Kerri Wachter

WASHINGTON — Military personnel are at risk for problem gambling, but it is often difficult for them to get adequate treatment, according to the director of a Veterans Affairs program for problem gamblers.

In 2002, there were 1.4 million active service members. That year, the Pentagon conducted a survey of health-related behaviors among military personnel. According to that survey, about 17,500 service members, or 1.2% of the military, met the DSM-IV criteria for pathological gambling. For comparison, the national average is 1.6%. In a 2005 VA study, 10% of Native American soldiers and 4.3% of Hispanic soldiers met the DSM-IV criteria for pathological gambling, Dr. Rena Nora said at the annual meeting of the American Psychiatric Association.

Yet only three programs for military members with problem gambling exist: one at Camp Pendleton in California; one at the VA facility in Brecksville, Ohio; and the intensive outpatient program for problem gamblers at the VA Southern Nevada Healthcare System in Las Vegas, of which Dr. Nora is the medical director.

Military personnel have a number of risk factors for gambling: the sociodemographic composition of the military (mostly young males), feelings of loneliness and alienation, prevalence of risk-taking personality, and severe stress and anxiety. The accessibility of gambling also is a risk factor because there are approximately 8,000 slot machines at 94 military facilities overseas.

Limited confidentiality for mental health treatment is also problematic. A soldier's commanding officer can request and obtain access to mental health records. “When the commander or anyone else wants the records, you do not say no,” said Dr. Nora, who also is with the department of psychiatry at the University of Nevada, Reno. “There is really no confidentiality if you are an active-duty service member.”

Although there is legislation that provides for treatment of mental health disorders such as pathological gambling, the provision of services in reality it is not so easy. “I had to go all of the way to the Department of Defense to get something in writing, so that we were able to justify budget and staffing for a gambling program,” said Dr. Nora. Since the program in Las Vegas began in fiscal year 2004, she and her colleagues have treated 1,423 patients.

Dr. Nora reported that she had no relevant conflicts of interest.

WASHINGTON — Military personnel are at risk for problem gambling, but it is often difficult for them to get adequate treatment, according to the director of a Veterans Affairs program for problem gamblers.

In 2002, there were 1.4 million active service members. That year, the Pentagon conducted a survey of health-related behaviors among military personnel. According to that survey, about 17,500 service members, or 1.2% of the military, met the DSM-IV criteria for pathological gambling. For comparison, the national average is 1.6%. In a 2005 VA study, 10% of Native American soldiers and 4.3% of Hispanic soldiers met the DSM-IV criteria for pathological gambling, Dr. Rena Nora said at the annual meeting of the American Psychiatric Association.

Yet only three programs for military members with problem gambling exist: one at Camp Pendleton in California; one at the VA facility in Brecksville, Ohio; and the intensive outpatient program for problem gamblers at the VA Southern Nevada Healthcare System in Las Vegas, of which Dr. Nora is the medical director.

Military personnel have a number of risk factors for gambling: the sociodemographic composition of the military (mostly young males), feelings of loneliness and alienation, prevalence of risk-taking personality, and severe stress and anxiety. The accessibility of gambling also is a risk factor because there are approximately 8,000 slot machines at 94 military facilities overseas.

Limited confidentiality for mental health treatment is also problematic. A soldier's commanding officer can request and obtain access to mental health records. “When the commander or anyone else wants the records, you do not say no,” said Dr. Nora, who also is with the department of psychiatry at the University of Nevada, Reno. “There is really no confidentiality if you are an active-duty service member.”

Although there is legislation that provides for treatment of mental health disorders such as pathological gambling, the provision of services in reality it is not so easy. “I had to go all of the way to the Department of Defense to get something in writing, so that we were able to justify budget and staffing for a gambling program,” said Dr. Nora. Since the program in Las Vegas began in fiscal year 2004, she and her colleagues have treated 1,423 patients.

Dr. Nora reported that she had no relevant conflicts of interest.

WASHINGTON — Military personnel are at risk for problem gambling, but it is often difficult for them to get adequate treatment, according to the director of a Veterans Affairs program for problem gamblers.

In 2002, there were 1.4 million active service members. That year, the Pentagon conducted a survey of health-related behaviors among military personnel. According to that survey, about 17,500 service members, or 1.2% of the military, met the DSM-IV criteria for pathological gambling. For comparison, the national average is 1.6%. In a 2005 VA study, 10% of Native American soldiers and 4.3% of Hispanic soldiers met the DSM-IV criteria for pathological gambling, Dr. Rena Nora said at the annual meeting of the American Psychiatric Association.

Yet only three programs for military members with problem gambling exist: one at Camp Pendleton in California; one at the VA facility in Brecksville, Ohio; and the intensive outpatient program for problem gamblers at the VA Southern Nevada Healthcare System in Las Vegas, of which Dr. Nora is the medical director.

Military personnel have a number of risk factors for gambling: the sociodemographic composition of the military (mostly young males), feelings of loneliness and alienation, prevalence of risk-taking personality, and severe stress and anxiety. The accessibility of gambling also is a risk factor because there are approximately 8,000 slot machines at 94 military facilities overseas.

Limited confidentiality for mental health treatment is also problematic. A soldier's commanding officer can request and obtain access to mental health records. “When the commander or anyone else wants the records, you do not say no,” said Dr. Nora, who also is with the department of psychiatry at the University of Nevada, Reno. “There is really no confidentiality if you are an active-duty service member.”

Although there is legislation that provides for treatment of mental health disorders such as pathological gambling, the provision of services in reality it is not so easy. “I had to go all of the way to the Department of Defense to get something in writing, so that we were able to justify budget and staffing for a gambling program,” said Dr. Nora. Since the program in Las Vegas began in fiscal year 2004, she and her colleagues have treated 1,423 patients.

Dr. Nora reported that she had no relevant conflicts of interest.

CHICAGO — Citalopram may be an effective option for reducing hot flashes, having performed twice as well as placebo in a randomized, placebo-controlled phase III trial conducted by the North Central Cancer Treatment Group.

“Hot flash relief can be obtained with as little as 10 mg/day citalopram,” Debra Barton, Ph.D., of the Mayo Clinic in Rochester, Minn., and her coauthors concluded in a poster reporting results of the trial (NCCTG N05C9) at the annual meeting of the American Society of Clinical Oncology.

A selective serotonin reuptake inhibitor (SSRI), citalopram (Celexa) is approved for depression, but is also used for some other disorders.

Postmenopausal women who had a history of breast cancer or wanted to avoid hormones due to breast cancer risk were enrolled in the study. They had to have at least 14 hot flashes per week for at least 1 month. Endocrine therapy was allowed, if the woman was on a stable dose for at least 1 month. No other antidepressants or hot flash therapies were permitted.

All 254 participants kept a record of their hot flashes for 1 week before starting treatment. The investigators randomized the women into four groups that received either (group 1) 10 mg/day of citalopram on weeks 2–7, (group 2) 10 mg/day of citalopram during week 2 followed by 20 mg/day of citalopram for weeks 3–7, (group 3) 10 mg/day of citalopram during week 2 followed by 20 mg/day for week 3 and 30 mg/day for weeks 4–7, or (group 4) placebo.

The placebo group comprised 83 women; each citalopram arm had 57 women. Most participants were 50 years or older (81%) and white (89%). A third of the women (34%) had a history of breast cancer. Nearly half the women (48%) had 4–9 hot flashes per day, another 38% had 10 or more per day, and 13% had less than 4 per day (13%). Mean baseline hot flash score and frequency were comparable between the groups.

The primary outcome was hot flash score as measured with a daily hot flash diary. Secondary outcomes included data from Hot Flash Daily Interference and Profile of Mood States measures, and from a symptom experience diary.

Women in the placebo group had a mean hot flash score reduction of 23%. Those in the 10-mg, 20-mg, and 30-mg citalopram groups had mean reductions of 49%, 50%, and 55%, respectively, with the differences relative to placebo being statistically significant for all three citalopram groups.

The mean reduction in hot flash frequency was 20% for the placebo group. The mean reductions for the 10-mg, 20-mg, and 30-mg citalopram groups were 46%, 43%, and 50%, respectively. All three comparisons to placebo were statistically significant.

The researchers also looked at quality of life measures. On the Profile of Mood States measure, women in the citalopram arms had greater improvement from baseline than did those in the placebo group on the tension/anxiety subscale, though the difference was only significant for the 20-mg citalopram group. Likewise, women in the citalopram arms had greater improvements from baseline than did those in the placebo group on the anger/hostility subscale, though the difference was only significant for the 10-mg arm.

On the Hot Flash Daily Interference Scale, women in the citalopram arms generally had greater improvements from baseline than did those in the placebo group on measures of work, social, leisure, sleep, mood, concentration, relationships, sexuality, enjoyment of life, and overall quality of life. Women on any dose of citalopram also had significantly greater improvements in abnormal sweating (P = .05), hot flash distress (P = .003), and hot flash control (P = .04) than did women in the placebo group. There were no significant differences in self-reported adverse events between the groups. The authors reported that they had no conflicts of interest.

Women in the 10-mg, 20-mg, and 30-mg citalopram groups had mean reductions of 49%, 50%, and 55%, respectively. DR. BARTON

CHICAGO — Citalopram may be an effective option for reducing hot flashes, having performed twice as well as placebo in a randomized, placebo-controlled phase III trial conducted by the North Central Cancer Treatment Group.

“Hot flash relief can be obtained with as little as 10 mg/day citalopram,” Debra Barton, Ph.D., of the Mayo Clinic in Rochester, Minn., and her coauthors concluded in a poster reporting results of the trial (NCCTG N05C9) at the annual meeting of the American Society of Clinical Oncology.

A selective serotonin reuptake inhibitor (SSRI), citalopram (Celexa) is approved for depression, but is also used for some other disorders.

Postmenopausal women who had a history of breast cancer or wanted to avoid hormones due to breast cancer risk were enrolled in the study. They had to have at least 14 hot flashes per week for at least 1 month. Endocrine therapy was allowed, if the woman was on a stable dose for at least 1 month. No other antidepressants or hot flash therapies were permitted.

