Kerri Wachter

WASHINGTON — Teriparatide appeared to increase lumbar spine bone mineral density and showed some promise in reducing nonvertebral fractures in patients on glucocorticoid therapy with low bone mineral density or a prior fragility fracture, according to data presented at an international symposium sponsored by the National Osteoporosis Foundation.

“In patients with glucocorticoid-induced osteoporosis treated with teriparatide or alendronate for 18 months, teriparatide resulted in significantly greater increases in lumbar spine bone mineral density (BMD) compared with alendronate. Significantly fewer patients had new vertebral fractures with teriparatide, compared with the alendronate group,” said Margaret R. Warner, Ph.D., a researcher with Eli Lilly & Co., which funded this trial.

At 18 months, lumbar spine BMD increased 7.2% for patients treated with teriparatide and 3.4% for those treated with alendronate. Differences could be seen between the two treatment groups as early as 6 months.

Teriparatide (Forteo), made by Eli Lilly, contains recombinant human parathyroid hormone (1–34) and is currently indicated for the treatment of postmenopausal women with osteoporosis who are at high risk for fracture. The drug also is indicated to increase bone mass in men with primary or hypogonadal osteoporosis who are at high risk for fracture. Teriparatide is the only osteoporosis drug shown to stimulate new bone growth.

Glucocorticoid therapy is the most common cause of secondary osteoporosis. Currently, only the bisphosphonates risedronate (Actonel, made by Procter & Gamble Pharmaceuticals) and alendronate (Fosamax, made by Merck & Co.) are indicated for the prevention and treatment of glucocorticoid-induced osteoporosis in men and women receiving glucocorticoids in a daily dosage equivalent to 7.5 mg or greater of prednisone and who have low BMD.

The trial included men and women at least 21 years of age who had taken a minimum dose of 5 mg/day of prednisone (or its equivalent) for 3 months or longer prior to screening. All patients had total hip, femoral neck, or lumbar spine T scores of at most −2.0 or at most −1.0 with a prior fragility fracture. A total of 428 patients (80% women) were randomized to receive 20 mcg/day teriparatide injection and an oral placebo tablet or 10 mg/day oral alendronate and an injectable placebo. All patients in the trial received calcium and vitamin D supplements. Patients were followed for 18 months.

The primary end point was the effect of teriparatide on lumbar spine BMD in patients with glucocorticoid-induced osteoporosis compared with alendronate. The researchers also looked at the effect of teriparatide versus alendronate on total hip and femoral neck BMD, on markers of bone turnover, and on the incidence of vertebral and nonvertebral fractures.

BMD was assessed using dual-energy x-ray absorptiometry. Vertebral fractures were assessed using semiquantitative visual scoring of radiographs taken at baseline and at 18 months. Nonvertebral fractures were assessed with radiograph or radiologist report. Both vertebral and nonvertebral fractures were assessed at a central reader site.

In addition, markers of bone turnover were analyzed in roughly half of the patients in each group. Adverse event data were collected throughout.

At baseline, both groups were fairly evenly matched in terms of gender, race, age, average prednisone dose, and average duration of prednisone use. Both groups were evenly matched in average BMD at the total hip, femoral neck, and lumbar spine, and vertebral and nonvertebral fractures. Three-quarters of patients in both groups had rheumatologic disease. Rheumatoid arthritis was the most common, accounting for 69% of those in the alendronate group and 61% of those in the teriparatide group.

Total hip BMD rose 3.6% for the teriparatide group, versus 2.2% for the alendronate group. Femoral neck BMD rose 3.7% for the teriparatide group, versus 2.1% for the alendronate group.

In terms of biomarkers of bone turnover, the researchers measured serum procollagen type 1 N-propeptide (P1NP)–a marker of bone formation—and serum C-terminal telopeptide of type 1 collagen (CTX)–a marker of bone resorption. “In the teriparatide group, there were increases in serum P1NP and CTX, whereas with the antiresorptive agent there were decreases in serum P1NP and CTX,” said Dr. Warner.

Adverse event profiles were similar between groups. In the teriparatide group there were 182 adverse events, with 45 considered serious. There were 170 adverse events in the alendronate group, and 39 were considered serious.

WASHINGTON — Teriparatide appeared to increase lumbar spine bone mineral density and showed some promise in reducing nonvertebral fractures in patients on glucocorticoid therapy with low bone mineral density or a prior fragility fracture, according to data presented at an international symposium sponsored by the National Osteoporosis Foundation.

“In patients with glucocorticoid-induced osteoporosis treated with teriparatide or alendronate for 18 months, teriparatide resulted in significantly greater increases in lumbar spine bone mineral density (BMD) compared with alendronate. Significantly fewer patients had new vertebral fractures with teriparatide, compared with the alendronate group,” said Margaret R. Warner, Ph.D., a researcher with Eli Lilly & Co., which funded this trial.

At 18 months, lumbar spine BMD increased 7.2% for patients treated with teriparatide and 3.4% for those treated with alendronate. Differences could be seen between the two treatment groups as early as 6 months.

Teriparatide (Forteo), made by Eli Lilly, contains recombinant human parathyroid hormone (1–34) and is currently indicated for the treatment of postmenopausal women with osteoporosis who are at high risk for fracture. The drug also is indicated to increase bone mass in men with primary or hypogonadal osteoporosis who are at high risk for fracture. Teriparatide is the only osteoporosis drug shown to stimulate new bone growth.

Glucocorticoid therapy is the most common cause of secondary osteoporosis. Currently, only the bisphosphonates risedronate (Actonel, made by Procter & Gamble Pharmaceuticals) and alendronate (Fosamax, made by Merck & Co.) are indicated for the prevention and treatment of glucocorticoid-induced osteoporosis in men and women receiving glucocorticoids in a daily dosage equivalent to 7.5 mg or greater of prednisone and who have low BMD.

The trial included men and women at least 21 years of age who had taken a minimum dose of 5 mg/day of prednisone (or its equivalent) for 3 months or longer prior to screening. All patients had total hip, femoral neck, or lumbar spine T scores of at most −2.0 or at most −1.0 with a prior fragility fracture. A total of 428 patients (80% women) were randomized to receive 20 mcg/day teriparatide injection and an oral placebo tablet or 10 mg/day oral alendronate and an injectable placebo. All patients in the trial received calcium and vitamin D supplements. Patients were followed for 18 months.

The primary end point was the effect of teriparatide on lumbar spine BMD in patients with glucocorticoid-induced osteoporosis compared with alendronate. The researchers also looked at the effect of teriparatide versus alendronate on total hip and femoral neck BMD, on markers of bone turnover, and on the incidence of vertebral and nonvertebral fractures.

BMD was assessed using dual-energy x-ray absorptiometry. Vertebral fractures were assessed using semiquantitative visual scoring of radiographs taken at baseline and at 18 months. Nonvertebral fractures were assessed with radiograph or radiologist report. Both vertebral and nonvertebral fractures were assessed at a central reader site.

In addition, markers of bone turnover were analyzed in roughly half of the patients in each group. Adverse event data were collected throughout.

At baseline, both groups were fairly evenly matched in terms of gender, race, age, average prednisone dose, and average duration of prednisone use. Both groups were evenly matched in average BMD at the total hip, femoral neck, and lumbar spine, and vertebral and nonvertebral fractures. Three-quarters of patients in both groups had rheumatologic disease. Rheumatoid arthritis was the most common, accounting for 69% of those in the alendronate group and 61% of those in the teriparatide group.

Total hip BMD rose 3.6% for the teriparatide group, versus 2.2% for the alendronate group. Femoral neck BMD rose 3.7% for the teriparatide group, versus 2.1% for the alendronate group.

In terms of biomarkers of bone turnover, the researchers measured serum procollagen type 1 N-propeptide (P1NP)–a marker of bone formation—and serum C-terminal telopeptide of type 1 collagen (CTX)–a marker of bone resorption. “In the teriparatide group, there were increases in serum P1NP and CTX, whereas with the antiresorptive agent there were decreases in serum P1NP and CTX,” said Dr. Warner.

Adverse event profiles were similar between groups. In the teriparatide group there were 182 adverse events, with 45 considered serious. There were 170 adverse events in the alendronate group, and 39 were considered serious.

WASHINGTON — Teriparatide appeared to increase lumbar spine bone mineral density and showed some promise in reducing nonvertebral fractures in patients on glucocorticoid therapy with low bone mineral density or a prior fragility fracture, according to data presented at an international symposium sponsored by the National Osteoporosis Foundation.

“In patients with glucocorticoid-induced osteoporosis treated with teriparatide or alendronate for 18 months, teriparatide resulted in significantly greater increases in lumbar spine bone mineral density (BMD) compared with alendronate. Significantly fewer patients had new vertebral fractures with teriparatide, compared with the alendronate group,” said Margaret R. Warner, Ph.D., a researcher with Eli Lilly & Co., which funded this trial.

At 18 months, lumbar spine BMD increased 7.2% for patients treated with teriparatide and 3.4% for those treated with alendronate. Differences could be seen between the two treatment groups as early as 6 months.

Teriparatide (Forteo), made by Eli Lilly, contains recombinant human parathyroid hormone (1–34) and is currently indicated for the treatment of postmenopausal women with osteoporosis who are at high risk for fracture. The drug also is indicated to increase bone mass in men with primary or hypogonadal osteoporosis who are at high risk for fracture. Teriparatide is the only osteoporosis drug shown to stimulate new bone growth.

