GALLSTONES

What are gallstones?

Gallstones are lumps of solid material that form in the gall bladder - the reservoir for bile. Most are the size of peas, but they can be as large as pebbles. Gallstones can be found in the gall bladder itself, or in the bile duct that connects the gall bladder to the small intestine.

Gallstones are made of cholesterol, bile pigments or calcium, or a combination of these.

Gallstones symptoms

Often gallstones don't cause symptoms, but if one partially or completely blocks the normal flow of bile it may cause an attack of biliary colic, with upper abdominal pain, nausea and vomiting.

These episodes are normally brief and typically follow a fatty meal, which causes the gall bladder to contract.

Stones that continue to block the drainage of bile can cause inflammation or infection of the gall bladder and bile ducts, jaundice and acute pancreatitis.

Causes of gallstones

Many people will develop gallstones. Overweight people over 40, pregnant women and women in general are all more likely to develop them. They're also more common in people of Asian and European origin.

Eating a high-fat diet makes gallstones more likely to form.

Gallstones treatments

Eating a low-fat diet and maintaining an ideal weight may help to prevent the formation of gallstones.

Occasionally they pass out into the intestines on their own, especially if they're small. Treatment is only needed if gallstones are causing problems.

Complementary therapies may be tried to help remove gallstones, but there's little evidence they do any good.

Medical (non-surgical) treatments include a drug to dissolve the gallstones (ursodeoxycholic acid) and ultrasonic shockwaves, called lithotripsy, to break down the stones within the body so they can pass out on their own. These are suitable for about one in five patients, but there may be side-effects and the stones may simply form again.

There are various different surgical options:

• Operating through an endoscope, a telescope into the gut. The stones may be broken down within the gall bladder and removed
• Removal of stones and gall bladder (cholecystectomy) - this is the most reliable treatment. As with all operations, there are risks and complications, but these are steadily reducing as techniques improve

Cholecystectomy may be done as an open operation through a cut in the abdomen, or a closed or minimally invasive operation via an endoscope put through a tiny cut in the abdominal wall. There used to be concern about the safety of this type of surgery, but in skilled hands it's now as safe as open surgery and is how most cholecystectomies are done in the UK.

After gall bladder surgery

It used to be thought people adapted quickly to the loss of a gall bladder, but there may be problems. Some patients still have symptoms, albeit much milder. Others have problems with bile refluxing into the stomach and gullet, causing severe indigestion.

There may also be reduced absorption of fat resulting in diarrhoea. This usually - but not always

Rapid growth of high-speed rail in China

CHINA only opened its high-speed rail service to passengers four years ago, but it now boasts the world's biggest network, with more than 8,300km of track - a figure that is growing rapidly.

Trains are by far the most popular form of long-distance transport in the country of more than 1.3 billion people where, despite three decades of blistering economic growth, air travel remains far too expensive for most people.

China recorded more than 1.68 billion passenger trips on its network in 2010, dwarfing the 248 million airline passenger journeys in the same period.

The vast country's 91,000km rail network carries hundreds of millions of people every year and stretches from the eastern metropolis of Shanghai to the remote Tibetan plateau.

In recent years, the government has invested heavily in high-speed train links as it strives to meet the growing demands on the transport system.

Last year, government spending on the high-speed railway surpassed 700 billion yuan (S$132 billion), and China is now home to around half the world's high-speed tracks.

Cracks appear in China's economic model

AS THE United States and Europe struggle with debt crises, China's economy appears in robust health, but analysts say its growth model is too dependent on investment and cannot be sustained.

Sitting on foreign exchange reserves worth nearly US$3.2 trillion (S$3.9 trillion) and with breakneck growth of 9.5 per cent in the second quarter, the world's second largest economy appears to have breezed through the global financial crisis.

'Clearly China is becoming a larger percentage of the world economy and its growth rate is higher than the developed world,' said Fraser Howie, co-author of Red Capitalism: the Fragile Financial Foundation of China's Extraordinary Rise.

'It is becoming stronger as a result of that but I would argue that much of that strength is misleading,' he told AFP.

When the global economic crisis hit its huge export industry in 2008-9, China unleashed a torrent of credit to finance new highways, high-speed railways and real-estate projects, in a bid to stimulate domestic demand.

Now, experts warn China's growth has become too reliant on investment.

