This is a design which truly can change traditional medical practice and encourage more effective treatment of metastatic cancers.”

A comprehensive review of the entries was performed by an impartial, multidisciplinary panel of third-party jurors with expertise in biomedical engineering, human factors, industrial design, medicine and diagnostics.

The 2006 Medical Design Excellence Award winners will be honored at a June 7 ceremony during the Medical Design & Manufacturing (MD&M) East Conference and Exposition in New York City’s Javits Convention Center.

For information about the Medical Design Excellence Awards, visit the MDEA Web site at www.MDEAwards.com Visit www.mdmeast.com to learn more about the MD&M East show.

Note to Editors: Product Photo Available Upon Request

About Immunicon Corporation

Immunicon Corporation is developing and commercializing proprietary cell- and molecular-based human diagnostic and life science research products with an initial focus on cancer disease management. Immunicon has developed platform technologies for selection and analysis of rare cells in blood, such as circulating tumor cells and circulating endothelial cells that are important in many diseases and biological processes. Immunicon’s products and underlying technology platforms also have application in the clinical development of cancer drugs and in cancer research and may have applications in other fields of medicine, such as cardiovascular and infectious diseases. www.immunicon.com.

Forward-Looking Statements

The information contained in this press release includes “forward-looking statements” within the meaning of the Private Securities Litigation Reform Act of 1995. These forward-looking statements are often preceded by words such as “hope,””may,””believe,””anticipate,””plan,””expect,””intend,””assume,””will” and similar expressions. Forward-looking statements contained in this press release include, among others, statements relating to Immunicon’s anticipated net cash burn for 2005, Immunicon’s funding strategy for commercialization activities and key product and clinical development programs and other statements not of historical fact. Immunicon cautions investors not to place undue reliance on the forward-looking statements contained in this press release. Forward-looking statements speak only as of the date of this press release, reflect management’s current expectations and involve certain factors, such as risks and uncertainties that may cause actual results to be far different from those suggested by Immunicon’s forward-looking statements. These factors include, but are not limited to, risks and uncertainties associated with: Immunicon’s dependence on Veridex, LLC, a Johnson & Johnson company, in the field of cancer cell analysis; Immunicon’s capital and financing needs; research and development and clinical trial expenditures; commercialization of Immunicon’s product candidates Immunicon’s ability to use licensed products and to obtain new licenses from third parties; Immunicon’s ability to manage its growth; obtaining necessary regulatory approvals; reliance on third party manufacturers and suppliers; reimbursement by third party payors to Immunicon’s customers for Immunicon’s products; compliance with applicable manufacturing standards; the ability to earn license and milestone payments under Immunicon’s agreement with Veridex; retaining key management or scientific personnel; delays in the development of new products or to planned improvements to Immunicon’s products; effectiveness Immunicon’s products compared to competitors’ products; protection of Immunicon’s intellectual property and other proprietary rights; conflicts with the intellectual property of third parties; product liability lawsuits that may be brought against Immunicon; labor, contract or technical difficulties; and competitive pressures in Immunicon’s industry. These factors are discussed in more detail in Immunicon’s filings with the Securities and Exchange Commission.

“Immunicon” and the Immunicon Corporation logo are registered trademarks of Immunicon Corporation. “CellSpotter,””CellTracks” and “AutoPrep” are registered trademarks of Immunivest Corporation, a wholly-owned subsidiary of Immunicon Corporation. CellTracks Analyzer II is a trademark of Immunivest Corporation. “CellSearch” is a trademark of Johnson & Johnson. All other trademarks or servicemarks appearing in this report are the property of their respective holders. ALL RIGHTS RESERVED.

By Smego, Raymond A Jr; Orlovic, Dragana; Wadula, Jeanette

Summary: We developed a diagnostic and therapeutic algorithm for intracranial mass lesions in patients with HIV/AIDS that obviates the need for neurosurgical intervention. The approach is based upon CD4+ lymphocyte count, serum toxoplasma immunoglobulin G (IgG) serology, chest X-ray, routine lumbar puncture studies, cerebrospinal fluid (CSF) cytology, CSF adenosine deaminase or Mycobacterium tuberculosis polymerase chain reaction testing, single positron emission-computed tomography (SPECT) scanning for intracranial enhancing lesions, and limited therapeutic trials. Over a 12-month period involving 26 patients, we found that the algorithm correctly identified the aetiology of focal intracranial lesions in all 23 evaluable patients. Costs for SPECT scanning for the entire study cohort were more than offset by the savings achieved by reduced hospital stays for the four patients with lymphoma alone. An algorithmic approach can accurately identify the cause(s) of central nervous system (CNS) mass lesions in HIV-infected patients, and SPECT scanning can replace stereotactic brain biopsy in most cases where opportunistic malignancy is suspected.

Keywords: HIV/AIDS, intracranial mass lesions, opportunistic infections, diagnostic algorithm

Introduction

Neurological signs and symptoms are among the commonest clinical presentations for HIV-infected patients. The detection of intracranial mass lesions on computed tomography (CT) or magnetic resonance imaging (MRI) scans is a frequent and often difficult diagnostic and management problem in patients with HIV/AIDS. Microbiologie agents such as Toxoplasma gondii, Mycobacterium tuberculosis, Cryptococcus neoformans, Treponema pallidum, and others, as well as primary central nervous systems (CNS) lymphoma can produce radiographically indistinguishable lesions on neuroimaging studies.1,2 Determining the specific cause of these lesions is crucial in order to prescribe specific and appropriate therapy, and in optimal situations can usually be accomplished by conducting a structured and systematic laboratory and radiologie work-up. A diagnostic approach that minimizes empiricism and the need for brain biopsy is the most desirable. However, financial constraints in poorer countries often demand presumptive clinical diagnosis and empirical treatment, with observation of the response to therapy. In this article, we report the results of a prospective study designed to determine the aetiology of intracranial mass lesions in patients with HIV/AIDS, and present a simplified diagnostic and therapeutic algorithm for these patients that is relevant and cost effective for both developed and resource-limited countries.

Patients and methods

This prospective clinical study was conducted at the Johannesburg Hospital, a 1700-bed public hospital and one of the three major teaching institutions of the University of the Witwatersrand, and at the Sizwe Tropical Hospital, a 500-bed provincial hospital in Rietfontein, South Africa. Approval for this research was granted by the University Committee for Ethics in Human Research. We developed a diagnostic and therapeutic algorithm for HIV-seropositive patients that included the following features: CD4+ lymphocyte count, serum toxoplasma immunoglobulin G (IgG) serology, chest X-ray, lumbar puncture studies including India ink smear, cryptococcal antigen assay, stain and culture for acid-fast bacilli and fungi, cerebrospinal fluid (CSF) cytology, CSF adenosine deaminase (ADA) determination or polymerase chain reaction (PCR) for M, tuberculosis, serum and CSF syphilis serologies (i.e., rapid plasma reagin, fluorescent treponemal antibody absorption, T. pallidum haemagglutination), single positron emission-computed tomography (SPECT) for selected patients, and limited therapeutic trials (Figure 1). If CSF was not available for cryptococcal antigen testing, a serum cryptococcal antigen test was substituted.

