Kerri Wachter

NATIONAL HARBOR, MD. — Hybrid plating for midfoot arthrodesis offers a high union rate, according to a review.

About three-fourths of patients (76%) had radiographic union by 9 weeks. An additional 15% had union by 12 weeks, and 4% had union by 16 weeks. Only four patients did not achieve union, Dr. Jorge Filippi Nussbaum reported. Most patients (82%) had no complications. In all, 5% of patients had wound dehiscence, 5% had neuropraxia, 2.5% had hardware irritation, 4% had screw breakage, and 2.5% had tendon adhesion, said Dr. Nussbaum.

The researchers conducted a retrospective, multicenter study of patients who had undergone multijoint tarsometatarsal fusion. This technique was used in 78 patients: 60% with primary osteoarthritis, 21% with posttraumatic osteoarthritis, and the remainder with instability and OA, nonunion, Paget's disease, or metatarsus adductus. A plate—flat or curved, depending on the dorsal surface—was aligned, and locking and compression screws were placed, said Dr. Nussbaum, an orthopedic surgeon at Pontifical Catholic University of Chile in Santiago.

Disclosures: Dr. Nussbaum reported that he has no relevant financial relationships.

NATIONAL HARBOR, MD. — Hybrid plating for midfoot arthrodesis offers a high union rate, according to a review.

About three-fourths of patients (76%) had radiographic union by 9 weeks. An additional 15% had union by 12 weeks, and 4% had union by 16 weeks. Only four patients did not achieve union, Dr. Jorge Filippi Nussbaum reported. Most patients (82%) had no complications. In all, 5% of patients had wound dehiscence, 5% had neuropraxia, 2.5% had hardware irritation, 4% had screw breakage, and 2.5% had tendon adhesion, said Dr. Nussbaum.

The researchers conducted a retrospective, multicenter study of patients who had undergone multijoint tarsometatarsal fusion. This technique was used in 78 patients: 60% with primary osteoarthritis, 21% with posttraumatic osteoarthritis, and the remainder with instability and OA, nonunion, Paget's disease, or metatarsus adductus. A plate—flat or curved, depending on the dorsal surface—was aligned, and locking and compression screws were placed, said Dr. Nussbaum, an orthopedic surgeon at Pontifical Catholic University of Chile in Santiago.

Disclosures: Dr. Nussbaum reported that he has no relevant financial relationships.

NATIONAL HARBOR, MD. — Hybrid plating for midfoot arthrodesis offers a high union rate, according to a review.

About three-fourths of patients (76%) had radiographic union by 9 weeks. An additional 15% had union by 12 weeks, and 4% had union by 16 weeks. Only four patients did not achieve union, Dr. Jorge Filippi Nussbaum reported. Most patients (82%) had no complications. In all, 5% of patients had wound dehiscence, 5% had neuropraxia, 2.5% had hardware irritation, 4% had screw breakage, and 2.5% had tendon adhesion, said Dr. Nussbaum.

The researchers conducted a retrospective, multicenter study of patients who had undergone multijoint tarsometatarsal fusion. This technique was used in 78 patients: 60% with primary osteoarthritis, 21% with posttraumatic osteoarthritis, and the remainder with instability and OA, nonunion, Paget's disease, or metatarsus adductus. A plate—flat or curved, depending on the dorsal surface—was aligned, and locking and compression screws were placed, said Dr. Nussbaum, an orthopedic surgeon at Pontifical Catholic University of Chile in Santiago.

Disclosures: Dr. Nussbaum reported that he has no relevant financial relationships.

Antimicrobial prophylaxis now should be administered within 60 minutes of the start of a cesarean delivery, rather than after cord clamping, which has been the preferred time for administration.

The recommended change in practice comes from a new opinion released Aug. 23 by the American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice as Committee Opinion No. 465, “Antimicrobial Prophylaxis for Cesarean Delivery: Timing of Administration” (Obstet. Gynecol. 2010;116:791-2).

“Based on the latest data, prophylactic antibiotics given to pregnant women before a cesarean significantly reduce maternal infections and do not appear to harm newborns,” Dr. William H. Barth Jr., chair of the committee, said in a statement.

“Anytime you have invasive surgery, you have an increased risk of developing an infection at the incision site,” he said in the statement. Infection is the most common complication of cesarean delivery and can occur in an estimated 10%-40% of women who undergo cesarean delivery, compared with 1%-3% of women who deliver vaginally, according to ACOG.

The committee recommends antimicrobial prophylaxis for all cesarean deliveries unless the patient is already receiving appropriate antibiotics. When it is not possible to begin administration within 60 minutes of the first incision – as with emergent delivery – prophylaxis should be administered as soon as possible.

Antimicrobial prophylaxis has been a common practice for cesarean deliveries. However, intraoperative antibiotics have been administered after umbilical clamping due to concerns about neonatal exposure to antibiotics. In particular, it has been theorized that antibiotics in neonatal serum could mask positive bacterial culture results in newborns and that fetal antibiotic exposure could lead to increased newborn colonization or infection with antibiotic-resistant organisms.

Older studies had suggested that when prophylactic antibiotics were given before the cesarean, pediatricians tended to do more invasive neonatal sepsis evaluations and costs were increased, Dr. Barth said in an interview. “This was based on the fear that the antibiotics given to the mother would cross rapidly to the fetus and then mask the signs of infection in the newborn child.” Pediatricians feared that the usual signs of sepsis might be masked by these antibiotics. Given this fear, tests such as blood draws and lumbar punctures that are useful in making a diagnosis of newborn sepsis tended to be used more frequently.

“However, based on recent randomized clinical trials and systematic reviews, giving the mother the antibiotics before the cesarean incision does not appear to increase problems in the newborn. None of the studies were large enough to say that definitively, but given the overall benefit to the mother, our committee – which included pediatricians – felt that this was the right thing to do,” said Dr. Barth, chief of maternal-fetal medicine at Massachusetts General Hospital, Boston.

In fact, preoperative antimicrobial prophylaxis “does not appear to have any deleterious effects on mother or neonate,” the committee wrote. Timing really does make a difference. In the studies reviewed, preoperative administration significantly reduced the rates of endometritis and total maternal infectious morbidity, compared with administration after cord clamping. Just as importantly, preoperative administration was not associated with an increase in neonatal infectious morbidity or the selection of antimicrobial-resistant bacteria causing neonatal sepsis.

The committee recommends that the infusion be timed so that a bactericidal serum level is reached by the time of skin incision. Therapeutic antibiotic levels should be maintained throughout the operation. Readministration is indicated at intervals of one or two times the half-life of the drug during longer procedures.

The committee recommends using narrow-spectrum drugs that are effective against gram-positive and gram-negative bacteria and against some anaerobic bacteria – such as first-generation cephalosporins. Notably, obese women may require doses larger than the recommended 1 gram intravenous cefazolin (with a therapeutic dose maintained for 3-4 hours). Clindamycin with gentamicin is an acceptable alternative for women with significant allergies to beta-lactam antibiotics.

Dr. Barth said he had conflicts of interest to disclose.

Antimicrobial prophylaxis now should be administered within 60 minutes of the start of a cesarean delivery, rather than after cord clamping, which has been the preferred time for administration.

The recommended change in practice comes from a new opinion released Aug. 23 by the American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice as Committee Opinion No. 465, “Antimicrobial Prophylaxis for Cesarean Delivery: Timing of Administration” (Obstet. Gynecol. 2010;116:791-2).

“Based on the latest data, prophylactic antibiotics given to pregnant women before a cesarean significantly reduce maternal infections and do not appear to harm newborns,” Dr. William H. Barth Jr., chair of the committee, said in a statement.

“Anytime you have invasive surgery, you have an increased risk of developing an infection at the incision site,” he said in the statement. Infection is the most common complication of cesarean delivery and can occur in an estimated 10%-40% of women who undergo cesarean delivery, compared with 1%-3% of women who deliver vaginally, according to ACOG.

