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A magnetic resonance imaging test is highly effective at detecting a life-threatening pregnancy complication called placenta accreta, researchers report.

The condition occurs when the placenta surrounding a fetus attaches too deeply to a woman’s uterus. During delivery, the placenta can pull out parts of the uterine wall, rupturing blood vessels and putting the mother at risk of severe hemorrhaging.

“Due to the increase in cesarean sections and other surgeries that leave scarring on the uterine wall, coupled with women giving birth later in life, the incidence of accreta has increased dramatically over the past 20 years,” lead researcher Dr. Reena Malhotra, a radiologist at the University of California, San Diego in La Jolla, said in a news release.

Routine prenatal ultrasound often detects placenta accreta, but can’t always definitively diagnose subtle cases, the study authors noted.

In this study, Malhotra and colleagues compared MRI findings and surgical and/or pathology results from 71 women who underwent MRI after a suspicious prenatal ultrasound or clinical examination or because they had significant risk factors for placenta accreta.

The researchers found that MRI was 90.1 percent accurate in detecting the presence of accreta.

“Our findings demonstrate that MRI is an extremely useful adjunct to ultrasound for assessing this potentially life-threatening obstetric condition,” Malhotra said.

Body weight and co-existing health problems don’t explain why black colon cancer patients have lower survival rates than whites, U.S. researchers say.

In an effort to determine why blacks have lower survival rates than whites for nearly all cancers, including colon cancers, investigators have explored a variety factors, such as differences in health care access, exposure to risk factors and tumor characteristics. However, the role these factors play in survival rate disparities remains unclear.

In the new study, researchers at the University of Alabama at Birmingham looked at how weight and comorbidity (the presence of other diseases in addition to colon cancer) affected colon cancer survival in 496 patients who had surgery for colon cancer between 1981 and 2002.

Black patients were 34 percent more likely than white patients to have died by 2008, according to the study published online Nov. 23 and in the Dec. 15 print issue of the journal Cancer.

Among patients with early-stage cancer, the risk of death from any cause was 2.2 times higher in those with a high level of comorbidity. Among patients with advanced cancer, being underweight was associated with an 87 percent increased risk of death. However, being overweight or obese reduced the risk of death by 42 percent among patients with stage IV colon cancer, the study authors noted.

These findings were the same regardless of race, which suggests that differences in weight or comorbidity don’t explain why black patients are more likely to die than white patients, the researchers concluded.

“Further efforts are needed to identify the basis for the survival difference by race for patients with colon cancer. A greater understanding of this complex issue may help eliminate the disparity,” research leader Upender Manne said in a news release from the journal’s publisher.

Heart disease is a leading cause of death in the United States, but you can reduce your risk by eating a heart-healthy diet.

The National Women’s Health Information Center offers these suggestions:
Eat plenty of fruits, vegetables and whole-grain foods.
Opt for low-fat or no-fat dairy products.
Choose lean, healthy proteins, such as chicken or turkey without the skin, fish, nuts and beans.
Limit your intake of saturated and trans fats, found in many forms of butter, fatty meats, fast food, desserts and creamy condiments such as mayonnaise.
Reduce cholesterol in your diet, found in organ meats, pork and sausage, and whole-fat dairy products.
Avoid foods that are high in salt (sodium) and sugar.

Researchers at the National Institutes of Health have identified a genetic mutation that accounts for a perplexing condition found in people with an inherited immunodeficiency. The disorder, called combined immunodeficiency, is characterized by a constellation of severe health problems, including persistent bacterial and viral skin infections, severe eczema, acute allergies and asthma, and cancer.

The team that made the discovery was led by Helen Su, M.D., Ph.D., at the National Institute of Allergy and Infectious Diseases (NIAID), and included collaborators from NIAID and the National Cancer Institute (NCI). The research is reported in this week’s New England Journal of Medicine.

“NIH clinicians have cared for people with unusual and difficult-to-treat immune disorders for decades,” says NIAID Director Anthony S. Fauci, M.D. “This study exemplifies their commitment to improving the lives of people with these diseases by trying to uncover the causes of these disorders and thereby better understanding how to treat them.”

