Dog Health

NEW YORK (AP) -- You can skip the mouth-to-mouth breathing and just press on the chest to save a life. In a major change, the American Heart Association said Monday that hands-only CPR - rapid, deep presses on the victim's chest until help arrives - works just as well as standard CPR for sudden cardiac arrest in adults.

Experts hope bystanders will now be more willing to jump in and help if they see someone suddenly collapse. Hands-only CPR is simpler and easier to remember and removes a big barrier for people skittish about the mouth-to-mouth breathing.

"You only have to do two things. Call 911 and push hard and fast on the middle of the person's chest," said Dr. Michael Sayre, an emergency medicine professor at Ohio State University who headed the committee that made the recommendation.

Hands-only CPR calls for uninterrupted chest presses - 100 a minute - until paramedics take over or an automated external defibrillator is available to restore a normal heart rhythm.

This action should be taken only for adults who unexpectedly collapse, stop breathing and are unresponsive. The odds are that the person is having cardiac arrest - the heart suddenly stops - which can occur after a heart attack or be caused by other heart problems. In such a case, the victim still has ample air in the lungs and blood and compressions keep blood flowing to the brain, heart and other organs.

A child who collapses is more likely to primarily have breathing problems - and in that case, mouth-to-mouth breathing should be used. That also applies to adults who suffer lack of oxygen from a near-drowning, drug overdose, or carbon monoxide poisoning. In these cases, people need mouth-to-mouth to get air into their lungs and bloodstream.

But in either case, "Something is better than nothing," Sayre said.

The CPR guidelines had been inching toward compression-only. The last update, in 2005, put more emphasis on chest pushes by alternating 30 presses with two quick breaths; those "unable or unwilling" to do the breaths could do presses alone.

Now the heart association has given equal standing to hands-only CPR. Those who have been trained in traditional cardiopulmonary resuscitation can still opt to use it.

Sayre said the association took the unusual step of making the changes now - the next update wasn't due until 2010 - because three studies last year showed hands-only was as good as traditional CPR. Hands-only will be added to CPR training.

An estimated 310,000 Americans die each year of cardiac arrest. Only about 6 percent of those who are stricken outside a hospital survive, although rates vary by location. People who quickly get CPR while awaiting medical treatment have double or triple the chance of surviving. But less than a third of victims get this essential help.

Dr. Gordon Ewy, who's been pushing for hands-only CPR for 15 years, said he was "dancing in the streets" over the heart association's change even though he doesn't think it goes far enough. Ewy (pronounced AY-vee) is director of the University of Arizona Sarver Heart Center in Tucson, where the compression-only technique was pioneered.

Ewy said there's no point to giving early breaths in the case of sudden cardiac arrest, and it takes too long to stop compressions to give two breaths - 16 seconds for the average person. He noted that victims often gasp periodically anyway, drawing in a little air on their own.

Anonymous surveys show that people are reluctant to do mouth-to-mouth, Ewy said, partly because of fear of infections.

"When people are honest, they're not going to do it," he said. "It's not only the yuck factor."

In recent years, emergency service dispatchers have been coaching callers in hands-only CPR rather than telling them how to alternate breaths and compressions.

"They love it. It's less complicated and the outcomes are better," said Dallas emergency medical services chief Dr. Paul Pepe, who also chairs emergency medicine at the University of Texas Southwestern Medical Center.

One person who's been spreading the word about hands-only CPR is Temecula, Calif., chiropractor Jared Hjelmstad, who helped save the life of a fellow health club member in Southern California

Hjelmstad, 40, had read about it in a medical journal and used it on Garth Goodall, who collapsed while working out at their gym in February. Hjelmstad's 15-year-old son Josh called 911 in the meantime.

Hjelmstad said he pumped on Goodall's chest for more than 12 minutes - encouraged by Goodall's intermittent gasps - until paramedics arrived. He was thrilled to find out the next day that Goodall had survived.

On Sunday, he visited Goodall in the hospital where he is recovering from triple bypass surgery.

"After this whole thing happened, I was on cloud nine," said Hjelmstad. "I was just fortunate enough to be there."

Goodall, a 49-year-old construction contractor, said he had been healthy and fit before the collapse, and there'd been no hint that he had clogged heart arteries.