The committee recommends antimicrobial prophylaxis for all cesarean deliveries unless the patient is already receiving appropriate antibiotics. When it is not possible to begin administration within 60 minutes of the first incision – as with emergent delivery – prophylaxis should be administered as soon as possible.

Antimicrobial prophylaxis has been a common practice for cesarean deliveries. However, intraoperative antibiotics have been administered after umbilical clamping due to concerns about neonatal exposure to antibiotics. In particular, it has been theorized that antibiotics in neonatal serum could mask positive bacterial culture results in newborns and that fetal antibiotic exposure could lead to increased newborn colonization or infection with antibiotic-resistant organisms.

Older studies had suggested that when prophylactic antibiotics were given before the cesarean, pediatricians tended to do more invasive neonatal sepsis evaluations and costs were increased, Dr. Barth said in an interview. “This was based on the fear that the antibiotics given to the mother would cross rapidly to the fetus and then mask the signs of infection in the newborn child.” Pediatricians feared that the usual signs of sepsis might be masked by these antibiotics. Given this fear, tests such as blood draws and lumbar punctures that are useful in making a diagnosis of newborn sepsis tended to be used more frequently.

“However, based on recent randomized clinical trials and systematic reviews, giving the mother the antibiotics before the cesarean incision does not appear to increase problems in the newborn. None of the studies were large enough to say that definitively, but given the overall benefit to the mother, our committee – which included pediatricians – felt that this was the right thing to do,” said Dr. Barth, chief of maternal-fetal medicine at Massachusetts General Hospital, Boston.

In fact, preoperative antimicrobial prophylaxis “does not appear to have any deleterious effects on mother or neonate,” the committee wrote. Timing really does make a difference. In the studies reviewed, preoperative administration significantly reduced the rates of endometritis and total maternal infectious morbidity, compared with administration after cord clamping. Just as importantly, preoperative administration was not associated with an increase in neonatal infectious morbidity or the selection of antimicrobial-resistant bacteria causing neonatal sepsis.

The committee recommends that the infusion be timed so that a bactericidal serum level is reached by the time of skin incision. Therapeutic antibiotic levels should be maintained throughout the operation. Readministration is indicated at intervals of one or two times the half-life of the drug during longer procedures.

The committee recommends using narrow-spectrum drugs that are effective against gram-positive and gram-negative bacteria and against some anaerobic bacteria – such as first-generation cephalosporins. Notably, obese women may require doses larger than the recommended 1 gram intravenous cefazolin (with a therapeutic dose maintained for 3-4 hours). Clindamycin with gentamicin is an acceptable alternative for women with significant allergies to beta-lactam antibiotics.

Dr. Barth said he had conflicts of interest to disclose.

Antimicrobial prophylaxis now should be administered within 60 minutes of the start of a cesarean delivery, rather than after cord clamping, which has been the preferred time for administration.

The recommended change in practice comes from a new opinion released Aug. 23 by the American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice as Committee Opinion No. 465, “Antimicrobial Prophylaxis for Cesarean Delivery: Timing of Administration” (Obstet. Gynecol. 2010;116:791-2).

“Based on the latest data, prophylactic antibiotics given to pregnant women before a cesarean significantly reduce maternal infections and do not appear to harm newborns,” Dr. William H. Barth Jr., chair of the committee, said in a statement.

“Anytime you have invasive surgery, you have an increased risk of developing an infection at the incision site,” he said in the statement. Infection is the most common complication of cesarean delivery and can occur in an estimated 10%-40% of women who undergo cesarean delivery, compared with 1%-3% of women who deliver vaginally, according to ACOG.

The committee recommends antimicrobial prophylaxis for all cesarean deliveries unless the patient is already receiving appropriate antibiotics. When it is not possible to begin administration within 60 minutes of the first incision – as with emergent delivery – prophylaxis should be administered as soon as possible.

Antimicrobial prophylaxis has been a common practice for cesarean deliveries. However, intraoperative antibiotics have been administered after umbilical clamping due to concerns about neonatal exposure to antibiotics. In particular, it has been theorized that antibiotics in neonatal serum could mask positive bacterial culture results in newborns and that fetal antibiotic exposure could lead to increased newborn colonization or infection with antibiotic-resistant organisms.

Older studies had suggested that when prophylactic antibiotics were given before the cesarean, pediatricians tended to do more invasive neonatal sepsis evaluations and costs were increased, Dr. Barth said in an interview. “This was based on the fear that the antibiotics given to the mother would cross rapidly to the fetus and then mask the signs of infection in the newborn child.” Pediatricians feared that the usual signs of sepsis might be masked by these antibiotics. Given this fear, tests such as blood draws and lumbar punctures that are useful in making a diagnosis of newborn sepsis tended to be used more frequently.

“However, based on recent randomized clinical trials and systematic reviews, giving the mother the antibiotics before the cesarean incision does not appear to increase problems in the newborn. None of the studies were large enough to say that definitively, but given the overall benefit to the mother, our committee – which included pediatricians – felt that this was the right thing to do,” said Dr. Barth, chief of maternal-fetal medicine at Massachusetts General Hospital, Boston.

In fact, preoperative antimicrobial prophylaxis “does not appear to have any deleterious effects on mother or neonate,” the committee wrote. Timing really does make a difference. In the studies reviewed, preoperative administration significantly reduced the rates of endometritis and total maternal infectious morbidity, compared with administration after cord clamping. Just as importantly, preoperative administration was not associated with an increase in neonatal infectious morbidity or the selection of antimicrobial-resistant bacteria causing neonatal sepsis.

The committee recommends that the infusion be timed so that a bactericidal serum level is reached by the time of skin incision. Therapeutic antibiotic levels should be maintained throughout the operation. Readministration is indicated at intervals of one or two times the half-life of the drug during longer procedures.

The committee recommends using narrow-spectrum drugs that are effective against gram-positive and gram-negative bacteria and against some anaerobic bacteria – such as first-generation cephalosporins. Notably, obese women may require doses larger than the recommended 1 gram intravenous cefazolin (with a therapeutic dose maintained for 3-4 hours). Clindamycin with gentamicin is an acceptable alternative for women with significant allergies to beta-lactam antibiotics.

Dr. Barth said he had conflicts of interest to disclose.

The Food and Drug Administration has approved Veltin, a gel containing clindamycin phosphate and tretinoin, for the topical treatment of acne vulgaris in patients aged 12 years and older.

The treatment brings together a topical retinoid and an antibiotic - which are often recommended for the treatment of acne vulgaris - in a water-based gel.

Veltin (1.2% clindamycin phosphate and 0.025% tretinoin) should not be used by patients who have Crohn’s disease or ulcerative colitis or have developed colitis with past antibiotic use. Patients using the treatment should avoid exposure to sunlight and sun lamps and should wear sunscreen daily.

Stiefel Laboratories Inc., a GlaxoSmithKline company, expects the gel to be available by prescription later this year.

For more information, including complete prescribing information, contact Stiefel by calling 919-483-2839.

The Food and Drug Administration has approved Veltin, a gel containing clindamycin phosphate and tretinoin, for the topical treatment of acne vulgaris in patients aged 12 years and older.

The treatment brings together a topical retinoid and an antibiotic - which are often recommended for the treatment of acne vulgaris - in a water-based gel.

Veltin (1.2% clindamycin phosphate and 0.025% tretinoin) should not be used by patients who have Crohn’s disease or ulcerative colitis or have developed colitis with past antibiotic use. Patients using the treatment should avoid exposure to sunlight and sun lamps and should wear sunscreen daily.

Stiefel Laboratories Inc., a GlaxoSmithKline company, expects the gel to be available by prescription later this year.

For more information, including complete prescribing information, contact Stiefel by calling 919-483-2839.

The Food and Drug Administration has approved Veltin, a gel containing clindamycin phosphate and tretinoin, for the topical treatment of acne vulgaris in patients aged 12 years and older.