Glucocorticoid therapy is the most common cause of secondary osteoporosis. Currently, only the bisphosphonates risedronate (Actonel, made by Procter & Gamble Pharmaceuticals) and alendronate (Fosamax, made by Merck & Co.) are indicated for the prevention and treatment of glucocorticoid-induced osteoporosis in men and women receiving glucocorticoids in a daily dosage equivalent to 7.5 mg or greater of prednisone and who have low BMD.

The trial included men and women at least 21 years of age who had taken a minimum dose of 5 mg/day of prednisone (or its equivalent) for 3 months or longer prior to screening. All patients had total hip, femoral neck, or lumbar spine T scores of at most −2.0 or at most −1.0 with a prior fragility fracture. A total of 428 patients (80% women) were randomized to receive 20 mcg/day teriparatide injection and an oral placebo tablet or 10 mg/day oral alendronate and an injectable placebo. All patients in the trial received calcium and vitamin D supplements. Patients were followed for 18 months.

The primary end point was the effect of teriparatide on lumbar spine BMD in patients with glucocorticoid-induced osteoporosis compared with alendronate. The researchers also looked at the effect of teriparatide versus alendronate on total hip and femoral neck BMD, on markers of bone turnover, and on the incidence of vertebral and nonvertebral fractures.

BMD was assessed using dual-energy x-ray absorptiometry. Vertebral fractures were assessed using semiquantitative visual scoring of radiographs taken at baseline and at 18 months. Nonvertebral fractures were assessed with radiograph or radiologist report. Both vertebral and nonvertebral fractures were assessed at a central reader site.

In addition, markers of bone turnover were analyzed in roughly half of the patients in each group. Adverse event data were collected throughout.

At baseline, both groups were fairly evenly matched in terms of gender, race, age, average prednisone dose, and average duration of prednisone use. Both groups were evenly matched in average BMD at the total hip, femoral neck, and lumbar spine, and vertebral and nonvertebral fractures. Three-quarters of patients in both groups had rheumatologic disease. Rheumatoid arthritis was the most common, accounting for 69% of those in the alendronate group and 61% of those in the teriparatide group.

Total hip BMD rose 3.6% for the teriparatide group, versus 2.2% for the alendronate group. Femoral neck BMD rose 3.7% for the teriparatide group, versus 2.1% for the alendronate group.

In terms of biomarkers of bone turnover, the researchers measured serum procollagen type 1 N-propeptide (P1NP)–a marker of bone formation—and serum C-terminal telopeptide of type 1 collagen (CTX)–a marker of bone resorption. “In the teriparatide group, there were increases in serum P1NP and CTX, whereas with the antiresorptive agent there were decreases in serum P1NP and CTX,” said Dr. Warner.

Adverse event profiles were similar between groups. In the teriparatide group there were 182 adverse events, with 45 considered serious. There were 170 adverse events in the alendronate group, and 39 were considered serious.

BALTIMORE – Supportive care for patients with dementia and their caregivers is an important component of overall dementia care, Dr. Constantine G. Lyketsos said at a meeting on Alzheimer's disease and related disorders sponsored by Johns Hopkins University.

Supportive care for the patient should provide comfort and emotional support, safety, structure, activity and stimulation, planning/assistance with decision making, management of medical comorbidities, and good nursing care for advanced stages, said Dr. Lyketsos, chair of psychiatry at Johns Hopkins Bayview Medical Center in Baltimore.

In terms of safety, “many patients with dementia, in fact most of them, should stop driving,” said Dr. Lyketsos. “Most of them can't live alone entirely. That doesn't mean that there needs to be someone in the house 24 hours a day, but there needs to be some support.”

Providing structure means ensuring a safe, predictable place to live with support for activities of daily living. “Because of diminishing cognition, making sure that structure is available is critical. … The more dementia advances, the more important it is to have daily structure in place that's predictable,” he said.

Participation in activities can make a big difference. “One of the things we found in the Maryland Assisted Living Study was that the more participation there was in activities, the longer patients were able to stay in their assisted living facility,” Dr. Lyketsos said.

Support for caregivers includes emotional support and comfort, education, instruction in the skills of caregiving, problem-solving and crisis-intervention help, respite, and attention to personal needs and wants.

“The piece that we don't have a good way to deliver yet is respite. Caregivers need breaks. They can get easily overwhelmed,” he said. Caregivers tend to overlook their own health, so they need to pay attention to their personal needs and wants as well. They also need to maintain touch with social contacts, which is an important part of the support network.

BALTIMORE – Supportive care for patients with dementia and their caregivers is an important component of overall dementia care, Dr. Constantine G. Lyketsos said at a meeting on Alzheimer's disease and related disorders sponsored by Johns Hopkins University.

Supportive care for the patient should provide comfort and emotional support, safety, structure, activity and stimulation, planning/assistance with decision making, management of medical comorbidities, and good nursing care for advanced stages, said Dr. Lyketsos, chair of psychiatry at Johns Hopkins Bayview Medical Center in Baltimore.

In terms of safety, “many patients with dementia, in fact most of them, should stop driving,” said Dr. Lyketsos. “Most of them can't live alone entirely. That doesn't mean that there needs to be someone in the house 24 hours a day, but there needs to be some support.”

Providing structure means ensuring a safe, predictable place to live with support for activities of daily living. “Because of diminishing cognition, making sure that structure is available is critical. … The more dementia advances, the more important it is to have daily structure in place that's predictable,” he said.

Participation in activities can make a big difference. “One of the things we found in the Maryland Assisted Living Study was that the more participation there was in activities, the longer patients were able to stay in their assisted living facility,” Dr. Lyketsos said.

Support for caregivers includes emotional support and comfort, education, instruction in the skills of caregiving, problem-solving and crisis-intervention help, respite, and attention to personal needs and wants.

“The piece that we don't have a good way to deliver yet is respite. Caregivers need breaks. They can get easily overwhelmed,” he said. Caregivers tend to overlook their own health, so they need to pay attention to their personal needs and wants as well. They also need to maintain touch with social contacts, which is an important part of the support network.

BALTIMORE – Supportive care for patients with dementia and their caregivers is an important component of overall dementia care, Dr. Constantine G. Lyketsos said at a meeting on Alzheimer's disease and related disorders sponsored by Johns Hopkins University.

Supportive care for the patient should provide comfort and emotional support, safety, structure, activity and stimulation, planning/assistance with decision making, management of medical comorbidities, and good nursing care for advanced stages, said Dr. Lyketsos, chair of psychiatry at Johns Hopkins Bayview Medical Center in Baltimore.

In terms of safety, “many patients with dementia, in fact most of them, should stop driving,” said Dr. Lyketsos. “Most of them can't live alone entirely. That doesn't mean that there needs to be someone in the house 24 hours a day, but there needs to be some support.”

Providing structure means ensuring a safe, predictable place to live with support for activities of daily living. “Because of diminishing cognition, making sure that structure is available is critical. … The more dementia advances, the more important it is to have daily structure in place that's predictable,” he said.

Participation in activities can make a big difference. “One of the things we found in the Maryland Assisted Living Study was that the more participation there was in activities, the longer patients were able to stay in their assisted living facility,” Dr. Lyketsos said.

Support for caregivers includes emotional support and comfort, education, instruction in the skills of caregiving, problem-solving and crisis-intervention help, respite, and attention to personal needs and wants.

“The piece that we don't have a good way to deliver yet is respite. Caregivers need breaks. They can get easily overwhelmed,” he said. Caregivers tend to overlook their own health, so they need to pay attention to their personal needs and wants as well. They also need to maintain touch with social contacts, which is an important part of the support network.

SNOWMASS, COLO. — Patients considering joint replacement are coming in to the office with some pretty specific questions these days. They want to know more about gender-specific knees, minimally invasive knee replacement, computer-assisted surgery, new indestructible materials, high-flexion designs, and rotating platforms, said Dr. Thomas S. Thornhill, chairman of the department of orthopedic surgery at Brigham and Women's Hospital in Boston.

Dr. Thornhill offered his advice on these issues at a symposium sponsored by the American College of Rheumatology.

Gender-Specific Knees

Approved in 2006, the Gender Solutions implant (made by Zimmer Inc.) was the first knee prosthesis to target the female knee. The company promotes the implant in part by stating that the implant better fits the size and shape of a woman's knee.

“There are really no significant clinical differences between male and female problems with the knee,” said Dr. Thornhill. However, some studies suggest that survivorship in total knee replacement may be better in women.

Men typically have knees that are broader in the medial-lateral dimension than in the anterior-posterior dimension. Women tend to have knees that are narrower in the medial-lateral dimension and a little longer in the anterior-posterior dimension.

While there clearly are differences between the aspect ratios—the ratio of medial-lateral length to anterior-posterior length—of men and women, some research suggests that the differences among women and among men are greater than those between the sexes.

Minimally Invasive Knee Replacement

Patients will come in asking for minimally invasive knee replacements but it's not clear what this means. “Is it a shorter incision? Is it the fact that you don't violate the quadriceps mechanism? Is it that you don't evert the patella when you thrust the knee?” asked Dr. Thornhill.

What patients think of as minimally invasive surgery actually is combined with many other variables: patient education and selection, preemptive analgesia, better post-operative pain control, and more rapid mobilization.

“There are no data demonstrating any long-term benefit to minimally invasive surgery. There are data showing a little bit better length of stay, a little less blood loss, a little bit shorter time getting to rehabilitation goals,” said Dr. Thornhill.

