Heidi Splete

GRAND CAYMAN, CAYMAN ISLANDS — Lid and ocular surface lesions are signs of conditions where the eye and the skin overlap, Dr. Catherine Newton said at the Caribbean Dermatology Symposium.

Dr. Newton, a professor of ophthalmology at the University of Louisville (Ky.), presented examples of cases with skin and eye involvement that are not inflammatory diseases, including benign conditions (neoplasms) and potentially serious infections such as herpes.

Dr. Newton presented a case of an 82-year-old man who reported "something blocking his view" during a visit for corneal care. It was a bumpy mass that was diagnosed as a verrucous papilloma.

Cysts and benign neoplasms near the eye are common, Dr. Newton said.

An ophthalmologist performed a surgical resection of the verrucous papilloma, and the patient has had no recurrence, she said in an interview.

Another case of a benign neoplasm involved a woman with a bump on the lower left lid (acanthoma). Dr. Newton treated this patient with lidocaine ointment, and she was later able to use a jeweler's forceps and remove the sac, which spared the patient an excision.

Dr. Newton presented a case of an 11-year-old girl with molluscum contagiosum as an example of an infectious disease that can involve the eyes and skin. Molluscum contagiosum lesions often occur on the faces in children who acquire the infection by nonsexual transmission. The lesions can be mistaken for pustules, but histology data confirm the infection.

She treated the girl by curetting the lesions using local anesthesia, and the lesions have resolved completely. Cryotherapy and a peeling agent such as salicylic acid may also be used to treat molluscum contagiosum lesions.

GRAND CAYMAN, CAYMAN ISLANDS — Lid and ocular surface lesions are signs of conditions where the eye and the skin overlap, Dr. Catherine Newton said at the Caribbean Dermatology Symposium.

Dr. Newton, a professor of ophthalmology at the University of Louisville (Ky.), presented examples of cases with skin and eye involvement that are not inflammatory diseases, including benign conditions (neoplasms) and potentially serious infections such as herpes.

Dr. Newton presented a case of an 82-year-old man who reported "something blocking his view" during a visit for corneal care. It was a bumpy mass that was diagnosed as a verrucous papilloma.

Cysts and benign neoplasms near the eye are common, Dr. Newton said.

An ophthalmologist performed a surgical resection of the verrucous papilloma, and the patient has had no recurrence, she said in an interview.

Another case of a benign neoplasm involved a woman with a bump on the lower left lid (acanthoma). Dr. Newton treated this patient with lidocaine ointment, and she was later able to use a jeweler's forceps and remove the sac, which spared the patient an excision.

Dr. Newton presented a case of an 11-year-old girl with molluscum contagiosum as an example of an infectious disease that can involve the eyes and skin. Molluscum contagiosum lesions often occur on the faces in children who acquire the infection by nonsexual transmission. The lesions can be mistaken for pustules, but histology data confirm the infection.

She treated the girl by curetting the lesions using local anesthesia, and the lesions have resolved completely. Cryotherapy and a peeling agent such as salicylic acid may also be used to treat molluscum contagiosum lesions.

GRAND CAYMAN, CAYMAN ISLANDS — Lid and ocular surface lesions are signs of conditions where the eye and the skin overlap, Dr. Catherine Newton said at the Caribbean Dermatology Symposium.

Dr. Newton, a professor of ophthalmology at the University of Louisville (Ky.), presented examples of cases with skin and eye involvement that are not inflammatory diseases, including benign conditions (neoplasms) and potentially serious infections such as herpes.

Dr. Newton presented a case of an 82-year-old man who reported "something blocking his view" during a visit for corneal care. It was a bumpy mass that was diagnosed as a verrucous papilloma.

Cysts and benign neoplasms near the eye are common, Dr. Newton said.

An ophthalmologist performed a surgical resection of the verrucous papilloma, and the patient has had no recurrence, she said in an interview.

Another case of a benign neoplasm involved a woman with a bump on the lower left lid (acanthoma). Dr. Newton treated this patient with lidocaine ointment, and she was later able to use a jeweler's forceps and remove the sac, which spared the patient an excision.

Dr. Newton presented a case of an 11-year-old girl with molluscum contagiosum as an example of an infectious disease that can involve the eyes and skin. Molluscum contagiosum lesions often occur on the faces in children who acquire the infection by nonsexual transmission. The lesions can be mistaken for pustules, but histology data confirm the infection.

She treated the girl by curetting the lesions using local anesthesia, and the lesions have resolved completely. Cryotherapy and a peeling agent such as salicylic acid may also be used to treat molluscum contagiosum lesions.

MIAMI — At-home tests involving self-collected vaginal samples that are sent to a lab for analysis are effective at identifying women with sexually transmitted diseases, suggests a pilot study presented at the annual meeting of the American College of Preventive Medicine.

“This may be another tool that we can use to reach out of the clinic and to save money. You can save a lot of money if you don't have to pay clinicians to collect the samples,” said Charlotte A. Gaydos, Dr.P.H., a microbiologist in the division of infectious diseases at Johns Hopkins University, Baltimore.

The researchers established a Web site (www.iwantthekit.org

Data from 778 samples that had been analyzed as of Jan. 31, 2007, show 71 samples (9%) were positive for Chlamydia trachomatis and 12 (1%) were positive for Neisseria gonorrhoeae. Four samples showed coinfection with chlamydia and gonorrhea. Samples collected since September 2006 were tested for Trichomonas vaginalis, and 13 of 115 samples (11%) tested positive.

The kit includes swabs for collecting vaginal samples and a questionnaire on demographics, sexual history, and the participants' opinions about at-home testing.

“We require two positive assays for a positive diagnosis,” Dr. Gaydos said. Samples are analyzed using nucleic acid amplification tests (NAATs), which are more than 90% sensitive, compared with the 85% sensitivity associated with cultures. Participants received their test results via a toll-free number. A study coordinator arranged treatment appointments at a free local clinic for women with positive results.

So far, most women who tested positive have been treated, Dr. Gaydos noted. All 11 patients with gonorrhea were treated, as were 66 of 69 (96%) chlamydia cases.

Of 760 participants who identified their race, 70% were black, 22% were white, and the remainder were another race or mixed race. Chlamydia rates were significantly higher among black women, compared with white women (12% vs. 2%).

The participants ranged from 14 to 63 years of age, with an average age of 23, but those who tested positive tended to be younger. Average age at first sex was 15 years, Dr. Gaydos noted.

Positive tests were most common in the 15- to 19-year-olds (16%), followed by 20- to 24-year-olds (8.5%) and 25- to 29-year-olds (8%).

After controlling for multiple factors including age and race, the strongest risk factors for positive test results were use of birth control, nonconsensual sex, and multiple partners.

More than half of the participants reported a history of STDs; 40% had a history of chlamydia and 15% reported a history of gonorrhea.

Results of the questionnaires showed that on a Likert scale of 1 to 5, 96% said the sampling process was “easy” or “very easy” and 93% said they would use it again.

Nearly 25% said they preferred to receive results by e-mail, but a secure Web site to provide results is too expensive at this time, Dr. Gaydos said.

Under current protocol, participants calling the toll-free number give the kit number and a password that they chose to ensure confidentiality.

Even with the phone-in method of requesting results, the success in recruiting patients for home sampling and treating those who test positive is encouraging, Dr. Gaydos added.

A test kit for men is also promoted on www.iwantthekit.org

MIAMI — At-home tests involving self-collected vaginal samples that are sent to a lab for analysis are effective at identifying women with sexually transmitted diseases, suggests a pilot study presented at the annual meeting of the American College of Preventive Medicine.

“This may be another tool that we can use to reach out of the clinic and to save money. You can save a lot of money if you don't have to pay clinicians to collect the samples,” said Charlotte A. Gaydos, Dr.P.H., a microbiologist in the division of infectious diseases at Johns Hopkins University, Baltimore.

The researchers established a Web site (www.iwantthekit.org

Data from 778 samples that had been analyzed as of Jan. 31, 2007, show 71 samples (9%) were positive for Chlamydia trachomatis and 12 (1%) were positive for Neisseria gonorrhoeae. Four samples showed coinfection with chlamydia and gonorrhea. Samples collected since September 2006 were tested for Trichomonas vaginalis, and 13 of 115 samples (11%) tested positive.

The kit includes swabs for collecting vaginal samples and a questionnaire on demographics, sexual history, and the participants' opinions about at-home testing.

“We require two positive assays for a positive diagnosis,” Dr. Gaydos said. Samples are analyzed using nucleic acid amplification tests (NAATs), which are more than 90% sensitive, compared with the 85% sensitivity associated with cultures. Participants received their test results via a toll-free number. A study coordinator arranged treatment appointments at a free local clinic for women with positive results.

