Every year, more than 37 million Americans suffer from at least one episode of sinusitis. Typically, the symptoms include nasal congestion, runny nose and pressure or pain felt behind the eyes or teeth. these symptoms are caused by inflammation and infection of the sinuses.  

The sinuses are air-filled spaces located behind the forehead, nose, cheeks and eyes. Normally, mucus drains from the sinus, while air is able to circulate within them. When the sinus opening becomes blocked, bacteria and germs can easily become overgrown, resulting in infection and discomfort.

Conditions that can put you at risk for developing a sinus infection include diseases which increase mucus production or a physical block of the sinus, such as a polyp. Allergies, which affect more than 67 million Americans each year, can also increase your risk. While we are no longer experiencing unseasonably warm weather, March’s early heat wave resulted in higher than normal pollen counts and is having lingering effects for those who suffer from seasonal allergies.

While one’s initial instinct might be to request antibiotics, growing research is showing that this is rarely the best course of action. A recent study in the Journal of the American Medical Association evaluated the efficacy of antibiotic treatment for sinus infection and found no difference in symptoms in those treated with antibiotics as compared to those who were given a placebo. this is because the vast majority of sinus infections are caused by viruses. In fact, only 2 percent of episodes are due to bacteria, which are the target of antibiotic medications. Antibiotics, unfortunately, are useless against viral sinus infections.

Viral infections are typically self-limited and the mainstay of therapy is symptom relief. Staying hydrated is key, because it helps thin the mucus and promotes drainage. Drinking warm non-caffeinated beverages helps keep you hydrated and can soothe a sore throat, while the steam helps loosen mucus. Over-the-counter medications, like ibuprofen or naproxen will help reduce pain and inflammation, while decongestants can help ease congestion.

The presence of green mucus is only a sign of infection — not the cause. the white blood cells of your immune system contain greenish-colored components, which in a large number, can color the mucus with a greenish hue. these cells are present regardless of whether your infection is bacterial or viral.

Taking antibiotics “just in case” is not harmless and can result in an upset stomach, rash, or even a life-threatening allergic reactions. on a population level, the volume of antibiotics prescribed is a major factor in the increasing rates of bacterial resistance. In the U.S., over 70 percent of hospital-acquired infections involve bacteria resistant to at least one antibiotic. this trend is making it more difficult to treat infections that were once simple to cure.

When you suspect a sinus infection, the best course of action is to consult your doctor, so that he or she can determine whether or not antibiotics are appropriate. If your symptoms persist for longer than 10 days or get worse, you may require antibiotics. If you experience a change in vision, a sustained fever higher than 101°F, or confusion, it is important to seek medical care immediately, as these could be signs of a more concerning condition.

Dr. David B. Samadi is the Vice Chairman of the Department of Urology and Chief of Robotics and Minimally Invasive Surgery at the Mount Sinai School of Medicine in New York City. He is a board-certified urologist, specializing in the diagnosis and treatment of urological disease, with a focus on robotic prostate cancer treatments. to learn more please visit his websites RoboticOncology.com and SMART-surgery.com. Find Dr. Samadi on Facebook.

Patients report seizure freedom and quality of life improvement

Newswise — BOSTON – Clinical trial results are so striking that neurologists should advocate for early surgical evaluation of patients with mesial temporal lobe epilepsy (MTLE), according to physicians at Boston’s Beth Israel Deaconess Medical Center and Harbor-UCLA Medical Center in Torrance, California.

In an editorial in the March 7 edition of the Journal of the American Medical Association, co-authors Donald L. Schomer, MD, a neurologist at BIDMC and Roger J. Lewis, MD, PhD, an emergency medicine physician and expert in clinical trial design at Harbor-UCLA Medical Center, say the results from a trial reported in that issue warrant the recommendation despite the fact the study was terminated early due to low enrollment.

“Seventy-three percent of the patients who had surgery were seizure-free after two years. in the same time period zero patients who were surgery eligible – but for whom surgery was delayed – were seizure-free,” says Schomer, a Professor of Neurology at Harvard Medical School. “That’s a very significant finding and should be taken into account when treating patients early in this disorder.”