Figure 1 Enhancing lesions on CT or MRI scan. ADA=adenosine deaminase; AFB=acid-fast bacilli; CSF=cerebrospinal fluid; CXR=chest X-ray; MRI=magnetic resonance imaging; PCR=polymerase chain reaction; PET=positron-emission tomography; PML=progressive multifocal leukencephalopathy; Rx=treatment; SPECT=single positron- emission computed tomography (CT); TB=tuberculosis; toxo=toxoplasma; toxo ab=toxoplasma antibodies

From April 1998 through March 1999, 26 HIV-infected individuals were identified with focal intracranial mass lesion(s) on CT scan, with or without surrounding oedema and mass effect, and were prospectively enrolled into the study. A correct diagnosis was assumed if patients demonstrated: (1) substantial radiologie improvement or resolution of lesion(s) on repeat CT scanning, (2) a clinically significant response to presumptive therapy, or (3) characteristic CT (for progressive multifocal leukoencephalopathy [PML]) or SPECT scan features (for lymphoma).

Results

Enrolled study subjects had the following definitive or presumptive aetiologies: tuberculous brain abscess(es) – 14 cases, primary CNS lymphoma – four cases, toxoplasma brain abscesses -four cases, and syphilis, cryptococcal brain abscess, and PML – one case each. One patient (patient 15) with six CNS lesions, a diffuse interstitial chest X-ray pattern, detectable serum toxoplasma antibodies, and a CSF ADA level of 30 U/L responded to treatment directed at both M. tuberculosis and T. gondii and was thought to have CNS tuberculosis and/or toxoplasmosis. A summary of study patients’ clinical, laboratory, and radiographie features is shown in Table 1. Intracranial lesions were solitary in 15 instances and multiple in 11 patients, ranging from two to >10 lesions. For tuberculous abscesses, nine patients had single lesion and five had more than one lesion (mean, three lesions). Toxoplasmosis lesions were multiple in three of four instances (mean, 4.5 lesions). Patients with tuberculous brain abscesses had a mean CD4+ count of 121 cells/mm^sup 3^, while for patients with primary CNS lymphoma or toxoplasmosis the mean CD4+ counts were lower at 61 cells/mm^sup 3^ (P = 0.0001) and 83cells/mm^sup 3^ (P = 0.0001), respectively.

Acute or chronic chest X-ray changes were noted in 11/14 (79%) patients with tuberculous abscesses, compared with 3/4 (75%) patients with toxoplasmosis and 3/4 (75%) with lymphoma. Five subjects with tuberculosis had a diffuse reticulonodular (interstitial) radiographic pattern, and three patients demonstrated unilateral or bilateral infiltrates, pleural effusion, or a pulmonary nodule suggesting active infection. In three individuals the chest radiograph showed only changes of healed, inactive infection (e.g., pleural or parenchymal fibrosis and scarring; calcified thoracic adenopathy). CSF ADA levels were elevated in three of eight (38%) individuals with tuberculous brain abscesses but in none of five patients with a nontuberculous aetiology (P = 0.38). Patient 15 with suspected tuberculosis and/or toxoplasmosis had a high CSF ADA level of 30U/L. Where performed, CSF culture for M. tuberculosis yielded growth in five of seven (71%) persons with suspected tuberculosis. Tuberculous cultures were positive in two additional patients (pleural fluid – patient 3; blood and sputum – patient 9), while one patient with CNS tuberculosis (patient 12) had concomitant pericarditis presumptively due to M. tuberculosis.

Table 1 Laboratory and radiographic features in 26 HIV- seropositive patients with intracranial mass lesions on computed tomography (CT)

Where serum toxoplasma serology was performed, the seroprevalence in this study was 32% (six of 19 patients). Active CNS toxoplasma infection was suspected in four and possibly five of these individuals (one with concomitant detectable CSF toxoplasma titres). Two patients had toxoplasma srologies of uncertain significance: patient 3 had detectable serum and CSF antibodies but had a follow- up CT scan that showed nearly complete resolution of his solitary abscess while receiving antituberculous therapy alone; patient 15, who was treated and had radiologie response to therapy directed at both tuberculosis and toxoplasmosis, had negative serum but detectable CSF toxoplasma antibody titres. Six subjects had reactive serum syphilis srologies, and inactive infection was presumed in five of these individuals. One patient, however, had active neurosyphilis as determined by positive CSF serology as well, and this was believed to be the aetiology of his cerebral infarction seen on CT scan. Patient 21 was given a diagnosis of PML based upon a characteristic CT scan appearance of multiple non-enhancing lesions without associated oedema, located exclusively in cerebral white matter and some in subcortical locales.?tlsb

For each of the four patients with CNS lymphoma, diagnosis was made solely on the basis of a characteristic SPECT scan showing increased 201Th uptake. Strictly according to the diagnostic algorithm, all patients with solitary mass lesions on CT scan should have undergone SPECT scanning. However, because of constrained provincial and hospital budgets these scans were not always performed as suggested (only eight patients had a SPECT scan). Three patients died (patients 1, 11, and 18) without consent given for an autopsy and so a definitive diagnosis could not be made in these instances. The patient with a fungal \brain abscess had his diagnosis definitively made by undergoing stereotactic needle biopsy of the lesion (after failure to respond to four weeks of empiric antituberculous therapy) with resultant visualization of yeast forms and confirmation by cultural growth of C. neoformans. Only after the biopsy was a serum cryptococcal antigen test performed; it revealed a positive result (1:1024 titre) and thus a correct presumptive diagnosis would have been made non-invasively according to the protocol if this test had been ordered earlier.

We tried to determine the potential cost-effectiveness of functional CNS imaging in our hospitals, and found that costs for SPECT scanning (R6 904) for the entire study cohort were more than offset by the savings achieved by reduced hospital stays for the four patients with lymphoma alone (R39 600). A total of 66 hospitals days would have been saved if SPECT scanning had been performed on these patients within the first week of their hospital admission. Costs for inappropriate antimicrobial drug therapy during these hospital days were not determined.

Discussion

We found that a structured and systematic diagnostic algorithm can accurately determine the cause of focal intracranial mass lesions in HIV-infected patients in most instances, obviating the need for neurosurgical intervention and guiding appropriate empiric therapy (Figure 1, Table 2). Using radiologie and/or clinical response to treatment rather than histopathologic confirmation as our diagnostic gold standard, or characteristic radiographie features for PML or CNS lymphoma, we found that our algorithm correctly identified the aetiology of focal intracranial lesions in all 23 evaluable patients. An empiric treatment approach for resource-limited settings where SPECT scan, CSF ADA and M. tuberculosis PCR assays, and other tests are not available is shown in Table 3.

It must be emphasized that caution is advised when considering lumbar puncture for patients with CNS space-occupying lesions. For individuals who demonstrate focal neurologic signs or papilloedema, or those who display significant cerebral oedema or mass effect on neuroimaging studies, lumbar puncture is contraindicated. While stereotactic needle biopsy of the brain can provide valuable diagnostic information in such instances, in all four patients in our study who were unable to undergo spinal tap a correct diagnosis was made without the need for brain tissue sampling.