The treatment brings together a topical retinoid and an antibiotic - which are often recommended for the treatment of acne vulgaris - in a water-based gel.

Veltin (1.2% clindamycin phosphate and 0.025% tretinoin) should not be used by patients who have Crohn’s disease or ulcerative colitis or have developed colitis with past antibiotic use. Patients using the treatment should avoid exposure to sunlight and sun lamps and should wear sunscreen daily.

Stiefel Laboratories Inc., a GlaxoSmithKline company, expects the gel to be available by prescription later this year.

For more information, including complete prescribing information, contact Stiefel by calling 919-483-2839.

BALTIMORE — The Wii video-game system helped seniors burn calories and become more active in a pilot study of 24 adults aged 66-78 years.

Group members burned 17-176 kcal during 30-minute games of Wii baseball, tennis, or team or individual bowling, Elizabeth Orsega-Smith, Ph.D., reported in a poster at the meeting.

The participants were enrolled at senior centers in Delaware. They were mostly women (87%) with an average age of 72 years. Participants were independent, community dwelling, and healthy but overweight—their mean body mass index was 32.67 kg/m

The participants wore accelerometers on their wrists during the games, and the researchers calculated caloric expenditure from the readings. Caloric expenditure ranged from 22 kcal to 114 kcal for baseball, 17 kcal to 72 kcal for tennis, 18 kcal to 89 kcal for team bowling, and 20 kcal to 176 kcal for individual bowling.

Wii games may be an easy option for senior centers and care facilities trying to get older adults to become more active. “The seniors were able to pick up the game pretty rapidly. They didn't really have much difficulty in grasping the concept of using the controller,” she said. The researchers are analyzing other measures of physical activity and general well-being that were collected during a Wii bowling tournament, said Dr. Orsega-Smith, an associate professor in the department of health, nutrition, and exercise sciences at the University of Delaware, Newark.

Dr. Orsega-Smith said she had no relevant financial conflicts of interest.

BALTIMORE — The Wii video-game system helped seniors burn calories and become more active in a pilot study of 24 adults aged 66-78 years.

Group members burned 17-176 kcal during 30-minute games of Wii baseball, tennis, or team or individual bowling, Elizabeth Orsega-Smith, Ph.D., reported in a poster at the meeting.

The participants were enrolled at senior centers in Delaware. They were mostly women (87%) with an average age of 72 years. Participants were independent, community dwelling, and healthy but overweight—their mean body mass index was 32.67 kg/m

The participants wore accelerometers on their wrists during the games, and the researchers calculated caloric expenditure from the readings. Caloric expenditure ranged from 22 kcal to 114 kcal for baseball, 17 kcal to 72 kcal for tennis, 18 kcal to 89 kcal for team bowling, and 20 kcal to 176 kcal for individual bowling.

Wii games may be an easy option for senior centers and care facilities trying to get older adults to become more active. “The seniors were able to pick up the game pretty rapidly. They didn't really have much difficulty in grasping the concept of using the controller,” she said. The researchers are analyzing other measures of physical activity and general well-being that were collected during a Wii bowling tournament, said Dr. Orsega-Smith, an associate professor in the department of health, nutrition, and exercise sciences at the University of Delaware, Newark.

Dr. Orsega-Smith said she had no relevant financial conflicts of interest.

BALTIMORE — The Wii video-game system helped seniors burn calories and become more active in a pilot study of 24 adults aged 66-78 years.

Group members burned 17-176 kcal during 30-minute games of Wii baseball, tennis, or team or individual bowling, Elizabeth Orsega-Smith, Ph.D., reported in a poster at the meeting.

The participants were enrolled at senior centers in Delaware. They were mostly women (87%) with an average age of 72 years. Participants were independent, community dwelling, and healthy but overweight—their mean body mass index was 32.67 kg/m

The participants wore accelerometers on their wrists during the games, and the researchers calculated caloric expenditure from the readings. Caloric expenditure ranged from 22 kcal to 114 kcal for baseball, 17 kcal to 72 kcal for tennis, 18 kcal to 89 kcal for team bowling, and 20 kcal to 176 kcal for individual bowling.

Wii games may be an easy option for senior centers and care facilities trying to get older adults to become more active. “The seniors were able to pick up the game pretty rapidly. They didn't really have much difficulty in grasping the concept of using the controller,” she said. The researchers are analyzing other measures of physical activity and general well-being that were collected during a Wii bowling tournament, said Dr. Orsega-Smith, an associate professor in the department of health, nutrition, and exercise sciences at the University of Delaware, Newark.

Dr. Orsega-Smith said she had no relevant financial conflicts of interest.

NATIONAL HARBOR, MD. — Joint-sparing surgical techniques can reduce pain, increase function, and improve the appearance of lesser metatarsophalangeal joint deformities in patients with severe rheumatoid arthritis, a small retrospective study has shown.

In a survey of 11 patients with RA undergoing joint-sparing surgery, 83% reported improved callosities and shoe wear. Half of the patients reported improved cosmesis, and almost all said they had less pain at rest and less weight-bearing pain after the surgery, Brockford D. Herring, D.O., said at the meeting.

The researchers retrospectively studied preoperative x-rays for dislocations and postoperative x-rays for recurrent dislocations from forefoot RA cases. They identified 11 patients with 30 lesser toe reconstructions and 10 metatarsal shortenings with an average follow-up of 4.7 years.

Among these patients, 60% of lesser toes were dislocated on preoperative x-ray and 30% were re-dislocated on postoperative x-ray. The fourth and fifth toes accounted for two-thirds of re-dislocations. Of the 10 metatarsal shortenings, only 1 was re-dislocated on postoperative x-ray.

The joint-sparing procedure involves metatarsophalangeal capsule release, extensor digitorum longus to extensor digitorum brevis tendon transfer, proximal phalangeal head resection, flexor digitorum longus to extensor tendon transfer through a drill hole in the proximal phalanx, and metatarsal shortening (on occasion).

Two-thirds of patients said their results were excellent, but no one reported changes in gait stability. All patients said that they would recommend the procedure to individuals with RA.

As the disease progresses, these techniques maintain bone stock for later salvage procedures, said Dr. Herring, an orthopedic surgeon in Sarasota, Fla.

Disclosures: Dr. Herring reported that he has no relevant disclosures.

NATIONAL HARBOR, MD. — Joint-sparing surgical techniques can reduce pain, increase function, and improve the appearance of lesser metatarsophalangeal joint deformities in patients with severe rheumatoid arthritis, a small retrospective study has shown.

In a survey of 11 patients with RA undergoing joint-sparing surgery, 83% reported improved callosities and shoe wear. Half of the patients reported improved cosmesis, and almost all said they had less pain at rest and less weight-bearing pain after the surgery, Brockford D. Herring, D.O., said at the meeting.

The researchers retrospectively studied preoperative x-rays for dislocations and postoperative x-rays for recurrent dislocations from forefoot RA cases. They identified 11 patients with 30 lesser toe reconstructions and 10 metatarsal shortenings with an average follow-up of 4.7 years.

Among these patients, 60% of lesser toes were dislocated on preoperative x-ray and 30% were re-dislocated on postoperative x-ray. The fourth and fifth toes accounted for two-thirds of re-dislocations. Of the 10 metatarsal shortenings, only 1 was re-dislocated on postoperative x-ray.

The joint-sparing procedure involves metatarsophalangeal capsule release, extensor digitorum longus to extensor digitorum brevis tendon transfer, proximal phalangeal head resection, flexor digitorum longus to extensor tendon transfer through a drill hole in the proximal phalanx, and metatarsal shortening (on occasion).

Two-thirds of patients said their results were excellent, but no one reported changes in gait stability. All patients said that they would recommend the procedure to individuals with RA.

As the disease progresses, these techniques maintain bone stock for later salvage procedures, said Dr. Herring, an orthopedic surgeon in Sarasota, Fla.

Disclosures: Dr. Herring reported that he has no relevant disclosures.