Computer-Assisted Surgery

Computer-assisted surgery—available in some centers—does have the advantage of eliminating some of the outliers of alignment. “This may be a benefit to people, who may not be high-volume surgeons,” said Dr. Thornhill.

Computer-assisted surgery has much potential as a teaching tool, partly because it can give feedback to surgeons. “The trouble is it costs a lot of money and it increases the surgical time,” said Dr. Thornhill. In addition, at the present time, computer-assisted surgery increases the dissection.

New Materials, High-Flexion Designs

Patients are interested in new, longer-lasting materials, such as ceramic-on-ceramic joints. What patients don't generally know is that there is a 6% incidence of squeaking in patients with ceramic-on-ceramic replacement hip joints, said Dr. Thornhill. Other options, such as cartilage repair/regeneration techniques, primarily are performed on an experimental basis for osteochondral defects.

In terms of postoperative flexion, the most important factor actually is preoperative flexion, said Dr. Thornhill. High-flexion designs “add little functional value.” These designs do increase the cost though.

Rotating Platforms

Rotating platforms allow rotation around a central axis, supposedly improving kinematics. However, the human knee does not rotate, Dr. Thornhill noted. These implants have unidirectional wear, which is a theoretical advantage, but studies have not shown that the range of motion is any better with rotating platforms.

Dr. Thornhill disclosed that he receives royalties from DePuy Inc. He also has received research grants from DePuy Inc., Biomet Inc., and Smith & Nephew.

SNOWMASS, COLO. — Patients considering joint replacement are coming in to the office with some pretty specific questions these days. They want to know more about gender-specific knees, minimally invasive knee replacement, computer-assisted surgery, new indestructible materials, high-flexion designs, and rotating platforms, said Dr. Thomas S. Thornhill, chairman of the department of orthopedic surgery at Brigham and Women's Hospital in Boston.

Dr. Thornhill offered his advice on these issues at a symposium sponsored by the American College of Rheumatology.

Gender-Specific Knees

Approved in 2006, the Gender Solutions implant (made by Zimmer Inc.) was the first knee prosthesis to target the female knee. The company promotes the implant in part by stating that the implant better fits the size and shape of a woman's knee.

“There are really no significant clinical differences between male and female problems with the knee,” said Dr. Thornhill. However, some studies suggest that survivorship in total knee replacement may be better in women.

Men typically have knees that are broader in the medial-lateral dimension than in the anterior-posterior dimension. Women tend to have knees that are narrower in the medial-lateral dimension and a little longer in the anterior-posterior dimension.

While there clearly are differences between the aspect ratios—the ratio of medial-lateral length to anterior-posterior length—of men and women, some research suggests that the differences among women and among men are greater than those between the sexes.

Minimally Invasive Knee Replacement

Patients will come in asking for minimally invasive knee replacements but it's not clear what this means. “Is it a shorter incision? Is it the fact that you don't violate the quadriceps mechanism? Is it that you don't evert the patella when you thrust the knee?” asked Dr. Thornhill.

What patients think of as minimally invasive surgery actually is combined with many other variables: patient education and selection, preemptive analgesia, better post-operative pain control, and more rapid mobilization.

“There are no data demonstrating any long-term benefit to minimally invasive surgery. There are data showing a little bit better length of stay, a little less blood loss, a little bit shorter time getting to rehabilitation goals,” said Dr. Thornhill.

Computer-Assisted Surgery

Computer-assisted surgery—available in some centers—does have the advantage of eliminating some of the outliers of alignment. “This may be a benefit to people, who may not be high-volume surgeons,” said Dr. Thornhill.

Computer-assisted surgery has much potential as a teaching tool, partly because it can give feedback to surgeons. “The trouble is it costs a lot of money and it increases the surgical time,” said Dr. Thornhill. In addition, at the present time, computer-assisted surgery increases the dissection.

New Materials, High-Flexion Designs

Patients are interested in new, longer-lasting materials, such as ceramic-on-ceramic joints. What patients don't generally know is that there is a 6% incidence of squeaking in patients with ceramic-on-ceramic replacement hip joints, said Dr. Thornhill. Other options, such as cartilage repair/regeneration techniques, primarily are performed on an experimental basis for osteochondral defects.

In terms of postoperative flexion, the most important factor actually is preoperative flexion, said Dr. Thornhill. High-flexion designs “add little functional value.” These designs do increase the cost though.

Rotating Platforms

Rotating platforms allow rotation around a central axis, supposedly improving kinematics. However, the human knee does not rotate, Dr. Thornhill noted. These implants have unidirectional wear, which is a theoretical advantage, but studies have not shown that the range of motion is any better with rotating platforms.

Dr. Thornhill disclosed that he receives royalties from DePuy Inc. He also has received research grants from DePuy Inc., Biomet Inc., and Smith & Nephew.

SNOWMASS, COLO. — Patients considering joint replacement are coming in to the office with some pretty specific questions these days. They want to know more about gender-specific knees, minimally invasive knee replacement, computer-assisted surgery, new indestructible materials, high-flexion designs, and rotating platforms, said Dr. Thomas S. Thornhill, chairman of the department of orthopedic surgery at Brigham and Women's Hospital in Boston.

Dr. Thornhill offered his advice on these issues at a symposium sponsored by the American College of Rheumatology.

Gender-Specific Knees

Approved in 2006, the Gender Solutions implant (made by Zimmer Inc.) was the first knee prosthesis to target the female knee. The company promotes the implant in part by stating that the implant better fits the size and shape of a woman's knee.

“There are really no significant clinical differences between male and female problems with the knee,” said Dr. Thornhill. However, some studies suggest that survivorship in total knee replacement may be better in women.

Men typically have knees that are broader in the medial-lateral dimension than in the anterior-posterior dimension. Women tend to have knees that are narrower in the medial-lateral dimension and a little longer in the anterior-posterior dimension.

While there clearly are differences between the aspect ratios—the ratio of medial-lateral length to anterior-posterior length—of men and women, some research suggests that the differences among women and among men are greater than those between the sexes.

Minimally Invasive Knee Replacement

Patients will come in asking for minimally invasive knee replacements but it's not clear what this means. “Is it a shorter incision? Is it the fact that you don't violate the quadriceps mechanism? Is it that you don't evert the patella when you thrust the knee?” asked Dr. Thornhill.

What patients think of as minimally invasive surgery actually is combined with many other variables: patient education and selection, preemptive analgesia, better post-operative pain control, and more rapid mobilization.

“There are no data demonstrating any long-term benefit to minimally invasive surgery. There are data showing a little bit better length of stay, a little less blood loss, a little bit shorter time getting to rehabilitation goals,” said Dr. Thornhill.

Computer-Assisted Surgery

Computer-assisted surgery—available in some centers—does have the advantage of eliminating some of the outliers of alignment. “This may be a benefit to people, who may not be high-volume surgeons,” said Dr. Thornhill.

Computer-assisted surgery has much potential as a teaching tool, partly because it can give feedback to surgeons. “The trouble is it costs a lot of money and it increases the surgical time,” said Dr. Thornhill. In addition, at the present time, computer-assisted surgery increases the dissection.

New Materials, High-Flexion Designs

Patients are interested in new, longer-lasting materials, such as ceramic-on-ceramic joints. What patients don't generally know is that there is a 6% incidence of squeaking in patients with ceramic-on-ceramic replacement hip joints, said Dr. Thornhill. Other options, such as cartilage repair/regeneration techniques, primarily are performed on an experimental basis for osteochondral defects.

In terms of postoperative flexion, the most important factor actually is preoperative flexion, said Dr. Thornhill. High-flexion designs “add little functional value.” These designs do increase the cost though.

Rotating Platforms

Rotating platforms allow rotation around a central axis, supposedly improving kinematics. However, the human knee does not rotate, Dr. Thornhill noted. These implants have unidirectional wear, which is a theoretical advantage, but studies have not shown that the range of motion is any better with rotating platforms.

Dr. Thornhill disclosed that he receives royalties from DePuy Inc. He also has received research grants from DePuy Inc., Biomet Inc., and Smith & Nephew.

SNOWMASS, COLO. — Patients considering joint replacement are coming in to the office with some pretty specific questions these days. They want to know more about gender-specific knees, minimally invasive knee replacement, computer-assisted surgery, new indestructible materials, high-flexion designs, and rotating platforms, said Dr. Thomas S. Thornhill, chairman of the department of orthopedic surgery at Brigham and Women's Hospital in Boston.

Dr. Thornhill offered his thoughts on these issues at a symposium sponsored by the American College of Rheumatology.

Gender-Specific Knees

Approved in 2006, the Gender Solutions implant (made by Zimmer Inc.) was the first knee prosthesis to target the female knee. The company promotes the implant in part by stating that the implant better fits the size and shape of a woman's knee.

“There are really no significant clinical differences between male and female problems with the knee,” said Dr. Thornhill. In fact, some studies suggest that survivorship in total knee replacement may even be better in women.

Men typically have knees that are broader in the medial-lateral dimension than in the anterior-posterior dimension. Women tend to have knees that are narrower in the medial-lateral dimension and a little longer in the anterior-posterior dimension.

While there clearly are differences between the aspect ratios of men and women, some research suggests that the differences among women and among men are greater than those between the sexes are.

Minimally Invasive Knee Replacement

Patients will come in asking for minimally invasive knee replacements but it's not clear what this means. What patients think of as minimally invasive surgery actually is combined with many other variables: patient education and selection, preemptive analgesia, better postoperative pain control, and more rapid mobilization.

Computer-Assisted Surgery

Computer-assisted surgery does have the advantage of eliminating some of the outliers of alignment.

