martes, 23 de enero de 2018

Bladder and bowel problems solved!

Harvard Health Publishing

Incontinence can be treated 70% of the time!

Better Bladder and Bowel Control
Here's the good news about incontinence. Treatments today are more effective and less invasive.
Today's medications have fewer side effects.
Exercises can help strengthen the muscles of the pelvic floor, shoring up those that control the bladder and bowel.
Surgical options include less invasive outpatient procedures that can work as well as older, open surgical procedures.
If you or someone you love struggles with these issues, then don't wait another minute.
Take charge of your health and send for your Special Health Report from Harvard Health.
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It was a beautiful summer evening when Jim’s family gathered to celebrate his 80th birthday.
As the band played “For He’s A Jolly Good Fellow,” and balloons floated onto the dance floor ...
... Jim overheard his eldest son lean over to his sister and whisper, “Dad soiled himself again. Maybe it’s time we put him in a home?”
Dear CERASALE,
It's everyone's worst nightmare.
Losing control of your bowels or bladder in public.
Today an estimated 20 million adults struggle with incontinence, which is why many of our elderly race to the bathroom so often and rely on absorbent pads for protection.
These same individuals are often too ashamed to tell their physicians that they struggle with this common medical condition.
The result is needless suffering.
Needless because incontinence can often be cured or significantly improved — 70% of the time!
Now a breakthrough special health report from the physicians at Harvard Medical School — Better Bladder and Bowel Control: Practical strategies for managing incontinence — will answer all your questions about this common medical condition and offer hope and solutions — explaining what you can do right now to minimize the difficulties, and even make incontinence issues disappear altogether.
On page after page of Better Bladder and Bowel Control, you'll get reliable answers to pressing questions such as ...
  • Which strategies work best for your type of incontinence?
  • Which common medications can cause urinary incontinence?
  • Why do some people have a strong urge to urinate even when their bladder isn't full?
After thumbing through your personal volume, you'll come to understand the common causes of urinary and fecal incontinence in men and women and the treatments we have available today for these conditions.
It's like having a dozen free consults with the finest doctors in the world whose goal is to help cure, or greatly reduce, the symptoms of this challenging ailment. This report can help you, or a loved one.
SAVE 30%! When you order your special report from Harvard Health Publishing today!
Read More
To your good health,
Howard E. LeWine, M.D.
Chief Medical Editor, Harvard Health Publishing

Discontinuing Nilotinib in Patients with CML - National Cancer Institute

Discontinuing Nilotinib in Patients with CML - National Cancer Institute

National Cancer Institute

Nilotinib Can Be Discontinued in Some Patients with Chronic Myelogenous Leukemia


January 19, 2018, by NCI Staff
FDA has approved a change to the nilotinib label, advising that the drug can be safely discontinued in patients with chronic myeloid leukemia who have been in remission for an extended period. 
Credit: adapted from Darryl Leja, National Human Genome Research Institute, CC BY 2.0
The Food and Drug Administration (FDA) has approved a major change to the recommended use of the drug nilotinib (Tasigna®) in patients with chronic myelogenous leukemia (CML).
On December 22, the agency approved an update to the drug’s label that states that some patients with CML who are taking nilotinib and whose cancer has been in remission for an extended period can safely stop taking it. These patients, however, must undergo regular testing to ensure the disease has not come back.
Until now, the practice has been to give nilotinib continuously until leukemia progresses, so treatment may continue for years, decades, or even the rest of a patient’s life. While this can keep CML at bay, nilotinib does have side effects including itching and rash, nausea, diarrhea, and tiredness. It can also cost insurers more than $100,000 a year for a single patient.
To be eligible to stop nilotinib under the new labeling, patients must have taken the drug for at least 3 years, and there must be evidence that almost no cells in their blood harbor the genetic mutation that causes CML—known as a sustained molecular response.
Once nilotinib treatment is stopped, patients must be tested regularly using an FDA-authorized test to monitor for possible disease recurrence.
In the two clinical trials that led to the label change, almost half of the patients who stopped nilotinib experienced disease relapse. However, almost all of these patients’ leukemia went back into remission after restarting nilotinib.
Discontinuing the drug for some patients “is a safe thing to do, as long as careful monitoring is done,” commented Richard Little, M.D., of NCI's Division of Cancer Treatment and Diagnosis.

