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Breast Biopsy Accuracy Is Questioned in Experimental Study

The Gilmer Free Press

CHICAGO — Here’s another reason for getting a second medical opinion: Biopsy specialists frequently misdiagnose breast tissue, potentially leading to too-aggressive treatment for some women and under-treatment for others, a study suggests.

The results indicate that pathologists are very good at determining when invasive cancer is present in breast tissue, but less adept at making the right diagnosis with less serious conditions or when biopsied tissue is normal.

The study involved 115 U.S. pathologists and 240 breast biopsy specimens. Their diagnoses were matched against those of three experts. It was an experiment and may not reflect what happens outside a research setting, but the authors say the results highlight the challenges of accurately interpreting tissue under a microscope.

The study was published in Tuesday’s Journal of the American Medical Association.

About 1.6 million breast biopsies are performed each year nationwide, typically after radiologists spot something suspicious on a mammogram. Tissue is withdrawn through a needle or from a surgically removed growth and examined under a microscope. Previous research has shown that interpreting mammograms can also be tricky and lead to under- or over-treatment.

Among the new study’s findings:

—Pathologists correctly diagnosed abnormal, precancerous cells about half the time, no better than a coin toss, said lead author Dr. Joann Elmore, a University of Washington researcher. Treatment for this condition typically includes frequent monitoring and sometimes medication. About a third of these cases were misdiagnosed as not worrisome or normal, while 17% were deemed more suspicious or cancer. Since as many as 160,000 U.S. women each year are diagnosed with this condition, the results suggest many may be getting inappropriate treatment, Elmore said.

—Pathologists mistakenly found something suspicious in 13% of normal tissue.

—They had similar trouble with a condition called DCIS — 13% of these cases were misdiagnosed as less serious, while 3% were mistaken for invasive cancer. DCIS involves abnormal cells confined to a milk duct and is diagnosed in about 60,000 U.S. women each year. Cases have increased because of rising mammogram use, and it can sometimes spread so usual treatment is surgery and radiation.

“As a woman, I would probably want to get a second opinion” with a diagnosis of abnormal pre-cancer or DCIS, Elmore said.

A JAMA editorial notes that the study lacks information on patient outcomes, so there’s no proof that the experts made the correct diagnosis. Also, pathologists weren’t allowed to consult with colleagues when they were uncertain about findings — while in the real world those consultations happen frequently, said editorial co-author Dr. David Rimm, a Yale University pathology professor who also interprets biopsies.

Still, he said the results are troubling and highlight that pathology is an imperfect science. Rimm said he has been asked to offer a second opinion, and that patients make those requests though their primary care physicians.

The editorial says the results “should be a call to action for pathologists and breast cancer scientists” to improve and refine definitions of breast tissue abnormalities.

___

Online:    JAMA          Breast Biopsies

Bon Appétit: Carrot and Beet Slaw with Pistachios and Raisins

The Gilmer Free Press

Ingredients:

Servings: 6

  2 garlic cloves, crushed
  ¾ cup golden raisins
  ¼ cup white wine vinegar
  6 medium carrots (about 1 lb.), peeled, julienned
  2 medium beets (any color; about 1 lb.), peeled, julienned
  ½ cup (packed) fresh flat-leaf parsley leaves
  ¼ cup (packed) fresh mint leaves
  3 Tbsp. fresh lemon juice
  ½ tsp. crushed red pepper flakes
  Kosher salt and freshly ground black pepper
  ⅓ cup extra-virgin olive oil
  ¾ cup unsalted, shelled raw pistachios


Directions:

Preheat oven to 350°. Spread out pistachios on a small rimmed baking sheet; toast, stirring occasionally until golden brown, 6–8 minutes. Let cool; coarsely chop.

Combine garlic, raisins, and vinegar in a large bowl; let sit 1 hour.

Remove garlic from raisin mixture and discard. Add carrots, beets, pistachios, parsley, mint, lemon juice, and red pepper flakes; season with salt and pepper and toss to combine. Add oil; toss gently.

Paleo Isn’t a Fad Diet But an Ideology That Selectively Denies the Modern World

The Gilmer Free Press

The assumptions underpinning paleo have a superficial plausibility.

Australian celebrity chef Pete Evans planned to publish a “paleo diet” cookbook for children, Bubba Yum Yum: The Paleo Way, that encouraged parents to feed infants with a baby formula concoction made from bone broth. After healthcare professionals noted the recipe contained 10 times the safe amount of vitamin A for babies, putting kids at risk of death, the book was last week put on hold.

Then, on Saturday, Evans appeared at Melbourne Town Hall to sell the paleo diet. He reportedly told the crowd that he’s “not going to be silenced” and encouraged them to try his broth anyway. Pan Macmillan on Monday reportedly dropped the book, but Evans will go ahead and self-publish it digitally.

It should be clear that in the view of many dieticians paleo is not just the Atkins diet in Flintstones drag, or just a fad: it’s regarded by many as an ideology, with its own leading lights, intellectual heritage and political hinterland. Paleo advocates don’t just want us to cut down on processed carbs and grains, they’re dedicated to a selective denial of modernity, which in some cases is accompanied by anti-feminist attitudes.