Computer-assisted surgery has much potential as a teaching tool, partly because it can provide feedback to surgeons. “The trouble is it costs a lot of money and it increases the surgical time,” said Dr. Thornhill.

New Materials, High-Flexion Designs

Patients are interested in new, longer-lasting materials, such as ceramic-on-ceramic joints. What patients don't generally know is that there is a 6% incidence of squeaking in patients with ceramic-on-ceramic replacement hip joints, said Dr. Thornhill. Other options, such as cartilage repair/regeneration techniques, primarily are performed on an experimental basis for osteochondral defects.

In terms of postoperative flexion, the most important factor actually is preoperative flexion, said Dr. Thornhill. High-flexion designs “add little functional value.” These designs do increase the cost though.

Rotating Platforms

Rotating platforms allow rotation around a central axis, supposedly improving kinematics. However, the human knee does not rotate, Dr. Thornhill noted. These implants have unidirectional wear, which is a theoretical advantage, but studies have not shown that the range of motion is any better with rotating platforms.

Dr. Thornhill disclosed that he receives royalties from DePuy Inc. He also has received research grants from DePuy Inc., Biomet Inc., and Smith & Nephew.

SNOWMASS, COLO. — Patients considering joint replacement are coming in to the office with some pretty specific questions these days. They want to know more about gender-specific knees, minimally invasive knee replacement, computer-assisted surgery, new indestructible materials, high-flexion designs, and rotating platforms, said Dr. Thomas S. Thornhill, chairman of the department of orthopedic surgery at Brigham and Women's Hospital in Boston.

Dr. Thornhill offered his thoughts on these issues at a symposium sponsored by the American College of Rheumatology.

Gender-Specific Knees

Approved in 2006, the Gender Solutions implant (made by Zimmer Inc.) was the first knee prosthesis to target the female knee. The company promotes the implant in part by stating that the implant better fits the size and shape of a woman's knee.

“There are really no significant clinical differences between male and female problems with the knee,” said Dr. Thornhill. In fact, some studies suggest that survivorship in total knee replacement may even be better in women.

Men typically have knees that are broader in the medial-lateral dimension than in the anterior-posterior dimension. Women tend to have knees that are narrower in the medial-lateral dimension and a little longer in the anterior-posterior dimension.

While there clearly are differences between the aspect ratios of men and women, some research suggests that the differences among women and among men are greater than those between the sexes are.

Minimally Invasive Knee Replacement

Patients will come in asking for minimally invasive knee replacements but it's not clear what this means. What patients think of as minimally invasive surgery actually is combined with many other variables: patient education and selection, preemptive analgesia, better postoperative pain control, and more rapid mobilization.

Computer-Assisted Surgery

Computer-assisted surgery does have the advantage of eliminating some of the outliers of alignment.

Computer-assisted surgery has much potential as a teaching tool, partly because it can provide feedback to surgeons. “The trouble is it costs a lot of money and it increases the surgical time,” said Dr. Thornhill.

New Materials, High-Flexion Designs

Patients are interested in new, longer-lasting materials, such as ceramic-on-ceramic joints. What patients don't generally know is that there is a 6% incidence of squeaking in patients with ceramic-on-ceramic replacement hip joints, said Dr. Thornhill. Other options, such as cartilage repair/regeneration techniques, primarily are performed on an experimental basis for osteochondral defects.

In terms of postoperative flexion, the most important factor actually is preoperative flexion, said Dr. Thornhill. High-flexion designs “add little functional value.” These designs do increase the cost though.

Rotating Platforms

Rotating platforms allow rotation around a central axis, supposedly improving kinematics. However, the human knee does not rotate, Dr. Thornhill noted. These implants have unidirectional wear, which is a theoretical advantage, but studies have not shown that the range of motion is any better with rotating platforms.

Dr. Thornhill disclosed that he receives royalties from DePuy Inc. He also has received research grants from DePuy Inc., Biomet Inc., and Smith & Nephew.

SNOWMASS, COLO. — Patients considering joint replacement are coming in to the office with some pretty specific questions these days. They want to know more about gender-specific knees, minimally invasive knee replacement, computer-assisted surgery, new indestructible materials, high-flexion designs, and rotating platforms, said Dr. Thomas S. Thornhill, chairman of the department of orthopedic surgery at Brigham and Women's Hospital in Boston.

Dr. Thornhill offered his thoughts on these issues at a symposium sponsored by the American College of Rheumatology.

Gender-Specific Knees

Approved in 2006, the Gender Solutions implant (made by Zimmer Inc.) was the first knee prosthesis to target the female knee. The company promotes the implant in part by stating that the implant better fits the size and shape of a woman's knee.

“There are really no significant clinical differences between male and female problems with the knee,” said Dr. Thornhill. In fact, some studies suggest that survivorship in total knee replacement may even be better in women.

Men typically have knees that are broader in the medial-lateral dimension than in the anterior-posterior dimension. Women tend to have knees that are narrower in the medial-lateral dimension and a little longer in the anterior-posterior dimension.

While there clearly are differences between the aspect ratios of men and women, some research suggests that the differences among women and among men are greater than those between the sexes are.

Minimally Invasive Knee Replacement

Patients will come in asking for minimally invasive knee replacements but it's not clear what this means. What patients think of as minimally invasive surgery actually is combined with many other variables: patient education and selection, preemptive analgesia, better postoperative pain control, and more rapid mobilization.

Computer-Assisted Surgery

Computer-assisted surgery does have the advantage of eliminating some of the outliers of alignment.

Computer-assisted surgery has much potential as a teaching tool, partly because it can provide feedback to surgeons. “The trouble is it costs a lot of money and it increases the surgical time,” said Dr. Thornhill.

New Materials, High-Flexion Designs

Patients are interested in new, longer-lasting materials, such as ceramic-on-ceramic joints. What patients don't generally know is that there is a 6% incidence of squeaking in patients with ceramic-on-ceramic replacement hip joints, said Dr. Thornhill. Other options, such as cartilage repair/regeneration techniques, primarily are performed on an experimental basis for osteochondral defects.

In terms of postoperative flexion, the most important factor actually is preoperative flexion, said Dr. Thornhill. High-flexion designs “add little functional value.” These designs do increase the cost though.

Rotating Platforms

Rotating platforms allow rotation around a central axis, supposedly improving kinematics. However, the human knee does not rotate, Dr. Thornhill noted. These implants have unidirectional wear, which is a theoretical advantage, but studies have not shown that the range of motion is any better with rotating platforms.

Dr. Thornhill disclosed that he receives royalties from DePuy Inc. He also has received research grants from DePuy Inc., Biomet Inc., and Smith & Nephew.

At the first follow-up, the patient's BMD, based on a DXA scan, was up 5.3%. However, at the second follow-up, his BMD had dropped by 5.1%. His primary care physician referred the man to determine why he was no longer responding to therapy.

“What is the first thing to do?” asked Dr. Michael Lewiecki, director of the New Mexico Clinical Research & Osteoporosis Center in Albuquerque. Should you “evaluate for adherence to therapy? Ask about calcium and vitamin D intake? Order lab tests to evaluate for factors contributing to bone loss?”

No, the first step is to actually look at the DXA image, said Dr. Lewiecki. In this case, the vertebral bodies were mislabeled on the second follow-up DXA scan.

Typically, the DXA computer program selects the labeling for vertebral bodies on DXA scans. It's not uncommon for mislabeling to occur though, said Dr. Lewiecki. A technologist goes over the labeling to double check the computer. Finally, the image should be reviewed by a physician interpreter as an additional check before the report is generated. In this case, the incorrectly labeled scan was not caught and false BMD measurements were reported to the ordering physician.

“When you have a situation in which BMD changes unexpectedly, it is important to verify that it is a valid comparison,” said Dr. Lewiecki.

Sometimes a left hip is incorrectly compared with the right hip or vice versa when assessing BMD over time. Other times, the lines used by the computer to delineate the edges of bone are misplaced, which can have a big effect on the amount of bone measured.

“Make sure you're comparing apples to apples,” he said. Reanalysis of the image with vertebral bodies correctly labeled showed that the patient's BMD for L1-L4 had been stable since the first follow-up. Response to therapy actually was good, requiring no change in alendronate and hydrochlorothiazide therapy and no laboratory testing for nonresponse to therapy.

Baseline DXA scan for L1-L4 (left): DXA at 1-year follow-up shows a 5.3% increase in BMD (center). However, a year later, mislabeling of vertebral bodies showed a 5.1% decrease in BMD (right). The erroneous labeling was clear when compared with the previous DXA images. Photos courtesy Dr. Michael Lewiecki

At the first follow-up, the patient's BMD, based on a DXA scan, was up 5.3%. However, at the second follow-up, his BMD had dropped by 5.1%. His primary care physician referred the man to determine why he was no longer responding to therapy.

“What is the first thing to do?” asked Dr. Michael Lewiecki, director of the New Mexico Clinical Research & Osteoporosis Center in Albuquerque. Should you “evaluate for adherence to therapy? Ask about calcium and vitamin D intake? Order lab tests to evaluate for factors contributing to bone loss?”

No, the first step is to actually look at the DXA image, said Dr. Lewiecki. In this case, the vertebral bodies were mislabeled on the second follow-up DXA scan.

Typically, the DXA computer program selects the labeling for vertebral bodies on DXA scans. It's not uncommon for mislabeling to occur though, said Dr. Lewiecki. A technologist goes over the labeling to double check the computer. Finally, the image should be reviewed by a physician interpreter as an additional check before the report is generated. In this case, the incorrectly labeled scan was not caught and false BMD measurements were reported to the ordering physician.