All 254 participants kept a record of their hot flashes for 1 week before starting treatment. The investigators randomized the women into four groups that received either (group 1) 10 mg/day of citalopram on weeks 2–7, (group 2) 10 mg/day of citalopram during week 2 followed by 20 mg/day of citalopram for weeks 3–7, (group 3) 10 mg/day of citalopram during week 2 followed by 20 mg/day for week 3 and 30 mg/day for weeks 4–7, or (group 4) placebo.

The placebo group comprised 83 women; each citalopram arm had 57 women. Most participants were 50 years or older (81%) and white (89%). A third of the women (34%) had a history of breast cancer. Nearly half the women (48%) had 4–9 hot flashes per day, another 38% had 10 or more per day, and 13% had less than 4 per day (13%). Mean baseline hot flash score and frequency were comparable between the groups.

The primary outcome was hot flash score as measured with a daily hot flash diary. Secondary outcomes included data from Hot Flash Daily Interference and Profile of Mood States measures, and from a symptom experience diary.

Women in the placebo group had a mean hot flash score reduction of 23%. Those in the 10-mg, 20-mg, and 30-mg citalopram groups had mean reductions of 49%, 50%, and 55%, respectively, with the differences relative to placebo being statistically significant for all three citalopram groups.

The mean reduction in hot flash frequency was 20% for the placebo group. The mean reductions for the 10-mg, 20-mg, and 30-mg citalopram groups were 46%, 43%, and 50%, respectively. All three comparisons to placebo were statistically significant.

The researchers also looked at quality of life measures. On the Profile of Mood States measure, women in the citalopram arms had greater improvement from baseline than did those in the placebo group on the tension/anxiety subscale, though the difference was only significant for the 20-mg citalopram group. Likewise, women in the citalopram arms had greater improvements from baseline than did those in the placebo group on the anger/hostility subscale, though the difference was only significant for the 10-mg arm.

On the Hot Flash Daily Interference Scale, women in the citalopram arms generally had greater improvements from baseline than did those in the placebo group on measures of work, social, leisure, sleep, mood, concentration, relationships, sexuality, enjoyment of life, and overall quality of life. Women on any dose of citalopram also had significantly greater improvements in abnormal sweating (P = .05), hot flash distress (P = .003), and hot flash control (P = .04) than did women in the placebo group. There were no significant differences in self-reported adverse events between the groups. The authors reported that they had no conflicts of interest.

Women in the 10-mg, 20-mg, and 30-mg citalopram groups had mean reductions of 49%, 50%, and 55%, respectively. DR. BARTON

CHICAGO — Citalopram may be an effective option for reducing hot flashes, having performed twice as well as placebo in a randomized, placebo-controlled phase III trial conducted by the North Central Cancer Treatment Group.

“Hot flash relief can be obtained with as little as 10 mg/day citalopram,” Debra Barton, Ph.D., of the Mayo Clinic in Rochester, Minn., and her coauthors concluded in a poster reporting results of the trial (NCCTG N05C9) at the annual meeting of the American Society of Clinical Oncology.

A selective serotonin reuptake inhibitor (SSRI), citalopram (Celexa) is approved for depression, but is also used for some other disorders.

Postmenopausal women who had a history of breast cancer or wanted to avoid hormones due to breast cancer risk were enrolled in the study. They had to have at least 14 hot flashes per week for at least 1 month. Endocrine therapy was allowed, if the woman was on a stable dose for at least 1 month. No other antidepressants or hot flash therapies were permitted.

All 254 participants kept a record of their hot flashes for 1 week before starting treatment. The investigators randomized the women into four groups that received either (group 1) 10 mg/day of citalopram on weeks 2–7, (group 2) 10 mg/day of citalopram during week 2 followed by 20 mg/day of citalopram for weeks 3–7, (group 3) 10 mg/day of citalopram during week 2 followed by 20 mg/day for week 3 and 30 mg/day for weeks 4–7, or (group 4) placebo.

The placebo group comprised 83 women; each citalopram arm had 57 women. Most participants were 50 years or older (81%) and white (89%). A third of the women (34%) had a history of breast cancer. Nearly half the women (48%) had 4–9 hot flashes per day, another 38% had 10 or more per day, and 13% had less than 4 per day (13%). Mean baseline hot flash score and frequency were comparable between the groups.

The primary outcome was hot flash score as measured with a daily hot flash diary. Secondary outcomes included data from Hot Flash Daily Interference and Profile of Mood States measures, and from a symptom experience diary.

Women in the placebo group had a mean hot flash score reduction of 23%. Those in the 10-mg, 20-mg, and 30-mg citalopram groups had mean reductions of 49%, 50%, and 55%, respectively, with the differences relative to placebo being statistically significant for all three citalopram groups.

The mean reduction in hot flash frequency was 20% for the placebo group. The mean reductions for the 10-mg, 20-mg, and 30-mg citalopram groups were 46%, 43%, and 50%, respectively. All three comparisons to placebo were statistically significant.

The researchers also looked at quality of life measures. On the Profile of Mood States measure, women in the citalopram arms had greater improvement from baseline than did those in the placebo group on the tension/anxiety subscale, though the difference was only significant for the 20-mg citalopram group. Likewise, women in the citalopram arms had greater improvements from baseline than did those in the placebo group on the anger/hostility subscale, though the difference was only significant for the 10-mg arm.

On the Hot Flash Daily Interference Scale, women in the citalopram arms generally had greater improvements from baseline than did those in the placebo group on measures of work, social, leisure, sleep, mood, concentration, relationships, sexuality, enjoyment of life, and overall quality of life. Women on any dose of citalopram also had significantly greater improvements in abnormal sweating (P = .05), hot flash distress (P = .003), and hot flash control (P = .04) than did women in the placebo group. There were no significant differences in self-reported adverse events between the groups. The authors reported that they had no conflicts of interest.

Women in the 10-mg, 20-mg, and 30-mg citalopram groups had mean reductions of 49%, 50%, and 55%, respectively. DR. BARTON

A new imaging system recently cleared for marketing by the Food and Drug Administration offers cardiologists help in assessing coronary artery plaque content to determine if the deposit is vulnerable to rupture.

Plaques containing large lipid cores have been associated with plaque rupture and thrombosis in patients with coronary artery disease. The ability to assess the makeup of coronary artery plaques and identify those patients at greatest risk of plaque rupture and subsequent heart attack has become something of a holy grail for cardiology.

The LipiScan near-infrared catheter imaging system (InfraReDx Inc.) “is the first device that can help assess the chemical makeup of coronary artery plaques and help physicians identify those plaques with lipid cores,” Dr. Daniel Schultz, director of the FDA's Center for Devices and Radiological Health, said in a press release.

The InfraReDx system relies on near-infrared spectroscopy (NIRS), which uses the near-infrared region of the electromagnetic spectrum (about 800–2,500 nm) to determine the chemical makeup of a plaque. NIR radiation can typically penetrate much further into a sample than even mid-infrared waves, making the technique useful in probing bulk material with little or no sample preparation.

The technique involves targeting a material with electromagnetic radiation over the NIR range. The amount of energy absorbed by material at different wavelengths results in a spectrum that serves as a unique fingerprint for a specific compound. Human tissues contain a variety of substances whose absorption spectra at NIR wavelengths are well defined.

The device is cleared for use by physicians who are evaluating patients with symptoms of coronary heart disease during coronary angiography.

“It's an excellent technology to identify lipid-rich plaques and vulnerable plaques in the coronary arterial wall,” said Dr. George Beller, professor of internal medicine and interim chief of the division of cardiovascular medicine at the University of Virginia, Charlottesville.

The technology has the potential to alter patient management. “The next question is whether it will prove to be a clinically useful tool,” said Dr. Beller.

The Spectroscopic Assessment of Coronary Lipid (SPECTACL) study, aimed at showing that spectra obtained in the coronaries of 125 patients with stable and unstable coronary artery disease are similar to postmortem specimens, is still ongoing. The trial's secondary end point is to determine the presence of lipid-rich plaques in the coronary arteries of these patients.

Although NIRS shows promise, research continues on the use of other imaging modalities to identify vulnerable plaques.

“The [NIRS] technique may have advantages over intravascular ultrasound [IVUS] or virtual histology IVUS, but that remains to be seen because that technique is also being evaluated to distinguish between predominantly fibrous plaques and those which have predominantly necrotic cores that are lipid laden,” Dr. Beller.

And the search continues for noninvasive means of evaluating plaque vulnerability. “This technology doesn't preclude the major goal of identifying plaques noninvasively, with nuclear or MR or CT techniques. That is still a very high priority,” said Dr. Beller.

A new imaging system recently cleared for marketing by the Food and Drug Administration offers cardiologists help in assessing coronary artery plaque content to determine if the deposit is vulnerable to rupture.

Plaques containing large lipid cores have been associated with plaque rupture and thrombosis in patients with coronary artery disease. The ability to assess the makeup of coronary artery plaques and identify those patients at greatest risk of plaque rupture and subsequent heart attack has become something of a holy grail for cardiology.

The LipiScan near-infrared catheter imaging system (InfraReDx Inc.) “is the first device that can help assess the chemical makeup of coronary artery plaques and help physicians identify those plaques with lipid cores,” Dr. Daniel Schultz, director of the FDA's Center for Devices and Radiological Health, said in a press release.

The InfraReDx system relies on near-infrared spectroscopy (NIRS), which uses the near-infrared region of the electromagnetic spectrum (about 800–2,500 nm) to determine the chemical makeup of a plaque. NIR radiation can typically penetrate much further into a sample than even mid-infrared waves, making the technique useful in probing bulk material with little or no sample preparation.

The technique involves targeting a material with electromagnetic radiation over the NIR range. The amount of energy absorbed by material at different wavelengths results in a spectrum that serves as a unique fingerprint for a specific compound. Human tissues contain a variety of substances whose absorption spectra at NIR wavelengths are well defined.

The device is cleared for use by physicians who are evaluating patients with symptoms of coronary heart disease during coronary angiography.