NATIONAL HARBOR, MD. — Joint-sparing surgical techniques can reduce pain, increase function, and improve the appearance of lesser metatarsophalangeal joint deformities in patients with severe rheumatoid arthritis, a small retrospective study has shown.

In a survey of 11 patients with RA undergoing joint-sparing surgery, 83% reported improved callosities and shoe wear. Half of the patients reported improved cosmesis, and almost all said they had less pain at rest and less weight-bearing pain after the surgery, Brockford D. Herring, D.O., said at the meeting.

The researchers retrospectively studied preoperative x-rays for dislocations and postoperative x-rays for recurrent dislocations from forefoot RA cases. They identified 11 patients with 30 lesser toe reconstructions and 10 metatarsal shortenings with an average follow-up of 4.7 years.

Among these patients, 60% of lesser toes were dislocated on preoperative x-ray and 30% were re-dislocated on postoperative x-ray. The fourth and fifth toes accounted for two-thirds of re-dislocations. Of the 10 metatarsal shortenings, only 1 was re-dislocated on postoperative x-ray.

The joint-sparing procedure involves metatarsophalangeal capsule release, extensor digitorum longus to extensor digitorum brevis tendon transfer, proximal phalangeal head resection, flexor digitorum longus to extensor tendon transfer through a drill hole in the proximal phalanx, and metatarsal shortening (on occasion).

Two-thirds of patients said their results were excellent, but no one reported changes in gait stability. All patients said that they would recommend the procedure to individuals with RA.

As the disease progresses, these techniques maintain bone stock for later salvage procedures, said Dr. Herring, an orthopedic surgeon in Sarasota, Fla.

Disclosures: Dr. Herring reported that he has no relevant disclosures.

NATIONAL HARBOR, MD. — Not only is arthroscopically assisted lateral ligament reconstruction possible, but the technique subjectively and objectively improved outcomes for these patients.

Dr. Peter G. Mangone, who developed the technique, presented outcome data for the first eight patients to undergo the treatment.

Three patients reported slight instability. However, all reported significant improvement, compared with preoperative symptoms, according to Dr. Mangone. No patients had any functional limitation or required bracing at an average of 8 months' follow-up.

Seven of the eight patients were negative on the anterior drawer test after the procedure; five of eight patients had a negative talar tilt test. One patient developed an unrelated neurologic process, causing weakness in the peroneal muscles. In terms of function, all patients returned to daily activities without the need for bracing. There were no significant nerve or wound complications in this series.

Although the preferred method for lateral ankle ligament reconstruction has been the Brostrom-Gould technique, which achieves ligament repair/shortening with advancement of the inferior extensor retinaculum, there is increasing evidence that arthroscopic examination at the same time may be beneficial. This prompted Dr. Mangone, an orthopedic surgeon in Asheville, N.C., to consider whether arthroscopic ligament reconstruction would be possible. He was already using an ankle scope and could easily see the ligament/capsule and the anterior talofibular ligament.

The patients in this series underwent arthroscopic lateral ankle ligament reconstruction in 2007-2008. All of the patients were positive for ankle instability on manual examination (anterior drawer test and talar tilt test) and had failed nonoperative management. No calcaneofibular ligament repair was performed.

The technique involves a popliteal block plus either general or monitored anesthesia care. A noninvasive distractor is placed and arthroscopic examination and debridement are performed with two normal portals. The lateral gutter is debrided more extensively in order to visualize the anterior distal fibula, the lateral capsular structures/anterior talofibular ligament, and the anterior fibula. A 30-degree scope works well.

A bone anchor is placed through the arthroscopic portal and suture exiting the portal. Although one bone anchor is sufficient, Dr. Mangone now places two. The first is placed distal to the anterior inferior fibula, through the inferior extensor retinaculum and capsule. The second anchor is placed slightly superior on the anterior fibula, through the anterior talofibular ligament/capsule and inferior extensor retinaculum. A sharp-tipped suture passer is used with the outside-in technique. However, the inside-out technique can be used as well. The noninvasive distractor is removed. The ankle is held neutral with respect to dorsiflexion/plantarflexion with a slight eversion. The sutures are pulled through a small incision and tied.

A splint is used in the immediate postoperative period. A short leg cast is used for 4-6 weeks. A lace-up ankle gauntlet brace is used for the next 6-12 weeks.

Disclosures: Dr. Mangone is consultant and speaker for Arthrex Inc., which makes orthopedic surgical equipment.

NATIONAL HARBOR, MD. — Not only is arthroscopically assisted lateral ligament reconstruction possible, but the technique subjectively and objectively improved outcomes for these patients.

Dr. Peter G. Mangone, who developed the technique, presented outcome data for the first eight patients to undergo the treatment.

Three patients reported slight instability. However, all reported significant improvement, compared with preoperative symptoms, according to Dr. Mangone. No patients had any functional limitation or required bracing at an average of 8 months' follow-up.

Seven of the eight patients were negative on the anterior drawer test after the procedure; five of eight patients had a negative talar tilt test. One patient developed an unrelated neurologic process, causing weakness in the peroneal muscles. In terms of function, all patients returned to daily activities without the need for bracing. There were no significant nerve or wound complications in this series.

Although the preferred method for lateral ankle ligament reconstruction has been the Brostrom-Gould technique, which achieves ligament repair/shortening with advancement of the inferior extensor retinaculum, there is increasing evidence that arthroscopic examination at the same time may be beneficial. This prompted Dr. Mangone, an orthopedic surgeon in Asheville, N.C., to consider whether arthroscopic ligament reconstruction would be possible. He was already using an ankle scope and could easily see the ligament/capsule and the anterior talofibular ligament.

The patients in this series underwent arthroscopic lateral ankle ligament reconstruction in 2007-2008. All of the patients were positive for ankle instability on manual examination (anterior drawer test and talar tilt test) and had failed nonoperative management. No calcaneofibular ligament repair was performed.

The technique involves a popliteal block plus either general or monitored anesthesia care. A noninvasive distractor is placed and arthroscopic examination and debridement are performed with two normal portals. The lateral gutter is debrided more extensively in order to visualize the anterior distal fibula, the lateral capsular structures/anterior talofibular ligament, and the anterior fibula. A 30-degree scope works well.

A bone anchor is placed through the arthroscopic portal and suture exiting the portal. Although one bone anchor is sufficient, Dr. Mangone now places two. The first is placed distal to the anterior inferior fibula, through the inferior extensor retinaculum and capsule. The second anchor is placed slightly superior on the anterior fibula, through the anterior talofibular ligament/capsule and inferior extensor retinaculum. A sharp-tipped suture passer is used with the outside-in technique. However, the inside-out technique can be used as well. The noninvasive distractor is removed. The ankle is held neutral with respect to dorsiflexion/plantarflexion with a slight eversion. The sutures are pulled through a small incision and tied.

A splint is used in the immediate postoperative period. A short leg cast is used for 4-6 weeks. A lace-up ankle gauntlet brace is used for the next 6-12 weeks.

Disclosures: Dr. Mangone is consultant and speaker for Arthrex Inc., which makes orthopedic surgical equipment.

NATIONAL HARBOR, MD. — Not only is arthroscopically assisted lateral ligament reconstruction possible, but the technique subjectively and objectively improved outcomes for these patients.

Dr. Peter G. Mangone, who developed the technique, presented outcome data for the first eight patients to undergo the treatment.

Three patients reported slight instability. However, all reported significant improvement, compared with preoperative symptoms, according to Dr. Mangone. No patients had any functional limitation or required bracing at an average of 8 months' follow-up.

Seven of the eight patients were negative on the anterior drawer test after the procedure; five of eight patients had a negative talar tilt test. One patient developed an unrelated neurologic process, causing weakness in the peroneal muscles. In terms of function, all patients returned to daily activities without the need for bracing. There were no significant nerve or wound complications in this series.