More than 2.5 million people in the United States have received treatment for epilepsy in the past five years. about 60 percent of those patients have partial epilepsy where the focus, or place in the brain where the seizure begins, can be identified on radiographic imaging. one of the more common forms of partial epilepsy is mesial temporal lobe epilepsy (MLTE).

In spite of improvements in antiepileptic drugs (AEDs), more than thirty percent of people with epilepsy continue to experience debilitating seizures.

“We know there are risks associated with having seizures and there are often serious adverse effects of medications, so surgery may be a good option for many patients,” says Schomer. “There’s also a lot of documentation about diagnosing MLTE and locating the seizure focus as well as about positive outcomes after surgery, but up until now, there has been only one other prospective study that recommended surgical intervention.”

The study Schomer and Lewis examined looked at patients who had experienced fewer than two years of disabling seizures from MTLE. The study group received a standardized anteromesial temporal resection (AMR), a surgery in which the area of seizure focus is removed from the brain. The control group, while eligible for surgery, delayed surgery and remained on anti-seizure medications.

The intent was to enroll 200 patients, but only 38 total patients had been enrolled in the study before it was terminated by the Data and Safety Monitoring Board. The low enrollment was likely due to the fact that the centers chosen for the study infrequently see and evaluate patients who are within two years of being diagnosed with mesial temporal lobe epilepsy, a requirement to participate in the study. Additionally, patients who have undergone such evaluations and are appropriate for surgery often do not wish to delay this form of treatment

“Studies can be stopped for various reasons. a review board may determine that there is too much associated risk, or the evidence of treatment difference may be overwhelming,” says Lewis. “This study was stopped because there weren’t enough participants, but not before some impressive outcomes were unequivocally identified.”

Not only did three quarters of the patients who received surgery remain seizure-free, but they also reported improved quality of life, which often correlates with seizure freedom. while the patients who received surgery did suffer some memory loss and were no more likely to return to work than the nonsurgical intervention group, Schomer and Lewis believe the benefits of seizure freedom outweigh the deterrents. they also note that the disappointing effect of the surgery on employment may relate more to the lack of availability of appropriate rehabilitative services for both groups of patients.

“We feel pretty strongly that stopping this trial early did not bias the findings and that this study along with we already know about seizures and seizure surgery makes a strong case for recommending surgery for this type of epilepsy when it’s indicated,” says Schomer. Lewis adds, “Although the trial was stopped much earlier than planned—albeit for good reasons—it answered the key question regarding how best to prevent further, disabling seizures in this patient population.”

Though not addressed in the study, Schomer and Lewis also stress the “critical importance of early diagnosis.” they say “recognizing the signs and symptoms of epilepsy early in the primary care setting and getting patients referred to level III and level IV epilepsy centers is essential for patients to receive the attention they need, including medical management, neurosurgical evaluations, counseling, and work training.” Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School, and currently ranks third in National Institutes of Health funding among independent hospitals nationwide. BIDMC is clinically affiliated with the Joslin Diabetes Center and is a research partner of Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox. for more information, visit bidmc.org.

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Date: Tuesday Aug. 16, 2011 6:47 PM ET

TORONTO — Cigarette smoking has long been linked to bladder cancer, but the risk of the disease developing appears to have climbed higher over the last several decades, especially among women who regularly light up, a large U.S. study has determined.

the study by the U.S. National Cancer Institute, which tracked almost 500,000 people over 11 years, found the likelihood of a smoker getting bladder cancer is about four times higher than someone who has never smoked.

Furthermore, the risk for female smokers now equals that for male tobacco users, according to the study published in this week’s edition of the Journal of the American Medical Association.

“So in our study, 50 per cent of bladder cancer in men and 50 per cent of bladder cancer in women was explained by smoking,” said Neal Freedman, an NIH investigator who led the research.

Earlier epidemiological research, some of it going back to the 1960s and ’70s, had estimated the “population attributable risk” at 50 to 60 per cent for male smokers and 20 to 30 per cent for their female counterparts, Freedman said Tuesday from Rockville, Md.

“But previous studies generally occurred in populations where women smoked less than men,” he said. “And so (now) in the U.S. population and most of the western world — I’m not certain about Canada, but I believe also — men and women smoke relatively similar amounts.”

To conduct the research, Freedman and colleagues used data from the National Institutes of Health-AARP Diet and Health Study, in which almost 500,000 men and women completed a lifestyle questionnaire and were followed up between October 1995 and December 2006.