So far, most women who tested positive have been treated, Dr. Gaydos noted. All 11 patients with gonorrhea were treated, as were 66 of 69 (96%) chlamydia cases.

Of 760 participants who identified their race, 70% were black, 22% were white, and the remainder were another race or mixed race. Chlamydia rates were significantly higher among black women, compared with white women (12% vs. 2%).

The participants ranged from 14 to 63 years of age, with an average age of 23, but those who tested positive tended to be younger. Average age at first sex was 15 years, Dr. Gaydos noted.

Positive tests were most common in the 15- to 19-year-olds (16%), followed by 20- to 24-year-olds (8.5%) and 25- to 29-year-olds (8%).

After controlling for multiple factors including age and race, the strongest risk factors for positive test results were use of birth control, nonconsensual sex, and multiple partners.

More than half of the participants reported a history of STDs; 40% had a history of chlamydia and 15% reported a history of gonorrhea.

Results of the questionnaires showed that on a Likert scale of 1 to 5, 96% said the sampling process was “easy” or “very easy” and 93% said they would use it again.

Nearly 25% said they preferred to receive results by e-mail, but a secure Web site to provide results is too expensive at this time, Dr. Gaydos said.

Under current protocol, participants calling the toll-free number give the kit number and a password that they chose to ensure confidentiality.

Even with the phone-in method of requesting results, the success in recruiting patients for home sampling and treating those who test positive is encouraging, Dr. Gaydos added.

A test kit for men is also promoted on www.iwantthekit.org

MIAMI — At-home tests involving self-collected vaginal samples that are sent to a lab for analysis are effective at identifying women with sexually transmitted diseases, suggests a pilot study presented at the annual meeting of the American College of Preventive Medicine.

“This may be another tool that we can use to reach out of the clinic and to save money. You can save a lot of money if you don't have to pay clinicians to collect the samples,” said Charlotte A. Gaydos, Dr.P.H., a microbiologist in the division of infectious diseases at Johns Hopkins University, Baltimore.

The researchers established a Web site (www.iwantthekit.org

Data from 778 samples that had been analyzed as of Jan. 31, 2007, show 71 samples (9%) were positive for Chlamydia trachomatis and 12 (1%) were positive for Neisseria gonorrhoeae. Four samples showed coinfection with chlamydia and gonorrhea. Samples collected since September 2006 were tested for Trichomonas vaginalis, and 13 of 115 samples (11%) tested positive.

The kit includes swabs for collecting vaginal samples and a questionnaire on demographics, sexual history, and the participants' opinions about at-home testing.

“We require two positive assays for a positive diagnosis,” Dr. Gaydos said. Samples are analyzed using nucleic acid amplification tests (NAATs), which are more than 90% sensitive, compared with the 85% sensitivity associated with cultures. Participants received their test results via a toll-free number. A study coordinator arranged treatment appointments at a free local clinic for women with positive results.

So far, most women who tested positive have been treated, Dr. Gaydos noted. All 11 patients with gonorrhea were treated, as were 66 of 69 (96%) chlamydia cases.

Of 760 participants who identified their race, 70% were black, 22% were white, and the remainder were another race or mixed race. Chlamydia rates were significantly higher among black women, compared with white women (12% vs. 2%).

The participants ranged from 14 to 63 years of age, with an average age of 23, but those who tested positive tended to be younger. Average age at first sex was 15 years, Dr. Gaydos noted.

Positive tests were most common in the 15- to 19-year-olds (16%), followed by 20- to 24-year-olds (8.5%) and 25- to 29-year-olds (8%).

After controlling for multiple factors including age and race, the strongest risk factors for positive test results were use of birth control, nonconsensual sex, and multiple partners.

More than half of the participants reported a history of STDs; 40% had a history of chlamydia and 15% reported a history of gonorrhea.

Results of the questionnaires showed that on a Likert scale of 1 to 5, 96% said the sampling process was “easy” or “very easy” and 93% said they would use it again.

Nearly 25% said they preferred to receive results by e-mail, but a secure Web site to provide results is too expensive at this time, Dr. Gaydos said.

Under current protocol, participants calling the toll-free number give the kit number and a password that they chose to ensure confidentiality.

Even with the phone-in method of requesting results, the success in recruiting patients for home sampling and treating those who test positive is encouraging, Dr. Gaydos added.

A test kit for men is also promoted on www.iwantthekit.org

Nine influenza-related deaths have been reported in children in six states during the 2006–2007 flu season as of Feb. 3, based on a report issued Feb. 16 by the Centers for Disease Control and Prevention.

Five children were boys; four were girls. The children ranged in age from 3 months to 14 years (average age 7.5 years).

All nine children tested positive for the influenza A virus, and two specimens were identified as the influenza A (H1) virus (MMWR 2007;56:118–21).

The preliminary rate of laboratory-confirmed flu hospitalizations among children aged 0–17 years was 0.13 per 10,000 children based on the Emerging Infections Program database for the period from Oct. 1, 2006, through Jan. 20, 2007.

When the children were divided by age group, the rates were 0.13 per 10,000 children aged 0–4 years, and 0.05 per 10,000 children aged 5–17 years.

In addition, the preliminary rate of laboratory-confirmed flu hospitalizations among children aged 0–4 years was 0.63 per 10,000 children, based on the New Vaccine Surveillance Network database for the period from Nov. 5, 2006, through Jan. 20, 2007.

Influenza A (H1) has been the most often reported virus in flu patients overall this year. The weekly percentage of deaths in patients of any age from pneumonia and influenza has ranged from 5.6% to 7.5% this year, but as of Feb. 3, these rates had not passed the epidemic threshold as defined by the CDC at any point during the 2006–2007 flu season.

Nine influenza-related deaths have been reported in children in six states during the 2006–2007 flu season as of Feb. 3, based on a report issued Feb. 16 by the Centers for Disease Control and Prevention.

Five children were boys; four were girls. The children ranged in age from 3 months to 14 years (average age 7.5 years).

All nine children tested positive for the influenza A virus, and two specimens were identified as the influenza A (H1) virus (MMWR 2007;56:118–21).

The preliminary rate of laboratory-confirmed flu hospitalizations among children aged 0–17 years was 0.13 per 10,000 children based on the Emerging Infections Program database for the period from Oct. 1, 2006, through Jan. 20, 2007.

When the children were divided by age group, the rates were 0.13 per 10,000 children aged 0–4 years, and 0.05 per 10,000 children aged 5–17 years.

In addition, the preliminary rate of laboratory-confirmed flu hospitalizations among children aged 0–4 years was 0.63 per 10,000 children, based on the New Vaccine Surveillance Network database for the period from Nov. 5, 2006, through Jan. 20, 2007.

Influenza A (H1) has been the most often reported virus in flu patients overall this year. The weekly percentage of deaths in patients of any age from pneumonia and influenza has ranged from 5.6% to 7.5% this year, but as of Feb. 3, these rates had not passed the epidemic threshold as defined by the CDC at any point during the 2006–2007 flu season.

Nine influenza-related deaths have been reported in children in six states during the 2006–2007 flu season as of Feb. 3, based on a report issued Feb. 16 by the Centers for Disease Control and Prevention.

Five children were boys; four were girls. The children ranged in age from 3 months to 14 years (average age 7.5 years).

All nine children tested positive for the influenza A virus, and two specimens were identified as the influenza A (H1) virus (MMWR 2007;56:118–21).

The preliminary rate of laboratory-confirmed flu hospitalizations among children aged 0–17 years was 0.13 per 10,000 children based on the Emerging Infections Program database for the period from Oct. 1, 2006, through Jan. 20, 2007.

When the children were divided by age group, the rates were 0.13 per 10,000 children aged 0–4 years, and 0.05 per 10,000 children aged 5–17 years.

In addition, the preliminary rate of laboratory-confirmed flu hospitalizations among children aged 0–4 years was 0.63 per 10,000 children, based on the New Vaccine Surveillance Network database for the period from Nov. 5, 2006, through Jan. 20, 2007.

Influenza A (H1) has been the most often reported virus in flu patients overall this year. The weekly percentage of deaths in patients of any age from pneumonia and influenza has ranged from 5.6% to 7.5% this year, but as of Feb. 3, these rates had not passed the epidemic threshold as defined by the CDC at any point during the 2006–2007 flu season.

Cranial ultrasound scanning significantly predicted developmental outcomes in symptomatic newborns with cytomegalovirus, based on a study of 57 infants reported in the February issue of the Journal of Pediatrics.

To determine how well cranial ultrasound predicted clinical outcomes, two of the researchers reviewed the scans of the infants while blinded to the results (J. Pediatr. 2007;150:157–61). The ultrasound scans were taken during the first week of life and repeated weekly for the first month in cases of abnormal findings, and then repeated monthly until the infants were 6 months old.