"I was lucky," he said. Had the situation been reversed, "I wouldn't have known what to do."

"It's a second lease on life," he added.

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On the Net:

Heart Association: http://www.americanheart.org/handsonlycpr

Sarver Heart Center: http://www.heart.arizona.edu/

© 2008 The Associated Press.

WASHINGTON (AP) -- Chronic heartburn is a daily acid bath for the esophagus, and complications from it are on the rise. New government figures show a worrisome increase in esophagus disorders from severe acid reflux. The worst one, esophageal cancer, is continuing its march as the nation's fastest-growing malignancy.

What to do if you're one of the estimated 3 million Americans whose eroded esophagus means high risk for this especially deadly cancer? More doctors are trying to zap away the worst damage, beaming radiofrequency energy down the throat to burn off precancerous cells.

While it's not yet certain that will block cancer from ever forming, the studies are promising enough that specialists have begun debating how to better find at-risk patients, people who suffer a condition called Barrett's esophagus. Ironically, a damaged esophagus may no longer feel the burn of acid reflux, keeping sufferers in the dark.

"You become desensitized. You can go a long time without knowing you have Barrett's," warns Dr. John I. Allen of the American Gastroenterological Association.

Heartburn sometimes is a temporary problem, but it also can signal gastrointestinal reflux disease, or GERD, where a loose valve allows stomach acid to regularly back up into the delicate esophagus. Millions have GERD, which is on the rise along with expanding waistlines. For most people, acid-suppressing medications are the answer.

But severe reflux over many years can cause serious problems for a fraction of people. The lining of the esophagus erodes until it bleeds, narrows to make swallowing difficult or, worse, starts to repair itself with more acid-resistant intestinal cells that happen to be more cancer-prone. That last condition is called Barrett's esophagus, and sufferers are 30 times more likely than the average person to go on to develop esophageal cancer.

Hospitalizations for all reflux-caused esophageal disorders doubled between 1998 and 2005, says a sobering new count by the U.S. Agency for Healthcare Research and Quality.

And over the past two decades, esophageal cancer has risen six-fold. About 16,470 Americans will be diagnosed with it this year, according to the American Cancer Society. Fewer than one in five survives five years, and 14,280 are predicted to die this year.

Hence a renewed focus on Barrett's patients, to try to prevent their damage from progressing to cancer.

The good news is that esophageal cancer is slow to develop, so Barrett's patients are given regular down-the-throat exams to spot precancerous changes in cells. Those termed "high-grade dysplasia" are the most dangerous - one in five of those patients will get full-blown cancer within five years.

Cutting out the esophagus has long been standard treatment to stop high-grade dysplasia from turning into cancer. Don't go straight to that extreme step, say guidelines issued last week by the American College of Gastroenterology.

Instead, the new guidelines urge a two-step process: Send a device down the throat to carefully slice off the precancerous layer and make sure it hasn't already turned into invasive cancer. Then burn away the remaining Barrett's tissue with other endoscopic techniques in hopes of getting healthy cells to grow back in its place - as long as patients stay on long-term, acid-controlling drugs, too.

There are various ways to burn away the problem areas, but specialists increasingly are turning to a device named Barrx that lets them nestle a balloon directly onto the esophagus lining and beam RF energy straight into it.

Small studies suggest Barrx can successfully treat precancerous spots in about 90 percent of patients with no return in two years and counting. Specialists are anxiously awaiting a more in-depth study, to be released later this spring, that compared 120 patients who got either Barrx or a sham procedure.

"It'll have very impressive results," promises Dr. Richard Sampliner of the University of Arizona Health Sciences Center, one of the 19 participating medical centers.

A big question, though, is whether precancerous cells still lurk under the new healthy cells that form, ready to grow again. So patients getting Barrx or other ablation treatments today can't yet abandon regular endoscopic exams.

"Common sense suggests if we eliminate the Barrett's segment, we're going to eliminate the cancer in people. That really will take decades to know for certain," cautions Dr. John Carroll of Georgetown University Hospital.

But Carroll is optimistic enough that this spring, Georgetown begins a study to see if it's worth doing Barrx treatment even earlier - in patients whose Barrett's esophagus hasn't yet developed precancerous spots.

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Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

© 2008 The Associated Press.

