Tuesday, November 1, 2011

Surgeons separate California conjoined twins (AP)

PALO ALTO, Calif. � Twin two-year-old girls who were joined at the chest and abdomen were separated Tuesday during a lengthy, complex procedure at Stanford University's children's hospital.

Sisters Angelina and Angelica Sabuco were undergoing an expected nine hours of surgery by a team of more than 20 doctors and nurses to gain their independence.

By mid-afternoon, hospital spokeswoman Reena Mukamal announced the girls had been separated and moved to their own operating rooms for the second phase of surgery � reconstructing the area where they were connected.

Mukamal said doctors were pleased with the progress of the operation so far at Lucile Packard Children's Hospital in Palo Alto.

Dr. Gary Hartman, lead surgeon on the case, had said keeping the girls connected carried bigger risks for their health than the separation procedure.

If one conjoined twin dies, the other will die within hours. Muscular and skeletal deformities can also worsen with time.

Ginady Sabuco, the girls' mother, has said the parents want them to live normally.

"When they argue, they can be alone. When they play, they can play together or apart," she said Monday.

The surgery required separating livers, diaphragms, breastbones, chest and abdominal wall muscles.

The reconstruction includes covering the holes that remained after the girls were separated. Surgeons had stretched their skin prior to the operation to patch the area.

The children were expected to be in the hospital for two to three weeks.

Born in the Philippines, Angelina and Angelica came to the United States with their mother last year. They live in San Jose with their parents and 10-year-old brother.

Given their otherwise good health, doctors were optimistic about a successful operation. Hartman has performed five other separations. This is the second such surgery at Stanford.



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Light drinking linked to slight breast cancer risk (AP)

CHICAGO � Whether sipping beer, wine or whiskey, women who drink just three alcoholic beverages a week face slightly higher chances for developing breast cancer compared with teetotalers, a study of more than 100,000 U.S. nurses found.

The link between alcohol and breast cancer isn't new, but most previous studies found no increased risk for breast cancer among light drinkers. The new research provides compelling evidence because it followed so many women for up to almost 30 years, experts said.

Still, the study only shows an association between alcohol and breast cancer; it doesn't prove that drinking causes the disease. There could be some other reason light drinkers appeared to be at higher risk � maybe they were less active than nondrinkers or had unhealthy diets, said Dr. Susan Love, a breast cancer expert and author who runs a Santa Monica, Calif.-based research foundation.

Women in the study who averaged three to six drinks a week throughout the study had a 15 percent higher chance of developing breast cancer than nondrinkers. That risk means, for example, that among women in their 50s, who on average face a 2.38 percent risk for breast cancer, light drinking would result in 4 additional cases of breast cancer per 1,000 women

Risks increased by 10 percent for every 10 grams of alcohol consumed daily. That's equal to a little less than one 12-ounce bottle of beer, a 4-ounce glass of wine or a shot of whiskey. The increasingly elevated risks were a little higher than seen in other research. It made no difference whether the women drank liquor, beer and wine.

Given research suggesting that drinking moderate amounts of alcohol including red wine may protect against heart disease, deciding whether to avoid alcohol is a personal choice that should be based on a woman's other risks for breast cancer and heart disease, the researchers said.

The study appears in Wednesday's Journal of the American Medical Association. It began in 1980, asking healthy, mostly white nurses aged 30 to 55 to fill out periodic questionnaires about lifestyle and risk factors for cancer and heart disease. Follow-up ended in 2008 or when women died or were diagnosed with cancer.

The researchers took into account other cancer risk factors, including age of menstruation and menopause, family history, weight and smoking, and still found a link with alcohol.

The strongest risks were seen with cumulative consistent alcohol use throughout the study. Increased risks also were seen in binge drinkers � women who consumed at least three drinks daily in a typical month. The results do not apply to women who may have partied hard during week-long vacations but otherwise rarely drank, said lead author Dr. Wendy Chen, a researcher at Brigham and Women's Hospital and Dana-Farber Cancer Institute and an assistant professor at Harvard Medical School.

"No one should feel guilty about one particular week or two," Chen said.

The results don't mean women can avoid breast cancer by not drinking, and they don't answer whether women can lower their risk if they stop drinking, said breast cancer specialist Dr. David Winchester, chief of surgical oncology with NorthShore University HealthSystem in Evanston, Ill.

Drinking alcohol "is definitely not one of the leading explanations" for why breast cancer develops, he said. "It's one of many contributing factors."