Although the preferred method for lateral ankle ligament reconstruction has been the Brostrom-Gould technique, which achieves ligament repair/shortening with advancement of the inferior extensor retinaculum, there is increasing evidence that arthroscopic examination at the same time may be beneficial. This prompted Dr. Mangone, an orthopedic surgeon in Asheville, N.C., to consider whether arthroscopic ligament reconstruction would be possible. He was already using an ankle scope and could easily see the ligament/capsule and the anterior talofibular ligament.

The patients in this series underwent arthroscopic lateral ankle ligament reconstruction in 2007-2008. All of the patients were positive for ankle instability on manual examination (anterior drawer test and talar tilt test) and had failed nonoperative management. No calcaneofibular ligament repair was performed.

The technique involves a popliteal block plus either general or monitored anesthesia care. A noninvasive distractor is placed and arthroscopic examination and debridement are performed with two normal portals. The lateral gutter is debrided more extensively in order to visualize the anterior distal fibula, the lateral capsular structures/anterior talofibular ligament, and the anterior fibula. A 30-degree scope works well.

A bone anchor is placed through the arthroscopic portal and suture exiting the portal. Although one bone anchor is sufficient, Dr. Mangone now places two. The first is placed distal to the anterior inferior fibula, through the inferior extensor retinaculum and capsule. The second anchor is placed slightly superior on the anterior fibula, through the anterior talofibular ligament/capsule and inferior extensor retinaculum. A sharp-tipped suture passer is used with the outside-in technique. However, the inside-out technique can be used as well. The noninvasive distractor is removed. The ankle is held neutral with respect to dorsiflexion/plantarflexion with a slight eversion. The sutures are pulled through a small incision and tied.

A splint is used in the immediate postoperative period. A short leg cast is used for 4-6 weeks. A lace-up ankle gauntlet brace is used for the next 6-12 weeks.

Disclosures: Dr. Mangone is consultant and speaker for Arthrex Inc., which makes orthopedic surgical equipment.

BALTIMORE — Cancer patients and survivors not only should be getting physical activity, but they should aim to meet federal recommendations for 150 minutes of moderate aerobic activity weekly, according to new guidelines released by the American College of Sports Medicine.

“The first two words of the [U.S.] Department of Health and Human Services' physical activity guidelines for Americans—for all Americans regardless of age—are this: Avoid inactivity. That, indeed, is our primary conclusion for this population during and post treatment,” the lead author of the guidelines, said Kathryn Schmitz, Ph.D.

Members of the ACSM roundtable panel concluded that the goals of the federal activity guidelines are safe for cancer survivors and cancer patients on treatment. The federal guidelines call for Americans aged 18-64 years to get 150 minutes each week of moderate-intensity aerobic exercise. Adults also should do resistance training of all major muscle groups performed on 2 or more days each week.

“There are dozens of studies that allow us to conclude that the current federal guidelines for physical activity for Americans are completely appropriate for individuals who are undergoing cancer treatment,” Dr. Schmitz said in an interview.

The preponderance of evidence shows that it is safe for people who are in treatment to follow the guidelines that the rest of Americans have been given for physical activity, she added.

In particular, cancer patients should walk, as well as do flexibility activities and resistance training. The panel stressed that the benefit to a cancer survivor from physical activity strongly outweighs the small risks that would be associated with exercising if the patient had developed a bony metastases or cardiotoxicity secondary to cancer treatment.

However, exercise recommendations should be tailored to the individual cancer survivor according to exercise tolerance and specific diagnosis. In addition, clinicians and fitness professionals should pay close attention to cancer survivors' responses to physical activity so that these individuals can safely progress through exercise programs and avoid injuries.

The primary objective of prescribing exercise to cancer patients and survivors is to help them regain and improve physical function, said Dr. Schmitz of the center for clinical epidemiology and biostatistics at the University of Pennsylvania in Philadelphia. Exercise can also help improve body image and quality of life for these patients.

There may even be value in exercise programs to reduce or delay recurrence or a second primary cancer, she said. “We're not foolish enough to believe that exercise all by itself is a panacea to prevent a second primary cancer or recurrence.”

However, there is value in this population's using exercise as an adjunctive treatment or activity. Exercise may help patients to be physically and psychologically able to deal with the rigors of treatment, should their cancer recur, Dr. Schmitz concluded.

The guidelines were published in the July issue of Medicine & Science in Sports & Exercise, the official journal of the ACSM (2010;42:1409-26).

Disclosures: Dr. Schmitz reported that she has no relevant financial relationships.

To watch an interview with Dr. Schmitz go to www.youtube.com/watch?v=oGKwHmtmbaA

Federal guidelines for activity are appropriate for individuals who are undergoing cancer treatment.

Source DR. SCHMITZ

BALTIMORE — Cancer patients and survivors not only should be getting physical activity, but they should aim to meet federal recommendations for 150 minutes of moderate aerobic activity weekly, according to new guidelines released by the American College of Sports Medicine.

“The first two words of the [U.S.] Department of Health and Human Services' physical activity guidelines for Americans—for all Americans regardless of age—are this: Avoid inactivity. That, indeed, is our primary conclusion for this population during and post treatment,” the lead author of the guidelines, said Kathryn Schmitz, Ph.D.

Members of the ACSM roundtable panel concluded that the goals of the federal activity guidelines are safe for cancer survivors and cancer patients on treatment. The federal guidelines call for Americans aged 18-64 years to get 150 minutes each week of moderate-intensity aerobic exercise. Adults also should do resistance training of all major muscle groups performed on 2 or more days each week.

“There are dozens of studies that allow us to conclude that the current federal guidelines for physical activity for Americans are completely appropriate for individuals who are undergoing cancer treatment,” Dr. Schmitz said in an interview.

The preponderance of evidence shows that it is safe for people who are in treatment to follow the guidelines that the rest of Americans have been given for physical activity, she added.

In particular, cancer patients should walk, as well as do flexibility activities and resistance training. The panel stressed that the benefit to a cancer survivor from physical activity strongly outweighs the small risks that would be associated with exercising if the patient had developed a bony metastases or cardiotoxicity secondary to cancer treatment.

However, exercise recommendations should be tailored to the individual cancer survivor according to exercise tolerance and specific diagnosis. In addition, clinicians and fitness professionals should pay close attention to cancer survivors' responses to physical activity so that these individuals can safely progress through exercise programs and avoid injuries.

The primary objective of prescribing exercise to cancer patients and survivors is to help them regain and improve physical function, said Dr. Schmitz of the center for clinical epidemiology and biostatistics at the University of Pennsylvania in Philadelphia. Exercise can also help improve body image and quality of life for these patients.

There may even be value in exercise programs to reduce or delay recurrence or a second primary cancer, she said. “We're not foolish enough to believe that exercise all by itself is a panacea to prevent a second primary cancer or recurrence.”

However, there is value in this population's using exercise as an adjunctive treatment or activity. Exercise may help patients to be physically and psychologically able to deal with the rigors of treatment, should their cancer recur, Dr. Schmitz concluded.

The guidelines were published in the July issue of Medicine & Science in Sports & Exercise, the official journal of the ACSM (2010;42:1409-26).

Disclosures: Dr. Schmitz reported that she has no relevant financial relationships.

To watch an interview with Dr. Schmitz go to www.youtube.com/watch?v=oGKwHmtmbaA

Federal guidelines for activity are appropriate for individuals who are undergoing cancer treatment.

Source DR. SCHMITZ

BALTIMORE — Cancer patients and survivors not only should be getting physical activity, but they should aim to meet federal recommendations for 150 minutes of moderate aerobic activity weekly, according to new guidelines released by the American College of Sports Medicine.

“The first two words of the [U.S.] Department of Health and Human Services' physical activity guidelines for Americans—for all Americans regardless of age—are this: Avoid inactivity. That, indeed, is our primary conclusion for this population during and post treatment,” the lead author of the guidelines, said Kathryn Schmitz, Ph.D.