“When you have a situation in which BMD changes unexpectedly, it is important to verify that it is a valid comparison,” said Dr. Lewiecki.

Sometimes a left hip is incorrectly compared with the right hip or vice versa when assessing BMD over time. Other times, the lines used by the computer to delineate the edges of bone are misplaced, which can have a big effect on the amount of bone measured.

“Make sure you're comparing apples to apples,” he said. Reanalysis of the image with vertebral bodies correctly labeled showed that the patient's BMD for L1-L4 had been stable since the first follow-up. Response to therapy actually was good, requiring no change in alendronate and hydrochlorothiazide therapy and no laboratory testing for nonresponse to therapy.

Baseline DXA scan for L1-L4 (left): DXA at 1-year follow-up shows a 5.3% increase in BMD (center). However, a year later, mislabeling of vertebral bodies showed a 5.1% decrease in BMD (right). The erroneous labeling was clear when compared with the previous DXA images. Photos courtesy Dr. Michael Lewiecki

At the first follow-up, the patient's BMD, based on a DXA scan, was up 5.3%. However, at the second follow-up, his BMD had dropped by 5.1%. His primary care physician referred the man to determine why he was no longer responding to therapy.

“What is the first thing to do?” asked Dr. Michael Lewiecki, director of the New Mexico Clinical Research & Osteoporosis Center in Albuquerque. Should you “evaluate for adherence to therapy? Ask about calcium and vitamin D intake? Order lab tests to evaluate for factors contributing to bone loss?”

No, the first step is to actually look at the DXA image, said Dr. Lewiecki. In this case, the vertebral bodies were mislabeled on the second follow-up DXA scan.

Typically, the DXA computer program selects the labeling for vertebral bodies on DXA scans. It's not uncommon for mislabeling to occur though, said Dr. Lewiecki. A technologist goes over the labeling to double check the computer. Finally, the image should be reviewed by a physician interpreter as an additional check before the report is generated. In this case, the incorrectly labeled scan was not caught and false BMD measurements were reported to the ordering physician.

“When you have a situation in which BMD changes unexpectedly, it is important to verify that it is a valid comparison,” said Dr. Lewiecki.

Sometimes a left hip is incorrectly compared with the right hip or vice versa when assessing BMD over time. Other times, the lines used by the computer to delineate the edges of bone are misplaced, which can have a big effect on the amount of bone measured.

“Make sure you're comparing apples to apples,” he said. Reanalysis of the image with vertebral bodies correctly labeled showed that the patient's BMD for L1-L4 had been stable since the first follow-up. Response to therapy actually was good, requiring no change in alendronate and hydrochlorothiazide therapy and no laboratory testing for nonresponse to therapy.

Baseline DXA scan for L1-L4 (left): DXA at 1-year follow-up shows a 5.3% increase in BMD (center). However, a year later, mislabeling of vertebral bodies showed a 5.1% decrease in BMD (right). The erroneous labeling was clear when compared with the previous DXA images. Photos courtesy Dr. Michael Lewiecki

Full immunization in children aged 6–59 months and partial immunization in children aged 24–59 months provide significant protection from influenza, even when the match between vaccine and circulating strains is suboptimal, Carrie M. Shuler, D.V.M., an epidemiologist with the Georgia Division of Public Health, and her colleagues reported.

However, children aged 6–23 months with partial vaccination had no benefit in terms of influenza protection, the authors wrote (Pediatrics 2007;119:587–95).

The researchers evaluated the effectiveness of the trivalent inactivated influenza vaccine at a private pediatric practice in Atlanta during the 2003–2004 influenza season.

During that season, only one-quarter of circulating influenza viruses nationally and in Georgia were similar antigenically to the vaccine strain.

Case patients (290) were identified as having laboratory-confirmed influenza between Nov. 1, 2003, and Jan. 31, 2004. Case patients were randomly matched with two control children based on age.

Children who had received two doses of the vaccine at least 1 month apart and at least 14 days before the date of symptom onset (the anchor date for the case child and matched control children) were considered fully vaccinated.

Children who were vaccinated during a previous season needed only one dose during the 2003–2004 season that was administered at least 14 days before the anchor date to be considered fully vaccinated. In all, 322 children were considered fully vaccinated.

A child was considered partially vaccinated if he had not been vaccinated in a previous season and had received two doses of vaccine since September 2003, with an anchor date less than 14 days after the second dose. A child also was considered partially vaccinated if she had not been vaccinated in a previous season and had received only one dose since September 2003 and was vaccinated at least 14 days prior to the anchor date. In all, 103 children were considered partially vaccinated.

Children who received no doses during the 2003–2004 season on or before the anchor date and children who had received one dose since September 2003 that was administered less than 14 days prior to the anchor date were considered unvaccinated. In all, 445 children were considered unvaccinated.

Fully vaccinated children aged 6–23 months had a significant reduction (52%) in influenza, compared with unvaccinated children.

Likewise, fully vaccinated children aged 24–59 months had a significant reduction (45%) in influenza, compared with unvaccinated children.

Partially vaccinated children aged 24–59 months also had a significant reduction (65%) in influenza, compared with unvaccinated children. However, partially vaccinated children aged 6–23 months did not have a significant reduction in influenza, compared with unvaccinated children who were not vaccinated the previous season (adjusted odds ratio 1.70).

Full immunization in children aged 6–59 months and partial immunization in children aged 24–59 months provide significant protection from influenza, even when the match between vaccine and circulating strains is suboptimal, Carrie M. Shuler, D.V.M., an epidemiologist with the Georgia Division of Public Health, and her colleagues reported.

However, children aged 6–23 months with partial vaccination had no benefit in terms of influenza protection, the authors wrote (Pediatrics 2007;119:587–95).

The researchers evaluated the effectiveness of the trivalent inactivated influenza vaccine at a private pediatric practice in Atlanta during the 2003–2004 influenza season.

During that season, only one-quarter of circulating influenza viruses nationally and in Georgia were similar antigenically to the vaccine strain.

Case patients (290) were identified as having laboratory-confirmed influenza between Nov. 1, 2003, and Jan. 31, 2004. Case patients were randomly matched with two control children based on age.

Children who had received two doses of the vaccine at least 1 month apart and at least 14 days before the date of symptom onset (the anchor date for the case child and matched control children) were considered fully vaccinated.

Children who were vaccinated during a previous season needed only one dose during the 2003–2004 season that was administered at least 14 days before the anchor date to be considered fully vaccinated. In all, 322 children were considered fully vaccinated.

A child was considered partially vaccinated if he had not been vaccinated in a previous season and had received two doses of vaccine since September 2003, with an anchor date less than 14 days after the second dose. A child also was considered partially vaccinated if she had not been vaccinated in a previous season and had received only one dose since September 2003 and was vaccinated at least 14 days prior to the anchor date. In all, 103 children were considered partially vaccinated.

Children who received no doses during the 2003–2004 season on or before the anchor date and children who had received one dose since September 2003 that was administered less than 14 days prior to the anchor date were considered unvaccinated. In all, 445 children were considered unvaccinated.

Fully vaccinated children aged 6–23 months had a significant reduction (52%) in influenza, compared with unvaccinated children.

Likewise, fully vaccinated children aged 24–59 months had a significant reduction (45%) in influenza, compared with unvaccinated children.

Partially vaccinated children aged 24–59 months also had a significant reduction (65%) in influenza, compared with unvaccinated children. However, partially vaccinated children aged 6–23 months did not have a significant reduction in influenza, compared with unvaccinated children who were not vaccinated the previous season (adjusted odds ratio 1.70).

Full immunization in children aged 6–59 months and partial immunization in children aged 24–59 months provide significant protection from influenza, even when the match between vaccine and circulating strains is suboptimal, Carrie M. Shuler, D.V.M., an epidemiologist with the Georgia Division of Public Health, and her colleagues reported.

However, children aged 6–23 months with partial vaccination had no benefit in terms of influenza protection, the authors wrote (Pediatrics 2007;119:587–95).

The researchers evaluated the effectiveness of the trivalent inactivated influenza vaccine at a private pediatric practice in Atlanta during the 2003–2004 influenza season.

During that season, only one-quarter of circulating influenza viruses nationally and in Georgia were similar antigenically to the vaccine strain.

Case patients (290) were identified as having laboratory-confirmed influenza between Nov. 1, 2003, and Jan. 31, 2004. Case patients were randomly matched with two control children based on age.

Children who had received two doses of the vaccine at least 1 month apart and at least 14 days before the date of symptom onset (the anchor date for the case child and matched control children) were considered fully vaccinated.

Children who were vaccinated during a previous season needed only one dose during the 2003–2004 season that was administered at least 14 days before the anchor date to be considered fully vaccinated. In all, 322 children were considered fully vaccinated.

A child was considered partially vaccinated if he had not been vaccinated in a previous season and had received two doses of vaccine since September 2003, with an anchor date less than 14 days after the second dose. A child also was considered partially vaccinated if she had not been vaccinated in a previous season and had received only one dose since September 2003 and was vaccinated at least 14 days prior to the anchor date. In all, 103 children were considered partially vaccinated.

Children who received no doses during the 2003–2004 season on or before the anchor date and children who had received one dose since September 2003 that was administered less than 14 days prior to the anchor date were considered unvaccinated. In all, 445 children were considered unvaccinated.

Fully vaccinated children aged 6–23 months had a significant reduction (52%) in influenza, compared with unvaccinated children.