Tall people more likely to get cancer

RESEARCH suggests that tall people are at greater risk of getting cancer as the likelihood of developing the disease rises by 16 per cent for every extra 10cm in height in both sexes, the Telegraph reported.

Dr Jane Green and her colleagues, who published the finding in The Lancet Oncology, point to two reasons for such correlation.

'One possible reason is fairly obvious - tall people have more cells so there is a great chance that one of them can mutate. But being tall is also related to hormonal growth factors which lead to a higher turnover of cells and this is an interesting possibility,' said Dr Green

The study also suggests the average increase in the height of European adults by about 1cm per decade during the 20th century might explain the 15 per cent of the rise in cancer cases over the same period.

However, tall people need not worry too much over these findings. Sara Horim, director of health information at Cancer Research UK said, 'Most people are not a lot taller than average, and their height will only have a small effect on their individual cancer risk.'

Moreover, while height is beyond a person's control, they can alter their lifestyle choices to be healthy.

Olive oil can help prevent strokes in people over 65, a study suggests.

Researchers followed around 7,000 people aged 65 and over living in three French cities, for at least five years.

They found those who used a lot of olive oil in cooking or as a dressing or dip had a lower risk of stroke than those who never used it.

The researchers say older people should be given new dietary advice regarding olive oil, based on the findings, which are published in the journal Neurology.

Lead author, Dr Cecilia Samieri, of the University of Bordeaux, said: "Our research suggests that a new set of dietary recommendations should be issued to prevent stroke in people 65 and older.

"Stroke is so common in older people, and olive oil would be an inexpensive and easy way to help prevent it."

“Start Quote

A lot more research needs to be carried out to scientifically test the effectiveness of olive oil as an ingredient that can protect against stroke”

End Quote Sharlin Ahmed The Stroke Association

The researchers studied the medical records of 7,625 people aged 65 and older living in Bordeaux, Dijon and Montpelier.

They were asked whether they used olive oil in cooking, on salads or with bread intensively, moderately or never.

Most used extra virgin olive oil, which is common in France.

After around five years, 148 of the men and women had had a stroke.

The study found the stroke risk was 41% lower in those who regularly used olive oil compared with those who abstained, once other factors such as diet, exercise and weight were taken into account.

This works out as a 1.5% risk over six years, compared with 2.6%.

Protective function

Commenting on the study, published in Neurology, Sharlin Ahmed of the Stroke Association, said: "Olive oil has long been known to have potential health benefits.

"It is believed that it could protect against conditions such as high cholesterol, high blood pressure and heart disease and so it's promising to see that it could have a similar protective function against stroke.

"However, it's important to note that a person's risk of stroke would only be reduced through consuming olive oil as an alternative to other cooking fats and as part of a healthy balanced diet that is low in saturated fat and salt.

"This is also a study based on responses from the public and not a clinical trial. A lot more research therefore needs to be carried out to scientifically test the effectiveness of olive oil as an ingredient that can protect against stroke."

Have a happy, healthy holiday

Like many Singaporeans, I usually plan an overseas vacation during the kid-friendly June and December school holidays season.

Unfortunately for me, it is also a time when the dreadful flu visits while I'm scrambling to pack my luggage. More often than not, I end up being so ill that I sometimes regret my holiday trip.

"Aiyah, why do I always spend so much money on a holiday to hang out with a sick goose," the spouse would grumble.

Apparently, I'm not alone. Doctors TODAY spoke to said falling ill before or during a vacation is a common phenomenon among Singaporeans.

Rather than relax and look forward to a vacation, stress levels of Singaporeans tend to spike - from squeezing in as much work as possible just before the trip to jam-packing too many activities into one holiday.

Said Dr Mohamed Faizal, a family physician at Raffles Medical: "They also do so much last-minute packing that they do not get sufficient sleep before their trip, which puts a lot of strain on their bodies."

Another explanation, he added, is that Singaporeans tend to travel during the school holidays, which usually coincides with the flu season in June and Dec.

And there's also the whole stress of going through airport security, making flight connections, ground transfers, and prepping kids for travel, added Associate Professor Helen Oh, a senior consultant at the department of medicine (infectious diseases) at Changi General Hospital.

According to the experts, a little clever travel planning is essential for a happy, healthy vacation. Find out how.