During that period, 3,896 men and 627 women were newly diagnosed with bladder cancer. the researchers found that former smokers were twice as likely as people who never used tobacco to develop bladder cancer. Those who had been smoke-free for at least 10 years had a lower incidence than those who quit for shorter periods or who still smoked.

“I think our work emphasizes the importance of preventing smoking initiation, and among people that smoke, quitting smoking,” said Freedman. “And that will have a really important effect on preventing bladder cancer.”

interestingly, the incidence of bladder cancer has remained relatively stable over the last 30 years, at the same time that overall smoking rates in Canada and the U.S. have declined.

in Canada, 7,200 cases of bladder cancer are expected to be diagnosed this year — 5,400 men and 1,800 women. About 1,850 people will die from the disease, Canadian Cancer Society estimates predict.

“The higher risk, as compared to studies reported in the mid- to late-1990s, may explain why bladder cancer rates haven’t declined,” said Freedman, noting that there may be other factors at work that complicate the picture.

Cigarettes and the smoke they produce have changed over the last 50 years, both in content and preparation, he pointed out. While amounts of tar and nicotine have been reduced, there have been apparent increases in concentrations of certain carcinogens, including beta-naphthylamine, a known bladder cancer-causing agent.

“In addition to that carcinogen there are many more, and all or some may play a role in bladder cancer.”

Dr. Michael Jewett, a uro-oncologist at Princess Margaret Hospital in Toronto, said the study’s risk estimates for U.S. smokers would likely hold true for Canadians as well.

“And I guess as we see more women smoking, we would expect there to be less difference between the genders,” said Jewett, who was not involved in the study.

While it’s not known what causes bladder cancer in people who have never smoked or been exposed to excess tobacco smoke, the link with the cancer-causing agents found in tobacco and industrial production have long been known.

“The urinary tract is a bit like the sewer systems: the bad things that go in come out,” said Jewett. “And the bladder itself, it’s the reservoir, so it will store until it’s convenient to be emptied, and things like the carcinogens in cigarette smoke … appear then to act on the lining of the bladder for longer than anywhere else.

“So it’s been well-established that there are carcinogens in the urine and cigarette smoking is probably the most well-known association.”

Bladder cancer affects about three or four times as many men as women and the average age of diagnosis is the late 60s, he said.

Typically, a patient’s first sign of bladder cancer is blood in the urine that’s visible to the naked eye. A sudden change in the frequency and-or urgency of urination is also a red flag, although other conditions such as kidney stones can cause similar symptoms.

“They need to be aware that if they see blood or if they have a change in the way their bladder is working, particularly if they’ve been a smoker or are a smoker or are around a smoker, they should have a visit to their doctor,” Jewett said.

it was seeing a gush of red urine that sent David Guttman of Georgetown, Ont., to the hospital and ultimately to a diagnosis of bladder cancer 17 years ago.

“It was as red as if someone had punctured a vein,” he said, explaining that blood in the urine is usually intermittent and may not appear again for another month, so people with the disease are often misdiagnosed initially.

Guttman, 71, had grown up with parents who smoked heavily, but after taking up the habit himself, he butted out for good 30 years before his diagnosis.

he was treated with a widely used drug to knock back the cancer, but like 80 per cent of patients with a malignancy in the lining of the bladder, the tumours kept recurring. five years ago, he had his bladder removed and now uses a urostomy bag.

Bladder cancer is the sixth most common malignancy among Canadians and the most expensive cancer to treat because of its recurring nature.

“When I was diagnosed, there was no one around to talk to,”said Guttman, who co-founded Bladder Cancer Canada to support patients, provide public education about the disease and to advocate for research funding.

the charitable organization is holding a series of five-kilometre bladder cancer awareness walks in various sites across Canada on Sept. 24.

“One of the problems that bladder cancer survivors and researchers and the system around it has with this disease is we haven’t had any real breakthroughs — new inventions, a new drug,” said Jewett. “And so as a result, the survivors are not in the spotlight.”

BACKGROUND: A study was undertaken to identify the diagnostic approaches that primary care physicians and gynecologists undertake in women with symptoms associated with ovarian cancer.

