CT Scans for Brain Hemorrhages
While extreme headaches typically call for an immediate CT scan of the head, milder headaches challenge physicians to decipher if they are simply headaches or indicators of a subarachnoid hemorrhage. Because they are difficult to detect, smaller hemorrhages are sometimes misdiagnosed as migraines; CT scans are not ordered and the patient is sent home. Unfortunately, untreated hemorrhages sometimes bleed again in the days or weeks after the first hemorrhage, often leading to severe disability or death.
Research at Columbia calls for a lower threshold for administering CT scans to include people with milder brain hemorrhage symptoms, such as less severe headaches, nausea, vomiting, and prominent neck or back pain. "Unlike prior studies that found the most common diagnostic errors were failure to interpret subtle CT or cerebrospinal fluid findings properly, we found that failure to obtain a CT in the first place was the most frequent diagnostic error," says Dr. Stephan A. Mayer, associate professor of clinical neurology (in neurological surgery) and director of the Neurointensive Care Unit at New York-Presbyterian Hospital's Columbia campus. Dr. Mayer led the research, which was published in the Feb. 18, 2004, issue of JAMA.

Impairment Inside Cells May Be Linked to Schizophrenia
A type of communication that goes on inside cells may be linked to schizophrenia, according to researchers at Columbia and Rockefeller University. Scientists have known for years that many different genes and environmental factors play a role in causing schizophrenia, but only during the past two years have some genes been convincingly linked to the disease.
The study suggests that malfunction and lack of communication between two key regulatory proteins inside the cells of people with schizophrenia are involved, impairing a pathway that plays an important role in cell survival and synaptic plasticity of the central nervous system. The study was published in the February 2004 issue of Nature Genetics.
"The challenge now for schizophrenia researchers is to understand how genes that increase the risk for schizophrenia interact with each other to cause disease," says one of the study's senior authors, Dr. Joseph Gogos, assistant professor of physiology and cellular biophysics. "My lab is actively working toward this goal."

Possible Link Between Prenatal Lead Exposure and Schizophrenia
A Columbia study has found a possible relationship between prenatal exposure to lead and a diagnosis of schizophrenia in young adults. The results were presented in February at the 2004 American Association for the Advancement of Science annual meeting.
Dr. Ezra Susser, professor and chairman of epidemiology at the Mailman School, and Dr. Mark Opler, postdoctoral research fellow in psychiatry at P&S, led a team that analyzed second-trimester blood serum samples from a group of people born in Oakland, Calif., between 1959 and 1966. After comparing levels of a well-known biological marker for lead exposure and a diagnosis of schizophrenia years later, the researchers found that people with elevated levels of the biological marker, delta-aminolevulinic acid, were about twice as likely in young adulthood to receive a diagnosis of schizophrenia as those with lower levels.
"The results of our study suggest that lead-induced prenatal damage to the developing brain may show itself decades following initial exposure to the substance," says Dr. Susser.

An Enriched Life May Improve Parkinson's Symptoms
Neurologists often notice that Parkinson's patients who remain socially and physically active do better than patients who become withdrawn. New research in mice suggests that chemical changes in the brain may underlie the benefit of an enriched environment. "Since it's not dangerous and it's easy to do, we can recommend that our patients stay involved in stimulating social and physical activities, though more follow-up studies are needed," says one of the study's authors, Dr. Serge Przedborski, professor of neurology at P&S.
The mouse study shows that the benefit of an enriched environment may stem from an increase in factors in the brain that protect neurons from the disease. Animals raised in a rich environment with several toys produced more of these factors and lost fewer neurons from a Parkinson's-inducing neurotoxin than animals raised in small empty cages. The study was published in the Dec. 3, 2003, issue of the Journal of Neuroscience.

Angioplasty May Benefit Women More
A new analysis comparing angioplasty with clot-busting drugs in female and male heart attack patients finds that women may benefit more from angioplasty than men. Part of the reason is that women treated with clot-busting drugs were found to have higher rates of cerebral hemorrhage than men, says a Columbia researcher who helped lead the research.
Dr. Jacqueline E. Tamis-Holland, assistant professor of clinical medicine and first author of the study, says the results could help women get more appropriate treatments. In general, female heart attack patients are at higher risk for additional cardiovascular problems such as hemorrhage, stroke, and further heart attacks.
The researchers analyzed data from previously published research on 877 male and 260 female heart attack patients who randomly received either angioplasty or clot-dissolving drugs. The study was published in the January 2004 issue of the American Heart Journal.

Hormone Levels and Alzheimer's
A number of studies that have looked at the relationship between hormone levels and Alzheimer's disease have yielded inconsistent results. Researchers at Columbia may have uncovered a critical piece of this puzzle, observing elevated levels of sex-hormone binding globulin — SHBG, a protein strongly associated with estrogen transport — in menopausal women with Alzheimer's disease. The study was published in the February 2004 issue of Neurobiology of Aging.
The researchers, led by Dr. Richard Mayeux, the Gertrude H. Sergievsky Professor of Neurology, Psychiatry, and Epidemiology, measured levels of seven hormones in 576 postmenopausal women, a number of whom had a diagnosis of Alzheimer's disease. The investigators noted significant differences between patients with Alzheimer's and their healthy counterparts only in levels of SHBG, which was 20 percent higher in Alzheimer's patients.
"This finding is noteworthy because we would expect SHBG levels to decrease along with estrogen levels in menopause," says Dr. Mayeux. "The fact that only the women with Alzheimer's demonstrated elevated SHBG levels — with no accompanying increase in estrogen — suggests an abnormality and a possible link between SHBG and Alzheimer's. The role of SHBG during the aging process needs further investigation, however."