The assumptions underpinning paleo have a superficial plausibility. While technology and culture have changed, it’s argued, our bodies have pretty well stayed the same. We evolved to be hunter-gatherers, and contemporary life, with its carbs and computers, is a mismatch with our biological make-up.

We shouldn’t therefore just give up on modern processed foods, but everything we began eating after we became sedentary farmers. We should stop eating not just Cheetos, but corn; not just Pepsi, but sugar. We should restrict ourselves to the meats, berries and nuts that our ancestors ate when they were living off the land.

The criticism of modern life meshes with the undeniable fact that Western affluence has produced many unintended consequences for public health – many modern processed foods are nutritionally valueless, and a lot of us don’t do as much exercise as we ought. It may also connect with the undeniable alienation many of us feel in a world where technology, fast food and urban living can sometimes seem like a self-imposed prison.

It’s shame, then, that the entire enterprise is to my way of thinking intellectually bankrupt. The presumptions about what people in the old stone age ate are anthropologically naive: many experts argue we can’t make universal claims about that with any degree of certainty, and inconveniently, evidence keeps emerging that people then did help themselves to high-carb foods when they were available. That’s because they were versatile, opportunistic and adaptable, like us.

After we learned how to farm, humans developed the ability to digest gluten and dairy products in a very short space of evolutionary time. (Even companion carnivore species, such as the dog, developed the ability to cope with a higher load of carbohydrates). The paleo diet is premised on a false image of stasis and harmony projected from an entirely arbitrary point in the long history of human evolution.

The human diet, as evolutionary biologist Marlene Zuk argues in her book Paleofantasies, is constantly changing. If we’re going to nominate a period to emulate, why not eat like a medieval peasant, or an ancestral tree shrew?

In my view, the answer to that has little to do with food. The paleolithic is a favoured era because of the way it answers to a desire to justify or reimpose certain social hierarchies, especially those concerning gender.

For John Durant, a paleo thought leader, feminism is a particular bête noire. He spends pages of his cash-in book, The Paleo Manifesto, railing against the feminist Carol Adams, who connected feminism with vegetarianism. At one point he writes that “Adams’s meat-hating, man-hating mantra – ‘Eat Rice Have Faith in Women’ – is intended to undermine the male culture of meat-eating, thus undermining male power, thus reducing rape”.

Durant constructs an image of the “natural” that is entirely ideological. The real appeal of hunter-gatherer life is what he imagines to be its strict partition of gender roles, where “Men were hunters, women were gatherers” and where “women rewarded great hunters” with sex. Paleo eating is here connected with an image of society which reproduces itself largely through masculine competition.

In this connection, to suggest parents feed babies offal soup seems doubly creepy. One interpretation is that it expresses a belief that the bones and guts obtained by the hunter can not only supplant the products of modern medicine, but can effectively substitute for mother’s milk. On this view, the mighty, masculine hunter really can provide everything – except, it seems, a diet that’s safe for children to eat.

~~  Jason Wilson - The Guardian ~~

Study: More Neurosurgeons Required for Brain Bleeds as Population Ages

The Gilmer Free Press

A new study has found that chronic subdural hemorrhage, or SDH, will be the most common adult brain disease in the United States to require neurosurgical intervention by 2030.

According to the study by researchers at NYU Langone Medical Center, published Friday in the Journal of Neurosurgery, the expected increase in SDH cases may cause a shortage of hospitals and neurosurgeons throughout the country.

The findings show that subdural hemorrhage, or subdural hematoma, is bleeding on the surface of the brain, caused by trauma to the head, that can accumulate over time.

The condition is more of a health concern for the elderly due to a spike in brain atrophy. As a result, even the slightest head injuries can trigger SDH. The condition is also common in military veterans and those who suffer from alcohol abuse.

“In 15 years, drainage for SDH will likely be the most common type of adult brain surgery performed, surpassing the number of operations required for brain tumors,“ Dr. Uzma Samadani, co-director of the Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury at NYU Langone, said in a press release.

“If we can identify patients at risk and prevent brain atrophy from occurring as Americans age, we may be able to slow this trend. If not, we are going to need increased neurosurgical and rehabilitation capacity to manage these patients.“

After sifting through U.S. Veterans Administration records from 2000-2012, Dr. Samadani and her team found that 695 new SDH cases were confirmed, with 29 percent of these cases needing surgical draining. That equals to 79.4 SHD cases per 100,000 veterans in the United States. She also found that over 70% of SDH cases affected patients over 65.

Researchers also analyzed data from civilian populations in Finland and Japan where there are more accurate records of SDH incidence rates.

By 2030, Samadani concludes that in the U.S. there will be a whopping 17.6 cases per 100,000 people.

“We have a very large population of elderly and the last of the 77 million baby boomers will have turned 65 by 2030,“ said Samadani. “We can anticipate that 60,000 Americans per year will develop chronic SDHs. Knowing what is ahead of us gives us time to prepare.“

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