Overall, 18 newborns had clinical and laboratory signs of cytomegalovirus (CMV) at birth, and 39 had no observable symptoms at birth. A total of 12 of the 57 (21%) infants had brain abnormalities that were visible on an ultrasound image. Ultrasound lesions were found in 10 of 18 (56%) newborns with clinical and laboratory symptoms, compared with 2 of 39 (5%) asymptomatic newborns.

None of the infants with normal ultrasound findings at birth had developed lesions at follow-up evaluations, and the negative predictive value of the ultrasound was 100% for motor delay and low developmental quotient and 93.3% for sensorineural hearing loss, Dr. Gina Ancora of the University of Bologna (Italy) and her colleagues wrote.

Data from evaluations at 12 months of age were available for 56 of 57 patients; one infant with visible ultrasound lesions had died of aortic thrombosis. Ten of the 11 remaining symptomatic newborns with abnormal ultrasound findings at birth developed at least one sequela, whereas none of the 8 newborns who were symptomatic but had normal ultrasound findings developed sequelae.

Similarly, only 3 of the 37 asymptomatic infants with no ultrasound abnormalities had poor outcomes at 12 months (sensorineural hearing loss), and 1 of 2 asymptomatic infants with abnormal ultrasound findings developed severe sequelae.

The presence of CMV symptoms at birth may not be enough to differentiate between children who will and will not develop lesions later, and ultrasound is a safe and easy diagnostic tool in this population, even for children in critical condition, the researchers wrote.

But the data were insufficient to make recommendations for ultrasound imaging in asymptomatic children, they said.

Cranial ultrasound scanning significantly predicted developmental outcomes in symptomatic newborns with cytomegalovirus, based on a study of 57 infants reported in the February issue of the Journal of Pediatrics.

To determine how well cranial ultrasound predicted clinical outcomes, two of the researchers reviewed the scans of the infants while blinded to the results (J. Pediatr. 2007;150:157–61). The ultrasound scans were taken during the first week of life and repeated weekly for the first month in cases of abnormal findings, and then repeated monthly until the infants were 6 months old.

Overall, 18 newborns had clinical and laboratory signs of cytomegalovirus (CMV) at birth, and 39 had no observable symptoms at birth. A total of 12 of the 57 (21%) infants had brain abnormalities that were visible on an ultrasound image. Ultrasound lesions were found in 10 of 18 (56%) newborns with clinical and laboratory symptoms, compared with 2 of 39 (5%) asymptomatic newborns.

None of the infants with normal ultrasound findings at birth had developed lesions at follow-up evaluations, and the negative predictive value of the ultrasound was 100% for motor delay and low developmental quotient and 93.3% for sensorineural hearing loss, Dr. Gina Ancora of the University of Bologna (Italy) and her colleagues wrote.

Data from evaluations at 12 months of age were available for 56 of 57 patients; one infant with visible ultrasound lesions had died of aortic thrombosis. Ten of the 11 remaining symptomatic newborns with abnormal ultrasound findings at birth developed at least one sequela, whereas none of the 8 newborns who were symptomatic but had normal ultrasound findings developed sequelae.

Similarly, only 3 of the 37 asymptomatic infants with no ultrasound abnormalities had poor outcomes at 12 months (sensorineural hearing loss), and 1 of 2 asymptomatic infants with abnormal ultrasound findings developed severe sequelae.

The presence of CMV symptoms at birth may not be enough to differentiate between children who will and will not develop lesions later, and ultrasound is a safe and easy diagnostic tool in this population, even for children in critical condition, the researchers wrote.

But the data were insufficient to make recommendations for ultrasound imaging in asymptomatic children, they said.

Cranial ultrasound scanning significantly predicted developmental outcomes in symptomatic newborns with cytomegalovirus, based on a study of 57 infants reported in the February issue of the Journal of Pediatrics.

To determine how well cranial ultrasound predicted clinical outcomes, two of the researchers reviewed the scans of the infants while blinded to the results (J. Pediatr. 2007;150:157–61). The ultrasound scans were taken during the first week of life and repeated weekly for the first month in cases of abnormal findings, and then repeated monthly until the infants were 6 months old.

Overall, 18 newborns had clinical and laboratory signs of cytomegalovirus (CMV) at birth, and 39 had no observable symptoms at birth. A total of 12 of the 57 (21%) infants had brain abnormalities that were visible on an ultrasound image. Ultrasound lesions were found in 10 of 18 (56%) newborns with clinical and laboratory symptoms, compared with 2 of 39 (5%) asymptomatic newborns.

None of the infants with normal ultrasound findings at birth had developed lesions at follow-up evaluations, and the negative predictive value of the ultrasound was 100% for motor delay and low developmental quotient and 93.3% for sensorineural hearing loss, Dr. Gina Ancora of the University of Bologna (Italy) and her colleagues wrote.

Data from evaluations at 12 months of age were available for 56 of 57 patients; one infant with visible ultrasound lesions had died of aortic thrombosis. Ten of the 11 remaining symptomatic newborns with abnormal ultrasound findings at birth developed at least one sequela, whereas none of the 8 newborns who were symptomatic but had normal ultrasound findings developed sequelae.

Similarly, only 3 of the 37 asymptomatic infants with no ultrasound abnormalities had poor outcomes at 12 months (sensorineural hearing loss), and 1 of 2 asymptomatic infants with abnormal ultrasound findings developed severe sequelae.

The presence of CMV symptoms at birth may not be enough to differentiate between children who will and will not develop lesions later, and ultrasound is a safe and easy diagnostic tool in this population, even for children in critical condition, the researchers wrote.

But the data were insufficient to make recommendations for ultrasound imaging in asymptomatic children, they said.

PHOENIX — Neonatal thyroid-stimulating hormone data can be used to detect epidemiologic trends in iodine sufficiency in pregnant women, even in countries where iodine intake is usually adequate, based on a study of 54,400 neonates presented at the annual meeting of the American Thyroid Association.

“Readily available neonatal TSH can be used to track the effects of altered trends in maternal iodine nutrition,” said Dr. Peter Smyth of the Conway Institute of Biomolecular and Biomedical Research at the University College Dublin.

Steps can be taken to increase iodine intake in pregnant women (which is important for proper fetal cognitive development) if the neonatal TSH in a population suggests low levels of maternal dietary iodine. The fetus depends on maternal thyroid hormones for normal development during the first 13–15 weeks of pregnancy, Dr. Smyth noted.

To assess the potential role of neonatal TSH as an indicator of a mother's iodine status, researchers screened a birth cohort of babies born in Ireland between 1988 and 2006.

Overall, TSH levels in newborns increased slightly but steadily during the study period, although the proportion of infants with severe iodine deficiency (TSH less than 5 mU/L) remained constant and stayed in a range of 2.35%–2.83%.

Notably, data from routine neonatal TSH screening showed a seasonal variation: Infants born in August had consistently higher TSH levels than infants born in January. Most dietary iodine in Ireland comes from milk and dairy products, and dietary iodine intake is disproportionately lower during the summer because the herd animals are out grazing and not receiving any nutritional supplements, Dr. Smyth explained.

Iodine levels in pregnant women were assessed using urinary iodine (UI) excretion values, and the decline in these values during the study period confirmed that the pregnant female population was borderline iodine deficient but relatively stable, although the UI values reflected the seasonal variation in dietary iodine intake.

From 1988 to 2003, the mean maternal UI values ranged from 70 to 83 mcg/L during the summer months and from 82 to 137 mcg/L during the winter months.

But findings from 2004 and 2005 showed a significant drop in maternal UI levels, which fell to a mean of 45 mcg/L in 2004 and 42.5 mcg/L in 2005. That trend has raised concerns about the need for dietary iodine supplementation in pregnant women in Ireland, said Dr. Smyth.

The study results support the link between declining urinary iodine levels in pregnant women and fetal thyroid function, and the trend data for maternal UI can be used to decide whether to initiate thyroid screening programs during pregnancy.

PHOENIX — Neonatal thyroid-stimulating hormone data can be used to detect epidemiologic trends in iodine sufficiency in pregnant women, even in countries where iodine intake is usually adequate, based on a study of 54,400 neonates presented at the annual meeting of the American Thyroid Association.

“Readily available neonatal TSH can be used to track the effects of altered trends in maternal iodine nutrition,” said Dr. Peter Smyth of the Conway Institute of Biomolecular and Biomedical Research at the University College Dublin.

Steps can be taken to increase iodine intake in pregnant women (which is important for proper fetal cognitive development) if the neonatal TSH in a population suggests low levels of maternal dietary iodine. The fetus depends on maternal thyroid hormones for normal development during the first 13–15 weeks of pregnancy, Dr. Smyth noted.