Absolute lymphopenia (

Table 2 Laboratory investigations in the work-up of HIV-infected patients with CNS mass lesions

Table 3 Therapeutic algorithm for HIV-seropositive patients with enhancing CNS mass lesions, for use in resource-limited areas

Other clues to the aetiology of tuberculous brain abscesses include the geographic occurrence in an area of hyperendemicity, and the presence of an abnormal chest X-ray showing active disease or chronic changes in a majority of cases.7 In the present series, 79% of patients with tuberculous brain abscesses had abnormal chest X- rays. In our series, CSF ADA levels were relatively insensitive in detecting tuberculous brain abscesses but, like CSF M. tuberculosis PCR testing, may serve as adjunctive diagnostic aids in some instances. Although the sensitivity of CSF PCR is good for tuberculous meningitis, the precise sensitivity for focal lesions is unclear because the diagnostic gold standard, CSF culture, can be negative in many cases of CNS tuberculosis.10

Radiographically, primary CNS lymphoma lesions are most often solitary but can occasionally be multiple (usually only two or three).11 They are larger than toxoplasmosis lesions but have identical circumferential ring-enhancement with surrounding cerebral oedema and frequent mass effect. Their location is usually within the periventricular white matter or the basal ganglia. Non-specific CSF abnormalities are seen in approximately 80% of patients with primary CNS lymphoma and include mild lymphocytic pleocytosis and protein elevation, and occasional mild hypoglycorrachia but these are rarely helpful diagnostically. Cytology of CSF can reveal typical malignant cells in up to 25% of cases,12 and is thus a useful diagnostic test. Flow cytometry and immunocytologic staining for B-cell markers may help demonstrate the monoclonal population of these tumors and establish the neoplastic nature of the cells. Additionally, detection of CSF Epstein-Barr virus (EBV) deoxyribonucleic acid (DNA) by PCR can be used as another surrogate marker for lymphoma.13 The functional neuroimaging techniques – positron emissions tomography (PET) and SPECT – can help accurately distinguish between primary CNS lymphoma and infectious lesions like tuberculosis, toxoplasmosis, and PML, and frequently obviate the need for brain tissue sampling.14-17 Lymphoma typically presents as a hypermetabolic or ‘hot’ area on PET or SPECT scan while infectious lesions appear as ‘cold’ lesions with little tracer uptake. While these scans are relatively expensive and not widely available in South Africa, they can, as we have shown, be cost effective by shortening the time until diagnosis and reducing hospital stays and the use of inappropriate antimicrobial therapies.

Knowledge of the background seropositivity of the population is important in accurately interpreting toxoplasma serology in the individual patient with focal CNS mass lesion(s). Detectable IgG antibody in areas of extremely high seroprevalence has less predictive value than in areas of low seroprevalence. It is rare for patients with CNS toxoplasmosis to lack serum IgG; and thus a negative toxoplasma serology has good negative predictive value.1,18 Anti-toxoplasma antibodies are seen in the CSF in only 30-50% of instances and add little to the diagnostic work-up.1 The likelihood of active CNS toxoplasmosis is also significantly reduced by the prior receipt of trimethoprim-sulphamethoxazole prophylaxis. In stable patients with radiographically compatible CNS lesions and detectable serum IgG antibodies, a therapeutic trial of sulphadiazine or clindamycin plus pyrimethamine with observation of the clinical and radiographie response to therapy is recommended.19 On repeat CT or MRI scanning, lesions dramatically decrease in size or disappear after 10-14 days of treatment, thus making brain biopsy generally unnecessary.

References

1 Clough LA, Clough JA, Maciunas RJ, Haas DW. Diagnosing CNS mass lesions in patients with AIDS. AiDS Reader 1997;7:83-8, 93-7, 100

2 Cobb MA, Krist AF. Current concepts in the management of HIV- related intracranial mass lesions. Contemp Neurosurg 1995;17:1-4

3 Jentsch U, Spencer DA. Causes of mortality in HIV-seropositive patients seen at the Johannesburg Hospital, South Africa, 1991-95. 36th South African Congress for Pathology and Microbiology, Pretoria, June 1996

4 Walkden D, Patel J, Snipelski M, Heney C. HIV statistics at Baragwanath Hospital, March 1998 to June 1989. 32nd South African Congress for Pathology and Microbiology, Pretoria, May 1992

5 Whiteman M, Espinosa L, Post MJD, et al. Central nervous tuberculosis in HIV-infected patients: clinical and radiographic findings. Am J Neuroradiol 1995;16:1319-27

6 Berenguer J, Moreno S, Laguna F, et al. Tuberculous meningitis in patients infected with the human immunodeficiency virus. N Engl J Med 1992;326:668-72

7 Sacks L, Thonell L, Pendle S. Tuberculous abscesses of the central nervous system in patients with HIV infection. Sixth Joint Biennial Congress of STD and Infectious Diseases Societies of Southern Africa, Cape Town, South Africa, November 1997

8 Villoria MF, Fortea F, Moreno S, et al. MR imaging and CT of central nervous system tuberculosis in patients with AIDS. Radial Clin North Am 1995;33:805-20

9 Haas DW. Current and future applications of polymerase chain reaction for Mycobacterium tuberculosis. Mayo Clin Proc 1996;71:311- 13

10 Miyazaki Y, Koga H, Kohno S, et al. N\ested polymerase chain reaction for Mycobacterium tuberculosis in clinical samples. J Clin Microbiol 1993;31:2228-33

11 Goldstein JD, Zeifer D, Chao C, et al. CT appearance of primary CNS lymphoma in patients with acquired immuno-deficiency syndrome. J Comput Assist Tomogr 1991;15:39-41

12 So YT, Beckstead JH, Davis RL. Primary central nervous system lymphoma in acquired immune deficiency syndrome, a clinical and pathological study. Ann Neurol 1986; 20:566-72

13 Arribas JR, Clifford DB, Fichtenbaum CJ, et al. Detection of Epstein-Barr virus DNA in cerebrospinal fluid for diagnosis of AIDS- related central nervous systems lymphoma. J Clin Microbiol 1995;33:1580-3

14 Pierce MA, Mahlan D, Maciunas RJ, et al. Evaluating contrast- enhancing brain lesions in patients with AIDS by using positron emission tomography. Ann Intern Med 1995;123:594-8

15 Heald AE, Huffman JM, Barlett JA, Waskin HA. Differentiation of central nervous system lesions in AIDS patients using positron emissions tomography (PET), lnt J STD AIDS 1996;7:337-16

16 Ruiz A, Ganz WI, Post MJD, et al. Use of thallium-201 brain SPECT to differentiate cerebral lymphoma from Toxoplasma encephalitis in AIDS patients. Am J Neuroradiol 1994; 15:1885-94

17 D’Amico A, Messa C, Castagna A, et al. Diagnostic accuracy and predictive value of Th SPECT for the differential diagnosis of cerebral lesions in AIDS patients. Nucl Med Comm 1997;18:741-50

18 Beaman MH, McCabe RE, Wong S-Y, et al. Toxoplasma gondii serology in HIV-infected patients: the development of central nervous systems toxoplasmosis in AIDS. AIDS 1990; 4:519-21

19 Cohn JA, McMeeking A, Cohen W, et al. Evaluation of the policy of empiric treatment of suspected Toxoplasma encephalitis in patients with the acquired immunodeficiency syndrome. Am J Med 1989;86:521-7

(Accepted 1 January 2005)

Raymond A Smego Jr MD FRCP1, Dragana Orlovic MD2 and Jeanette Wadula MD1

1 Department of Clinical Microbiology and Infectious Diseases, University of the Witwatersrand, Johannesburg; 2 Sizwe Tropical Diseases Hospital, Rietfontein, Republic of South Africa

Correspondence to: Dr Raymond A Smego )r, Oman Medical College, PO Box 391, PC 321, AI-Tareef, Sohar, Sultanate of Oman

Email: [email protected]

Presented in part at the 30th IUATLD World Conference on Lung Health, Madrid, Spain. 15-18 September, 1999.

Copyright Royal Society of Medicine Press Ltd. Apr 2006

(c) 2006 International Journal of STD & AIDS. Provided by ProQuest Information and Learning. All rights Reserved.

By Rocco Parascandola And Luis Perez, Newsday, Melville, N.Y.

Apr. 17–A woman in a Laundromat. A husband and wife. A 58-year-old man.