Likewise, fully vaccinated children aged 24–59 months had a significant reduction (45%) in influenza, compared with unvaccinated children.

Partially vaccinated children aged 24–59 months also had a significant reduction (65%) in influenza, compared with unvaccinated children. However, partially vaccinated children aged 6–23 months did not have a significant reduction in influenza, compared with unvaccinated children who were not vaccinated the previous season (adjusted odds ratio 1.70).

BETHESDA, MD. – Teens and young adults who are prescribed opioids for a specific event, but who take them at other times for pain relief, are at lower risk for substance abuse than those who use the drugs to get high, Carol J. Boyd, Ph.D., said at a meeting of the National Institute on Drug Abuse.

In addition, teens who obtain drugs from family members for pain relief are at less risk than those who seek drugs from other sources such as friends or dealers. The data, based on the Student Life Survey (SLS)–an online survey of drug and alcohol use among students (average age 20 years) at the University of Michigan–show that women who have never used a prescription opioid drug and those who have only used these drugs when given to them by a family member are less likely to abuse other substances.

“However, as soon as they start getting it from a peer or another source–like a drug dealer–or an unspecified source … that's when we start seeing increased rates of substance abuse,” said Dr. Boyd, director of the Institute for Research on Women and Gender at the University of Michigan in Ann Arbor. The same pattern is seen in men, though they typically abuse substances at higher rates than women.

Half of young women got prescription drugs from their peers, while the rate is slightly higher for young men (58%), based on 1,387 responses in 2003. Women were more likely to get prescription drugs from family members than were men–23% versus 11%.

In 2005, of 2,305 women who responded, 26% had a prescription for an analgesic opioid and had used it in the last year, compared with 20% of 2,275 men surveyed. About 10% of men and 8% of women reported nonmedical use of prescription drugs in the last year, that is, use of drugs for which they had not obtained a prescription from a physician for a specific indication. Of these nonmedical users, 50% reported using hydrocodone; 38%, codeine; 14%, oxycodone; and 10%, propoxyphene.

Of 641 students surveyed, most men (60%) and women (66%) responded that they misused prescription opioids to relieve pain. Men were more likely to report experimentation and getting high as reasons.

The researchers included 10 questions, taken from the Drug Abuse Screening Test (DAST), which provide insight into potential drug abuse. A score of at least 2 indicates a person may have substance abuse problems. “If individuals endorsed only nonmedical use to relieve pain, they look no different than the group of students who never had used an opioid analgesic nonmedically,” Dr. Boyd said. “But as soon as they start endorsing a motivation other than pain relief, their DAST scores increase.”

Similar results were seen among younger students. The Web-based Secondary Student Life Survey involves participants in grades 7–12 in an ethnically diverse (47% African American) school system in Southern Michigan. Students are asked the same questions as college students taking the SLS.

In 2005, 1,086 students completed the survey. The lifetime prevalence of nonmedical use was greatest for pain medications (18%), followed by sleep drugs, anxiolytics, and stimulants. Girls were significantly more likely to report nonmedical use of pain medications, but there were no gender differences for the nonmedical use of any other prescription drugs. In terms of race, there were no differences in the nonmedical use of analgesic opioids.

Most students (80%) reported pain relief as their motivation for nonmedical use of prescription opioids. In addition, 16% reported sleep as their motivation, 20% reported getting high, and 3% said prescription drugs are safer than street drugs.

BETHESDA, MD. – Teens and young adults who are prescribed opioids for a specific event, but who take them at other times for pain relief, are at lower risk for substance abuse than those who use the drugs to get high, Carol J. Boyd, Ph.D., said at a meeting of the National Institute on Drug Abuse.

In addition, teens who obtain drugs from family members for pain relief are at less risk than those who seek drugs from other sources such as friends or dealers. The data, based on the Student Life Survey (SLS)–an online survey of drug and alcohol use among students (average age 20 years) at the University of Michigan–show that women who have never used a prescription opioid drug and those who have only used these drugs when given to them by a family member are less likely to abuse other substances.

“However, as soon as they start getting it from a peer or another source–like a drug dealer–or an unspecified source … that's when we start seeing increased rates of substance abuse,” said Dr. Boyd, director of the Institute for Research on Women and Gender at the University of Michigan in Ann Arbor. The same pattern is seen in men, though they typically abuse substances at higher rates than women.

Half of young women got prescription drugs from their peers, while the rate is slightly higher for young men (58%), based on 1,387 responses in 2003. Women were more likely to get prescription drugs from family members than were men–23% versus 11%.

In 2005, of 2,305 women who responded, 26% had a prescription for an analgesic opioid and had used it in the last year, compared with 20% of 2,275 men surveyed. About 10% of men and 8% of women reported nonmedical use of prescription drugs in the last year, that is, use of drugs for which they had not obtained a prescription from a physician for a specific indication. Of these nonmedical users, 50% reported using hydrocodone; 38%, codeine; 14%, oxycodone; and 10%, propoxyphene.

Of 641 students surveyed, most men (60%) and women (66%) responded that they misused prescription opioids to relieve pain. Men were more likely to report experimentation and getting high as reasons.

The researchers included 10 questions, taken from the Drug Abuse Screening Test (DAST), which provide insight into potential drug abuse. A score of at least 2 indicates a person may have substance abuse problems. “If individuals endorsed only nonmedical use to relieve pain, they look no different than the group of students who never had used an opioid analgesic nonmedically,” Dr. Boyd said. “But as soon as they start endorsing a motivation other than pain relief, their DAST scores increase.”

Similar results were seen among younger students. The Web-based Secondary Student Life Survey involves participants in grades 7–12 in an ethnically diverse (47% African American) school system in Southern Michigan. Students are asked the same questions as college students taking the SLS.

In 2005, 1,086 students completed the survey. The lifetime prevalence of nonmedical use was greatest for pain medications (18%), followed by sleep drugs, anxiolytics, and stimulants. Girls were significantly more likely to report nonmedical use of pain medications, but there were no gender differences for the nonmedical use of any other prescription drugs. In terms of race, there were no differences in the nonmedical use of analgesic opioids.

Most students (80%) reported pain relief as their motivation for nonmedical use of prescription opioids. In addition, 16% reported sleep as their motivation, 20% reported getting high, and 3% said prescription drugs are safer than street drugs.

BETHESDA, MD. – Teens and young adults who are prescribed opioids for a specific event, but who take them at other times for pain relief, are at lower risk for substance abuse than those who use the drugs to get high, Carol J. Boyd, Ph.D., said at a meeting of the National Institute on Drug Abuse.

In addition, teens who obtain drugs from family members for pain relief are at less risk than those who seek drugs from other sources such as friends or dealers. The data, based on the Student Life Survey (SLS)–an online survey of drug and alcohol use among students (average age 20 years) at the University of Michigan–show that women who have never used a prescription opioid drug and those who have only used these drugs when given to them by a family member are less likely to abuse other substances.

“However, as soon as they start getting it from a peer or another source–like a drug dealer–or an unspecified source … that's when we start seeing increased rates of substance abuse,” said Dr. Boyd, director of the Institute for Research on Women and Gender at the University of Michigan in Ann Arbor. The same pattern is seen in men, though they typically abuse substances at higher rates than women.

Half of young women got prescription drugs from their peers, while the rate is slightly higher for young men (58%), based on 1,387 responses in 2003. Women were more likely to get prescription drugs from family members than were men–23% versus 11%.

In 2005, of 2,305 women who responded, 26% had a prescription for an analgesic opioid and had used it in the last year, compared with 20% of 2,275 men surveyed. About 10% of men and 8% of women reported nonmedical use of prescription drugs in the last year, that is, use of drugs for which they had not obtained a prescription from a physician for a specific indication. Of these nonmedical users, 50% reported using hydrocodone; 38%, codeine; 14%, oxycodone; and 10%, propoxyphene.

Of 641 students surveyed, most men (60%) and women (66%) responded that they misused prescription opioids to relieve pain. Men were more likely to report experimentation and getting high as reasons.

The researchers included 10 questions, taken from the Drug Abuse Screening Test (DAST), which provide insight into potential drug abuse. A score of at least 2 indicates a person may have substance abuse problems. “If individuals endorsed only nonmedical use to relieve pain, they look no different than the group of students who never had used an opioid analgesic nonmedically,” Dr. Boyd said. “But as soon as they start endorsing a motivation other than pain relief, their DAST scores increase.”

Similar results were seen among younger students. The Web-based Secondary Student Life Survey involves participants in grades 7–12 in an ethnically diverse (47% African American) school system in Southern Michigan. Students are asked the same questions as college students taking the SLS.

In 2005, 1,086 students completed the survey. The lifetime prevalence of nonmedical use was greatest for pain medications (18%), followed by sleep drugs, anxiolytics, and stimulants. Girls were significantly more likely to report nonmedical use of pain medications, but there were no gender differences for the nonmedical use of any other prescription drugs. In terms of race, there were no differences in the nonmedical use of analgesic opioids.

Most students (80%) reported pain relief as their motivation for nonmedical use of prescription opioids. In addition, 16% reported sleep as their motivation, 20% reported getting high, and 3% said prescription drugs are safer than street drugs.

SNOWMASS, COLO. — Patients considering joint replacement are coming in to the office with some pretty specific questions these days. They want to know more about gender-specific knees, minimally invasive knee replacement, computer-assisted surgery, new indestructible materials, high-flexion designs, and rotating platforms, said Dr. Thomas S. Thornhill, chairman of the department of orthopedic surgery at Brigham and Women's Hospital in Boston.

