Omega-3 may fight Alzheimer brain changes

A fatty acid found in fish may help thwart the buildup of brain proteins linked to Alzheimer's disease, a study in mice suggests. In Alzheimer's disease, lesions known as "plaques" and "tangles" form in the brain, due to the abnormal clumping of two proteins called beta-amyloid and tau. The mouse study found that a diet rich in the fatty acid DHA might interfere with this process. DHA, short for docosahexaenoic acid, is a type of omega-3 fatty acid found mainly in fatty fish like salmon and mackerel, and to a lesser extent in seaweed, eggs, organ meats and DHA-fortified foods. While the new findings come from studying mice, they complement studies in humans that have linked higher fish intake, as well as higher blood levels of DHA, to a lower risk of Alzheimer's disease. Such research suggests that the animal findings might well translate to people, Dr. Frank LaFerla, the senior author on the new study, told Reuters Health.
He and his colleagues at the University of California at Irvine report their results in the Journal of Neuroscience. Several co-authors on the study are with Martek Biosciences Corp., a Maryland-based company that makes a DHA product used in a range of infant formulas, foods and supplements. For their study, the researchers used mice genetically engineered to develop Alzheimer's- like plaques and tangles. At the age of 3 months, the animals were placed on one of four diets. One diet mimicked the typical American diet, with low amounts of omega-3 fats and far higher levels of omega-6 fats, which are found in various vegetable oils, eggs and meat. The other three diets were rich in omega-3 fatty acids; one was supplemented with DHA only, while the other two had added DHA and omega-6 fats.
After 9 months, the study found, mice on the diet supplemented with DHA alone had lower levels of beta-amyloid and tau in their brain tissue than the animals in the other three groups.
The researchers also discovered that DHA may confer its benefit by lowering levels of an enzyme needed to generate beta-amyloid. What's needed now, according to LaFerla, are clinical trials involving people with early-stage Alzheimer's to see whether DHA supplements can slow the progression of the disease. Martek has just launched such a study, he said.
(AP)

Eating Disorders

What is an eating disorder?
An eating disorder is an obsession with food and weight that harms a person's well-being. Although we all worry about our weight sometimes, people with an eating disorder go to extremes to keep from gaining weight. There are two main eating disorders: anorexia nervosa and bulimia.

What causes eating disorders?
Did you know?

• Millions of people have an eating disorder.
• 90% are women.
• Victims may be rich or poor.
• Eating disorders usually start in the teens but may begin as early as age 8.
  

We don't know exactly. Possible causes include feeling stressed out or upset about something in your life, or feeling like you need to be "in control." Society also puts a lot of pressure on people to be thin. This pressure can contribute too.

What is anorexia?
People with anorexia are obsessed with being thin. They don't want to eat, and they are afraid of gaining weight. They may constantly worry about how many calories they take in or how much fat is in their food. They may take diet pills, laxatives or water pills to lose weight. They may exercise too much. Anorexics usually think they're fat even though they're very thin. People with anorexia may get so thin that they look like they're sick.

What is bulimia?
Bulimia is eating a lot of food at once (called bingeing), and then throwing up or using laxatives to remove the food from the body (called purging). After a binge, some bulimics fast (don't eat) or overexercise to keep from gaining weight. People with bulimia may also use water pills, laxatives or diet pills to "control" their weight. People with bulimia often try to hide their bingeing and purging. They may hide food for binges. Bulimics are usually close to normal weight, but their weight may go up and down.

What's wrong with trying to be thin?
It's healthy to watch what you eat and to exercise. What isn't healthy is worrying all the time about your weight and what you eat. People with eating disorders do harmful things to their bodies because of their obsession about their weight. If it isn't treated, anorexia can cause the following health problems:

• Stomach problems
• Heart problems
• Irregular periods or no periods
• Fine hair all over the body, including the face
• Dry, scaly skin
  

If it isn't treated, bulimia can cause the following health problems:

• Stomach problems
• Heart problems
• Kidney problems
• Dental problems (from throwing up stomach acid)
• Dehydration (not enough water in the body)
  

Can eating disorders be treated?
Yes. For anorexics, the first step is getting back to a normal weight. If you're malnourished or very thin, you may be put in the hospital. Your doctor will probably want you to see a dietitian to learn how to pick healthy foods and eat at regular times. For both anorexics and bulimics, family and individual counseling (talking about your feelings about your weight and problems in your life) is helpful.

What are the warning signs?
The following are possible warning signs of anorexia and bulimia:

• Unnatural concern about body weight (even if the person is not overweight)
• Obsession with calories, fat grams and food
• Use of any medicines to keep from gaining weight (diet pills, laxatives, water pills)
  

More serious warning signs may be harder to notice because people who have an eating disorder try to keep it secret. Watch for these signs:

• Throwing up after meals
• Refusing to eat or lying about how much was eaten
• Fainting
• Over-exercising
• Not having periods
• Increased anxiety about weight
• Calluses or scars on the knuckle (from forced throwing up)
• Denying that there is anything wrong

[AAFP]

Earwax

What is earwax?
Earwax, or cerumen (suh-ROO-mun) , is a wax made in your ear. It protects the skin inside your ear canal.

Can earwax cause a problem?
Not in most people. But wax can build up and block your ear canal. This can cause pain, hearing problems, ringing in the ear, or dizziness.

Who gets earwax buildup?
Anyone can get it. It is more likely in:
. Older people
. People with mental retardation
. People who use cotton swabs in their ears
. People who wear hearing aids or earplugs

How can my doctor tell if I have too much earwax?
Your family doctor can look into your ear canal to see if there is too much wax or if it is blocking your ear canal.

What if I have earwax buildup?
Your doctor can remove wax buildup with an ear spoon, use ear drops to soften the wax, or wash out the ear with water. There are many over-the-counter products that can remove wax. If you use one of these, be sure to follow the directions on the package. Never put cotton swabs or other items into your ear canal. Talk to your family doctor if you are worried about wax buildup.
[AAFP]

Thimerosal in vaccines has no link to autism

Exposure to thimerosal, a mercury-containing chemical previously used as a preservative in vaccines, does not increase the risk of autism. "Fierce debate" continues over whether thimerosal exposure raises the risk of autism, the authors point out. In the last two decades, there has been a rise in autism cases, which coincided with increased usage of vaccines containing thimerosal. Although studies have shown no evidence of an association, thimerosal was removed from all routine childhood vaccines in the U.S. in 2002.
The present study involved a telephone survey of 214 mothers of 230 children with autism or a related disorder. Exposure to thimerosal-containi ng Rh immune globulin, a vaccine administered to some women to avoid pregnancy complications, was compared between this group and the general population. The researchers found that autistic children were no more likely than unaffected children to have been exposed to Rh immune globulin, lead author Dr. Judith Miles, from the University of Missouri-Columbia, and colleagues report.
These findings provide more evidence that childhood autism is not caused by thimerosal, the authors conclude. They hope this report will encourage all parents to adhere to immunization recommendations. A lack of compliance is known to increase the risk of serious complications and death in children who may contract infectious diseases.
(Am J of Med Genetics)

The Dieter's Dilemma

The Dieter's Dilemma: People will try almost anything to lose weight. Really

In her quest to shed pounds, Amy Jamieson-Petonic tried the cabbage-soup diet, a hot-dog and peanut-butter diet, and just about everything in between. Then, after an "aha" moment as she tried on a size 22 coat, she said, "No more." She started eating smaller portions and healthier foods, and took up running. Lo and behold, she slowly lost 100 pounds. Fifteen years later, Jamieson-Petonic, now a 38-year-old registered dietitian and spokeswoman for the American Dietetic Association, has kept off all the weight. "Real people can do this," she says.
Easier said than done. A remarkable 41 percent of U.S. adults are trying to lose weight-and their average goal is 37 pounds, according to a Consumer Reports survey published this month. (Two thirds of U.S. adults are overweight or obese.) Small wonder they're tempted to try such, um, unusual regimens as Beyonc�'s maple-syrup, lemon-juice and cayenne-pepper diet. Or the grapefruit diet. Or the blood-type diet. But experts say they should try some common sense instead. "They sound wacky, and they are wacky," says Walter Willett, professor of epidemiology and nutrition at the Harvard School of Public Health. "If you do something extreme in your diet, you will likely lose weight in the short term because you're excluding the majority of foods. But it's not going to be something you can live with for the rest of your life, and so it's bound to fail." As swimsuit season approaches, here's a rundown on some of today's odder diet options.

The Astrology Diet
In "Zodiaction: Fat-Burning Fitness Tailored to Your Personal Star Quality," trainer Ellen Barrett and astrologer Barrie Dolnick promote an exercise and eating plan based on the 12 astrological signs. Scorpios are "fiery" and need "cooling foods," says Barrett. "It sounds fun, but there's no scientific backing for it," says the ADA's Andrea Giancoli.

The Blood-Type Diet
In "Eat Right 4 Your Type," Peter D'Adamo, a naturopathic doctor, argues that people should eat according to their blood type. A type A, he eats lots of fish and avoids processed meats. "There's no evidence that different people with different blood types need different diets," says Willett. So what's the appeal? People "think it's more personal than other diets," says Giancoli.

Single-Food Diets
Grapefruit. Cabbage Soup. Pineapple. Single-food diets are perennial favorites. "They keep coming back," says Giancoli, who admits she tried single-food diets-including her own popcorn diet-before becoming a registered dietitian and trying (gasp!) a balanced diet and moderate quantities. Eliminating complete food groups can lead to nutrient deficiencies. The body needs protein, for example, to build and repair muscles.

The Maple-Syrup Diet
Sounds yummy, but this draconian plan doesn't allow pancakes. Instead, it asks dieters to drink a concoction of 2 tablespoons of maple syrup, 2 tablespoons of lemon juice, a pinch of cayenne pepper and a cup of water. The diet seems new because Beyonc� said she used it to slim down for "Dreamgirls. " But it actually took off in 1976, when Stanley Burroughs wrote "The Master Cleanser." "The really critical thing for weight control is to find something we can live with for the rest of our lives," says Willett. "That would not be maple syrup." The ADA's Susan Moores worries that the diet can interfere with the body's balance of sodium, potassium and fluids. It's particularly detrimental, she says, for kids, teens, pregnant women and nursing moms.

Detox Diets
"For some reason, people think our bodies are full of all kinds of toxins," says dietitian Tara Gidus. Some detox diets, including "21 Pounds in 21 Days," call for "cleansing" with colonics. Translation: enemas. The problem with using them to clear the colon of waste: "it's not really waste at all," says Northwestern University gastroenterologist Alan Buchman. "What people describe as 'toxins' include the normal metabolic products of digestion and the normal bacteria that produce vitamin K and folic acid-and other substances that keep the colon healthy.

The final word goes to James Hill, who runs the University of Colorado-based National Weight Loss Registry, which tracks dieters who have kept off 30 or more pounds for at least a year. What's their secret? They eat a low-fat diet and watch their total calories. They eat breakfast and weigh themselves often. And they get 60 to 90 minutes of exercise a day. No mention of maple syrup.
(Time)

Gastroesophageal Reflux Disease (GERD)

Mitchell Cohen

Every adult, at one time or another, has experienced heartburn and that gnawing mid-chest discomfort after a big meal. Maybe you had one too many hot dogs at the ballpark, or maybe your cousin's chili was a bit too hot for you.
But when these symptoms are frequent or can't be attributed to spicy ingredients, it could be gastroesophageal reflux disease (GERD). And it can be a problem not just for adults, but for children as young as newborns. In fact, it's not uncommon for infants to experience the post-feeding vomiting and fussiness of GERD. Most will outgrow the disease without medication, but there are some who will need more aggressive treatment.