METHODS: A vignette-based survey was mailed to 3200 primary care physicians from the American Medical Association Physician Masterfile. the vignette described a 55-year-old woman with symptoms associated with ovarian cancer, although ovarian cancer was never mentioned. the authors evaluated patient, physician, and practice characteristics associated with a workup that could detect ovarian cancer.

RESULTS: the survey response rate was 61.7%. after exclusions, 1532 physicians were included. Overall, 89.5% of physicians reported that they would recommend testing that can detect ovarian cancer (71.2% ultrasound; 25.4% pelvic computed tomography; 26.5% CA125). in adjusted analysis, the only patient factor associated with ovarian cancer testing was symptom type, genitourinary versus gastrointestinal (risk ratio, 1.07; 95% confidence interval, 1.03-1.11). Physician and practice characteristics associated with recommending of ovarian cancer testing included specialty (gynecologists > family physicians and internists); type of practice (group > solo); clinical teaching (yes > no); and within Census division, location of practice, with all Central (East, West, North, and South) and Atlantic (Middle and South) areas having a lower likelihood than New England.

CONCLUSIONS: On the basis of a vignette in which a woman reported symptoms associated with ovarian cancer, the majority of primary care physicians and gynecologists would not recommend CA125, but would recommend imaging of the pelvis. Gynecologists, physicians involved with clinical teaching, and those in group practices were significantly more likely to recommend testing that could lead to an ovarian cancer diagnosis.

See the full abstract here

We hear it all the time … lose weight for your health. Few yet realize how far this is critical to their physical and ultimately their life expectancy.

In January 2003, the Journal of the American Medical Association presented a study finding that obesity appears to lessen life expectancy, especially among young adults. the study showed an obese white man 20 years old, (5’10 “) 178 cm and weight (288 lbs) 130 kg was estimated to lose 13 years of his life as a consequence of obesity.

It is now well research that a Western diet leading to obesity may actually act to stimulate the growth of cancer cells. it is never too late to improve your health through healthful eating and adopting a lifestyle that gives health. here are the simple steps to follow which can make an immediate improvement to your health and vitality.

1. Check if you are overweight or obese.

To find your BMI is necessary to divide the weight (measured in kilos) by height (in meters) squared. if the result is greater than 25 years, their health can be improved by weight loss.

2. Match your diet to your body’s needs.

If you eat and drink more calories than your body requires putting on weight. Learn to control calories and portion sizes, make recipes leaner, and eat infrequently from fast food restaurants. they also learn how to snack with healthful choices.

3. Color your diet with a variety of fruit, and cancer-fighting vegetables.there are seven different color ranges of both fruit and vegetables and by choosing between 5 to 9 daily serves from a wide range of fruits and vegetables, we are extending our consumption of cancer (and other disease) fighting nutrients.

4. Eat lean protein at every meal.Protein provides a powerful signal to the brain providing a longer sense of fullness. Adequate supply of protein is essential to control your hunger with fewer calories and necessary to maintain your lean muscle mass. Choices of protein should be flavored soy shakes with fruit, white meat chicken and turkey, seafood such as shrimps, prawns scallops and lobster and ocean fish or vegetarians may prefer soy substitutes for meat .

5. Speed ??up your metabolism with activity.if you want to enjoy a lifetime of well-being, exercise is a key ingredient. thirty minutes of activity every day that takes as much effort as brisk walking, is recommended for adults. Children should be active for an hour each day.

6. get support to ensure you develop a healthy eating plan and reach your ideal weight.

One study, “Effects of Internet behavioral counseling on weight loss in adults with type 2 diabetes risk,” shows that participants who had the support of weight loss coaching lost more weight than those who do not made. the study concluded that the support of a coach weight loss can significantly improve weight loss results.

Being overweight or obese has been identified next to smoking, as the principal avoidable risk of cancer development. even small weight losses have been shown to have beneficial health effects. So it’s never too late to start and never too young or too old to be concerned about their health and do something about achieving a healthier weight.

TUESDAY, Jan. 4 (HealthDay News) — three treatments for chronic pelvic pain syndrome in men — antibiotics, anti-inflammatories, and alpha-blockers or nerve inhibitors — were found to be effective in curing or reducing symptoms of the often puzzling condition, according to a recent analysis of published research.