Cancer researcher Jo Freudenheim noted that the risks linked with alcohol, shown in this study and others, are much lower than those associated with smoking and lung cancer.

The study "doesn't change the picture; it just brings it into a little sharper focus," said Freudenheim, head of social and preventive medicine at the University at Buffalo.

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Online:

JAMA: http://www.jama.ama-assn.org

National Cancer Institute: http://1.usa.gov/gy2JSo



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Study: ADHD drugs don't raise heart risks for kids (AP)

Ritalin and similar medicines that millions of children and teens take to curb hyperactivity and boost attention do not raise their risk of serious heart problems, the largest safety study of these drugs concludes.

Heart attacks, strokes and sudden death were very rare and no more common in children on the drugs than in kids not taking them, the federally funded study found. That was true even for children and young adults with a higher risk of heart problems � a group doctors have long worried about when prescribing these drugs.

"This study would suggest that their risk is remarkably low. And that's good news," said the study's leader, Dr. William Cooper, a pediatrics and preventive medicine professor at Vanderbilt University.

"Parents should be very reassured," said Dr. Laurel Leslie, a pediatrician at Tufts Medical Center in Boston who had no role in the study but served on a Food and Drug Administration advisory panel examining drugs for ADHD, or attention deficit-hyperactivity disorder.

The study was sponsored by the federal Agency for Healthcare Research and Quality and the FDA. Results were published online Tuesday by the New England Journal of Medicine. Results from similar studies of these medicines in adults are expected soon.

More than 5 million children in the United States have been diagnosed with ADHD, which hampers a child's ability to pay attention and control behavior. Although it seems counterintuitive, stimulant medications such as Ritalin, Adderall, Concerta and Strattera can help these children, and about 2.7 million of them are prescribed such drugs each year.

However, isolated reports of heart attacks and strokes in kids taking the drugs caused worry, and the Canadian government curbed use of one drug in 2006. The FDA added a black box warning to some ADHD drugs, and the American Heart Association gave the controversial advice in 2008 that it was reasonable to screen a child starting on such a drug with a heart EKG test.

"There's such strong feelings around these drugs" and whether they are overused in children who might be helped by behavioral therapy alone, Cooper said. "The potential safety questions have added another layer of concern."

His study was aimed at resolving the safety question. Researchers used medical records from four big health plans covering more than 1.2 million people ages 2 through 24. They found 81 cases of serious heart problems from 1998 through 2005 among all people in the study.

Those on ADHD medicines were no more likely to suffer a heart attack, stroke or sudden death than were non-users or former users of such drugs. More than half of children and young adults taking ADHD drugs used methylphenidate � generic Ritalin � and researchers saw no increased risk from that specific drug either.

"The good news is that it doesn't look like overall, there's an increase in cardiovascular events in kids who are on ADHD drugs," said Dr. Gordon Tomaselli, a Johns Hopkins University heart specialist and president of the American Heart Association. "The question parents should be asking themselves is, `Does my child really need this?'"

Cooper, the study's leader, and Leslie, the Boston pediatrician, defended the drugs' use, especially with careful medical monitoring and behavioral therapy.

"I take care of kids all the time who are helped by these drugs," Cooper said.

FDA spokeswoman Sandy Walsh said stimulants "should generally not be used in patients with serious heart problems, or for whom an increase in blood pressure or heart rate would be problematic."

Patients on ADHD medications also should be watched for changes in heart rate or blood pressure, she said.

The drugs cost from $40 to $100 a month.

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Online:

Study: http://www.nejm.org

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP



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Deaths from painkiller overdose triple in decade (AP)

NEW YORK � A new government report shows the number of overdose deaths from powerful painkillers have more than tripled over a decade.

Prescription painkillers such as OxyContin, Vicodin and methadone contributed to the deaths of nearly 15,000 people in 2008. That's more than three times the 4,000 deaths in 1999.

According to the Centers for Disease Control and Prevention, nearly 5 percent of Americans ages 12 and older say they've abused prescription painkillers. The highest rate of abuse was reported in Oklahoma while the lowest was in Nebraska and Iowa.

Fatal overdoses were more likely in men and middle-aged adults.

The report was released Tuesday by the CDC.

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Online:

CDC report: http://cdc.gov/mmwr/



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White House staff lose weight, credit first lady (AP)

WASHINGTON � Surrounded all day and most nights by delicious cakes, cookies, pies and more, Susie Morrison gave in to temptation too often during long hours at work in the White House pastry kitchen.

But no more.

