Sharon Worcester

NEW ORLEANS — Men and women with moderate levels of cardiorespiratory fitness may be at significantly reduced risk for stroke, according to the findings of a large, prospective study with long-term follow-up.

More than 46,400 men and nearly 15,300 women aged 18–100 years participated in the study and were followed for an average of 18 years. Participants underwent a baseline physical examination between 1970 and 2001 and, at enrollment, had no known history of MI or stroke, had a normal resting electrocardiogram, and could achieve at least 85% of the age-predicted maximal heart rate during a treadmill exercise test, Steven Hooker, Ph.D., reported at International Stroke Conference 2008.

During the follow-up period, 692 strokes occurred in the men, and 171 occurred in the women. Significant linear trends between fitness levels and the rates of total stroke and nonfatal stroke were found in both men and women, and between fitness levels and the rate of fatal stroke in men, after adjustment for such demographic and biologic factors as age, examination year, smoking, family history of cardiovascular disease, and body mass index, Dr. Hooker said.

The risk of total stroke was reduced by 40% in men in the highest fitness level quartile, compared with those in the lowest quartile, and by 43% in women in the highest fitness quartile, compared with those in the lowest (hazard ratios of 0.6 and 0.57, respectively), Dr. Hooker, director of the Prevention Research Center at the University of South Carolina, Columbia, noted at the conference, sponsored by the American Stroke Association.

The risk of nonfatal stroke was reduced by 38% in men and by 44% in the women (HR 0.62 and 0.56, respectively) when comparing those in the highest and lowest fitness quartiles.

As for the fatal stroke rates, 186 fatal strokes occurred in men, and only 55 occurred in women in the study. The risk for men in the highest, compared with the lowest, fitness quartiles was significantly reduced by 50% (HR 0.5), but the difference between the rates in women in those quartiles (nearly 60%, HR 0.42) was not significant, most likely because the study wasn't powered to detect a significant difference because of the small number of fatal strokes in women.

“We [saw] a noticeable drop in the rate of stroke at a fitness level associated with 7–8 METs [metabolic equivalents] based on their maximal treadmill test to exhaustion. Interestingly, beyond that point, there is no further decline in total stroke rate,” Dr. Hooker said, noting that pattern was the same in men and women.

The study was the first to show a significant independent association between cardiorespiratory fitness and fatal and nonfatal stroke in men and nonfatal stroke in women, and one of few to use objective measures of fitness rather than self-reported physical activity levels. It shows a dramatic reduction in stroke incidence at those fitness levels, which are actually low levels of fitness for younger patients and moderate levels for older patients and which were seen in the lowest fitness quartile in the men and the second lowest in the women in this study.

“Basically, if folks are participating in some kind of physical activity that would meet current guidelines and recommendations for adults—brisk walking for 30 minutes 5 days a week, or jogging for 20–30 minutes 3 times a week—they would probably be able to attain and/or maintain that level of fitness, so I think there's some hope here for a lot of people out there,” Dr. Hooker said.

The study has a number of strengths but is limited by the fact that nonfatal strokes were self-reported (although in those for whom medical records were verified, the agreement rate between self-reports and records was 89%), the inability to adjust for dietary and medical issues and changes in fitness levels over time, and the fact that participants were mostly white, well educated, and had middle to upper level incomes, thus limiting the generalizability of the findings to populations, Dr. Hooker noted.

Among those strengths were the use of a baseline examination to detect clinical disease, the number of measured risk factors, and the large number of person-years of follow-up (about 800,000 for men and 250,000 for women).

NEW ORLEANS — Men and women with moderate levels of cardiorespiratory fitness may be at significantly reduced risk for stroke, according to the findings of a large, prospective study with long-term follow-up.

More than 46,400 men and nearly 15,300 women aged 18–100 years participated in the study and were followed for an average of 18 years. Participants underwent a baseline physical examination between 1970 and 2001 and, at enrollment, had no known history of MI or stroke, had a normal resting electrocardiogram, and could achieve at least 85% of the age-predicted maximal heart rate during a treadmill exercise test, Steven Hooker, Ph.D., reported at International Stroke Conference 2008.

During the follow-up period, 692 strokes occurred in the men, and 171 occurred in the women. Significant linear trends between fitness levels and the rates of total stroke and nonfatal stroke were found in both men and women, and between fitness levels and the rate of fatal stroke in men, after adjustment for such demographic and biologic factors as age, examination year, smoking, family history of cardiovascular disease, and body mass index, Dr. Hooker said.

The risk of total stroke was reduced by 40% in men in the highest fitness level quartile, compared with those in the lowest quartile, and by 43% in women in the highest fitness quartile, compared with those in the lowest (hazard ratios of 0.6 and 0.57, respectively), Dr. Hooker, director of the Prevention Research Center at the University of South Carolina, Columbia, noted at the conference, sponsored by the American Stroke Association.

The risk of nonfatal stroke was reduced by 38% in men and by 44% in the women (HR 0.62 and 0.56, respectively) when comparing those in the highest and lowest fitness quartiles.

As for the fatal stroke rates, 186 fatal strokes occurred in men, and only 55 occurred in women in the study. The risk for men in the highest, compared with the lowest, fitness quartiles was significantly reduced by 50% (HR 0.5), but the difference between the rates in women in those quartiles (nearly 60%, HR 0.42) was not significant, most likely because the study wasn't powered to detect a significant difference because of the small number of fatal strokes in women.

“We [saw] a noticeable drop in the rate of stroke at a fitness level associated with 7–8 METs [metabolic equivalents] based on their maximal treadmill test to exhaustion. Interestingly, beyond that point, there is no further decline in total stroke rate,” Dr. Hooker said, noting that pattern was the same in men and women.

The study was the first to show a significant independent association between cardiorespiratory fitness and fatal and nonfatal stroke in men and nonfatal stroke in women, and one of few to use objective measures of fitness rather than self-reported physical activity levels. It shows a dramatic reduction in stroke incidence at those fitness levels, which are actually low levels of fitness for younger patients and moderate levels for older patients and which were seen in the lowest fitness quartile in the men and the second lowest in the women in this study.

“Basically, if folks are participating in some kind of physical activity that would meet current guidelines and recommendations for adults—brisk walking for 30 minutes 5 days a week, or jogging for 20–30 minutes 3 times a week—they would probably be able to attain and/or maintain that level of fitness, so I think there's some hope here for a lot of people out there,” Dr. Hooker said.

The study has a number of strengths but is limited by the fact that nonfatal strokes were self-reported (although in those for whom medical records were verified, the agreement rate between self-reports and records was 89%), the inability to adjust for dietary and medical issues and changes in fitness levels over time, and the fact that participants were mostly white, well educated, and had middle to upper level incomes, thus limiting the generalizability of the findings to populations, Dr. Hooker noted.

Among those strengths were the use of a baseline examination to detect clinical disease, the number of measured risk factors, and the large number of person-years of follow-up (about 800,000 for men and 250,000 for women).

NEW ORLEANS — Men and women with moderate levels of cardiorespiratory fitness may be at significantly reduced risk for stroke, according to the findings of a large, prospective study with long-term follow-up.

More than 46,400 men and nearly 15,300 women aged 18–100 years participated in the study and were followed for an average of 18 years. Participants underwent a baseline physical examination between 1970 and 2001 and, at enrollment, had no known history of MI or stroke, had a normal resting electrocardiogram, and could achieve at least 85% of the age-predicted maximal heart rate during a treadmill exercise test, Steven Hooker, Ph.D., reported at International Stroke Conference 2008.

During the follow-up period, 692 strokes occurred in the men, and 171 occurred in the women. Significant linear trends between fitness levels and the rates of total stroke and nonfatal stroke were found in both men and women, and between fitness levels and the rate of fatal stroke in men, after adjustment for such demographic and biologic factors as age, examination year, smoking, family history of cardiovascular disease, and body mass index, Dr. Hooker said.

The risk of total stroke was reduced by 40% in men in the highest fitness level quartile, compared with those in the lowest quartile, and by 43% in women in the highest fitness quartile, compared with those in the lowest (hazard ratios of 0.6 and 0.57, respectively), Dr. Hooker, director of the Prevention Research Center at the University of South Carolina, Columbia, noted at the conference, sponsored by the American Stroke Association.