Members of the ACSM roundtable panel concluded that the goals of the federal activity guidelines are safe for cancer survivors and cancer patients on treatment. The federal guidelines call for Americans aged 18-64 years to get 150 minutes each week of moderate-intensity aerobic exercise. Adults also should do resistance training of all major muscle groups performed on 2 or more days each week.

“There are dozens of studies that allow us to conclude that the current federal guidelines for physical activity for Americans are completely appropriate for individuals who are undergoing cancer treatment,” Dr. Schmitz said in an interview.

The preponderance of evidence shows that it is safe for people who are in treatment to follow the guidelines that the rest of Americans have been given for physical activity, she added.

In particular, cancer patients should walk, as well as do flexibility activities and resistance training. The panel stressed that the benefit to a cancer survivor from physical activity strongly outweighs the small risks that would be associated with exercising if the patient had developed a bony metastases or cardiotoxicity secondary to cancer treatment.

However, exercise recommendations should be tailored to the individual cancer survivor according to exercise tolerance and specific diagnosis. In addition, clinicians and fitness professionals should pay close attention to cancer survivors' responses to physical activity so that these individuals can safely progress through exercise programs and avoid injuries.

The primary objective of prescribing exercise to cancer patients and survivors is to help them regain and improve physical function, said Dr. Schmitz of the center for clinical epidemiology and biostatistics at the University of Pennsylvania in Philadelphia. Exercise can also help improve body image and quality of life for these patients.

There may even be value in exercise programs to reduce or delay recurrence or a second primary cancer, she said. “We're not foolish enough to believe that exercise all by itself is a panacea to prevent a second primary cancer or recurrence.”

However, there is value in this population's using exercise as an adjunctive treatment or activity. Exercise may help patients to be physically and psychologically able to deal with the rigors of treatment, should their cancer recur, Dr. Schmitz concluded.

The guidelines were published in the July issue of Medicine & Science in Sports & Exercise, the official journal of the ACSM (2010;42:1409-26).

Disclosures: Dr. Schmitz reported that she has no relevant financial relationships.

To watch an interview with Dr. Schmitz go to www.youtube.com/watch?v=oGKwHmtmbaA

Federal guidelines for activity are appropriate for individuals who are undergoing cancer treatment.

Source DR. SCHMITZ

Major Finding: The incidence of colorectal cancer among those aged 40-44 years increased 50% between 1987 and 2006 (from 12 per 100,000 to 18 per 100,000).

Data Source: An analysis of data from the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) database.

Disclosures: Dr. Davis reported that he had no relevant financial relationships; senior author Dr. Jorge Marcet reported that he has significant financial relationships with GlaxoSmithKline and two surgical device manufacturers.

MINNEAPOLIS — An increase in the national incidence of colorectal cancer among individuals who are younger than age 50 years has prompted some experts to call for lowering the screening age to at least 40 years.

Although the colorectal cancer (CRC) incidence across all age groups has decreased 18%—from 55 per 100,000 in 1987 to 45 per 100,000 in 2006—the incidence among those aged 40-44 years increased 50% during that same period, from 12 per 100,000 to 18 per 100,000.

The findings are based on an analysis of data from the National Cancer Institute's SEER (Surveillance, Epidemiology, and End Results) database, which includes information on the incidence, prevalence, and survival from specific geographic areas representing 26% of the U.S. population.

“This has led us to the conclusion that the screening age for colorectal cancer for average-risk persons should be reduced to at least 40 years,” Dr. Donald Davis said at the meeting.

Currently, it is recommended that CRC screening begin at age 50 years for those with average risk.

The researchers looked at yearly data from 1987 to 2006 for five age groups, ranging from 0-4 years to older than 85 years.

They then examined data from 2002 to 2006 to determine the location of colorectal cancers and the incidence by age for CRC, colon cancer, and rectal cancer.

Overall, colon cancer dropped 17% and rectal cancer decreased 18%. People older than 50 years had a lower incidence of CRC in 2006 than in 1987.

However, those aged between 20 and 50 years had higher incidence in 2006 than in 1987.

Colon cancer increased 40% and rectal cancer increased 63% among those aged 40-44 years during this period.

Regarding the location of tumors, the highest percentage (approximately 30%) was in the rectum. More than half were located in the in the rectum or sigmoid.

For comparison, the researchers also looked at the change in cervical cancer incidence.

“We used cervical cancer because it is considered a successfully screened cancer,” said Dr. Donald Davis, a surgical resident at the University of South Florida in Tampa.

In the 1970s, the incidence of cervical cancer was approximately 15 per 100,000; today, it is about 8 per 100,000. Current recommendations are to begin screening women for cervical cancer by age 21.

The incidence of cervical cancer peaks among women aged 40-44 years (15 per 100,000), according to recent data. The incidence of CRC is equal to that of cervical cancer in this age group, Dr. Davis noted.

“However, after this age group, colo-rectal cancer exponentially increases while cervical cancer continues to decline,” he said.

The researchers were prompted to look for a national trend based on the results of an institutional review. They found that 100 patients younger than 50 years had been diagnosed with CRC in the past 7 years. “The results were not evenly distributed. There was an exponential increase among those aged 35-40 years,” said Dr. Davis.

Major Finding: The incidence of colorectal cancer among those aged 40-44 years increased 50% between 1987 and 2006 (from 12 per 100,000 to 18 per 100,000).

Data Source: An analysis of data from the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) database.

Disclosures: Dr. Davis reported that he had no relevant financial relationships; senior author Dr. Jorge Marcet reported that he has significant financial relationships with GlaxoSmithKline and two surgical device manufacturers.

MINNEAPOLIS — An increase in the national incidence of colorectal cancer among individuals who are younger than age 50 years has prompted some experts to call for lowering the screening age to at least 40 years.

Although the colorectal cancer (CRC) incidence across all age groups has decreased 18%—from 55 per 100,000 in 1987 to 45 per 100,000 in 2006—the incidence among those aged 40-44 years increased 50% during that same period, from 12 per 100,000 to 18 per 100,000.

The findings are based on an analysis of data from the National Cancer Institute's SEER (Surveillance, Epidemiology, and End Results) database, which includes information on the incidence, prevalence, and survival from specific geographic areas representing 26% of the U.S. population.

“This has led us to the conclusion that the screening age for colorectal cancer for average-risk persons should be reduced to at least 40 years,” Dr. Donald Davis said at the meeting.

Currently, it is recommended that CRC screening begin at age 50 years for those with average risk.

The researchers looked at yearly data from 1987 to 2006 for five age groups, ranging from 0-4 years to older than 85 years.

They then examined data from 2002 to 2006 to determine the location of colorectal cancers and the incidence by age for CRC, colon cancer, and rectal cancer.

Overall, colon cancer dropped 17% and rectal cancer decreased 18%. People older than 50 years had a lower incidence of CRC in 2006 than in 1987.

However, those aged between 20 and 50 years had higher incidence in 2006 than in 1987.

Colon cancer increased 40% and rectal cancer increased 63% among those aged 40-44 years during this period.

Regarding the location of tumors, the highest percentage (approximately 30%) was in the rectum. More than half were located in the in the rectum or sigmoid.

For comparison, the researchers also looked at the change in cervical cancer incidence.

“We used cervical cancer because it is considered a successfully screened cancer,” said Dr. Donald Davis, a surgical resident at the University of South Florida in Tampa.

In the 1970s, the incidence of cervical cancer was approximately 15 per 100,000; today, it is about 8 per 100,000. Current recommendations are to begin screening women for cervical cancer by age 21.

The incidence of cervical cancer peaks among women aged 40-44 years (15 per 100,000), according to recent data. The incidence of CRC is equal to that of cervical cancer in this age group, Dr. Davis noted.

“However, after this age group, colo-rectal cancer exponentially increases while cervical cancer continues to decline,” he said.

The researchers were prompted to look for a national trend based on the results of an institutional review. They found that 100 patients younger than 50 years had been diagnosed with CRC in the past 7 years. “The results were not evenly distributed. There was an exponential increase among those aged 35-40 years,” said Dr. Davis.