CHICAGO (AP) -- Two big studies offer good news to people with high blood pressure, finding that novel ways to use cheap drugs already on the market can lower their risk of heart attacks, stroke and death - even if they are very old.

Both studies were stopped early so the surprising benefits could be made known. Doctors presented results Monday at an American College of Cardiology conference in Chicago.

"It is never too late to start" on blood pressure drugs, said Dr. Nigel Beckett of Imperial College in London, who led one study in the elderly that also was published online by the New England Journal of Medicine.

More than 70 million Americans have high blood pressure - readings of 140 over 90 or more - and only a third have it well controlled by medicines. Guidelines advise starting on one, usually a "water pill," and adding others as needed.

With each new medication, "You get more pills, more copays," said Dr. Kenneth Jamerson of the University of Michigan. "Our idea is, if you have to add on, why not do two right off the bat" in a single pill.

He led a study testing a single daily pill combining a diuretic and the ACE inhibitor benazepril versus a daily pill containing benazepril and a calcium channel blocker, amlodipine. ACE inhibitors dilate blood vessels to lower pressure. Calcium channel blockers do the same in a different way.

A total of 11,462 people in the United States and Nordic countries were given one combo or the other. Their average age was 68, and besides high blood pressure they were obese, had diabetes or other health problems.

Neither they nor their doctors knew which drugs they were taking until the study was stopped in October after it was clear that people on the ACE-calcium blocker combo were doing better.

Those people had about 15 percent fewer heart-related problems or strokes - 531 among the 5,721 in this group versus 653 events among the 5,741 others, Jamerson said.

Six months of treatment with either combo brought blood pressure to an acceptable range for 73 percent of patients.

The study was paid for by Novartis, which sells Lotrel, the combo that proved better, and Jamerson consults for the company. The drugs are all sold as generics, although the doses in some require two pills a day instead of one.

The findings could shape treatment guidelines due to be reviewed in a few months, said Dr. Daniel Jones, a University of Mississippi blood pressure specialist and president of the American Heart Association.

Doctors can start with a combination, but few do, partly for lack of evidence, he said.

Guidelines also may change to reflect a second study that found dramatic benefits for treating people in their 80s, an age when blood pressure drugs were not known to be safe or effective.

"The over-80s are the most rapidly expanding segment of our population," and the prevalence of blood pressure rises as people age, Beckett noted.

His study assigned 3,845 older people in Europe, China and several other countries to take the diuretic indapamide or dummy pills plus the ACE inhibitor perindopril as needed to reach a goal of 150/80 from an average starting pressure of 173/91.

The study was stopped last July after monitors saw that those on the diuretic had 39 percent fewer fatal strokes and 21 percent fewer deaths from any cause - benefits far exceeding what researchers predicted.

Jones called it one of the most important studies at the cardiology meeting and a key advance for older people. The study did not include frail older people in nursing homes, who might reap less benefit than healthier people, doctors noted.

Also at the conference:

-The diabetes drug Actos shrunk artery buildups that can lead to heart disease when tested against glimepiride, an older diabetes drug, in a study of 360 diabetics led by Cleveland Clinic cardiologist Steven Nissen.

"This is the first time in which a diabetes therapy has been shown to slow or prevent" heart disease, he said. Results were published online by the Journal of the American Medical Association.

-A combined analysis of six studies on Celebrex, the only COX-2 inhibitor painkiller still on the market since the withdrawal of Vioxx, gives reassurance of the drug's relative safety for people who do not have big heart disease risk factors when they start taking the drug.

It tested doses used by people with rheumatoid arthritis and other severe chronic pain - roughly double the levels used by people with more common osteoarthritis.

The federally funded study was published in the journal Circulation.

"It gives me some comfort" about the safety of Celebrex, said Nissen, who is leading a larger study of the Pfizer Inc. drug and other painkillers.

© 2008 The Associated Press.

DES MOINES, Iowa (AP) -- An outbreak of a sometimes dangerous lung ailment that affected an unlikely group - associates of the American Lung Association - probably stemmed from a meeting they attended at the Iowa governor's mansion, officials say.

Doctors began reporting cases of histoplasmosis, an unusual but treatable lung disease caused by a fungus this year, and eventually there were 36 confirmed cases and 12 probable ones.