Never a runner, the assistant pastry chef has finished her first 5K run. When the weather cooperates, she pedals her bicycle 26 miles roundtrip to work. She's eating more vegetables, limiting coffee and drinking up to a gallon of water every day � dietary changes that Morrison says helped her drop 30 pounds from her 5-foot-5 frame in about 18 months.

One person gets most of the credit for Morrison's lifestyle makeover: Michelle Obama.

While the first lady's campaign to lower childhood obesity rates will need time to produce results, if ever, the White House is one place where her message about eating balanced meals and getting more exercise is not only resonating, but showing results, too.

"She is a great inspiration for me to focus every day to try harder, and I have," Morrison said.

Some of Morrison's colleagues are also taking the message to heart � and the proof is in their waistlines. Four members of the White House residence staff � Morrison, two chef colleagues and an assistant curator � have lost more than 110 pounds since July 2010. They have kept the weight off so far.

Executive chef Cristeta Comerford, now 15 pounds lighter, said Mrs. Obama's campaign helped the group recognize their poor eating habits.

Instead of the cookie she reached for daily, Morrison, 44, said she now snacks on an apple or a handful of grapes.

Comerford often lined up a cup of coffee, a can of soda and a can of Red Bull and sipped from all three during the day.

Assistant chef Adam Collick cut out hundreds of calories by eliminating a daily coffee fix � three 20-ounce cups topped with whipped cream drizzled with chocolate syrup. He and Comerford have replaced their caffeinated drinks mostly with calorie-free water. They still drink coffee, but stop at two cups a day.

Collick also has cut down on mindless eating and is limiting dessert to a few times a week, instead of with every meal. Those changes and about an hour of exercise most days have helped the 46-year-old lose 30 pounds. He said consistency is important for good results.

"Once you see the changes in your body and the way you feel, it's going to make you want to keep doing it," said Collick, who became a de facto coach to colleagues battling the bulge. The 25-year veteran of the White House kitchen helped motivate them to stick with their programs or get back on track after they'd overdone it a little.

Overdoing it is easy as a chef in a place where there are few food-free functions � ranging from receptions and dinners for hundreds of visitors to lunch for President Barack Obama and a guest in his private dining room off the Oval Office. One occupational hazard for the chefs is having to taste the food during all stages of preparation to check the flavorings, a seemingly simple task that when performed again and again every day can jeopardize anyone's well-intentioned efforts to eat right.

If not careful, Collick said, the chefs could easily eat an entire meal just by tasting their way through the work day.

"We're preparing really good food so it's really very easy to just snack all the time," added Comerford.

Comerford, 47, said she wanted more stamina to keep up with her 10-year-old daughter, a competitive gymnast, and to set an example with her smart food choices. The family sticks to a balanced diet of whole grains, low-fat proteins and plenty of vegetables but will loosen up enough on weekends to enjoy a hamburger or equally indulgent meal.

That's the basic advice Mrs. Obama dispenses � that losing weight doesn't have to mean deprivation. The first lady has said french fries are her favorite food and she also has been taken to task from time to time after being spotted at burger joints around town.

Assistant curator Lydia Tederick said she lost more than 35 pounds after signing up for Weight Watchers and joining a gym with her husband. They work out at least three times a week, and Tederick said she spends most Saturday mornings at the farmer's market stocking up on fresh fruit and vegetables.

Her initial goal was just to lose weight so she could fit into her clothing better.

"But now my goal is to maintain my weight, to tone up, be more fit, and I would love to have arms that look as fabulous as Mrs. Obama's," Tederick said.

Jim White, a spokesman for the American Dietetic Association, applauded the employees. He said studies have shown that having a partner in weight loss aids the process.

"Losing weight is not the easiest thing to do or we wouldn't have overweight in this country," said White, a registered dietitian and personal trainer in Virginia Beach, Va.

Morrison, who has worked in the pastry kitchen since 1995, said she gained weight after giving up exercise because of injuries and not paying attention to her diet. After deciding it was time to refocus on her fitness, Morrison said she would envision herself working out and getting healthier and stronger.

"I persevered and it's nice to come to this point and have happy results," she said.

Perseverance will be important for Morrison in the days ahead. White House chefs will soon begin preparing for a holiday season that, despite Mrs. Obama's focus on eating healthier, still serves up traditional, calorie-laden fare at dozens of parties and receptions that jam the calendar between Thanksgiving and Christmas.

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Darlene Superville can be reached at http://www.twitter.com/dsupervilleap



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