To assess the potential role of neonatal TSH as an indicator of a mother's iodine status, researchers screened a birth cohort of babies born in Ireland between 1988 and 2006.

Overall, TSH levels in newborns increased slightly but steadily during the study period, although the proportion of infants with severe iodine deficiency (TSH less than 5 mU/L) remained constant and stayed in a range of 2.35%–2.83%.

Notably, data from routine neonatal TSH screening showed a seasonal variation: Infants born in August had consistently higher TSH levels than infants born in January. Most dietary iodine in Ireland comes from milk and dairy products, and dietary iodine intake is disproportionately lower during the summer because the herd animals are out grazing and not receiving any nutritional supplements, Dr. Smyth explained.

Iodine levels in pregnant women were assessed using urinary iodine (UI) excretion values, and the decline in these values during the study period confirmed that the pregnant female population was borderline iodine deficient but relatively stable, although the UI values reflected the seasonal variation in dietary iodine intake.

From 1988 to 2003, the mean maternal UI values ranged from 70 to 83 mcg/L during the summer months and from 82 to 137 mcg/L during the winter months.

But findings from 2004 and 2005 showed a significant drop in maternal UI levels, which fell to a mean of 45 mcg/L in 2004 and 42.5 mcg/L in 2005. That trend has raised concerns about the need for dietary iodine supplementation in pregnant women in Ireland, said Dr. Smyth.

The study results support the link between declining urinary iodine levels in pregnant women and fetal thyroid function, and the trend data for maternal UI can be used to decide whether to initiate thyroid screening programs during pregnancy.

PHOENIX — Neonatal thyroid-stimulating hormone data can be used to detect epidemiologic trends in iodine sufficiency in pregnant women, even in countries where iodine intake is usually adequate, based on a study of 54,400 neonates presented at the annual meeting of the American Thyroid Association.

“Readily available neonatal TSH can be used to track the effects of altered trends in maternal iodine nutrition,” said Dr. Peter Smyth of the Conway Institute of Biomolecular and Biomedical Research at the University College Dublin.

Steps can be taken to increase iodine intake in pregnant women (which is important for proper fetal cognitive development) if the neonatal TSH in a population suggests low levels of maternal dietary iodine. The fetus depends on maternal thyroid hormones for normal development during the first 13–15 weeks of pregnancy, Dr. Smyth noted.

To assess the potential role of neonatal TSH as an indicator of a mother's iodine status, researchers screened a birth cohort of babies born in Ireland between 1988 and 2006.

Overall, TSH levels in newborns increased slightly but steadily during the study period, although the proportion of infants with severe iodine deficiency (TSH less than 5 mU/L) remained constant and stayed in a range of 2.35%–2.83%.

Notably, data from routine neonatal TSH screening showed a seasonal variation: Infants born in August had consistently higher TSH levels than infants born in January. Most dietary iodine in Ireland comes from milk and dairy products, and dietary iodine intake is disproportionately lower during the summer because the herd animals are out grazing and not receiving any nutritional supplements, Dr. Smyth explained.

Iodine levels in pregnant women were assessed using urinary iodine (UI) excretion values, and the decline in these values during the study period confirmed that the pregnant female population was borderline iodine deficient but relatively stable, although the UI values reflected the seasonal variation in dietary iodine intake.

From 1988 to 2003, the mean maternal UI values ranged from 70 to 83 mcg/L during the summer months and from 82 to 137 mcg/L during the winter months.

But findings from 2004 and 2005 showed a significant drop in maternal UI levels, which fell to a mean of 45 mcg/L in 2004 and 42.5 mcg/L in 2005. That trend has raised concerns about the need for dietary iodine supplementation in pregnant women in Ireland, said Dr. Smyth.

The study results support the link between declining urinary iodine levels in pregnant women and fetal thyroid function, and the trend data for maternal UI can be used to decide whether to initiate thyroid screening programs during pregnancy.

OTTAWA — Determine the vascular supply to a limb as the first step in the treatment of a lower extremity wound, Dr. Stephan Mostowy said at the annual conference of the Canadian Association of Wound Care.

Early identification of a wound's etiology and assessment of a patient's risk factors can give the patient the best chance to heal, he said. “The overall incidence of vascular disease is growing as our population ages,” but only 10% of patients are symptomatic, said Dr. Mostowy, a vascular surgeon at Credit Valley Hospital in Mississauga, Ont.

Smoking, hypertension, and hyperlipidemia are common culprits in peripheral vascular disease, so physicians should consider arterial insufficiency in patients with these risk factors who present with leg wounds, he said.

In addition to a physical exam and checking pulses, an ankle brachial index (ABI) of less than 0.9 mm Hg can indicate peripheral vascular disease because it demonstrates decreased blood flow to the legs. In some cases, a vascular surgeon can improve the blood flow to the wounded area and improve the patient's chances for healing.

“Working in a multidisciplinary team is crucial to improving rates of healing in our patients,” emphasized Dr. Mostowy and Laurie Goodman, a clinical wound care specialist at the hospital. Dr. Mostowy and Ms. Goodman copresented three cases that are typical of wounds with three different etiologies: arterial, venous, and diabetic.

Surgery Needed

Dr. Mostowy began with the case of a 74-year-old male smoker who had diabetes, hypertension, and hypercholesterolemia. The patient presented with a painful, pale, and punched-out ulcer on the back of his calf. He had no discernible pulses in the lower leg, which was cool to the touch, and he had a reduced ABI of 0.3 mm Hg, which suggested arterial insufficiency.

By contrast, venous ulcers are usually shallower than arterial wounds, and they are often located on the lower leg just above the ankle and below the calf (the “gaiter” area), Dr. Mostowy said. Venous ulcers also are more likely to be associated with varicose veins, he added.

Surgery (femoral-distal bypass) was the appropriate choice for this patient to improve his blood supply and heal the lesion. The procedure involved making two incisions in the patient's leg and harvesting an arm vein to use as a conduit.

The result was a well-healed ulcer that was completely closed and pain free after a few weeks. The patient also quit smoking, which will help the long-term durability of the bypass, Dr. Mostowy noted.

A Very Venous Problem

The next case involved a 39-year-old male with a recurrent venous ulcer on his left leg. The patient was a professional cook and a single father, and was standing all day. He had a history of varicose veins and deep venous insufficiency from a similar ulcer 2 years ago that had healed, but he was nonadherent about wearing the compression stocking that was necessary to keep his leg healthy, Dr. Mostowy said.

The patient presented with a new ulcer that was so infected and advanced that he was hospitalized for wound management and pain relief. He had strong digital pulses suggestive of a normal arterial supply, indicating a venous etiology rather than arterial, Dr. Mostowy explained.

The patient underwent surgical wound debridement, received intravenous antibiotics, and had dressing changes. Once the ulcer was under control, he was treated as an outpatient with a four-layer compression system of dressing, which addressed his venous hypertension. The use of analgesia and an airbed made a significant difference in his comfort at home and reduced his pain to a 5 on a 10-point scale.

When the ulcer was nearly healed, the patient was matched with a compression stocking supplier to help him transition to a stocking with better compliance. This case is an example of a successful team effort to heal the ulcer. “Hopefully, this patient is better educated and will wear the compression stocking to prevent future recurrences,” Dr. Mostowy said.

Diabetic Foot Fix-Up

The third case involved a 63-year-old woman who “arrived at the emergency department with a terrible diabetic foot infection,” Dr. Mostowy said.

The patient had pus draining from the bottom of her foot, and she had a fever and chills. The wound required surgical draining of the plantar space and amputation of the fourth and fifth toes to control the infection. After the area was drained, the wound was stabilized with antibiotics and a local dressing and the wound care team assessed the vascularity of the wound to determine the potential for healing.

Because the patient's blood supply was adequate (ABI greater than 0.9 mm Hg), the defect had the potential to heal. Vacuum-assisted closure therapy was instituted to accelerate healing, and the wound care team saved the patient's foot.

During the wound care process, the patient learned how to improve control of her diabetes, and she learned the importance of using moisturizer and orthotics and protective footwear to better care for her feet, he said.

An arterial ulcer on the calf of this patient has a “punched out” appearance.

A superinfected venous ulcer became circumferential with the infection.

A diabetic infection requires amputation of two toes, leaving a large cavity. Photos courtesy Dr. Stephan Mostowy

OTTAWA — Determine the vascular supply to a limb as the first step in the treatment of a lower extremity wound, Dr. Stephan Mostowy said at the annual conference of the Canadian Association of Wound Care.

Early identification of a wound's etiology and assessment of a patient's risk factors can give the patient the best chance to heal, he said. “The overall incidence of vascular disease is growing as our population ages,” but only 10% of patients are symptomatic, said Dr. Mostowy, a vascular surgeon at Credit Valley Hospital in Mississauga, Ont.

