Sharon Worcester

FORT LAUDERDALE, FLA. — Ablation is playing an increasingly important role in the treatment of breast cancers, according to experts at the annual meeting of the American College of Surgeons.

Ablation-assisted lumpectomy techniques, including radiofrequency ablation-assisted lumpectomy and cryoassisted lumpectomy, which were designed to reduce the need for reexcision after breast tumor removal, are showing promise for improving outcomes in breast cancer patients.

Percutaneous laser ablation, which targets the tumors themselves, is also showing promise.

As tumors are detected earlier and at smaller sizes, surgical precision becomes more of a challenge, said Lorraine Tafra, M.D., who is the director of the breast center at Anne Arundel Medical Center, Annapolis, Md.

She added that conventional techniques may remove more tissue than necessary, leaving patients with excessive scarring, pain, and loss of tissue volume. Ablative techniques are being explored to provide more precision and reduce the need for additional surgical procedures to clear margins.

Lumpectomy assisted with radiofrequency ablation (RFA) involves the use of heat to sear a 1-cm margin around a tumor that has been excised. The goal is to reduce the risk of tumor recurrence and, thus, the need for repeat lumpectomy and/or radiation therapy, said Suzanne Klimberg, M.D., director of the division of breast surgical oncology at the University of Arkansas, Little Rock.

In an ongoing pilot study, 26 patients have undergone the procedure, which is followed by intraoperative immunofluorescence to ensure no residual live cells remain in the ablation zone. Of seven patients with positive margins who were successfully ablated, six most likely would have required reexcision had they undergone standard needle localization and lumpectomy, Dr. Klimberg noted.

The patients, who had been followed for up to 6 months at the time of her presentation, are doing well, she said.

Cryoassisted lumpectomy, which involves ultrasound-guided prelumpectomy insertion of a cryoprobe through the center of the tumor via a 3-mm incision, appears to facilitate more accurate tissue resection and to decrease positive margin rates, said Dr. Tafra.

The cryoprobe technique, which creates an ice ball that envelopes the tumor and the adjacent 5–10 mm of normal surrounding tissue, creating a template for excision, has been used successfully for fibroadenomas. It also appears to be of benefit for early breast cancers, said Dr. Tafra, who has served as a paid consultant for Sanarus.

In a pilot study, 24 patients with ultrasonographically visible stage T1 breast cancers that otherwise would have required wire localization underwent the cryoablative procedure. All lesions were successfully localized without complications. The mean tumor size was 1.2 cm (Ann. Surg. Oncol. 2003;10:1018–24).

The cryoassisted technique appears to eliminate many of the challenges associated with prelumpectomy wire localization, including patient discomfort associated with the relatively invasive procedure.

Studies are also underway to evaluate the use of percutaneous laser ablation on small breast cancers. This minimally invasive technique uses a needle the size of that used for stereotactic breast biopsy to deliver laser energy directly into a tumor until the tumor is heated to 140° F for 12–15 minutes, according to Kambiz Dowlatshahi, M.D., of Rush Medical College, Chicago.

The technique is useful for early invasive or in situ breast cancers that are less than 5 cm, he said.

Dr. Dowlatshahi said the benefits of percutaneous laser ablation include a low complication rate (there have been no complications in his experience), a short procedure duration (about 30 minutes), and the ability to perform the procedure in an office setting under local anesthesia. Most patients are sent home on acetaminophen, he said.

In early studies, lumpectomy following this procedure revealed that the laser energy completely destroyed the tumor and surrounding tissue.

FORT LAUDERDALE, FLA. — Ablation is playing an increasingly important role in the treatment of breast cancers, according to experts at the annual meeting of the American College of Surgeons.

Ablation-assisted lumpectomy techniques, including radiofrequency ablation-assisted lumpectomy and cryoassisted lumpectomy, which were designed to reduce the need for reexcision after breast tumor removal, are showing promise for improving outcomes in breast cancer patients.

Percutaneous laser ablation, which targets the tumors themselves, is also showing promise.

As tumors are detected earlier and at smaller sizes, surgical precision becomes more of a challenge, said Lorraine Tafra, M.D., who is the director of the breast center at Anne Arundel Medical Center, Annapolis, Md.

She added that conventional techniques may remove more tissue than necessary, leaving patients with excessive scarring, pain, and loss of tissue volume. Ablative techniques are being explored to provide more precision and reduce the need for additional surgical procedures to clear margins.

Lumpectomy assisted with radiofrequency ablation (RFA) involves the use of heat to sear a 1-cm margin around a tumor that has been excised. The goal is to reduce the risk of tumor recurrence and, thus, the need for repeat lumpectomy and/or radiation therapy, said Suzanne Klimberg, M.D., director of the division of breast surgical oncology at the University of Arkansas, Little Rock.

In an ongoing pilot study, 26 patients have undergone the procedure, which is followed by intraoperative immunofluorescence to ensure no residual live cells remain in the ablation zone. Of seven patients with positive margins who were successfully ablated, six most likely would have required reexcision had they undergone standard needle localization and lumpectomy, Dr. Klimberg noted.

The patients, who had been followed for up to 6 months at the time of her presentation, are doing well, she said.

Cryoassisted lumpectomy, which involves ultrasound-guided prelumpectomy insertion of a cryoprobe through the center of the tumor via a 3-mm incision, appears to facilitate more accurate tissue resection and to decrease positive margin rates, said Dr. Tafra.

The cryoprobe technique, which creates an ice ball that envelopes the tumor and the adjacent 5–10 mm of normal surrounding tissue, creating a template for excision, has been used successfully for fibroadenomas. It also appears to be of benefit for early breast cancers, said Dr. Tafra, who has served as a paid consultant for Sanarus.

In a pilot study, 24 patients with ultrasonographically visible stage T1 breast cancers that otherwise would have required wire localization underwent the cryoablative procedure. All lesions were successfully localized without complications. The mean tumor size was 1.2 cm (Ann. Surg. Oncol. 2003;10:1018–24).

The cryoassisted technique appears to eliminate many of the challenges associated with prelumpectomy wire localization, including patient discomfort associated with the relatively invasive procedure.

Studies are also underway to evaluate the use of percutaneous laser ablation on small breast cancers. This minimally invasive technique uses a needle the size of that used for stereotactic breast biopsy to deliver laser energy directly into a tumor until the tumor is heated to 140° F for 12–15 minutes, according to Kambiz Dowlatshahi, M.D., of Rush Medical College, Chicago.

The technique is useful for early invasive or in situ breast cancers that are less than 5 cm, he said.

Dr. Dowlatshahi said the benefits of percutaneous laser ablation include a low complication rate (there have been no complications in his experience), a short procedure duration (about 30 minutes), and the ability to perform the procedure in an office setting under local anesthesia. Most patients are sent home on acetaminophen, he said.

In early studies, lumpectomy following this procedure revealed that the laser energy completely destroyed the tumor and surrounding tissue.

FORT LAUDERDALE, FLA. — Ablation is playing an increasingly important role in the treatment of breast cancers, according to experts at the annual meeting of the American College of Surgeons.

Ablation-assisted lumpectomy techniques, including radiofrequency ablation-assisted lumpectomy and cryoassisted lumpectomy, which were designed to reduce the need for reexcision after breast tumor removal, are showing promise for improving outcomes in breast cancer patients.

Percutaneous laser ablation, which targets the tumors themselves, is also showing promise.

As tumors are detected earlier and at smaller sizes, surgical precision becomes more of a challenge, said Lorraine Tafra, M.D., who is the director of the breast center at Anne Arundel Medical Center, Annapolis, Md.

She added that conventional techniques may remove more tissue than necessary, leaving patients with excessive scarring, pain, and loss of tissue volume. Ablative techniques are being explored to provide more precision and reduce the need for additional surgical procedures to clear margins.

Lumpectomy assisted with radiofrequency ablation (RFA) involves the use of heat to sear a 1-cm margin around a tumor that has been excised. The goal is to reduce the risk of tumor recurrence and, thus, the need for repeat lumpectomy and/or radiation therapy, said Suzanne Klimberg, M.D., director of the division of breast surgical oncology at the University of Arkansas, Little Rock.

In an ongoing pilot study, 26 patients have undergone the procedure, which is followed by intraoperative immunofluorescence to ensure no residual live cells remain in the ablation zone. Of seven patients with positive margins who were successfully ablated, six most likely would have required reexcision had they undergone standard needle localization and lumpectomy, Dr. Klimberg noted.