It doesn’t sound like the typical drug crew, but authorities say these people are among 53 suspects linked to a South Jamaica drug operation that has brought with it a level of violence not seen in southeast Queens in a number of years, with seven slayings near one notorious intersection – 109th Avenue and Guy R. Brewer Boulevard.

“I would put 109th and Guy Brewer just about right up there with any other place in the city for violence,” says Insp. Robert Napolitano, head of Queens Narcotics. “There has been a lot of violence – and the catalyst has been the continuing drug trade.”

The intersection looks harmless enough; its most distinguishing feature is a huge billboard for Combat bug spray.

“Kill one and destroy them all,” the ad reads.

For quite some time, police say, such words seemed to describe life on the street below, with drug users hitting the area to buy crack, marijuana and heroin. The illicit trade has made life tough for merchants and residents, particularly those who live in the South Jamaica and Baisley Park houses, projects on either side of Guy R. Brewer Boulevard.

“A lot of nice and good people live there,” Napolitano said. “These people don’t deserve this crap.”

Following the drug trail

Now police are hoping they have put a permanent dent in the area drug trade by going after the mid- and top-level dealers and dedicating a uniformed presence to the hot spot since the 53 arrests made beginning in late February.

None of those charged are responsible, police say, for any of the killings or the shooting injuries of nine people near the intersection since the beginning of 2004.

But police and Queens District Attorney Richard Brown say those charged in six of the killings have proven links to the area’s flourishing drug trade. So, too, do most of those slain or wounded in the violence, they said.

In two cases, however, innocent people were shot.

Take, for instance, the death of Correction Officer Gregory Goff, 24, who was killed by a bullet meant for someone else.

Goff, of Jamaica, was off duty in the early-morning hours of Feb. 7, 2004, at a party at the Lebanon Lodge No. 54 when two men opened fire, the result of an argument over who was going to dance with a particular woman.

Two of the three suspects later arrested had been previously arrested in the area on drug charges, police said.

The same goes for ex-con Jeffrey Heirs, 33, accused of shooting a bodega clerk on Guy R. Brewer Boulevard on Dec. 27, 2004.

Heirs, who was convicted recently of robbery in the case and is awaiting sentencing, has served time for a drug conviction.

Unusual suspects

Among those arrested as part of the five-month investigation is Kim Perkins, 48, a woman who each afternoon would leave her home and step right next door to go to work at the Guy R. Brewer Boulevard Laundromat.

There, police said, Perkins was the sole worker on the 1 p.m. to 11 p.m. shift and often dealt heroin to her customers, street-level sellers.

Perkins, who did 2 years in prison in the early 1990s for selling drugs, has pleaded not guilty and is being held on $25,000 bail.

Police said that when they busted Perkins inside the Laundromat on April 5, she made a mad dash toward the bathroom. But officers stopped her before she was able to flush about 100 envelopes of heroin down the toilet, police said.

Perkins’ son, David, could not be reached for comment, and her court-appointed lawyer, Russell Rothberg, said he was not yet familiar enough with Perkins or the charges against her to comment.

Doing brisk business close by, police said, were crack dealers and a marijuana operation fronted by a husband-and-wife team, Walter and Deanna McIlwain, both of whom are accused of selling the drug out of their home on Union Hall Street.

Walter McIlwain, 45, is an ex-con who has served time for drugs and robbery, police said. Deanna McIlwain, 44, has no previous arrests.

The couple’s lawyers did not respond to requests for comment.

The oldest suspect, police said, is John Smith, 58. Arrested April 6 for crack possession, he has pleaded guilty and is serving 10 days in jail.

Smith will probably be out by the beginning of this week, but Napolitano said the NYPD is hoping its game plan of intensive uniformed street presence will keep Smith and other dealers and users away from Guy R. Brewer Boulevard.

Napolitano said this strategy still is in place in Far Rockaway, where officers have been on the streets by the Dix McBride Apartments and the Redfern Houses for up to 18 hours a day following a series of crack dealer arrests earlier this year.

“Our sources down there have not reported any resurgence of drugs, either street-level or inside,” Napolitano said. “We don’t want to lose any ground to the dealers.”

Will it work?

Several South Jamaica residents and merchants say they already have seen a difference. But one Baisley Park Houses resident, a 25-year-old woman who identified herself only as Star, sounded a cautionary note.

“If you can’t get a job and the baby is screaming down your back, you have to do whatever to survive,” she said. “What else are you supposed to do?”

The victims

Slayings and nonfatal shootings, many of them drug-related, near 109th Avenue and Guy R. Brewer Boulevard since January 2004, according to the NYPD:

Jan. 21, 2004: Terrance Neal, 19, of South Jamaica, was stabbed to death at 106-57 160th St. Andre Shobey, 47, was convicted of killing Neal.

Feb. 7, 2004: Four people were shot, including off-duty Correction Officer Gregory Goff, 24, of Jamaica, killed during a party at Lebanon Lodge No. 54, a Masonic temple at 107-51 Guy R. Brewer Blvd.

Feb. 24, 2004: Terence Burt, 35, of South Jamaica, was shot dead at 167th Street and 108th Avenue, and two others were shot. The suspect in the case had prior drug arrests.

May 1, 2004: Stanley Hammond, 37, of South Jamaica, was beaten to death at a playground at 106-50 159th St. Authorities say the slaying stemmed from a drug-turf dispute.

May 3, 2004: Roger Helenese was shot in front of 109-56 Guy R. Brewer Blvd.

Aug. 23, 2004: JoJo Leverette, 24, of South Jamaica, a heroin dealer, was fatally shot at 109th Avenue and 164th Street.

Dec. 27, 2004: A clerk in a bodega at 109-02 Guy R. Brewer Blvd. was shot and wounded during a robbery gone bad. The suspect in the shooting has a history of drug arrests.

July 28, 2005: Tabias Walker, 29, was robbed and beaten to death at 107-01 166th St. Authorities said he had just bought and used crack.

Oct. 24, 2005: Jeffrey Bellamy, 40, was shot dead at 109th Avenue and Guy R. Brewer Boulevard. Police said Bellamy had a history of drug arrests.

—–

Copyright (c) 2006, Newsday, Melville, N.Y.

Distributed by Knight Ridder/Tribune Business News.

For information on republishing this content, contact us at (800) 661-2511 (U.S.), (213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail [email protected].

By Lakiesha McGhee and Jennifer K. Morita, The Sacramento Bee, Calif.

Apr. 16–For years, 70-year-old Roseville resident Gene Winters got his exercise by taking daily strolls through his neighborhood.

Bad weather used to force Winters to hold off on his morning walks, but last November, he and his son Tim took to Roseville’s Galleria mall instead.

“We started walking in the mall on days that it rains,” Gene Winters said. “We walk upstairs, and then we’ll go downstairs for another lap or two. We probably walk about three miles.”

While some people say shopping is a sport, strides have been taken throughout the Sacramento region to take the game to a new level by encouraging “mall-walking” programs for health.

“We want to make sure people have the opportunity to be heart-healthy,” Citrus Heights Mayor Jeannie Bruins said recently, after completing a few laps inside Sunrise Mall and burning 51.2 calories.

Bruins was at the mall to proclaim March 15 as “Go Mall Walking” day. The observance celebrates the 20th anniversary of the city’s popular Mall Walks program, sponsored by Sunrise Mall and Mercy Heart Institute. Bruins was joined by a group of dedicated mall walkers, about 85 elementary students and comedian/actor and “mall walk coach” Jack Gallagher.

The new “Go Mall Walking” effort also highlights Sunrise Mall’s longtime role as a central gathering place – not just for shopping – but for entertainment and exercise, Bruins told the crowd. The mall has opened its doors early for mall walkers since 1986. The free program now includes 100 registered members.