Smoking, hypertension, and hyperlipidemia are common culprits in peripheral vascular disease, so physicians should consider arterial insufficiency in patients with these risk factors who present with leg wounds, he said.

In addition to a physical exam and checking pulses, an ankle brachial index (ABI) of less than 0.9 mm Hg can indicate peripheral vascular disease because it demonstrates decreased blood flow to the legs. In some cases, a vascular surgeon can improve the blood flow to the wounded area and improve the patient's chances for healing.

“Working in a multidisciplinary team is crucial to improving rates of healing in our patients,” emphasized Dr. Mostowy and Laurie Goodman, a clinical wound care specialist at the hospital. Dr. Mostowy and Ms. Goodman copresented three cases that are typical of wounds with three different etiologies: arterial, venous, and diabetic.

Surgery Needed

Dr. Mostowy began with the case of a 74-year-old male smoker who had diabetes, hypertension, and hypercholesterolemia. The patient presented with a painful, pale, and punched-out ulcer on the back of his calf. He had no discernible pulses in the lower leg, which was cool to the touch, and he had a reduced ABI of 0.3 mm Hg, which suggested arterial insufficiency.

By contrast, venous ulcers are usually shallower than arterial wounds, and they are often located on the lower leg just above the ankle and below the calf (the “gaiter” area), Dr. Mostowy said. Venous ulcers also are more likely to be associated with varicose veins, he added.

Surgery (femoral-distal bypass) was the appropriate choice for this patient to improve his blood supply and heal the lesion. The procedure involved making two incisions in the patient's leg and harvesting an arm vein to use as a conduit.

The result was a well-healed ulcer that was completely closed and pain free after a few weeks. The patient also quit smoking, which will help the long-term durability of the bypass, Dr. Mostowy noted.

A Very Venous Problem

The next case involved a 39-year-old male with a recurrent venous ulcer on his left leg. The patient was a professional cook and a single father, and was standing all day. He had a history of varicose veins and deep venous insufficiency from a similar ulcer 2 years ago that had healed, but he was nonadherent about wearing the compression stocking that was necessary to keep his leg healthy, Dr. Mostowy said.

The patient presented with a new ulcer that was so infected and advanced that he was hospitalized for wound management and pain relief. He had strong digital pulses suggestive of a normal arterial supply, indicating a venous etiology rather than arterial, Dr. Mostowy explained.

The patient underwent surgical wound debridement, received intravenous antibiotics, and had dressing changes. Once the ulcer was under control, he was treated as an outpatient with a four-layer compression system of dressing, which addressed his venous hypertension. The use of analgesia and an airbed made a significant difference in his comfort at home and reduced his pain to a 5 on a 10-point scale.

When the ulcer was nearly healed, the patient was matched with a compression stocking supplier to help him transition to a stocking with better compliance. This case is an example of a successful team effort to heal the ulcer. “Hopefully, this patient is better educated and will wear the compression stocking to prevent future recurrences,” Dr. Mostowy said.

Diabetic Foot Fix-Up

The third case involved a 63-year-old woman who “arrived at the emergency department with a terrible diabetic foot infection,” Dr. Mostowy said.

The patient had pus draining from the bottom of her foot, and she had a fever and chills. The wound required surgical draining of the plantar space and amputation of the fourth and fifth toes to control the infection. After the area was drained, the wound was stabilized with antibiotics and a local dressing and the wound care team assessed the vascularity of the wound to determine the potential for healing.

Because the patient's blood supply was adequate (ABI greater than 0.9 mm Hg), the defect had the potential to heal. Vacuum-assisted closure therapy was instituted to accelerate healing, and the wound care team saved the patient's foot.

During the wound care process, the patient learned how to improve control of her diabetes, and she learned the importance of using moisturizer and orthotics and protective footwear to better care for her feet, he said.

An arterial ulcer on the calf of this patient has a “punched out” appearance.

A superinfected venous ulcer became circumferential with the infection.

A diabetic infection requires amputation of two toes, leaving a large cavity. Photos courtesy Dr. Stephan Mostowy

OTTAWA — Determine the vascular supply to a limb as the first step in the treatment of a lower extremity wound, Dr. Stephan Mostowy said at the annual conference of the Canadian Association of Wound Care.

Early identification of a wound's etiology and assessment of a patient's risk factors can give the patient the best chance to heal, he said. “The overall incidence of vascular disease is growing as our population ages,” but only 10% of patients are symptomatic, said Dr. Mostowy, a vascular surgeon at Credit Valley Hospital in Mississauga, Ont.

Smoking, hypertension, and hyperlipidemia are common culprits in peripheral vascular disease, so physicians should consider arterial insufficiency in patients with these risk factors who present with leg wounds, he said.

In addition to a physical exam and checking pulses, an ankle brachial index (ABI) of less than 0.9 mm Hg can indicate peripheral vascular disease because it demonstrates decreased blood flow to the legs. In some cases, a vascular surgeon can improve the blood flow to the wounded area and improve the patient's chances for healing.

“Working in a multidisciplinary team is crucial to improving rates of healing in our patients,” emphasized Dr. Mostowy and Laurie Goodman, a clinical wound care specialist at the hospital. Dr. Mostowy and Ms. Goodman copresented three cases that are typical of wounds with three different etiologies: arterial, venous, and diabetic.

Surgery Needed

Dr. Mostowy began with the case of a 74-year-old male smoker who had diabetes, hypertension, and hypercholesterolemia. The patient presented with a painful, pale, and punched-out ulcer on the back of his calf. He had no discernible pulses in the lower leg, which was cool to the touch, and he had a reduced ABI of 0.3 mm Hg, which suggested arterial insufficiency.

By contrast, venous ulcers are usually shallower than arterial wounds, and they are often located on the lower leg just above the ankle and below the calf (the “gaiter” area), Dr. Mostowy said. Venous ulcers also are more likely to be associated with varicose veins, he added.

Surgery (femoral-distal bypass) was the appropriate choice for this patient to improve his blood supply and heal the lesion. The procedure involved making two incisions in the patient's leg and harvesting an arm vein to use as a conduit.

The result was a well-healed ulcer that was completely closed and pain free after a few weeks. The patient also quit smoking, which will help the long-term durability of the bypass, Dr. Mostowy noted.

A Very Venous Problem

The next case involved a 39-year-old male with a recurrent venous ulcer on his left leg. The patient was a professional cook and a single father, and was standing all day. He had a history of varicose veins and deep venous insufficiency from a similar ulcer 2 years ago that had healed, but he was nonadherent about wearing the compression stocking that was necessary to keep his leg healthy, Dr. Mostowy said.

The patient presented with a new ulcer that was so infected and advanced that he was hospitalized for wound management and pain relief. He had strong digital pulses suggestive of a normal arterial supply, indicating a venous etiology rather than arterial, Dr. Mostowy explained.

The patient underwent surgical wound debridement, received intravenous antibiotics, and had dressing changes. Once the ulcer was under control, he was treated as an outpatient with a four-layer compression system of dressing, which addressed his venous hypertension. The use of analgesia and an airbed made a significant difference in his comfort at home and reduced his pain to a 5 on a 10-point scale.

When the ulcer was nearly healed, the patient was matched with a compression stocking supplier to help him transition to a stocking with better compliance. This case is an example of a successful team effort to heal the ulcer. “Hopefully, this patient is better educated and will wear the compression stocking to prevent future recurrences,” Dr. Mostowy said.

Diabetic Foot Fix-Up

The third case involved a 63-year-old woman who “arrived at the emergency department with a terrible diabetic foot infection,” Dr. Mostowy said.

The patient had pus draining from the bottom of her foot, and she had a fever and chills. The wound required surgical draining of the plantar space and amputation of the fourth and fifth toes to control the infection. After the area was drained, the wound was stabilized with antibiotics and a local dressing and the wound care team assessed the vascularity of the wound to determine the potential for healing.

Because the patient's blood supply was adequate (ABI greater than 0.9 mm Hg), the defect had the potential to heal. Vacuum-assisted closure therapy was instituted to accelerate healing, and the wound care team saved the patient's foot.

During the wound care process, the patient learned how to improve control of her diabetes, and she learned the importance of using moisturizer and orthotics and protective footwear to better care for her feet, he said.

An arterial ulcer on the calf of this patient has a “punched out” appearance.

A superinfected venous ulcer became circumferential with the infection.

A diabetic infection requires amputation of two toes, leaving a large cavity. Photos courtesy Dr. Stephan Mostowy

A new formulation of intranasal influenza live virus vaccine that can be stored in a standard refrigerator, rather than kept frozen, has been approved by the Food and Drug Administration.