Antiviral Drugs for Sickle Cell Anemia
A random screening of several drugs by P&S researchers has found that three common antivirals can transform sickled red blood cells into normal, rounded shapes. The antivirals — acyclovir, valacyclovir, and ganciclovir — are usually prescribed to lessen the symptoms of chickenpox and herpes infections. Their efficacy in transforming the shape of red blood cells, however, could lead to new drugs for sickle cell anemia, say the researchers, Dr. Robert DeBellis, associate clinical professor of medicine, and Dr. Bernard Erlanger, professor emeritus of microbiology. The research was published in the September 2003 issue of Blood Cells, Molecules, and Diseases.
In sickle cell anemia, sickled cells lead to blood clots in all organs of the body. Clots in the brain can cause stroke, and, over the years, the constant interference with other organs leads to organ failure. Clots also cause excruciating pain. "If you can prevent sickling, you essentially stop what the disease is all about," says Dr. DeBellis. The researchers found that, in vitro, the three antivirals turned nearly all the sickled red blood cells from a patient into normal-shaped cells.

Macrophages Unexpectedly Linked to Obesity
Fat cells have taken the blame for such obesity-related conditions as Type 2 diabetes and hypertension, but new research suggests a cell more commonly associated with inflammation may be an equally important contributor.
The new study found that macrophages, cells known to promote and regulate inflammation by releasing inflammatory molecules, infiltrate fat in proportion to obesity in both mice and humans. In the most obese mice, macrophages make up an astounding 50 percent of cells in fat tissue. The macrophages were also found to release the majority of diabetes-related molecules produced by fat tissue. The research appeared in the
Dec. 15, 2003, issue of the Journal of Clinical Investigation.
"The exciting thing is this moves the target of potential therapies away from the fat cell to the macrophage," says the study's leader, Dr. Tony Ferrante, assistant professor of medicine. "We have lots of experience developing anti-inflammatory drugs directed at these types of cells. Pharmaceutical companies may be able to develop ones that affect the fat's macrophages specifically."

Study Changes Field Treatment of Asthma Attacks
Before 2001, if you called an ambulance in New York City because your child was having an asthma attack, the emergency medical technician who arrived was probably an EMT basic who was not allowed to administer asthma medications. That has changed now in New York City and New York state due to the findings of a study led by Dr. David Markenson, a Columbia pediatrician who started his health care career as teenage EMT on Manhattan's Upper East Side.
Dr. Markenson, assistant professor of pediatrics and of population and family health and director of the Program for Pediatric Preparedness at the National Center for Disaster Preparedness in the Mailman School, reported his study results in the January/March issue of PreHospital Emergency Care. With help from colleagues at New York University and support of the Regional EMS Council of New York City, Dr. Markenson designed a research project to see if EMT basics, after passing a four-hour training course, could correctly identify an asthma attack and administer the asthma drug albuterol, used to curtail wheezing and stop asthma attacks. "In our study," Dr. Markenson says, "we found that EMTs correctly identified asthma attacks 85 to 90 percent of the time and that the patients improved because the EMT gave them albuterol." In many cases, the EMT's actions stopped the patient from going into respiratory failure, a fatal condition if not treated adequately.
Even before Dr. Markenson's results were published, the study prompted New York to change the rules for administering albuterol. With additional training, all EMT basics are allowed to treat asthma attacks with albuterol in children over age 5 and adults under age 59.

Elderly Should Not Be Denied a Heart Transplant
Many heart transplant centers rule out cardiac transplants for people over age 65, but a new study from Columbia finds that older heart recipients do just as well as younger recipients in terms of survival, organ rejection, infection, and length of hospital stay.
The study compared the results of 63 patients above age 65 with the same number of patients between the ages of 18 and 65 in the first 10 years after the transplant. No significant health differences were noted in the groups before the operation in terms of diabetes, high blood pressure, lung disease, or vascular disease. The study was published in the December 2003 Annals of Thoracic Surgery.
"Our results show that age alone should not preclude an older person from getting a transplant," says Dr. Mehmet Oz, professor of surgery and one of the paper's authors. "A person over 65 should receive a careful evaluation similar to what younger patients get when being considered for a transplant."

Questionnaire Detects Suicide Risk in Teens
A 10-minute questionnaire can identify teenagers who are at risk of suicide, say researchers at Columbia and the New York State Psychiatric Institute. Although teenage suicide rates have declined in the past decade, suicide is still the third leading cause of death among 15- to 19-year-olds. Most suicide prevention programs are ineffective, however, with some causing distress among adolescents at greatest risk.
In the study, 1,700 high school students completed the questionnaire, which identified 356 students at risk. The researchers then compared their results with a longer interview already known to reliably identify at-risk adolescents. The screening picked up 75 percent of at-risk youths identified by the longer interview. The results appeared in the January 2004 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.
"The screen is very good at picking up kids at risk, and it's so quick an entire school could be screened in a day or two," says Dr. Michelle Scott, assistant professor of clinical psychiatry and one of the paper's authors. The short questionnaire, combined with more detailed follow-up interviews to weed out false positives, could be a critical component of an in-school screening initiative.

ILLUSTRATIONS: CLAUDIA BRANDENBURG

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