The review, published in the Jan. 5 issue of the Journal of the American Medical Association, noted that about 9 percent of men in the United States suffer from different types of inflammation of the prostate gland, accounting for about 2 million medical visits annually. Symptoms include pain in the pelvis, urethra or penis, back pain, trouble urinating and frequent urination.

Up to 95 percent of these cases are caused by chronic pelvic pain syndrome triggered by chronic prostatitis, an inflammation of the prostate gland that surrounds the male urethra. The condition — usually caused by a chronic bacterial infection — is most likely to affect men between the ages of 35 and 45, according to government statistics.

Not enough research has been done on effective treatments for this condition, one expert said, noting that only 23 studies met the researchers' criteria for inclusion.

"This is a very ambitious study, and it appears to shed some light on a very challenging condition," said Dr. Paul C. Cook, a urologist at the Hermann Memorial Medical Center in Houston, who was not connected to the study. "The fact that they distilled it down to only 23 studies in all the literature that met their criteria exemplifies that there [are so few] really good controlled studies out there."

The most effective treatment for chronic pelvic pain syndrome was the combination of antibiotics and alpha-blockers, particularly when the main symptom was pain while urinating, but "anti-inflammatory medications remain an option for patients" who seek help for pain, according to the authors of the report.

The researchers noted that the role of antibiotics was unclear, since infection has to be ruled out before a man is diagnosed with chronic pelvic pain syndrome. they speculated that the antibiotics might work against unrecognized germs and noted that antibiotics such as quinolones also have anti-inflammatory properties.

Chronic pelvic pain, or pain lasting three of the previous six months, can be a very debilitating condition, said Cook. Symptoms of chronic pelvic pain syndrome include pain in the pelvis, urethra or penis, back pain, trouble voiding, sexual difficulties and frequent urination.

Alpha-blockers, used to block the nerves going into the muscles of the prostate, are often prescribed along with antibiotics for the condition. If that doesn't work another antibiotic is tried. but a man with chronic pelvic pain shouldn't just keep switching around "from one antibiotic to another," Cook said.

"If the patient comes back and the treatment isn't working, it's time to rethink the diagnosis," he suggested. "It's time to start thinking outside the box."

Other conditions that can cause chronic pelvic pain include pudendal nerve entrapment (when nerves get trapped in bony canals) and compression of blood vessels in the pelvis, sometimes caused by long distance bicycle riding, Cook noted.

Calling chronic pelvic pain a "poorly understood condition," Cook said patients need to become proactive.

"It's very important that the patient be a partner with their physician," he said. "I always encourage patients to do independent research on their condition." This sometimes results in a patient helping to pinpoint what is wrong, said Cook.

As men get older the prostate grows naturally, but men sometimes develop an enlarged prostate that presses on the urethra, causing pain and interfering with urination. an enlarged prostate can be treated (shrunken) with medication.

In the study, an international team looked at research published between 1949 and 2010 that compared numerous treatments and their impact on pain, voiding, quality of life and total symptom scores. More than 1,500 subjects were included in the analysis.

Other treatments included steroids, phytotherapy (plant-based alternative medicines), finasteride (also used to treat enlarged prostate) and gabapentinoids, which are used to treat nerve pain. The researchers found that phytotherapies and finasteride might benefit some patients, but added that more research was needed.

Another expert said the study was important because chronic pelvic pain syndrome can cause "enormous frustration" and can interfere with sexual function and overall quality of life.

"For the most part they [patients] fare well," said Dr. David Samadi, vice chairman of urology at Mount Sinai Medical Center in New York City. "Everyone's regimen is a little different. but there are patients who go on for years [with symptoms] and end up trying alternative medicines because they become desperate."

And, he added, 20 to 25 percent of patients with chronic pelvic pain fail to find effective treatment.

A very stubborn bacteria may sometimes be the cause, said Samadi, also chief of robotics and minimally invasive surgery at Mount Sinai.

"We have tried injecting antibiotics directly into the prostate" in such cases, said Samadi, "with some success." he cautioned against overusing alpha-blockers because they can cause drowsiness, headaches and low blood pressure.

Factors that predispose men to the pelvic pain syndrome include infection, hormone imbalance, allergic and immune system triggers, and psychological and hereditary traits, according to the researchers. Samadi also noted that men who are not sexually active for a long time may be a bit more prone to the syndrome.