The patients, who had been followed for up to 6 months at the time of her presentation, are doing well, she said.

Cryoassisted lumpectomy, which involves ultrasound-guided prelumpectomy insertion of a cryoprobe through the center of the tumor via a 3-mm incision, appears to facilitate more accurate tissue resection and to decrease positive margin rates, said Dr. Tafra.

The cryoprobe technique, which creates an ice ball that envelopes the tumor and the adjacent 5–10 mm of normal surrounding tissue, creating a template for excision, has been used successfully for fibroadenomas. It also appears to be of benefit for early breast cancers, said Dr. Tafra, who has served as a paid consultant for Sanarus.

In a pilot study, 24 patients with ultrasonographically visible stage T1 breast cancers that otherwise would have required wire localization underwent the cryoablative procedure. All lesions were successfully localized without complications. The mean tumor size was 1.2 cm (Ann. Surg. Oncol. 2003;10:1018–24).

The cryoassisted technique appears to eliminate many of the challenges associated with prelumpectomy wire localization, including patient discomfort associated with the relatively invasive procedure.

Studies are also underway to evaluate the use of percutaneous laser ablation on small breast cancers. This minimally invasive technique uses a needle the size of that used for stereotactic breast biopsy to deliver laser energy directly into a tumor until the tumor is heated to 140° F for 12–15 minutes, according to Kambiz Dowlatshahi, M.D., of Rush Medical College, Chicago.

The technique is useful for early invasive or in situ breast cancers that are less than 5 cm, he said.

Dr. Dowlatshahi said the benefits of percutaneous laser ablation include a low complication rate (there have been no complications in his experience), a short procedure duration (about 30 minutes), and the ability to perform the procedure in an office setting under local anesthesia. Most patients are sent home on acetaminophen, he said.

In early studies, lumpectomy following this procedure revealed that the laser energy completely destroyed the tumor and surrounding tissue.

ST. PETE BEACH, FLA. — Diclectin used for nausea and vomiting of pregnancy does not appear to affect the later neurocognitive development of children who are exposed to the drug in utero, Irena Nulman, M.D., and her colleagues at the Hospital for Sick Children, Toronto, reported at the annual meeting of the Teratology Society.

The drug, available in Canada but not in the United States at this time, has proved safe in terms of fetal dysmorphology, but its effects on the developing central nervous system have been unclear, the investigators reported in a poster at the meeting.

In a prospective, randomized, double-blind study, they examined children's neurocognitive development and measures of child behavior and language development. The study included 42 mother-child pairs exposed to nausea and vomiting of pregnancy (NVP) and diclectin, 37 pairs exposed to NVP but not to pharmacotherapy, and 25 pairs not exposed to NVP.

Groups did not differ significantly in any of these measures. Children in all groups had scores in the normal range on total indexes of IQ and on measures of temperament, behavior, and language. For example, performance IQ scores were a mean of 119.76 in the NVP/diclectin-exposed group, 111.75 in the NVP-only group, and 110.08 in the unexposed group.

“Exposure to diclectin does not adversely affect child long-term full-scale IQ. … When indicated, diclectin therapy should be instituted to prevent hyperemesis gravid[ar]um and improve pregnant women's life style,” they concluded.

Diclectin, manufactured by Duchesnay Inc., is a generic form of the drug Bendectin, which was marketed in the United States until 1983 when it was voluntarily withdrawn by its manufacturer, Merrell Dow Pharmaceuticals Inc., following a series of lawsuits claiming the drug caused birth defects. The company won every case and numerous studies have confirmed the drug's safety. Duchesnay Inc. is seeking FDA clearance to market the drug here.

ST. PETE BEACH, FLA. — Diclectin used for nausea and vomiting of pregnancy does not appear to affect the later neurocognitive development of children who are exposed to the drug in utero, Irena Nulman, M.D., and her colleagues at the Hospital for Sick Children, Toronto, reported at the annual meeting of the Teratology Society.

The drug, available in Canada but not in the United States at this time, has proved safe in terms of fetal dysmorphology, but its effects on the developing central nervous system have been unclear, the investigators reported in a poster at the meeting.

In a prospective, randomized, double-blind study, they examined children's neurocognitive development and measures of child behavior and language development. The study included 42 mother-child pairs exposed to nausea and vomiting of pregnancy (NVP) and diclectin, 37 pairs exposed to NVP but not to pharmacotherapy, and 25 pairs not exposed to NVP.

Groups did not differ significantly in any of these measures. Children in all groups had scores in the normal range on total indexes of IQ and on measures of temperament, behavior, and language. For example, performance IQ scores were a mean of 119.76 in the NVP/diclectin-exposed group, 111.75 in the NVP-only group, and 110.08 in the unexposed group.

“Exposure to diclectin does not adversely affect child long-term full-scale IQ. … When indicated, diclectin therapy should be instituted to prevent hyperemesis gravid[ar]um and improve pregnant women's life style,” they concluded.

Diclectin, manufactured by Duchesnay Inc., is a generic form of the drug Bendectin, which was marketed in the United States until 1983 when it was voluntarily withdrawn by its manufacturer, Merrell Dow Pharmaceuticals Inc., following a series of lawsuits claiming the drug caused birth defects. The company won every case and numerous studies have confirmed the drug's safety. Duchesnay Inc. is seeking FDA clearance to market the drug here.

ST. PETE BEACH, FLA. — Diclectin used for nausea and vomiting of pregnancy does not appear to affect the later neurocognitive development of children who are exposed to the drug in utero, Irena Nulman, M.D., and her colleagues at the Hospital for Sick Children, Toronto, reported at the annual meeting of the Teratology Society.

The drug, available in Canada but not in the United States at this time, has proved safe in terms of fetal dysmorphology, but its effects on the developing central nervous system have been unclear, the investigators reported in a poster at the meeting.

In a prospective, randomized, double-blind study, they examined children's neurocognitive development and measures of child behavior and language development. The study included 42 mother-child pairs exposed to nausea and vomiting of pregnancy (NVP) and diclectin, 37 pairs exposed to NVP but not to pharmacotherapy, and 25 pairs not exposed to NVP.

Groups did not differ significantly in any of these measures. Children in all groups had scores in the normal range on total indexes of IQ and on measures of temperament, behavior, and language. For example, performance IQ scores were a mean of 119.76 in the NVP/diclectin-exposed group, 111.75 in the NVP-only group, and 110.08 in the unexposed group.

“Exposure to diclectin does not adversely affect child long-term full-scale IQ. … When indicated, diclectin therapy should be instituted to prevent hyperemesis gravid[ar]um and improve pregnant women's life style,” they concluded.

Diclectin, manufactured by Duchesnay Inc., is a generic form of the drug Bendectin, which was marketed in the United States until 1983 when it was voluntarily withdrawn by its manufacturer, Merrell Dow Pharmaceuticals Inc., following a series of lawsuits claiming the drug caused birth defects. The company won every case and numerous studies have confirmed the drug's safety. Duchesnay Inc. is seeking FDA clearance to market the drug here.

NEW ORLEANS — A recent series of “curious” cases of large vulvar or labial abscesses in previously healthy children were associated with methicillin-resistant Staphylococcus aureus and represent the first reported cases of such abscesses in the pediatric and adolescent population, S. Paige Hertweck, M.D., reported at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

Six patients, aged 2, 16, and 17 months and 3, 12, and 16 years, presented during 2004 with vulvar or labial abscesses requiring debridement and drainage. All had confirmed S. aureus infection, and five of the patients had MRSA.

The MRSA cases presented initially with a red papule that progressed rapidly.

By day 2 a fulminant abscess extended significantly beyond the labia. The abscesses had an area greater than 5 cm.

After debridement and 48–72 hours of continuous drainage, all patients were treated with antibiotics. The use of small incisions at each end of the abscess cavities allowed digital manipulation, and the use of a small Penrose drain threaded through each incision and tied to itself allowed continuous drainage that negated the need for extensive packing, which can be difficult in children.

None of the children had typical risk factors for MRSA, although three did have household contacts with lesions that might have been associated with MRSA. All the infections were sensitive to clindamycin, Bactrim (trimethoprim-sulfamethoxazole), and vancomycin, Dr. Hertweck noted.

MRSA should be considered in all patients presenting with rapidly progressing vulvar or labial erythema. Aggressive treatment with incision and drainage in such cases is warranted, she said, noting that a limited incision site and the use of a Penrose drain are recommended in children. Appropriate antibiotic therapy should also be initiated.