Major Finding: The incidence of colorectal cancer among those aged 40-44 years increased 50% between 1987 and 2006 (from 12 per 100,000 to 18 per 100,000).

Data Source: An analysis of data from the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) database.

Disclosures: Dr. Davis reported that he had no relevant financial relationships; senior author Dr. Jorge Marcet reported that he has significant financial relationships with GlaxoSmithKline and two surgical device manufacturers.

MINNEAPOLIS — An increase in the national incidence of colorectal cancer among individuals who are younger than age 50 years has prompted some experts to call for lowering the screening age to at least 40 years.

Although the colorectal cancer (CRC) incidence across all age groups has decreased 18%—from 55 per 100,000 in 1987 to 45 per 100,000 in 2006—the incidence among those aged 40-44 years increased 50% during that same period, from 12 per 100,000 to 18 per 100,000.

The findings are based on an analysis of data from the National Cancer Institute's SEER (Surveillance, Epidemiology, and End Results) database, which includes information on the incidence, prevalence, and survival from specific geographic areas representing 26% of the U.S. population.

“This has led us to the conclusion that the screening age for colorectal cancer for average-risk persons should be reduced to at least 40 years,” Dr. Donald Davis said at the meeting.

Currently, it is recommended that CRC screening begin at age 50 years for those with average risk.

The researchers looked at yearly data from 1987 to 2006 for five age groups, ranging from 0-4 years to older than 85 years.

They then examined data from 2002 to 2006 to determine the location of colorectal cancers and the incidence by age for CRC, colon cancer, and rectal cancer.

Overall, colon cancer dropped 17% and rectal cancer decreased 18%. People older than 50 years had a lower incidence of CRC in 2006 than in 1987.

However, those aged between 20 and 50 years had higher incidence in 2006 than in 1987.

Colon cancer increased 40% and rectal cancer increased 63% among those aged 40-44 years during this period.

Regarding the location of tumors, the highest percentage (approximately 30%) was in the rectum. More than half were located in the in the rectum or sigmoid.

For comparison, the researchers also looked at the change in cervical cancer incidence.

“We used cervical cancer because it is considered a successfully screened cancer,” said Dr. Donald Davis, a surgical resident at the University of South Florida in Tampa.

In the 1970s, the incidence of cervical cancer was approximately 15 per 100,000; today, it is about 8 per 100,000. Current recommendations are to begin screening women for cervical cancer by age 21.

The incidence of cervical cancer peaks among women aged 40-44 years (15 per 100,000), according to recent data. The incidence of CRC is equal to that of cervical cancer in this age group, Dr. Davis noted.

“However, after this age group, colo-rectal cancer exponentially increases while cervical cancer continues to decline,” he said.

The researchers were prompted to look for a national trend based on the results of an institutional review. They found that 100 patients younger than 50 years had been diagnosed with CRC in the past 7 years. “The results were not evenly distributed. There was an exponential increase among those aged 35-40 years,” said Dr. Davis.

MINNEAPOLIS — The use of oral antibiotics along with mechanical bowel preparation before colon resection significantly reduced the number of superficial surgical site infections, compared with the use of mechanical bowel preparation alone, according to the results of a retrospective study of 227 patients.

Superficial surgical site infections occurred in 3% of patients who were given oral antibiotics along with mechanical bowel preparation (MBP) vs. 11% of those who had MBP alone. There were also trends toward fewer deep surgical site infections, organ space surgical site infections, and anastomotic leaks, Dr. Khaled El-Badawi reported at the meeting.

The researchers performed a retrospective review of all elective segmental colon resections performed between 2007 and 2009. Patients were grouped by whether oral antibiotics had been used in conjunction with MBP. A total of 125 patients underwent MBP alone and 102 underwent MBP with oral antibiotics.

All patients were restricted to a clear liquid diet for at least 24 hours prior to surgery, and were also given 20 mg of bisacodyl and polyethylene glycol. Patients in the antibiotic group also received three doses of 1 g neomycin and 750 mg metronidazole on the day before surgery. Within 1 hour of surgical incision, all patients received 1 g ertapenem.

Dr. El-Badawi, who is a surgical resident at Grand Rapids Medical Education Partners in Michigan, noted that there was a significant difference between the two groups in terms of operative time: 154 minutes for the MBP-alone group vs. 125 minutes for the antibiotics and MBP group.

Disclosures: Dr. El-Badawi reported that he had no relevant financial relationships.

MINNEAPOLIS — The use of oral antibiotics along with mechanical bowel preparation before colon resection significantly reduced the number of superficial surgical site infections, compared with the use of mechanical bowel preparation alone, according to the results of a retrospective study of 227 patients.

Superficial surgical site infections occurred in 3% of patients who were given oral antibiotics along with mechanical bowel preparation (MBP) vs. 11% of those who had MBP alone. There were also trends toward fewer deep surgical site infections, organ space surgical site infections, and anastomotic leaks, Dr. Khaled El-Badawi reported at the meeting.

The researchers performed a retrospective review of all elective segmental colon resections performed between 2007 and 2009. Patients were grouped by whether oral antibiotics had been used in conjunction with MBP. A total of 125 patients underwent MBP alone and 102 underwent MBP with oral antibiotics.

All patients were restricted to a clear liquid diet for at least 24 hours prior to surgery, and were also given 20 mg of bisacodyl and polyethylene glycol. Patients in the antibiotic group also received three doses of 1 g neomycin and 750 mg metronidazole on the day before surgery. Within 1 hour of surgical incision, all patients received 1 g ertapenem.

Dr. El-Badawi, who is a surgical resident at Grand Rapids Medical Education Partners in Michigan, noted that there was a significant difference between the two groups in terms of operative time: 154 minutes for the MBP-alone group vs. 125 minutes for the antibiotics and MBP group.

Disclosures: Dr. El-Badawi reported that he had no relevant financial relationships.

MINNEAPOLIS — The use of oral antibiotics along with mechanical bowel preparation before colon resection significantly reduced the number of superficial surgical site infections, compared with the use of mechanical bowel preparation alone, according to the results of a retrospective study of 227 patients.

Superficial surgical site infections occurred in 3% of patients who were given oral antibiotics along with mechanical bowel preparation (MBP) vs. 11% of those who had MBP alone. There were also trends toward fewer deep surgical site infections, organ space surgical site infections, and anastomotic leaks, Dr. Khaled El-Badawi reported at the meeting.

The researchers performed a retrospective review of all elective segmental colon resections performed between 2007 and 2009. Patients were grouped by whether oral antibiotics had been used in conjunction with MBP. A total of 125 patients underwent MBP alone and 102 underwent MBP with oral antibiotics.

All patients were restricted to a clear liquid diet for at least 24 hours prior to surgery, and were also given 20 mg of bisacodyl and polyethylene glycol. Patients in the antibiotic group also received three doses of 1 g neomycin and 750 mg metronidazole on the day before surgery. Within 1 hour of surgical incision, all patients received 1 g ertapenem.

Dr. El-Badawi, who is a surgical resident at Grand Rapids Medical Education Partners in Michigan, noted that there was a significant difference between the two groups in terms of operative time: 154 minutes for the MBP-alone group vs. 125 minutes for the antibiotics and MBP group.

Disclosures: Dr. El-Badawi reported that he had no relevant financial relationships.

Major Finding: Sacral nerve stimulation reduced the number of weekly episodes of fecal incontinence by at least half for 86% of 77 patients at 3 years.

Data Source: A prospective study of 133 patients with at least two episodes of fecal incontinence per week.

Disclosures: The study was funded entirely by Medtronic Inc., which makes the InterStim device. Three of the study's authors reported receiving research support from and acting as consultants to Medtronic. One of the authors reported being an employee of Medtronic.

MINNEAPOLIS — Improvements in fecal incontinence achieved with sacral nerve stimulation appear to persist at least 3 years, based on the results of a study involving 133 patients.