The risk of nonfatal stroke was reduced by 38% in men and by 44% in the women (HR 0.62 and 0.56, respectively) when comparing those in the highest and lowest fitness quartiles.

As for the fatal stroke rates, 186 fatal strokes occurred in men, and only 55 occurred in women in the study. The risk for men in the highest, compared with the lowest, fitness quartiles was significantly reduced by 50% (HR 0.5), but the difference between the rates in women in those quartiles (nearly 60%, HR 0.42) was not significant, most likely because the study wasn't powered to detect a significant difference because of the small number of fatal strokes in women.

“We [saw] a noticeable drop in the rate of stroke at a fitness level associated with 7–8 METs [metabolic equivalents] based on their maximal treadmill test to exhaustion. Interestingly, beyond that point, there is no further decline in total stroke rate,” Dr. Hooker said, noting that pattern was the same in men and women.

The study was the first to show a significant independent association between cardiorespiratory fitness and fatal and nonfatal stroke in men and nonfatal stroke in women, and one of few to use objective measures of fitness rather than self-reported physical activity levels. It shows a dramatic reduction in stroke incidence at those fitness levels, which are actually low levels of fitness for younger patients and moderate levels for older patients and which were seen in the lowest fitness quartile in the men and the second lowest in the women in this study.

“Basically, if folks are participating in some kind of physical activity that would meet current guidelines and recommendations for adults—brisk walking for 30 minutes 5 days a week, or jogging for 20–30 minutes 3 times a week—they would probably be able to attain and/or maintain that level of fitness, so I think there's some hope here for a lot of people out there,” Dr. Hooker said.

The study has a number of strengths but is limited by the fact that nonfatal strokes were self-reported (although in those for whom medical records were verified, the agreement rate between self-reports and records was 89%), the inability to adjust for dietary and medical issues and changes in fitness levels over time, and the fact that participants were mostly white, well educated, and had middle to upper level incomes, thus limiting the generalizability of the findings to populations, Dr. Hooker noted.

Among those strengths were the use of a baseline examination to detect clinical disease, the number of measured risk factors, and the large number of person-years of follow-up (about 800,000 for men and 250,000 for women).

KISSIMMEE, FLA. — Photopneumatic therapy is highly effective and nearly painless for the treatment of acne vulgaris, according to Dr. Michael Gold.

The recently approved Aesthera PPx laser system—which combines light energy and a vacuum apparatus to cleanse pores and destroy bacteria associated with acne vulgaris—was used to treat both pustular and comedonal acne in an open-label study involving 11 patients with mild to moderate acne, Dr. Gold said at the annual meeting of the American Society for Laser Medicine and Surgery.

Up to four treatments were provided at 3-week intervals, and all of the patients experienced significant and rapid clearing of their lesions, he reported.

Drying and flattening of the lesions were noted within 2 days of treatment in more than half of the patients, and most experienced sustained clearance at 3-month follow-up with a 78% reduction in inflammatory lesions, and up to a 70% reduction in noninflammatory lesions, Dr. Gold said.

Reported pain was minimal in more than 85% of patients, and 82% of patients said they were moderately or very satisfied with the outcomes.

Adverse events included only slight dryness post treatment, which was managed with application of a daily moisturizer, he said.

The findings are comparable with those from other studies of this device as reported in the literature, all of which have demonstrated its efficacy for the treatment of acne, said Dr. Gold of the Tennessee Clinical Research Center in Nashville.

Given that more than one-third of dermatology visits are associated with acne, this device—which is the only device that has been approved by the Food and Drug Administration to treat both comedonal and inflammatory acne, and which appears to be effective even in those patients who are nonresponders to traditional therapies—is a welcome addition to the acne treatment armamentarium, he concluded.

The study was sponsored by Aesthera Corp., which provided equipment, discounts, travel expenses, a research grant, and honoraria to Dr. Gold.

Photo at left shows a patient before treatment with the photopneumatic device. Photo at right shows improvement of the patient's acne after receiving four treatments over an interval of 3 weeks. Photos courtesty Dr. Michael Gold/Tennessee Clinical Research Center

KISSIMMEE, FLA. — Photopneumatic therapy is highly effective and nearly painless for the treatment of acne vulgaris, according to Dr. Michael Gold.

The recently approved Aesthera PPx laser system—which combines light energy and a vacuum apparatus to cleanse pores and destroy bacteria associated with acne vulgaris—was used to treat both pustular and comedonal acne in an open-label study involving 11 patients with mild to moderate acne, Dr. Gold said at the annual meeting of the American Society for Laser Medicine and Surgery.

Up to four treatments were provided at 3-week intervals, and all of the patients experienced significant and rapid clearing of their lesions, he reported.

Drying and flattening of the lesions were noted within 2 days of treatment in more than half of the patients, and most experienced sustained clearance at 3-month follow-up with a 78% reduction in inflammatory lesions, and up to a 70% reduction in noninflammatory lesions, Dr. Gold said.

Reported pain was minimal in more than 85% of patients, and 82% of patients said they were moderately or very satisfied with the outcomes.

Adverse events included only slight dryness post treatment, which was managed with application of a daily moisturizer, he said.

The findings are comparable with those from other studies of this device as reported in the literature, all of which have demonstrated its efficacy for the treatment of acne, said Dr. Gold of the Tennessee Clinical Research Center in Nashville.

Given that more than one-third of dermatology visits are associated with acne, this device—which is the only device that has been approved by the Food and Drug Administration to treat both comedonal and inflammatory acne, and which appears to be effective even in those patients who are nonresponders to traditional therapies—is a welcome addition to the acne treatment armamentarium, he concluded.

The study was sponsored by Aesthera Corp., which provided equipment, discounts, travel expenses, a research grant, and honoraria to Dr. Gold.

Photo at left shows a patient before treatment with the photopneumatic device. Photo at right shows improvement of the patient's acne after receiving four treatments over an interval of 3 weeks. Photos courtesty Dr. Michael Gold/Tennessee Clinical Research Center

KISSIMMEE, FLA. — Photopneumatic therapy is highly effective and nearly painless for the treatment of acne vulgaris, according to Dr. Michael Gold.

The recently approved Aesthera PPx laser system—which combines light energy and a vacuum apparatus to cleanse pores and destroy bacteria associated with acne vulgaris—was used to treat both pustular and comedonal acne in an open-label study involving 11 patients with mild to moderate acne, Dr. Gold said at the annual meeting of the American Society for Laser Medicine and Surgery.

Up to four treatments were provided at 3-week intervals, and all of the patients experienced significant and rapid clearing of their lesions, he reported.

Drying and flattening of the lesions were noted within 2 days of treatment in more than half of the patients, and most experienced sustained clearance at 3-month follow-up with a 78% reduction in inflammatory lesions, and up to a 70% reduction in noninflammatory lesions, Dr. Gold said.

Reported pain was minimal in more than 85% of patients, and 82% of patients said they were moderately or very satisfied with the outcomes.

Adverse events included only slight dryness post treatment, which was managed with application of a daily moisturizer, he said.

The findings are comparable with those from other studies of this device as reported in the literature, all of which have demonstrated its efficacy for the treatment of acne, said Dr. Gold of the Tennessee Clinical Research Center in Nashville.

Given that more than one-third of dermatology visits are associated with acne, this device—which is the only device that has been approved by the Food and Drug Administration to treat both comedonal and inflammatory acne, and which appears to be effective even in those patients who are nonresponders to traditional therapies—is a welcome addition to the acne treatment armamentarium, he concluded.

The study was sponsored by Aesthera Corp., which provided equipment, discounts, travel expenses, a research grant, and honoraria to Dr. Gold.

Photo at left shows a patient before treatment with the photopneumatic device. Photo at right shows improvement of the patient's acne after receiving four treatments over an interval of 3 weeks. Photos courtesty Dr. Michael Gold/Tennessee Clinical Research Center

Survivors of childhood cancers have a substantially increased risk of developing heart disease in early adulthood, compared with their healthy siblings, new findings from the Childhood Cancer Survivor Study show.

The investigators analyzed data from 14,358 5-year survivors of eight childhood cancers and 3,899 sibling controls. Increased risk in survivors ranged from 5 times more likely to suffer a heart attack to 10 times more likely to have atherosclerosis at an early age.