“While our sensitivities may not translate to your community, it might be appropriate to start with something like clindamycin,” she said.

NEW ORLEANS — A recent series of “curious” cases of large vulvar or labial abscesses in previously healthy children were associated with methicillin-resistant Staphylococcus aureus and represent the first reported cases of such abscesses in the pediatric and adolescent population, S. Paige Hertweck, M.D., reported at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

Six patients, aged 2, 16, and 17 months and 3, 12, and 16 years, presented during 2004 with vulvar or labial abscesses requiring debridement and drainage. All had confirmed S. aureus infection, and five of the patients had MRSA.

The MRSA cases presented initially with a red papule that progressed rapidly.

By day 2 a fulminant abscess extended significantly beyond the labia. The abscesses had an area greater than 5 cm.

After debridement and 48–72 hours of continuous drainage, all patients were treated with antibiotics. The use of small incisions at each end of the abscess cavities allowed digital manipulation, and the use of a small Penrose drain threaded through each incision and tied to itself allowed continuous drainage that negated the need for extensive packing, which can be difficult in children.

None of the children had typical risk factors for MRSA, although three did have household contacts with lesions that might have been associated with MRSA. All the infections were sensitive to clindamycin, Bactrim (trimethoprim-sulfamethoxazole), and vancomycin, Dr. Hertweck noted.

MRSA should be considered in all patients presenting with rapidly progressing vulvar or labial erythema. Aggressive treatment with incision and drainage in such cases is warranted, she said, noting that a limited incision site and the use of a Penrose drain are recommended in children. Appropriate antibiotic therapy should also be initiated.

“While our sensitivities may not translate to your community, it might be appropriate to start with something like clindamycin,” she said.

NEW ORLEANS — A recent series of “curious” cases of large vulvar or labial abscesses in previously healthy children were associated with methicillin-resistant Staphylococcus aureus and represent the first reported cases of such abscesses in the pediatric and adolescent population, S. Paige Hertweck, M.D., reported at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

Six patients, aged 2, 16, and 17 months and 3, 12, and 16 years, presented during 2004 with vulvar or labial abscesses requiring debridement and drainage. All had confirmed S. aureus infection, and five of the patients had MRSA.

The MRSA cases presented initially with a red papule that progressed rapidly.

By day 2 a fulminant abscess extended significantly beyond the labia. The abscesses had an area greater than 5 cm.

After debridement and 48–72 hours of continuous drainage, all patients were treated with antibiotics. The use of small incisions at each end of the abscess cavities allowed digital manipulation, and the use of a small Penrose drain threaded through each incision and tied to itself allowed continuous drainage that negated the need for extensive packing, which can be difficult in children.

None of the children had typical risk factors for MRSA, although three did have household contacts with lesions that might have been associated with MRSA. All the infections were sensitive to clindamycin, Bactrim (trimethoprim-sulfamethoxazole), and vancomycin, Dr. Hertweck noted.

MRSA should be considered in all patients presenting with rapidly progressing vulvar or labial erythema. Aggressive treatment with incision and drainage in such cases is warranted, she said, noting that a limited incision site and the use of a Penrose drain are recommended in children. Appropriate antibiotic therapy should also be initiated.

“While our sensitivities may not translate to your community, it might be appropriate to start with something like clindamycin,” she said.

ST. PETE BEACH, FLA. – Attending a specialized clinic for pregnant women with substance use disorders helped medical students in a recent study feel more comfortable and less judgmental when working with such patients.

A total of 104 consecutive third-year students rotating on an 8-week obstetrics-gynecology clerkship were enrolled in the study and randomized to attend or not to attend the half-day clinic. Responses to a 36-item survey administered at the start of participants' clerkship and midway through the clerkship showed significant improvements in the comfort level of clinic attendees with regard to talking with patients about smoking, alcohol use, and other substance use, William A. Ramirez-Cacho, M.D., of the University of New Mexico, Albuquerque, and his colleagues reported in a poster at the annual meeting of the Teratology Society.

The responses also demonstrated that the clinic attendees were significantly less judgmental of patients with substance use disorders and significantly more aware of multidisciplinary therapy approaches for treatment.

Control students' survey responses indicated a significant decline in comfort level when it came to discussing patients' habits, and a significant decline in awareness about how common substance use disorders are in this population, Dr. Ramirez-Cacho and his colleagues noted.

ST. PETE BEACH, FLA. – Attending a specialized clinic for pregnant women with substance use disorders helped medical students in a recent study feel more comfortable and less judgmental when working with such patients.

A total of 104 consecutive third-year students rotating on an 8-week obstetrics-gynecology clerkship were enrolled in the study and randomized to attend or not to attend the half-day clinic. Responses to a 36-item survey administered at the start of participants' clerkship and midway through the clerkship showed significant improvements in the comfort level of clinic attendees with regard to talking with patients about smoking, alcohol use, and other substance use, William A. Ramirez-Cacho, M.D., of the University of New Mexico, Albuquerque, and his colleagues reported in a poster at the annual meeting of the Teratology Society.

The responses also demonstrated that the clinic attendees were significantly less judgmental of patients with substance use disorders and significantly more aware of multidisciplinary therapy approaches for treatment.

Control students' survey responses indicated a significant decline in comfort level when it came to discussing patients' habits, and a significant decline in awareness about how common substance use disorders are in this population, Dr. Ramirez-Cacho and his colleagues noted.

ST. PETE BEACH, FLA. – Attending a specialized clinic for pregnant women with substance use disorders helped medical students in a recent study feel more comfortable and less judgmental when working with such patients.

A total of 104 consecutive third-year students rotating on an 8-week obstetrics-gynecology clerkship were enrolled in the study and randomized to attend or not to attend the half-day clinic. Responses to a 36-item survey administered at the start of participants' clerkship and midway through the clerkship showed significant improvements in the comfort level of clinic attendees with regard to talking with patients about smoking, alcohol use, and other substance use, William A. Ramirez-Cacho, M.D., of the University of New Mexico, Albuquerque, and his colleagues reported in a poster at the annual meeting of the Teratology Society.

The responses also demonstrated that the clinic attendees were significantly less judgmental of patients with substance use disorders and significantly more aware of multidisciplinary therapy approaches for treatment.

Control students' survey responses indicated a significant decline in comfort level when it came to discussing patients' habits, and a significant decline in awareness about how common substance use disorders are in this population, Dr. Ramirez-Cacho and his colleagues noted.

Flu Vaccine May Lower Stroke Risk

Influenza vaccination may be associated with reduced stroke risk.

In a case-control study, only 19% of 370 consecutive patients with stroke or TIA had been vaccinated against flu during the most recent vaccination campaign, compared with 31% of 370 age- and sex-matched controls, reported Armin J. Grau, M.D., of the neurology department at the University of Heidelberg, Germany, and colleagues (Stroke 2005;36:1501–6).

After adjustment for several potential confounders, influenza vaccination was associated with a significantly reduced overall risk of stroke and TIA (odds ratio 0.46). The effects were significant for ischemic stroke and for three subject groups: men, those over age 65 years, and those with previous vascular disease. Nonsignificant trends toward reduced risk were found for hemorrhagic stroke, women, and those aged 65 and younger.

Meningococcal Meningitis Rx

Single-dose ceftriaxone should be considered as a first-line treatment alternative to oily chloramphenicol for epidemic meningococcal meningitis, according to N. Nathan, M.D., of Paris, and colleagues.

In a randomized, open-label, noninferiority trial that compared the two drugs for treating suspected meningococcal disease, the treatment failure rate at 72 hours was 9% in both groups (247 patients who received ceftriaxone and 256 who received chloramphenicol).

Case fatality rates were similar in the two groups, at 6% for ceftriaxone and 5% for chloramphenicol, as were clinical failure rates, which were 3% for ceftriaxone and 4% for chloramphenicol (Lancet 2005;366:308–12).

Chloramphenicol is the drug currently recommended by the World Health Organization for treatment of epidemic meningococcal meningitis, but the continued production of the drug is uncertain; ceftriaxone appears to be an efficacious, easy-to-use, low-cost alternative treatment, the investigators concluded.

Pulmonary TB Infectivity

Two negative sputum smears appear to be as informative as three or more for assessing the probability of pulmonary tuberculosis transmission, a recent study shows.