The new formulation of the trivalent vaccine, FluMist, is approved for healthy children and adults aged 5-49 years, and it will be available for the 2007-2008 flu season, according to a statement from the vaccine's manufacturer, MedImmune Inc. The company is seeking FDA approval of the refrigerated vaccine for use in children aged 12-59 months (1-5 years).

“This is a useful advance because the vaccine can be stored more easily and implemented better,” Dr. Sarah Long, chief of the infectious diseases section at St. Christopher's Hospital for Children, Philadelphia, said in an interview.

But the new formulation's effect on physician practices will not necessarily be substantial at this time, added Dr. Long, who is also a member of the American Academy of Pediatrics' Red Book Committee.

“It will be very useful if it is approved for [younger] children,” she noted.

The refrigerated formulation of FluMist will likely be appealing because of its ease of use, but the major factors driving influenza vaccination rates in primary care offices will continue to be cost (including reimbursement), vaccine supply and distribution, efficacy, and safety concerns, Dr. Jonathan Temte, of the University of Wisconsin, Madison, said in an interview.

“FluMist appears to have had better supply and distribution characteristics than the other influenza vaccines of late, but it is hampered by a higher price,” said Dr. Temte, who also serves as American Academy of Family Physicians' liaison to the Center for Disease Control and Prevention's Advisory Committee on Immunization Practices.

That said, data have shown good efficacy for FluMist even in years when the vaccine was not well matched to the flu virus, he added.

Compared with injectable vaccine, FluMist provides better, longer lasting immunity and better cross-protection from year to year as the flu virus drifts, said Dr. Michael Pichichero, a private practice pediatrician and professor of microbiology and immunology at the University of Rochester (N.Y.). But the biggest drawback is cost. “Refrigeration is a minor advance in my opinion. If it were the same cost, it would be a no-brainer,” he said.

Should universal influenza vaccination be recommended, the new FluMist formulation would theoretically make that goal more feasible. Most people are not willing to line up for an injection each year. At the same time, the refrigerated formulation broadens the potential for flu immunizations to be offered in locations outside of the physician's office, such as schools or clinics. But the caveat is that FluMist of either formulation can be given only to persons who are otherwise healthy, Dr. Long said.

The high cost will continue to be a major impediment to FluMist's utilization, although the new formulation would help to ensure a steadier vaccine supply if universal vaccination is advised, Dr. Temte added.

The original FluMist, which is also manufactured by MedImmune, has been available in a frozen formulation since its FDA approval in 2003.

A new formulation of intranasal influenza live virus vaccine that can be stored in a standard refrigerator, rather than kept frozen, has been approved by the Food and Drug Administration.

The new formulation of the trivalent vaccine, FluMist, is approved for healthy children and adults aged 5-49 years, and it will be available for the 2007-2008 flu season, according to a statement from the vaccine's manufacturer, MedImmune Inc. The company is seeking FDA approval of the refrigerated vaccine for use in children aged 12-59 months (1-5 years).

“This is a useful advance because the vaccine can be stored more easily and implemented better,” Dr. Sarah Long, chief of the infectious diseases section at St. Christopher's Hospital for Children, Philadelphia, said in an interview.

But the new formulation's effect on physician practices will not necessarily be substantial at this time, added Dr. Long, who is also a member of the American Academy of Pediatrics' Red Book Committee.

“It will be very useful if it is approved for [younger] children,” she noted.

The refrigerated formulation of FluMist will likely be appealing because of its ease of use, but the major factors driving influenza vaccination rates in primary care offices will continue to be cost (including reimbursement), vaccine supply and distribution, efficacy, and safety concerns, Dr. Jonathan Temte, of the University of Wisconsin, Madison, said in an interview.

“FluMist appears to have had better supply and distribution characteristics than the other influenza vaccines of late, but it is hampered by a higher price,” said Dr. Temte, who also serves as American Academy of Family Physicians' liaison to the Center for Disease Control and Prevention's Advisory Committee on Immunization Practices.

That said, data have shown good efficacy for FluMist even in years when the vaccine was not well matched to the flu virus, he added.

Compared with injectable vaccine, FluMist provides better, longer lasting immunity and better cross-protection from year to year as the flu virus drifts, said Dr. Michael Pichichero, a private practice pediatrician and professor of microbiology and immunology at the University of Rochester (N.Y.). But the biggest drawback is cost. “Refrigeration is a minor advance in my opinion. If it were the same cost, it would be a no-brainer,” he said.

Should universal influenza vaccination be recommended, the new FluMist formulation would theoretically make that goal more feasible. Most people are not willing to line up for an injection each year. At the same time, the refrigerated formulation broadens the potential for flu immunizations to be offered in locations outside of the physician's office, such as schools or clinics. But the caveat is that FluMist of either formulation can be given only to persons who are otherwise healthy, Dr. Long said.

The high cost will continue to be a major impediment to FluMist's utilization, although the new formulation would help to ensure a steadier vaccine supply if universal vaccination is advised, Dr. Temte added.

The original FluMist, which is also manufactured by MedImmune, has been available in a frozen formulation since its FDA approval in 2003.

A new formulation of intranasal influenza live virus vaccine that can be stored in a standard refrigerator, rather than kept frozen, has been approved by the Food and Drug Administration.

The new formulation of the trivalent vaccine, FluMist, is approved for healthy children and adults aged 5-49 years, and it will be available for the 2007-2008 flu season, according to a statement from the vaccine's manufacturer, MedImmune Inc. The company is seeking FDA approval of the refrigerated vaccine for use in children aged 12-59 months (1-5 years).

“This is a useful advance because the vaccine can be stored more easily and implemented better,” Dr. Sarah Long, chief of the infectious diseases section at St. Christopher's Hospital for Children, Philadelphia, said in an interview.

But the new formulation's effect on physician practices will not necessarily be substantial at this time, added Dr. Long, who is also a member of the American Academy of Pediatrics' Red Book Committee.

“It will be very useful if it is approved for [younger] children,” she noted.

The refrigerated formulation of FluMist will likely be appealing because of its ease of use, but the major factors driving influenza vaccination rates in primary care offices will continue to be cost (including reimbursement), vaccine supply and distribution, efficacy, and safety concerns, Dr. Jonathan Temte, of the University of Wisconsin, Madison, said in an interview.

“FluMist appears to have had better supply and distribution characteristics than the other influenza vaccines of late, but it is hampered by a higher price,” said Dr. Temte, who also serves as American Academy of Family Physicians' liaison to the Center for Disease Control and Prevention's Advisory Committee on Immunization Practices.

That said, data have shown good efficacy for FluMist even in years when the vaccine was not well matched to the flu virus, he added.

Compared with injectable vaccine, FluMist provides better, longer lasting immunity and better cross-protection from year to year as the flu virus drifts, said Dr. Michael Pichichero, a private practice pediatrician and professor of microbiology and immunology at the University of Rochester (N.Y.). But the biggest drawback is cost. “Refrigeration is a minor advance in my opinion. If it were the same cost, it would be a no-brainer,” he said.

Should universal influenza vaccination be recommended, the new FluMist formulation would theoretically make that goal more feasible. Most people are not willing to line up for an injection each year. At the same time, the refrigerated formulation broadens the potential for flu immunizations to be offered in locations outside of the physician's office, such as schools or clinics. But the caveat is that FluMist of either formulation can be given only to persons who are otherwise healthy, Dr. Long said.

The high cost will continue to be a major impediment to FluMist's utilization, although the new formulation would help to ensure a steadier vaccine supply if universal vaccination is advised, Dr. Temte added.

The original FluMist, which is also manufactured by MedImmune, has been available in a frozen formulation since its FDA approval in 2003.

WASHINGTON — Presurgical patch testing may prompt surgeons to change devices to prevent allergic reactions in patients, Kurtis Reed said at the annual meeting of the American Contact Dermatitis Society.

To evaluate the clinical impact of a positive patch test before and after surgery, Mr. Reed, a third-year medical student at Mayo Medical School, Rochester, Minn., and his colleagues reviewed data from 22 patients who were patch tested before receiving an orthopedic device or pacemaker and 22 patients who were referred for patch testing after receiving their devices.

Five of the 22 patients who were tested prior to surgery tested positive to at least one component of the prospective device. In four of the five cases, the surgeon changed the device. In the fifth case, the surgeon proceeded as planned because the odds of an adverse reaction were low, and that patient has reported no complications, Mr. Reed said.

The surgeon proceeded as planned in 16 of the 17 patients whose patch tests were negative. The device was changed in one case based on the patient's allergy history, he said.

By contrast, the clinical value of patch testing was unclear in patients who were referred following surgery. Reasons for referral included 13 cases of unexplained rash at the device site, 8 cases of chronic joint pain, and 1 case of joint loosening.