Other area shopping centers have followed in Sunrise Mall’s footsteps. Arden Fair mall in Sacramento started its free “Inside Track Mall Walker” program in 2002. It now has 350 members, mall officials say. In recent years, walking programs became available at the Galleria at Roseville and Country Club Plaza mall in Sacramento. Hundreds of mall-walking programs across the nation can be found on the Internet. The Galleria at Roseville mall opens two hours before the stores so walkers can get their daily exercise.

“We look in all the store windows as we walk by and we have seen stuff, so we’ve gone back when the stores were open,” Winters said.

So what’s behind the mall-walking craze? Those who have been doing it for years say they like the idea of window shopping while improving their health and getting fit.

“What I really enjoy and love about mall walking is that the stores aren’t open,” Citrus Heights resident Laura Harter said as she participated with her granddaughter at the Sunrise Mall event. “But sometimes I cheat by bringing my wallet.”

Walking has long been identified as the No. 1 low-impact aerobic exercise, according to WalkSport America Inc., a national health and fitness company based in Tempe, Ariz. The company teamed with malls across the country in 1992 to provide accessible, safe places to walk. WalkSport America reports the health benefits of walking, combined with the social aspects of an indoor mall program, can make for an effective aerobic exercise. The fitness company recommends walking at a pace fast enough to challenge you for about 20 minutes and adding a proper warm-up and cool-down for a total 30-minute aerobic workout.

Walking in a mall also helps to “excuse-proof” your exercise program, according to WalkSport’s Web site, www.walksport.com. Mall walkers don’t have to worry about weather, bugs, traffic, sunburn or any other outdoor excuse. Restrooms, water and often security officers also are nearby.

Gallagher, who took the role March 15 as the Sunrise Mall group’s walk coach, said such benefits make his job easy.

“I don’t have to tell these people anything to keep them motivated,” the comedian/actor said as he watched walkers follow a designated path at a brisk, steady pace. “These people are here everyday at 8 a.m.”

Ida Murchison, 85, of Citrus Heights was among the first to sign up 20 years ago for the Sunrise Mall Walk program. Since then, she has walked a total of 25,000 miles at the mall, lost 100 pounds and has lowered her cholesterol count and blood pressure, she said.

“I don’t have anything wrong with me, and that’s because I walk,” Murchison said during a brief rest.

GALLERIA AT ROSEVILLE * 1151 Galleria Blvd., Roseville

* Walk times: 8 a.m. until closing daily.

* Course distance: 1 lap (upper and lower level) = 1 mile.

* Entrance: All doors open.

* Contact: Galleria at Roseville, (916) 789-7467.

————

TIPS FOR MALL WALKERS Walk with a buddy: Make sure you both can walk the same pace for the same amount of time.

Window shop: It’s a great way to spot bargains.

Listen to “walking songs”: Compile songs that include “walking” or “walk” in the title or chorus, or listen to other songs that get you moving.

Make plans for after your walk: Something special to look forward to is good motivation.

Aim for prizes: Many mall walk programs include incentives for miles and hours walked.

Play games: Like those played on family car trips, they help pass the time.

Set personal goals: Plan on increasing frequency and intensity of walks. Keep a journal.

Enjoy the scenery: Many malls are fun places to people-watch.

Think, dream and plan: Use walking time to clear your head.

Reward yourself: Small indulgences remind you that you’re doing something positive.

Source: “The Complete Mall Walker’s Handbook: Walking for Fun and Fitness” by Dr. John H. Bland and Jenna Colby

—–

Copyright (c) 2006, The Sacramento Bee, Calif.

Distributed by Knight Ridder/Tribune Business News.

For information on republishing this content, contact us at (800) 661-2511 (U.S.), (213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail [email protected].

NEW YORK — Although statins lower mortality in heart attack sufferers who are between 65 and 80 years old, they may not be as effective in older patients, according to a study.

“While statins reduce mortality in a wide range of older patients up to age 80 years, due to competing risks and decreased life expectancy, these agents have diminished benefits in those over the age of 80 years,” Dr. JoAnne Micale Foody from Yale University School of Medicine in New Haven, Connecticut, told Reuters Health.

Foody and colleagues used Medicare claims data to investigate the effect of statins on outcomes in more than 65,000 patients with a hospital discharge diagnosis of acute myocardial infarction (heart attack).

Less than a quarter of them who were eligible for statin initiation after the event were actually taking a statin upon hospital discharge, the authors report. Overall, 3-year mortality was 11 percent lower for patients receiving statins.

However, statin therapy was associated with a significant 16 percent reduction in all-cause mortality in patients younger than 80 years. This was not the case in patients aged 80 years and older.

“Bad” LDL cholesterol level also interacted with statin therapy to influence survival, the researchers note. Patients who had high levels of LDL cholesterol (above 130 mg/dL) were most likely to benefit from statin therapy, and patients who had LDL cholesterol levels below 100 mg/dL were least likely to benefit.

“Decision-making in older persons is often complex and requires the careful balancing of potential benefits, risks of therapies, as well as accounting for patient preferences for clinical outcomes,” Foody said.

“Many of the interventions we apply in patients of this age group have few clinical data to support their use, but in well-selected individual patients, we are likely to see benefits.”

“Randomized clinical trials,” she and colleagues conclude, “will be required to address the potential role of statins in the significant and growing proportion of patients aged 80 and older who remain at risk for cardiovascular events.”

SOURCE: Journal of the American Geriatrics Society, March 2006.

By Karla Gale

SAN DIEGO (Reuters Health) – Injections of botulinum toxin
A relieve pain in an animal model of diabetic neuropathy,
according to research reported at the American Academy of
Neurology’s annual meeting in San Diego.

Diabetic neuropathy is a term used for the nerve damage
that occurs in people with diabetes and that often leads to
pain, numbness, or tingling in the feet and hands.

Five days after scientists injected the paw pad of rats
with diabetic neuropathy with botulinum toxin A, the animals
became less sensitive to pain, as demonstrated by reductions in
flinches and shaking of the injected paw, compared with
diabetic rats treated with saline. The effect lasted for 15
days.

Dr. Zdravko Lackovic, from Zagreb University in Croatia and
colleagues believe this is the first demonstration that a
single shot of botulinum toxin might have a long-lasting
pain-relieving effect in diabetic neuropathy. Botulinum toxin A
is commonly known as Botox, although the product goes by
several brand names.

A second presentation at the meeting hints that a
combination of Ginkgo biloba extract and folate reduces
symptoms of diabetic neuropathy.

For their research, Dr. Susanne Koeppen, from the
University of Essen in Germany, and colleagues randomly
assigned 60 diabetic patients with neuropathy to Ginkgo biloba
extract, folate, both agents, or placebo.

“We found out that all three active treatments were
superior to placebo, with the best effect seen with the
combination of folate and Ginkgo biloba extract,” told Reuters
Health.

“I think it is important to know that even a short
treatment period can have an effect on neuropathic symptoms,”
she added, even though there were no changes in
electrophysiologic tests.

By Georgia East, South Florida Sun-Sentinel

Apr. 10–When Sophie Hecker turned 6 earlier this year, she invited about 15 friends to celebrate with a day of facials and finger sandwiches in her Hollywood home.

In terrycloth robes and flip-flops, the girls sipped sparkling punch, got manicures and pedicures and did a little “hokey pokey.”

“It was lots of fun. It felt nice,” said Sophie, sporting painted nails and lavender eye shadow.

Once the domain of pampered adults, spa days are becoming increasingly popular on the birthday party circuit, with girls as young as 4 having them.