The findings bring into question the current Centers for Disease Control and Prevention recommendation that respiratory isolation for pulmonary TB patients should be discontinued only if a patient is on efficacious therapy, is showing response, and has three consecutive negative sputum smears, reported George Mixides, M.D., of the Baylor College of Medicine, Houston, and his colleagues.

The retrospective analysis involved 122 index cases with only negative acid-fast bacilli smear results: 40 had only one or two such results, and 82 had three or more such results or at least one bronchoscopic specimen. Tuberculin skin test results of patient contacts were also obtained (Chest 2005;128:108–15).

Positive skin test results in contacts were independently associated with male gender and younger age of index patients, and Hispanic ethnicity of contacts. The smear category (one or two smears vs. three or more) of the index case was not independently associated with TB transmission.

Among those in the three-plus smear category, the first two specimens yielded 90% of all culture results positive for Mycobacterium tuberculosis, the investigators noted.

Ethambutol and Ocular Toxicity

Ethambutol, a component of multidrug treatment regimens for Mycobacterium avium complex lung disease, is associated with ocular toxicity, a study shows.

A total of 229 patients with M. avium complex lung disease received a mean of 16 months of multidrug therapy that included ethambutol during the study. Of those, 97 (42%) consulted an ophthalmologist, and 24 (10%) stopped using the drug at least temporarily, David E. Griffith, M.D., of the University of Texas Health Center in Tyler, and his colleagues reported.

The toxicity—which typically affected the optic nerve causing blurred vision, decreased visual acuity, and central blind or dark spots—was reversed in all patients upon discontinuation of treatment. Toxicity appears to be avoided with intermittent, rather than daily, treatment: 8 of 139 patients receiving daily therapy were diagnosed with ethambutol ocular toxicity, compared with 0 of 90 patients on intermittent therapy (Am. J. Respir. Crit. Care Med. 2005;172:250–3).

Inasmuch as ethambutol is a critical component of routine therapy for M. avium complex disease, and because there are few effective alternative drugs, maintaining patients on this drug should be a high priority. Intermittent treatment, such as every other day rather than daily, could be a treatment option for those who develop ocular toxicity during therapy, the investigators noted.

Flu Vaccine May Lower Stroke Risk

Influenza vaccination may be associated with reduced stroke risk.

In a case-control study, only 19% of 370 consecutive patients with stroke or TIA had been vaccinated against flu during the most recent vaccination campaign, compared with 31% of 370 age- and sex-matched controls, reported Armin J. Grau, M.D., of the neurology department at the University of Heidelberg, Germany, and colleagues (Stroke 2005;36:1501–6).

After adjustment for several potential confounders, influenza vaccination was associated with a significantly reduced overall risk of stroke and TIA (odds ratio 0.46). The effects were significant for ischemic stroke and for three subject groups: men, those over age 65 years, and those with previous vascular disease. Nonsignificant trends toward reduced risk were found for hemorrhagic stroke, women, and those aged 65 and younger.

Meningococcal Meningitis Rx

Single-dose ceftriaxone should be considered as a first-line treatment alternative to oily chloramphenicol for epidemic meningococcal meningitis, according to N. Nathan, M.D., of Paris, and colleagues.

In a randomized, open-label, noninferiority trial that compared the two drugs for treating suspected meningococcal disease, the treatment failure rate at 72 hours was 9% in both groups (247 patients who received ceftriaxone and 256 who received chloramphenicol).

Case fatality rates were similar in the two groups, at 6% for ceftriaxone and 5% for chloramphenicol, as were clinical failure rates, which were 3% for ceftriaxone and 4% for chloramphenicol (Lancet 2005;366:308–12).

Chloramphenicol is the drug currently recommended by the World Health Organization for treatment of epidemic meningococcal meningitis, but the continued production of the drug is uncertain; ceftriaxone appears to be an efficacious, easy-to-use, low-cost alternative treatment, the investigators concluded.

Pulmonary TB Infectivity

Two negative sputum smears appear to be as informative as three or more for assessing the probability of pulmonary tuberculosis transmission, a recent study shows.

The findings bring into question the current Centers for Disease Control and Prevention recommendation that respiratory isolation for pulmonary TB patients should be discontinued only if a patient is on efficacious therapy, is showing response, and has three consecutive negative sputum smears, reported George Mixides, M.D., of the Baylor College of Medicine, Houston, and his colleagues.

The retrospective analysis involved 122 index cases with only negative acid-fast bacilli smear results: 40 had only one or two such results, and 82 had three or more such results or at least one bronchoscopic specimen. Tuberculin skin test results of patient contacts were also obtained (Chest 2005;128:108–15).

Positive skin test results in contacts were independently associated with male gender and younger age of index patients, and Hispanic ethnicity of contacts. The smear category (one or two smears vs. three or more) of the index case was not independently associated with TB transmission.

Among those in the three-plus smear category, the first two specimens yielded 90% of all culture results positive for Mycobacterium tuberculosis, the investigators noted.

Ethambutol and Ocular Toxicity

Ethambutol, a component of multidrug treatment regimens for Mycobacterium avium complex lung disease, is associated with ocular toxicity, a study shows.

A total of 229 patients with M. avium complex lung disease received a mean of 16 months of multidrug therapy that included ethambutol during the study. Of those, 97 (42%) consulted an ophthalmologist, and 24 (10%) stopped using the drug at least temporarily, David E. Griffith, M.D., of the University of Texas Health Center in Tyler, and his colleagues reported.

The toxicity—which typically affected the optic nerve causing blurred vision, decreased visual acuity, and central blind or dark spots—was reversed in all patients upon discontinuation of treatment. Toxicity appears to be avoided with intermittent, rather than daily, treatment: 8 of 139 patients receiving daily therapy were diagnosed with ethambutol ocular toxicity, compared with 0 of 90 patients on intermittent therapy (Am. J. Respir. Crit. Care Med. 2005;172:250–3).

Inasmuch as ethambutol is a critical component of routine therapy for M. avium complex disease, and because there are few effective alternative drugs, maintaining patients on this drug should be a high priority. Intermittent treatment, such as every other day rather than daily, could be a treatment option for those who develop ocular toxicity during therapy, the investigators noted.

Flu Vaccine May Lower Stroke Risk

Influenza vaccination may be associated with reduced stroke risk.

In a case-control study, only 19% of 370 consecutive patients with stroke or TIA had been vaccinated against flu during the most recent vaccination campaign, compared with 31% of 370 age- and sex-matched controls, reported Armin J. Grau, M.D., of the neurology department at the University of Heidelberg, Germany, and colleagues (Stroke 2005;36:1501–6).

After adjustment for several potential confounders, influenza vaccination was associated with a significantly reduced overall risk of stroke and TIA (odds ratio 0.46). The effects were significant for ischemic stroke and for three subject groups: men, those over age 65 years, and those with previous vascular disease. Nonsignificant trends toward reduced risk were found for hemorrhagic stroke, women, and those aged 65 and younger.

Meningococcal Meningitis Rx

Single-dose ceftriaxone should be considered as a first-line treatment alternative to oily chloramphenicol for epidemic meningococcal meningitis, according to N. Nathan, M.D., of Paris, and colleagues.

In a randomized, open-label, noninferiority trial that compared the two drugs for treating suspected meningococcal disease, the treatment failure rate at 72 hours was 9% in both groups (247 patients who received ceftriaxone and 256 who received chloramphenicol).

Case fatality rates were similar in the two groups, at 6% for ceftriaxone and 5% for chloramphenicol, as were clinical failure rates, which were 3% for ceftriaxone and 4% for chloramphenicol (Lancet 2005;366:308–12).

Chloramphenicol is the drug currently recommended by the World Health Organization for treatment of epidemic meningococcal meningitis, but the continued production of the drug is uncertain; ceftriaxone appears to be an efficacious, easy-to-use, low-cost alternative treatment, the investigators concluded.

Pulmonary TB Infectivity

Two negative sputum smears appear to be as informative as three or more for assessing the probability of pulmonary tuberculosis transmission, a recent study shows.

The findings bring into question the current Centers for Disease Control and Prevention recommendation that respiratory isolation for pulmonary TB patients should be discontinued only if a patient is on efficacious therapy, is showing response, and has three consecutive negative sputum smears, reported George Mixides, M.D., of the Baylor College of Medicine, Houston, and his colleagues.