“It's an excellent technology to identify lipid-rich plaques and vulnerable plaques in the coronary arterial wall,” said Dr. George Beller, professor of internal medicine and interim chief of the division of cardiovascular medicine at the University of Virginia, Charlottesville.

The technology has the potential to alter patient management. “The next question is whether it will prove to be a clinically useful tool,” said Dr. Beller.

The Spectroscopic Assessment of Coronary Lipid (SPECTACL) study, aimed at showing that spectra obtained in the coronaries of 125 patients with stable and unstable coronary artery disease are similar to postmortem specimens, is still ongoing. The trial's secondary end point is to determine the presence of lipid-rich plaques in the coronary arteries of these patients.

Although NIRS shows promise, research continues on the use of other imaging modalities to identify vulnerable plaques.

“The [NIRS] technique may have advantages over intravascular ultrasound [IVUS] or virtual histology IVUS, but that remains to be seen because that technique is also being evaluated to distinguish between predominantly fibrous plaques and those which have predominantly necrotic cores that are lipid laden,” Dr. Beller.

And the search continues for noninvasive means of evaluating plaque vulnerability. “This technology doesn't preclude the major goal of identifying plaques noninvasively, with nuclear or MR or CT techniques. That is still a very high priority,” said Dr. Beller.

A new imaging system recently cleared for marketing by the Food and Drug Administration offers cardiologists help in assessing coronary artery plaque content to determine if the deposit is vulnerable to rupture.

Plaques containing large lipid cores have been associated with plaque rupture and thrombosis in patients with coronary artery disease. The ability to assess the makeup of coronary artery plaques and identify those patients at greatest risk of plaque rupture and subsequent heart attack has become something of a holy grail for cardiology.

The LipiScan near-infrared catheter imaging system (InfraReDx Inc.) “is the first device that can help assess the chemical makeup of coronary artery plaques and help physicians identify those plaques with lipid cores,” Dr. Daniel Schultz, director of the FDA's Center for Devices and Radiological Health, said in a press release.

The InfraReDx system relies on near-infrared spectroscopy (NIRS), which uses the near-infrared region of the electromagnetic spectrum (about 800–2,500 nm) to determine the chemical makeup of a plaque. NIR radiation can typically penetrate much further into a sample than even mid-infrared waves, making the technique useful in probing bulk material with little or no sample preparation.

The technique involves targeting a material with electromagnetic radiation over the NIR range. The amount of energy absorbed by material at different wavelengths results in a spectrum that serves as a unique fingerprint for a specific compound. Human tissues contain a variety of substances whose absorption spectra at NIR wavelengths are well defined.

The device is cleared for use by physicians who are evaluating patients with symptoms of coronary heart disease during coronary angiography.

“It's an excellent technology to identify lipid-rich plaques and vulnerable plaques in the coronary arterial wall,” said Dr. George Beller, professor of internal medicine and interim chief of the division of cardiovascular medicine at the University of Virginia, Charlottesville.

The technology has the potential to alter patient management. “The next question is whether it will prove to be a clinically useful tool,” said Dr. Beller.

The Spectroscopic Assessment of Coronary Lipid (SPECTACL) study, aimed at showing that spectra obtained in the coronaries of 125 patients with stable and unstable coronary artery disease are similar to postmortem specimens, is still ongoing. The trial's secondary end point is to determine the presence of lipid-rich plaques in the coronary arteries of these patients.

Although NIRS shows promise, research continues on the use of other imaging modalities to identify vulnerable plaques.

“The [NIRS] technique may have advantages over intravascular ultrasound [IVUS] or virtual histology IVUS, but that remains to be seen because that technique is also being evaluated to distinguish between predominantly fibrous plaques and those which have predominantly necrotic cores that are lipid laden,” Dr. Beller.

And the search continues for noninvasive means of evaluating plaque vulnerability. “This technology doesn't preclude the major goal of identifying plaques noninvasively, with nuclear or MR or CT techniques. That is still a very high priority,” said Dr. Beller.

WASHINGTON – Military personnel are at risk for problem gambling, but it is often difficult for them to get adequate treatment, according to the director of a Veterans Affairs program for problem gamblers.

In 2002, there were 1.4 million active service members. That year, the Pentagon conducted a survey of health-related behaviors among military personnel. According to that survey, about 17,500 service members, or 1.2% of the military, met the DSM-IV criteria for pathological gambling. For comparison, the national average is 1.6%. In a 2005 VA study, 10% of Native American soldiers and 4.3% of Hispanic soldiers met the DSM-IV criteria for pathological gambling, Dr. Rena Nora said at the annual meeting of the American Psychiatric Association.

Yet only three programs for military members with problem gambling exist: one at Camp Pendleton in California; one at the VA facility in Brecksville, Ohio; and the intensive outpatient program for problem gamblers at the VA Southern Nevada Healthcare System in Las Vegas, of which Dr. Nora is the medical director.

Military personnel have a number of risk factors for gambling: the sociodemographic composition of the military (mostly young males), feelings of loneliness and alienation, prevalence of risk-taking personality, and severe stress and anxiety. The accessibility of gambling also is a risk factor because there are approximately 8,000 slot machines at 94 military facilities overseas.

Limited confidentiality for mental health treatment is also problematic. A soldier's commanding officer can request and obtain access to mental health records. “When the commander or anyone else wants the records, you do not say no,” said Dr. Nora, who also is with the department of psychiatry at the University of Nevada, Reno. “There is really no confidentiality if you are an active-duty service member.”

Although there is legislation that provides for treatment of mental health disorders such as pathological gambling, the provision of services in reality it is not so easy. “I had to go all of the way to the Department of Defense to get something in writing, so that we were able to justify budget and staffing for a gambling program,” said Dr. Nora. Since the program in Las Vegas began in fiscal year 2004, she and her colleagues have treated 1,423 patients.

Dr. Nora reported that she had no relevant conflicts of interest.

WASHINGTON – Military personnel are at risk for problem gambling, but it is often difficult for them to get adequate treatment, according to the director of a Veterans Affairs program for problem gamblers.

In 2002, there were 1.4 million active service members. That year, the Pentagon conducted a survey of health-related behaviors among military personnel. According to that survey, about 17,500 service members, or 1.2% of the military, met the DSM-IV criteria for pathological gambling. For comparison, the national average is 1.6%. In a 2005 VA study, 10% of Native American soldiers and 4.3% of Hispanic soldiers met the DSM-IV criteria for pathological gambling, Dr. Rena Nora said at the annual meeting of the American Psychiatric Association.

Yet only three programs for military members with problem gambling exist: one at Camp Pendleton in California; one at the VA facility in Brecksville, Ohio; and the intensive outpatient program for problem gamblers at the VA Southern Nevada Healthcare System in Las Vegas, of which Dr. Nora is the medical director.

Military personnel have a number of risk factors for gambling: the sociodemographic composition of the military (mostly young males), feelings of loneliness and alienation, prevalence of risk-taking personality, and severe stress and anxiety. The accessibility of gambling also is a risk factor because there are approximately 8,000 slot machines at 94 military facilities overseas.

Limited confidentiality for mental health treatment is also problematic. A soldier's commanding officer can request and obtain access to mental health records. “When the commander or anyone else wants the records, you do not say no,” said Dr. Nora, who also is with the department of psychiatry at the University of Nevada, Reno. “There is really no confidentiality if you are an active-duty service member.”

Although there is legislation that provides for treatment of mental health disorders such as pathological gambling, the provision of services in reality it is not so easy. “I had to go all of the way to the Department of Defense to get something in writing, so that we were able to justify budget and staffing for a gambling program,” said Dr. Nora. Since the program in Las Vegas began in fiscal year 2004, she and her colleagues have treated 1,423 patients.

Dr. Nora reported that she had no relevant conflicts of interest.

WASHINGTON – Military personnel are at risk for problem gambling, but it is often difficult for them to get adequate treatment, according to the director of a Veterans Affairs program for problem gamblers.

In 2002, there were 1.4 million active service members. That year, the Pentagon conducted a survey of health-related behaviors among military personnel. According to that survey, about 17,500 service members, or 1.2% of the military, met the DSM-IV criteria for pathological gambling. For comparison, the national average is 1.6%. In a 2005 VA study, 10% of Native American soldiers and 4.3% of Hispanic soldiers met the DSM-IV criteria for pathological gambling, Dr. Rena Nora said at the annual meeting of the American Psychiatric Association.

Yet only three programs for military members with problem gambling exist: one at Camp Pendleton in California; one at the VA facility in Brecksville, Ohio; and the intensive outpatient program for problem gamblers at the VA Southern Nevada Healthcare System in Las Vegas, of which Dr. Nora is the medical director.

Military personnel have a number of risk factors for gambling: the sociodemographic composition of the military (mostly young males), feelings of loneliness and alienation, prevalence of risk-taking personality, and severe stress and anxiety. The accessibility of gambling also is a risk factor because there are approximately 8,000 slot machines at 94 military facilities overseas.

Limited confidentiality for mental health treatment is also problematic. A soldier's commanding officer can request and obtain access to mental health records. “When the commander or anyone else wants the records, you do not say no,” said Dr. Nora, who also is with the department of psychiatry at the University of Nevada, Reno. “There is really no confidentiality if you are an active-duty service member.”

Although there is legislation that provides for treatment of mental health disorders such as pathological gambling, the provision of services in reality it is not so easy. “I had to go all of the way to the Department of Defense to get something in writing, so that we were able to justify budget and staffing for a gambling program,” said Dr. Nora. Since the program in Las Vegas began in fiscal year 2004, she and her colleagues have treated 1,423 patients.

Dr. Nora reported that she had no relevant conflicts of interest.

WASHINGTON – The antismoking drug varenicline also appears to curb alcohol cravings in smokers who are heavy drinkers, results of a small pilot study show.

Nondependent heavy drinkers taking varenicline (Chantix) were more likely to be abstinent during the 2-hour period of free access to alcoholic drinks than were those in the placebo group, based on logistic regression analysis, Sherry A. McKee, Ph.D., reported at a joint meeting sponsored by the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism.