Combined immunodeficiency is a type of primary immune deficiency disease (PIDD) in which several parts of the immune system are affected. This inherited disorder is characterized by increased susceptibility to bacterial, viral and fungal infections of various organs of the body. In some cases, susceptibility to cancers also may be seen.

There are 150 known PIDDs. Approximately 500,000 people in the United States have been diagnosed with a PIDD, while many more remain undiagnosed.

The NIAID and NCI investigators recognized that certain patients with an undefined form of combined immunodeficiency shared enough clinical features to make it likely that the cause might be a common genetic mutation. Originally, these individuals were thought to have a variant form of hyper-immunoglobulinema E syndrome (HIES), a disorder characterized by increased levels of a class of antibodies known as immunoglobulin E, superficial and systemic bacterial and fungal infections, and atopic dermatitis, also known as eczema.

This newly described group, however, had far more severe eczema than is typical in people with variant HIES. They also had extensive and difficult-to-manage viral infections of the skin, such as warts, molluscum contagiosum — a type of poxvirus that only infects the skin — and herpes simplex. Some in this group also developed skin cancers, as well as lymphoma of the skin.

“Even though these individuals were diagnosed with a more uncommon form of HIES, they were still considered to have a mystery disease, because they had severe allergies and had developed cancers,” says Dr. Su.

Using a technique called comparative genomic hybridization, a process by which large amounts of DNA are fixed to a computer chip and analyzed for changes in the genes, scientists examined the genes in the tissue samples from five different groups: the 11 individuals with the unknown immunodeficiencies, people with the variant form of HIES, people with classic HIES, those with other immunological diseases, and healthy individuals.

The researchers discovered that people with the unique form of HIES had mutations in a gene called DOCK8 that led to deletions in parts of the gene. The normal function of DOCK8 is currently unknown.

When compared with healthy individuals, the people with DOCK 8 mutations had fewer CD8 positive T cells, immune cells needed to fight viral infections; fewer antibody-producing B cells; and increased numbers of eosinophils — immune cells associated with allergy.

According to Dr. Su, these findings indicate that DOCK8 is essential for defense against viral infections and for preventing the development of cancer and allergies.

Although further study is required to determine if DOCK8 mutations occur in other people with similar disease symptoms, DOCK8 immunodeficiency syndrome may be a new PIDD. These findings mean that individuals with this rare disease will be able to receive a more accurate diagnosis. Identifying a genetic cause for the disease provided comfort to some of those diagnosed who had battled an unknown immune disease for years, according to Dr. Su.

“The study of inherited disorders and the genetic alterations that are responsible for their complex array of disease symptoms has often resulted in the discovery of causative genes that play a role in cancer initiation,” said NCI Director John E. Niederhuber, M.D. “The disease mutations found in this study in the DOCK8 gene exemplify that kind of important finding. As with any discovery of a genetic defect, the challenge going forward is to develop a complete knowledge of the cascading pathways of biological function for which DOCK8 is responsible.”

Parents want to know how their children measure up on the growth charts widely used in pediatrician’s offices, but many parents don’t understand how to read or interpret the information, a new survey shows.

About 85 percent of parents could look at a growth chart with one point plotted and correctly identify that the point corresponded to the child’s age, according to an online survey of a nationally representative group of 1,000 moms and dads. About two-thirds of parents were able to identify both a child’s weight and percentile on a chart with one plotted point.

But only 56 percent could correctly identify the meaning of “percentile” from a list of choices. In the context of a growth chart, a percentile measures how a child stacks up to his or her peers. A child who is in the 80th percentile for height, for example, is taller than 80 percent of other children his or her age, while a child in the 25th percentile, is shorter than 75 percent of his or her peers.

Only one-third of parents could identify a child’s age, weight and percentile on a chart, as well as the correct definition of percentile, according to the study in the October issue of Pediatrics.

Growth charts were developed in the 1960s to help physicians monitor a child’s development, said study author Dr. Elana Pearl Ben-Joseph, consulting medical editor at Nemours Center for Children’s Health Media. The latest versions, from the U.S. Centers for Disease Control and Prevention, were updated in 2001.

While the charts were meant for use by health-care providers, in practice, physicians often use the charts as visual aids for parents. About 31 percent of parents said they marked their child’s growth on a chart at home.