What Is GERD?
The burping, heartburn, and spitting up that are associated with GERD happen when acidic stomach contents move backward into the esophagus (called reflux). If the lower esophageal sphincter (the muscle that connects the esophagus with the stomach) relaxes or is weak, it can allow stomach contents to reflux.
More than 60 million adults experience reflux at least once a month, and it's not usually a cause for alarm. Many times, people aren't even aware that they are experiencing reflux.
With GERD, however, reflux occurs more frequently and causes enough discomfort that the person affected is aware of the condition. About 19 million people have GERD. After nearly all meals, a person with GERD suffers heartburn, also known as acid indigestion, which feels like a burning sensation in the chest, neck, and throat.
It's normal for babies to occasionally spit up small amounts of formula or breast milk following a feeding, particularly when being burped or during periods of movement. For babies with GERD, however, breast milk or formula regularly refluxes into the esophagus and sometimes out of the mouth.
Sometimes babies regurgitate forcefully; other times they experience something like a "wet burp." Because stomach acid is part of what's refluxed, the esophagus can become irritated, resulting in esophagitis. In some cases, babies with GERD can have choking episodes or develop aspiration pneumonia when stomach contents are refluxed up to the level of the trachea (windpipe) and then into the lungs. Babies with GERD may also experience extended periods without breathing known as apnea. If prolonged, these apneic episodes can be life-threatening.

Signs and Symptoms
Heartburn is the most common symptom of GERD in adults and children, and it can last up to 2 hours and is worse after meals. Those with reflux also may feel like food is coming back up into the mouth, leaving a bitter aftertaste of stomach acid.
The symptoms may be worse if a child or adult lies down or if a baby is held in a face-up position after a meal.
Some foods are thought to make GERD worse. Chocolate, peppermint, fried or fatty foods, caffeine, and alcohol may weaken the lower esophageal sphincter. Studies show that smoking may relax the muscle, as may pregnancy (which may explain why many pregnant women experience heartburn). Here are the most common signs that your infant or young child may have GERD:

• pain, irritability, or constant or sudden crying (signs that may be mistaken for colic) after eating
• frequent spitting up or vomiting after eating
• vomiting more than 1 hour after eating
• regular spitting up that continues after the first year, the age when most children grow out of it
• inability to sleep soundly
• "wet burp" or "wet hiccup" sounds
• poor weight gain or weight loss
  

Other, less common signs include:

• constant eating and drinking
• inability to eat certain foods
• refusing food or accepting only a few bites despite hunger
• swallowing problems (such as gagging or choking)
• hoarse voice
• frequent sore throats
• frequent respiratory problems (such as pneumonia, bronchitis, wheezing, or coughing)
• bad breath
• drooling
  

Diagnosing GERD
GERD is often diagnosed by doctors simply taking a good history of the problem. Sometimes a special X-ray called a barium swallow is performed to exclude other causes of vomiting. A barium swallow can also show the refluxing of liquid into the esophagus, and it may show whether the esophagus is irritated or whether there are any physical abnormalities in the upper digestive tract. If your doctor orders this test, your child will be given a small amount of a chalky liquid (barium) to swallow - this liquid will show up on the X-ray.
A more sensitive test called the 24-hour pH-probe study is considered the most accurate way to diagnose reflux. A thin, flexible tube is placed in the esophagus and the tip rests just above the lower esophageal sphincter. The tube is connected to a device that monitors the acid levels in the esophagus. Consistently high acid levels in the lower esophagus indicate the refluxing of stomach acid, as found in GERD.
Another test called a milk scan involves a series of scans that track the journey of a liquid after it's swallowed. A milk scan can show whether a refluxed liquid is aspirated into the lungs. Upper endoscopy, which involves the direct visualization of the esophagus, stomach, and a portion of the small intestines using a tiny fiberoptic camera, also can be used to diagnose GERD. Biopsies (small pinches of the lining of the esophagus) can be obtained at the time of endoscopy to determine whether there is inflammation due to GERD or whether there are other problems such as allergic esophagitis (inflammation of the esophagus due to allergies) that are causing the symptoms.

Complications of GERD
Most babies outgrow the condition by the time they are 1 year old, and it's uncommon for a child to have GERD beyond age 2. Children with developmental or neurological disorders like cerebral palsy, however, are more at risk for the condition and can experience more severe symptoms.
Some children may develop complications as a result of GERD. Because of constant reflux of stomach acid, the esophagus can become red and irritated (esophagitis) . The constant reflux also can be painful, causing a child to refuse to eat. If severe, GERD also can cause bleeding and result in scar tissue that can make it difficult to swallow.
Because a child with GERD loses nutrients from spitting up and also may have a decreased desire to eat, proper nutrition is sometimes a concern. If your child is not gaining weight as expected or is losing weight, talk to your doctor.
Respiratory problems are another possible complication of GERD. If the stomach contents enter the trachea, lungs, or nose, your child can develop breathing problems or pneumonia.

Treating GERD
Although there's no evidence that breast-fed babies spit up less than formula-fed babies or that soy formula is a solution, some babies may benefit from special formulas. Doctors have had more success in recommending that parents slightly thicken their baby's formula or breast milk with rice cereal so that it may cause less reflux. Your doctor may recommend that you try thickening your child's breast milk or formula or that you try a different brand of formula.
Your doctor may also prescribe a medicine to reduce the amount of acid in your stomach.
If medical treatment alone is not successful and your child is failing to grow or develop complications of reflux, a surgical procedure called fundoplication may be an option. Though the procedure may vary, it basically involves creating a valve at the top of the stomach by wrapping a portion of the stomach around the esophagus. In some patients, the fundoplication can be performed using minimally invasive surgery, or laparoscopy.
After surgery, your child may experience a gagging sensation during meals and may feel full more quickly. Also, your child may not be able to burp or vomit.

Caring for Your Child
Babies with GERD should be fed in a vertical position and burped frequently but not too forcefully. After meals, your child should be kept in a seated position or held upright. Meal size may have to be reduced, and you should avoid feeding your child spicy, fatty, and acidic foods (like citrus fruits).
If your child has had surgery, you may need to adjust meal sizes. Smaller meals may help your child feel less full. Encourage your child to chew food more slowly to avoid gagging. Call your doctor if your child is not growing or begins losing weight.
(AAFP)

How to get kids to eat more vegetables

To many children, broccoli, beans and their ilk are just nasty. But a few clever strategies can turn that 'yuck' into 'yes.' The picky eating habits of children can drive parents to distraction. Foods that smell funny, or are too hot, too cold, too crunchy or too mushy: all are candidates for rejection.
And when it comes to trying to get kids to eat their vegetables, the task often seems insurmountable. Youngsters naturally prefer tasty foods that are high in calories - a nod to their biology, which is designed to ensure adequate intake while they're growing rapidly. But these days, with kids eating more of these plentiful, palatable foods and exercising less and less, the most obvious rapid growth is in the size of their waistlines.
Numerous agencies, including the American Heart Assn. and the American Dietetic Assn., are calling for changes to our children's diets. They want kids to eat fewer high-fat, high-sugar foods in favor of foods with more vitamins, minerals and fiber - ones, in other words, that supply the most nutritional bang for their calorie buck.
No one would argue that one way to reduce calorie intake is to eat more nutrient-dense fruits and vegetables. But many kids have a food "neophobia" - literally, fear of the new - that reaches a peak between the ages of 2 and 6. And this, again, can partly be blamed on biology.
Avoiding the unfamiliar may be an evolutionarily adaptive mechanism - one that serves to protect us from eating potentially poisonous substances that existed in abundance in the plant-rich environment of our ancestors. Still, studies suggest that with repeated exposure, dislikes can be transformed into desire.
In a report published in the journal Appetite in 2003, for example, researchers at University College London randomly assigned children ages 2 to 6 and their parents to one of three groups for a two-week study. In one group, parents offered their child a daily taste of a vegetable for which the child had indicated a low preference ranking. In a second group, parents received only general nutrition information about how to increase fruits and vegetables in the diet. The third group served as a control - receiving neither dietary recommendations nor literature. The kids who received daily exposure increased their liking and consumption of the food, and increased the ranking of the vegetable in question significantly more than children in the other two groups.
And, a majority of parents in the "exposure" group felt that the intervention could have a lasting effect on their children. In some cases, foods their youngsters previously wouldn't touch had actually become their favorites. One parent commented that her child looked forward to the daily tasting, because it had "made food more fun."
If the concept of repeated vegetable exposure sounds too daunting, a group at Pennsylvania State University in University Park suggest another tactic for parents - more of a vegetable "sneak attack." In a study presented at a scientific meeting last month, the researchers added pur�ed broccoli and cauliflower to pasta sauce, increasing the nutritional value and decreasing the caloric density of the meal. Children fed the doctored dish could not distinguish it from the conventionally prepared item.
The kids, ages 3 to 5, showed no clear preference for one dish over the other and ate consistent amounts of both. As a result, they ate significantly more vegetables - while reducing their calorie intake by nearly 20%.
Of course, "hiding" vegetables from kids won't necessarily help them acquire a taste for them, which is important for lifelong healthy habits. But there are other strategies to try. It's been shown that kids who help take part in planting, harvesting, purchasing and preparing vegetables generally consume more of these foods. It's also known that parents who offer new foods and set good examples with their own dietary habits are also on the right track. Still, a little covert cookery may be a good strategy for adults, too - recent surveys indicate that only 40% of Americans eat five or more servings of fruits and vegetables per day, and the newest recommendations are that we consume even more than that.
If sneaking a few vegetables into a pasta sauce, soup, casserole or meat loaf will increase vegetable consumption and decrease calorie intake, the whole family wins.
(LAT)

Drug misuse kills 200,000 Chinese a year: doctors

About 200,000 people die in China each year from improper use of drugs, Chinese doctors and pharmacists said during a weekend meeting, and they called for greater efforts to educate consumers.
Mainland Chinese rely more on traditional Chinese medicines than on Western drugs and they tend to use them carelessly because of a widespread misconception that traditional medicines are not toxic or have no side effects.
"People should be told that they can't consume drugs any way they want. There is no drug that has no side effects, they must not take drugs like they eat rice," said Professor Jin Shiming, a committee member of the Guangdong Provincial Science and Technological Association. Speaking at a conference on drug safety organized by the Guangdong Province Association of Traditional Chinese Medicine and a Chinese newspaper, Jin said nearly 200,000 people die each year from improper use of legitimate drugs.
He did not explain how the panelists had calculated that number. "All drugs have some level of toxicity. We can only cut back on the toxicity and reduce adverse reactions with accurate usage," he said.
Jin and other experts at the seminar on Saturday described patients who took excessive doses of traditional medicine in the belief that they would recover more quickly.
Traditional Chinese doctor Mei Quanxi from the Zhongshan Chinese Medicine Hospital cited a case where a man died after consuming a whole ginseng root that his wife bought him. Ginseng is used in the treatment of diabetes and sexual dysfunction.
"Ginseng is a very heaty herb. If you use a lot of it as a tonic, it is dangerous, which is why we have a saying that ginseng can kill," Mei told Reuters after the conference.

SIDE EFFECTS
Many consumers were also ignorant about potential side effects, they said. "For example, some people don't know that they can't mix certain drugs with alcohol, so they die," Jin said. The young are not spared, and a substantial percentage of deaf and mute children in the country owed their conditions to improper drug consumption, another panelist said.
However, they stressed that these 200,000 deaths each year were due to improper use of drugs and not a result of fake drugs, which is also a problem in China.
"These are approved, proper drugs, but if you do not strictly follow instructions when taking them, you will get into problems," Jin said. "This has nothing to do with fake medicine. Anyway, fake medicine is not medicine. They are criminal."
Food and drug safety is under increasing scrutiny in China, following a series of breaches that have drawn attention to insufficient product inspections and oversight.
On Monday, Chinese media reported a second official from China's food and drug agency went on trial last week alongside the watchdog body's former head, in the latest blow to the country's record on food safety. The Beijing Youth Daily reported that Cao Wenzhuang, who headed the medicine registration office at the State Food and Drug Administration, was accused of taking 2 million yuan ($261,000) in bribes from drug companies in exchange for granting approvals.
Fake or bad drugs have killed dozens of people in China in recent years and have raised widespread public fears about drug safety. A Chinese-made medicine ingredient also killed at least 100 people in Panama recently, according to a report in the New York Times.
(Reuters)

Pelvic Inflammatory Disease (PID)

B.P. Homeier

Pelvic inflammatory disease, sometimes called PID, is a progressive (meaning it becomes worse over time) infection of the fallopian tubes, uterus, cervix, or ovaries. Most women develop PID as a result of sexually transmitted diseases (STDs), such as chlamydia or gonorrhea.
Each year, more than a million women will develop PID, with the highest infection rate amongst teenagers. Women with multiple partners and those who don't use condoms are most likely to get STDs and are at risk for PID. If PID goes untreated, it can lead to internal scarring that can result in chronic pelvic pain, infertility, or a tubal pregnancy.