The retrospective analysis involved 122 index cases with only negative acid-fast bacilli smear results: 40 had only one or two such results, and 82 had three or more such results or at least one bronchoscopic specimen. Tuberculin skin test results of patient contacts were also obtained (Chest 2005;128:108–15).

Positive skin test results in contacts were independently associated with male gender and younger age of index patients, and Hispanic ethnicity of contacts. The smear category (one or two smears vs. three or more) of the index case was not independently associated with TB transmission.

Among those in the three-plus smear category, the first two specimens yielded 90% of all culture results positive for Mycobacterium tuberculosis, the investigators noted.

Ethambutol and Ocular Toxicity

Ethambutol, a component of multidrug treatment regimens for Mycobacterium avium complex lung disease, is associated with ocular toxicity, a study shows.

A total of 229 patients with M. avium complex lung disease received a mean of 16 months of multidrug therapy that included ethambutol during the study. Of those, 97 (42%) consulted an ophthalmologist, and 24 (10%) stopped using the drug at least temporarily, David E. Griffith, M.D., of the University of Texas Health Center in Tyler, and his colleagues reported.

The toxicity—which typically affected the optic nerve causing blurred vision, decreased visual acuity, and central blind or dark spots—was reversed in all patients upon discontinuation of treatment. Toxicity appears to be avoided with intermittent, rather than daily, treatment: 8 of 139 patients receiving daily therapy were diagnosed with ethambutol ocular toxicity, compared with 0 of 90 patients on intermittent therapy (Am. J. Respir. Crit. Care Med. 2005;172:250–3).

Inasmuch as ethambutol is a critical component of routine therapy for M. avium complex disease, and because there are few effective alternative drugs, maintaining patients on this drug should be a high priority. Intermittent treatment, such as every other day rather than daily, could be a treatment option for those who develop ocular toxicity during therapy, the investigators noted.

ST. PETE BEACH, FLA. — Young pregnant women who smoke cigarettes or marijuana or who are malnourished have a significantly increased risk of having an infant with gastroschisis, a case-control study suggests.

Those who have both risk factors have an even greater risk of having an infant with this severe birth defect, Phung Kim Lam, Ph.D., reported at the annual meeting of the Teratology Society.

Dr. Lam studied 55 infants with gastroschisis and 94 age-matched controls. Maternal information was based on interviews and food-frequency questionnaires.

Mothers were said to have high carbon monoxide (CO) exposure if they smoked at least one pack of cigarettes daily near the time of conception or if they smoked marijuana habitually around that time, said Dr. Lam of the University of California, San Diego.

Malnutrition was characterized by protein intake of less than 72 g/day, zinc intake of less than 10 mg/day, and maternal body mass index of less than 22 kg/m₂; these three factors were highly correlated (low zinc with low protein, and low protein with BMI). They are also correlated with numerous other markers of nutritional status, such as intake of certain other vitamins and minerals.

On multiple conditional logistic regression, gastroschisis was associated with high CO exposure (odds ratio 2.64) and low animal protein intake (OR 2.45).

Young mothers without low BMI but with high CO exposure were more likely than controls to have a baby with gastroschisis (odds ratio 16.81), as were those with low BMI and no CO exposure (OR 19.69). But the finding was much more marked in those with low BMI and high CO exposure, compared with controls (OR 26.49), she said.

The findings support those of an animal model in which exposure to high levels of carbon monoxide and low protein and zinc intake in pregnant mice led to this birth defect.

ST. PETE BEACH, FLA. — Young pregnant women who smoke cigarettes or marijuana or who are malnourished have a significantly increased risk of having an infant with gastroschisis, a case-control study suggests.

Those who have both risk factors have an even greater risk of having an infant with this severe birth defect, Phung Kim Lam, Ph.D., reported at the annual meeting of the Teratology Society.

Dr. Lam studied 55 infants with gastroschisis and 94 age-matched controls. Maternal information was based on interviews and food-frequency questionnaires.

Mothers were said to have high carbon monoxide (CO) exposure if they smoked at least one pack of cigarettes daily near the time of conception or if they smoked marijuana habitually around that time, said Dr. Lam of the University of California, San Diego.

Malnutrition was characterized by protein intake of less than 72 g/day, zinc intake of less than 10 mg/day, and maternal body mass index of less than 22 kg/m₂; these three factors were highly correlated (low zinc with low protein, and low protein with BMI). They are also correlated with numerous other markers of nutritional status, such as intake of certain other vitamins and minerals.

On multiple conditional logistic regression, gastroschisis was associated with high CO exposure (odds ratio 2.64) and low animal protein intake (OR 2.45).

Young mothers without low BMI but with high CO exposure were more likely than controls to have a baby with gastroschisis (odds ratio 16.81), as were those with low BMI and no CO exposure (OR 19.69). But the finding was much more marked in those with low BMI and high CO exposure, compared with controls (OR 26.49), she said.

The findings support those of an animal model in which exposure to high levels of carbon monoxide and low protein and zinc intake in pregnant mice led to this birth defect.

ST. PETE BEACH, FLA. — Young pregnant women who smoke cigarettes or marijuana or who are malnourished have a significantly increased risk of having an infant with gastroschisis, a case-control study suggests.

Those who have both risk factors have an even greater risk of having an infant with this severe birth defect, Phung Kim Lam, Ph.D., reported at the annual meeting of the Teratology Society.

Dr. Lam studied 55 infants with gastroschisis and 94 age-matched controls. Maternal information was based on interviews and food-frequency questionnaires.

Mothers were said to have high carbon monoxide (CO) exposure if they smoked at least one pack of cigarettes daily near the time of conception or if they smoked marijuana habitually around that time, said Dr. Lam of the University of California, San Diego.

Malnutrition was characterized by protein intake of less than 72 g/day, zinc intake of less than 10 mg/day, and maternal body mass index of less than 22 kg/m₂; these three factors were highly correlated (low zinc with low protein, and low protein with BMI). They are also correlated with numerous other markers of nutritional status, such as intake of certain other vitamins and minerals.

On multiple conditional logistic regression, gastroschisis was associated with high CO exposure (odds ratio 2.64) and low animal protein intake (OR 2.45).

Young mothers without low BMI but with high CO exposure were more likely than controls to have a baby with gastroschisis (odds ratio 16.81), as were those with low BMI and no CO exposure (OR 19.69). But the finding was much more marked in those with low BMI and high CO exposure, compared with controls (OR 26.49), she said.

The findings support those of an animal model in which exposure to high levels of carbon monoxide and low protein and zinc intake in pregnant mice led to this birth defect.

ST. PETE BEACH, FLA. — The use of oral steroids for asthma during pregnancy has long been discussed as a possible cause of orofacial clefts in newborns, but findings from a large cohort study suggest this is not the case.

In nearly 82,000 mother/infant pairs, not a single infant with an orofacial cleft was born to any of the more than 400 women who received at least one oral steroid prescription in the 90 days before pregnancy or during early pregnancy, Janet R. Hardy, Ph.D., reported at the annual meeting of the Teratology Society.

The findings could put an end to long-held beliefs—based on findings in laboratory animals decades ago—that a link exists between the medication and an increased risk for such defects.

About 6% of mothers in the retrospective population-based cohort study were asthmatic, and nearly 2% had other respiratory conditions. A total of 130 babies included in the study were born with orofacial cleft; only 6 of these were born to asthmatic mothers, and 3 others were born to women with other respiratory conditions. None of the nine mothers had received a prescription for an oral steroid during pregnancy, said Dr. Hardy, of the University of Massachusetts, Worcester.

The relative risk of cleft overall in this study was 1.30; the relative risk in babies born to women who received a prescription for any type of steroid medication was 1.26.

Dr. Hardy noted that the study, based on data in automated medical records from 1991 to 1999, is limited by its basis on prescribed medications. Medications prescribed do not necessarily equate to medications taken, she said, noting that she also was unable to study asthma severity, maternal smoking, family history, and racial and ethnic background.

Adjustment for other possible confounders, including other medications used, did not affect the results, however, she said.

Asthma complicates 3.7%–8.4% of pregnancies, and these findings suggest that any steroid use is associated with only a slightly increased risk of orofacial clefts.

Given the small overall risk with any steroid use and the apparent absence of risk with oral steroids, it is of concern that the data show a decline in the prescribing of oral steroids for the treatment of asthma in the first trimester, Dr. Hardy said.

In the prepregnancy period, 318 mothers (including 203 who were asthmatic) received at least one oral steroid prescription. In early pregnancy, however, only 149 (including 89 who were asthmatic) received at least one oral steroid prescription.