After several dead ends, the investigation led to the 139-year-old governor's mansion, called Terrace Hill, just west of downtown Des Moines.

While the initial cases of histoplasmosis involved people associated with the American Lung Association's state chapter, not all of them had visited the group's headquarters. They had, however, attended an association event at the governor's mansion on Nov. 29.

"Those people had only one thing in common, and that was Terrace Hill," said Patricia Quinlisk, the state's chief epidemiologist. "Other things happened, linked them, but they seemed to drop away. There was a correlation."

Neither Gov. Chet Culver nor his wife, Mari Culver, attended the gathering, but both were tested and found not to have the condition.

While the mansion is suspect No. 1, final test results for the cause of the outbreak were still pending.

"We are waiting for the test results so we can say, 'Aha, it really was there," Quinlisk said.

The ailment is caused by an airborne fungus from bird or bat droppings, sometimes kicked up during remodeling of an old building.

Officials have noted that there was some construction at Terrace Hill around the time of the Lung Association event. That might have been enough of a disturbance to put the offending spores in the air. The ornate mansion, built in 1869, has served as the official governor's residence since 1977.

Officials said the investigation has been long but in some ways beneficial.

"We had some folks get fairly sick," said Tom Newton, the director of the state Public Health Department. "They needed to get on anti-fungal drugs and in some cases are still recovering. But it is a teachable moment. ... It gives us a chance to test our public health system and to learn from it."

The respiratory ailment passes as flu-like symptoms in most people but can be fatal, particularly to those with suppressed immune systems.

One of the nation's largest histoplasmosis epidemics occurred in 1978, when more than 100,000 people in Indianapolis were affected, about 300 so seriously that they were sent to hospitals. Fifteen people died. The fungus was believed to have been in the soil and hurled into the air at a construction site.

© 2008 The Associated Press.

NEW YORK (AP) -- Scientists are scanning human DNA with a precision and scope once unthinkable and rapidly finding genes linked to cancer, arthritis, diabetes and other diseases.

It's a payoff from a landmark achievement completed five years ago - the identification of all the building blocks in the human DNA. Follow-up research and leaps in DNA-scanning technology have opened the door to a flood of new reports about genetic links to disease.

On a single day in February, for example, three separate research groups reported finding several genetic variants tied to the risk of getting prostate cancer.

And over the past year or so, scientists have reported similar results for conditions ranging from heart attack to multiple sclerosis to gallstones. The list even includes restless legs syndrome, a twitching condition best known as "jimmy legs" in an episode of "Seinfeld."

Interviews with scientists at the center of this revolution and a review of published studies over the past six months by The Associated Press make clear the rapid adoption of the new technology and the high expectations for it.

Since 2005, studies with the gene-scanning technique have linked nearly 100 DNA variants to as many as 40 common diseases and traits, scientists noted this month in the Journal of the American Medical Association.

"There have been few, if any, similar bursts of discovery in the history of medical research," two Harvard researchers declared last summer in the New England Journal of Medicine.

What does all this excitement mean for ordinary people? Not so much just yet. Simply finding the genes that can raise the risk of an illness doesn't mean you can prevent the disease. And developing a treatment for it can take years.

But there have been some payoffs already.

One involves a leading cause of blindness in older people, age-related macular degeneration. A series of genome-wide scans, the most recent in 2005, "led to huge breakthroughs in understanding" that disease, said Stephen Daiger, a Houston scientist.

When scientists implicated a particular gene that's involved in a system of disease-fighting proteins in the blood, it gave scientists a "slap-on-the-forehead kind of insight ... into the biology of what's going on," said Daiger, a vision genetics expert at the University of Texas Health Sciences Center.

That galvanized research into the disease. And at least one new drug is being tested in patients now.

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What's made this and other hopeful findings possible is the "genome-wide association study," which lets scientists scan the entire complement of DNA from thousands of people in unprecedented detail. While the basic technique is not new, its popularity has exploded recently because of cost-cutting advances in technology and discoveries about the genome.

"It lets you go searching for that needle in the haystack," says Michael Watson, executive director of the American College of Medical Genetics.

It's a big haystack. DNA is made up of long sequences of building blocks, sort of like sentences composed from a four-letter alphabet: A, C, G and T. The human genome contains about 3 billion letters, about as many as the total number of letters and digits in more than 100 Manhattan phone books.