Anthracycline exposure and radiation to the heart also increased the risk of heart disease in early adulthood when exposed survivors were compared with survivors who had not received anthracycline drugs or radiation to the heart.

The data were presented at the annual meeting of the American Society of Clinical Oncology (ASCO). An abstract was posted on the society's Web site (www.asco.org

Survivors in the study had been diagnosed with leukemia, central nervous system tumors, Hodgkin's or non-Hodgkin's lymphoma, renal tumors, neuroblastoma, soft-tissue sarcoma, or bone cancer between 1970 and 1986 before reaching 21 years of age. Their mean age was 7.8 years at diagnosis, and 27.5 years at follow-up.

After adjustment for age, gender, race, sociodemographic factors, and smoking status, survivors were more likely than were their siblings to report congestive heart failure (relative risk 5.7), myocardial infarction (RR 4.9), atherosclerosis (RR 10), pericardial and valvular disease (RR 6.3 and 4.8, respectively), and coronary angiography (RR 8.2), reported Dr. Mulrooney of the University of Minnesota, Minneapolis.

He noted that cardiac toxicity can occur years after the cancer diagnosis, and that incidence increases steadily over time. “Cardiovascular monitoring of early childhood cancer survivors should begin early and be life long,” he concluded.

Dr. Richard L. Schilsky, president-elect of ASCO and professor of medicine at the University of Chicago, said the findings add to the increasing knowledge of the effects of childhood cancer on later health outcomes, and that they underscore the need for appropriate monitoring of survivors.

Previous studies have shown childhood cancer treatments have consequences on bone health, fertility, thyroid health, and mental health, and that survivors are also at increased risk of developing another malignancy. These findings have become increasingly important given the improvements in cancer treatments—and thus the increasing number of childhood cancer survivors. Currently, there are more than 11 million cancer survivors in the United States; among them, about 270,000 are survivors of childhood cancers, Dr. Mulrooney said.

“Patients and their physicians [must] keep in mind that being a cancer survivor is a very special diagnosis in many ways and carries with it a responsibility to understand the long-term consequences of cancer treatment and to monitor patients appropriately for health problems that might develop,” Dr. Schilsky said.

Since many survivors elect to transfer their care from oncologists to primary care physicians, it is incumbent on both the patients and their physicians to be aware of the patient's cancer and treatment history and the potential consequences of that history, he added.

ASCO is developing a care planning tool for oncologists to provide to patients who transfer their care in an effort to ensure appropriate monitoring and continuity of care, he noted.

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Survivors of childhood cancers have a substantially increased risk of developing heart disease in early adulthood, compared with their healthy siblings, new findings from the Childhood Cancer Survivor Study show.

The investigators analyzed data from 14,358 5-year survivors of eight childhood cancers and 3,899 sibling controls. Increased risk in survivors ranged from 5 times more likely to suffer a heart attack to 10 times more likely to have atherosclerosis at an early age.

Anthracycline exposure and radiation to the heart also increased the risk of heart disease in early adulthood when exposed survivors were compared with survivors who had not received anthracycline drugs or radiation to the heart.

The data were presented at the annual meeting of the American Society of Clinical Oncology (ASCO). An abstract was posted on the society's Web site (www.asco.org

Survivors in the study had been diagnosed with leukemia, central nervous system tumors, Hodgkin's or non-Hodgkin's lymphoma, renal tumors, neuroblastoma, soft-tissue sarcoma, or bone cancer between 1970 and 1986 before reaching 21 years of age. Their mean age was 7.8 years at diagnosis, and 27.5 years at follow-up.

After adjustment for age, gender, race, sociodemographic factors, and smoking status, survivors were more likely than were their siblings to report congestive heart failure (relative risk 5.7), myocardial infarction (RR 4.9), atherosclerosis (RR 10), pericardial and valvular disease (RR 6.3 and 4.8, respectively), and coronary angiography (RR 8.2), reported Dr. Mulrooney of the University of Minnesota, Minneapolis.

He noted that cardiac toxicity can occur years after the cancer diagnosis, and that incidence increases steadily over time. “Cardiovascular monitoring of early childhood cancer survivors should begin early and be life long,” he concluded.

Dr. Richard L. Schilsky, president-elect of ASCO and professor of medicine at the University of Chicago, said the findings add to the increasing knowledge of the effects of childhood cancer on later health outcomes, and that they underscore the need for appropriate monitoring of survivors.

Previous studies have shown childhood cancer treatments have consequences on bone health, fertility, thyroid health, and mental health, and that survivors are also at increased risk of developing another malignancy. These findings have become increasingly important given the improvements in cancer treatments—and thus the increasing number of childhood cancer survivors. Currently, there are more than 11 million cancer survivors in the United States; among them, about 270,000 are survivors of childhood cancers, Dr. Mulrooney said.

“Patients and their physicians [must] keep in mind that being a cancer survivor is a very special diagnosis in many ways and carries with it a responsibility to understand the long-term consequences of cancer treatment and to monitor patients appropriately for health problems that might develop,” Dr. Schilsky said.

Since many survivors elect to transfer their care from oncologists to primary care physicians, it is incumbent on both the patients and their physicians to be aware of the patient's cancer and treatment history and the potential consequences of that history, he added.

ASCO is developing a care planning tool for oncologists to provide to patients who transfer their care in an effort to ensure appropriate monitoring and continuity of care, he noted.

ELSEVIER GLOBAL MEDICAL NEWS

ELSEVIER GLOBAL MEDICAL NEWS

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Survivors of childhood cancers have a substantially increased risk of developing heart disease in early adulthood, compared with their healthy siblings, new findings from the Childhood Cancer Survivor Study show.

The investigators analyzed data from 14,358 5-year survivors of eight childhood cancers and 3,899 sibling controls. Increased risk in survivors ranged from 5 times more likely to suffer a heart attack to 10 times more likely to have atherosclerosis at an early age.

Anthracycline exposure and radiation to the heart also increased the risk of heart disease in early adulthood when exposed survivors were compared with survivors who had not received anthracycline drugs or radiation to the heart.

The data were presented at the annual meeting of the American Society of Clinical Oncology (ASCO). An abstract was posted on the society's Web site (www.asco.org

Survivors in the study had been diagnosed with leukemia, central nervous system tumors, Hodgkin's or non-Hodgkin's lymphoma, renal tumors, neuroblastoma, soft-tissue sarcoma, or bone cancer between 1970 and 1986 before reaching 21 years of age. Their mean age was 7.8 years at diagnosis, and 27.5 years at follow-up.

After adjustment for age, gender, race, sociodemographic factors, and smoking status, survivors were more likely than were their siblings to report congestive heart failure (relative risk 5.7), myocardial infarction (RR 4.9), atherosclerosis (RR 10), pericardial and valvular disease (RR 6.3 and 4.8, respectively), and coronary angiography (RR 8.2), reported Dr. Mulrooney of the University of Minnesota, Minneapolis.

He noted that cardiac toxicity can occur years after the cancer diagnosis, and that incidence increases steadily over time. “Cardiovascular monitoring of early childhood cancer survivors should begin early and be life long,” he concluded.

Dr. Richard L. Schilsky, president-elect of ASCO and professor of medicine at the University of Chicago, said the findings add to the increasing knowledge of the effects of childhood cancer on later health outcomes, and that they underscore the need for appropriate monitoring of survivors.

Previous studies have shown childhood cancer treatments have consequences on bone health, fertility, thyroid health, and mental health, and that survivors are also at increased risk of developing another malignancy. These findings have become increasingly important given the improvements in cancer treatments—and thus the increasing number of childhood cancer survivors. Currently, there are more than 11 million cancer survivors in the United States; among them, about 270,000 are survivors of childhood cancers, Dr. Mulrooney said.

“Patients and their physicians [must] keep in mind that being a cancer survivor is a very special diagnosis in many ways and carries with it a responsibility to understand the long-term consequences of cancer treatment and to monitor patients appropriately for health problems that might develop,” Dr. Schilsky said.

Since many survivors elect to transfer their care from oncologists to primary care physicians, it is incumbent on both the patients and their physicians to be aware of the patient's cancer and treatment history and the potential consequences of that history, he added.