Testing the Safety of Stopping Nilotinib

Nilotinib is a type of drug called a tyrosine kinase inhibitor (TKI). It interferes with the protein produced by the genetic mutation that causes CML, and this interference can keep cancer cells from growing.
Patients newly diagnosed with CML are usually treated with nilotinib or one of two other TKIs, imatinib (Gleevec®) or dasatinib (Sprycel®).
FDA based the label change for nilotinib on the results of two phase 2 clinical trials, called ENESTfreedom and ENESTop.
The ENESTfreedom trial enrolled 215 patients who had taken nilotinib for at least 2 years. All trial participants continued to take the drug for one more year as part of the trial. After a year, the 190 patients still in remission discontinued the drug.
During follow-up, the participants were monitored with blood tests every 4 weeks for the first 48 weeks, every 6 weeks for the next 48 weeks, and then every 12 weeks.
After the first 48 weeks of follow-up, 98 participants who had discontinued nilotinib (52%) remained in remission. Of the remaining 91 patients, 86 restarted nilotinib after testing showed their disease had returned, and all but one of these patients went back into remission. None of the patients progressed to the deadly later stages of CML during the trial.
Early results from the ENESTop trial were very similar to the results of ENESTfreedom. The ENESTop researchers enrolled 163 patients who had taken imatinib followed by nilotinib for a total of 3 or more years.
After an additional year of nilotinib treatment during the trial, 126 participants remained in remission and discontinued the drug. Participants were monitored with blood tests every 4 weeks for the first 48 weeks.
During those 48 weeks, 73 patients (58%) remained in remission. Fifty-one patients (41%) experienced a relapse and restarted nilotinib. Of those, 50 regained a response to the drug. The one patient who did not regain a response switched to a different drug used to treat CML.
About 25% to 40% of patients in the two trials experienced muscle pain, bone pain, or both during the first 48 weeks after stopping the drug. These side effects have previously been seen in patients who stop taking nilotinib. Longer-term follow up is needed to understand whether the risk of muscle or bone pain decreases over time, wrote the ENESTfreedom study authors.

Better Responses, Safer Stopping?

An important question for future research is whether it is possible to predict whether an individual patient will maintain a molecular response after stopping nilotinib, the ENESTfreedom authors explained.
Although neither trial identified predictive factors, Dr. Little noted that doctors have a fairly good idea of which patients might safely try discontinuation: patients whose disease responds rapidly to nilotinib and who have been in remission for a long time are more likely to maintain their remission.
Conversely, patients whose leukemia took a long time to respond to nilotinib, those who needed more than one drug to generate a remission, and those who haven’t been in remission for long are riskier candidates, added Dr. Little.
This difference highlights the importance of people taking nilotinib as prescribed, stressed Dr. Little.
Nilotinib, like other TKIs used to treat CML, comes in pill form. This makes patients responsible for administering their own treatment every day, often for years on end.
“Adherence to the medication has to be quite high to achieve a molecular response,” Dr. Little said.
“Patients should start [treatment] with the idea that if they take their pills exactly as prescribed for a number of years, then the prospect of their being able to stop treatment all together is pretty high,” he continued. “But if they don’t, then the likelihood of being able to successfully stop is decreased.”
The results from these two trials, along with previous research exploring how to safely stop other TKIs, generates excitement about how CML treatment might be adjusted to get more patients’ disease to respond early and durably, said Dr. Little.
Currently, he explained, researchers are looking at whether adding other types of treatment—such as immunotherapy—to TKIs might create faster, longer-lasting remissions.
“If we can get more patients into a molecular remission and then they’re able to successfully stop [therapy], that’s going to be a tremendous benefit both to the individual patient and to the overall national health expenditures for CML,” he concluded.

Does Gastric Bypass Reduce Cardiovascular Complications of Diabetes? | NIH Director's Blog

Does Gastric Bypass Reduce Cardiovascular Complications of Diabetes? | NIH Director's Blog



Does Gastric Bypass Reduce Cardiovascular Complications of Diabetes?