Dr. Thornhill offered his thoughts on these issues at a symposium sponsored by the American College of Rheumatology.

Gender-Specific Knees

Approved in 2006, the Gender Solutions implant (made by Zimmer Inc.) was the first knee prosthesis to target the female knee. The company promotes the implant in part by stating that the implant better fits the size and shape of a woman's knee.

“There are really no significant clinical differences between male and female problems with the knee,” Dr. Thornhill said. In fact, some studies suggest that survivorship in total knee replacement may even be better in women.

Men typically have knees that are broader in the medial-lateral dimension than in the anterior-posterior dimension. Women tend to have knees that are narrower in the medial-lateral dimension and a little longer in the anterior-posterior dimension.

While there clearly are differences between the aspect ratios—the ratio of medial-lateral length to anterior-posterior length—of men and women, some research suggests that the differences among women and among men are greater than those between the sexes are.

Minimally Invasive Knee Replacement

Patients will come in asking for minimally invasive knee replacements but it's not clear what this means. “Is it a shorter incision? Is it the fact that you don't violate the quadriceps mechanism? Is it that you don't evert the patella when you thrust the knee?” Dr. Thornhill asked.

What patients think of as minimally invasive surgery actually is combined with many other variables: patient education and selection, preemptive analgesia, better postoperative pain control, and more rapid mobilization.

“There are no data demonstrating any long-term benefit to minimally invasive surgery. There are data showing a little bit better length of stay, a little less blood loss, a little bit shorter time getting to rehabilitation goals,” he said.

Computer-Assisted Surgery

Computer-assisted surgery—available in some centers—does have the advantage of eliminating some of the outliers of alignment. “This may be a benefit to people, who may not be high-volume surgeons,” Dr. Thornhill said.

Computer-assisted surgery has much potential as a teaching tool, partly because it can provide feedback to surgeons. “The trouble is it costs a lot of money and it increases the surgical time,” he said. In addition, computer-assisted surgery currently increases the dissection.

New Materials, High-Flexion Designs

Patients are interested in new, longer-lasting materials, such as ceramic-on-ceramic joints. What patients don't generally know is that there is a 6% incidence of squeaking in patients with ceramic-on-ceramic replacement hip joints, Dr. Thornhill said. Other options, such as cartilage repair/regeneration techniques, primarily are performed on an experimental basis for osteochondral defects.

In terms of postoperative flexion, the most important factor actually is preoperative flexion, he said. High-flexion designs “add little functional value.” These designs do increase the cost though.

Rotating Platforms

Rotating platforms allow rotation around a central axis, supposedly improving kinematics. However, the human knee does not rotate, Dr. Thornhill noted.

These implants have unidirectional wear, which is a theoretical advantage, but studies have not shown that the range of motion is any better with rotating platforms.

Dr. Thornhill disclosed that he receives royalties from DePuy Inc. He also has received research grants from DePuy Inc., Biomet Inc., and Smith & Nephew.

SNOWMASS, COLO. — Patients considering joint replacement are coming in to the office with some pretty specific questions these days. They want to know more about gender-specific knees, minimally invasive knee replacement, computer-assisted surgery, new indestructible materials, high-flexion designs, and rotating platforms, said Dr. Thomas S. Thornhill, chairman of the department of orthopedic surgery at Brigham and Women's Hospital in Boston.

Dr. Thornhill offered his thoughts on these issues at a symposium sponsored by the American College of Rheumatology.

Gender-Specific Knees

Approved in 2006, the Gender Solutions implant (made by Zimmer Inc.) was the first knee prosthesis to target the female knee. The company promotes the implant in part by stating that the implant better fits the size and shape of a woman's knee.

“There are really no significant clinical differences between male and female problems with the knee,” Dr. Thornhill said. In fact, some studies suggest that survivorship in total knee replacement may even be better in women.

Men typically have knees that are broader in the medial-lateral dimension than in the anterior-posterior dimension. Women tend to have knees that are narrower in the medial-lateral dimension and a little longer in the anterior-posterior dimension.

While there clearly are differences between the aspect ratios—the ratio of medial-lateral length to anterior-posterior length—of men and women, some research suggests that the differences among women and among men are greater than those between the sexes are.

Minimally Invasive Knee Replacement

Patients will come in asking for minimally invasive knee replacements but it's not clear what this means. “Is it a shorter incision? Is it the fact that you don't violate the quadriceps mechanism? Is it that you don't evert the patella when you thrust the knee?” Dr. Thornhill asked.

What patients think of as minimally invasive surgery actually is combined with many other variables: patient education and selection, preemptive analgesia, better postoperative pain control, and more rapid mobilization.

“There are no data demonstrating any long-term benefit to minimally invasive surgery. There are data showing a little bit better length of stay, a little less blood loss, a little bit shorter time getting to rehabilitation goals,” he said.

Computer-Assisted Surgery

Computer-assisted surgery—available in some centers—does have the advantage of eliminating some of the outliers of alignment. “This may be a benefit to people, who may not be high-volume surgeons,” Dr. Thornhill said.

Computer-assisted surgery has much potential as a teaching tool, partly because it can provide feedback to surgeons. “The trouble is it costs a lot of money and it increases the surgical time,” he said. In addition, computer-assisted surgery currently increases the dissection.

New Materials, High-Flexion Designs

Patients are interested in new, longer-lasting materials, such as ceramic-on-ceramic joints. What patients don't generally know is that there is a 6% incidence of squeaking in patients with ceramic-on-ceramic replacement hip joints, Dr. Thornhill said. Other options, such as cartilage repair/regeneration techniques, primarily are performed on an experimental basis for osteochondral defects.

In terms of postoperative flexion, the most important factor actually is preoperative flexion, he said. High-flexion designs “add little functional value.” These designs do increase the cost though.

Rotating Platforms

Rotating platforms allow rotation around a central axis, supposedly improving kinematics. However, the human knee does not rotate, Dr. Thornhill noted.

These implants have unidirectional wear, which is a theoretical advantage, but studies have not shown that the range of motion is any better with rotating platforms.

Dr. Thornhill disclosed that he receives royalties from DePuy Inc. He also has received research grants from DePuy Inc., Biomet Inc., and Smith & Nephew.

SNOWMASS, COLO. — Patients considering joint replacement are coming in to the office with some pretty specific questions these days. They want to know more about gender-specific knees, minimally invasive knee replacement, computer-assisted surgery, new indestructible materials, high-flexion designs, and rotating platforms, said Dr. Thomas S. Thornhill, chairman of the department of orthopedic surgery at Brigham and Women's Hospital in Boston.

Dr. Thornhill offered his thoughts on these issues at a symposium sponsored by the American College of Rheumatology.

Gender-Specific Knees

Approved in 2006, the Gender Solutions implant (made by Zimmer Inc.) was the first knee prosthesis to target the female knee. The company promotes the implant in part by stating that the implant better fits the size and shape of a woman's knee.

“There are really no significant clinical differences between male and female problems with the knee,” Dr. Thornhill said. In fact, some studies suggest that survivorship in total knee replacement may even be better in women.

Men typically have knees that are broader in the medial-lateral dimension than in the anterior-posterior dimension. Women tend to have knees that are narrower in the medial-lateral dimension and a little longer in the anterior-posterior dimension.

While there clearly are differences between the aspect ratios—the ratio of medial-lateral length to anterior-posterior length—of men and women, some research suggests that the differences among women and among men are greater than those between the sexes are.

Minimally Invasive Knee Replacement

Patients will come in asking for minimally invasive knee replacements but it's not clear what this means. “Is it a shorter incision? Is it the fact that you don't violate the quadriceps mechanism? Is it that you don't evert the patella when you thrust the knee?” Dr. Thornhill asked.

What patients think of as minimally invasive surgery actually is combined with many other variables: patient education and selection, preemptive analgesia, better postoperative pain control, and more rapid mobilization.

“There are no data demonstrating any long-term benefit to minimally invasive surgery. There are data showing a little bit better length of stay, a little less blood loss, a little bit shorter time getting to rehabilitation goals,” he said.

Computer-Assisted Surgery

Computer-assisted surgery—available in some centers—does have the advantage of eliminating some of the outliers of alignment. “This may be a benefit to people, who may not be high-volume surgeons,” Dr. Thornhill said.

Computer-assisted surgery has much potential as a teaching tool, partly because it can provide feedback to surgeons. “The trouble is it costs a lot of money and it increases the surgical time,” he said. In addition, computer-assisted surgery currently increases the dissection.

New Materials, High-Flexion Designs

Patients are interested in new, longer-lasting materials, such as ceramic-on-ceramic joints. What patients don't generally know is that there is a 6% incidence of squeaking in patients with ceramic-on-ceramic replacement hip joints, Dr. Thornhill said. Other options, such as cartilage repair/regeneration techniques, primarily are performed on an experimental basis for osteochondral defects.

In terms of postoperative flexion, the most important factor actually is preoperative flexion, he said. High-flexion designs “add little functional value.” These designs do increase the cost though.

Rotating Platforms

Rotating platforms allow rotation around a central axis, supposedly improving kinematics. However, the human knee does not rotate, Dr. Thornhill noted.

These implants have unidirectional wear, which is a theoretical advantage, but studies have not shown that the range of motion is any better with rotating platforms.

Dr. Thornhill disclosed that he receives royalties from DePuy Inc. He also has received research grants from DePuy Inc., Biomet Inc., and Smith & Nephew.