Usually held at the birthday girl’s house, some are throwing more lavish parties at hotel suites, with prices ranging from $200 to $600 for about 15 girls, depending on the perks.

Party planners say it’s a girl thing. Boys are rarely invited, and it’s catching on among a broad range of families.

“We have at least one a week,” said Arelys Cantena, owner of Kids Fiesta in Pembroke Pines. “I have girls of Middle Eastern descent, some from the Native American community. It’s people of all different backgrounds.”

But in an era of extreme makeovers, some are questioning if a spa party is just another step in creating mini-women out of little girls.

Children are about fantasy play, and putting them in an adult-themed event can hamper that, said Don Elium, a marriage and family therapist who is co-author of Raising A Daughter.

“Don’t dress them up in a fluffy white robe. Give them a dollhouse over to the side to play with and let kids be kids,” he said.

Kimberly Chastain, a family therapist and author of the e-book, Help, My Pre-teen/teenager is Driving Me Nuts said she questions whether some children are too young for such parties.

“If you do all these things as a kid, what do you have to look forward to when you grow up?” Chastain said.

But Andrea Johnston, author of Girls Speak Out: Finding Your True Self, said if the point is to teach girls how to take care of themselves, rather than change their looks, she doesn’t see anything wrong with it.

“It’s another variation of the sleepover,” Johnston said. “If it’s an activity that bolsters their self esteem, that’s the litmus test.”

Cheryl Graham, owner of Creative Adventures, in Boynton Beach, says her parties “stress beauty on the inside” and she sometimes slips in reflexology for her teenage clients. “It’s not superficial fun.”

Spa parties for kids have become so popular it convinced Miami-Dade businesswoman Alina Sanchez last year to open Fantasia Youth Spa.

The two-level space in Doral is exclusively for kids ages 4 through 15. Aside from facials and other spa treatments, she said they offer karaoke and fashion shows.

Betsy Isroelit, a spokesperson for Spafinder.com, said the trend is positive but spas should be associated with health and wellness, rather than just beauty.

“We don’t think it’s negative to introduce children to this,” she said. “It’s a trend. You see more children in spas with their parents, more travel spas where you can bring children, even spas where it’s okay to bring babies.”

Lauren Cariski, a pre-school teacher, founded Pretty Petite Makeover about six years ago after doing a party for twin girls in her class.

“When I started the business, people thought I was nuts,” said Cariski, whose business serves the tri-county area.

But it caught on.

Marlene Klein, owner of Princess Spa Parties in Davie, used to own a beauty salon. She started the spa parties after her adult clients began asking her about a similar service for kids. Her clients now range in age from 3 to 12.

For her 9-year-old daughter’s party recently, Cindy Soto, of Boynton Beach, took the spa party to a higher level.

Soto, owner of mydreamparty.com, had a limo pick up the 14 guests and take them to two adjoining hotel suites at Embassy Suites in Boca Raton. The girls were then treated to various spa services.

Soto’s spa parties cater to ages 9 and up.

“A lot of 4-year-olds are not going to sit there,” she said. “I tell parents you need to think about not just your child but the other kids who are involved.”

Allyson Tomchin hired Princes Spa Parties to throw the party for her only child, Sophie.

She said every year there’s the challenge of finding something different.

“My daughter has been getting manicures and pedicures for a long time,” said Tomchin, a life coach. “This way, I keep [the party numbers] down, I keep it intimate and do something she really loves to do.”

Georgia East can be reached at [email protected] or 954-385-7921.

—–

Copyright (c) 2006, South Florida Sun-Sentinel

Distributed by Knight Ridder/Tribune Business News.

For information on republishing this content, contact us at (800) 661-2511 (U.S.), (213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail [email protected].

(RedOrbit) Researchers at the National Institute of Allergy and Infectious Disease (NIAID) have identified a molecule called xCT which is found on the surface of human cells and is involved in aiding infection by Kaposi’s sarcoma herpesvirus (KSHV.) The virus causes Kaposi’s sarcoma, a major HIV/AIDS-related cancer, as well as certain forms of lymphoma.

The function of xCT in normal cells is to transport molecules necessary for protecting against stress into cells. When cells are stressed, they express more xCT on their surfaces.

When the body becomes infected with KSHV, however, expression of xCT at the cell surface increases. This suggests that the virus facilitates its own infectivity and dissemination in the body by inducing a physiological state that results in an increased number of its own receptor.

The research, published in the March 31, 2006 issue of Science by NIAID research fellow Johnan Kaleeba, Ph.D. and senior investigator Edward A. Berger; Ph.D., describes how the molecule xCT is a major gateway that KSHV uses to enter human cells.

“Understanding the mechanisms of cell entry of Kaposi’s sarcoma herpesvirus is a landmark achievement in and of itself,” says NIAID director Anthony S. Fauci, M.D. “but the connection between the virus and expression of its own receptor on a cell is even more provocative because it might change the way we think about KSHV-associated diseases and their treatment.”

Dr. Berger’s work is the result of a decade-long journey of studying how viruses enter cells which has resulted in the identification of other coreceptors that allow HIV to gain entry into cells of the immune system, such as CXCR4 and CCR5.

This study is important because it may lead to new avenues for treating KSHV, enable scientists to study whether levels of xCT determine disease severity or even help explain why certain groups are more at risk for Kaposi’s sarcoma, based on the level of expression of xCT in their cells.

According to Dr. Kaleeba, “our finding provides a new perspective on the disease. Hopefully this will be the beginning of exciting new directions in this field, as it is likely to provide a useful framework for integration of the cell biology and epidemiology of this clinically important virus.”

By Karen Ventii of RedOrbit from Wire reports

RedOrbit Blogwatch

By Anna Driver

ATLANTIC CITY, New Jersey (Reuters) – Merck & Co.’s former
chief executive denied the company hid data on Vioxx from
regulators as he took the stand on Thursday before a jury that
will decide whether to award punitive damages to a man who said
the painkiller caused his heart attack.

On Wednesday, the jury awarded 77-year-old John McDarby
$4.5 million dollars in compensatory damages. To award punitive
damages under New Jersey law, the plaintiff’s attorneys must
prove that Merck misrepresented material information to the
U.S. Food and Drug Administration.

Raymond Gilmartin, who led Merck during the development and
withdrawal of Vioxx, repeatedly maintained the company did not
try to mislead doctors or regulators.

“Merck wasn’t trying to hide data from the FDA?” asked
Merck lawyer Christy Jones. “No,” replied Gilmartin, who took
the stand for the first time in a Vioxx trial.

Merck stock fell 3.2 percent to close at $34.84 on the New
York Stock Exchange, hurt by concerns over the size of the
damages and Merck’s ability to defend itself in a slew of other
Vioxx suits.

After Gilmartin’s testimony ended, Jones filed two oral
motions for a mistrial. She argued that the plaintiff’s
attorney Mark Lanier had talked loudly enough for the jury to
hear during sidebars with the judge and said Lanier was
presenting evidence that was not relevant.

Judge Carol Higbee denied the motion.

On Wednesday, the N.J. Superior Court jury found that Vioxx
had been a substantial contributing cause of a heart attack
suffered by McDarby. The jury decided the drug was not a
significant cause of a heart attack suffered by a second
plaintiff, Thomas Cona.

Merck, which faces nearly 10,000 Vioxx product liability
cases, pulled the $2.5 billion-a-year drug off the market in
September 2004 after a study showed it doubled the risk of
heart attack and stroke among people who used it for at least
18 months.

Regarding that 2004 study Gilmartin told jurors, “The way
science is, one can only say what that study showed.” He
earlier testified that the drugmaker saw no increased heart
attack risk after reviewing a 2000 study involving Vioxx.