Participants were male and female non-treatment seeking, nondependent heavy drinkers who also were daily smokers, said Dr. McKee of Yale University, New Haven, Conn.

Subjects were titrated to steady-state levels of varenicline (2 mg/day) or placebo over the course of a week. On day 8, all participants were given free access to cigarettes and were administered a priming drink, which was designed to raise blood alcohol levels to 0.03 g/dL.

Subjective and psychological responses to alcohol were then assessed. A 2-hour period of self-administration followed, during which time participants could choose to consume up to eight additional drinks (designed to raise blood alcohol levels by 0.015 g/dL) or to receive monetary reinforcement for drinks not consumed.

Participants had to have smoked at least 10 cigarettes/day for the last year. Men had to consume more than 14 drinks/week or 5 or more drinks on one occasion; women had to consume more than 7 drinks/week or 4 or more drinks on one occasion. Urine testing was used to assess varenicline compliance on days 4-8.

A total of 20 participants were enrolled–10 in each arm. The groups were matched in terms of age, gender, number of cigarettes per day, weekly frequency of drinking, and the number of drinks per episode.

During the period of unrestricted access to alcohol, varenicline “significantly reduced drinking by about two drinks,” Dr. McKee said.

Two subjects in the varenicline group consumed drinks, compared with seven in the placebo group. After the priming drink, no difference was found in blood alcohol levels between the two groups. However, a significant difference was found in alcohol craving. Those on varenicline reported a sharp decrease in alcohol craving; those on placebo reported an increase.

Over the same time period, the subjective effects of alcohol remained steady for those in the varenicline group but increased in the placebo group. The difference was statistically significant. There was no effect of varenicline on tobacco craving in this period.

There was also no effect of varenicline on physiologic reactivity as measured by diastolic/systolic blood pressure. In terms of smoking, over the treatment period, the number of cigarettes per day decreased by 1.5 cigarettes in the varenicline group, compared with 0.5 in the placebo group.

Adverse events were few and included nausea, sleep disturbance, abnormal dreams, constipation, and vomiting.

Notably, subjects in neither group were able to discern whether they were on placebo or active drug. In the varenicline group, 60% thought that they were on placebo, and in the placebo group, 44% thought they were taking the active drug.

Alcohol and tobacco dependence are highly comorbid disorders. Preclinical evidence suggests a role for nicotinic acetylcholine receptors in alcohol drinking. In fact, the drug has demonstrated efficacy in reducing alcohol intake in animals. However, to date the effects of the drug on alcohol consumption has not been tested in humans.

The results, in addition to findings from animal studies, support a role for nicotinic receptor involvement in alcohol consumption and suggest that targeting nicotinic receptors might be a viable strategy for drug development, said Dr. McKee, who had no conflicts of interest to report.

WASHINGTON – The antismoking drug varenicline also appears to curb alcohol cravings in smokers who are heavy drinkers, results of a small pilot study show.

Nondependent heavy drinkers taking varenicline (Chantix) were more likely to be abstinent during the 2-hour period of free access to alcoholic drinks than were those in the placebo group, based on logistic regression analysis, Sherry A. McKee, Ph.D., reported at a joint meeting sponsored by the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism.

Participants were male and female non-treatment seeking, nondependent heavy drinkers who also were daily smokers, said Dr. McKee of Yale University, New Haven, Conn.

Subjects were titrated to steady-state levels of varenicline (2 mg/day) or placebo over the course of a week. On day 8, all participants were given free access to cigarettes and were administered a priming drink, which was designed to raise blood alcohol levels to 0.03 g/dL.

Subjective and psychological responses to alcohol were then assessed. A 2-hour period of self-administration followed, during which time participants could choose to consume up to eight additional drinks (designed to raise blood alcohol levels by 0.015 g/dL) or to receive monetary reinforcement for drinks not consumed.

Participants had to have smoked at least 10 cigarettes/day for the last year. Men had to consume more than 14 drinks/week or 5 or more drinks on one occasion; women had to consume more than 7 drinks/week or 4 or more drinks on one occasion. Urine testing was used to assess varenicline compliance on days 4-8.

A total of 20 participants were enrolled–10 in each arm. The groups were matched in terms of age, gender, number of cigarettes per day, weekly frequency of drinking, and the number of drinks per episode.

During the period of unrestricted access to alcohol, varenicline “significantly reduced drinking by about two drinks,” Dr. McKee said.

Two subjects in the varenicline group consumed drinks, compared with seven in the placebo group. After the priming drink, no difference was found in blood alcohol levels between the two groups. However, a significant difference was found in alcohol craving. Those on varenicline reported a sharp decrease in alcohol craving; those on placebo reported an increase.

Over the same time period, the subjective effects of alcohol remained steady for those in the varenicline group but increased in the placebo group. The difference was statistically significant. There was no effect of varenicline on tobacco craving in this period.

There was also no effect of varenicline on physiologic reactivity as measured by diastolic/systolic blood pressure. In terms of smoking, over the treatment period, the number of cigarettes per day decreased by 1.5 cigarettes in the varenicline group, compared with 0.5 in the placebo group.

Adverse events were few and included nausea, sleep disturbance, abnormal dreams, constipation, and vomiting.

Notably, subjects in neither group were able to discern whether they were on placebo or active drug. In the varenicline group, 60% thought that they were on placebo, and in the placebo group, 44% thought they were taking the active drug.

Alcohol and tobacco dependence are highly comorbid disorders. Preclinical evidence suggests a role for nicotinic acetylcholine receptors in alcohol drinking. In fact, the drug has demonstrated efficacy in reducing alcohol intake in animals. However, to date the effects of the drug on alcohol consumption has not been tested in humans.

The results, in addition to findings from animal studies, support a role for nicotinic receptor involvement in alcohol consumption and suggest that targeting nicotinic receptors might be a viable strategy for drug development, said Dr. McKee, who had no conflicts of interest to report.

WASHINGTON – The antismoking drug varenicline also appears to curb alcohol cravings in smokers who are heavy drinkers, results of a small pilot study show.

Nondependent heavy drinkers taking varenicline (Chantix) were more likely to be abstinent during the 2-hour period of free access to alcoholic drinks than were those in the placebo group, based on logistic regression analysis, Sherry A. McKee, Ph.D., reported at a joint meeting sponsored by the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism.

Participants were male and female non-treatment seeking, nondependent heavy drinkers who also were daily smokers, said Dr. McKee of Yale University, New Haven, Conn.

Subjects were titrated to steady-state levels of varenicline (2 mg/day) or placebo over the course of a week. On day 8, all participants were given free access to cigarettes and were administered a priming drink, which was designed to raise blood alcohol levels to 0.03 g/dL.

Subjective and psychological responses to alcohol were then assessed. A 2-hour period of self-administration followed, during which time participants could choose to consume up to eight additional drinks (designed to raise blood alcohol levels by 0.015 g/dL) or to receive monetary reinforcement for drinks not consumed.

Participants had to have smoked at least 10 cigarettes/day for the last year. Men had to consume more than 14 drinks/week or 5 or more drinks on one occasion; women had to consume more than 7 drinks/week or 4 or more drinks on one occasion. Urine testing was used to assess varenicline compliance on days 4-8.

A total of 20 participants were enrolled–10 in each arm. The groups were matched in terms of age, gender, number of cigarettes per day, weekly frequency of drinking, and the number of drinks per episode.

During the period of unrestricted access to alcohol, varenicline “significantly reduced drinking by about two drinks,” Dr. McKee said.

Two subjects in the varenicline group consumed drinks, compared with seven in the placebo group. After the priming drink, no difference was found in blood alcohol levels between the two groups. However, a significant difference was found in alcohol craving. Those on varenicline reported a sharp decrease in alcohol craving; those on placebo reported an increase.

Over the same time period, the subjective effects of alcohol remained steady for those in the varenicline group but increased in the placebo group. The difference was statistically significant. There was no effect of varenicline on tobacco craving in this period.

There was also no effect of varenicline on physiologic reactivity as measured by diastolic/systolic blood pressure. In terms of smoking, over the treatment period, the number of cigarettes per day decreased by 1.5 cigarettes in the varenicline group, compared with 0.5 in the placebo group.

Adverse events were few and included nausea, sleep disturbance, abnormal dreams, constipation, and vomiting.

Notably, subjects in neither group were able to discern whether they were on placebo or active drug. In the varenicline group, 60% thought that they were on placebo, and in the placebo group, 44% thought they were taking the active drug.

Alcohol and tobacco dependence are highly comorbid disorders. Preclinical evidence suggests a role for nicotinic acetylcholine receptors in alcohol drinking. In fact, the drug has demonstrated efficacy in reducing alcohol intake in animals. However, to date the effects of the drug on alcohol consumption has not been tested in humans.

The results, in addition to findings from animal studies, support a role for nicotinic receptor involvement in alcohol consumption and suggest that targeting nicotinic receptors might be a viable strategy for drug development, said Dr. McKee, who had no conflicts of interest to report.

WASHINGTON — An outbreak of methicillin-resistant Staphylococcus aureus in a Spanish hospital may be the first reported appearance of a linezolid-resistant strain of the organism, according to data reported Oct. 27.

Between April and June of this year, 12 patients in an intensive care unit at the Hospital Clinico San Carlos in Madrid were identified as having methicillin-resistant Staphylococcus aureus (MRSA) that was also resistant to linezolid (Zyvox). Dr. Miguel Sanchez, an internist at the hospital, reported the outbreak during a press briefing at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) and the annual meeting of the Infectious Diseases Society of America (IDSA).

Linezolid-resistant MRSA was identified during surveillance and/or diagnostic culture from eight men and four women in the ICU—eight patients were critically ill, three were surgical cases, and one was a trauma patient.

LR-MRSA caused infection in 11 patients—5 with ventilator-associated pneumonia, 5 with primary bacteremia, and 1 with catheter-related sepsis.

Five patients died, but they had cleared the infection at the time of death. No deaths were attributed to LR-MRSA.

