Common Infection Caused First U.S. Uterus Transplant to Fail, Hospital Says

By Steven Reinberg
HealthDay Reporter

FRIDAY, April 8, 2016 (HealthDay News) — A common fungus caused the complication that forced Cleveland Clinic doctors to remove a transplanted uterus from a 26-year-old woman just two weeks after the groundbreaking procedure was performed, hospital officials said Friday.

“Preliminary results suggest that the complication was due to an infection caused by an organism that is commonly found in a woman’s reproductive system,” Cleveland Clinic doctors said in a statement. “The infection appears to have compromised the blood supply to the uterus, causing the need for its removal.”

The transplant, the first of its kind in the United States, was performed on Feb. 24. The organ was removed on March 9.

The bacteria involved causes vaginal yeast infections. It is not known whether the infection was caused by bacteria from the recipient or the donor, since some of the donor’s vaginal tissue was involved in the operation, The New York Times reported.

When Cleveland Clinic doctors first announced they had to remove the transplanted uterus back in March, they noted that “there is a known risk in solid organ transplantation that the transplanted organ may have to be removed should a complication arise. The medical team took all necessary precautions and measures to ensure the safety of our patient.”

The patient, Lindsey McFarland, has adopted three children with her husband, but had always longed to give birth to her own child.

Unfortunately, the loss of the implanted organ has set back that dream, Lindsey said in a statement issued in March.

“I just wanted to take a moment to express my gratitude towards all of my doctors,” she said at the time. “They acted very quickly to ensure my health and safety. Unfortunately, I did lose the uterus to complications. However, I am doing OK and appreciate all of your prayers and good thoughts.”

The Cleveland Clinic doctors plan to hold off on more of these procedures, to avoid similar problems in the future, the Times reported. Measures being considered include using antifungal medicines preventively and washing the tissues of both the donor and recipient to reduce the risk of infection.

Initially, 10 transplants were planned as part of a research study, with the uteruses in future operations coming from deceased organ donors. In Lindsey’s case, the uterus came from a woman in her 30s who died suddenly.

The doctors said they are putting a limit on how long a transplanted uterus remains in the body because women have to take powerful drugs to prevent the body from rejecting the uterus, and they do not want women to have to take these drugs their entire life.

Although this was the first U.S. uterus transplant, the technique was pioneered in Sweden. As of last September, nine transplants had been performed, resulting in five pregnancies and four births. The children born to these women are all doing well, the Cleveland Clinic researchers have said.

In Sweden, the transplanted uteruses were all from live donors.

About one in 5,000 women is born without a uterus.

More information

For more on uterus transplants, visit the Cleveland Clinic.

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Tracking Kids’ Eye Movements Might Shed New Light on Autism

FRIDAY, April 8, 2016 (HealthDay News) — New findings about where children with autism look during conversations could lead to changes in treatment programs, researchers say.

The researchers used special technology to monitor the eye movements of 18 children with autism between the ages of 6 and 12, and 19 children without the developmental disorder.

The researchers from the University of Vermont found that children with autism tended to focus more on a speaker’s mouth instead of the eyes when the conversation turned to emotional topics, such as what makes the children sad or scared.

“What you talk about really matters for children with ASD [autism spectrum disorder],” said lead author Tiffany Hutchins, an assistant professor of communication sciences and disorders.

“You just change a few words by talking about what people do versus how they feel and you can have a profound impact on where eyes go for information,” she said in a university news release.

The researchers also found that focusing on the mouth rather than the eyes during emotional conversations was more common among those children with more severe autism and poorer verbal and intellectual ability. It was also common among those with more limited executive function — the mental skills that help people pay attention, manage time and get things done, the researchers said.

It’s not clear why children with autism seem to look at the mouth more often during emotional talks, but it could be because the conversations strain their executive function, according to Hutchins.

Highly emotional topics “likely place high demand on working memory, which, when a threshold is surpassed, makes rendering information from the eye region particularly difficult,” she said.