ASCO is developing a care planning tool for oncologists to provide to patients who transfer their care in an effort to ensure appropriate monitoring and continuity of care, he noted.

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TAMPA — Vaginal radical trachelectomy is a safe and effective option for preserving fertility in young women with early-stage cervical cancer, according to a review of outcomes in 113 patients.

A review of consecutive patients who underwent vaginal radical trachelectomy (VRT) between October 1991 and October 2007 showed that, at 74 months, disease-free survival was greater than 95%, and 87 pregnancies had occurred in 51 of the 113 women, Dr. Marie Plante reported in a poster at the annual meeting of the Society of Gynecologic Oncologists.

Thirty-one women had one pregnancy, nine had two pregnancies, six had three pregnancies, and five had four pregnancies during the study period. There were 58 third-trimester deliveries; 17 pregnancies ended in miscarriage in the first trimester, and 3 ended in miscarriage in the second trimester. Four women had therapeutic abortions, and five women were pregnant at the time of the report, Dr. Plante said.

Of those who delivered during the third trimester, 3 delivered prior to 32 weeks' gestation, 8 delivered between 32 and 37 weeks, and 47 delivered after 37 weeks.

VRT in this study was used in patients who desired to preserve fertility and who were under the age of 45 years. However, a history of infertility and advanced maternal age are not considered absolute contraindications to the procedure, noted Dr. Plante of Laval University, Quebec City.

The patients had International Federation of Gynecology and Obstetrics stage IA1 with vascular space involvement, IA2, or IB1 disease; squamous or adenocarcinoma histology; lesion size of 2-cm diameter or less; and limited endocervical involvement.

VRT was preceded by laparoscopic sentinel node mapping and bilateral pelvic node dissection, and sentinel nodes were sent for frozen section. VRT was abandoned if the nodes were positive or if extensive endocervical involvement was found.

Neoadjuvant chemotherapy was used in three patients for locally advanced disease. Each received three cycles of chemotherapy with paclitaxel, ifosfamide, and platinum, followed by VRT, node mapping, and dissection. Of these patients, two had residual dysplasia, and all had negative lymph nodes.

One of the patients who received neoadjuvant chemotherapy delivered two term babies (1 year apart), one patient was infertile because of cervical stenosis and transient ovarian failure (but she conceived with intrauterine insemination and Clomid and delivered at 36 weeks' gestation), and one was infertile because of ovarian failure and was unable to conceive.

TAMPA — Vaginal radical trachelectomy is a safe and effective option for preserving fertility in young women with early-stage cervical cancer, according to a review of outcomes in 113 patients.

A review of consecutive patients who underwent vaginal radical trachelectomy (VRT) between October 1991 and October 2007 showed that, at 74 months, disease-free survival was greater than 95%, and 87 pregnancies had occurred in 51 of the 113 women, Dr. Marie Plante reported in a poster at the annual meeting of the Society of Gynecologic Oncologists.

Thirty-one women had one pregnancy, nine had two pregnancies, six had three pregnancies, and five had four pregnancies during the study period. There were 58 third-trimester deliveries; 17 pregnancies ended in miscarriage in the first trimester, and 3 ended in miscarriage in the second trimester. Four women had therapeutic abortions, and five women were pregnant at the time of the report, Dr. Plante said.

Of those who delivered during the third trimester, 3 delivered prior to 32 weeks' gestation, 8 delivered between 32 and 37 weeks, and 47 delivered after 37 weeks.

VRT in this study was used in patients who desired to preserve fertility and who were under the age of 45 years. However, a history of infertility and advanced maternal age are not considered absolute contraindications to the procedure, noted Dr. Plante of Laval University, Quebec City.

The patients had International Federation of Gynecology and Obstetrics stage IA1 with vascular space involvement, IA2, or IB1 disease; squamous or adenocarcinoma histology; lesion size of 2-cm diameter or less; and limited endocervical involvement.

VRT was preceded by laparoscopic sentinel node mapping and bilateral pelvic node dissection, and sentinel nodes were sent for frozen section. VRT was abandoned if the nodes were positive or if extensive endocervical involvement was found.

Neoadjuvant chemotherapy was used in three patients for locally advanced disease. Each received three cycles of chemotherapy with paclitaxel, ifosfamide, and platinum, followed by VRT, node mapping, and dissection. Of these patients, two had residual dysplasia, and all had negative lymph nodes.

One of the patients who received neoadjuvant chemotherapy delivered two term babies (1 year apart), one patient was infertile because of cervical stenosis and transient ovarian failure (but she conceived with intrauterine insemination and Clomid and delivered at 36 weeks' gestation), and one was infertile because of ovarian failure and was unable to conceive.

TAMPA — Vaginal radical trachelectomy is a safe and effective option for preserving fertility in young women with early-stage cervical cancer, according to a review of outcomes in 113 patients.

A review of consecutive patients who underwent vaginal radical trachelectomy (VRT) between October 1991 and October 2007 showed that, at 74 months, disease-free survival was greater than 95%, and 87 pregnancies had occurred in 51 of the 113 women, Dr. Marie Plante reported in a poster at the annual meeting of the Society of Gynecologic Oncologists.

Thirty-one women had one pregnancy, nine had two pregnancies, six had three pregnancies, and five had four pregnancies during the study period. There were 58 third-trimester deliveries; 17 pregnancies ended in miscarriage in the first trimester, and 3 ended in miscarriage in the second trimester. Four women had therapeutic abortions, and five women were pregnant at the time of the report, Dr. Plante said.

Of those who delivered during the third trimester, 3 delivered prior to 32 weeks' gestation, 8 delivered between 32 and 37 weeks, and 47 delivered after 37 weeks.

VRT in this study was used in patients who desired to preserve fertility and who were under the age of 45 years. However, a history of infertility and advanced maternal age are not considered absolute contraindications to the procedure, noted Dr. Plante of Laval University, Quebec City.

The patients had International Federation of Gynecology and Obstetrics stage IA1 with vascular space involvement, IA2, or IB1 disease; squamous or adenocarcinoma histology; lesion size of 2-cm diameter or less; and limited endocervical involvement.

VRT was preceded by laparoscopic sentinel node mapping and bilateral pelvic node dissection, and sentinel nodes were sent for frozen section. VRT was abandoned if the nodes were positive or if extensive endocervical involvement was found.

Neoadjuvant chemotherapy was used in three patients for locally advanced disease. Each received three cycles of chemotherapy with paclitaxel, ifosfamide, and platinum, followed by VRT, node mapping, and dissection. Of these patients, two had residual dysplasia, and all had negative lymph nodes.

One of the patients who received neoadjuvant chemotherapy delivered two term babies (1 year apart), one patient was infertile because of cervical stenosis and transient ovarian failure (but she conceived with intrauterine insemination and Clomid and delivered at 36 weeks' gestation), and one was infertile because of ovarian failure and was unable to conceive.

KISSIMMEE, FLA. — Fractional CO2 laser treatment is highly effective for neck rejuvenation, offering substantial improvement in skin laxity, rhytids, texture, and pigmentation with a favorable adverse events profile, reported Dr. Lori Brightman.

In a study of 13 patients aged 30–75 years who underwent treatment of the neck using the Fraxel CO2 laser, improvement on these outcome measures was mostly in the 25%-75% range after two treatments, with some patients experiencing 75%-100% improvement, she said at the annual meeting of the American Society for Laser Medicine and Surgery.

The mean improvement for each measure was well above 50%, she said, noting that "this is something we consistently reproduced." Some patients also experienced platysmal band improvement, added Dr. Brightman of the Laser & Skin Surgery Center of New York.

The patients were treated using a 15-mm spot size, an energy setting of 4–70 mJ, and 100–200 microthermal zones with a 30%-50% density for each pass. Between two and four passes were made, depending on the degree of skin laxity and rhytids. Each patient underwent two treatments at 1–3 months apart, with follow-up at 3 months following the second procedure.

Three blinded dermatologic physicians evaluated pre- and posttreatment photos to determine improvements in the degree of rhytids, crepe-like skin, skin tightening, and pigmentation.

All patients experienced posttreatment erythema and some slight edema with resolution in about 1 week. There were no cases of scarring, hyperpigmentation, or hypopigmentation in the short or long term.

