Woman wins lawsuit over embryos
 

SAN FRANCISCO, California: A California woman has been awarded $1 million in damages to settle a malpractice lawsuit against a fertility specialist who accidentally implanted her with the wrong embryos, then hid the mistake until her baby was 10 months old, her lawyer said.

The embryos Susan Buchweitz received at a San Francisco clinic were intended for a married couple who underwent in-vitro fertilization the same day using the husband's sperm and a different egg donor. The couple is now seeking custody of the 3-year-old son Buchweitz has raised since birth.

"The whole thing is creepy," said Nancy Hersh, Buchweitz's lawyer in her civil suit against the clinic, its lead doctor and its former embryologist.

The settlement, made public Monday, arose from allegations that both the infertility doctor, Steven L. Katz, and Imam El-Danasouri, the scientist who incubated the embryos and allegedly provided the wrong ones, knew of the mix-up within minutes of Buchweitz's June 15, 2000, in-vitro fertilization procedure.

According to court papers, they concluded it would be better to let nature take its course rather than disclose the error, possibly causing the patient to end the pregnancy. Several experts summoned by Katz's defense in pretrial testimony agreed with that decision.

The couple who provided the embryos also underwent an in-vitro procedure using the same set, and the wife gave birth to a child 10 days after Buchweitz did, making her son and the couple's daughter siblings.

Katz's attorney, Robert Slattery, said Tuesday that his client figured that at age 47 and after two years of trying unsuccessfully to get pregnant, Buchweitz faced long odds with her in-vitro procedure. He worried that if he told her about the switched embryos, he would have to tell the married couple, too, thereby setting the scenario for a custody skirmish.

"The dilemma he had was that if he told somebody, he had to tell everybody, and somebody would be harmed as a result of it," Slattery said.
Buchweitz learned about the switched embryos in December 2001 after the Medical Board of California, acting on an anonymous complaint from a former worker at Katz's clinic, contacted her and said there had been a mistake with her in-vitro procedure. In response to her panicked call, Katz and El-Danasouri went to her home and revealed what had happened.

They also notified the couple, who are unnamed in court papers and filed their own fraud-and-negligence case against Katz and El-Danasouri. The couple, meanwhile, is seeking permanent custody of Buchweitz's son.

A family court judge has granted Buchweitz temporary custody of the little boy and the husband, as the biological father, twice-weekly custody. The issue of how the couple and Buchweitz will divide his care in the future is scheduled to be decided in October, Hersh said.

"It's so ironic the court would ask people who don't know each other to co-parent," Buchweitz said. "There is no psychology book that says how to do this."
Katz, who is being investigated by the Medical Board of California but continues to operate his fertility clinic, indirectly offered his own thoughts in an article published last year in the journal of the San Francisco Medical Society.

"Science can move ahead very quickly," he wrote. "However, ethical standards don't often develop as rapidly."

  
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Hernia Repair Safely Combined with Cesarean Section
 
NEW YORK Aug 13 - Findings from a new study suggest that an inguinal or umbilical hernia arising during pregnancy can be safely repaired at the time of cesarean section, thereby avoiding rehospitalization for a separate repair procedure.

Previous reports have described combining hernia repair with prostatectomy, cholecystectomy, and other abdominal procedures. However, few have described hernia repair performed in conjunction with c-section.

Dr. Nicole Ochsenbein-Kolble and colleagues, from University Hospital in Zurich, compared the outcomes of 8 women who underwent c-section plus hernia repair with those of 305 women who underwent c-section alone over a 10-year period. The hernias repaired included an inguinal hernia in five women and an umbilical one in three.

The new findings appear in the Archives of Surgery for August.

No major complications were observed in any of the women undergoing the combined procedure, but one inguinal hernia patient did experience a minor delay in wound healing, the researchers note.

Compared with c-section alone, adding an inguinal hernia repair, but not an umbilical hernia repair, significantly increased the operating time. No differences in blood loss, opiate use, or hospital stay were noted between combination surgery patients and controls.

After a mean follow-up period of 56 months, no hernia recurrences were noted in the study group. With the exception of one patient who attributed chronic leg pain to the combined procedure, the subjects were satisfied with the operation and said they would recommend it to others.

"Our results in a pilot group indicate that the combination approach is safe, effective, and well accepted," the authors state. "Confirmation in a larger population should establish it as a recommendable procedure."

Arch Surg 2004;139:893-895.

 
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Increased Diesel Exhaust Exposure increases Risk of Ovarian Cancer
 
The risk of ovarian cancer, but not esophageal or testicular cancers, increases with increased exposure to diesel exhaust, according to a new study in the August 20th issue of the International Journal of Cancer.