What Are the Symptoms of PID?
PID can cause severe symptoms or very mild to no symptoms. Women who do have symptoms however, may experience:

• pain and tenderness in the lower abdomen
• large amounts of foul-smelling or abnormally colored discharge
• pain during sexual intercourse
• heavier than normal periods
• more painful periods with more cramps than usual
• spotting between periods
• chills, fever, and vomiting
• increased tiredness
• loss of appetite
• backache and perhaps even difficulty walking
• painful or more frequent urination
  

What Can Happen if You Get PID?
Any women with symptoms of an STD should get medical care as soon as possible. An untreated STD has a greater chance of becoming PID. If it is not treated or goes unrecognized, the PID can continue to spread through a woman's reproductive organs and may lead to long-term reproductive problems:

• PID can cause scarring in a woman's ovaries, fallopian tubes, and uterus, and widespread scarring may lead to infertility (the inability to have a baby). A woman who has had PID three times (or more) has an almost 50% chance of being infertile.
• If someone who has had PID does get pregnant, scarring of the fallopian tubes may cause the fertilized egg to implant in one of the fallopian tubes rather than in the uterus. The fetus would then begin to develop in the tube, where there is no room for it to keep growing. This is called an ectopic pregnancy. An untreated ectopic pregnancy could cause the fallopian tube to burst suddenly, which might lead to life-threatening bleeding in a pregnant woman.
• Untreated PID also puts a woman at risk for a tubo-ovarian abscess (TOA). A TOA is a collection of bacteria, pus, and fluid that occurs in the fallopian tube. A TOA is also more likely to occur in women who use intrauterine devices (IUDs) as birth control. A woman with a TOA often looks sick and has a fever and pain that makes it difficult to walk. The abscess will be treated in the hospital with antibiotics, and surgery may be needed to remove it.
  

How Is PID Diagnosed and Treated?
If you think you may have PID, you need to see your family doctor as soon as possible. He/she will likely do a pelvic exam, which may reveal that you have a painful cervix, abnormal bleeding from the cervix, or pain over one or both ovaries. Your family doctor will also take swabs of fluid from your cervix and vagina, and this fluid will then be tested for STDs. A pregnancy test also will be done. Sometimes blood tests will be taken to look for signs of infection, and newer tests have been developed that can diagnose chlamydia and gonorrhea from checking your urine as well.
Sometimes an ultrasound or CT scan of the lower abdomen is needed to take a three-dimensional picture of the reproductive organs. These are often used to diagnose a TOA or ectopic pregnancy. If your provider diagnoses PID, you will be given antibiotics to take for a couple of weeks. It's very important that you take every dose of the medication to completely treat the infection. It's also important to be rechecked 2-3 days after you have begun treatment to make sure that you are starting to improve because PID can be difficult to treat.
Women who have more severe cases of PID - for instance, if they have a fever or look ill - are often treated in the hospital for a few days with antibiotics given directly into a vein through a straw-like plastic catheter. Surgery is sometimes needed for cases of PID that do not get better with antibiotics or if a woman has an abscess. Ectopic pregnancies can require emergency surgery.
If you're not feeling better even after you take all your medication for PID, it's important to follow up with your gynecological health care provider. Be sure to let your provider know you're still not feeling well. Also, it's very important that anyone with whom you've had sex be checked for STDs right away, so they can get treatment. An untreated partner is likely to give you the same STD again, even after you've been treated.

Can PID Be Prevented?
The best way to prevent STDs or PID is to not have sex. However, for those who choose to be sexually active, it's important to use protection and to have as few sexual partners as possible. Using a latex condom effectively and consistently helps protect against most STDs. However, it's very important to have regular check-ups with your family doctor. So when you're making choices about sex, be smart - and be safe.
[AAFP]

HPV Vaccine May Prevent Vaginal, Vulval Cancers

The human papillomavirus vaccine, sold under the brand name Gardasil, may be effective in preventing the vulval and vaginal lesions that cause cancer, according to a new study.
Clinical trials involving more than 18,000 women ages 16-26 in 24 countries across the United States, Europe and Asia showed that the vaccine prevented vulval and vaginal cancers in 71 percent of women previously exposed to HPV and in 100 percent of women who had not been exposed to the virus prior to using the vaccine.
The study was conducted by Professor Jorma Paavonen, of the Department of Obstetric and Gynecology at the University Central Hospital in Helsinki, Finland, and his colleagues. It was published in this week's edition of The Lancet.
The study's authors say there has been a "striking" increase of high-grade vulval pre-cancer lesions, as well as vulval cancer in the past 30 years. "This trend is worrying because these cancers are not amenable to a screening (program)," the authors wrote in the study. "Whereas, previously vulval cancer was seen almost exclusively in older women, recent studies have shown that 20 percent of these cancers now occur in women under 50 years (of age)."
The authors said vulval and vaginal cancers are dangerous because they are often not recognized. And treatment of these cancers "can be mutilating" and cause patients "anxiety, depression, sexual dysfunction and poor self-image."
For maximum results, girls should be vaccinated before they become sexually active. The vaccines effectiveness in preventing vulval and vaginal cancers in women that are already sexually active is expected to be lower due to the prevalence of HPV, the authors said.
(AP)

For aging eyes, vitamins

Antioxidant supplements really can slow macular degeneration, the main cause of severe vision loss.
The product: Eye supplements are a hot topic of conversation in Kerry Beebe's optometry office in Brainerd, Minn., right up there with the weather and Frances McDormand trivia. "We field questions about vitamins multiple times a day," says Beebe, chairman of the Clinical Care Group for the American Optometric Assn.
Patients mainly want to know if vitamins can help save them from macular degeneration, the leading cause of severe vision loss in America. About 13 million Americans - mostly people older than 60 - already have macular degeneration, a disease that breaks down the light-sensitive rods and cones in the center of the retina. Over time, it can blur a person's central field of vision, making tasks such as reading or driving impossible. Treatment options are limited, so it's no wonder many people are interested in vitamins, Beebe says.
Drugstores across the country offer an array of eye supplements, but the market is dominated by Bausch & Lomb products such as PreserVision and several varieties of Ocuvite, including Ocuvite Adult 50 +. All of the Bausch & Lomb supplements combine zinc with large doses of antioxidant vitamins.
PreserVision is especially packed with antioxidants: Two pills (the suggested dose) contain more than 1,000% of the recommended daily allowance of vitamin E and nearly 600% the RDA of beta carotene. The various forms of Ocuvite contain a pigment called lutein but omit beta carotene, a vitamin that can be dangerous to smokers. Ocuvite Adult 50 + combines lutein with
omega-3 fatty acids.
Users are instructed to take two pills of PreserVision or one Ocuvite Adult 50 + each day. Prices vary, but a foray into the vitamin aisle found a one-month supply of PreserVision selling for $18. A one-month supply of Ocuvite Adult 50 + costs about $10.
The claims: John Stewart, senior product manager for vitamins at Bausch & Lomb, says there's "gold-standard clinical evidence" that PreserVision and Ocuvite products can slow down macular degeneration.
The evidence comes from the National Eye Institute's Age-Related Eye Disease Study, or AREDS, published in 2001. The six-year study of more than 3,600 people with mild-to-moderate macular degeneration found that the formula in PreserVision slowed vision loss by about 25%. Supplements also cut the risk by about 25% of moderate cases progressing to a more severe form. Bausch & Lomb has trumpeted the results since. The "AREDS" name is displayed prominently on bottle labels and the Bausch & Lomb website, and labels for PreserVision and varieties of Ocuvite feature the words "clinically proven." Bottom line: In this case, the "clinically proven" label actually fits, Beebe says. Thanks to AREDS, he says, most eye doctors think that antioxidant supplements really can put the brakes on the disease. "The study had a lot of credibility. "
The biology makes sense too, he adds. As he explains, antioxidants should help "gobble up" waste products in the retina. "If we can keep those waste products away, we can keep the rods and cones functioning. " Beebe recommends PreserVision or Ocuvite products to his patients with macular degeneration. Smokers should take Ocuvite Adult 50 + or another variety that contains lutein instead of beta carotene, he says. There's growing evidence that the lutein and omega-3s in Ocuvite Adult 50 + can help slow macular degeneration, he says, but the definitive study - AREDS II - is just getting started.
Patients in their 40s and beyond who want to prevent macular degeneration should also consider taking supplements, Beebe says, although "there's no guarantee it will work."
Dr. David Sarraf, an ophthalmologist at UCLA's Jules Stein Eye Institute, also recommends supplements (including less-expensive store brands) to patients, "but I'm not fanatical about it," he says. Benefits documented by the AREDS trial were fairly modest - enough to make supplements worth considering, he says, but not enough to make them a can't-miss part of treatment.
(AP)