“Growth charts can be helpful if used properly and if the parents understand them and they are explained properly,” Ben-Joseph said. “But they can be detrimental if not explained well or if parents aren’t understanding them.”

And many don’t. In the survey, about half of parents said a child in the 10th percentile for height and weight was underweight. To doctors, the child’s height and weight is proportional and probably no cause for concern, Ben-Joseph noted.

Many parents expressed concern about a child in the 25th percentile for height and weight year after year. About 16 percent said they would encourage the child to eat more and 18 percent said they didn’t know what the information meant.

A child following a 25th percentile growth curve is smaller and lighter than average, but again, nothing to worry about, Ben-Joseph explained.

When reading growth charts, doctors tend to look for abrupt changes, such as a child whose height or weight trend suddenly drops off, which could be a sign of a problem. They also look for proportionality in height and weight.

A child with a height in the 10th percentile and weight in the 90th percentile is overweight, though about half of parents in a survey didn’t realize this.

The confusion over growth charts brings up the larger issue of “numeracy” — the numerical counterpart to literacy — or the ability of patients to understand risk, statistics, graphs and charts used with increasing frequency in health care, said Dr. Goutham Rao, clinical director of the Weight Management and Wellness Center at Children’s Hospital of Pittsburgh.

“When a patient comes to a doctor’s office or a health-care facility, there are specific numeracy skills they need to understand their condition and what transpires in the health-care environment,” Rao said. “It’s not just patients that can have trouble with this: physicians can also have difficulty putting numbers into terms patients can understand.”

Even so, growth charts remain a useful tool for broaching the delicate issue of a child’s weight with parents, Rao pointed out. About 12.4 percent of children 2 to 5 years old are overweight, 17 percent of children aged 6 to 11 are overweight and 17.6 percent of teens aged 12 to 19 are overweight, according to the U.S. Centers for Disease Control and Prevention.

“Many times parents don’t recognize that their child is overweight,” said Rao, whose clinic uses electronic charts so parents can take home printouts of the result. “We can show the parent where the child is on the growth chart, provide a very detailed explanation of the numbers and make sure the parents are able to understand it. Then we can ask the parents if it’s something they would like to work on.”

Further research should be done into developing growth charts that are easier for parents to understand, Ben-Joseph added.

“There is a desire by the parents to see the growth chart and have doctors talk to them about it,” Ben-Joseph said. “It’s important for doctors to be aware that not all parents will understand these complicated mathematical concepts and to take that into account when they are doing the explaining.”

Avoid eating foods that are high in fat or cholesterol. Lipitor will not be as effective in lowering your cholesterol if you do not follow a cholesterol-lowering diet plan.

Avoid drinking alcohol while taking Lipitor. Alcohol can raise triglyceride levels, and may also damage your liver while you are taking Lipitor.

Grapefruit and grapefruit juice may interact with Lipitor and lead to potentially dangerous effects. Discuss the use of grapefruit products with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.

A surgeon’s experience doesn’t affect trauma patients’ chances of survival if they’re treated within a structured trauma program, according to a new report.

In the study, researchers examined deaths among almost 14,000 trauma patients treated at the Johns Hopkins Hospital in Baltimore over 10 years (1994-2004). This period included years before and after the hospital hired a highly experienced trauma surgeon to serve as trauma program director.

During the first 3.5 years, 4,499 patients were treated by novice surgeons. During the remaining years, novice surgeons treated 5,783 patients while the experienced surgeon treated 3,612 patients. There were no differences in death rates between patients treated by novice surgeons during the latter years and patients treated by the experienced surgeon, the researchers found.

Patients treated by novice surgeons were 44 percent less likely to die after the hiring of the experienced surgeon as trauma program director.

“Together, these data support the belief that in a structured trauma program, surgeons with vastly different levels of training can safely provide care and obtain equivalent outcomes,” the Johns Hopkins University School of Medicine researchers concluded.

“System effects outweigh any potential benefits of individual surgeon experience in the care of trauma patients. The implementation of an organized trauma program with evidence-based protocols and senior surgical guidance may have a greater effect on mortality than individual surgeon experience alone.”

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