Tonsillectomy may improve sleep, ADHD for some

CHILD BEHAVIOR
As many as 2 percent of children suffer from breathing difficulties while sleeping. These breathing problems have been linked to learning and behavioral problems including attention deficit/hyperactivity disorder. Now there is evidence to suggest that children with sleep disturbances may benefit from having their tonsils -- which can block airflow in the back of the throat -- removed. Researchers from the University of Michigan and elsewhere evaluated 78 children ages 5 to 13 undergoing tonsillectomy and found that their performance on various behavioral tests improved considerably one year after the surgery -- bringing them to essentially normal levels. Sleep disturbances, as measured by special breathing tests, did not improve substantially, however. ''An undiagnosed sleep disorder is not the solution for all children with ADHD," said lead author Dr. Ronald Chervin, director of the Sleep Disorders Center at the University of Michigan. ''But it could be something worth looking into for a substantial minority, especially those children with symptoms that suggest a sleep disorder."

BOTTOM LINE: Tonsil surgery is an option to consider in children with sleep disturbances.

CAUTIONS: The children's behavior might have improved even if they hadn't had their tonsils out.

WHAT'S NEXT: There are many children with behavioral problems such as ADHD who have apparently normal sleep patterns. More work is needed to determine whether some of these children may actually have mild sleep disturbances that are not detected by parents and, if so, whether these children would benefit from tonsillectomy.

WHERE TO FIND IT: Pediatrics, April 2006

MICHAEL E. HOCHMAN

PHOBIAS

Hormone helps people confront what they fear

One pill, and that creeping spider won't seem so scary. Researchers at the University of Zurich discovered that the hormone cortisol can help phobics confront the objects of their fears, reducing the anxiety they feel. People who fear spiders were given a pill with cortisol and then, one hour later, they were shown a photo of a spider. They felt less fear than those who did not have cortisol. The same effect was found in people with social phobia, according to research published last week. Scientists have found that the brain releases cortisol in frightening circumstances. The new research suggests that the cortisol plays a protective function, preventing the fear from becoming debilitating. The researchers, led by Dr. Dominique de Quervain, hope that that the finding might someday be used to treat phobias. Currently, phobias can be treated with behavioral therapy, in which a patient is exposed to what they fear to help them overcome the phobia. The hope, he said, is that cortisol could make this therapy more effective. It may also be useful in treating post-traumatic stress disorder.

BOTTOM LINE: The hormone cortisol helps people who have phobias confront what they fear.

CAUTIONS: The research tested people with only two kinds of fears, and it tested only whether a dose of cortisol could temporarily reduce the experience of the phobia -- not whether it could be a part of a cure.

WHAT'S NEXT: The team is organizing a clinical trial to see whether cortisol treatment can lead to lasting improvements for people with phobias.

WHERE TO FIND IT: Proceedings of the National Academy of Sciences, April 4, 2006

GARETH COOK

CANCER

Nicotine shown to interfere with life-saving treatment

Smoking interferes with the chemotherapy used to treat lung cancer, University of South Florida researchers have found, perhaps explaining why patients who continue to smoke fare worse than those who quit the habit. Researchers treated tissue cultures of lung cancer cells with nicotine -- a chemical found in cigarettes -- and found that these cells were less susceptible to three commonly used anti-cancer drugs compared with cells not treated with nicotine. They then identified two genes that are expressed in higher concentration in the nicotine-treated cells and showed that these genes may be responsible for nicotine's effects. Finally, the researchers showed that it might be possible to partly block nicotine's actions on cancer cells by chemically interfering with the biochemical pathway through which nicotine works. But typical smoking cessation products such as the nicotine patch and nicotine gums are probably not the answer for lung cancer patients -- because they all contain nicotine.

BOTTOM LINE: Nicotine seems to make lung cancer cells less responsive to commonly used drugs.

CAUTIONS: It is not clear that the genes the authors identified are actually responsible for nicotine's harmful actions. Nicotine may make cancer cells less susceptible to anti-cancer drugs directly, i.e. without the involvement of genes.

WHAT'S NEXT: It may be possible to block the effects of nicotine that cause lung cancer cells to be more resistant to chemotherapy. More research is needed to explore this possibility.

WHERE TO FIND IT: The Proceedings of the National Academy of Sciences, Online Early Edition, April 3, 2006

MICHAEL E. HOCHMAN