Anesthesia: A medical mainstay re-examined

Some worry about brain cell death in studies of young animals. Human trials are planned. You are asleep on the table, surrounded by beeping monitors and people in white, unaware of the tube down your throat and the slice of the surgeon's knife. You wake a few hours later, as if from deep slumber - and, thanks to the miracle of anesthesia, remember nothing. Back to normal - or so it has long been assumed. The use of anesthetics dates back at least 150 years to when a traveling dentist reported using laughing gas on a patient. Today, anesthesia is an integral part of modern medicine: A survey by the British Medical Journal earlier this year ranked it among the five most important medical advances in recent times.
But recently, a few scientists and clinicians have raised concerns about its possible long-term effects. They suspect, based on studies in animals and lab dishes as well as some preliminary human data, that for patients who are very young, old or sick, anesthesia might have longer-term consequences. "Anesthesia was thought to be something that lasted a few hours, and any consequences would be gone within a day," says Dr. Daniel Sessler, an anesthesiologist and chair of the outcomes research department at the Cleveland Clinic in Ohio. "There is increasing evidence that it is not the case."
It is a minority viewpoint: Most anesthesiologists and surgeons, citing the millions of people the world over who live long, healthy lives after surgery, say there is no call for worry. But the possibility has led Sessler and others to start human trials to examine the issue. The Food and Drug Administration is also taking notice. In March, it convened a panel of experts to look into the long-term safety of pediatric anesthesia.
Those worried about long-term effects cite several possible risks. Sessler suggests that general anesthesia might weaken the body's ability to kill tumor cells released into the bloodstream during cancer surgery, making the disease more likely to return. Other researchers fear that anesthesia could trigger an inflammatory response in the body, eventually leading to atherosclerosis and other serious conditions. But the biggest concern is the effect of anesthetic drugs upon brain cells, especially in infants.
In 2003, Dr. John Olney, professor of psychiatry and neuropathology at the Washington University School of Medicine in St. Louis, reported that an anesthetic mix commonly used on children caused significant loss of brain cells in infant rats. (The cause: a sharp increase in a kind of cell death that naturally occurs during brain development. ) Olney and other researchers have also found that anesthetized baby rodents develop memory and learning problems - as measured by skills such as maze navigation - in adulthood. "The chances are pretty strong that the same effect can occur in humans," Olney says.
Researchers at the FDA have repeated Olney's experiments with rhesus monkeys, which live longer than rats - about 20 years - and are biologically more similar to humans. They also found that 24 hours of anesthesia caused unborn and 5-day-old rhesus monkeys to lose brain cells, although not as many as the rats did. The cell death didn't happen, however, with shorter periods of anesthesia or in older monkeys.
Gregory Crosby, associate professor of anesthesia at Harvard Medical School and Brigham and Women's Hospital in Boston, has found effects on older animals. In 2004, he reported that aged rats given two hours of general anesthesia did more poorly in a maze-running test two weeks later. He also detected abnormalities in the rats' hippocampus - the part of the brain linked to spatial reasoning and memory formation. Mental confusion after surgery has been reported in humans: For example, in 1998, a study in Lancet found that about 10% of elderly surgery patients had a worse score in cognitive tests three months after the operation. But it's not clear if the real culprit for this condition, called post-operative cognitive dysfunction, is anesthesia or the surgery itself.
Many clinical anesthesiologists question the relevance of the animal studies. "Human babies are not large rat pups," says Dr. Sulpicio Soriano, associate professor of anesthesia at Harvard Medical School and senior associate in anesthesia at Children's Hospital Boston. In his own experiments, he says, he had to anesthetize the baby rodents for at least six hours to trigger brain cell death: equivalent to giving several weeks-worth of anesthesia to a human patient. "That is a very artificial condition," he says.
If human infants need major surgery, "we should not be delaying that because of this very preliminary result in rats," says Dr. Roger Moore, first vice president of the Park Ridge, Ill.-based American Society of Anesthesiologists and chair emeritus of the Deborah Heart and Lung Center in Brown Mills, N.J.
A group of researchers including anesthesiologist Dr. Andrew Davidson of the Royal Children's Hospital in Melbourne, Australia, is planning a multinational study of the long-term outcomes of infants undergoing hernia surgery. The patients will get either general anesthesia or spinal anesthesia, which, in theory, has less effect on the brain. The researchers will assess the mental development of the children at two and five years after surgery to see if those who got general anesthesia suffered any long-term effects.
"The study can be regarded as a safety trial," Davidson says. "We'd like to show that anesthesia is safe in babies and doesn't cause injuries." If any of the concerns turns out to be true, what then? Some researchers suggest postponing elective surgery for infants - such as cleft lip repair - until about 3 years of age. Most surgeries on newborns, however, are emergency life-saving operations. "We are not giving anesthesia for fun," Soriano says.
Olney suggests developing a drug that interrupts the cascade of biochemical changes by which anesthetics might destroy brain cells. By giving this hypothetical drug along with the anesthetic, "you can have the benefits of a nesthesia" without the unwelcome side effects, he says. Crosby says he has found, in as-yet-unpublished work, that one commonly used anesthetic is less harmful to lab animals than the others he has tested. Maybe, he says, some of the potentially harmful effects of anesthesia could be avoided by changing the cocktail of anesthetic drugs administered to patients.
An already available option is regional anesthesia - in which only a region of the body is numbed instead of making the patient fully unconscious. In February, Sessler started a clinical trial to compare the cancer recurrence rate of about 1,100 women undergoing breast cancer surgery with either general or regional anesthesia. He hopes to show the latter is more benign. In another clinical trial, he's investigating the long-term outcomes of patients undergoing vascular surgery whose dose of general anesthetic is optimized based on their level of consciousness, as measured by a brain monitor. The idea is to give just enough medication to keep the patient unconscious, he says. A preliminary study of 1,064 patients published in 2005 suggested that this technique could reduce the likelihood of death in the year after vascular surgery. Results of such studies are likely to be subtle, all agree. "Obviously," Crosby says, "we are not rotting out people's brains in a big way or you'd have known that a hundred years ago."
(AP)

Male Reproductive System

Wayne Ho & Steven Dowshen

Ever wonder how the universe could allow the existence of someone as annoying as your bratty little brother or sister? The answer lies in reproduction. If people - like your parents - didn't reproduce, families would die out and the human race would cease to exist.
All living things reproduce. Reproduction - the process by which organisms make more organisms like themselves - is one of the things that sets living things apart from nonliving matter. But even though the reproductive system is essential to keeping a species alive, unlike other body systems it's not essential to keeping an individual alive.
In the human reproductive process, two kinds of sex cells, or gametes (pronounced: gah-meetz), are involved. The male gamete, or sperm, and the female gamete, the egg or ovum, meet in the female's reproductive system to create a new individual. Both the male and female reproductive systems are essential for reproduction.
Humans, like other organisms, pass certain characteristics of themselves to the next generation through their genes, the special carriers of human traits. The genes parents pass along to their children are what make children similar to others in their family, but they are also what make each child unique. These genes come from the father's sperm and the mother's egg, which are produced by the male and female reproductive systems.

What Is the Male Reproductive System?
Most species have two sexes: male and female. Each sex has its own unique reproductive system. They are different in shape and structure, but both are specifically designed to produce, nourish, and transport either the egg or sperm.
Unlike the female, whose sex organs are located entirely within the pelvis, the male has reproductive organs, or genitals (pronounced: jeh-nuh-tulz) , that are both inside and outside the pelvis. The male genitals include:

• the testicles
• the duct system, which is made up of the epididymis and the vas deferens
• the accessory glands, which include the seminal vesicles and prostate gland
• the penis
  

In a man who's reached sexual maturity, the two testicles (pronounced: tes-tih-kulz) , or testes (pronounced: tes-teez), produce and store millions of tiny sperm cells. The testicles are oval-shaped and grow to be about 5 centimeters in length and 3 centimeters in diameter. The testicles are also part of the endocrine system because they produce hormones, including testosterone (pronounced: teh-stass-tuh- rone). Testosterone is a major part of puberty in men, and as a man makes his way through puberty, his testicles produce more and more of it. Testosterone is the hormone that causes men to develop deeper voices, bigger muscles, and body and facial hair, and it also stimulates the production of sperm.
Alongside the testicles are the epididymis (pronounced: eh-puh-dih-duh- mus) and the vas deferens (pronounced: vass de-fuh-runz) , which make up the duct system of the male reproductive organs. The vas deferens is a muscular tube that passes upward alongside the testicles and transports the sperm-containing fluid called semen (pronounced: see-mun). The epididymis is a set of coiled tubes (one for each testicle) that connects to the vas deferens.
The epididymis and the testicles hang in a pouch-like structure outside the pelvis called the scrotum. This bag of skin helps to regulate the temperature of testicles, which need to be kept cooler than body temperature to produce sperm. The scrotum changes size to maintain the right temperature. When the body is cold, the scrotum shrinks and becomes tighter to hold in body heat. When it's warm, the scrotum becomes larger and more floppy to get rid of extra heat. This happens without a man ever having to think about it. The brain and the nervous system give the scrotum the cue to change size.
The accessory glands, including the seminal vesicles and the prostate gland, provide fluids that lubricate the duct system and nourish the sperm. The seminal vesicles (pronounced: seh-muh-nul veh-sih-kulz) are sac-like structures attached to the vas deferens to the side of the bladder. The prostate gland, which produces some of the parts of semen, surrounds the ejaculatory ducts at the base of the urethra (pronounced: yoo-ree-thruh), just below the bladder. The urethra is the channel that carries the semen to the outside of the body through the penis. The urethra is also part of the urinary system because it is also the channel through which urine passes as it leaves the bladder and exits the body.
The penis is actually made up of two parts: the shaft and the glans (pronounced: glanz). The shaft is the main part of the penis and the glans is the tip (sometimes called the head). At the end of the glans is a small slit or opening, which is where semen and urine exit the body through the urethra. The inside of the penis is made of a spongy tissue that can expand and contract.

What Does the Male Reproductive System Do?
The male sex organs work together to produce and release semen into the reproductive system of the female during sexual intercourse. The male reproductive system also produces sex hormones, which help a boy develop into a sexually mature man during puberty (pronounced: pyoo-bur-tee) .
When a baby boy is born, he has all the parts of his reproductive system in place, but it isn't until puberty that he is able to reproduce. When puberty begins, usually between the ages of 10 and 14, the pituitary (pronounced: puh-too-uh-ter- ee) gland - which is located in the brain - secretes hormones that stimulate the testicles to produce testosterone. The production of testosterone brings about many physical changes. Although the timing of these changes is different for every man, the stages of puberty generally follow a set sequence.

• During the first stage of male puberty, the scrotum and testes grow larger.
• Next, the penis becomes longer, and the seminal vesicles and prostate gland grow.
• Hair begins to appear in the pubic area and later it grows on the face and underarms. During this time, a male's voice also deepens.
• Boys also undergo a growth spurt during puberty as they reach their adult height and weight.
  

Once a man has reached puberty, he will produce millions of sperm cells every day. Each sperm is extremely small: only 0.05 millimeters long. Sperm develop in the testicles within a system of tiny tubes called the seminiferous tubules (pronounced: seh-muh-nih- fuh-rus too-byoolz). At birth, these tubules contain simple round cells, but during puberty, testosterone and other hormones cause these cells to transform into sperm cells. The cells divide and change until they have a head and short tail, like tadpoles. The head contains genetic material (genes). The sperm use their tails to push themselves into the epididymis, where they complete their development. It takes sperm about 4 to 6 weeks to travel through the epididymis.
The sperm then move to the vas deferens, or sperm duct. The seminal vesicles and prostate gland produce a whitish fluid called seminal fluid, which mixes with sperm to form semen when a male is sexually stimulated. The penis, which usually hangs limp, becomes hard when a male is sexually excited. Tissues in the penis fill with blood and it becomes stiff and erect (an erection). The rigidity of the erect penis makes it easier to insert into the female's vagina during sexual intercourse. When the erect penis is stimulated, muscles around the reproductive organs contract and force the semen through the duct system and urethra. Semen is pushed out of the male's body through his urethra - this process is called ejaculation (pronounced: ih-jah-kyuh- lay-shun) . Each time a man ejaculates, it can contain up to 500 million sperm.
When the male ejaculates during intercourse, semen is deposited into the female's vagina. From the vagina the sperm make their way up through the cervix and move through the uterus with help from uterine contractions. If a mature egg is in one of the female's fallopian tubes, a single sperm may penetrate it, and fertilization, or conception, occurs. This fertilized egg is now called a zygote (pronounced: zy-goat) and contains 46 chromosomes - half from the egg and half from the sperm. The genetic material from the male and female has combined so that a new individual can be created. The zygote divides again and again as it grows in the female's uterus, maturing over the course of the pregnancy into an embryo, a fetus, and finally a newborn baby.

Things That Can Go Wrong With the Male Reproductive System
Men may sometimes experience reproductive system problems. Below are some examples of disorders that affect the male reproductive system:

Disorders of the Scrotum, Testicles, or Epididymis
Conditions affecting the scrotal contents may involve the testicles, epididymis, or the scrotum itself.

• Testicular injury. Even a mild injury to the testicles can cause severe pain, bruising, or swelling. Most testicular injuries occur when the testicles are struck, hit, kicked, or crushed, usually during sports or due to other trauma. Testicular torsion (pronounced: tor-zhun), when one of the testicles twists around, cutting off the blood supply, is also a problem that some teen men experience - although it's not common.
• Varicocele (pronounced: var-uh-koh-seal) . This is a varicose vein (an abnormally swollen vein) in the network of veins that run from the testicles. Varicoceles commonly develop while a man is going through puberty. A varicocele is usually not harmful, although in some people it may damage the testicle or decrease sperm production, so it helps for a man to see his family doctor if he's concerned about changes in his testicles.
• Testicular cancer. This is one of the most common cancers in men younger than 40. It occurs when cells in the testicle divide abnormally and form a tumor. Testicular cancer can spread to other parts of the body, but if it's detected early, the cure rate is excellent. All men should perform testicular self-examinations regularly to help with early detection.
• Epididymitis (pronounced: eh-puh-dih-duh- my-tus) is inflammation of the epididymis, the coiled tubes that connect the testes with the vas deferens. It is usually caused by an infection, such as the sexually transmitted disease chlamydia, and results in pain and swelling next to one of the testicles.
  