This may lead the child to start looking for other ways to get information, such as focusing on the mouth. But by doing so, they miss important social meaning provided by the speaker’s eyes, Hutchins said.

The next step is to determine how these findings might apply to speech therapy and other treatment for children with autism.

“Some social skills programs and many treatment goals for children with autism involve trying to get them to initiate and sustain eye contact during interaction,” Hutchins said.

The study is being published in the June issue of the journal Research in Autism Spectrum Disorders.

More information

The National Alliance on Mental Illness has more about autism.

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4 Things New Moms Don’t Need to Feel Guilty About, According to an Ob-Gyn

Photo: Getty Images

As moms, we come up with countless reasons to feel guilty. (My motto as I was raising my four kids: I mother, therefore I am guilty.) But there are certain things that should never, ever cause you an ounce of guilt, including your childbirth choices, and the choices you make during your baby’s early infancy.

How do I know? As an obstetrician-gynecologist who writes extensively about natural childbirth, breastfeeding, and attachment parenting, I’ve read the scientific literature and know that it often differs dramatically from what new moms are told. Below, four instances in which feeling guilty is completely unjustified.

You had an epidural

Childbirth hurts—an unbelievable amount. Pain specialists have found that the pain of childbirth is among the worst pain a human being can experience.

What’s that you say? It’s good pain. No, there’s no such thing as good pain.

Childbirth pain is carried by the exact same nerves, along the same pathways in the spinal cord, to the same pain centers in the brain, by way of the same neurotransmitters as every other source of pain. Yes, the pain comes from a happy event, giving birth. But passing a kidney stone is also a happy event for a sufferer and you don’t notice men declining pain relief for kidney stones.

Epidurals “drug” the baby? The medication in an epidural isn’t injected into the blood stream. It bathes the nerves as they leave the spinal cord. So little of the medication gets into the mother’s blood stream that it doesn’t “drug” her. Even less crosses the placenta so it couldn’t possibly drug the baby.

Sure, epidurals like any form of pain medication carry risks, but those risks apply to the mother, not the baby, and if the mother judges the pain to be severe enough to accept the small risks associated with epidurals (like the 1% risk of spinal headache), it makes sense to accept those risks.

The pain of childbirth is empowering? Call me when they start telling men that unmedicated vasectomy is empowering.

RELATED: 16 Things You Must Know About Sex After Pregnancy

You had a C-section

Childbirth is dangerous. It is a leading cause of death among young women and the leading cause of death for babies. We’ve come a long way in preventing and managing deadly complications, but we can’t abolish all risk. Often the only thing we can decide is who—mother or baby—is going to shoulder that risk.

For example, when a baby is breech (bottom first), the risk of injury and death during childbirth is much higher than if it were positioned head first. If the mother opts to have a C-section, the additional risk to the baby disappears as mom takes on risk (from the surgery) to herself. Women who choose a C-section to protect the baby are behaving selflessly and deserve our admiration, not condemnation.

What about the harms of C-sections to babies? Most of those purported harms are either short-term breathing issues that resolve by themselves or purely speculative, like claims that a C-section can disturb an infant’s gut microbiome (the population of bacteria that lives in the digestive tract). We don’t yet know what constitutes a normal gut microbiome in infants, let alone what a disrupted microbiome looks like.

You stopped breastfeeding (or never started in the first place)

The biggest risk of infant formula comes from making it with contaminated water. In countries with clean water, that risk disappears.

How about the benefits of breastfeeding? The only benefits supported by solid scientific evidence are fewer colds and fewer episodes of diarrheal illness across the entire population of infants.

What about claims that breastfeeding prevents obesity, allergies, and other illnesses? They’re based on evidence that is weak, conflicting, and doesn’t correct for confounding variables like maternal education and socioeconomic status. Women who are more educated and wealthier are more likely to breastfeed. Most of the claimed benefits of breastfeeding are really benefits of having more money and access to high-quality healthcare.