“We saw no evidence there was increased risk of heart
attack,” Gilmartin told the court.

The 2000 Vioxx study, known as Vigor, found higher rates of
heart problems among patients taking Vioxx than among patients
taking an older painkiller, naproxen. Merck has argued that the
Vigor study showed the heart-protective qualities of naproxen
rather than increased risks of Vioxx.

Lawyers for McDarby have argued throughout the trial that
Merck, based in Whitehouse Station, N.J., put profits ahead of
patient safety when marketing Vioxx.

Gilmartin resigned from Merck in May 2005, ahead of his
scheduled retirement in 2006.

Under New Jersey law, any punitive damages, which can be
awarded as a punishment to rectify a wrong committed by a
defendant, would be capped at $22.5 million — five times
compensatory damages.

“The compensatory damages amount by itself is already
large, in our opinion,” Prudential analyst Tim Anderson wrote
in a research note.

On Friday, the jury may hear testimony from Dr. Lisa
Rarick, a former FDA official and witness called by Merck.

The McDarby case is the second multimillion-dollar Vioxx
verdict against Merck.

In August 2005, Merck was ordered by a Texas jury to pay
$229 million in punitive damages and $24 million for mental
anguish and loss of companionship to the widow of a Texas man
who took the drug for about eight months. The total award is
set to be cut because of a Texas law limiting damages.

Rob Gordon, a McDarby attorney, said his New York law firm,
Weitz and Luxenberg, has 1,000 Vioxx cases filed in Atlantic
County and plans to file 1,500 more before September.

JP Morgan analyst Chris Shibutani said he still believes
Merck has a strong case when it comes to whether Vioxx caused a
heart attack in a particular case and whether the company
adequately warned about the drug.

Merck shares dropped to the mid-20s after the company
pulled Vioxx off the market. But the stock has risen about 30
percent in the past six months.

(Additional reporting by Julie Steenhuysen in Chicago)

NEW YORK (Reuters Health) – After someone is exposed to
rabies, they have to be treated quickly with anti-rabies serum,
or immune globulin – a scarce commodity. Now, researchers may
have come up with an alternative.

Anti-rabies immune globulin is derived from the blood of
horses or people who have been infected with the rabies virus,
producing antibodies that can be used to neutralize rabies in
newly infected people.

The new study, involving experiments in hamsters, shows
that a combination of two monoclonal antibodies or MAbs, which
can be produced consistently and in relatively large
quantities, may be as effective and safe as anti-rabies immune
globulin for post-exposure prevention, according to Dutch and
US researchers.

Dr. Jaap Goudsmit of Crucell Holland BV, Leiden, and
colleagues point out in the Journal of Infectious Diseases that
the annual death rate from canine rabies is about 55,000. There
is a limited supply of anti-rabies immune globulin, which in
combination with rabies vaccine is effective in preventing
full-blown disease developing after someone has been exposed to
the virus.

The researchers have identified a combination of two MAbs,
CR57 and CR4098, that show promise as a method of post-exposure
prevention. The MAb combination neutralized a panel of 26
subtypes of rabies virus that are common sources of infection.

When administered to hamsters along with the rabies vaccine
24 hours after the animals were exposed to a lethal dose of
rabies, the hamsters were protected. The results were
comparable to those achieved with human immune globulin,
Goudsmit’s group reports.

The researchers also note that unlike human immune
globulin, production of these MAbs would be consistent from
batch to batch and would avoid the risks associated with
blood-derived products.

They conclude that the MAb cocktail is a safe and
efficacious alternative to anti-rabies immune globulin for
rabies post-exposure prevention.

SOURCE: Journal of Infectious Diseases, March 15, 2006.

NEW YORK (Reuters Health) – Contrary to expectations, high-dose chromium supplementation does not improve blood-sugar control or other parameters in obese patients with poorly controlled, insulin-treated type 2 diabetes, according to a new study.

“Chromium treatment has been reported to improve glycemic control and insulin sensitivity in specific populations of patients with type 2 diabetes,” Dr. Nanne Kleefstra, of Isala Clinics, Zwolle, the Netherlands, and colleagues write.

They examined the effect of chromium treatment in a 6-month blinded study of obese insulin-dependent type 2 diabetes patients within a Western population. Participants had elevated levels of glycosylated hemoglobin (HbA1c), a common measure of blood sugar, and insulin requirements of greater than 50 units/day.

They were randomly assigned to receive placebo or 500 or 1000 micrograms of chromium daily.

A total of 53 patients were initially randomized. Of these, 46 completed the study. Overall, 17 received placebo, 14 received 500 micrograms chromium, and 15 received 1000 micrograms chromium.

According to the team, chromium did not produce any greater reductions in HbA1c than placebo. The decrease in HbA1c was similar across the three study groups.

A weak association was found between an increasing serum chromium concentration and improvement in the lipid profile.

“Further independent (larger-designed) studies may be necessary to further investigate the possible effects of chromium supplementation on glycemic control or lipid profile in Western populations,” Kleefstra and colleagues explain. “Whether it is possible to select subgroups of patients … that may or may not benefit from chromium therapy also needs further attention.”

SOURCE: Diabetes Care March, 2006.

LOS ANGELES (Reuters) – An experimental migraine drug under
review by U.S. regulators works better than industry leader
Imitrex, according to research presented on Wednesday.

The drug, called Trexima, was developed by Pozen Inc. and
will be produced and sold by GlaxoSmithKline Plc, which
currently markets Imitrex, a migraine drug with sales of about
$1.2 billion last year.

Two trials comparing Trexima, which combines Imitrex with
the anti-inflammatory drug naproxen, showed that 57 percent to
65 percent of patients treated with the drug reported pain
relief after two hours, compared with 50-55 percent of patients
treated with Imitrex alone and 28-29 percent of patients given
placebo.

After four hours, 72-78 percent of Trexima patients
reported pain relief, compared with 61-66 percent for the
Imitrex group and 37 percent of patients on placebo.

“We now have a better understanding of how a migraine
develops in the brain … A therapy that both inhibits
inflammation and treats pain may address multiple mechanisms of
migraine,” Dr. Stephen Silberstein, professor of neurology at
Thomas Jefferson University, said in a statement.

Side effects of Trexima included dizziness, nausea and
tingling.

Results from the two trials involving more than 2,800
patients were presented at a San Diego meeting of the American
Academy of Neurology.

The U.S. Food and Drug Administration is expected to
decided in June whether to approve sales of Trexima.

GLN Registry for Healthcare(TM) Provides One Online Database Containing Location Information about U.S. Healthcare Facilities

Five leading U.S. healthcare group purchasing organizations (GPOs), Amerinet, Consorta, MedAssets Supply Chain Systems, Novation, and Premier, are subscribers to the GLN Registry for Healthcare(TM), a database containing a comprehensive list of healthcare facilities within the United States and their unique Global Location Numbers (GLNs). A GLN is a globally recognized identification number based on GS1 System (formerly EAN.UCC System) standards.

GS1 US, a not-for-profit organization dedicated to the adoption and implementation of standards-based, global supply chain solutions, in collaboration with the Coalition for Healthcare eStandards (CHeS), established the GLN Registry for Healthcare in 2004 to help drive down supply chain costs for the United States healthcare industry. To drive mass adoption of the registry, Amerinet, Consorta, MedAssets Supply Chain Systems, Novation, and Premier have forwarded, or are in the process of forwarding, a list of their member company facilities to GS1 US. GLNs have been assigned to tens of thousands of the member company facilities (e.g. hospitals, clinics) and their internal locations (e.g. pharmacy departments). Healthcare facilities are adding additional internal locations as needed. GS1 US is also soliciting suppliers and distributors to subscribe and list their GLNs in the registry. Today, the registry includes more than 84,000 GLNs for hospitals, healthcare manufacturers and distributors, clinics, retail and mail-order pharmacies, and other healthcare-related facilities.