Patients had a mean ICU stay of about a month (34 days) before the index culture. At the index culture, all patients were intubated, had been on prolonged broad-spectrum antibiotic therapy, and had concomitant linezolid-susceptible MRSA. Eleven of the patients had received intravenous linezolid, one of the oxazolidinone class of antibiotics.

Hospital staff members were able to quickly control the outbreak by stepping up routine surveillance and isolating these patients. Patients identified with LR-MRSA were sampled once a week at three different sites.

Surveillance of the environment and staff also was performed. Only 1 of 91 environmental surface samples tested positive for LR-MRSA. This sample was taken from an intravenous catheter connection.

The hands of health care personnel also were sampled, and none was positive for LR-MRSA. Genotyping revealed that a single clone was responsible for 10 infections.

As a result of the outbreak, hospital personnel reviewed their antibiotic use. Subsequent use of linezolid was limited to either documented or suspected cases of respiratory tract MRSA infections.

As a result, use of linezolid at the hospital dropped from 202 defined daily doses in April to 25 in July.

The LR-MRSA was susceptible to vancomycin, daptomycin (Cubicin), and tigecycline (Tygacil), which were used to treat these patients. For comparison, the minimum inhibitory concentration was greater than 8 mg/L for linezolid but less than 0.32 mg/L for tigecycline and daptomycin.

“Linezolid is a relatively new drug,” noted Dr. Robert S. Daum, a pediatric infectious diseases specialist at the University of Chicago who spoke at the press conference but was not involved with the Spanish outbreak.

“In general, resistance has been very infrequent. We've seen some in Chicago … but it's actually quite rare in this country.”

He attributed this to antibiotic stewardship programs at many U.S. hospitals. “In our hospital, we have a very tight grip on linezolid use.” The drug can be prescribed only with the approval of an infectious disease specialist. Limiting use of the drug limits the chances for an organism to develop resistance to it.

Dr. Sanchez agreed, noting that “the take-home message for us is that we have to find ways to administer antibiotics prudently. … We also have to find ways to shorten antibiotic courses.”

Dr. Sanchez and his colleagues are planning a case-control study to investigate the means of LR-MRSA transmission.

Dr. Sanchez did not report whether he had any conflicts of interest.

WASHINGTON — An outbreak of methicillin-resistant Staphylococcus aureus in a Spanish hospital may be the first reported appearance of a linezolid-resistant strain of the organism, according to data reported Oct. 27.

Between April and June of this year, 12 patients in an intensive care unit at the Hospital Clinico San Carlos in Madrid were identified as having methicillin-resistant Staphylococcus aureus (MRSA) that was also resistant to linezolid (Zyvox). Dr. Miguel Sanchez, an internist at the hospital, reported the outbreak during a press briefing at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) and the annual meeting of the Infectious Diseases Society of America (IDSA).

Linezolid-resistant MRSA was identified during surveillance and/or diagnostic culture from eight men and four women in the ICU—eight patients were critically ill, three were surgical cases, and one was a trauma patient.

LR-MRSA caused infection in 11 patients—5 with ventilator-associated pneumonia, 5 with primary bacteremia, and 1 with catheter-related sepsis.

Five patients died, but they had cleared the infection at the time of death. No deaths were attributed to LR-MRSA.

Patients had a mean ICU stay of about a month (34 days) before the index culture. At the index culture, all patients were intubated, had been on prolonged broad-spectrum antibiotic therapy, and had concomitant linezolid-susceptible MRSA. Eleven of the patients had received intravenous linezolid, one of the oxazolidinone class of antibiotics.

Hospital staff members were able to quickly control the outbreak by stepping up routine surveillance and isolating these patients. Patients identified with LR-MRSA were sampled once a week at three different sites.

Surveillance of the environment and staff also was performed. Only 1 of 91 environmental surface samples tested positive for LR-MRSA. This sample was taken from an intravenous catheter connection.

The hands of health care personnel also were sampled, and none was positive for LR-MRSA. Genotyping revealed that a single clone was responsible for 10 infections.

As a result of the outbreak, hospital personnel reviewed their antibiotic use. Subsequent use of linezolid was limited to either documented or suspected cases of respiratory tract MRSA infections.

As a result, use of linezolid at the hospital dropped from 202 defined daily doses in April to 25 in July.

The LR-MRSA was susceptible to vancomycin, daptomycin (Cubicin), and tigecycline (Tygacil), which were used to treat these patients. For comparison, the minimum inhibitory concentration was greater than 8 mg/L for linezolid but less than 0.32 mg/L for tigecycline and daptomycin.

“Linezolid is a relatively new drug,” noted Dr. Robert S. Daum, a pediatric infectious diseases specialist at the University of Chicago who spoke at the press conference but was not involved with the Spanish outbreak.

“In general, resistance has been very infrequent. We've seen some in Chicago … but it's actually quite rare in this country.”

He attributed this to antibiotic stewardship programs at many U.S. hospitals. “In our hospital, we have a very tight grip on linezolid use.” The drug can be prescribed only with the approval of an infectious disease specialist. Limiting use of the drug limits the chances for an organism to develop resistance to it.

Dr. Sanchez agreed, noting that “the take-home message for us is that we have to find ways to administer antibiotics prudently. … We also have to find ways to shorten antibiotic courses.”

Dr. Sanchez and his colleagues are planning a case-control study to investigate the means of LR-MRSA transmission.

Dr. Sanchez did not report whether he had any conflicts of interest.

WASHINGTON — An outbreak of methicillin-resistant Staphylococcus aureus in a Spanish hospital may be the first reported appearance of a linezolid-resistant strain of the organism, according to data reported Oct. 27.

Between April and June of this year, 12 patients in an intensive care unit at the Hospital Clinico San Carlos in Madrid were identified as having methicillin-resistant Staphylococcus aureus (MRSA) that was also resistant to linezolid (Zyvox). Dr. Miguel Sanchez, an internist at the hospital, reported the outbreak during a press briefing at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) and the annual meeting of the Infectious Diseases Society of America (IDSA).

Linezolid-resistant MRSA was identified during surveillance and/or diagnostic culture from eight men and four women in the ICU—eight patients were critically ill, three were surgical cases, and one was a trauma patient.

LR-MRSA caused infection in 11 patients—5 with ventilator-associated pneumonia, 5 with primary bacteremia, and 1 with catheter-related sepsis.

Five patients died, but they had cleared the infection at the time of death. No deaths were attributed to LR-MRSA.

Patients had a mean ICU stay of about a month (34 days) before the index culture. At the index culture, all patients were intubated, had been on prolonged broad-spectrum antibiotic therapy, and had concomitant linezolid-susceptible MRSA. Eleven of the patients had received intravenous linezolid, one of the oxazolidinone class of antibiotics.

Hospital staff members were able to quickly control the outbreak by stepping up routine surveillance and isolating these patients. Patients identified with LR-MRSA were sampled once a week at three different sites.

Surveillance of the environment and staff also was performed. Only 1 of 91 environmental surface samples tested positive for LR-MRSA. This sample was taken from an intravenous catheter connection.

The hands of health care personnel also were sampled, and none was positive for LR-MRSA. Genotyping revealed that a single clone was responsible for 10 infections.

As a result of the outbreak, hospital personnel reviewed their antibiotic use. Subsequent use of linezolid was limited to either documented or suspected cases of respiratory tract MRSA infections.

As a result, use of linezolid at the hospital dropped from 202 defined daily doses in April to 25 in July.

The LR-MRSA was susceptible to vancomycin, daptomycin (Cubicin), and tigecycline (Tygacil), which were used to treat these patients. For comparison, the minimum inhibitory concentration was greater than 8 mg/L for linezolid but less than 0.32 mg/L for tigecycline and daptomycin.

“Linezolid is a relatively new drug,” noted Dr. Robert S. Daum, a pediatric infectious diseases specialist at the University of Chicago who spoke at the press conference but was not involved with the Spanish outbreak.

“In general, resistance has been very infrequent. We've seen some in Chicago … but it's actually quite rare in this country.”

He attributed this to antibiotic stewardship programs at many U.S. hospitals. “In our hospital, we have a very tight grip on linezolid use.” The drug can be prescribed only with the approval of an infectious disease specialist. Limiting use of the drug limits the chances for an organism to develop resistance to it.

Dr. Sanchez agreed, noting that “the take-home message for us is that we have to find ways to administer antibiotics prudently. … We also have to find ways to shorten antibiotic courses.”

Dr. Sanchez and his colleagues are planning a case-control study to investigate the means of LR-MRSA transmission.

Dr. Sanchez did not report whether he had any conflicts of interest.

CHICAGO — Single nucleotide polymorphisms in DNA repair genes may help predict not only metastatic capacity but also survival in patients with primary cutaneous melanoma, according to a 400-patient study presented as a poster at the annual meeting of the American Society of Clinical Oncology.

Dr. Dirk Schadendorf of the skin cancer unit of the German Cancer Research Center in Heidelberg, Germany, and his coauthors genotyped 13 single-nucleotide polymorphisms (SNPs) from eight different DNA repair genes in 400 cutaneous melanoma patients. Average patient follow-up was 3.7 years, with 46% of patients having metastasis during that period.

The researchers found that melanoma patients with the AA genotype for the R399Q XRCC1 polymorphism showed better overall survival (hazard ratio, 0.32; P = .03) and metastasis-free survival (HR, 0.40; P = .007) compared with patients who were heterozygous and homozygous (GG). However, survival following metastasis was comparable between the groups.

The study also found that patients with AG and GG genotypes for the −1842 XRCC3 polymorphism (1843bp 5′ of the start codon in the promoter region) showed decreased survival following metastasis, although these differences in mortality after metastasis were significant only for the AG genotype (HR, 1.99; P = .003 [for AG]; HR, 1.53; P = .5 [for GG]) as was mortality overall (HR, 1.68; P = .02 for AG), compared with patients who were homozygous (AA). Metastasis-free survival did not differ between the groups.

No association was found for the other nine SNPs.

"Genetic stability, at least during a specific phase of tumor development, appears to be necessary for a malignant melanoma cell to give rise to metastasis. Accordingly, impaired repair functionality could account for reduced metastatic capacity, better metastasis-free survival, and overall survival as observed in patients homozygous for the variant allele for the R399Q XRCC1 and the K751Q ERCC2 polymorphisms in our study," the researchers wrote.