The risks associated with uncontrolled asthma are likely to be worse for the fetus than the risks of asthma medications, she concluded.

ST. PETE BEACH, FLA. — The use of oral steroids for asthma during pregnancy has long been discussed as a possible cause of orofacial clefts in newborns, but findings from a large cohort study suggest this is not the case.

In nearly 82,000 mother/infant pairs, not a single infant with an orofacial cleft was born to any of the more than 400 women who received at least one oral steroid prescription in the 90 days before pregnancy or during early pregnancy, Janet R. Hardy, Ph.D., reported at the annual meeting of the Teratology Society.

The findings could put an end to long-held beliefs—based on findings in laboratory animals decades ago—that a link exists between the medication and an increased risk for such defects.

About 6% of mothers in the retrospective population-based cohort study were asthmatic, and nearly 2% had other respiratory conditions. A total of 130 babies included in the study were born with orofacial cleft; only 6 of these were born to asthmatic mothers, and 3 others were born to women with other respiratory conditions. None of the nine mothers had received a prescription for an oral steroid during pregnancy, said Dr. Hardy, of the University of Massachusetts, Worcester.

The relative risk of cleft overall in this study was 1.30; the relative risk in babies born to women who received a prescription for any type of steroid medication was 1.26.

Dr. Hardy noted that the study, based on data in automated medical records from 1991 to 1999, is limited by its basis on prescribed medications. Medications prescribed do not necessarily equate to medications taken, she said, noting that she also was unable to study asthma severity, maternal smoking, family history, and racial and ethnic background.

Adjustment for other possible confounders, including other medications used, did not affect the results, however, she said.

Asthma complicates 3.7%–8.4% of pregnancies, and these findings suggest that any steroid use is associated with only a slightly increased risk of orofacial clefts.

Given the small overall risk with any steroid use and the apparent absence of risk with oral steroids, it is of concern that the data show a decline in the prescribing of oral steroids for the treatment of asthma in the first trimester, Dr. Hardy said.

In the prepregnancy period, 318 mothers (including 203 who were asthmatic) received at least one oral steroid prescription. In early pregnancy, however, only 149 (including 89 who were asthmatic) received at least one oral steroid prescription.

The risks associated with uncontrolled asthma are likely to be worse for the fetus than the risks of asthma medications, she concluded.

ST. PETE BEACH, FLA. — The use of oral steroids for asthma during pregnancy has long been discussed as a possible cause of orofacial clefts in newborns, but findings from a large cohort study suggest this is not the case.

In nearly 82,000 mother/infant pairs, not a single infant with an orofacial cleft was born to any of the more than 400 women who received at least one oral steroid prescription in the 90 days before pregnancy or during early pregnancy, Janet R. Hardy, Ph.D., reported at the annual meeting of the Teratology Society.

The findings could put an end to long-held beliefs—based on findings in laboratory animals decades ago—that a link exists between the medication and an increased risk for such defects.

About 6% of mothers in the retrospective population-based cohort study were asthmatic, and nearly 2% had other respiratory conditions. A total of 130 babies included in the study were born with orofacial cleft; only 6 of these were born to asthmatic mothers, and 3 others were born to women with other respiratory conditions. None of the nine mothers had received a prescription for an oral steroid during pregnancy, said Dr. Hardy, of the University of Massachusetts, Worcester.

The relative risk of cleft overall in this study was 1.30; the relative risk in babies born to women who received a prescription for any type of steroid medication was 1.26.

Dr. Hardy noted that the study, based on data in automated medical records from 1991 to 1999, is limited by its basis on prescribed medications. Medications prescribed do not necessarily equate to medications taken, she said, noting that she also was unable to study asthma severity, maternal smoking, family history, and racial and ethnic background.

Adjustment for other possible confounders, including other medications used, did not affect the results, however, she said.

Asthma complicates 3.7%–8.4% of pregnancies, and these findings suggest that any steroid use is associated with only a slightly increased risk of orofacial clefts.

Given the small overall risk with any steroid use and the apparent absence of risk with oral steroids, it is of concern that the data show a decline in the prescribing of oral steroids for the treatment of asthma in the first trimester, Dr. Hardy said.

In the prepregnancy period, 318 mothers (including 203 who were asthmatic) received at least one oral steroid prescription. In early pregnancy, however, only 149 (including 89 who were asthmatic) received at least one oral steroid prescription.

The risks associated with uncontrolled asthma are likely to be worse for the fetus than the risks of asthma medications, she concluded.

NEW ORLEANS — Premenstrual syndrome is common in adolescents, and symptoms are similar to those reported by women, a study suggests.

The findings debunk the “commonly accepted belief that adolescents suffer mostly from dysmenorrhea, and older women suffer mostly from PMS,” Michelle D. Vichnin, M.D., said, noting that in her experience, teens do indeed suffer from PMS.

A total of 94 girls aged 13–18 years took part in the 6-month study during which they completed the Daily Symptom Report (DSR), a validated tool for measuring 17 PMS symptoms in women.

A total of 31% of the participants had self-reported and confirmed PMS; 54% had self-reported PMS, but did not meet the criteria for confirmed PMS; and 15% had no PMS, Dr. Vichnin reported during the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

Confirmed PMS was defined as a self-report of PMS along with a 50% increase in premenstrual vs. postmenstrual DSR scores, said Dr. Vichnin of the University of Pennsylvania, Philadelphia.

The worst symptoms among teens with PMS were mood swings, anxiety, irritability, food cravings, and increased appetite, swelling and/or bloating, and cramps. These symptoms are identical to those reported in studies of women with PMS, she noted.

As is also true in women, the greatest impact of these symptoms was on the home/family scale, she said.

In this study, older age and family history of PMS were significantly associated with PMS. Oral contraceptive use and dysmenorrhea were not associated with PMS.

Since these data suggest that PMS is the same condition in teens as it is in women, the next question is whether treatments shown to be effective in women would be effective in teens. Selective serotonin reuptake inhibitors (SSRIs), for example, have been shown to be quite safe and effective for PMS in women, but their use for this purpose in teens has not been well studied.

“So I would like to see a randomized placebo-controlled trial of SSRIs in adolescents with premenstrual syndrome,” she said

NEW ORLEANS — Premenstrual syndrome is common in adolescents, and symptoms are similar to those reported by women, a study suggests.

The findings debunk the “commonly accepted belief that adolescents suffer mostly from dysmenorrhea, and older women suffer mostly from PMS,” Michelle D. Vichnin, M.D., said, noting that in her experience, teens do indeed suffer from PMS.

A total of 94 girls aged 13–18 years took part in the 6-month study during which they completed the Daily Symptom Report (DSR), a validated tool for measuring 17 PMS symptoms in women.

A total of 31% of the participants had self-reported and confirmed PMS; 54% had self-reported PMS, but did not meet the criteria for confirmed PMS; and 15% had no PMS, Dr. Vichnin reported during the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

Confirmed PMS was defined as a self-report of PMS along with a 50% increase in premenstrual vs. postmenstrual DSR scores, said Dr. Vichnin of the University of Pennsylvania, Philadelphia.

The worst symptoms among teens with PMS were mood swings, anxiety, irritability, food cravings, and increased appetite, swelling and/or bloating, and cramps. These symptoms are identical to those reported in studies of women with PMS, she noted.

As is also true in women, the greatest impact of these symptoms was on the home/family scale, she said.

In this study, older age and family history of PMS were significantly associated with PMS. Oral contraceptive use and dysmenorrhea were not associated with PMS.

Since these data suggest that PMS is the same condition in teens as it is in women, the next question is whether treatments shown to be effective in women would be effective in teens. Selective serotonin reuptake inhibitors (SSRIs), for example, have been shown to be quite safe and effective for PMS in women, but their use for this purpose in teens has not been well studied.

“So I would like to see a randomized placebo-controlled trial of SSRIs in adolescents with premenstrual syndrome,” she said

NEW ORLEANS — Premenstrual syndrome is common in adolescents, and symptoms are similar to those reported by women, a study suggests.

The findings debunk the “commonly accepted belief that adolescents suffer mostly from dysmenorrhea, and older women suffer mostly from PMS,” Michelle D. Vichnin, M.D., said, noting that in her experience, teens do indeed suffer from PMS.

