Prostate Cancer Treatment Tied To Hernia Risk

Prostate removal or radiation therapy to treat cancer is tied to two- to four-fold higher than usual risk of later having a hernia repaired, according to a new study. It's not clear why hernia repairs are more common among these men. There might be tissue damage caused by the cancer treatment, or perhaps doctors are finding hernias that might otherwise go undetected, the author said. "You're looking for this in this population," said the author. "These men are being actively treated for prostate cancer, so they're more in tune with the health system and their providers are picking up these hernias." Whether this is leading to overtreatment of hernias that could be left alone is uncertain. There are various types of hernias, and the researchers included femoral and inguinal hernias, which both occur in the groin, in their analysis. They collected medical information from a Swedish national database on more than 28,000 men who had been treated for prostate cancer between 1998 and 2010. Among them, nearly 15,000 had their prostate removed with standard open surgery, another 4,650 had their prostate removed in a minimally invasive surgery and about 9,000 men had radiation treatment. The research team compared the number of hernia procedures among these men to 105,000 men who did not have prostate cancer. Six years after the cancer treatment, 14 percent of men who had open surgery, 10 percent who had the minimally invasive surgery and eight percent who went through radiation ended up having a hernia repaired. In comparison, just four percent of the men who did not have prostate cancer received a hernia repair, the researchers report in the Annals of Surgery. The results translate to a four-fold higher likelihood of hernia repair among men who had open prostate surgery and a two-fold higher risk with radiation therapy. He said he doesn't know why men who received radiation were also at an increased risk of a hernia repair, but that it might be explained by additional hernia diagnoses. The increased detection could also account for some of the additional hernia repairs among men who had prostate removal surgery, he added. Opting for minimally invasive surgery might be one route; men who had this type of surgery were 18 percent less likely to have a hernia repair than the men who had their prostate removed by a larger incision. "I think there has to be an open discussion with the healthcare providers. Just because it exists doesn't mean it has to be fixed," he said.

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Kids' Sinusitis Might Not Need Antibiotics, New Guidelines Say

Doctors don't have to automatically prescribe an antibiotic to treat children who appear to have acute sinus infections, according to new guidelines issued by a leading group of pediatricians. Instead, they can take a "watch and wait" approach if it appears the infection might clear on its own, according to the new American Academy of Pediatrics guidelines. "The practitioner can either treat immediately or consider waiting for a couple of days," said the chairwoman of the academy's subcommittee on acute sinusitis. "If the kid doesn't look dramatically ill, you can wait an extra couple of days to see if they improve on their own." The previous guidelines, passed in 2001, recommended antibiotic therapy for all children diagnosed with acute bacterial sinusitis, which is defined as persistent signs of sinus infection lasting more than 10 days. Doctors now can observe kids for up to an additional three days past that 10-day period to see if their symptoms will ease without antibiotic treatment. "There's nothing absolutely sacred about 10 days. It could be 11 days. It could be 12 days," she added. "In the child who looks sicker, we wouldn't do that. We would start on antibiotics immediately." The new guidelines, published online June 24 in the journal Pediatrics, are driven primarily by concern over antibiotic resistance, she said. There is a lot of overlap between the common cold and acute sinusitis, and some children who are not suffering from a bacterial infection may be receiving antibiotics. "If we prescribe fewer antibiotics, then the problem of antibiotic resistance is controlled," she said. "If you can avoid the use of antibiotics, then that is reasonable." Between 6 percent and 7 percent of children who visit doctors seeking care for a respiratory condition have acute sinusitis, according to the report. Most cases of acute sinusitis develop from a common cold. Colds usually last five to seven days and peak within two or three days, she said. Acute sinusitis does not often develop into a life-threatening illness, but it can be very uncomfortable and even painful. Symptoms of sinusitis include a runny nose, a persistent daytime cough, headache and fever. "I think cases of acute sinusitis resolve on their own, by and by," the chairwoman said. "There are not children who are dying left and right from sinusitis. But there is a quality-of-life issue too. You get better more quickly with treatment." The new guidelines for acute sinusitis also discourage the use of imaging tests to help diagnose the condition in uncomplicated cases.

SOURCE: HealthDay News, June 2013

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Polluted Air Linked To Autism Risk

Pregnant women who live in smog-filled areas may be twice as likely to have children with autism, a new study suggests. "The study does not prove that pollution increases risk for autism. It found an association," said the  lead author. "It adds to the weight of the evidence that there may be something in air pollution that increases risk for autism." Researchers compared exposure to air pollution among 325 women who had a child with autism and 22,000 women who did not. The women were participants in the Nurses' Health Study II. Pollutants measured included diesel particulate matter, lead, manganese, mercury, methylene chloride, and a combined measure of metal exposure. Twenty percent to 60 percent of the women lived in areas considered highly polluted. And the study showed that: those women who lived in the 20 percent of locations that had the highest levels of diesel particulates or mercury in the air were twice as likely to have a child with autism, compared to those who lived in the 20 percent of areas with the lowest levels of these pollutants. In addition, those who lived in the 20 percent of locations with the highest levels of lead, manganese, methylene chloride, and combined metal exposure were about 50 percent more likely to have a child with autism than those who lived in the 20 percent of areas with the lowest concentrations. The findings held even after the researchers took into account other factors known to affect autism risk, such as income, education and smoking during pregnancy. Overall, the association was stronger for boys than it was for girls, but the number of girls included in the new study was too low to draw any firm conclusions. Exactly how, or even if, air pollution affects the developing brain is murky. "By definition, pollution is stuff that is not good for us," the author said. Still, the overall increase in autism risk that may be attributed to pollution is low. "Let's say a woman's risk for having a child with autism is one in 100, women who live in the most polluted cities have a risk that is about one in 50, which means that 49 children would not have autism," researcher added.

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