• Hydrocele. A hydrocele (pronounced: high-druh-seel) occurs when fluid collects in the membranes surrounding the testes. Hydroceles may cause swelling of the testicle but are generally painless. In some cases, surgery may be needed to correct the condition.
• Inguinal hernia. When a portion of the intestines pushes through an abnormal opening or weakening of the abdominal wall and into the groin or scrotum, it is known as an inguinal hernia (pronounced: in-gwuh-nul her-nee-uh). The hernia may look like a bulge or swelling in the groin area. It can be corrected with surgery.
  

Disorders of the Penis
Disorders affecting the penis include the following:

• Inflammation of the penis. Symptoms of penile inflammation include redness, itching, swelling, and pain. Balanitis occurs when the glans (the head of the penis) becomes inflamed. Posthitis is inflammation which is usually due to a yeast or bacterial infection.
• Hypospadius is a disorder in which the urethra opens on the underside of the penis, not at the tip.
• Sexually transmitted diseases. Sexually transmitted diseases (STDs) that can affect men include human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), human papilloma virus (HPV, or genital warts), syphilis, chlamydia, gonorrhea, herpes genitalis, and hepatitis B. They are spread from one person to another mainly through sexual intercourse.
  

If you think you have symptoms of a problem with your reproductive system or if you have questions about your growth and development, talk to your family doctor - many problems with the male reproductive system can be treated.
(AAFP)

Female Reproductive System

Wayne Ho & Steven Dowshen

Ever wonder how the universe could allow the existence of someone as annoying as your bratty little brother or sister? The answer lies in reproduction. If people - like your parents - didn't reproduce, families would die out and the human race would cease to exist.
All living things reproduce. Reproduction - the process by which organisms make more organisms like themselves - is one of the things that set living things apart from nonliving matter. But even though the reproductive system is essential to keeping a species alive, unlike other body systems, it's not essential to keeping an individual alive.
In the human reproductive process, two kinds of sex cells, or gametes (pronounced: gah-meetz), are involved. The male gamete, or sperm, and the female gamete, the egg or ovum, meet in the female's reproductive system to create a new individual. Both the male and female reproductive systems are essential for reproduction. The female needs a male to fertilize her egg, even though it is she who carries offspring through pregnancy and childbirth.
Humans, like other organisms, pass certain characteristics of themselves to the next generation through their genes, the special carriers of human traits. The genes that parents pass along to their children are what make children similar to others in their family, but they are also what make each child unique. These genes come from the father's sperm and the mother's egg, which are produced by the male and female reproductive systems.

What Is the Female Reproductive System?
Most species have two sexes: male and female. Each sex has its own unique reproductive system. They are different in shape and structure, but both are specifically designed to produce, nourish, and transport either the egg or sperm.
Unlike the male, the human female has a reproductive system located entirely in the pelvis (that's the lowest part of the abdomen). The external part of the female reproductive organs is called the vulva, which means covering. Located between the legs, the vulva covers the opening to the vagina (pronounced: vuh-jigh-nuh) and other reproductive organs located inside the body.
The fleshy area located just above the top of the vaginal opening is called the mons pubis (pronounced: manz pyoo-bis). Two pairs of skin flaps called the labia (which means lips and is pronounced: lay-bee-uh) surround the vaginal opening. The clitoris (pronounced: klih-tuh-rus) , a small sensory organ, is located toward the front of the vulva where the folds of the labia join. Between the labia are openings to the urethra (the canal that carries urine from the bladder to the outside of the body, which is pronounced: yoo-ree-thruh) and vagina. Once women become sexually mature, the outer labia and the mons pubis are covered by pubic hair.
A female's internal reproductive organs are the vagina, uterus, fallopian tubes, and ovaries. The vagina is a muscular, hollow tube that extends from the vaginal opening to the uterus. The vagina is about 8 to 12 centimeters long in a grown woman. Because it has muscular walls it can expand and contract. This ability to become wider or narrower allows the vagina to accommodate something as slim as a tampon and as wide as a baby. The vagina's muscular walls are lined with mucous membranes, which keep it protected and moist.
The vagina has several functions: for sexual intercourse, as the pathway that a baby takes out of a woman's body during childbirth, and as the route for the menstrual blood (the period) to leave the body from the uterus. A thin sheet of tissue with one or more holes in it called the hymen (pronounced: hi-mun) partially covers the opening of the vagina. Hymens are often different from person to person. Most women find their hymens have stretched or torn after their first sexual experience, and the hymen may bleed a little (this usually causes little, if any, pain). Some women who have had sex don't have much of a change in their hymens, though. The vagina connects with the uterus (pronounced: yoo-tuh-rus) , or womb, at the cervix. The cervix has strong, thick walls. The opening of the cervix is very small (no wider than a straw), which is why a tampon can never get lost inside a woman's body. During childbirth, the cervix can expand to allow a baby to pass.
The uterus is shaped like an upside-down pear, with a thick lining and muscular walls - in fact, the uterus contains some of the strongest muscles in the female body. These muscles are able to expand and contract to accommodate a growing fetus and then help push the baby out during labor. When a woman isn't pregnant, the uterus is only about 7.5 centimeters long and 5 centimeters wide. At the upper corners of the uterus, the fallopian (pronounced: fuh-lo-pee-un) tubes connect the uterus to the ovaries (pronounced: o-vuh-reez). The ovaries are two oval-shaped organs that lie to the upper right and left of the uterus. They produce, store, and release eggs into the fallopian tubes in the process called ovulation (pronounced: av-yoo-lay-shun) . Each ovary measures about 4 to 5 centimeters in a grown woman.
There are two fallopian tubes, each attached to a side of the uterus. The fallopian tubes are about 10 centimeters long and about as wide as a piece of spaghetti. Within each tube is a tiny passageway no wider than a sewing needle. At the other end of each fallopian tube is a fringed area that looks like a funnel. This fringed area wraps around the ovary but doesn't completely attach to it. When an egg pops out of an ovary, it enters the fallopian tube. Once the egg is in the fallopian tube, tiny hairs in the tube's lining help push it down the narrow passageway toward the uterus. The ovaries are also part of the endocrine system because they produce female sex hormones such as estrogen (pronounced: es-truh-jun) and progesterone (pronounced: pro-jes-tuh- rone).

What Does the Female Reproductive System Do?
The female reproductive system enables a woman to:

• produce eggs (ova)
• have sexual intercourse
• protect and nourish the fertilized egg until it is fully developed
• give birth
  

Sexual reproduction couldn't happen without the sexual organs called the gonads (pronounced: go-nadz). Although most people think of the gonads as the male testicles, both sexes actually have gonads: In females the gonads are the ovaries. The female gonads produce female gametes (eggs); the male gonads produce male gametes (sperm). After an egg is fertilized by the sperm, the fertilized egg is called the zygote (pronounced: zi-gote). When a baby woman is born, her ovaries contain hundreds of thousands of eggs, which remain inactive until puberty begins. At puberty, the pituitary gland, located in the central part of the brain, starts making hormones that stimulate the ovaries to produce female sex hormones, including estrogen. The secretion of these hormones causes a woman to develop into a sexually mature woman.
Toward the end of puberty, women begin to release eggs as part of a monthly period called the menstrual cycle. Approximately once a month, during ovulation, an ovary sends a tiny egg into one of the fallopian tubes. Unless the egg is fertilized by a sperm while in the fallopian tube, the egg dries up and leaves the body about 2 weeks later through the uterus. This process is called menstruation (pronounced: men-stray-shun) . Blood and tissues from the inner lining of the uterus combine to form the menstrual flow, which in most women lasts from 3 to 5 days. A woman's the first period is called menarche (pronounced: meh-nar-kee) .
It's common for women to experience some discomfort in the days leading to their periods. Premenstrual syndrome (PMS) includes both physical and emotional symptoms that many women get right before their periods, such as acne, bloating, fatigue, backaches, sore breasts, headaches, constipation, diarrhea, food cravings, depression, irritability, or difficulty concentrating or handling stress. PMS is usually at its worst during the 7 days before a woman's period starts and disappears once it begins. Many women also experience abdominal cramps during the first few days of their periods. They are caused by prostaglandin, a chemical in the body that makes the smooth muscle in the uterus contract. These involuntary contractions can be either dull or sharp and intense. It can take up to 2 years from menarche for a woman's body to develop a regular menstrual cycle. During that time, her body is adjusting to the hormones puberty brings. On average, the monthly cycle for an adult woman is 28 days, but the range is from 23 to 35 days.
If a female and male have sex within several days of the female's ovulation (egg release), fertilization can occur. When the male ejaculates (which is when semen leaves a man's penis), between 0.05 and 0.2 fluid ounces (1.5 to 6.0 milliliters) of semen is deposited into the vagina. Between 75 and 900 million sperm are in this small amount of semen, and they "swim" up from the vagina through the cervix and uterus to meet the egg in the fallopian tube. It takes only one sperm to fertilize the egg.
About a week after the sperm fertilizes the egg, the fertilized egg (zygote) has become a multi-celled blastocyst (pronounced: blas-tuh-sist) . A blastocyst is about the size of a pinhead, and it's a hollow ball of cells with fluid inside. The blastocyst burrows itself into the lining of the uterus, called the endometrium (pronounced: en-doh-mee-tree- um). The hormone estrogen causes the endometrium to become thick and rich with blood. Progesterone, another hormone released by the ovaries, keeps the endometrium thick with blood so that the blastocyst can attach to the uterus and absorb nutrients from it. This process is called implantation (pronounced: im-plan-tay- shun).
As cells from the blastocyst take in nourishment, another stage of development, the embryonic stage, begins. The inner cells form a flattened circular shape called the embryonic disk, which will develop into a baby. The outer cells become thin membranes that form around the baby. The cells multiply thousands of times and move to new positions to eventually become the embryo (pronounced: em-bree-o). After approximately 8 weeks, the embryo is about the size of an adult's thumb, but almost all of its parts - the brain and nerves, the heart and blood, the stomach and intestines, and the muscles and skin - have formed.
During the fetal stage, which lasts from 9 weeks after fertilization to birth, development continues as cells multiply, move, and change. The fetus (pronounced: fee-tus) floats in amniotic (pronounced: am-nee-ah-tik) fluid inside the amniotic sac. The fetus receives oxygen and nourishment from the mother's blood via the placenta (pronounced: pluh-sen-tuh) , a disk-like structure that sticks to the inner lining of the uterus and connects to the fetus via the umbilical (pronounced: um-bih-lih-kul) cord. The amniotic fluid and membrane cushion the fetus against bumps and jolts to the mother's body.
Pregnancy lasts an average of 280 days - about 9 months. When the baby is ready for birth, its head presses on the cervix, which begins to relax and widen to get ready for the baby to pass into and through the vagina. The mucus that has formed a plug in the cervix loosens, and with amniotic fluid, comes out through the vagina when the mother's water breaks. When the contractions of labor begin, the walls of the uterus contract as they are stimulated by the pituitary hormone oxytocin (pronounced: ahk-see-toh- sin). The contractions cause the cervix to widen and begin to open. After several hours of this widening, the cervix is dilated (opened) enough for the baby to come through. The baby is pushed out of the uterus, through the cervix, and along the birth canal. The baby's head usually comes first; the umbilical cord comes out with the baby and is cut after the baby is delivered. The last stage of the birth process involves the delivery of the placenta, which is now called the afterbirth. After it has separated from the inner lining of the uterus, contractions of the uterus push it out, along with its membranes and fluids.

Things That Can Go Wrong With the Female Reproductive System.
Women may sometimes experience reproductive system problems. Below are some examples of disorders that affect the female reproductive system.