"Our data support the concept that overall survival is a sum of factors influencing time from diagnosis of the primary [cancer] to first relapse and factors contributing independently after tumor progression to final outcome," they wrote.

The researchers reported that they had no conflicts of interest.

CHICAGO — Single nucleotide polymorphisms in DNA repair genes may help predict not only metastatic capacity but also survival in patients with primary cutaneous melanoma, according to a 400-patient study presented as a poster at the annual meeting of the American Society of Clinical Oncology.

Dr. Dirk Schadendorf of the skin cancer unit of the German Cancer Research Center in Heidelberg, Germany, and his coauthors genotyped 13 single-nucleotide polymorphisms (SNPs) from eight different DNA repair genes in 400 cutaneous melanoma patients. Average patient follow-up was 3.7 years, with 46% of patients having metastasis during that period.

The researchers found that melanoma patients with the AA genotype for the R399Q XRCC1 polymorphism showed better overall survival (hazard ratio, 0.32; P = .03) and metastasis-free survival (HR, 0.40; P = .007) compared with patients who were heterozygous and homozygous (GG). However, survival following metastasis was comparable between the groups.

The study also found that patients with AG and GG genotypes for the −1842 XRCC3 polymorphism (1843bp 5′ of the start codon in the promoter region) showed decreased survival following metastasis, although these differences in mortality after metastasis were significant only for the AG genotype (HR, 1.99; P = .003 [for AG]; HR, 1.53; P = .5 [for GG]) as was mortality overall (HR, 1.68; P = .02 for AG), compared with patients who were homozygous (AA). Metastasis-free survival did not differ between the groups.

No association was found for the other nine SNPs.

"Genetic stability, at least during a specific phase of tumor development, appears to be necessary for a malignant melanoma cell to give rise to metastasis. Accordingly, impaired repair functionality could account for reduced metastatic capacity, better metastasis-free survival, and overall survival as observed in patients homozygous for the variant allele for the R399Q XRCC1 and the K751Q ERCC2 polymorphisms in our study," the researchers wrote.

"Our data support the concept that overall survival is a sum of factors influencing time from diagnosis of the primary [cancer] to first relapse and factors contributing independently after tumor progression to final outcome," they wrote.

The researchers reported that they had no conflicts of interest.

CHICAGO — Single nucleotide polymorphisms in DNA repair genes may help predict not only metastatic capacity but also survival in patients with primary cutaneous melanoma, according to a 400-patient study presented as a poster at the annual meeting of the American Society of Clinical Oncology.

Dr. Dirk Schadendorf of the skin cancer unit of the German Cancer Research Center in Heidelberg, Germany, and his coauthors genotyped 13 single-nucleotide polymorphisms (SNPs) from eight different DNA repair genes in 400 cutaneous melanoma patients. Average patient follow-up was 3.7 years, with 46% of patients having metastasis during that period.

The researchers found that melanoma patients with the AA genotype for the R399Q XRCC1 polymorphism showed better overall survival (hazard ratio, 0.32; P = .03) and metastasis-free survival (HR, 0.40; P = .007) compared with patients who were heterozygous and homozygous (GG). However, survival following metastasis was comparable between the groups.

The study also found that patients with AG and GG genotypes for the −1842 XRCC3 polymorphism (1843bp 5′ of the start codon in the promoter region) showed decreased survival following metastasis, although these differences in mortality after metastasis were significant only for the AG genotype (HR, 1.99; P = .003 [for AG]; HR, 1.53; P = .5 [for GG]) as was mortality overall (HR, 1.68; P = .02 for AG), compared with patients who were homozygous (AA). Metastasis-free survival did not differ between the groups.

No association was found for the other nine SNPs.

"Genetic stability, at least during a specific phase of tumor development, appears to be necessary for a malignant melanoma cell to give rise to metastasis. Accordingly, impaired repair functionality could account for reduced metastatic capacity, better metastasis-free survival, and overall survival as observed in patients homozygous for the variant allele for the R399Q XRCC1 and the K751Q ERCC2 polymorphisms in our study," the researchers wrote.

"Our data support the concept that overall survival is a sum of factors influencing time from diagnosis of the primary [cancer] to first relapse and factors contributing independently after tumor progression to final outcome," they wrote.

The researchers reported that they had no conflicts of interest.

CHICAGO — KIT gene mutations that are susceptible to imatinib occur in some acral and mucosal melanomas, opening up new therapeutic options for patients with melanoma, according to a study presented as a poster at the annual meeting of the American Society of Clinical Oncology.

KIT mutations were found in 23% of acral melanomas and 16% of mucosal melanomas, reported Dr. Michael C. Heinrich, professor of medicine at the Oregon Health and Science University, Portland, and his colleagues. The mutation frequency was greater among tumors of the anorectum, vulva, and vagina (44%) than among the head and neck (8%).

In contrast, KIT mutations accounted for only 2% of cutaneous melanomas and for 8% of conjunctival melanomas. No mutations were found in an additional 60 choroidal melanomas.

"Based on our study, approximately 40%-50% of all types of melanoma have an oncogenic mutation that could be treated with drugs that are or will be in clinical studies within the next 18 months," Dr. Heinrich said in an interview.

For the study, DNA from archival melanomas was amplified by polymerase-chain reaction (PCR) and the products were screened for mutations in KIT exons 11, 13, 17 (n = 189), BRAF exon 15 (n = 116), and NRAS exons 1 and 2 (n = 117). Mutations were confirmed by direct sequencing.

In addition, immunohistochemistry for CD117 (KIT) was performed on a subset of cases. Lastly, the researchers assessed increases in KIT copy number in specific melanoma subtypes using quantitative real-time PCR.

Six of seven KIT mutations identified were of the type predicted to be sensitive to imatinib (Gleevec). KIT mutations did not overlap with NRAS mutations—which were also common in acral and mucosal tumors—or with BRAF mutations, which were absent in mucosal tumors.

"In the not too distant future, we envision that advanced melanoma tumors would be routinely tested for these types of mutations and the results used to make clinical decisions about the best medical treatment. This would be similar to the existing breast cancer model where ER [estrogen receptor] and HER2 [human epidermal growth factor receptor 2] testing are routine pathology tests that are used to individualize treatment programs," said Dr. Heinrich.

Imatinib is indicated for the treatment of Philadelphia chromosome-positive chronic myeloid leukemia, Philadelphia chromosome-positive acute lymphoblastic leukemia, myelodysplastic/myeloproliferative diseases, hypereosinophilic syndrome and/or chronic eosinophilic leukemia, dermatofibrosarcoma protuberans, and KIT-positive gastrointestinal stromal tumors.

Using a PCR-based assay, the researchers found that KIT was increased in acral and mucosal melanoma cases, though most of the tumors with increased KIT did not have a mutation. Extra KIT copies were not as common in cutaneous and conjunctival tumors. KIT (CD-117) expression was detected in 39% of 105 tumors; however, there was no correlation between CD-117 staining and tumor genotype. KIT mutations of the type known to be sensitive to imatinib do not necessarily correlate with either KIT copy number or CD-117 expression, the researchers noted.

The study was prompted by a recent rectal melanoma case in which a patient with a KIT mutation had a dramatic response to imatinib.

Dr. Heinrich reported that he has received research funding from Novartis and Pfizer Inc., is a consultant for Novartis, and has equity interest in MolecularMD. One of his coauthors has received research funding from Novartis and Pfizer and is a consultant for Novartis.

CHICAGO — KIT gene mutations that are susceptible to imatinib occur in some acral and mucosal melanomas, opening up new therapeutic options for patients with melanoma, according to a study presented as a poster at the annual meeting of the American Society of Clinical Oncology.

KIT mutations were found in 23% of acral melanomas and 16% of mucosal melanomas, reported Dr. Michael C. Heinrich, professor of medicine at the Oregon Health and Science University, Portland, and his colleagues. The mutation frequency was greater among tumors of the anorectum, vulva, and vagina (44%) than among the head and neck (8%).

In contrast, KIT mutations accounted for only 2% of cutaneous melanomas and for 8% of conjunctival melanomas. No mutations were found in an additional 60 choroidal melanomas.

"Based on our study, approximately 40%-50% of all types of melanoma have an oncogenic mutation that could be treated with drugs that are or will be in clinical studies within the next 18 months," Dr. Heinrich said in an interview.

For the study, DNA from archival melanomas was amplified by polymerase-chain reaction (PCR) and the products were screened for mutations in KIT exons 11, 13, 17 (n = 189), BRAF exon 15 (n = 116), and NRAS exons 1 and 2 (n = 117). Mutations were confirmed by direct sequencing.

In addition, immunohistochemistry for CD117 (KIT) was performed on a subset of cases. Lastly, the researchers assessed increases in KIT copy number in specific melanoma subtypes using quantitative real-time PCR.

Six of seven KIT mutations identified were of the type predicted to be sensitive to imatinib (Gleevec). KIT mutations did not overlap with NRAS mutations—which were also common in acral and mucosal tumors—or with BRAF mutations, which were absent in mucosal tumors.

"In the not too distant future, we envision that advanced melanoma tumors would be routinely tested for these types of mutations and the results used to make clinical decisions about the best medical treatment. This would be similar to the existing breast cancer model where ER [estrogen receptor] and HER2 [human epidermal growth factor receptor 2] testing are routine pathology tests that are used to individualize treatment programs," said Dr. Heinrich.

Imatinib is indicated for the treatment of Philadelphia chromosome-positive chronic myeloid leukemia, Philadelphia chromosome-positive acute lymphoblastic leukemia, myelodysplastic/myeloproliferative diseases, hypereosinophilic syndrome and/or chronic eosinophilic leukemia, dermatofibrosarcoma protuberans, and KIT-positive gastrointestinal stromal tumors.

