Sound Medicine -- July 12, 2003

Hosts Barbara Lewis and Dr. Kathy Miller talk to physicians and researchers about:

Aspirin and Colon Cancer

Liver Transplantation

Pediatric Liver Disease

Real Media | Windows Media

Aspirin and Colon Cancer

A simple aspirin taken once a day may reduce the risk of colon cancer, according to two separate studies published recently in the New England Journal of Medicine. The studies included patients who had been cured of colon cancer but were at risk of developing new polyps and patients who had pre-cancerous polyps that were at risk of turning cancerous. In both studies aspirin showed some benefit. However, critics claim the risks associated with taking aspirin do not outweigh the benefits. Dr. Doug Rex, a gastroenterologist and professor of medicine at Indiana University School of Medicine, describes both sides of the debate.

Researchers have been aware of aspirin's cancer-suppressing properties for about ten years. Aspirin has between a 30-50% effectiveness rate in reducing the development rate of colorectal cancer and reducing number of deaths. Studies have shown that people need to take several (4-5) doses per week for it to have any effect. It is not yet known if intermittent use of aspirin has any effect.

However, physicians are not readily recommending aspirin for the treatment and prevention of cancer. Aspirin can cause gastro-intestinal bleeding, particularly in people who have suffered from ulcers or intestinal bleeding in the past. Those taking blood thinners, or who have cirrhosis of the liver are also especially at risk. Regular colonoscopies are much more effective than aspirin for colorectal cancer prevention. Aspirin must not be used as a substitute.

Resources:

Read an IU School of Medicine news release about the study.

More information about aspirin's effects on cancer and the possible risks and drawbacks at WebMD.

A technical explanation of how aspirin and similar drugs work to prevent colorectal cancer.

Liver Transplantation

More than 17,000 patients in the United States are awaiting liver transplants. Sixty-five of those patients reside in Indiana. Clarian Health, which is comprised of Methodist, Riley and Indiana University Hospitals, is the largest transplant center in the state, and liver transplants make up a large part of the transplantation surgeries done there each year. Dr. Joseph Tector, assistant professor of surgery at the IU School of Medicine and a member of Clarian's transplant team, discusses new research in liver transplantation.

Liver transplants have evolved over the years as we learn more about how the liver functions, develop better preservation systems, and acquire more organs. Over 50% of transplants in adults are in response to liver damage from Hepatitis C. Liver disease caused by alcoholism is also frequent, but it is hard to quantify because victims usually have other health problems exacerbated by alcoholism. Auto-immune diseases are another cause for transplantation.

Dr. Tector also describes the organ procurement process and how recipients are chosen.

Resources:

Learn all about organ transplantation at the United Network for Organ Sharing, or UNOS.

Get current statistics about donors and recipients for regions across the U.S. from the Organ Procurement and Transplantation Network, or OPTN.

Candidates for liver transplantation and their families can get the big picture from the University of Southern California'sPatient Guide to Liver Transplant Surgery.

Research from the University of Pittsburgh shows that simple modification of immunosuppressant drug dosages can improve transplantation outcomes. Read about the findings published in the May 2003 issue of Lancet.

Pediatric Liver Disease

In the past twenty years, great strides have been made in the treatment of liver disease in children, which are mostly genetic and metabolic abnormalities. The surgery and drugs needed to prevent rejection of the organ have improved so much that children now often lead normal, long lives. Dr. Jean Molleston discusses pediatric liver transplants with us. She is associate professor of clinical pediatrics at the IU School of Medicine and medical director of the pediatric liver transplant program at Riley Hospital for Children.

Dr. Molleston explains how it's possible to use a piece of a living adult's liver for pediatric liver transplants or to use adult cadaver organs and resize them for children, although a child-sized liver is optimal. Transplanted livers in children appear to work successfully and last a long time, giving the patients amazingly good quality of life, complete with sports and other physical activities.

Although great progress is being made in transplantation for children, a liver-damaging condition called nonalcoholic steatohepatitis (NASH) is on the rise. The result of obesity in children, NASH is caused by fatty tissue in the liver and can lead to heart disease and cirrhosis. Most people who suffer from the disease are between 12-14 years old, and very overweight. Other factors -- such as diabetes, cholesterol disorders, and certain conditions of the ovaries -- can also cause NASH. In most children, however, NASH is caused by obesity.

Resources:

Read a factsheet on nonalcoholic steatohepatitis (NASH) from UpToDate.com. Includes more Web resources.

Experiments in liver transplantation began only 40 years ago. Read a short history of pediatric liver transplants at Emedicine.com.

Get an excellent overview of biliary atresia at the MEDLINEplus Medical Encyclopedia.

A new treatment for infants with biliary atresia may reduce the need for pediatric liver transplants.

Is there a medical topic you'd like us to cover? Reach us by email: soundmed@iu.edu
or by phone:
(317) 274-4848.

With the sun out, new varieties of sunglasses are in – from retro and wraparounds to rectangular and angular styles, from metal and plastic to plain and jeweled. And if that is not enough variety for you, you may pick your lens color as well. What color is safest for tinted sunglasses?

A. Brown
B. Mint green
C. Aqua
D. Doesn't matter

Find out!

Whether you are burning the midnight oil to finish a project or just want a jump-start on a slow morning, you might reach for a cup of hot coffee or a soda to get you started and keep you going. But what is it about caffeine that makes you energetic and helps you keep awake?

Find out!

There is insufficient data to indicate whether patients who do not have symptoms of memory loss or confusion should be administered dementia screening tests, according to a report prepared for the US Preventative Services Task Force and published in the Annals of Internal Medicine.

Early diagnosis of Alzheimer disease has benefits and drawbacks. On the one hand, prescription of medications could slow the initial course of the disease and treat the depression that often accompanies dementia. Patients can also prepare advanced medical directives.

The downside of early diagnosis, however, includes the stigma of being labeled demented, possible employment and insurance discrimination, and depression. And although medications may delay progression of disease, permanent stalling is not possible.

Additionally, routine screening may lead to a high number of both false positive and false negative results. For instance, in the PREVENT study conducted at the Indiana University School of Medicine, a screening trial assessing the benefits or detriments of routine dementia screening in the general population age 65 and above, revealed that 20 percent of individuals considered by their physicians to be demented were not.

Resources:
Read about this report in a June 2003 news release from IU School of Medicine.