RELATED: Myths and Facts About Breastfeeding

You didn’t feel bonded to your baby right away

Some women feel love at first sight when they meet their future partner, but most don’t. That’s because it takes time for deep and abiding love to develop. The same is true for many mothers and their infants. Love isn’t instantaneous; it grows slowly.

Babies are not ducklings. They don’t imprint on their mothers shortly after birth. Human bonding is a long process that happens spontaneously and inevitably. Everything we know about mother-infant attachment tells us that skin-to-skin contact isn’t necessary. Breastfeeding isn’t necessary. Even being born from the body of your mother isn’t necessary (as any adoptive parent could tell you).

The reality is that being a good mother is NOT about specific parenting choices. The most critical ingredient of good mothering is love. And that love is what makes for a healthy child.

Amy Tuteur, MD, is the author of the new book Push Back: Guilt in the Age of Natural Parenting ($27; amazon.com).

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Some 9/11 First Responders Suffer Severe Sinus Problems: Study

FRIDAY, April 8, 2016 (HealthDay News) — Sinus surgery is more common among firefighters who responded during the first two days of the World Trade Center disaster than those who had less intense or shorter exposures, a new study shows.

The same is true for those firefighters who were at the site for six months or more, the investigators added.

Researchers analyzed the medical records of more than 8,000 firefighters who worked at the Trade Center site and found that over 13.5 years, roughly 1,900 developed chronic rhinosinusitis (CRS) and 479 had surgery for the condition.

CRS causes nasal blockage and drip, facial pain and affects the ability to smell. Most patients can be treated with drugs and don’t require surgery.

Firefighters who responded during the first two days of the 9/11 disaster were 45 percent more likely to need surgery for CRS than those who responded on the third day, when rain reduced air pollution levels, the study found.

Firefighters who worked at the site for six months or more were 48 percent more likely to need surgery for CRS than those who worked at the site for one month, according to the study published April 8 in the Annals of the American Thoracic Society.

The researchers also found that firefighters who needed surgery for CRS had higher levels of immune system white blood cells called eosinophils even before they worked at the Trade Center site. Eosinophil levels are usually checked during routine blood tests.

“Approximately five years after the towers collapsed, we began seeing more and more sinusitis and that has continued unabated to this day,” study senior author Dr. Michael Weiden said in a journal news release. Weiden is an associate professor of medicine and environmental medicine at New York University and a New York City Fire Department medical officer.

“Something that happened 14 years ago still has direct medical consequences in firefighters whose immune system was turned on in a way that prevents it from being shut off,” he added.

Weiden said the startling finding is that those who did not respond well to medication were “different immunologically before 9/11 than those who did.” He said treating those with high eosinophil levels earlier, more intensively or with different medicines might help them avoid surgery.

More information

The American Academy of Family Physicians has more on sinusitis.

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Exercise May Counter Harms From Too Much Sitting, Study Says

FRIDAY, April 8, 2016 (HealthDay News) — Regular exercise helps counteract the harmful health effects of too much sitting, a new British study suggests.

“This research is significant because it demonstrates yet again why physical activity and exercise is so important. It shows that people who spend large amounts of time not moving, either through work, leisure or lifestyle, can counteract some of the negative effects of sedentary behavior by regularly exercising,” study co-author Kishan Bakrania, a University of Leicester researcher, said in a university news release.

Researchers analyzed data from a 2008 national health survey of adults in England. They grouped people according to their levels of physical activity and sitting time.

Adults who sat a lot and didn’t get any exercise had more heart disease and diabetes risk factors than those who spent a lot of time sitting but got regular exercise, the researchers said.

They also found that people who spent less time sitting had higher levels of “good” HDL cholesterol, even if they didn’t get regular exercise.

“By suggesting that being physically active may offset some of the deleterious consequences of routinely engaging in high levels of sedentary behavior, this study further emphasizes the importance of physical activity in the promotion and maintenance of health,” said lead researcher Thomas Yates, from the Leicester Diabetes Centre and the University of Leicester.