"We feel that these results strongly support the use of the fractional CO2 laser off of the face, in particular to rejuvenate the neck with a very low risk of adverse events," Dr. Brightman concluded.

Dr. Brightman stated that she had no disclosures relevant to her presentation.

KISSIMMEE, FLA. — Fractional CO2 laser treatment is highly effective for neck rejuvenation, offering substantial improvement in skin laxity, rhytids, texture, and pigmentation with a favorable adverse events profile, reported Dr. Lori Brightman.

In a study of 13 patients aged 30–75 years who underwent treatment of the neck using the Fraxel CO2 laser, improvement on these outcome measures was mostly in the 25%-75% range after two treatments, with some patients experiencing 75%-100% improvement, she said at the annual meeting of the American Society for Laser Medicine and Surgery.

The mean improvement for each measure was well above 50%, she said, noting that "this is something we consistently reproduced." Some patients also experienced platysmal band improvement, added Dr. Brightman of the Laser & Skin Surgery Center of New York.

The patients were treated using a 15-mm spot size, an energy setting of 4–70 mJ, and 100–200 microthermal zones with a 30%-50% density for each pass. Between two and four passes were made, depending on the degree of skin laxity and rhytids. Each patient underwent two treatments at 1–3 months apart, with follow-up at 3 months following the second procedure.

Three blinded dermatologic physicians evaluated pre- and posttreatment photos to determine improvements in the degree of rhytids, crepe-like skin, skin tightening, and pigmentation.

All patients experienced posttreatment erythema and some slight edema with resolution in about 1 week. There were no cases of scarring, hyperpigmentation, or hypopigmentation in the short or long term.

"We feel that these results strongly support the use of the fractional CO2 laser off of the face, in particular to rejuvenate the neck with a very low risk of adverse events," Dr. Brightman concluded.

Dr. Brightman stated that she had no disclosures relevant to her presentation.

KISSIMMEE, FLA. — Fractional CO2 laser treatment is highly effective for neck rejuvenation, offering substantial improvement in skin laxity, rhytids, texture, and pigmentation with a favorable adverse events profile, reported Dr. Lori Brightman.

In a study of 13 patients aged 30–75 years who underwent treatment of the neck using the Fraxel CO2 laser, improvement on these outcome measures was mostly in the 25%-75% range after two treatments, with some patients experiencing 75%-100% improvement, she said at the annual meeting of the American Society for Laser Medicine and Surgery.

The mean improvement for each measure was well above 50%, she said, noting that "this is something we consistently reproduced." Some patients also experienced platysmal band improvement, added Dr. Brightman of the Laser & Skin Surgery Center of New York.

The patients were treated using a 15-mm spot size, an energy setting of 4–70 mJ, and 100–200 microthermal zones with a 30%-50% density for each pass. Between two and four passes were made, depending on the degree of skin laxity and rhytids. Each patient underwent two treatments at 1–3 months apart, with follow-up at 3 months following the second procedure.

Three blinded dermatologic physicians evaluated pre- and posttreatment photos to determine improvements in the degree of rhytids, crepe-like skin, skin tightening, and pigmentation.

All patients experienced posttreatment erythema and some slight edema with resolution in about 1 week. There were no cases of scarring, hyperpigmentation, or hypopigmentation in the short or long term.

"We feel that these results strongly support the use of the fractional CO2 laser off of the face, in particular to rejuvenate the neck with a very low risk of adverse events," Dr. Brightman concluded.

Dr. Brightman stated that she had no disclosures relevant to her presentation.

KISSIMMEE, FLA. — A second-generation erbium-doped 1550-nm laser is highly effective for fractional nonablative treatment of acne and surgical scars, and for moderate photoaging, data from a review of 877 cases revealed.

All patients had clear photographic documentation of improvement, with most achieving 70%-80% improvement, Dr. Vic A. Narurkar reported at the annual meeting of the American Society for Laser Medicine and Surgery.

Patients with Fitzpatrick skin types I-VI were treated over an 18-month period between 2005 and 2007 using the Fraxel laser (Reliant Technologies Inc.). Treatment parameters and treatment number varied based on skin type and indication. Patient charts and standardized photography were used to analyze clinical indication with efficacy, adverse effects, and skin types, said Dr. Narurkar, a dermatologist in private practice in San Francisco.

"We found that the best results were achieved with scars," he said, noting that the average improvement in his patients with acne and nonacne scars was about 80%. The next best results were seen with resurfacing on and off the face, with improvement ranging from 60% to 80%. The results were best in patients with Glogau photoaging II-III.

The most variable results were seen in patients undergoing treatment for melasma and deep rhytids; these patients had 20%-40% improvement.

The most common short-term adverse events in this study were transient edema and erythema, which occurred in all patients but resolved within 48 hours, and acne flares, which occurred in 26% of patients. The most common long-term side effect was postinflammatory hyperpigmentation, which was most common in those with type V skin, and which resolved in all patients, Dr. Narurkar said, noting that there were no permanent side effects.

Dr. Narurkar, who disclosed that he has received consulting fees and honoraria from Reliant, concluded that the second-generation erbium-doped 1550-nm laser is safe and effective for all skin types.

KISSIMMEE, FLA. — A second-generation erbium-doped 1550-nm laser is highly effective for fractional nonablative treatment of acne and surgical scars, and for moderate photoaging, data from a review of 877 cases revealed.

All patients had clear photographic documentation of improvement, with most achieving 70%-80% improvement, Dr. Vic A. Narurkar reported at the annual meeting of the American Society for Laser Medicine and Surgery.

Patients with Fitzpatrick skin types I-VI were treated over an 18-month period between 2005 and 2007 using the Fraxel laser (Reliant Technologies Inc.). Treatment parameters and treatment number varied based on skin type and indication. Patient charts and standardized photography were used to analyze clinical indication with efficacy, adverse effects, and skin types, said Dr. Narurkar, a dermatologist in private practice in San Francisco.

"We found that the best results were achieved with scars," he said, noting that the average improvement in his patients with acne and nonacne scars was about 80%. The next best results were seen with resurfacing on and off the face, with improvement ranging from 60% to 80%. The results were best in patients with Glogau photoaging II-III.

The most variable results were seen in patients undergoing treatment for melasma and deep rhytids; these patients had 20%-40% improvement.

The most common short-term adverse events in this study were transient edema and erythema, which occurred in all patients but resolved within 48 hours, and acne flares, which occurred in 26% of patients. The most common long-term side effect was postinflammatory hyperpigmentation, which was most common in those with type V skin, and which resolved in all patients, Dr. Narurkar said, noting that there were no permanent side effects.

Dr. Narurkar, who disclosed that he has received consulting fees and honoraria from Reliant, concluded that the second-generation erbium-doped 1550-nm laser is safe and effective for all skin types.

KISSIMMEE, FLA. — A second-generation erbium-doped 1550-nm laser is highly effective for fractional nonablative treatment of acne and surgical scars, and for moderate photoaging, data from a review of 877 cases revealed.

All patients had clear photographic documentation of improvement, with most achieving 70%-80% improvement, Dr. Vic A. Narurkar reported at the annual meeting of the American Society for Laser Medicine and Surgery.

Patients with Fitzpatrick skin types I-VI were treated over an 18-month period between 2005 and 2007 using the Fraxel laser (Reliant Technologies Inc.). Treatment parameters and treatment number varied based on skin type and indication. Patient charts and standardized photography were used to analyze clinical indication with efficacy, adverse effects, and skin types, said Dr. Narurkar, a dermatologist in private practice in San Francisco.

"We found that the best results were achieved with scars," he said, noting that the average improvement in his patients with acne and nonacne scars was about 80%. The next best results were seen with resurfacing on and off the face, with improvement ranging from 60% to 80%. The results were best in patients with Glogau photoaging II-III.

The most variable results were seen in patients undergoing treatment for melasma and deep rhytids; these patients had 20%-40% improvement.

The most common short-term adverse events in this study were transient edema and erythema, which occurred in all patients but resolved within 48 hours, and acne flares, which occurred in 26% of patients. The most common long-term side effect was postinflammatory hyperpigmentation, which was most common in those with type V skin, and which resolved in all patients, Dr. Narurkar said, noting that there were no permanent side effects.