More information

The U.S. National Library of Medicine has more about prostatitis.

WASHINGTON–(BUSINESS WIRE)–Smoking cessation treatment that is made part of mental health care for Veterans with Post Traumatic Stress Disorder (PTSD) improves quit rates, according to a Department of Veterans Affairs (VA) study published in the Dec. 8 Journal of the American Medical Association.

“these study findings will help us empower more Veterans with the resources they need to quit smoking. Single-shot, brief episodic care for nicotine addiction is no match for what is a chronic, relapsing disorder for many of our Veterans.”

“The smoking cessation techniques used in this new approach will give Veterans an important step towards a better quality of life,” said VA under Secretary for Health Dr. Robert Petzel. “Veterans will be at a lower risk for cardiovascular or lung disease if they do not smoke.”

on measures of smoking abstinence for shorter periods of time, researchers found that quit rates were as high as 18 percent for the integrated care group, versus 11 percent for those receiving usual care. When compared to usual care—referral to a standard smoking cessation clinic—the new, integrated approach nearly doubled the rate at which study volunteers stayed smoke-free for a year or longer, from 4.5 percent to almost 9 percent.

Importantly, Veterans in the study who quit smoking showed no worsening of symptoms of PTSD or depression. In fact, study participants averaged a 10-percent reduction in PTSD symptoms, regardless of which treatment they received or whether they quit smoking or not. The findings help dispel concerns that combining care for PTSD and smoking cessation detracts from PTSD treatment or makes it less effective.

Study leaders Miles McFall, Ph.D., and Andrew Saxon, M.D., say the results validate a promising new VA model of care that can make safe, effective smoking cessation treatment accessible to far more Veterans with PTSD. The new approach may also be effective for smokers receiving mental health care for other psychiatric illnesses, they add.

Says McFall, “One of the most important things mental health providers can do to improve the quality and length of their patients’ lives is to help them stop smoking by using proven, evidence-based practices.”

McFall is director of PTSD Programs and Saxon is director of the Addictions Treatment Center at the VA Puget Sound Health Care system. both are professors in the department of psychiatry and behavioral sciences at the University of Washington.

VA smoking cessation care generally involves a mix of group and individual counseling, typically in combination with nicotine replacement therapy or other medication prescribed by a VA health care provider. In VA’s study, Veterans in the integrated-care group worked with the same therapist on PTSD and smoking issues. Medication for smoking cessation, if used, was prescribed on an individual basis by the same medical provider managing pharmacologic treatment of the Veteran’s PTSD symptoms.

The study followed 943 Veterans at 10 VA medical centers nationwide. Prolonged abstinence from tobacco, as reported by participants, was confirmed using breath and urine tests to detect evidence of smoking. Using such “bio-verification” measures in combination with self-reports is considered the “gold standard” in smoking cessation research, says McFall.

Of some 400,000 Veterans being treated for PTSD in the VA health care system, roughly 30 to 50 percent are smokers, compared to a smoking rate of about 20 percent among VA enrollees and U.S. adults in general. Research shows, also, that those with PTSD smoke more heavily than smokers without PTSD and have an especially hard time quitting.

“We’ve come a long way in understanding that nicotine dependence for many Veterans with PTSD is a chronic, relapsing condition that responds best to intensive treatment extended over time,” McFall says. “These study findings will help us empower more Veterans with the resources they need to quit smoking. Single-shot, brief episodic care for nicotine addiction is no match for what is a chronic, relapsing disorder for many of our Veterans.”

Based on the findings and evidence from prior research, VA has begun piloting the integrated smoking cessation approach as a standard of practice at six VA medical centers. The researchers say they hope to see the new approach further expanded over time.

McFall notes that while most of the participants in the study were Vietnam-era Veterans, integrated smoking cessation care may be especially beneficial for younger Veterans with PTSD, such as many of those returning from Iraq or Afghanistan, who stand to benefit greatly from quitting smoking relatively early in life.

Says McFall, “Ideally, we can help Veterans quit smoking before it becomes a chronic or intractable condition and causes irreversible health problems such as cardiovascular or lung disease.”

The study was conducted by VA’s Cooperative Studies Program. For more information on CSP, visit csp.research.va.gov.