However, this was a so-called observational study and further research is needed to confirm these findings, he added.

The study was published online recently in the journal BMC Public Health.

More information

The U.S. National Heart, Lung, and Blood Institute offers a guide to physical activity.

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Better Sleep May Boost Young Students’ Grades

FRIDAY, April 8, 2016 (HealthDay News) — Improving elementary school students’ sleep habits might give their grades a boost, new research suggests.

The study included 74 children in Montreal, aged 7 to 11, who were enrolled in a six-week school program to improve their sleep habits.

An average increase of about 18 minutes of sleep each night led to significant improvements in report card grades, especially in English and math, according to the study published recently in the journal Sleep Medicine.

The findings show that small, cumulative increases in children’s sleep may lead to better marks at school, lead researcher Reut Gruber, a professor at McGill University in Montreal, said in a university news release.

The researchers said parents should ensure children get enough sleep every night and that schools need to find ways to include sleep education programs in their health curriculum.

More information

The National Sleep Foundation has more about children and sleep.

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Schools in Most States Skimp on Phys Ed, Study Finds

FRIDAY, April 8, 2016 (HealthDay News) — Most states don’t provide students with enough physical education, a new report finds.

Just 19 states require elementary school students to take physical education classes for a set amount of time, and only 15 set minimum rules for middle school students.

Only Oregon and the District of Columbia require the amount of physical education time recommended by national experts. That’s 150 minutes a week for elementary students, and 225 minutes for older kids.

In 62 percent of states, students are allowed to substitute other activities for their required physical education credit. Many states let schools withhold physical activity or use it to punish students, according to the 2016 Shape of the Nation report.

The report was released by Voices for Healthy Kids, an initiative of the American Heart Association and the Robert Wood Johnson Foundation, and by SHAPE America — Society of Health and Physical Educators.

“The benefits of physical education ring clear as a school bell,” Nancy Brown, chief executive officer of the American Heart Association, said in a Voices for Health Kids news release. “With effective physical education, we can keep kids’ hearts healthy and their minds in gear to do their best at school every day.”

The good news is that school districts, under a recent law, will be able to get federal funding to improve their programs, the report said.

More information

The U.S. Centers for Disease Control and Prevention has more about children and physical activity.

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Freezing Technique May Ease ‘Phantom Limb’ Pain for Amputees

By Alan Mozes
HealthDay Reporter

FRIDAY, April 8, 2016 (HealthDay News) — A freezing technique may reduce the debilitating phantom limb pain that many amputees experience, according to a new, small study.

Chronic pain that emanates from the site of a severed limb can be reduced in some cases when the remaining nerve and scar tissue is frozen in place, researchers said.

The minimally invasive technique, known as cryoablation therapy, may offer hope to the roughly 200,000 Americans who undergo an amputation every year, according to U.S. Centers for Disease Control and Prevention statistics.

Many such patients, including military veterans and people with diabetes, experience a crippling form of nervous system disorientation after losing a limb.

The study authors said the problem stems from inaccurate signaling among the remaining limb nerve endings and/or overactivity among neighboring nerves.

The result is a distinct feeling of limb pain despite loss of the limb.

The researchers said recent work with 20 patients suggests that targeted freezing may prove a vast improvement on inadequate phantom limb pain treatments.

Typically, “many things are tried to see if it may or may not work,” said study lead author Dr. J. David Prologo, an assistant professor in the division of interventional radiology at Emory University School of Medicine, in Atlanta.

That can mean any combination of psychological counseling, mind-body relaxation techniques, narcotics, antidepressants and/or visual therapy. Surgery may also come into play, in an attempt to remove injured nerves, he said.

Despite all of these varied approaches, “the rate and severity of phantom limb pain in patients today are equal to the rate and severity of patients from 50 years ago,” Prologo said.

But recent freezing therapy research — which focused on the underlying nerve problems responsible for premature ejaculation — suggested that cryoablation might help with phantom limb pain. The bottom line for both conditions, said Prologo, is the same: nerve freezing to stop nerve communication to improve quality of life.