Dr. Narurkar, who disclosed that he has received consulting fees and honoraria from Reliant, concluded that the second-generation erbium-doped 1550-nm laser is safe and effective for all skin types.

KISSIMMEE, FLA. — Combined radiofrequency energy and indocyanine green-mediated pulsed light phototherapy proved highly effective for the treatment of acne in a study of 14 Fitzpatrick skin type IV patients with substantial facial acne.

The patients, who were aged 16–35 years (mean age 25 years), and who had at least 10 inflamed facial acne lesions, were treated with 1 mg/mL indocyanine green (ICG) cream, which was applied to the face for 30 minutes and then wiped off. This was followed by combination pulsed light at 580–980 nm, and a radiofrequency device, Syneron Medical Ltd.'s Aurora SR, at an optical energy of 18–22 J/cm

The patients, who received no topical or oral acne medications in the 2 months prior to study initiation, received three treatments at 4-week intervals. Lesion count decreased by 18%, 49%, 68%, and 76%, at 4, 8, 12, and 16 weeks, respectively, after the initial treatment, said Dr. Rho of the Leaders Clinic in Seoul, South Korea.

Follow-up at 1, 4, 7, and 14 days after each treatment showed that side effects were minimal, and included only transient stinging and slight peeling, said Dr. Rho, who reported that he had no financial disclosures associated with his presentation.

ICG-mediated near-infrared light phototherapy has received a great deal of attention for the treatment of acne because of its sebaceous gland selectivity and high penetration depth. In addition, radiofrequency energy is known to reduce sebum production. Together, these treatments can substantially reduce the number of acne lesions, he said.

A 31-year-old female patient is shown before treatment (top). Improvement is seen after one session (bottom). Photos courtesy Dr. Nark-Kyoung Rho

ELSEVIER GLOBAL MEDICAL NEWS

KISSIMMEE, FLA. — Combined radiofrequency energy and indocyanine green-mediated pulsed light phototherapy proved highly effective for the treatment of acne in a study of 14 Fitzpatrick skin type IV patients with substantial facial acne.

The patients, who were aged 16–35 years (mean age 25 years), and who had at least 10 inflamed facial acne lesions, were treated with 1 mg/mL indocyanine green (ICG) cream, which was applied to the face for 30 minutes and then wiped off. This was followed by combination pulsed light at 580–980 nm, and a radiofrequency device, Syneron Medical Ltd.'s Aurora SR, at an optical energy of 18–22 J/cm

The patients, who received no topical or oral acne medications in the 2 months prior to study initiation, received three treatments at 4-week intervals. Lesion count decreased by 18%, 49%, 68%, and 76%, at 4, 8, 12, and 16 weeks, respectively, after the initial treatment, said Dr. Rho of the Leaders Clinic in Seoul, South Korea.

Follow-up at 1, 4, 7, and 14 days after each treatment showed that side effects were minimal, and included only transient stinging and slight peeling, said Dr. Rho, who reported that he had no financial disclosures associated with his presentation.

ICG-mediated near-infrared light phototherapy has received a great deal of attention for the treatment of acne because of its sebaceous gland selectivity and high penetration depth. In addition, radiofrequency energy is known to reduce sebum production. Together, these treatments can substantially reduce the number of acne lesions, he said.

A 31-year-old female patient is shown before treatment (top). Improvement is seen after one session (bottom). Photos courtesy Dr. Nark-Kyoung Rho

ELSEVIER GLOBAL MEDICAL NEWS

KISSIMMEE, FLA. — Combined radiofrequency energy and indocyanine green-mediated pulsed light phototherapy proved highly effective for the treatment of acne in a study of 14 Fitzpatrick skin type IV patients with substantial facial acne.

The patients, who were aged 16–35 years (mean age 25 years), and who had at least 10 inflamed facial acne lesions, were treated with 1 mg/mL indocyanine green (ICG) cream, which was applied to the face for 30 minutes and then wiped off. This was followed by combination pulsed light at 580–980 nm, and a radiofrequency device, Syneron Medical Ltd.'s Aurora SR, at an optical energy of 18–22 J/cm

The patients, who received no topical or oral acne medications in the 2 months prior to study initiation, received three treatments at 4-week intervals. Lesion count decreased by 18%, 49%, 68%, and 76%, at 4, 8, 12, and 16 weeks, respectively, after the initial treatment, said Dr. Rho of the Leaders Clinic in Seoul, South Korea.

Follow-up at 1, 4, 7, and 14 days after each treatment showed that side effects were minimal, and included only transient stinging and slight peeling, said Dr. Rho, who reported that he had no financial disclosures associated with his presentation.

ICG-mediated near-infrared light phototherapy has received a great deal of attention for the treatment of acne because of its sebaceous gland selectivity and high penetration depth. In addition, radiofrequency energy is known to reduce sebum production. Together, these treatments can substantially reduce the number of acne lesions, he said.

A 31-year-old female patient is shown before treatment (top). Improvement is seen after one session (bottom). Photos courtesy Dr. Nark-Kyoung Rho

ELSEVIER GLOBAL MEDICAL NEWS

KISSIMMEE, FLA. — Focal radiofrequency ablation of the neural innervation of the glabella muscle complex provided an effective and possibly more durable alternative to botulinum toxin in a series of 10 patients with concerns about glabellar frown lines.

The procedure, which is known as glabellar frown relaxation (GFX) radiofrequency ablation, was approved by the Food and Drug Administration for tissue ablation last year and has been touted as a new and improved means of relaxing frown lines without the use of toxins.

Of the 10 patients who underwent the treatment, 6 had an immediate complete response and 4 had partial attenuation of their frown lines, as judged by the inability to frown, said Dr. Cameron Rokhsar of Albert Einstein College of Medicine, New York.

Additionally, medial brow elevation occurred in five of the patients, he noted at the annual meeting of the American Society for Laser Medicine and Surgery.

The effects remained apparent at 3-month follow-up.

All patients tolerated the procedure; side effects were limited to bruising and moderate pain during treatment.

The GFX radiofrequency ablation procedure, which is performed under local anesthesia, involves insertion of a probe at the lateral canthi on each side and the use of mild electrostimulation to identify the rami of the temporal branch of the facial nerve innervating the corrugators.

A 20-second radiofrequency pulse is applied to cause the focal nerve injury, and the probe is then advanced on the nasal sidewall to identify and ablate the branches of the angular nerve innervating the procerus.

Although both botulinum toxin and GFX radiofrequency ablation target the nerves that cause frown lines, botulinum toxin therapies block signals sent from the nerves to the muscles while GFX radiofrequency energy is used to create focal damage to effectively weaken the motor nerves, Dr. Rokhsar explained.

As a result, the duration of effect is increased with GFX radiofrequency; some reports suggest that the duration can be up to 2 years, compared with 3–4 months for botulinum toxin treatments. Studies to review long-term efficacy are underway, he said, adding that "the procedure has a learning curve."

KISSIMMEE, FLA. — Focal radiofrequency ablation of the neural innervation of the glabella muscle complex provided an effective and possibly more durable alternative to botulinum toxin in a series of 10 patients with concerns about glabellar frown lines.

The procedure, which is known as glabellar frown relaxation (GFX) radiofrequency ablation, was approved by the Food and Drug Administration for tissue ablation last year and has been touted as a new and improved means of relaxing frown lines without the use of toxins.

Of the 10 patients who underwent the treatment, 6 had an immediate complete response and 4 had partial attenuation of their frown lines, as judged by the inability to frown, said Dr. Cameron Rokhsar of Albert Einstein College of Medicine, New York.

Additionally, medial brow elevation occurred in five of the patients, he noted at the annual meeting of the American Society for Laser Medicine and Surgery.

The effects remained apparent at 3-month follow-up.

All patients tolerated the procedure; side effects were limited to bruising and moderate pain during treatment.

The GFX radiofrequency ablation procedure, which is performed under local anesthesia, involves insertion of a probe at the lateral canthi on each side and the use of mild electrostimulation to identify the rami of the temporal branch of the facial nerve innervating the corrugators.