Only 1 of the 22 patients (one of the cases of unexplained rash) tested positive to an orthopedic device component, but the device could not be confirmed as the source of the rash, Mr. Reed noted.

WASHINGTON — Presurgical patch testing may prompt surgeons to change devices to prevent allergic reactions in patients, Kurtis Reed said at the annual meeting of the American Contact Dermatitis Society.

To evaluate the clinical impact of a positive patch test before and after surgery, Mr. Reed, a third-year medical student at Mayo Medical School, Rochester, Minn., and his colleagues reviewed data from 22 patients who were patch tested before receiving an orthopedic device or pacemaker and 22 patients who were referred for patch testing after receiving their devices.

Five of the 22 patients who were tested prior to surgery tested positive to at least one component of the prospective device. In four of the five cases, the surgeon changed the device. In the fifth case, the surgeon proceeded as planned because the odds of an adverse reaction were low, and that patient has reported no complications, Mr. Reed said.

The surgeon proceeded as planned in 16 of the 17 patients whose patch tests were negative. The device was changed in one case based on the patient's allergy history, he said.

By contrast, the clinical value of patch testing was unclear in patients who were referred following surgery. Reasons for referral included 13 cases of unexplained rash at the device site, 8 cases of chronic joint pain, and 1 case of joint loosening.

Only 1 of the 22 patients (one of the cases of unexplained rash) tested positive to an orthopedic device component, but the device could not be confirmed as the source of the rash, Mr. Reed noted.

WASHINGTON — Presurgical patch testing may prompt surgeons to change devices to prevent allergic reactions in patients, Kurtis Reed said at the annual meeting of the American Contact Dermatitis Society.

To evaluate the clinical impact of a positive patch test before and after surgery, Mr. Reed, a third-year medical student at Mayo Medical School, Rochester, Minn., and his colleagues reviewed data from 22 patients who were patch tested before receiving an orthopedic device or pacemaker and 22 patients who were referred for patch testing after receiving their devices.

Five of the 22 patients who were tested prior to surgery tested positive to at least one component of the prospective device. In four of the five cases, the surgeon changed the device. In the fifth case, the surgeon proceeded as planned because the odds of an adverse reaction were low, and that patient has reported no complications, Mr. Reed said.

The surgeon proceeded as planned in 16 of the 17 patients whose patch tests were negative. The device was changed in one case based on the patient's allergy history, he said.

By contrast, the clinical value of patch testing was unclear in patients who were referred following surgery. Reasons for referral included 13 cases of unexplained rash at the device site, 8 cases of chronic joint pain, and 1 case of joint loosening.

Only 1 of the 22 patients (one of the cases of unexplained rash) tested positive to an orthopedic device component, but the device could not be confirmed as the source of the rash, Mr. Reed noted.

LAS VEGAS — Endometrial ablation as a treatment for dysfunctional uterine bleeding achieves symptom relief comparable in the short term to a hysterectomy, with less morbidity, Dr. Malcolm G. Munro reported at the annual meeting of the American Association of Gynecologic Laparoscopists.

Data were collected from 237 women aged 18 years and older who were randomized to either endometrial ablation (EA) or hysterectomy as part of the Surgical Treatments Outcomes Project for Dysfunctional Uterine Bleeding (STOP-DUB), the largest trial to date to compare the two procedures in terms of patient satisfaction and complications.

“Chronic dysfunctional uterine bleeding is commonly an indication for hysterectomy,” noted Dr. Munro of the University of California, Los Angeles, and Kaiser Permanente Southern California.

Patient reports of symptom relief were similar in the EA and hysterectomy groups at 12 months and 2 years after the procedures, according to results from the multicenter trial. The hysterectomy rate for EA patients due to a return of symptoms was 30% at 4 years and seemed equivalent for those who underwent traditional resectoscopic EA and for those who underwent balloon EA, Dr. Munro said.

None of the 119 women who had EA needed readmission or surgery for significant complications within 42 days of the procedure, compared with 3 of 118 women who had hysterectomies.

In addition, there were more intraoperative and early postoperative complications in the hysterectomy patients compared with the EA patients. Complications in the hysterectomy group included two cystotomies, seven hematomas or seromas, and four wound infections, compared with one hematoma in an EA patient.

Although EA is not an option for women who wish to become pregnant or are undecided about it, patients who aren't concerned with preserving fertility may consider EA to improve their dysfunctional uterine bleeding and avoid the potential complications of a hysterectomy.

“The primary outcome was a 12-month assessment of the impact of surgery on the woman's assessment of her problem,” said Dr. Munro. The researchers also looked at specific symptoms including bleeding, pain, and fatigue, as well as quality of life.

All the patients reported dysfunctional uterine bleeding that had lasted at least 6 months. They had failed to respond to medical therapy, and they were willing to undergo a procedure that would remove their fertility. Dysfunctional uterine bleeding was defined as abnormal uterine bleeding during the reproductive years that could not be linked to uterine abnormalities such as submucosal myomas and polyps; the investigators excluded women with these abnormalities from the trial.

EA patients had an average hospital stay of less than 1 day vs. an average of 1–3 days for hysterectomy, depending on whether the hysterectomy was abdominal, vaginal, or laparoscopic. Patient reports of satisfaction with their assigned procedures were not significantly different between the groups at any follow-up visit, although, as expected, EA patients were more likely to have continued menstruation while the hysterectomy patients had amenorrhea.

“Endometrial ablation is devoid of incisions, and is compatible with an individual's returning to work or virtually all other activities of daily living within a day or so of the procedure,” Dr. Munro said in an interview.

In general, both hysterectomy and endometrial ablation were effective at resolving the bleeding problems. But the differences in pain, risk, and a delayed return to activity associated with each procedure also are associated with direct and indirect costs, and Dr. Munro and his colleagues plan to evaluate those data.

The STOP-DUB study, funded by the Agency for Healthcare Research and Quality, involved more than 30 treatment centers in the United States and Canada.

EA patients had an average hospital stay of less than 1 day vs. an average of 1–3 days for hysterectomy. DR. MUNRO

LAS VEGAS — Endometrial ablation as a treatment for dysfunctional uterine bleeding achieves symptom relief comparable in the short term to a hysterectomy, with less morbidity, Dr. Malcolm G. Munro reported at the annual meeting of the American Association of Gynecologic Laparoscopists.

Data were collected from 237 women aged 18 years and older who were randomized to either endometrial ablation (EA) or hysterectomy as part of the Surgical Treatments Outcomes Project for Dysfunctional Uterine Bleeding (STOP-DUB), the largest trial to date to compare the two procedures in terms of patient satisfaction and complications.

“Chronic dysfunctional uterine bleeding is commonly an indication for hysterectomy,” noted Dr. Munro of the University of California, Los Angeles, and Kaiser Permanente Southern California.

Patient reports of symptom relief were similar in the EA and hysterectomy groups at 12 months and 2 years after the procedures, according to results from the multicenter trial. The hysterectomy rate for EA patients due to a return of symptoms was 30% at 4 years and seemed equivalent for those who underwent traditional resectoscopic EA and for those who underwent balloon EA, Dr. Munro said.

None of the 119 women who had EA needed readmission or surgery for significant complications within 42 days of the procedure, compared with 3 of 118 women who had hysterectomies.

In addition, there were more intraoperative and early postoperative complications in the hysterectomy patients compared with the EA patients. Complications in the hysterectomy group included two cystotomies, seven hematomas or seromas, and four wound infections, compared with one hematoma in an EA patient.

Although EA is not an option for women who wish to become pregnant or are undecided about it, patients who aren't concerned with preserving fertility may consider EA to improve their dysfunctional uterine bleeding and avoid the potential complications of a hysterectomy.

“The primary outcome was a 12-month assessment of the impact of surgery on the woman's assessment of her problem,” said Dr. Munro. The researchers also looked at specific symptoms including bleeding, pain, and fatigue, as well as quality of life.

All the patients reported dysfunctional uterine bleeding that had lasted at least 6 months. They had failed to respond to medical therapy, and they were willing to undergo a procedure that would remove their fertility. Dysfunctional uterine bleeding was defined as abnormal uterine bleeding during the reproductive years that could not be linked to uterine abnormalities such as submucosal myomas and polyps; the investigators excluded women with these abnormalities from the trial.

EA patients had an average hospital stay of less than 1 day vs. an average of 1–3 days for hysterectomy, depending on whether the hysterectomy was abdominal, vaginal, or laparoscopic. Patient reports of satisfaction with their assigned procedures were not significantly different between the groups at any follow-up visit, although, as expected, EA patients were more likely to have continued menstruation while the hysterectomy patients had amenorrhea.