The new findings were presented Wednesday at a meeting of the Society of Interventional Radiology, in Vancouver, Canada.

For the study, 20 amputees diagnosed with phantom limb pain underwent image-guided cryoablation, which involved insertion of a probe needle under the skin at the point of limb loss. Local nerves were then exposed to 25 minutes of cold blasts, which are supposed to shut down localized nerve signaling.

Forty-five days after treatment, average patient pain scores on a scale of 1 to 10 went from 6.4 pre-freezing to 2.4, the study found.

Prologo said efforts are underway to get the process approved by the American Medical Association for phantom limb pain treatment. But, he remains cautious about the current preliminary findings until further research is completed.

“It may not work for everyone,” Prologo said. “Although the overall average change in pain scores and quality of life improved and reached statistical significance, not every single patient got better. How to identify the patient who will respond is the focus of our ongoing research.”

The effectiveness of the new approach will likely depend on each particular case, said Dustin Tyler, a biomedical engineer at the Louis Stokes Cleveland VA Medical Center.

“Phantom pain is very complex,” said Tyler, who is also an associate professor of biomedical engineering at Case Western Reserve University, in Cleveland. For example, for patients whose pain stems from the brain’s search for now-lost sensory input, the procedure will probably not prove helpful, he said.

But for those whose pain has a neurological basis — involving the abnormal firing of pain fibers surrounding the amputation site — “guided cryoablation is an interesting alternative to surgical intervention,” Tyler said.

However, even for these patients, long-term follow-up would be needed to confirm the effectiveness of this approach, he said.

More information

There’s more on phantom limb pain at the U.S. National Library of Medicine.

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Mom’s Obesity, Diabetes May Spur Fetus to Grow Too Fast

By Amy Norton
HealthDay Reporter

THURSDAY, April 7, 2016 (HealthDay News) — Doctors have long known that pregnant women who are obese or have diabetes are more likely to have abnormally large babies. Now a new study suggests that this rapid fetal growth happens early in pregnancy.

British researchers found that babies born to mothers who were obese or had pregnancy-related diabetes were often already overly large by the sixth month of pregnancy.

The researchers said the findings could have practical implications: Right now, pregnant women are routinely screened for diabetes, but often not until the sixth month (24 weeks).

This study raises the question of whether that’s too late, said senior researcher Dr. Gordon Smith, of the University of Cambridge.

“Our study shows that the babies of obese women were more likely to be excessively large around the abdomen even as early as 20 weeks [into pregnancy],” Smith said.

Women who were diagnosed with pregnancy-related diabetes showed a similar pattern — though their babies’ rapid growth became apparent a bit later, at the 28th week of pregnancy, he said.

In the United States, the U.S. Preventive Services Task Force recommends that women be screened for pregnancy-related diabetes after the 24th week of pregnancy.

But, the American Congress of Obstetricians and Gynecologists (ACOG) does advise earlier screening for women at increased risk of pregnancy-related diabetes — including those who are obese, said Dr. Raul Artal. He is professor emeritus of obstetrics and gynecology at Saint Louis University School of Medicine, in St. Louis.

If a woman screens negative, the test should be repeated between the 24th and 28th week of pregnancy, he added.

Regardless, having an excessively large baby is risky for a number of reasons, Artal explained.

For one, it can complicate childbirth and necessitate a cesarean-section delivery. Big babies are also at risk of dangerous blood sugar lows and breathing difficulties after delivery, said Artal.

Some studies have also linked high birth weight to longer-term problems: Big babies may be at higher risk of obesity and diabetes later on, according to Smith’s team.

To Artal, the new findings underscore the importance of going into pregnancy at as healthy a weight as possible.

In a 2013 study, Artal said, his team found that when obese women lost a modest amount of weight after a first pregnancy, it cut their risk of having an abnormally large baby the next time around.

“The best time to lose weight is before or between pregnancies,” he suggested.