A total of 94 girls aged 13–18 years took part in the 6-month study during which they completed the Daily Symptom Report (DSR), a validated tool for measuring 17 PMS symptoms in women.

A total of 31% of the participants had self-reported and confirmed PMS; 54% had self-reported PMS, but did not meet the criteria for confirmed PMS; and 15% had no PMS, Dr. Vichnin reported during the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

Confirmed PMS was defined as a self-report of PMS along with a 50% increase in premenstrual vs. postmenstrual DSR scores, said Dr. Vichnin of the University of Pennsylvania, Philadelphia.

The worst symptoms among teens with PMS were mood swings, anxiety, irritability, food cravings, and increased appetite, swelling and/or bloating, and cramps. These symptoms are identical to those reported in studies of women with PMS, she noted.

As is also true in women, the greatest impact of these symptoms was on the home/family scale, she said.

In this study, older age and family history of PMS were significantly associated with PMS. Oral contraceptive use and dysmenorrhea were not associated with PMS.

Since these data suggest that PMS is the same condition in teens as it is in women, the next question is whether treatments shown to be effective in women would be effective in teens. Selective serotonin reuptake inhibitors (SSRIs), for example, have been shown to be quite safe and effective for PMS in women, but their use for this purpose in teens has not been well studied.

“So I would like to see a randomized placebo-controlled trial of SSRIs in adolescents with premenstrual syndrome,” she said

ST. PETE BEACH, FLA. — Assisted reproductive techniques may be a risk factor for CHARGE association and Goldenhar's syndrome, a small study suggests.

Of 31 patients with CHARGE association and 20 patients with Goldenhar's syndrome, 7 (23%) were conceived via maternal use of an assisted fertilization technique, Kerstin Stromland, M.D., reported at the annual meeting of the Teratology Society.

Of those with CHARGE association, one boy and one girl were the product of intracytoplasmic sperm injection, and another boy was conceived after his mother's use of ovulation stimulating hormone.

Of those with Goldenhar's syndrome, two twin boys (who had a healthy sibling) and one girl, who had a healthy twin sister, were born following intracytoplasmic sperm injection, and another girl was born after standard in vitro fertilization, said Dr. Stromland of Sahlgrenska University Hospital, Gothenburg, Sweden.

The possible link was identified after mothers completed a questionnaire asking about medical history and use of drugs, alcohol, or tobacco, and following the collection of data from medical records and interviews with parents of the children.

While there are a few publications suggesting a link between CHARGE association and Goldenhar's syndrome and assisted reproduction techniques (ART) this is the first to suggest a specific link between CHARGE association and intracytoplasmic sperm injection, Dr. Stromland said, noting that one possible reason for the lack of reports on such cases is the multiple malformations that characterize these syndromes. That is, patients' deformities are often registered as separate malformations, rather than malformations occurring as part of a syndrome.

Further study is needed to elucidate any relationship between assisted fertilization and these conditions, she concluded.

CHARGE association is a constellation of congenital malformations. The acronym stands for some of the most common features:

▸ Coloboma of the eye and cranial nerve abnormalities.

▸ Heart malformation.

▸ Choanal atresia.

▸ Retardation of growth after birth and of development.

▸ Genital hypoplasia in males and urinary tract.

▸ Ear malformations and/or deafness.

ST. PETE BEACH, FLA. — Assisted reproductive techniques may be a risk factor for CHARGE association and Goldenhar's syndrome, a small study suggests.

Of 31 patients with CHARGE association and 20 patients with Goldenhar's syndrome, 7 (23%) were conceived via maternal use of an assisted fertilization technique, Kerstin Stromland, M.D., reported at the annual meeting of the Teratology Society.

Of those with CHARGE association, one boy and one girl were the product of intracytoplasmic sperm injection, and another boy was conceived after his mother's use of ovulation stimulating hormone.

Of those with Goldenhar's syndrome, two twin boys (who had a healthy sibling) and one girl, who had a healthy twin sister, were born following intracytoplasmic sperm injection, and another girl was born after standard in vitro fertilization, said Dr. Stromland of Sahlgrenska University Hospital, Gothenburg, Sweden.

The possible link was identified after mothers completed a questionnaire asking about medical history and use of drugs, alcohol, or tobacco, and following the collection of data from medical records and interviews with parents of the children.

While there are a few publications suggesting a link between CHARGE association and Goldenhar's syndrome and assisted reproduction techniques (ART) this is the first to suggest a specific link between CHARGE association and intracytoplasmic sperm injection, Dr. Stromland said, noting that one possible reason for the lack of reports on such cases is the multiple malformations that characterize these syndromes. That is, patients' deformities are often registered as separate malformations, rather than malformations occurring as part of a syndrome.

Further study is needed to elucidate any relationship between assisted fertilization and these conditions, she concluded.

CHARGE association is a constellation of congenital malformations. The acronym stands for some of the most common features:

▸ Coloboma of the eye and cranial nerve abnormalities.

▸ Heart malformation.

▸ Choanal atresia.

▸ Retardation of growth after birth and of development.

▸ Genital hypoplasia in males and urinary tract.

▸ Ear malformations and/or deafness.

ST. PETE BEACH, FLA. — Assisted reproductive techniques may be a risk factor for CHARGE association and Goldenhar's syndrome, a small study suggests.

Of 31 patients with CHARGE association and 20 patients with Goldenhar's syndrome, 7 (23%) were conceived via maternal use of an assisted fertilization technique, Kerstin Stromland, M.D., reported at the annual meeting of the Teratology Society.

Of those with CHARGE association, one boy and one girl were the product of intracytoplasmic sperm injection, and another boy was conceived after his mother's use of ovulation stimulating hormone.

Of those with Goldenhar's syndrome, two twin boys (who had a healthy sibling) and one girl, who had a healthy twin sister, were born following intracytoplasmic sperm injection, and another girl was born after standard in vitro fertilization, said Dr. Stromland of Sahlgrenska University Hospital, Gothenburg, Sweden.

The possible link was identified after mothers completed a questionnaire asking about medical history and use of drugs, alcohol, or tobacco, and following the collection of data from medical records and interviews with parents of the children.

While there are a few publications suggesting a link between CHARGE association and Goldenhar's syndrome and assisted reproduction techniques (ART) this is the first to suggest a specific link between CHARGE association and intracytoplasmic sperm injection, Dr. Stromland said, noting that one possible reason for the lack of reports on such cases is the multiple malformations that characterize these syndromes. That is, patients' deformities are often registered as separate malformations, rather than malformations occurring as part of a syndrome.

Further study is needed to elucidate any relationship between assisted fertilization and these conditions, she concluded.

CHARGE association is a constellation of congenital malformations. The acronym stands for some of the most common features:

▸ Coloboma of the eye and cranial nerve abnormalities.

▸ Heart malformation.

▸ Choanal atresia.

▸ Retardation of growth after birth and of development.

▸ Genital hypoplasia in males and urinary tract.

▸ Ear malformations and/or deafness.

ST. PETE BEACH, FLA. — Typical primary effects of parvovirus B19 infection during pregnancy include hydrops fetalis, fetal death, and spontaneous abortion, but a recent case and a review of the literature suggest that central nervous system abnormalities are a rare but possible effect of such infection, Dr. Kenneth Lyon Jones reported at the annual meeting of the Teratology Society.

Dr. Jones' case involved an 11-year-old boy whose mother had documented parvovirus B19 infection early in her first trimester. The child had severe brain development defects secondary to the prenatal exposure. Mental retardation was severe; he had not learned to speak and had been diagnosed with hypertonic cerebral palsy.

Diagnosis of maternal infection was made during the first trimester. An ultrasound at 20.5 weeks' gestation indicated fetal ventricular enlargement, and at birth the boy weighed 2,898 g. At day 5 he received a blood transfusion because he had severe anemia, said Dr. Jones of the University of California, San Diego.

During the newborn period, ultrasound showed severe cerebral atrophy.

At age 11 his height was 122 cm (below the 3rd percentile), and his weight was 27.3 kg (10th percentile).

The child was markedly hirsute and had a frontal hair upsweep, a large hemangioma over the helix of his right ear, a large space between his upper central incisors, and clinodactyly of the index and fifth fingers of his left hand, Dr. Jones noted.

His inner canthal distance was 2.7 cm (25th percentile), and his palpebral fissure was 2.3 cm (below the 2nd percentile).

Valproic acid and carbamazepine treatment failed to control seizures, which he began having at birth.

