The moment when a cancer begins to spread throughout the body — metastasis — has always been the most dreaded turning point of the disease.

The development of surgical tools designed for young patients lags behind that for adults, largely, experts say, because of economics and a smaller market.

New figures strongly suggest that obesity is the most likely reason for the rise of knee replacement surgeries in younger patients.

The American Academy of Pediatrics says that food can pose lethal hazards to young children and should be subject to as much scrutiny as toys.

Researchers conducting a trial have found that a bone marrow transplant from a donor who is only half-matched genetically can cure sickle cell.

Major medical specialty groups recommended that doctors greatly reduce their use of 90 widely used but largely unnecessary tests and treatments.

Average cholesterol levels in Americans have stopped falling since 2008, a study finds, raising concerns about an increase in heart disease and the effectiveness of statins.

Many emergency room patients are discharged without understanding how to care for themselves once they get home, researchers say.

A hormone deficiency, often misdiagnosed, can affect ovulation.

Few patients are aware that testing the blood for immunoglobulin E, or IgE, is an alternative to skin tests for allergies.

Experts say that adult-onset allergies are on rise in United States; hold that causes could include imbalanced immune system or increased exposure to indoor allergens; explain that adult allergy sufferers may never be treated for symptoms, either because they do not recognize they have allergies or because they are resistant to taking medication because of fear of unwanted side effects; treatment options discussed; drawing (M)

Studies indicate that stress and depression in pregnant women significantly increases risk of learning and behavioral problems in their children; Dr Catherine Monk, Columbia University College of Physicians and Surgeons assistant psychiatry professor, advocates prenatal mental health screening to help mothers and unborn children; various studies on impact of stress on fetus and child discussed; photo (M)

American Hospital Assn reports that about 13 percent of nursing positions nationwide are vacant and trend is expected to continue with 20% of positions open by 2005; strategies to attract and keep nurses are discussed, including Mom shifts, shift bidding, concierge-type services and day care; current use of robots and potential for surgical robots described; high patient-to-nurse ratios, long shifts and mandatory overtime, along with other similar variables, have been shown to contribute to high

Article on new focus by many infertility centers in US on emotional health of their patients; about half of 370 centers approved by Society for Assisted Reproductive Technology have hired psychologists and started support groups and stress-reduction workshops in past two years; photo; graph (M)

fter having a biopsy taken of a suspicious lump, a patient usually puts his fate in the hands of a person he has never met: a pathologist.

Article on growing number of laboratories that are opening up across US and on Internet that offer tests directly to consumers without doctor referrals; in addition, estimated 10 to 15 percent of existing commercial and hospital labs offer tests to consumers; many doctors question medical implications of patients trying to diagnose conditions and interpret test results themselves; photos (M)