But a healthy diet and lifestyle during pregnancy are also vital, according to Artal, who was the main author of guidelines on exercise during pregnancy from ACOG.

Those guidelines encourage women to be active for at least 30 minutes a day, on most days of the week — in part, because it may help prevent or treat pregnancy-related diabetes.

The latest findings are based on over 4,000 first-time mothers who were followed through pregnancy. Just over 4 percent were diagnosed with pregnancy-related diabetes during or after the 28th week of pregnancy, the findings showed.

Using ultrasound scans, Smith’s team found early signs of rapid fetal growth in obese women. Their babies were 63 percent more likely to show abnormally large abdominal growth by the 20th week of pregnancy, versus babies born to thinner women.

When it came to women eventually diagnosed with diabetes, their babies were twice as likely to show excessive growth by the 28th week of pregnancy, versus women without diabetes.

Women who were both obese and diabetic had the fastest-growing babies: They were five times more likely to be excessively large by week 28, compared with babies born to moms who were neither obese nor diabetic, the investigators found.

According to Smith, it’s not clear whether earlier diabetes screening should be more widely adopted. “One response to the current findings might be to screen as close as possible to 24 weeks,” he said.

But it’s not known whether routinely testing even earlier in pregnancy would benefit women and their babies, Smith said.

For now, he advised women to pay attention to their eating habits throughout pregnancy — especially if they are obese or have other risk factors for pregnancy-related diabetes, such as a history of the condition.

“This involves not eating excessive quantities of simple carbohydrates, controlling portion sizes, eating plentiful fresh fruit and vegetables, and remaining active during the pregnancy,” Smith said.

Obese women should also limit their weight gain during pregnancy, Artal said. In the United States, guidelines from different groups recommend obese women gain 11 to 20 pounds during pregnancy — less than the 25 to 35 pounds recommended for normal-weight women.

Artal said he believes the 11-to-20 guideline is actually too much: There is evidence that obese women can safely gain less than that during pregnancy.

The report was published in the April 7 issue of the journal Diabetes Care.

More information

The American Congress of Obstetricians and Gynecologists has more on gestational diabetes.

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Happy Marriage May Prompt Men to Get Colonoscopy: Study

THURSDAY, April 7, 2016 (HealthDay News) — Older men are more likely to get a colonoscopy to screen for colon cancer if they’re happily married and have a highly educated wife, according to a new study.

Researchers looked at more than 800 male-female couples across the United States between 55 and 90 years of age. They found that married men were nearly 20 percent more likely to have had a colonoscopy in the past five years than those who were single.

The rate was nearly 30 percent higher among men in happy marriages, and over 40 percent higher if their wives had high levels of education.

But women who were married, happily or not, were no more likely to get colonoscopies than single women, and their husband’s education level made no difference, according to the University of Chicago researchers.

“Women are thought to control the health capital in most households. They act as health gatekeepers, overseeing their husband’s health choices and directing decisions at the margins. Her decisions influence both partners,” said study director Dr. William Dale, chief of geriatrics and palliative medicine.

Women appear to get fewer direct health benefits from marriage, he said.

“We suspect they depend more on alternate support sources, such as friends and other relatives,” Dale said in a university news release.

Learning more about the influence of spouses may help boost colon cancer screening rates.

Colon cancer is the second-leading cause of cancer death in the United States, but nearly 40 percent of Americans who meet screening guidelines do not get tested. The U.S. Centers for Disease Control and Prevention recommends most people get screened once every 10 years, beginning at age 50.

“We suspect that women who are more emotionally invested in their marriage are more likely to encourage healthy behaviors in their husbands. Husbands are more likely to take this advice when they view their wives as supportive,” Dale said.

Men don’t like to discuss cancer screening, he noted.

“But our data suggest that they will more often do it with proper encouragement and support from their spouse. Our goal now is to engage the wives, to have them in the office when we discuss cancer screening with the husband,” Dale said.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more on colonoscopy.

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