Things That Can Go Wrong With the Vulva and Vagina

• vulvovaginitis (pronounced: vul-vo-vah-juh- ni-tus), an inflammation of the vulva and vagina. It may be caused by irritating substances (such as laundry soaps or bubble baths). Poor personal hygiene (such as wiping from back to front after a bowel movement) may also cause this problem. Symptoms include redness and itching in the vaginal and vulvar areas and sometimes vaginal discharge. Vulvovaginitis can also be caused by an overgrowth of candida, a fungus normally present in the vagina.
• nonmenstrual vaginal bleeding, most commonly due to the presence of a vaginal foreign body, often wadded-up toilet paper. It may also be due to urethral prolapse, a condition in which the mucous membranes of the urethra protrude into the vagina and form a tiny, donut-shaped mass of tissue that bleeds easily. It can also be due to a straddle injury (such as when falling onto a beam or bicycle frame) or vaginal trauma from sexual abuse.
  

Things That Can Go Wrong With the Ovaries and Fallopian Tubes

• ectopic (pronounced: ek-tah-pik) pregnancy, when a fertilized egg, or zygote, doesn't travel into the uterus, but instead grows rapidly in the fallopian tube. Women with this condition can develop severe abdominal pain and should see a doctor because surgery may be necessary.
• endometriosis (pronounced: en-doh-mee-tree- o-sus), when tissue normally found only in the uterus starts to grow outside the uterus - in the ovaries, fallopian tubes, or other parts of the pelvic cavity. It can cause abnormal bleeding, painful periods, and general pelvic pain.
• ovarian tumors, although rare, can occur. Women with ovarian tumors may have abdominal pain and masses that can be felt in the abdomen. Surgery may be needed to remove the tumor.
• ovarian cysts, noncancerous sacs filled with fluid or semi-solid material.
  

Although they are common and generally harmless, they can become a problem if they grow very large. Large cysts may push on surrounding organs, causing abdominal pain. In most cases, cysts will disappear on their own and treatment is unnecessary. If the cysts are painful, a doctor may prescribe birth control pills to alter their growth, or they may be removed by a surgeon.

• polycystic (pronounced: pah-lee-sis- tik) ovary syndrome, a hormone disorder in which too many male hormones (androgens) are produced by the ovaries. This condition causes the ovaries to become enlarged and develop many fluid-filled sacs, or cysts. It often first appears during the teen years. Depending on the type and severity of the condition, it may be treated with drugs to regulate hormone balance and menstruation.
  

Menstrual Problems
A variety of menstrual problems can affect women. Some of the more common conditions are:

• dysmenorrhea (pronounced: dis-meh-nuh- ree-uh), when a woman has painful periods.
• menorrhagia (pronounced: meh-nuh-rah- zhuh), when a woman has a very heavy periods with excess bleeding.
• oligomenorrhea (pronounced: o-lih-go-meh- nuh-ree-uh) , when a woman misses or has infrequent periods, even though she's been menstruating for a while and isn't pregnant.
• amenorrhea (pronounced: a-meh-nuh-ree- uh), when a woman hasn't started her period by the time she is 16 years old or 3 years after starting puberty, has not developed signs of puberty by age 14, or has had normal periods but has stopped menstruating for some reason other than pregnancy.
  

Infections of the Female Reproductive System

• Sexually transmitted diseases. These include infections and diseases such as pelvic inflammatory disease (PID), human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), human papilloma virus (HPV, or genital warts), syphilis, chlamydia, gonorrhea, and genital herpes. Most are spread from one person to another by sexual intercourse.
• Toxic shock syndrome. This uncommon illness is caused by toxins released into the body during a type of bacterial infection that is more likely to develop if a tampon is left in too long. It can produce high fever, diarrhea, vomiting, and shock.
  

If you think you have symptoms of a problem with your reproductive system or if you have questions about your growth and development, talk to your family doctor - many problems with the female reproductive system can be treated.
(AAFP)

Mental Illness Strains Schools

Across America, college counseling centers are strained by rising numbers of mentally ill students and surging demand for mental health services - a challenging trend as campus officials try to identify potential threats like the unstable Virginia Tech gunman.
And even when serious emotional problems are detected, university officials often feel constrained in how they respond due to an array of laws and policies protecting students' rights and privacy.
"The number of people coming to colleges who've had psychiatric treatment has increased tremendously, " said Dr. Gerald Kay, a psychiatry professor at Wright State University and chair of the American Psychiatric Association committee on college mental health.
"Now they're able to come to college - that would not have been the case earlier," Kay said. "You've got a very large number of people who may have some vulnerabilities. It has stressed the availability of resources." Reasons for the surge include the Americans with Disabilities Act, which gives mentally ill students the right to be at college, and increasingly sophisticated medications which enable them to function better than in the past.
Recent surveys and studies underscore the scope of the increase. A survey last year by the American College Health Association found that 8.5 percent of students had seriously considered suicide, and 15 percent were diagnosed for depression, up from 10 percent in 2000. The Anxiety Disorders Association of America found that 13 percent of students at major universities and 25 percent at liberal arts colleges are using campus mental health services.
Dr. Chris Flynn, director of Virginia Tech's counseling center, has declined to discuss details of gunman Cho Seung-Hui's case, but said the center's staff - which includes a psychiatrist and 11 psychologists - treats about 2,000 students per school year.
In December 2005, a magistrate ordered Cho to undergo an evaluation at a private psychiatric hospital after two women complained about annoying calls from him, and an acquaintance reported he might be suicidal. An initial evaluation found probable cause that Cho was a danger to himself or others as a result of mental illness, but court papers indicate he was free to leave the hospital within days - a step allowed only if hospital officials judged him no longer a danger.
"We have to provide services to students with mental illness - it's not grounds to exclude them from our property," Flynn said. "We cannot discriminate against the mentally ill, nor do we want to."
He said the type of complaints lodged against Cho by the two women are a common and challenging phenomenon on campuses nationwide. "It is very difficult to predict when what someone perceives as stalking is stalking, and then how it might translate into violence later," Flynn said. "Clearly, if anyone had any warning about a violent incident, people would have stepped in and acted." Psychologist Sherry Benton, assistant director of counseling services at Kansas State University, has conducted research concluding that students' mental health problems are more complex and severe than 20 years ago. "We're well aware that problems are getting worse, but what hasn't happened is increasing funding for mental health services," she said. "Most centers are now overwhelmed. Business has gone up and up, but budgets have remained the same or been cut, and that's a huge problem."
One factor, Benton said, is that mental health services are usually not among the categories assessed during colleges' periodic accreditation reviews. If schools needed good services to remain accredited, they might invest more, she said.
Benton views the rising demand for campus mental health services as a good news-bad news development. "We do get a lot more students into college who have mental illness but are no problem whatsoever," she said. "They do need support and use medication; they go on to lead full, productive lives." On the downside, she and her colleagues see stress levels among students far higher than a generation ago due to increased workloads and financial strains, often coupled with lack of healthy lifestyles. Complicating the overall picture is a web of laws and policies that limit the options for worried staff members. Troubled students generally can't be forced to obtain treatment, and privacy laws may limit sharing information about them, even to the extent that some parents have sued schools - including the Massachusetts Institute of Technology and the Oregon Institute of Technology - for not advising them of their children's serious disorders.
Nonetheless, officials on many campuses have set up committees to pool information about students with emotional or behavioral problems so patterns can be detected in what might otherwise be seen as isolated incidents. The trick, officials say, is to find the proper balance between respecting a student's rights and protecting the university.
"That's the tightrope administrators have to walk," said Wright State's Gerald Kay.
"The issue in most instances is how do you bring these people into some sort of treatment."
Benton said any student who issues threats should be dealt with forcefully, regardless of privacy guidelines. "Safety trumps confidentiality every time," she said. "If someone is a danger to themselves or others, then confidentiality is out the window and you notify who you need to notify to ensure the safety of them and those around them."
Peter Lake, a law professor at Stetson University, contends that officials on many campuses have been too deferential to privacy concerns, at the risk of safety at their schools.
"There's a false consciousness of privacy in higher education - as an institution, we don't like to share information, " he said.
"Now, you're going to be seeing a greater emphasis on a management team or a safety czar - someone whose job it is to look at students' overall profiles," Lake said. "It's not only a good idea - it's an idea we can't live without."
(Newsweek)

Obese women less likely to be screened for cancer

Women who are extremely obese are less likely than thinner women to undergo screening for breast and cervical cancer, according to a new study. Using data from a national health survey, researchers found that severely obese women were about half as likely as normal-weight women to be up-to-date with their mammograms and Pap tests.
The National Cancer Institute recommends that women have a mammogram to detect breast cancer every 1 to 2 years, starting at age 40, and a Pap test to screen for cervical cancer at least once every 3 years, beginning about 3 years after they start having sex.
It's not clear why severely obese women are less likely to be compliant with these guidelines. But the study found no evidence that their doctors were lax in recommending the screening tests. Instead, these women appeared less likely to follow their doctors' advice, according to findings published in the American Journal of Preventive Medicine.
It will be important to figure out why, since obesity has been linked to higher risks of breast and cervical cancers, the study authors point out. "We are currently conducting focus groups with women and interviews with physicians to determine what can be done to help improve cancer screening among severely obese women," said lead study author Dr. Jeanne M. Ferrante, of the University of Medicine and Dentistry of New Jersey in Newark.
These discussions have yielded some ideas on what could be done, she told Reuters Health -- including making sure doctors' offices have appropriately sized gowns, scales, exam tables and other equipment, or having special facilities for severely obese women so they don't feel self-conscious. Special training for doctors and other health professionals on how to deal with severely obese women sensitively and professionally might also be helpful, according to Ferrante.
The study included 8,289 women between the ages of 40 and 74 years. The researchers found that women who were severely obese were half as likely as normal-weight women to have had a mammogram in the past 2 years and 57-percent less likely to have had a Pap test in the past 3 years.
This was despite the fact that obese women were as likely to have received a doctor's recommendation to have the screening tests. It's uncertain whether women, in particular, find their weight to be a barrier to preventive healthcare. In a previous study, Ferrante and her colleagues found that obese women and men alike had lower rates of colon cancer screening. But, she noted, some other studies have failed to show that obese men undergo less cancer screening.
(AP)