Before you jet off

1. Read up on your travel destination

Keep up-to-date on the health risks within the country you are visiting. For instance, in light of the current E coli outbreak in Europe, travellers to Germany should following certain precautionary measures while vacationing there (see next story).

2. Visit your doctor or travel clinic to get pre-travel health advice

Do so at least four to six weeks before you depart to check if you need any vaccinations or anti-malaria medications, advised Assoc Prof Oh. Some vaccines require multiple doses and a long period to take effect, so it is wise to visit your doctor early. Be sure to also keep your kids' vaccinations up-to-date, added Dr Faizal.

3. If you have chronic diseases, check with your doctor before travelling

This includes those with conditions such as chronic obstructive lung disease, cardiovascular diseases, diabetes, chronic renal failure and hepatic disease. Your doctor will advise you if you're fit to travel and how to manage your condition while overseas, said Assoc Prof Oh.

In addition, don't forget to prepare a travel medical kit, your medications, a letter from your doctor and comprehensive travel insurance.



During your vacation

1. Be practical about your travel itinerary, if you're travelling with kids

Consider the age of your child. Dr Faizal cited an example: If you're travelling with your four-year-old, forget about a jungle hike and settle for Disneyland instead.

Factor in jet lag and include rest time.

2. Avoid taking unnecessary risks

Traveller's diarrhoea (TD) is one of the most common ailments for vacationers. According to Assoc Prof Oh, travellers contract TD by consuming contaminated food or water. Risky foods include undercooked meat, poultry, seafood, raw fruits and vegetables. Tap water, ice and unpasteurized milk are also associated with an increased risk of TD, she said.

In countries where tap water is unsafe, use bottled water to brush your teeth and avoid putting ice into your drinks.

3. Don't forget your meds

If you are on regular medication, don't forget to pop your pills.

Separate your medications between your luggages, in case bags go missing.

Cell phone use 'possibly carcinogenic to humans', say WHO

The use of cell phones and other wireless communication devices are "possibly carcinogenic to humans", the World Health Organisation's cancer research agency said on Tuesday.

The radio frequency electromagnetic fields generated by such devices are possibly cancer-causing "based on an increased risk for glioma, a malignant type of brain cancer," the International Agency for Research on Cancer (IARC) said in a statement.

A group of 31 experts meeting in the French city of Lyon over the past eight days "reached this classification based on its review of the human evidence coming from epidemiological studies," said Jonathan Samet, president of the work group.

Two studies in particular, the largest conducted over the last decade, provided evidence that cell phone use was associated with higher rates of glioma, "particularly in those that had the most intensive use of such phones," Samet said.

A number of individuals tracked in the studies had used their phones for 10 to 15 years.

"We simply don't know what might happen as people use their phones over longer time periods, possible over a lifetime," he said.

There are about five billion mobile phones registered in the world.

Both the number of phones in circulation, and the average time spent using them, have climbed steadily in recent years, the working group found.

The IARC cautioned that their review of scientific evidence showed only a possible link, not a proven one, between wireless devices and cancers.

"There is some evidence of increased risk of glioma" and another form of brain cancer called acoustic neuroma, said Kurt Straif, the scientist in charge of editing the IARC reports on potentially carcinogenic agents.

"But it is not at the moment clearly established that the use of mobile phones does in fact cause cancer in humans," he said in a telephone press conference.

The IARC does not issue formal recommendations, but pointed to a number of ways consumers can reduce risk.

"What probably entails some of the highest exposure is using your mobile for voice calls," Straif said.

"If you use it for texting, or as a hands-free set for voice calls, this is clearly lowering the exposure by at least an order of magnitude," or by ten-fold, he said.

A year ago the IARC concluded in a major report that there was no link between cell phones and brain cancer, but the review was widely criticised as based on out-of-date data that did not correspond to current usage levels.

The new review, conducted by a panel of 31 scientists from 14 countries, was based on a "full consensus," said Robert Baan, in charge of the written report, yet to be released.

Exposure data, studies of cancer in humans, experiments on animals and other data were all evaluated in establishing the new classification.

The IARC ranks potentially cancer-causing elements as either carcinogenic, probably carcinogenic, possibly carcinogenic or "probably not carcinogenic." It can also determine that a material is "not classifiable".

Cigarettes and sunbeds, for examples, are rated as "group 1", the top threat category.