“Endometrial ablation is devoid of incisions, and is compatible with an individual's returning to work or virtually all other activities of daily living within a day or so of the procedure,” Dr. Munro said in an interview.

In general, both hysterectomy and endometrial ablation were effective at resolving the bleeding problems. But the differences in pain, risk, and a delayed return to activity associated with each procedure also are associated with direct and indirect costs, and Dr. Munro and his colleagues plan to evaluate those data.

The STOP-DUB study, funded by the Agency for Healthcare Research and Quality, involved more than 30 treatment centers in the United States and Canada.

EA patients had an average hospital stay of less than 1 day vs. an average of 1–3 days for hysterectomy. DR. MUNRO

LAS VEGAS — Endometrial ablation as a treatment for dysfunctional uterine bleeding achieves symptom relief comparable in the short term to a hysterectomy, with less morbidity, Dr. Malcolm G. Munro reported at the annual meeting of the American Association of Gynecologic Laparoscopists.

Data were collected from 237 women aged 18 years and older who were randomized to either endometrial ablation (EA) or hysterectomy as part of the Surgical Treatments Outcomes Project for Dysfunctional Uterine Bleeding (STOP-DUB), the largest trial to date to compare the two procedures in terms of patient satisfaction and complications.

“Chronic dysfunctional uterine bleeding is commonly an indication for hysterectomy,” noted Dr. Munro of the University of California, Los Angeles, and Kaiser Permanente Southern California.

Patient reports of symptom relief were similar in the EA and hysterectomy groups at 12 months and 2 years after the procedures, according to results from the multicenter trial. The hysterectomy rate for EA patients due to a return of symptoms was 30% at 4 years and seemed equivalent for those who underwent traditional resectoscopic EA and for those who underwent balloon EA, Dr. Munro said.

None of the 119 women who had EA needed readmission or surgery for significant complications within 42 days of the procedure, compared with 3 of 118 women who had hysterectomies.

In addition, there were more intraoperative and early postoperative complications in the hysterectomy patients compared with the EA patients. Complications in the hysterectomy group included two cystotomies, seven hematomas or seromas, and four wound infections, compared with one hematoma in an EA patient.

Although EA is not an option for women who wish to become pregnant or are undecided about it, patients who aren't concerned with preserving fertility may consider EA to improve their dysfunctional uterine bleeding and avoid the potential complications of a hysterectomy.

“The primary outcome was a 12-month assessment of the impact of surgery on the woman's assessment of her problem,” said Dr. Munro. The researchers also looked at specific symptoms including bleeding, pain, and fatigue, as well as quality of life.

All the patients reported dysfunctional uterine bleeding that had lasted at least 6 months. They had failed to respond to medical therapy, and they were willing to undergo a procedure that would remove their fertility. Dysfunctional uterine bleeding was defined as abnormal uterine bleeding during the reproductive years that could not be linked to uterine abnormalities such as submucosal myomas and polyps; the investigators excluded women with these abnormalities from the trial.

EA patients had an average hospital stay of less than 1 day vs. an average of 1–3 days for hysterectomy, depending on whether the hysterectomy was abdominal, vaginal, or laparoscopic. Patient reports of satisfaction with their assigned procedures were not significantly different between the groups at any follow-up visit, although, as expected, EA patients were more likely to have continued menstruation while the hysterectomy patients had amenorrhea.

“Endometrial ablation is devoid of incisions, and is compatible with an individual's returning to work or virtually all other activities of daily living within a day or so of the procedure,” Dr. Munro said in an interview.

In general, both hysterectomy and endometrial ablation were effective at resolving the bleeding problems. But the differences in pain, risk, and a delayed return to activity associated with each procedure also are associated with direct and indirect costs, and Dr. Munro and his colleagues plan to evaluate those data.

The STOP-DUB study, funded by the Agency for Healthcare Research and Quality, involved more than 30 treatment centers in the United States and Canada.

EA patients had an average hospital stay of less than 1 day vs. an average of 1–3 days for hysterectomy. DR. MUNRO

GRAND CAYMAN, CAYMAN ISLANDS — A topical solution containing 2% mequinol and 0.01% tretinoin can noticeably improve facial melasma in men, based on results from a small study presented at the Caribbean Dermatology Symposium.

Male melasma is undertreated, in part because many men are ashamed to seek help given the condition's association with women and pregnancy, said Dr. Jon Keeling, a dermatology resident at Wellington Regional Medical Center in West Palm Beach, Fla.

“There are no previous reports of using mequinol in the treatment of melasma in women or men,” he said. Dr. Keeling presented the data on behalf of Dr. Marta I. Rendon, who conducted the study at her private dermatology practice in Boca Raton, Fla.

Five healthy men aged 30–45 years with at least a 1-year history of melasma were instructed to apply a 2% mequinol/0.01% tretinoin solution nightly for 12 weeks along with a 6% zinc oxide sunscreen with SPF 30 each day. All of the patients had failed at least one previous treatment for melasma.

After 12 weeks, four of the five patients' faces were cleared, based on physician assessment, patient self-assessment, and evaluations of standardized photos taken at 2, 4, 8, 12, and 16 weeks after baseline.

The fifth patient had partial clearance after 12 weeks, Dr. Keeling said.

All patients showed some improvement after 4 weeks and the maximum improvement after 12 weeks of treatment. Their skin remained clear 16 weeks after the start of the study.

Overall, the medication was well tolerated; one patient reported mild stinging when he applied the solution.

“It is important to note the psychosocial impact of melasma for men,” said Dr. Keeling, adding that the number of men seeking treatment for skin pigment problems is rapidly growing.

GRAND CAYMAN, CAYMAN ISLANDS — A topical solution containing 2% mequinol and 0.01% tretinoin can noticeably improve facial melasma in men, based on results from a small study presented at the Caribbean Dermatology Symposium.

Male melasma is undertreated, in part because many men are ashamed to seek help given the condition's association with women and pregnancy, said Dr. Jon Keeling, a dermatology resident at Wellington Regional Medical Center in West Palm Beach, Fla.

“There are no previous reports of using mequinol in the treatment of melasma in women or men,” he said. Dr. Keeling presented the data on behalf of Dr. Marta I. Rendon, who conducted the study at her private dermatology practice in Boca Raton, Fla.

Five healthy men aged 30–45 years with at least a 1-year history of melasma were instructed to apply a 2% mequinol/0.01% tretinoin solution nightly for 12 weeks along with a 6% zinc oxide sunscreen with SPF 30 each day. All of the patients had failed at least one previous treatment for melasma.

After 12 weeks, four of the five patients' faces were cleared, based on physician assessment, patient self-assessment, and evaluations of standardized photos taken at 2, 4, 8, 12, and 16 weeks after baseline.

The fifth patient had partial clearance after 12 weeks, Dr. Keeling said.

All patients showed some improvement after 4 weeks and the maximum improvement after 12 weeks of treatment. Their skin remained clear 16 weeks after the start of the study.

Overall, the medication was well tolerated; one patient reported mild stinging when he applied the solution.

“It is important to note the psychosocial impact of melasma for men,” said Dr. Keeling, adding that the number of men seeking treatment for skin pigment problems is rapidly growing.

GRAND CAYMAN, CAYMAN ISLANDS — A topical solution containing 2% mequinol and 0.01% tretinoin can noticeably improve facial melasma in men, based on results from a small study presented at the Caribbean Dermatology Symposium.

Male melasma is undertreated, in part because many men are ashamed to seek help given the condition's association with women and pregnancy, said Dr. Jon Keeling, a dermatology resident at Wellington Regional Medical Center in West Palm Beach, Fla.

“There are no previous reports of using mequinol in the treatment of melasma in women or men,” he said. Dr. Keeling presented the data on behalf of Dr. Marta I. Rendon, who conducted the study at her private dermatology practice in Boca Raton, Fla.

Five healthy men aged 30–45 years with at least a 1-year history of melasma were instructed to apply a 2% mequinol/0.01% tretinoin solution nightly for 12 weeks along with a 6% zinc oxide sunscreen with SPF 30 each day. All of the patients had failed at least one previous treatment for melasma.

After 12 weeks, four of the five patients' faces were cleared, based on physician assessment, patient self-assessment, and evaluations of standardized photos taken at 2, 4, 8, 12, and 16 weeks after baseline.

The fifth patient had partial clearance after 12 weeks, Dr. Keeling said.

All patients showed some improvement after 4 weeks and the maximum improvement after 12 weeks of treatment. Their skin remained clear 16 weeks after the start of the study.

Overall, the medication was well tolerated; one patient reported mild stinging when he applied the solution.

“It is important to note the psychosocial impact of melasma for men,” said Dr. Keeling, adding that the number of men seeking treatment for skin pigment problems is rapidly growing.