Health Updates 19 July 2012

• Non-surgical treatment of common shoulder injury in baseball players may increase chances of return-to-play: “Surgically repairing a painful shoulder injury in baseball players known as a SLAP tear (superior labral) varies widely and often doesn’t allow for return to play at the same level as before the injury.  However, researchers presenting their findings at the American Orthopaedic Society  for Sports Medicine‘s Annual Meeting in Baltimore, Maryland suggest that nonsurgical treatment may be more beneficial.  ‘Our research showed that nonsurgical treatment of SLAP tears was more often successful than surgery, and in position players more frequently than for pitchers,’ said David Lintner, MD, lead researcher from Methodist Center for Sports Medicine in Houston, Texas.  ‘We need more research to determine why the nonsurgical treatment was more beneficial to one population than the other, but our findings did illustrate that nonsurgical treatment should be preferred’.”  Dr. Lintner and his team underwent a retrospective review of 119 professional baseball players who had persistent shoulder pain that limited their ability to play and compete.  More than half had MRI-confirmed SLAP lesions  and had failed initial physical therapy.  All were treated nonsurgically.  Return to playing appeared to occur at a higher rate among position players than pitchers – 73% vs. 40%.  “‘Returning to the same level of competition as before the injury, is almost always difficult for an athlete, and surgery is often thought of as the best avenue.  With additional research, orthopaedists are finding different routes to treat some of the most common throwing injuries,’ said  Lintner.” (AOSSM news release)
  
• Chemical intolerance a common complaint: study “A sizable percentage of low-income patients in primary care may be particularly sensitive to chemicals in household cleaners, perfumes, and other everyday products, a small study suggests.  The study, done at two Texas family medicine practices, screened patients for symptoms of ‘chemical intolerance’, also known as multiple chemical sensitivity.  It’s a controversial diagnosis, and there’s no agreement on the cause – or that it even should be considered a disorder unto itself.  But there is a standard screening questionnaire that’s been used in studies and in some doctors’ practices.  It asks people about whether they feel sick when they’re around various smells and chemicals – like gasoline, paint, perfumes, cleaning products or insecticides – and how bad the symptoms are.  Using that questionnaire, researchers found that 20 percent of 400 patients they screened met the criteria for chemical intolerance.  Most studies on chemical intolerance have focused on higher-income, white people.  But patients in this study were largely lower-income and Hispanic.  So the findings give an idea of the prevalence of such symptoms on an understudied group, according to lead researcher Dr. David A. Katemdahl, of the University of Texas Health Science Center at San Antonio.  He said lower-income Americans may, in theory, be more likely to have chemical intolerance since they more often have jobs that would routinely expose them to chemicals.”  The whole subject is controversial.  Many doctors do not believe the intolerance exists at all; chemical intolerance often goes hand-in-hand with mental health issues.  According to Dr. Katemdahl, however, having mental health problems does not rule out intolerance.  And some might become depressed or anxious because of their chemical intolerance symptoms, which include headaches, dizziness, breathing problems and stomach upsets. (Reuters Health)
• Watching equals surgery in early prostate cancer: “Radical prostatectomy for localized prostate cancer did not significantly reduce mortality compared with observation, results of a randomized clinical trial showed.  Neither overall mortality nor cancer-specific mortality differed significantly between men who had surgery and those who were prospectively followed.  The absolute difference was less than 3% for both outcomes, as reported in the July 19 issue of the New England Journal of Medicine.…’Our findings support observation for men with localized prostate cancer, especially those who have a low PSA value and those who have low-risk disease,’ Timothy J. Wilt, MD,of the University of Minnesota…and co-authors wrote.  ‘Up to two-thirds of men who have received a diagnosis of prostate cancer have a low PSA value or low-risk disease, but nearly 90% receive early intervention – typically surgery or radiotherapy’.  ‘Informing men of the favorable long-term effects of  observation on mortality, bone metastases, urinary and erectile function, and quality of life and increasing the use of observation may avert the harms of unnecessary biopsies and interventions while maintaining excellent long-term disease-specific survival,’ they added.  In an interview with MedPage Today and ABC News, Wilt described the results as a convincing demonstration that surgery does not reduce mortality versus observation in men with PSA screening-detected prostate cancer.  Moreover, the study showed that observation not only is a wise decision but the right decision for most men with prostate cancer.  Despite the study’s limitations – most notably, low statistical power – the trial produced results consistent with those of a prior study of active surveillance for men with low-risk prostate cancer, authors of the accompanying editorial wrote.”  Of course, aggressive, high-grade prostate cancers will require swift treatment.  The authors emphasize that prostate cancer is not a monolithic cancer but a spectrum of disease.  “The screening, detection and treatment we provide must focus on cancers that matter, and future clinical trials must do so as well.” (Charles Bankhead, MedPage Today)
• FDA makes it official: BPA can’t be used in baby bottles and cups: “The Food and Drug Administration said Tuesday that baby bottles and children’s drinking cups could no longer contain bisphenol A, or BPA, an estrogen-mimicking industrial chemical used in some plastic bottles and food packaging.  Manufacturers have already stopped using the chemical in baby bottles and sippy cups, and the FDA said that its decision was a response to a request by the American Chemistry Council, the chemical industry’s main trade association, that rules allowing BPA in those products be phased out, in part to boost consumer confidence.  But the new prohibition does not apply more broadly to the use of BPA in other containers, said an FDA spokesman, Steven Immergut.  He said the decision did not amount to a reversal of the agency’s position on the chemical.  The FDA declared BPA safe in 2008, but began expressing concerns about possible health risks in 2010.  Michael Taylor, deputy commissioner for foods at the agency, said the decision simply codified what the industry was already doing based on the preference of consumers and did not reflect concerns about the safety of BPA in baby bottles or toddler’s cups.  The decision ‘solidifies legally that the use will not happen again in the future’ in baby bottles and cups for toddlers, he said.  He added that the agency ‘has been looking hard at BPA for a long time, and based on all the evidence, we continue to support its safe use’.  BPA has been used since the 1960s to make hard plastic bottles, cups for toddlers and the linings of food and beverage cans, including those that hold infant formula and soda.  Until recently, it was used in baby bottles, but major manufacturers are now making bottles without it.  Plastic items containing BPA are generally  marked with a 7 on the bottom for recycling purposes.  The chemical can leach into food, and a study of over 2,000 people found that more than 90 percent of them had BPA in their urine.  Traces have also been found in breast milk, the blood of pregnant women and umbilical cord blood.” (NY Times)