A 20-second radiofrequency pulse is applied to cause the focal nerve injury, and the probe is then advanced on the nasal sidewall to identify and ablate the branches of the angular nerve innervating the procerus.

Although both botulinum toxin and GFX radiofrequency ablation target the nerves that cause frown lines, botulinum toxin therapies block signals sent from the nerves to the muscles while GFX radiofrequency energy is used to create focal damage to effectively weaken the motor nerves, Dr. Rokhsar explained.

As a result, the duration of effect is increased with GFX radiofrequency; some reports suggest that the duration can be up to 2 years, compared with 3–4 months for botulinum toxin treatments. Studies to review long-term efficacy are underway, he said, adding that "the procedure has a learning curve."

KISSIMMEE, FLA. — Focal radiofrequency ablation of the neural innervation of the glabella muscle complex provided an effective and possibly more durable alternative to botulinum toxin in a series of 10 patients with concerns about glabellar frown lines.

The procedure, which is known as glabellar frown relaxation (GFX) radiofrequency ablation, was approved by the Food and Drug Administration for tissue ablation last year and has been touted as a new and improved means of relaxing frown lines without the use of toxins.

Of the 10 patients who underwent the treatment, 6 had an immediate complete response and 4 had partial attenuation of their frown lines, as judged by the inability to frown, said Dr. Cameron Rokhsar of Albert Einstein College of Medicine, New York.

Additionally, medial brow elevation occurred in five of the patients, he noted at the annual meeting of the American Society for Laser Medicine and Surgery.

The effects remained apparent at 3-month follow-up.

All patients tolerated the procedure; side effects were limited to bruising and moderate pain during treatment.

The GFX radiofrequency ablation procedure, which is performed under local anesthesia, involves insertion of a probe at the lateral canthi on each side and the use of mild electrostimulation to identify the rami of the temporal branch of the facial nerve innervating the corrugators.

A 20-second radiofrequency pulse is applied to cause the focal nerve injury, and the probe is then advanced on the nasal sidewall to identify and ablate the branches of the angular nerve innervating the procerus.

Although both botulinum toxin and GFX radiofrequency ablation target the nerves that cause frown lines, botulinum toxin therapies block signals sent from the nerves to the muscles while GFX radiofrequency energy is used to create focal damage to effectively weaken the motor nerves, Dr. Rokhsar explained.

As a result, the duration of effect is increased with GFX radiofrequency; some reports suggest that the duration can be up to 2 years, compared with 3–4 months for botulinum toxin treatments. Studies to review long-term efficacy are underway, he said, adding that "the procedure has a learning curve."

KISSIMMEE, FLA. — A single treatment with a microfractional 2940-nm erbium:YAG laser resulted in perioral wrinkle reduction of greater than 40% and an improvement of 2–3 grades on the Fitzpatrick wrinkle assessment scale in a recent study.

In all, 23 patients with a score of 5–9 on the 9-point Fitzpatrick scale underwent full-face laser treatment. The improvements from baseline were noted after the first treatment, Dr. E. Victor Ross reported at the annual meeting of the American Society for Laser Medicine and Surgery.

The patients, who had skin types ranging from I to III, were treated with a 6- to 10-mm spot size and energy ranging from 400 to 920 microbeams/cm

Between one and three passes were used in less photodamaged areas, and three to eight passes were used in more severely damaged areas. Additionally, small areas were treated with a traditional short-pulse erbium:YAG laser at four passes and 5 J/cm

Preliminary findings suggest that the microfractional erbium:YAG treatments resulted in a similar wrinkle response to that observed with traditional short-pulse erbium:YAG laser treatments; however, healing times were reduced with the microfractional erbium:YAG, said Dr. Ross of the Scripps Clinic in San Diego.

Dr. Ross acknowledged that he has received equipment, consulting fees, and a research grant from Palomar Medical Technologies Inc.

"There was very rapid recovery, both histologically and clinically," he said, noting that the average full-face treatment time was 48 minutes. Re-epithelialization of the basal layer of the epidermis occurred within 12–24 hours, and complete re-epithelialization occurred within 4–5 days.

Bronzed skin was noted immediately after the treatments, and some patients experienced focal pinpoint hemorrhage. At 2 weeks, however, only mild erythema remained, he said.

On microscopic examination, separated columns of ablation were noted, typically with a depth of 200 microns and 20–30 microns of residual thermal damage at the periphery of the conical microwounds.

Not only did the treatment lead to smoothing of the skin and reduction of perioral wrinkles, but improvements in dyschromia were also noted, Dr. Ross said.

Although optimal treatment parameters for wrinkle reduction remain to be defined, these findings suggest that microfractional 2940-nm laser treatment is superior to traditional short-pulse erbium:YAG laser treatment for this purpose, he concluded.

KISSIMMEE, FLA. — A single treatment with a microfractional 2940-nm erbium:YAG laser resulted in perioral wrinkle reduction of greater than 40% and an improvement of 2–3 grades on the Fitzpatrick wrinkle assessment scale in a recent study.

In all, 23 patients with a score of 5–9 on the 9-point Fitzpatrick scale underwent full-face laser treatment. The improvements from baseline were noted after the first treatment, Dr. E. Victor Ross reported at the annual meeting of the American Society for Laser Medicine and Surgery.

The patients, who had skin types ranging from I to III, were treated with a 6- to 10-mm spot size and energy ranging from 400 to 920 microbeams/cm

Between one and three passes were used in less photodamaged areas, and three to eight passes were used in more severely damaged areas. Additionally, small areas were treated with a traditional short-pulse erbium:YAG laser at four passes and 5 J/cm

Preliminary findings suggest that the microfractional erbium:YAG treatments resulted in a similar wrinkle response to that observed with traditional short-pulse erbium:YAG laser treatments; however, healing times were reduced with the microfractional erbium:YAG, said Dr. Ross of the Scripps Clinic in San Diego.

Dr. Ross acknowledged that he has received equipment, consulting fees, and a research grant from Palomar Medical Technologies Inc.

"There was very rapid recovery, both histologically and clinically," he said, noting that the average full-face treatment time was 48 minutes. Re-epithelialization of the basal layer of the epidermis occurred within 12–24 hours, and complete re-epithelialization occurred within 4–5 days.

Bronzed skin was noted immediately after the treatments, and some patients experienced focal pinpoint hemorrhage. At 2 weeks, however, only mild erythema remained, he said.

On microscopic examination, separated columns of ablation were noted, typically with a depth of 200 microns and 20–30 microns of residual thermal damage at the periphery of the conical microwounds.

Not only did the treatment lead to smoothing of the skin and reduction of perioral wrinkles, but improvements in dyschromia were also noted, Dr. Ross said.

Although optimal treatment parameters for wrinkle reduction remain to be defined, these findings suggest that microfractional 2940-nm laser treatment is superior to traditional short-pulse erbium:YAG laser treatment for this purpose, he concluded.

KISSIMMEE, FLA. — A single treatment with a microfractional 2940-nm erbium:YAG laser resulted in perioral wrinkle reduction of greater than 40% and an improvement of 2–3 grades on the Fitzpatrick wrinkle assessment scale in a recent study.

In all, 23 patients with a score of 5–9 on the 9-point Fitzpatrick scale underwent full-face laser treatment. The improvements from baseline were noted after the first treatment, Dr. E. Victor Ross reported at the annual meeting of the American Society for Laser Medicine and Surgery.

The patients, who had skin types ranging from I to III, were treated with a 6- to 10-mm spot size and energy ranging from 400 to 920 microbeams/cm

Between one and three passes were used in less photodamaged areas, and three to eight passes were used in more severely damaged areas. Additionally, small areas were treated with a traditional short-pulse erbium:YAG laser at four passes and 5 J/cm

Preliminary findings suggest that the microfractional erbium:YAG treatments resulted in a similar wrinkle response to that observed with traditional short-pulse erbium:YAG laser treatments; however, healing times were reduced with the microfractional erbium:YAG, said Dr. Ross of the Scripps Clinic in San Diego.

Dr. Ross acknowledged that he has received equipment, consulting fees, and a research grant from Palomar Medical Technologies Inc.

"There was very rapid recovery, both histologically and clinically," he said, noting that the average full-face treatment time was 48 minutes. Re-epithelialization of the basal layer of the epidermis occurred within 12–24 hours, and complete re-epithelialization occurred within 4–5 days.