Among 77 patients who were implanted with the InterStim device and followed for at least 3 years, therapeutic success—defined as at least a 50% reduction in the number of incontinent episodes per week—was 86%, Dr. Anders Mellgren reported at the meeting.

The study was supported entirely by Medtronic Inc., which makes the InterStim device.

The researchers included 133 patients who were experiencing chronic fecal incontinence of at least two episodes per week and who had an external anal sphincter defect of less than 60 degrees. In addition, these patients either were not candidates for more conservative treatments or had experienced failure with such attempts.

The sacral nerve stimulation procedure is a two-step process. The patient is first implanted with a test lead for a 1- to 2-week trial. If the number of incontinent episodes is reduced by at least 50% during the trial, the stimulation device is implanted. In this study, following the initial test period, a total of 120 patients were implanted with the InterStim device.

The device delivers mild electrical stimulation to the sacral nerves that control the bladder, sphincter, and pelvic floor muscles.

Patients were asked to record their total number of incontinent episodes per week, total urgent incontinent episodes per week, and total incontinent days per week. Data were recorded at 3 months, 6 months, and 12 months, and annually thereafter. The average total follow-up period was 28 months, said Dr. Mellgren of colon and rectal surgery at the University of Minnesota in Minneapolis.

Depending on the type of analysis that was performed, the success rate ranged from 59% to 86%, Dr. Mellgren said.

A total of 77 patients completed treatment and had a 3-year follow-up period. Success in these patients was 86%. However, when all the implanted patients were included and the last observation was carried forward, the success rate was 79%.

And in a modified worst-case analysis, all patients who did not complete the follow-up period were considered failures, so the success rate dropped to 59%.

The average number of incontinent episodes per week decreased from almost 10 at baseline to about 2 at the end of 3 years (77 patients).

In addition, perfect continence (100% improvement) was achieved in about 40% of the patients, while 20%-30% of patients had a 75% improvement in symptoms.

The most common device- or therapy-related adverse events that occurred during the implant phase of the study were implant site pain (28% of patients), paresthesia (15%), change in sensation of stimulation (12%), and implant site infection (10%). Half of the patients with infection had to be reoperated, and five had the device removed, Dr. Mellgren noted. Most events were successfully handled by minimal interventions.

Major Finding: Sacral nerve stimulation reduced the number of weekly episodes of fecal incontinence by at least half for 86% of 77 patients at 3 years.

Data Source: A prospective study of 133 patients with at least two episodes of fecal incontinence per week.

Disclosures: The study was funded entirely by Medtronic Inc., which makes the InterStim device. Three of the study's authors reported receiving research support from and acting as consultants to Medtronic. One of the authors reported being an employee of Medtronic.

MINNEAPOLIS — Improvements in fecal incontinence achieved with sacral nerve stimulation appear to persist at least 3 years, based on the results of a study involving 133 patients.

Among 77 patients who were implanted with the InterStim device and followed for at least 3 years, therapeutic success—defined as at least a 50% reduction in the number of incontinent episodes per week—was 86%, Dr. Anders Mellgren reported at the meeting.

The study was supported entirely by Medtronic Inc., which makes the InterStim device.

The researchers included 133 patients who were experiencing chronic fecal incontinence of at least two episodes per week and who had an external anal sphincter defect of less than 60 degrees. In addition, these patients either were not candidates for more conservative treatments or had experienced failure with such attempts.

The sacral nerve stimulation procedure is a two-step process. The patient is first implanted with a test lead for a 1- to 2-week trial. If the number of incontinent episodes is reduced by at least 50% during the trial, the stimulation device is implanted. In this study, following the initial test period, a total of 120 patients were implanted with the InterStim device.

The device delivers mild electrical stimulation to the sacral nerves that control the bladder, sphincter, and pelvic floor muscles.

Patients were asked to record their total number of incontinent episodes per week, total urgent incontinent episodes per week, and total incontinent days per week. Data were recorded at 3 months, 6 months, and 12 months, and annually thereafter. The average total follow-up period was 28 months, said Dr. Mellgren of colon and rectal surgery at the University of Minnesota in Minneapolis.

Depending on the type of analysis that was performed, the success rate ranged from 59% to 86%, Dr. Mellgren said.

A total of 77 patients completed treatment and had a 3-year follow-up period. Success in these patients was 86%. However, when all the implanted patients were included and the last observation was carried forward, the success rate was 79%.

And in a modified worst-case analysis, all patients who did not complete the follow-up period were considered failures, so the success rate dropped to 59%.

The average number of incontinent episodes per week decreased from almost 10 at baseline to about 2 at the end of 3 years (77 patients).

In addition, perfect continence (100% improvement) was achieved in about 40% of the patients, while 20%-30% of patients had a 75% improvement in symptoms.

The most common device- or therapy-related adverse events that occurred during the implant phase of the study were implant site pain (28% of patients), paresthesia (15%), change in sensation of stimulation (12%), and implant site infection (10%). Half of the patients with infection had to be reoperated, and five had the device removed, Dr. Mellgren noted. Most events were successfully handled by minimal interventions.

Major Finding: Sacral nerve stimulation reduced the number of weekly episodes of fecal incontinence by at least half for 86% of 77 patients at 3 years.

Data Source: A prospective study of 133 patients with at least two episodes of fecal incontinence per week.

Disclosures: The study was funded entirely by Medtronic Inc., which makes the InterStim device. Three of the study's authors reported receiving research support from and acting as consultants to Medtronic. One of the authors reported being an employee of Medtronic.

MINNEAPOLIS — Improvements in fecal incontinence achieved with sacral nerve stimulation appear to persist at least 3 years, based on the results of a study involving 133 patients.

Among 77 patients who were implanted with the InterStim device and followed for at least 3 years, therapeutic success—defined as at least a 50% reduction in the number of incontinent episodes per week—was 86%, Dr. Anders Mellgren reported at the meeting.

The study was supported entirely by Medtronic Inc., which makes the InterStim device.

The researchers included 133 patients who were experiencing chronic fecal incontinence of at least two episodes per week and who had an external anal sphincter defect of less than 60 degrees. In addition, these patients either were not candidates for more conservative treatments or had experienced failure with such attempts.

The sacral nerve stimulation procedure is a two-step process. The patient is first implanted with a test lead for a 1- to 2-week trial. If the number of incontinent episodes is reduced by at least 50% during the trial, the stimulation device is implanted. In this study, following the initial test period, a total of 120 patients were implanted with the InterStim device.

The device delivers mild electrical stimulation to the sacral nerves that control the bladder, sphincter, and pelvic floor muscles.

Patients were asked to record their total number of incontinent episodes per week, total urgent incontinent episodes per week, and total incontinent days per week. Data were recorded at 3 months, 6 months, and 12 months, and annually thereafter. The average total follow-up period was 28 months, said Dr. Mellgren of colon and rectal surgery at the University of Minnesota in Minneapolis.

Depending on the type of analysis that was performed, the success rate ranged from 59% to 86%, Dr. Mellgren said.

A total of 77 patients completed treatment and had a 3-year follow-up period. Success in these patients was 86%. However, when all the implanted patients were included and the last observation was carried forward, the success rate was 79%.

And in a modified worst-case analysis, all patients who did not complete the follow-up period were considered failures, so the success rate dropped to 59%.

The average number of incontinent episodes per week decreased from almost 10 at baseline to about 2 at the end of 3 years (77 patients).

In addition, perfect continence (100% improvement) was achieved in about 40% of the patients, while 20%-30% of patients had a 75% improvement in symptoms.

The most common device- or therapy-related adverse events that occurred during the implant phase of the study were implant site pain (28% of patients), paresthesia (15%), change in sensation of stimulation (12%), and implant site infection (10%). Half of the patients with infection had to be reoperated, and five had the device removed, Dr. Mellgren noted. Most events were successfully handled by minimal interventions.