Using a PCR-based assay, the researchers found that KIT was increased in acral and mucosal melanoma cases, though most of the tumors with increased KIT did not have a mutation. Extra KIT copies were not as common in cutaneous and conjunctival tumors. KIT (CD-117) expression was detected in 39% of 105 tumors; however, there was no correlation between CD-117 staining and tumor genotype. KIT mutations of the type known to be sensitive to imatinib do not necessarily correlate with either KIT copy number or CD-117 expression, the researchers noted.

The study was prompted by a recent rectal melanoma case in which a patient with a KIT mutation had a dramatic response to imatinib.

Dr. Heinrich reported that he has received research funding from Novartis and Pfizer Inc., is a consultant for Novartis, and has equity interest in MolecularMD. One of his coauthors has received research funding from Novartis and Pfizer and is a consultant for Novartis.

CHICAGO — KIT gene mutations that are susceptible to imatinib occur in some acral and mucosal melanomas, opening up new therapeutic options for patients with melanoma, according to a study presented as a poster at the annual meeting of the American Society of Clinical Oncology.

KIT mutations were found in 23% of acral melanomas and 16% of mucosal melanomas, reported Dr. Michael C. Heinrich, professor of medicine at the Oregon Health and Science University, Portland, and his colleagues. The mutation frequency was greater among tumors of the anorectum, vulva, and vagina (44%) than among the head and neck (8%).

In contrast, KIT mutations accounted for only 2% of cutaneous melanomas and for 8% of conjunctival melanomas. No mutations were found in an additional 60 choroidal melanomas.

"Based on our study, approximately 40%-50% of all types of melanoma have an oncogenic mutation that could be treated with drugs that are or will be in clinical studies within the next 18 months," Dr. Heinrich said in an interview.

For the study, DNA from archival melanomas was amplified by polymerase-chain reaction (PCR) and the products were screened for mutations in KIT exons 11, 13, 17 (n = 189), BRAF exon 15 (n = 116), and NRAS exons 1 and 2 (n = 117). Mutations were confirmed by direct sequencing.

In addition, immunohistochemistry for CD117 (KIT) was performed on a subset of cases. Lastly, the researchers assessed increases in KIT copy number in specific melanoma subtypes using quantitative real-time PCR.

Six of seven KIT mutations identified were of the type predicted to be sensitive to imatinib (Gleevec). KIT mutations did not overlap with NRAS mutations—which were also common in acral and mucosal tumors—or with BRAF mutations, which were absent in mucosal tumors.

"In the not too distant future, we envision that advanced melanoma tumors would be routinely tested for these types of mutations and the results used to make clinical decisions about the best medical treatment. This would be similar to the existing breast cancer model where ER [estrogen receptor] and HER2 [human epidermal growth factor receptor 2] testing are routine pathology tests that are used to individualize treatment programs," said Dr. Heinrich.

Imatinib is indicated for the treatment of Philadelphia chromosome-positive chronic myeloid leukemia, Philadelphia chromosome-positive acute lymphoblastic leukemia, myelodysplastic/myeloproliferative diseases, hypereosinophilic syndrome and/or chronic eosinophilic leukemia, dermatofibrosarcoma protuberans, and KIT-positive gastrointestinal stromal tumors.

Using a PCR-based assay, the researchers found that KIT was increased in acral and mucosal melanoma cases, though most of the tumors with increased KIT did not have a mutation. Extra KIT copies were not as common in cutaneous and conjunctival tumors. KIT (CD-117) expression was detected in 39% of 105 tumors; however, there was no correlation between CD-117 staining and tumor genotype. KIT mutations of the type known to be sensitive to imatinib do not necessarily correlate with either KIT copy number or CD-117 expression, the researchers noted.

The study was prompted by a recent rectal melanoma case in which a patient with a KIT mutation had a dramatic response to imatinib.

Dr. Heinrich reported that he has received research funding from Novartis and Pfizer Inc., is a consultant for Novartis, and has equity interest in MolecularMD. One of his coauthors has received research funding from Novartis and Pfizer and is a consultant for Novartis.

CHICAGO — Citalopram may be an effective option for reducing hot flashes, having performed twice as well as placebo in a randomized, placebo-controlled phase III trial conducted by the North Central Cancer Treatment Group.

“Hot flash relief can be obtained with as little as 10 mg/day citalopram,” Debra Barton, Ph.D., of the Mayo Clinic in Rochester, Minn., and her coauthors concluded in a poster reporting results of the trial (NCCTG N05C9) at the annual meeting of the American Society of Clinical Oncology.

A selective serotonin reuptake inhibitor (SSRI), citalopram (Celexa) is approved for depression, but is also used for some other disorders.

Postmenopausal women who had a history of breast cancer or wanted to avoid hormones due to breast cancer risk were enrolled in the study. They had to have at least 14 hot flashes per week for at least 1 month. Endocrine therapy was allowed, if the woman was on a stable dose for at least 1 month. No other antidepressants or hot flash therapies were permitted.

All 254 participants kept a record of their hot flashes for 1 week before starting treatment. The investigators randomized the women into four groups that received either 10 mg/day of citalopram on weeks 2–7, 10 mg/day of citalopram during week 2 followed by 20 mg/day of citalopram for weeks 3–7, 10 mg/day of citalopram during week 2 followed by 20 mg/day for week 3 and 30 mg/day for weeks 4–7, or placebo.

The placebo group comprised 83 women; each citalopram arm had 57 women. Most participants were 50 years or older (81%) and white (89%). A third of the women (34%) had a history of breast cancer. Nearly half the women (48%) had 4–9 hot flashes per day, another 38% had 10 or more per day, and 13% had less than 4 per day (13%). Mean baseline hot flash score and frequency were comparable between the groups.

The primary outcome was hot flash score as measured with a daily hot flash diary. Secondary outcomes included data from Hot Flash Daily Interference and Profile of Mood States measures, and from a symptom experience diary.

Women in the placebo group had a mean hot flash score reduction of 23%. Women in the 10-mg, 20-mg, and 30-mg citalopram groups had mean reductions of 49%, 50%, and 55%, respectively, with the differences relative to placebo being statistically significant for all three citalopram groups. The mean reduction in hot flash frequency was 20% for the placebo group. The mean reductions for the 10- mg, 20-mg, and 30-mg citalopram groups were 46%, 43%, and 50%, respectively. Again all three comparisons to placebo were statistically significant.

The researchers also looked at quality of life measures. On the Profile of Mood States measure, women in the citalopram arms had greater improvement from baseline than did those in the placebo group on the tension/anxiety subscale, though the difference was only significant for the 20-mg citalopram group. Likewise, women in the citalopram arms had greater improvements from baseline than did those in the placebo group on the anger/hostility subscale, though the difference was only significant for the 10-mg arm.

On the Hot Flash Daily Interference Scale, women in the citalopram arms generally had greater improvements from baseline than did those in the placebo group on measures of work, social, leisure, sleep, mood, concentration, relationships, sexuality, enjoyment of life, and overall quality of life.

Women on any dose of citalopram also had significantly greater improvements in abnormal sweating, hot flash distress, and hot flash control than did women in the placebo group.

There were no significant differences in self-reported adverse events between the groups.

The authors reported that they had no conflicts of interest.

Women in the 10-mg, 20-mg, and 30-mg citalopram groups had mean reductions of 49%, 50%, and 55%. DR. BARTON

CHICAGO — Citalopram may be an effective option for reducing hot flashes, having performed twice as well as placebo in a randomized, placebo-controlled phase III trial conducted by the North Central Cancer Treatment Group.

“Hot flash relief can be obtained with as little as 10 mg/day citalopram,” Debra Barton, Ph.D., of the Mayo Clinic in Rochester, Minn., and her coauthors concluded in a poster reporting results of the trial (NCCTG N05C9) at the annual meeting of the American Society of Clinical Oncology.

A selective serotonin reuptake inhibitor (SSRI), citalopram (Celexa) is approved for depression, but is also used for some other disorders.

Postmenopausal women who had a history of breast cancer or wanted to avoid hormones due to breast cancer risk were enrolled in the study. They had to have at least 14 hot flashes per week for at least 1 month. Endocrine therapy was allowed, if the woman was on a stable dose for at least 1 month. No other antidepressants or hot flash therapies were permitted.

All 254 participants kept a record of their hot flashes for 1 week before starting treatment. The investigators randomized the women into four groups that received either 10 mg/day of citalopram on weeks 2–7, 10 mg/day of citalopram during week 2 followed by 20 mg/day of citalopram for weeks 3–7, 10 mg/day of citalopram during week 2 followed by 20 mg/day for week 3 and 30 mg/day for weeks 4–7, or placebo.

The placebo group comprised 83 women; each citalopram arm had 57 women. Most participants were 50 years or older (81%) and white (89%). A third of the women (34%) had a history of breast cancer. Nearly half the women (48%) had 4–9 hot flashes per day, another 38% had 10 or more per day, and 13% had less than 4 per day (13%). Mean baseline hot flash score and frequency were comparable between the groups.

The primary outcome was hot flash score as measured with a daily hot flash diary. Secondary outcomes included data from Hot Flash Daily Interference and Profile of Mood States measures, and from a symptom experience diary.

Women in the placebo group had a mean hot flash score reduction of 23%. Women in the 10-mg, 20-mg, and 30-mg citalopram groups had mean reductions of 49%, 50%, and 55%, respectively, with the differences relative to placebo being statistically significant for all three citalopram groups. The mean reduction in hot flash frequency was 20% for the placebo group. The mean reductions for the 10- mg, 20-mg, and 30-mg citalopram groups were 46%, 43%, and 50%, respectively. Again all three comparisons to placebo were statistically significant.

The researchers also looked at quality of life measures. On the Profile of Mood States measure, women in the citalopram arms had greater improvement from baseline than did those in the placebo group on the tension/anxiety subscale, though the difference was only significant for the 20-mg citalopram group. Likewise, women in the citalopram arms had greater improvements from baseline than did those in the placebo group on the anger/hostility subscale, though the difference was only significant for the 10-mg arm.

On the Hot Flash Daily Interference Scale, women in the citalopram arms generally had greater improvements from baseline than did those in the placebo group on measures of work, social, leisure, sleep, mood, concentration, relationships, sexuality, enjoyment of life, and overall quality of life.