Bronzed skin was noted immediately after the treatments, and some patients experienced focal pinpoint hemorrhage. At 2 weeks, however, only mild erythema remained, he said.

On microscopic examination, separated columns of ablation were noted, typically with a depth of 200 microns and 20–30 microns of residual thermal damage at the periphery of the conical microwounds.

Not only did the treatment lead to smoothing of the skin and reduction of perioral wrinkles, but improvements in dyschromia were also noted, Dr. Ross said.

Although optimal treatment parameters for wrinkle reduction remain to be defined, these findings suggest that microfractional 2940-nm laser treatment is superior to traditional short-pulse erbium:YAG laser treatment for this purpose, he concluded.

NEW ORLEANS — Differential prophylactic aspirin use may contribute to racial disparities in stroke mortality, but does not appear to play a role in geographic disparities, according to findings from a cohort of patients in the ongoing Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.

Nearly 17,000 adults, aged 45 years and older, participated in this segment of REGARDS, which included a computer-?assisted telephone survey regarding patterns of prophylactic aspirin use, a follow-up home visit for a brief medical evaluation including blood pressure measurement and blood sampling within 2 weeks of the survey, and follow-up telephone interviews every 6 months thereafter regarding events and changes in cognitive function, Virginia Howard explained at International Stroke Conference 2008, sponsored by the American Stroke Association.

Patients who self-reported a history of heart disease, stroke, or aspirin use for pain relief, and patients in whom aspirin use could not be determined, were excluded from the study.

Overall, about 31% of participants used aspirin prophylactically, with slightly higher rates in the “stroke belt” of the southeastern United States, compared with the rest of the country. Oversampling was done in the stroke belt because of the higher stroke rates in that region, explained Ms. Howard of the University of Alabama at Birmingham.

Men were significantly more likely than women to use aspirin prophylactically, and white participants were significantly more likely than blacks to use aspirin prophylactically. (See box.) There was also a trend toward increasing use with advancing age, she said.

Aspirin use also was higher among those with higher income levels and among those with the highest educational levels (although there was little difference in usage patterns at other educational levels), as well as among smokers (particularly past smokers) and those with hypertension, diabetes, and/or dyslipidemia.

The investigators also analyzed aspirin doses, comparing use of 75 mg vs. 325 mg. No geographic or age differences were noted in regard to dose, but the use of the lower dose was more common in whites, women, and those with higher socioeconomic status. No differences in dose were noted according to risk factors.

Overall, “we found that prophylactic aspirin use was remarkably common in this cohort,” said Ms. Howard, who holds a master of science degree in public health.

“Related to our primary goals, we did find that prophylactic aspirin use was higher among whites than African Americans, so this raises the possibility that this could be contributing to racial disparities in stroke mortality.”

However, counter to the investigators' hypothesis, the disparity in prophylactic aspirin use does not appear to contribute to the excess mortality in the stroke belt, as use was more common in that region compared with the rest of the nation, she said.

Ms. Howard noted that she had no financial conflicts of interest.

However, the lead investigator for this portion of the REGARD study, Dr. Stephen P. Glasser, who is also with the university, was a clinical site principal investigator for a previous trial sponsored by Bayer Healthcare.

ELSEVIER GLOBAL MEDICAL NEWS

NEW ORLEANS — Differential prophylactic aspirin use may contribute to racial disparities in stroke mortality, but does not appear to play a role in geographic disparities, according to findings from a cohort of patients in the ongoing Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.

Nearly 17,000 adults, aged 45 years and older, participated in this segment of REGARDS, which included a computer-?assisted telephone survey regarding patterns of prophylactic aspirin use, a follow-up home visit for a brief medical evaluation including blood pressure measurement and blood sampling within 2 weeks of the survey, and follow-up telephone interviews every 6 months thereafter regarding events and changes in cognitive function, Virginia Howard explained at International Stroke Conference 2008, sponsored by the American Stroke Association.

Patients who self-reported a history of heart disease, stroke, or aspirin use for pain relief, and patients in whom aspirin use could not be determined, were excluded from the study.

Overall, about 31% of participants used aspirin prophylactically, with slightly higher rates in the “stroke belt” of the southeastern United States, compared with the rest of the country. Oversampling was done in the stroke belt because of the higher stroke rates in that region, explained Ms. Howard of the University of Alabama at Birmingham.

Men were significantly more likely than women to use aspirin prophylactically, and white participants were significantly more likely than blacks to use aspirin prophylactically. (See box.) There was also a trend toward increasing use with advancing age, she said.

Aspirin use also was higher among those with higher income levels and among those with the highest educational levels (although there was little difference in usage patterns at other educational levels), as well as among smokers (particularly past smokers) and those with hypertension, diabetes, and/or dyslipidemia.

The investigators also analyzed aspirin doses, comparing use of 75 mg vs. 325 mg. No geographic or age differences were noted in regard to dose, but the use of the lower dose was more common in whites, women, and those with higher socioeconomic status. No differences in dose were noted according to risk factors.

Overall, “we found that prophylactic aspirin use was remarkably common in this cohort,” said Ms. Howard, who holds a master of science degree in public health.

“Related to our primary goals, we did find that prophylactic aspirin use was higher among whites than African Americans, so this raises the possibility that this could be contributing to racial disparities in stroke mortality.”

However, counter to the investigators' hypothesis, the disparity in prophylactic aspirin use does not appear to contribute to the excess mortality in the stroke belt, as use was more common in that region compared with the rest of the nation, she said.

Ms. Howard noted that she had no financial conflicts of interest.

However, the lead investigator for this portion of the REGARD study, Dr. Stephen P. Glasser, who is also with the university, was a clinical site principal investigator for a previous trial sponsored by Bayer Healthcare.

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NEW ORLEANS — Differential prophylactic aspirin use may contribute to racial disparities in stroke mortality, but does not appear to play a role in geographic disparities, according to findings from a cohort of patients in the ongoing Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.

Nearly 17,000 adults, aged 45 years and older, participated in this segment of REGARDS, which included a computer-?assisted telephone survey regarding patterns of prophylactic aspirin use, a follow-up home visit for a brief medical evaluation including blood pressure measurement and blood sampling within 2 weeks of the survey, and follow-up telephone interviews every 6 months thereafter regarding events and changes in cognitive function, Virginia Howard explained at International Stroke Conference 2008, sponsored by the American Stroke Association.

Patients who self-reported a history of heart disease, stroke, or aspirin use for pain relief, and patients in whom aspirin use could not be determined, were excluded from the study.

Overall, about 31% of participants used aspirin prophylactically, with slightly higher rates in the “stroke belt” of the southeastern United States, compared with the rest of the country. Oversampling was done in the stroke belt because of the higher stroke rates in that region, explained Ms. Howard of the University of Alabama at Birmingham.

Men were significantly more likely than women to use aspirin prophylactically, and white participants were significantly more likely than blacks to use aspirin prophylactically. (See box.) There was also a trend toward increasing use with advancing age, she said.

Aspirin use also was higher among those with higher income levels and among those with the highest educational levels (although there was little difference in usage patterns at other educational levels), as well as among smokers (particularly past smokers) and those with hypertension, diabetes, and/or dyslipidemia.

The investigators also analyzed aspirin doses, comparing use of 75 mg vs. 325 mg. No geographic or age differences were noted in regard to dose, but the use of the lower dose was more common in whites, women, and those with higher socioeconomic status. No differences in dose were noted according to risk factors.

Overall, “we found that prophylactic aspirin use was remarkably common in this cohort,” said Ms. Howard, who holds a master of science degree in public health.

“Related to our primary goals, we did find that prophylactic aspirin use was higher among whites than African Americans, so this raises the possibility that this could be contributing to racial disparities in stroke mortality.”

However, counter to the investigators' hypothesis, the disparity in prophylactic aspirin use does not appear to contribute to the excess mortality in the stroke belt, as use was more common in that region compared with the rest of the nation, she said.

Ms. Howard noted that she had no financial conflicts of interest.

However, the lead investigator for this portion of the REGARD study, Dr. Stephen P. Glasser, who is also with the university, was a clinical site principal investigator for a previous trial sponsored by Bayer Healthcare.

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