Scientists have identified the order of the letters in the human genome, a feat the government declared accomplished in 2003. But of course, different people have slightly different DNA sequences. People commonly differ in what letter they have at about 10 million positions along the full genome. Some folks may have a T where most people have a C, for example.

And those single-letter variations are key to the genome-wide scans. Basically, scientists compare DNA from a large number of people, some sick with a particular disease, and others healthy. They can look at a half-million or more positions to see what letter appears. If sick people tend to show a different result than healthy ones - say, if they tend to have a T in some spot more often than healthy people do - it's a red flag.

It suggests that some genetic influence on the risk of that disease comes from that spot or nearby. So it gives scientists a specific place to look more closely for a disease-promoting gene.

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In practice, genome scans can be big undertakings.

Scientists in Iowa and Denmark are searching blood samples from 7,000 babies and new mothers in the United States and Denmark for genetic variations that raise the risk for premature birth.

DNA will be extracted, and early this summer, more than half a million spots on the microscopic strands from each mother and baby will be assessed for clues to where the genetic variations may lie.

The DNA will be analyzed at the Center for Inherited Disease Research at Johns Hopkins University in Baltimore. Robots will put a tiny drop of DNA-bearing solution from each person onto a clear glass slide roughly the size of a business card, with four drops per slide.

The lab's DNA scanners, blue boxes each about twice as big as a desktop printer, will reveal what DNA "letter" appears in more than 580,000 spots in the genetic material, said lab director Kimberly Doheny.

This scan takes about half an hour per sample. Once the results are available, the scientists will use statistical tests to find the telltale signs of a possible gene affecting risk of premature birth. They'll double-check to make sure any such signal shows up in more than one population.

Even five years ago, such a detailed examination of DNA from so many people would have been inconceivable.

Genome scans offer some major advantages over previous gene-hunting techniques. Scientists don't have to start by guessing what genes might be involved in a disease, or confine themselves to families where a tendency to an illness is inherited.

And the genome-scan approach reveals genes with only subtle influence on the risk of getting sick, too slight to be found by earlier methods. That's just the kind of gene that plays a role in common illnesses like heart disease.

Even if its impact on risk is small, a newly found gene can be a bonanza to scientists if it reveals something new about the biology of a disease. That in turn can give hints for finding new treatments.

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For non-scientists, the most direct payoff of finding new disease genes may be in devising tests to identify people at elevated risk for a particular disorder.

Most genetic variants found in the genome scans boost a person's risk by around 50 percent. If the disease risk is fairly low, that's "not something you'd lose much sleep over," Watson said.

More useful, he said, is the notion of finding variants in maybe a half-dozen genes that affect the risk for a disease, then testing a person for all of them at once to come up with a more powerful indicator.

Earlier this year, for example, Swedish researchers reported preliminary evidence that men with four or five particular gene variants ran more than four times the risk of getting prostate cancer than men with none of them. When family history was factored in, such a combined test could identify men who ran a nine-fold higher risk.

An Iceland-based company, deCode Genetics, announced in February that it is offering a test for eight genetic variants related to prostate cancer. Altogether, the variants make 10 percent of men run twice the normal risk of prostate cancer, and 1 percent run three times the normal risk, the company said.

Dr. Teri Manolio of the National Human Genome Research Institute said it'll take more work to figure out the value of genetic testing for prostate cancer. There is no proven treatment to prevent it; the only advice to a man at higher risk would probably be for more aggressive screening for the disease.

Then there's the question about what people will do with gene test results. What if you already know that everybody should watch their weight, for example, and then a DNA test shows a heightened risk for diabetes and your doctor tells you to ... watch your weight?

Maybe people would pay more attention to health advice if they knew they were genetically vulnerable to getting sick otherwise. But maybe not. It's an open question, Manolio said.

"I think some people will," Watson said. "I think some people just won't, because they're the kind of people who aren't influenced by those sorts of things.... I'm not pessimistic or optimistic, but I'm sure not everybody does the right thing."

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On the Net:

Explanation of genome scans: http://www.genome.gov/20019523

More information: http://www.genome.gov/20019523 2

Catalog of published gene scans: http://www.genome.gov/GWAstudies

© 2008 The Associated Press.