Women on any dose of citalopram also had significantly greater improvements in abnormal sweating, hot flash distress, and hot flash control than did women in the placebo group.

There were no significant differences in self-reported adverse events between the groups.

The authors reported that they had no conflicts of interest.

Women in the 10-mg, 20-mg, and 30-mg citalopram groups had mean reductions of 49%, 50%, and 55%. DR. BARTON

CHICAGO — Citalopram may be an effective option for reducing hot flashes, having performed twice as well as placebo in a randomized, placebo-controlled phase III trial conducted by the North Central Cancer Treatment Group.

“Hot flash relief can be obtained with as little as 10 mg/day citalopram,” Debra Barton, Ph.D., of the Mayo Clinic in Rochester, Minn., and her coauthors concluded in a poster reporting results of the trial (NCCTG N05C9) at the annual meeting of the American Society of Clinical Oncology.

A selective serotonin reuptake inhibitor (SSRI), citalopram (Celexa) is approved for depression, but is also used for some other disorders.

Postmenopausal women who had a history of breast cancer or wanted to avoid hormones due to breast cancer risk were enrolled in the study. They had to have at least 14 hot flashes per week for at least 1 month. Endocrine therapy was allowed, if the woman was on a stable dose for at least 1 month. No other antidepressants or hot flash therapies were permitted.

All 254 participants kept a record of their hot flashes for 1 week before starting treatment. The investigators randomized the women into four groups that received either 10 mg/day of citalopram on weeks 2–7, 10 mg/day of citalopram during week 2 followed by 20 mg/day of citalopram for weeks 3–7, 10 mg/day of citalopram during week 2 followed by 20 mg/day for week 3 and 30 mg/day for weeks 4–7, or placebo.

The placebo group comprised 83 women; each citalopram arm had 57 women. Most participants were 50 years or older (81%) and white (89%). A third of the women (34%) had a history of breast cancer. Nearly half the women (48%) had 4–9 hot flashes per day, another 38% had 10 or more per day, and 13% had less than 4 per day (13%). Mean baseline hot flash score and frequency were comparable between the groups.

The primary outcome was hot flash score as measured with a daily hot flash diary. Secondary outcomes included data from Hot Flash Daily Interference and Profile of Mood States measures, and from a symptom experience diary.

Women in the placebo group had a mean hot flash score reduction of 23%. Women in the 10-mg, 20-mg, and 30-mg citalopram groups had mean reductions of 49%, 50%, and 55%, respectively, with the differences relative to placebo being statistically significant for all three citalopram groups. The mean reduction in hot flash frequency was 20% for the placebo group. The mean reductions for the 10- mg, 20-mg, and 30-mg citalopram groups were 46%, 43%, and 50%, respectively. Again all three comparisons to placebo were statistically significant.

The researchers also looked at quality of life measures. On the Profile of Mood States measure, women in the citalopram arms had greater improvement from baseline than did those in the placebo group on the tension/anxiety subscale, though the difference was only significant for the 20-mg citalopram group. Likewise, women in the citalopram arms had greater improvements from baseline than did those in the placebo group on the anger/hostility subscale, though the difference was only significant for the 10-mg arm.

On the Hot Flash Daily Interference Scale, women in the citalopram arms generally had greater improvements from baseline than did those in the placebo group on measures of work, social, leisure, sleep, mood, concentration, relationships, sexuality, enjoyment of life, and overall quality of life.

Women on any dose of citalopram also had significantly greater improvements in abnormal sweating, hot flash distress, and hot flash control than did women in the placebo group.

There were no significant differences in self-reported adverse events between the groups.

The authors reported that they had no conflicts of interest.

Women in the 10-mg, 20-mg, and 30-mg citalopram groups had mean reductions of 49%, 50%, and 55%. DR. BARTON

SAVANNAH, GA. — Obesity appears to confer a fourfold increased risk for urinary incontinence and twofold increased risk for anal incontinence, according to a study presented as a poster at the annual meeting of the Society of Gynecologic Surgeons.

In a study of more than 400 women, those who were obese were four times more likely to suffer from urinary incontinence than were their normal-weight counterparts, after adjustment for demographics, medical history, menopausal status, parity, and number of C-sections. Obese women were also twice as likely to have anal incontinence than were normal-weight women, reported Dr. Chi Chiung Grace Chen of the department of gynecology and obstetrics at the Cleveland Clinic Foundation, and her colleagues.

The researchers questioned obese and morbidly obese women (body mass index greater than or equal to 30 kg/m

Urinary incontinence severity was classified as slight, moderate, or severe based on responses to the Sandvik incontinence severity index. Anal incontinence severity was measured using the Rockwood fecal incontinence severity index; greater scores indicated greater severity.

The prevalence of pelvic floor disorders, including SUI, UUI, and all types of AI, was higher in the obese and morbidly obese patients than in the normal-weight women. The prevalence of urinary incontinence was 71% in the obese group and 38% in the normal-weight group. Of the obese women, 60% and 53% had SUI and UUI, respectively. By comparison, 28% and 26% of the normal-weight women had SUI and UUI, respectively. POP was comparable in the two groups—4% of obese women and 5% of normal-weight women. The prevalence of anal incontinence was 25% for obese women, compared with 10% for normal-weight women.

“Obesity was associated with increased severity of urinary and anal incontinence,” the researchers wrote in their presentation at the meeting, which was jointly sponsored by the American College of Surgeons.

In terms of urinary incontinence severity, 44% of obese women and 74% of normal-weight women were classified as slight. More obese women had moderate (32%) or severe (23%) urinary incontinence than did normal-weight women (20% and 6%, respectively). Likewise, obese women had more severe anal incontinence, with a mean Rockwood score of 21, compared with 15 for normal-weight women. All of the findings were statistically significant.

Dr. Chen reported that she had no relevant financial relationships to disclose.

ELSEVIER GLOBAL MEDICAL NEWS

SAVANNAH, GA. — Obesity appears to confer a fourfold increased risk for urinary incontinence and twofold increased risk for anal incontinence, according to a study presented as a poster at the annual meeting of the Society of Gynecologic Surgeons.

In a study of more than 400 women, those who were obese were four times more likely to suffer from urinary incontinence than were their normal-weight counterparts, after adjustment for demographics, medical history, menopausal status, parity, and number of C-sections. Obese women were also twice as likely to have anal incontinence than were normal-weight women, reported Dr. Chi Chiung Grace Chen of the department of gynecology and obstetrics at the Cleveland Clinic Foundation, and her colleagues.

The researchers questioned obese and morbidly obese women (body mass index greater than or equal to 30 kg/m

Urinary incontinence severity was classified as slight, moderate, or severe based on responses to the Sandvik incontinence severity index. Anal incontinence severity was measured using the Rockwood fecal incontinence severity index; greater scores indicated greater severity.

The prevalence of pelvic floor disorders, including SUI, UUI, and all types of AI, was higher in the obese and morbidly obese patients than in the normal-weight women. The prevalence of urinary incontinence was 71% in the obese group and 38% in the normal-weight group. Of the obese women, 60% and 53% had SUI and UUI, respectively. By comparison, 28% and 26% of the normal-weight women had SUI and UUI, respectively. POP was comparable in the two groups—4% of obese women and 5% of normal-weight women. The prevalence of anal incontinence was 25% for obese women, compared with 10% for normal-weight women.

“Obesity was associated with increased severity of urinary and anal incontinence,” the researchers wrote in their presentation at the meeting, which was jointly sponsored by the American College of Surgeons.

In terms of urinary incontinence severity, 44% of obese women and 74% of normal-weight women were classified as slight. More obese women had moderate (32%) or severe (23%) urinary incontinence than did normal-weight women (20% and 6%, respectively). Likewise, obese women had more severe anal incontinence, with a mean Rockwood score of 21, compared with 15 for normal-weight women. All of the findings were statistically significant.

Dr. Chen reported that she had no relevant financial relationships to disclose.

ELSEVIER GLOBAL MEDICAL NEWS

SAVANNAH, GA. — Obesity appears to confer a fourfold increased risk for urinary incontinence and twofold increased risk for anal incontinence, according to a study presented as a poster at the annual meeting of the Society of Gynecologic Surgeons.

In a study of more than 400 women, those who were obese were four times more likely to suffer from urinary incontinence than were their normal-weight counterparts, after adjustment for demographics, medical history, menopausal status, parity, and number of C-sections. Obese women were also twice as likely to have anal incontinence than were normal-weight women, reported Dr. Chi Chiung Grace Chen of the department of gynecology and obstetrics at the Cleveland Clinic Foundation, and her colleagues.

The researchers questioned obese and morbidly obese women (body mass index greater than or equal to 30 kg/m

Urinary incontinence severity was classified as slight, moderate, or severe based on responses to the Sandvik incontinence severity index. Anal incontinence severity was measured using the Rockwood fecal incontinence severity index; greater scores indicated greater severity.

The prevalence of pelvic floor disorders, including SUI, UUI, and all types of AI, was higher in the obese and morbidly obese patients than in the normal-weight women. The prevalence of urinary incontinence was 71% in the obese group and 38% in the normal-weight group. Of the obese women, 60% and 53% had SUI and UUI, respectively. By comparison, 28% and 26% of the normal-weight women had SUI and UUI, respectively. POP was comparable in the two groups—4% of obese women and 5% of normal-weight women. The prevalence of anal incontinence was 25% for obese women, compared with 10% for normal-weight women.

“Obesity was associated with increased severity of urinary and anal incontinence,” the researchers wrote in their presentation at the meeting, which was jointly sponsored by the American College of Surgeons.

In terms of urinary incontinence severity, 44% of obese women and 74% of normal-weight women were classified as slight. More obese women had moderate (32%) or severe (23%) urinary incontinence than did normal-weight women (20% and 6%, respectively). Likewise, obese women had more severe anal incontinence, with a mean Rockwood score of 21, compared with 15 for normal-weight women. All of the findings were statistically significant.

Dr. Chen reported that she had no relevant financial relationships to disclose.

ELSEVIER GLOBAL MEDICAL NEWS