From China to Panama, A Trail of Poisoned Medicine

The kidneys fail first. Then the central nervous system begins to misfire. Paralysis spreads, making breathing difficult, then often impossible without assistance. In the end, most victims die. Many of them are children, poisoned at the hands of their unsuspecting parents.
The syrupy poison, diethylene glycol, is an indispensable part of the modern world, an industrial solvent and prime ingredient in some antifreeze. It is also a killer. And the deaths, if not intentional, are often no accident. Over the years, the poison has been loaded into all varieties of medicine - cough syrup, fever medication, injectable drugs - a result of counterfeiters who profit by substituting the sweet-tasting solvent for a safe, more expensive syrup, usually glycerin, commonly used in drugs, food, toothpaste and other products.
Toxic syrup has figured in at least eight mass poisonings around the world in the past two decades. Researchers estimate that thousands have died. In many cases, the precise origin of the poison has never been determined. But records and interviews show that in three of the last four cases it was made in China, a major source of counterfeit drugs.
Panama is the most recent victim. Last year, government officials there unwittingly mixed diethylene glycol into 260,000 bottles of cold medicine - with devastating results. Families have reported 365 deaths from the poison, 100 of which have been confirmed so far. With the onset of the rainy season, investigators are racing to exhume as many potential victims as possible before bodies decompose even more.
Panama's death toll leads directly to Chinese companies that made and exported the poison as 99.5 percent pure glycerin. Forty-six barrels of the toxic syrup arrived via a poison pipeline stretching halfway around the world. Through shipping records and interviews with government officials, The Times traced this pipeline from the Panamanian port of Col�n, back through trading companies in Barcelona, Spain, and Beijing, to its beginning near the Yangtze Delta in a place local people call "chemical country."
The counterfeit glycerin passed through three trading companies on three continents, yet not one of them tested the syrup to confirm what was on the label. Along the way, a certificate falsely attesting to the purity of the shipment was repeatedly altered, eliminating the name of the manufacturer and previous owner. As a result, traders bought the syrup without knowing where it came from, or who made it. With this information, the traders might have discovered - as The Times did - that the manufacturer was not certified to make pharmaceutical ingredients.
An examination of the two poisoning cases last year - in Panama and earlier in China - shows how China's safety regulations have lagged behind its growing role as low-cost supplier to the world. It also demonstrates how a poorly policed chain of traders in country after country allows counterfeit medicine to contaminate the global market.
Last week, the United States Food and Drug Administration warned drug makers and suppliers in the United States "to be especially vigilant" in watching for diethylene glycol. The warning did not specifically mention China, and it said there was "no reason to believe" that glycerin in this country was tainted. Even so, the agency asked that all glycerin shipments be tested for diethylene glycol, and said it was "exploring how supplies of glycerin become contaminated. "
China is already being accused by United States authorities of exporting wheat gluten containing an industrial chemical, melamine, that ended up in pet food and livestock feed. The F.D.A. recently banned imports of Chinese-made wheat gluten after it was linked to pet deaths in the United States.
Beyond Panama and China, toxic syrup has caused mass poisonings in Haiti, Bangladesh, Argentina, Nigeria and twice in India. In Bangladesh, investigators found poison in seven brands of fever medication in 1992, but only after countless children died. A Massachusetts laboratory detected the contamination after Dr. Michael L. Bennish, a pediatrician who works in developing countries, smuggled samples of the tainted syrup out of the country in a suitcase. Dr. Bennish, who investigated the Bangladesh epidemic and helped write a 1995 article about it for BMJ, formerly known as the British Medical Journal, said that given the amount of medication distributed, deaths "must be in the thousands or tens of thousands."
"It's vastly underreported, " Dr. Bennish said of diethylene glycol poisoning. Doctors might not suspect toxic medicine, particularly in poor countries with limited resources and a generally unhealthy population, he said, adding, "Most people who die don't come to a medical facility." The makers of counterfeit glycerin, which superficially looks and acts like the real thing but generally costs considerably less, are rarely identified, much less prosecuted, given the difficulty of tracing shipments across borders. "This is really a global problem, and it needs to be handled in a global way," said Dr. Henk Bekedam, the World Health Organization' s top representative in Beijing. Seventy years ago, medicine laced with diethylene glycol killed more than 100 people in the United States, leading to the passage of the toughest drug regulations of that era and the creation of the modern Food and Drug Administration. The F.D.A. has tried to help in poisoning cases around the world, but there is only so much it can do.
When at least 88 children died in Haiti a decade ago, F.D.A. investigators traced the poison to the Manchurian city of Dalian, but their attempts to visit the suspected manufacturer were repeatedly blocked by Chinese officials, according to internal State Department records. Permission was granted more than a year later, but by then the plant had moved and its records had been destroyed. "Chinese officials we contacted on this matter were all reluctant to become involved," the American Embassy in Beijing wrote in a confidential cable. "We cannot be optimistic about our chances for success in tracking down the other possible glycerine shipments."
In fact, The Times found records showing that the same Chinese company implicated in the Haiti poisoning also shipped about 50 tons of counterfeit glycerin to the United States in 1995. Some of it was later resold to another American customer, Avatar Corporation, before the deception was discovered. "Thank God we caught it when we did," said Phil Ternes, chief operating officer of Avatar, a Chicago-area supplier of bulk pharmaceuticals and nonmedicinal products. The F.D.A. said it was unaware of the shipment.
In China, the government is vowing to clean up its pharmaceutical industry, in part because of criticism over counterfeit drugs flooding the world markets. In December, two top drug regulators were arrested on charges of taking bribes to approve drugs. In addition, 440 counterfeiting operations were closed down last year, the World Health Organization said.
But when Chinese officials investigated the role of Chinese companies in the Panama deaths, they found that no laws had been broken, according to an official of the nation's drug enforcement agency. China's drug regulation is "a black hole," said one trader who has done business through CNSC Fortune Way, the Beijing-based broker that investigators say was a crucial conduit for the Panama poison.
In this environment, Wang Guiping, a tailor with a ninth-grade education and access to a chemistry book, found it easy to enter the pharmaceutical supply business as a middleman. He quickly discovered what others had before him: that counterfeiting was a simple way to increase profits. And then people in China began to die.

Cheating the System
Mr. Wang spent years as a tailor in the manufacturing towns of the Yangtze Delta, in eastern China. But he did not want to remain a common craftsman, villagers say. He set his sights on trading chemicals, a business rooted in the many small chemical plants that have sprouted in the region. "He didn't know what he was doing," Mr. Wang's older brother, Wang Guoping, said in an interview. "He didn't understand chemicals." But he did understand how to cheat the system. Wang Guiping, 41, realized he could earn extra money by substituting cheaper, industrial-grade syrup - not approved for human consumption - for pharmaceutical grade syrup. To trick pharmaceutical buyers, he forged his licenses and laboratory analysis reports, records show. Mr. Wang later told investigators that he figured no harm would come from the substitution, because he initially tested a small quantity. He did it with the expertise of a former tailor. He swallowed some of it. When nothing happened, he shipped it.
One company that used the syrup beginning in early 2005 was Qiqihar No. 2 Pharmaceutical, about 1,000 miles away in Heilongjiang Province in the northeast. A buyer for the factory had seen a posting for Mr. Wang's syrup on an industry Web site.
After a while, Mr. Wang set out to find an even cheaper substitute syrup so he could increase his profit even more, according to a Chinese investigator. In a chemical book he found what he was looking for: another odorless syrup - diethylene glycol. At the time, it sold for 6,000 to 7,000 yuan a ton, or about $725 to $845, while pharmaceutical- grade syrup cost 15,000 yuan, or about $1,815, according to the investigator. Mr. Wang did not taste-test this second batch of syrup before shipping it to Qiqihar Pharmaceutical, the government investigator said, adding, "He knew it was dangerous, but he didn't know that it could kill." The manufacturer used the toxic syrup in five drug products: ampules of Amillarisin A for gall bladder problems; a special enema fluid for children; an injection for blood vessel diseases; an intravenous pain reliever; and an arthritis treatment.
In April 2006, one of southern China's finest hospitals, in Guangzhou, Guangdong Province, began administering Amillarisin A. Within a month or so, at least 18 people had died after taking the medicine, though some had already been quite sick.
Zhou Jianhong, 33, said his father took his first dose of Amillarisin A on April 19. A week later he was in critical condition. "If you are going to die, you want to die at home," Mr. Zhou said. "So we checked him out of the hospital." He died the next day.
"Everybody wants to invest in the pharmaceutical industry and it is growing, but the regulators can't keep up," Mr. Zhou said. "We need a system to assure our safety." The final death count is unclear, since some people who took the medicine may have died in less populated areas. In a small town in Sichuan Province, a man named Zhou Lianghui said the authorities would not acknowledge that his wife had died from taking tainted Amillarisin A. But Mr. Zhou, 38, said he matched the identification number on the batch of medicine his wife received with a warning circular distributed by drug officials.
"You probably cannot understand a small town if you are in Beijing," Zhou Lianghui said in a telephone interview. "The sky is high, and the emperor is far away. There are a lot of problems here that the law cannot speak to."
The failure of the government to stop poison from contaminating the drug supply caused one of the bigger domestic scandals of the year. Last May, China's premier, Wen Jiabao, ordered an investigation of the deaths, declaring, "The pharmaceutical market is in disorder." At about the same time, 9,000 miles away in Panama, the long rainy season had begun.
Anticipating colds and coughs, the government health program began manufacturing cough and antihistamine syrup. The cough medicine was sugarless so that even diabetics could use it. The medicine was mixed with a pale yellow, almost translucent syrup that had arrived in 46 barrels from Barcelona on the container ship Tobias Maersk. Shipping records showed the contents to be 99.5 percent pure glycerin. It would be months and many deaths later before that certification was discovered to be pure fiction.

A Mysterious Illness
Early last September, doctors at Panama City's big public hospital began to notice patients exhibiting unusual symptoms. They initially appeared to have Guillain-Barr� syndrome, a relatively rare neurological disorder that first shows up as a weakness or tingling sensation in the legs. That weakness often intensifies, spreading upward to the arms and chest, sometimes causing total paralysis and an inability to breathe.
The new patients had paralysis, but it did not spread upward. They also quickly lost their ability to urinate, a condition not associated with Guillain-Barr� . Even more unusual was the number of cases.
In a full year, doctors might see eight cases of Guillain-Barr� , yet they saw that many in just two weeks. Doctors sought help from an infectious disease specialist, N�stor Sosa, an intense, driven doctor who competes in triathlons and high-level chess.
Dr. Sosa's medical specialty had a long, rich history in Panama, once known as one of the world's unhealthiest places. In one year in the late 1800s, a lethal mix of yellow fever and malaria killed nearly 1 in every 10 residents of Panama City. Only after the United States managed to overcome those mosquito-borne diseases was it able to build the Panama Canal without the devastation that undermined an earlier attempt by the French.
The suspected Guillain-Barr� cases worried Dr. Sosa. "It was something really extraordinary, something that was obviously reaching epidemic dimensions in our hospital," he said. With the death rate from the mystery illness near 50 percent, Dr. Sosa alerted the hospital management, which asked him to set up and run a task force to handle the situation. The assignment, a daunting around-the-clock dash to catch a killer, was one he eagerly embraced.
Several years earlier, Dr. Sosa had watched as other doctors identified the cause of another epidemic, later identified as hantavirus, a pathogen spread by infected rodents. "I took care of patients but I somehow felt I did not do enough," he said. The next time, he vowed, would be different. Dr. Sosa set up a 24-hour "war room" in the hospital, where doctors could compare notes and theories as they scoured medical records for clues.
As a precaution, the patients with the mystery illness were segregated and placed in a large empty room awaiting renovation. Health care workers wore masks, heightening fears in the hospital and the community. That spread a lot of panic," said Dr. Jorge Motta, a cardiologist who runs the Gorgas Memorial Institute, a widely respected medical research center in Panama. "That is always a terrifying thought, that you will be the epicenter of a new infectious disease, and especially a new infectious disease that kills with a high rate of death, like this." eanwhile, patients kept coming, and hospital personnel could barely keep up.
"I ended up giving C.P.R.," Dr. Sosa said. "I haven't given C.P.R. since I was a resident, but there were so many crises going on." Frightened hospital patients had to watch others around them die for reasons no one understood, fearing that they might be next. As reports of strange Guillain-Barr� symptoms started coming in from other parts of the country, doctors realized they were not just dealing with a localized outbreak.
Pascuala P�rez de Gonz�lez, 67, sought treatment for a cold at a clinic in Cocl� Province, about a three-hour drive from Panama City. In late September she was treated and sent home. Within days, she could no longer eat; she stopped urinating and went into convulsions. A decision was made to take her to the public hospital in Panama City, but on the way she stopped breathing and had to be resuscitated. She arrived at the hospital in a deep coma and later died.
Medical records contained clues but also plenty of false leads. Early victims tended to be males older than 60 and diabetic with high blood pressure. About half had been given Lisinopril, a blood pressure medicine distributed by the public health system. But many who did not receive Lisinopril still got sick. On the chance that those patients might have forgotten that they had taken the drug, doctors pulled Lisinopril from pharmacy shelves - only to return it after tests found nothing wrong. Investigators would later discover that Lisinopril did play an important, if indirect role in the epidemic, but not in the way they had imagined.