Doctor with patient
Thinkstock/IPGGutenbergUKLtd
For obese people with diabetes, doctors have increasingly been offering gastric bypass surgery as a way to lose weight and control blood glucose levels. Short-term results are often impressive, but questions have remained about the long-term benefits of such operations. Now, a large, international study has some answers.
Soon after gastric bypass surgery, about 50 percent of folks not only lost weight but they also showed well-controlled blood glucose, cholesterol, and blood pressure. The good news is that five years later about half of those who originally showed those broad benefits of surgery maintained that healthy profile. The not-so-good news is that the other half, while they generally continued to sustain weight loss and better glucose control, began to show signs of increasing risk for cardiovascular complications.
In fact, earlier studies have consistently shown that gastric bypass surgery offers benefits in terms of weight loss and improved blood glucose control for people with diabetes. But diabetes also comes with an increased risk for cardiovascular complications. People with diabetes are at greater risk of suffering a heart attack or stroke [1]. They are also more likely than people without diabetes to have other cardiovascular risk factors, including high blood pressure and cholesterol levels. Does gastric bypass help to reduce those risks too?
That’s the question the NIH-funded Diabetes Surgery Study set out to answer about a decade ago. To get a more holistic view on the benefits of gastric bypass surgery, they relied on the American Diabetes Association’s (ADA’s) composite triple endpoint for diabetes. Those guidelines include a hemoglobin A1C of less than 7 percent. The A1C test measures the amount of glucose attached to hemoglobin in red blood cells, which reflects a person’s average blood glucose level in the preceding months. An A1C below 5.7 percent is considered normal. An A1C above 6.5 is consistent with a diagnosis of diabetes.
In addition, the ADA’s composite end point includes a low-density lipoprotein or “bad” cholesterol level of less than 100 milligrams per deciliter (mg/dL) and systolic blood pressure less than 130 milligrams of mercury (mmHg). That’s the upper number in a typical blood pressure reading. For people with diabetes, the triple endpoint is often remarkably tough to achieve; most never do.
Led by Sayeed Ikramuddin and Charles Billington at the University of Minnesota, Minneapolis, the Diabetes Surgery Study enrolled 120 people in the United States and Taiwan who had type 2 diabetes and a hemoglobin A1C above 8 percent. All participants also had a body mass index (BMI) above 30, which is generally considered obese. Half of the study’s participants were randomly selected to undergo a Roux-en-Y gastric bypass procedure along with two years of intensive lifestyle and medical management. The remaining study participants received two years of intensive lifestyle and medical management without surgery.
The Roux-en-Y procedure involves reducing the stomach size by 90 percent and attaching the remaining stomach pouch into a latter section of the small intestine. As a result, people eat less and absorb fewer calories. The question was: Would that surgical procedure, when added to those other interventions, help more people to reach and maintain the ADA’s triple endpoint?
As reported in JAMA, the initial results were quite encouraging [2]. In the first year, half of the gastric bypass group (28 people) achieved the composite triple endpoint. That’s compared to 16 percent of those (9 people) who didn’t undergo surgery. However, that early success began to slip by year three. By that time, 23 percent of those in the gastric bypass group compared to 4 percent in the lifestyle-medical management group met the goals for blood glucose, cholesterol, and blood pressure.
The five-year outcomes data now show that those improvements seen at year three have held steady, with those who received a gastric bypass continuing to fare significantly better on average than those who received the lifestyle and medical intervention alone. However, the diminished magnitude of those effects raises doubts about the procedure’s longer-term benefits to prevent cardiovascular disease.
Further study is needed to determine the continued durability of those improvements and whether they will ultimately translate into fewer cardiovascular complications, including heart attack and stroke. In weighing those benefits, it’s also important to note that some people have suffered serious adverse events after gastric bypass, including small bowel obstructions and leaks.
This study is one of several in JAMA’s special issue on “reimagining obesity” to explore the benefits of bariatric surgery, including the Roux-en-Y procedure and the increasingly popular sleeve gastrectomy, which is less technically complex and appears to come with fewer complications [3]. Bariatric surgery is now recognized as a standard treatment option for people with obesity and diabetes, and especially for those who have failed other treatments [4]. While considerable progress in understanding the benefits and risks of these approaches has been made, it’s clear that plenty of questions about the role of surgery for treating people with obesity, diabetes, and associated health complications remain.
References:
[1] Diabetes, Heart Disease, and Stroke.National Institute of Diabetes and Digestive and Kidney Diseases.
[2] Lifestyle Intervention and Medical Management With vs Without Roux-en-Y Gastric Bypass and Control of Hemoglobin A1c, LDL Cholesterol, and Systolic Blood Pressure at 5 Years in the Diabetes Surgery Study. Ikramuddin S, Korner J, Lee WJ, Thomas AJ, Connett JE, Bantle JP, Leslie DB, Wang Q, Inabnet WB 3rd, Jeffery RW, Chong K, Chuang LM, Jensen MD, Vella A, Ahmed L, Belani K, Billington CJ. JAMA. 2018 Jan 16;319(3):266-278.
[3] Reimagining Obesity in 2018. JAMA. 2018 Jan 16;319(3).
Links:
Overweight and Obesity Statistics (National Institute of Diabetes and Digestive and Kidney Diseases)
Charles Billington (University of Minnesota, Minneapolis)
Diabetes Surgery Study (Clinicaltrials.gov)
NIH Support: National Center for Advancing Translational Sciences; National Institute of Diabetes and Digestive and Kidney Diseases

Thyroid Cancer Treatment (PDQ®)—Health Professional Version - National Cancer Institute

Thyroid Cancer Treatment (PDQ®)—Health Professional Version - National Cancer Institute

National Cancer Institute

Thyroid Cancer Treatment (Adult) (PDQ®)–Health Professional Version



SECTIONS

Changes to This Summary (01/19/2018)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
This summary was renamed from Thyroid Cancer Treatment.
Updated statistics with estimated new cases and deaths for 2018 (cited American Cancer Society as reference 2).
This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ® - NCI's Comprehensive Cancer Database pages.
  • Updated: January 19, 2018