"Occupational exposure to diesel exhaust has been classified as probably carcinogenic and that to gasoline engine exhaust as possibly carcinogenic to humans," Dr. Johannes Guo, of the Finnish Institute of Occupational Health, Helsinki, Finland, and colleagues write. "Earlier results concerning cancers other than lung cancer are scarce and inconsistent, and exposure-response relations have seldom been reported."

The researchers assessed the risk of leukemia and cancers of the esophagus, ovary, testes, kidney, and bladder associated with engine exhaust. They followed a cohort of active Finns born between 1906 and 1945 for 30 million person-years during 1971 to 1995. A record linkage with the Finnish Cancer Registry was used to identify incident cases of esophageal cancer (n = 2198), ovarian cancer (n = 5082), testicular cancer (n = 387), kidney cancer (n = 7366), bladder cancer (n = 8110), and leukemia (n = 4562).

A job-exposure matrix was used to convert occupations from the population census in 1970 to exposure to diesel and gasoline engine exhausts. The team calculated cumulative exposure (CE) as product of prevalence, level and estimated duration of exposure.

There was an increased risk ratio (RR) for ovarian cancer with increasing CE to diesel exhaust (p = 0.006). The RR was 3.69 in the highest CE category. The RR was significantly increased only in the middle CE category for gasoline engine exhaust (RR = 1.70).

"A significant increase of the RR (1.17) was found for kidney cancer among men with the lowest CE levels to diesel exhaust, but there was no increase at higher exposure levels," Dr. Guo and colleagues write. "An excess of bladder cancer was observed only at the lowest level of exposure to gasoline engine exhaust."

"In conclusion, our study suggests a positive exposure-response relation between occupational exposure to diesel exhaust (or a factor related to diesel exhaust) and ovarian cancer," the authors conclude. "Our results do not support previous findings suggesting an association between engine exhausts and risk of esophageal, testicular, kidney, or bladder cancers, or that of leukemia."

Int J Cancer 2004;111:286-292.

 
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Worm protien may slow Parkinson's
 
A type of protein which helps increase lifespan in yeast and worms could offer hope for new treatments in diseases such as Parkinson's and Alzheimer's.
Researchers from Washington School of Medicine say it appears to help prevent damage to nerve cells in the brain which occur in such diseases.

The team say it may be possible to create drug or gene treatments which can mimic this action.
The research is published in the magazine Science.
The scientists, based in St Louis, looked at nerve cells in mice.
They looked at axons, which connect nerve cells to other cells.

In diseases such as Parkinson's and Alzheimer's, it is thought these axons may start to "self-destruct" before the nerve cells actually die.

It was found that a protein called SIRT1 appeared to block some or all of this process.

The effect was confirmed when the scientists administered a drug which shuts down the activity of this type of protein to the nerve cells - and found the protective effect disappeared.

The proteins have previously been linked to extending the lifespan in yeast and the tiny worm C. elegans.
Jeffrey Milbrandt, professor of medicine and of pathology and immunology at the medical school, who led the research, said: "It's becoming clear that nerve cell death in these disorders is often preceded by the degeneration and loss of axons.

"If this mechanism for delaying or preventing axonal degeneration after an injury proves to be something we can activate via genetic or pharmaceutical treatments, then we may be able to use it to delay or inhibit nerve cell death in neurodegenerative diseases."

The researchers said the next step in the research was to look at exactly how SIRT1 delayed axon damage.

Death rates
In a second study, published online by the British Medical Journal, researchers from the University of Birmingham found a cheap, but rarely used drug could be one of the most effective treatments for Parkinson's Disease.

The team looked at results from 17 separate studies which compared the effectiveness of Selegiline, from a group of drugs called monoamine oxidase type B inhibitors (MAOBIs), with the commonly used drug levodopa and dummy treatments.

Use of Selegiline fell significantly in the UK after a 1995 study showed it was linked to high death rates.
But the scientists who carried out this latest analysis suggest this was probably a chance finding.
They say further long-term studies are needed to provide a conclusive answer.

A spokeswoman for the Parkinson's Disease Society said it supported any investigations into more effective drug treatments for the disease.
She added: "We also welcome the US study into the potential of treatments to slow nerve cell damage.

"Research into therapies and treatments, which may enable the rate of this degeneration to be slowed or even reversed, is a key area of interest."
Professor Clive Ballard, Director of Research at the Alzheimer's Society. added: "Further research holds great potential for developing a novel therapeutic approach for Alzheimer's disease and other diseases involving the death of nerve cells.

"There is however a long way to go before there will be practical applications for people with dementia."
 
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