A Major Clue
One patient of particular interest to Dr. Sosa came into the hospital with a heart attack, but no Guillain-Barr� -type symptoms. While undergoing treatment, the patient received several drugs, including Lisinopril. After a while, he began to exhibit the same neurological distress that was the hallmark of the mystery illness. "This patient is a major clue," Dr. Sosa recalled saying. "This is not something environmental, this is not a folk medicine that's been taken by the patients at home. This patient developed the disease in the hospital, in front of us."
Soon after, another patient told Dr. Sosa that he, too, developed symptoms after taking Lisinopril, but because the medicine made him cough, he also took cough syrup - the same syrup, it turned out, that had been given to the heart patient.
"I said this has got to be it," Dr. Sosa recalled. "We need to investigate this cough syrup." The cough medicine had not initially aroused much suspicion because many victims did not remember taking it. "Twenty-five percent of those people affected denied that they had taken cough syrup, because it's a nonevent in their lives," Dr. Motta said. Investigators from the United States Centers for Disease Control and Prevention, who were in Panama helping out, quickly put the bottles on a government jet and flew them to the United States for testing. The next day, Oct. 11, as Panamanian health officials were attending a news conference, a Blackberry in the room went off. The tests, the C.D.C. was reporting, had turned up diethylene glycol in the cough syrup. The mystery had been solved. The barrels labeled glycerin turned out to contain poison. Dr. Sosa's exhilaration at learning the cause did not last long. "It's our medication that is killing these people," he said he thought. "It's not a virus, it's not something that they got outside, but it was something we actually manufactured. " A nationwide campaign was quickly begun to stop people from using the cough syrup. Neighborhoods were searched, but thousands of bottles either had been discarded or could not be found. As the search wound down, two major tasks remained: count the dead and assign blame. Neither has been easy.
A precise accounting is all but impossible because, medical authorities say, victims were buried before the cause was known, and poor patients might not have seen doctors. Another problem is that finding traces of diethylene glycol in decomposing bodies is difficult at best, medical experts say. Nonetheless, an Argentine pathologist who has studied diethylene glycol poisonings helped develop a test for the poison in exhumed bodies. Seven of the first nine bodies tested showed traces of the poison, Panamanian authorities said. With the rainy season returning, though, the exhumations are about to end. Dr. Jos� Vicente Pachar, director of Panama's Institute of Legal Medicine and Forensic Sciences, said that as a scientist he would like a final count of the dead. But he added, "I should accept the reality that in the case of Panama we are not going to know the exact number."
Local prosecutors have made some arrests and are investigating others connected to the case, including officials of the import company and the government agency that mixed and distributed the cold medicine. "Our responsibilities are to establish or discover the truth," said Dimas Guevara, the homicide investigator guiding the inquiry. But prosecutors have yet to charge anyone with actually making the counterfeit glycerin. And if the Panama investigation unfolds as other inquiries have, it is highly unlikely that they ever will.

A Suspect Factory
Panamanians wanting to see where their toxic nightmare began could look up the Web site of the company in Hengxiang, China, that investigators in four countries have identified as having made the syrup - the Taixing Glycerine Factory. There, under the words "About Us," they would see a picture of a modern white building nearly a dozen stories tall, adorned by three arches at the entrance. The factory, the Web site boasts, "can strictly obey the contract and keep its word." But like the factory's syrup, all is not as it seems.
There are no tall buildings in Hengxiang, a country town with one main road. The factory is not certified to sell any medical ingredients, Chinese officials say. And it looks nothing like the picture on the Internet. In reality, its chemicals are mixed in a plain, one-story brick building. The factory is in a walled compound, surrounded by small shops and farms. In the spring, nearby fields of rape paint the countryside yellow. Near the front gate, a sign over the road warns, "Beware of counterfeits. " But it was posted by a nearby noodle machine factory that appears to be worried about competition. The Taixing Glycerine Factory bought its diethylene glycol from the same manufacturer as Mr. Wang, the former tailor, the government investigator said. From this spot in China's chemical country, the 46 barrels of toxic syrup began their journey, passing from company to company, port to port and country to country, apparently without anyone testing their contents. Traders should be thoroughly familiar with their suppliers, United States health officials say. "One simply does not assume that what is labeled is indeed what it is," said Dr. Murray Lumpkin, deputy commissioner for international and special programs for the Food and Drug Administration.
In the Panama case, names of suppliers were removed from shipping documents as they passed from one entity to the next, according to records and investigators. That is a practice some traders use to prevent customers from bypassing them on future purchases, but it also hides the provenance of the product. The first distributor was the Beijing trading company, CNSC Fortune Way, a unit of a state-owned business that began by supplying goods and services to Chinese personnel and business officials overseas. As China's market reach expanded, Fortune Way focused its business on pharmaceutical ingredients, and in 2003, it brokered the sale of the suspect syrup made by the Taixing Glycerine Factory. The manufacturer' s certificate of analysis showed the batch to be 99.5 percent pure. Whether the Taixing Glycerine Factory actually performed the test has not been publicly disclosed.
Original certificates of analysis should be passed on to each new buyer, said Kevin J. McGlue, a board member of the International Pharmaceutical Excipients Council. In this case, that was not done. Fortune Way translated the certificate into English, putting its name - not the Taixing Glycerine Factory's - at the top of the document, before shipping the barrels to a second trading company, this one in Barcelona.
Li Can, managing director at Fortune Way, said he did not remember the transaction and could not comment, adding, "There is a high volume of trade." Upon receiving the barrels in September 2003, the Spanish company, Rasfer International, did not test the contents, either. It copied the chemical analysis provided by Fortune Way, then put its logo on it.
Ascensi�n Criado, Rasfer's manager, said in an e-mail response to written questions that when Fortune Way shipped the syrup, it did not say who made it.
Several weeks later, Rasfer shipped the drums to a Panamanian broker, the Medicom Business Group. "Medicom never asked us for the name of the manufacturer, " Ms. Criado said. A lawyer for Medicom, Valent�n Ja�n, said his client was a victim, too. "They were tricked by somebody," Mr. Ja�n said. "They operated in good faith." In Panama, the barrels sat unused for more than two years, and officials said Medicom improperly changed the expiration date on the syrup. During that time, the company never tested the product. And the Panamanian government, which bought the 46 barrels and used them to make cold medicine, also failed to detect the poison, officials said.
The toxic pipeline ultimately emptied into the bloodstream of people like Ernesto Osorio, a former high school teacher in Panama City. He spent two months in the hospital after ingesting poison cough syrup last September.
Just before Christmas, after a kidney dialysis treatment, Mr.Osorio stood outside the city's big public hospital in a tear-splattered shirt, describing what his life had become. I'm not an eighth of what I used to be," Mr. Osorio said, his partly paralyzed face hanging like a slab of meat. "I have trouble walking. Look at my face, look at my tears." The tears, he said apologetically, were not from emotion, but from nerve damage. And yet, Mr. Osorio knows he is one of the lucky victims. "They didn't know how to keep the killer out of the medicine," he said simply. While the suffering in Panama was great, the potential profit - at least for the Spanish trading company, Rasfer - was surprisingly small. For the 46 barrels of glycerin, Rasfer paid Fortune Way $9,900, then sold them to Medicom for $11,322, according to records. Chinese authorities have not disclosed how much Fortune Way and the Taixing Glycerine Factory made on their end, or how much they knew about what was in the barrels. "The fault has to be traced back to areas of production," said Dr. Motta, the cardiologist in Panama who helped uncover the source of the epidemic. "This was my plea - please, this thing is happening to us, make sure whoever did this down the line is not doing it to Peru or Sierra Leone or some other place."

A Counterfeiter' s Confession
The power to prosecute the counterfeiters is now in the hands of the Chinese. Last spring, the government moved quickly against Mr. Wang, the former tailor who poisoned Chinese residents. The authorities caught up with him at a roadblock in Taizhou, a city just north of Taixing, in chemical country. He was weak and sick, and he had not eaten in two days. Inside his white sedan was a bankbook and cash. He had fled without his wife and teenage son. Chinese patients were dead, a political scandal was brewing and the authorities wanted answers. Mr. Wang was taken to a hospital. Then, in long sessions with investigators, he gave them what they wanted, explaining his scheme, how he tested industrial syrup by drinking it, how he decided to use diethylene glycol and how he conned pharmaceutical companies into buying his syrup, according to a government official who was present for his interrogation. "He made a fortune, but none of it went to his family," said Wang Xiaodong, a former village official who knows Mr. Wang and his siblings. "He liked to gamble."
Mr. Wang remains in custody as the authorities decide whether he should be put to death. The Qiqihar drug plant that made the poisonous medicine has been closed, and five employees are now being prosecuted for causing "a serious accident."
In contrast to the Wang Guiping investigation, Chinese authorities have been tentative in acknowledging China's link to the Panama tragedy, which involved a state-owned trading company. No one in China has been charged with committing the fraud that ended up killing so many in Panama. Sun Jing, the pharmaceutical program officer for the World Health Organization in Beijing, said the health agency sent a fax "to remind the Chinese government that China should not be selling poisonous products overseas." Ms. Sun said the agency did not receive an official reply. Last fall, at the request of the United States - Panama has no diplomatic relations with China - the State Food and Drug Administration of China investigated the Taixing Glycerine Factory and Fortune Way. The agency tested one batch of glycerin from the factory, and found no glycerin, only diethylene glycol and two other substances, a drug official said. Since then, the Chinese drug administration has concluded that it has no jurisdiction in the case because the factory is not certified to make medicine.
The agency reached a similar conclusion about Fortune Way, saying that as an exporter it was not engaged in the pharmaceutical business. "We did not find any evidence that either of these companies had broken the law," said Yan Jiangying, a spokeswoman for the drug administration. "So a criminal investigation was never opened." A drug official said the investigation was subsequently handed off to an agency that tests and certifies commercial products - the General Administration of Quality Supervision, Inspection and Quarantine.
But the agency acted surprised to learn that it was now in charge. "What investigation? " asked Wang Jian, director of its Taixing branch. "I'm not aware of any investigation involving a glycerin factory." Besides, Huang Tong, an investigator in that office, said, "We rarely get involved in products that are sold for export." Wan Qigang, the legal representative for the Taixing Glycerine Factory, said in an interview late last year that the authorities had not questioned him about the Panama poisoning, and that his company made only industrial-grade glycerin. "I can tell you for certain that we have no connection with Panama or Spain," Mr. Wan said. But in recent months, the Glycerine Factory has advertised 99.5 percent pure glycerin on the Internet.
Mr. Wan recently declined to answer any more questions. "If you come here as a guest, I will welcome you," Mr. Wan said. "But if you come again wanting to talk about this matter, I will make a telephone call." A local government official said Mr. Wan was told not to grant interviews. A five-minute walk away, another manufacturer, the Taixing White Oil Factory, also advertises medical glycerin on the Internet, yet it, too, has no authorization to make it. The company's Web site says its products "have been exported to America, Australia and Italy."
Ding Xiang, who represents the White Oil Factory, denied that his company made pharmaceutical- grade glycerin, but he said chemical trading companies in Beijing often called, asking for it. "They want us to mark the barrels glycerin," Mr. Ding said in late December. "I tell them we cannot do that." Mr. Ding said he stopped answering calls from Beijing. "If this stuff is taken overseas and improperly used. ..." He did not complete the thought. In chemical country, product names are not always what they seem. "The only two factories in Taixing that make glycerin don't even make glycerin," said Jiang Peng, who oversees inspections and investigations in the Taixing branch of the State Food and Drug Administration. "It is a different product."

All in a Name
One lingering mystery involves the name of the product made by the Taixing Glycerine Factory. The factory had called its syrup "TD" glycerin. The letters TD were in virtually all the shipping documents. What did TD mean? Spanish medical authorities concluded that it stood for a manufacturing process. Chinese inspectors thought it was the manufacturer' s secret formula. But Yuan Kailin, a former salesman for the factory , said he knew what the TD meant because a friend and former manager of the factory, Ding Yuming, had once told him. TD stood for the Chinese word "tidai" (pronounced tee-die), said Mr. Yuan, who left his job in 1998 and still lives about a mile from the factory. In Chinese, tidai means substitute. A clue that might have revealed the poison, the counterfeit product, was hiding in plain sight. It was in the product name.
(NYT)