“We applaud the commitment demonstrated by these leading GPOs and their support of the standards of the GS1 System. Standards, such as GLNs, provide essential tools to help the healthcare industry improve its business practices,” says Dennis Harrison, Senior Vice President, GS1 US. “Achieving end-to-end supply chain accuracy allows suppliers and providers to reduce costly, time-consuming errors in processes such as invoicing and logistics.”

GLN Registry for Healthcare subscribers, including members of the five major GPOs, can access or download accurate, up-to-date location information about a healthcare facility, ensuring the accuracy of their supply chain activities. GLN Registry for Healthcare subscribers have the ability to load their location information into the registry and obtain a unique GLN at any time. As information changes, subscribers have the option of cutting and pasting updated information into the database or running an interface program that keeps information synchronized with the database. To date, the registry has reduced a significant amount of redundant location information.

For additional information about the GLN Registry for Healthcare, visit http://www.gs1us.org/healthcare or contact John Roberts, Director of Healthcare, GS1 US, 609.620.4563 or email [email protected].

About GS1 US

GS1 US Inc.(R) is a not-for-profit organization dedicated to the adoption and implementation of standards-based, global supply chain solutions. GS1 US operates wholly owned subsidiaries EPCglobal US(TM), RosettaNet, and 1SYNC(TM). GS1 US manages the United Nations Standard Products and Services Code (UNSPSC(R)) for the UN Development Programme. EPCglobal Inc(TM) is a joint venture of GS1 US and GS1. GS1 US-based solutions, including business processes, XML standards, EDI transaction sets, and the bar code identification standards of the GS1 System (formerly known as the EAN.UCC System) are currently used by more than one million companies worldwide. www.gs1us.org

NEW YORK — In adults needing a new liver, transplanting a portion of a liver donated from a living donor works just as well as transplanting an entire organ donated from a deceased person, according to a study of liver transplants performed at a hospital in Hong Kong.

The only difference that doctors observed was a higher incidence of abnormal narrowing of the bile ducts associated with partial transplants, but this complication was amenable to treatment and did not affect survival of the graft or patient.

Retrospective studies have suggested that graft survival with so-called “right lobe live donor liver transplantation” was inferior to cadaveric liver transplantation, which was blamed on small graft size. However, Dr. Sheung Tat Fan and others at the University of Hong Kong point out that a prospective comparison of the two procedures within a single center has not been reported.

They therefore compared outcomes for adults treated between 2000 and 2004 at Queen Mary Hospital. Included were 124 patients who underwent right lobe live donor liver transplantation and 56 who underwent cadaveric whole-graft liver transplantation.

According to the team, there were no marked differences between the two groups in terms of length of hospital or ICU stay or deaths occurring before hospital discharge.

After a median follow-up of 27 months in the living donor group and 25 months in the cadaver donor group, corresponding patient survival was 90 percent and 84 percent. During the same period, the mortality rate of patients on the wait list was 43 percent.

Not surprisingly, preop waiting times were much shorter for partial live liver transplants as opposed to cadaveric whole-organ transplants — 14 days versus 237 days, the investigators report in the Annals of Surgery.

As noted, the only significant difference between groups was the incidence of bile duct narrowing — 25 percent in the living donor group and 5 percent in the cadaveric donor group. This complication was treated successfully with a variety of techniques including stenting.

Fan’s team also points out that none of the individuals who donated part of their liver died or required any transfusions and complications in the live donors that did arise were successfully managed.

This study, the authors conclude, do not support past studies that have suggested that partial live donor liver transplantation is less effective than cadaveric whole-organ liver transplantation. Partial liver grafts “should not be considered as marginal grafts,” they conclude.

SOURCE: Annals of Surgery March 2006.

By Lee Chyen Yee

TAOYUAN, Taiwan — It tastes bitter, turns your teeth black and causes cancer, but it also gives you a buzz and is served by scantily clad young women.

And that is why it is proving hard for Taiwan’s government to get its heavy betel nut chewers, mostly blue-collar workers, to kick the habit despite the widely known health risks and the red stains left on the sidewalks where users spit out the juice.

Truck drivers in Taiwan, like their counterparts in China, India, Indonesia and elsewhere, chew the nut, which looks like a green olive, for the warming buzz and lightheadedness it gives them, helping them stay awake through long-night journeys.

“I just can’t get enough of betel nuts because eating them is like making love to my wife on our wedding night,” said Lin Shuei-wang, 58, as he popped into his mouth a betel nut freshly wrapped in a leaf coated with spices.

“Taking it with a cigarette and a sip of Wisby (energy drink) is more than heaven,” said Lin, as he took a break from distributing pamphlets in a betel nut shop in Taoyuan county, a drab industrial suburb 40 minutes from Taipei.

Efforts to wean Taiwan off the habit range from puritanical — a ban on young saleswomen showing off their breasts, bellies and buttocks in town — to an environmental appeal for farmers to switch crops as the shallow-rooted betel nut trees have been blamed for deadly mudslides.

“It’s really a dilemma for the government,” said Chang Ching-cheng, agriculture research fellow at the Academia Sinica. “They know that it is harmful and causes cancer, which is a burden on the healthcare system.

“But it’s also hard to imagine the consequences of wiping it out completely. Some farmers rely on it for their livelihood and besides, there are those who are employed in betel nut processing and the betel nut stalls,” she said.

And the women say splitting the nuts, smearing lime down the middle and working at the stands is more lucrative than a job on the assembly line at one of Taiwan’s many high-tech factories.

100 PACKS A DAY

“I’m selling betel nuts because the money is good,” said Hsiao Han, 23, dressed only in a bra, checkered mini-skirt and six-inch-high platform shoes as she tended her stall off a highway in Taoyuan.

“I can easily sell more than 100 packs every day,” she said, as she grabbed a pack of betel nuts from her neon-lit stall and skipped across to a car that had just pulled up. Each pack, the size of a cigarette box, sells for T$50.

It is people like Lin and Hsiao Han who keep Taiwan’s betel nut industry, with output worth T$11.5 billion (US$350 million) in 2004, humming.

The percentage of betel nut chewers among Taiwan’s 16.7 million adults has hovered at 9 percent over the past few years, down from 10.9 percent in 1996.

Taiwan’s output of betel nuts, known as Taiwanese chewing gum, has also fallen steadily to 143,368 tons in 2004 from 172,574 tons in 1998. But it is still Taiwan’s second biggest crop after rice.

Huang Meihua, director for crop production at the Council of Agriculture, said the government had been trying to get local communities to substitute crops, but analysts said that’s easier said than done.

“It’s tough for adults to kick the habit. It’s like smoking. Once you get hooked, it’s hard to quit,” said Chao Kunyu, deputy director-general at the health department bureau.

“That’s why we are spending more efforts in educating young people, so that they don’t pick up the habit. We’re focusing on counties and villages that have a higher proportion of betel nut chewers,” Chao said.

Health officials said it was difficult to provide specific data on how many people contract cancer from chewing betel nuts as the habit was usually accompanied by smoking and drinking.

But die-hard fans like Lin are unfazed.

“If I’m so scared of getting cancer, I would have quit long ago,” said red-lipped Lin as he spat a betel nut quid on to the streets.

(Additional reporting by Richard Dobson)