Radiographs obtained of both hands showed similar changes in multiple phalanges. In particular, the lesions had a lacy, punched-out appearance that suggested osseous sarcoidosis, said Dr. Sterling G. West, a professor of medicine in the division of rheumatology at the University of Colorado at Denver.

The lesions reflect granulomatous involvement of the phalangeal shafts.

Notably, the lesions are not associated with periostitis or sequestra helping to separate sarcoid bone involvement from chronic osteomyelitis.

Sarcoidosis can have a number of manifestations, though pulmonary involvement is present in more than 90% of patients with the disease. Symptoms of pulmonary involvement include dyspnea and dry cough, as in this patient.

Patients tend to have well-established sarcoidosis by the time that bone involvement is present, said Dr. West. Bone involvement tends to occur more frequently in African Americans.

Cystic lesions have a predilection for the phalanges of the hands and feet. Soft tissue swelling can occur over the lesions. Sarcoidosis is the major cause of unidigital clubbing. When sarcoid bone involvement is associated with lupus pernio, the prognosis is generally poor.

Uveitis is another common manifestation of sarcoidosis and is usually bilateral. Dr. West recommends that all sarcoid patients get an eye screening.

Many patients with sarcoidosis undergo spontaneous remission, while some remit with steroids. Others may have a chronic course. Signs of poor prognosis include the involvement of three or more organs, disease onset after age 40, African American race, and symptoms lasting more than 6 months.

Osseous sarcoid typically indicates advanced sarcoidosis, which requires treatment with high-dose prednisone and additional agents such as azathioprine, methotrexate, or biologic agents—particularly infliximab to control all the sarcoidosis manifestations and prevent progression. This patient was initially treated with prednisone and azathioprine. Later, infliximab was added helping to stabilize his disease.

Osseous sarcoid lesions affected multiple phalanges (hand, above left). These bony changes typically have a lacy, punched-out appearance (detail, above right). Photos courtesy Dr. Sterling G. West

Radiographs obtained of both hands showed similar changes in multiple phalanges. In particular, the lesions had a lacy, punched-out appearance that suggested osseous sarcoidosis, said Dr. Sterling G. West, a professor of medicine in the division of rheumatology at the University of Colorado at Denver.

The lesions reflect granulomatous involvement of the phalangeal shafts.

Notably, the lesions are not associated with periostitis or sequestra helping to separate sarcoid bone involvement from chronic osteomyelitis.

Sarcoidosis can have a number of manifestations, though pulmonary involvement is present in more than 90% of patients with the disease. Symptoms of pulmonary involvement include dyspnea and dry cough, as in this patient.

Patients tend to have well-established sarcoidosis by the time that bone involvement is present, said Dr. West. Bone involvement tends to occur more frequently in African Americans.

Cystic lesions have a predilection for the phalanges of the hands and feet. Soft tissue swelling can occur over the lesions. Sarcoidosis is the major cause of unidigital clubbing. When sarcoid bone involvement is associated with lupus pernio, the prognosis is generally poor.

Uveitis is another common manifestation of sarcoidosis and is usually bilateral. Dr. West recommends that all sarcoid patients get an eye screening.

Many patients with sarcoidosis undergo spontaneous remission, while some remit with steroids. Others may have a chronic course. Signs of poor prognosis include the involvement of three or more organs, disease onset after age 40, African American race, and symptoms lasting more than 6 months.

Osseous sarcoid typically indicates advanced sarcoidosis, which requires treatment with high-dose prednisone and additional agents such as azathioprine, methotrexate, or biologic agents—particularly infliximab to control all the sarcoidosis manifestations and prevent progression. This patient was initially treated with prednisone and azathioprine. Later, infliximab was added helping to stabilize his disease.

Osseous sarcoid lesions affected multiple phalanges (hand, above left). These bony changes typically have a lacy, punched-out appearance (detail, above right). Photos courtesy Dr. Sterling G. West

Radiographs obtained of both hands showed similar changes in multiple phalanges. In particular, the lesions had a lacy, punched-out appearance that suggested osseous sarcoidosis, said Dr. Sterling G. West, a professor of medicine in the division of rheumatology at the University of Colorado at Denver.

The lesions reflect granulomatous involvement of the phalangeal shafts.

Notably, the lesions are not associated with periostitis or sequestra helping to separate sarcoid bone involvement from chronic osteomyelitis.

Sarcoidosis can have a number of manifestations, though pulmonary involvement is present in more than 90% of patients with the disease. Symptoms of pulmonary involvement include dyspnea and dry cough, as in this patient.

Patients tend to have well-established sarcoidosis by the time that bone involvement is present, said Dr. West. Bone involvement tends to occur more frequently in African Americans.

Cystic lesions have a predilection for the phalanges of the hands and feet. Soft tissue swelling can occur over the lesions. Sarcoidosis is the major cause of unidigital clubbing. When sarcoid bone involvement is associated with lupus pernio, the prognosis is generally poor.

Uveitis is another common manifestation of sarcoidosis and is usually bilateral. Dr. West recommends that all sarcoid patients get an eye screening.

Many patients with sarcoidosis undergo spontaneous remission, while some remit with steroids. Others may have a chronic course. Signs of poor prognosis include the involvement of three or more organs, disease onset after age 40, African American race, and symptoms lasting more than 6 months.

Osseous sarcoid typically indicates advanced sarcoidosis, which requires treatment with high-dose prednisone and additional agents such as azathioprine, methotrexate, or biologic agents—particularly infliximab to control all the sarcoidosis manifestations and prevent progression. This patient was initially treated with prednisone and azathioprine. Later, infliximab was added helping to stabilize his disease.

Osseous sarcoid lesions affected multiple phalanges (hand, above left). These bony changes typically have a lacy, punched-out appearance (detail, above right). Photos courtesy Dr. Sterling G. West

BETHESDA, MD. — More than half of patients in the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL) are on two or more medications to treat their disease, said Dr. Michael McGoon, who is chairman of the registry's steering committee.

“One of the revealing outcomes early on … is that already 54% of the 460 patients on any pulmonary arterial hypertension medication are on two or more medications,” said Dr. McGoon, at a meeting on pulmonary hypertension sponsored by the National Institutes of Health.

The REVEAL registry is designed to look at the clinical course and medical management of pulmonary arterial hypertension. Researchers hope to enroll 3,000 patients with PAH, who will be followed for at least 5 years, regardless of their therapy. The registry is intended to capture demographic data and clinical treatment patterns and factors associated with improved clinical outcomes.

As of October 2006, 545 patients had been enrolled. Of these, slightly less than half (46%) had idiopathic PAH. Roughly half (51%) had PAH associated with other diseases. Of those enrolled, 71% also had cardiovascular disease, said Dr. McGoon, who is also director of the pulmonary hypertension clinic at the Mayo Medical School, Rochester, Minn.

The registry is sponsored by CoTherix Inc., which makes Ventavis (iloprost) for the treatment of pulmonary arterial hypertension. Dr. McGoon disclosed that he has financial ties to several pharmaceutical companies, including CoTherix.

BETHESDA, MD. — More than half of patients in the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL) are on two or more medications to treat their disease, said Dr. Michael McGoon, who is chairman of the registry's steering committee.

“One of the revealing outcomes early on … is that already 54% of the 460 patients on any pulmonary arterial hypertension medication are on two or more medications,” said Dr. McGoon, at a meeting on pulmonary hypertension sponsored by the National Institutes of Health.

The REVEAL registry is designed to look at the clinical course and medical management of pulmonary arterial hypertension. Researchers hope to enroll 3,000 patients with PAH, who will be followed for at least 5 years, regardless of their therapy. The registry is intended to capture demographic data and clinical treatment patterns and factors associated with improved clinical outcomes.

As of October 2006, 545 patients had been enrolled. Of these, slightly less than half (46%) had idiopathic PAH. Roughly half (51%) had PAH associated with other diseases. Of those enrolled, 71% also had cardiovascular disease, said Dr. McGoon, who is also director of the pulmonary hypertension clinic at the Mayo Medical School, Rochester, Minn.

The registry is sponsored by CoTherix Inc., which makes Ventavis (iloprost) for the treatment of pulmonary arterial hypertension. Dr. McGoon disclosed that he has financial ties to several pharmaceutical companies, including CoTherix.

BETHESDA, MD. — More than half of patients in the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL) are on two or more medications to treat their disease, said Dr. Michael McGoon, who is chairman of the registry's steering committee.

“One of the revealing outcomes early on … is that already 54% of the 460 patients on any pulmonary arterial hypertension medication are on two or more medications,” said Dr. McGoon, at a meeting on pulmonary hypertension sponsored by the National Institutes of Health.

The REVEAL registry is designed to look at the clinical course and medical management of pulmonary arterial hypertension. Researchers hope to enroll 3,000 patients with PAH, who will be followed for at least 5 years, regardless of their therapy. The registry is intended to capture demographic data and clinical treatment patterns and factors associated with improved clinical outcomes.

As of October 2006, 545 patients had been enrolled. Of these, slightly less than half (46%) had idiopathic PAH. Roughly half (51%) had PAH associated with other diseases. Of those enrolled, 71% also had cardiovascular disease, said Dr. McGoon, who is also director of the pulmonary hypertension clinic at the Mayo Medical School, Rochester, Minn.

The registry is sponsored by CoTherix Inc., which makes Ventavis (iloprost) for the treatment of pulmonary arterial hypertension. Dr. McGoon disclosed that he has financial ties to several pharmaceutical companies, including CoTherix.