A search of the literature revealed three publications documenting CNS abnormalities after maternal parvovirus B19 infection, Dr. Jones said. The first, which was published as an abstract, involved three cases. In one case, the fetus died, and in the other two cases the fetuses survived but had severe mental retardation.

Neuropathology at the time of death in the nonsurviving fetus, which was exposed to infection at 24 weeks' gestation, showed brain atrophy with widespread dysplasia and focal destruction of spinal cord and piriform cells, among other abnormal findings.

One of the survivors was exposed to infection at 18 weeks' gestation. The child had cerebral palsy, developmental delay, and infantile spasms. Neuroimaging revealed enlarged ventricles with small periventricular calcifications, cortical dysplasia with polymicrogyria, and periventricular hypodensity.

The final case in that report involved a fetus exposed at 23 weeks' gestation. A CT scan of the brain revealed periventricular calcifications.

The second publication was a case report involving a fetus that was exposed at 15 weeks' gestation and died 7 hours after birth. Neuropathology showed multinucleated giant cells, macrophages, microglia, and many small calcifications around the vessels, predominantly in the cerebral white matter. Polymerase chain reaction amplification showed that parvovirus DNA was present in the nuclei of the multinucleated giant cells and endothelial cells, Dr. Jones said.

The final publication involved a series of 92 consecutive singleton pregnancies with serologic evidence of parvovirus B19 infection. There were 3 therapeutic abortions, 64 fetal deaths, 10 premature births (8 of the babies subsequently died), and 15 term births (1 baby subsequently died).

Of the 73 fetal or neonatal deaths, 21 had adequate histologic evaluation of the brain, and 9 of these showed CNS abnormalities. Of the 16 surviving babies, 5 had CNS abnormalities.

One of the 14 with CNS abnormalities had trisomy 13 syndrome; no etiology was determined in the remaining cases, but the findings suggested anemia might be an important mechanism for CNS abnormalities, Dr. Jones noted.

Based on the findings of the published reports, it appears three patterns of abnormalities are associated with maternal parvovirus B19 infection: positional limb deformities, radiographic evidence of intercranial calcifications, and dysplastic changes, including agyria, macrogyria, polymicrogyria, and dysgenesis of the corpus callosum, he said.

“CNS involvement is a rare occurrence following maternal parvovirus infection, but it clearly occurs, and when it does, it's clearly significant,” Dr. Jones said, noting that the mechanism of action most likely includes both infection of cells in the central nervous system and hypoxia secondary to severe anemia.

It is possible that subtle neurobehavioral effects in otherwise normal children result from a mild case of maternal parvovirus B19 infection, he added.

ST. PETE BEACH, FLA. — Typical primary effects of parvovirus B19 infection during pregnancy include hydrops fetalis, fetal death, and spontaneous abortion, but a recent case and a review of the literature suggest that central nervous system abnormalities are a rare but possible effect of such infection, Dr. Kenneth Lyon Jones reported at the annual meeting of the Teratology Society.

Dr. Jones' case involved an 11-year-old boy whose mother had documented parvovirus B19 infection early in her first trimester. The child had severe brain development defects secondary to the prenatal exposure. Mental retardation was severe; he had not learned to speak and had been diagnosed with hypertonic cerebral palsy.

Diagnosis of maternal infection was made during the first trimester. An ultrasound at 20.5 weeks' gestation indicated fetal ventricular enlargement, and at birth the boy weighed 2,898 g. At day 5 he received a blood transfusion because he had severe anemia, said Dr. Jones of the University of California, San Diego.

During the newborn period, ultrasound showed severe cerebral atrophy.

At age 11 his height was 122 cm (below the 3rd percentile), and his weight was 27.3 kg (10th percentile).

The child was markedly hirsute and had a frontal hair upsweep, a large hemangioma over the helix of his right ear, a large space between his upper central incisors, and clinodactyly of the index and fifth fingers of his left hand, Dr. Jones noted.

His inner canthal distance was 2.7 cm (25th percentile), and his palpebral fissure was 2.3 cm (below the 2nd percentile).

Valproic acid and carbamazepine treatment failed to control seizures, which he began having at birth.

A search of the literature revealed three publications documenting CNS abnormalities after maternal parvovirus B19 infection, Dr. Jones said. The first, which was published as an abstract, involved three cases. In one case, the fetus died, and in the other two cases the fetuses survived but had severe mental retardation.

Neuropathology at the time of death in the nonsurviving fetus, which was exposed to infection at 24 weeks' gestation, showed brain atrophy with widespread dysplasia and focal destruction of spinal cord and piriform cells, among other abnormal findings.

One of the survivors was exposed to infection at 18 weeks' gestation. The child had cerebral palsy, developmental delay, and infantile spasms. Neuroimaging revealed enlarged ventricles with small periventricular calcifications, cortical dysplasia with polymicrogyria, and periventricular hypodensity.

The final case in that report involved a fetus exposed at 23 weeks' gestation. A CT scan of the brain revealed periventricular calcifications.

The second publication was a case report involving a fetus that was exposed at 15 weeks' gestation and died 7 hours after birth. Neuropathology showed multinucleated giant cells, macrophages, microglia, and many small calcifications around the vessels, predominantly in the cerebral white matter. Polymerase chain reaction amplification showed that parvovirus DNA was present in the nuclei of the multinucleated giant cells and endothelial cells, Dr. Jones said.

The final publication involved a series of 92 consecutive singleton pregnancies with serologic evidence of parvovirus B19 infection. There were 3 therapeutic abortions, 64 fetal deaths, 10 premature births (8 of the babies subsequently died), and 15 term births (1 baby subsequently died).

Of the 73 fetal or neonatal deaths, 21 had adequate histologic evaluation of the brain, and 9 of these showed CNS abnormalities. Of the 16 surviving babies, 5 had CNS abnormalities.

One of the 14 with CNS abnormalities had trisomy 13 syndrome; no etiology was determined in the remaining cases, but the findings suggested anemia might be an important mechanism for CNS abnormalities, Dr. Jones noted.

Based on the findings of the published reports, it appears three patterns of abnormalities are associated with maternal parvovirus B19 infection: positional limb deformities, radiographic evidence of intercranial calcifications, and dysplastic changes, including agyria, macrogyria, polymicrogyria, and dysgenesis of the corpus callosum, he said.

“CNS involvement is a rare occurrence following maternal parvovirus infection, but it clearly occurs, and when it does, it's clearly significant,” Dr. Jones said, noting that the mechanism of action most likely includes both infection of cells in the central nervous system and hypoxia secondary to severe anemia.

It is possible that subtle neurobehavioral effects in otherwise normal children result from a mild case of maternal parvovirus B19 infection, he added.

ST. PETE BEACH, FLA. — Typical primary effects of parvovirus B19 infection during pregnancy include hydrops fetalis, fetal death, and spontaneous abortion, but a recent case and a review of the literature suggest that central nervous system abnormalities are a rare but possible effect of such infection, Dr. Kenneth Lyon Jones reported at the annual meeting of the Teratology Society.

Dr. Jones' case involved an 11-year-old boy whose mother had documented parvovirus B19 infection early in her first trimester. The child had severe brain development defects secondary to the prenatal exposure. Mental retardation was severe; he had not learned to speak and had been diagnosed with hypertonic cerebral palsy.

Diagnosis of maternal infection was made during the first trimester. An ultrasound at 20.5 weeks' gestation indicated fetal ventricular enlargement, and at birth the boy weighed 2,898 g. At day 5 he received a blood transfusion because he had severe anemia, said Dr. Jones of the University of California, San Diego.

During the newborn period, ultrasound showed severe cerebral atrophy.

At age 11 his height was 122 cm (below the 3rd percentile), and his weight was 27.3 kg (10th percentile).

The child was markedly hirsute and had a frontal hair upsweep, a large hemangioma over the helix of his right ear, a large space between his upper central incisors, and clinodactyly of the index and fifth fingers of his left hand, Dr. Jones noted.

His inner canthal distance was 2.7 cm (25th percentile), and his palpebral fissure was 2.3 cm (below the 2nd percentile).

Valproic acid and carbamazepine treatment failed to control seizures, which he began having at birth.

A search of the literature revealed three publications documenting CNS abnormalities after maternal parvovirus B19 infection, Dr. Jones said. The first, which was published as an abstract, involved three cases. In one case, the fetus died, and in the other two cases the fetuses survived but had severe mental retardation.

Neuropathology at the time of death in the nonsurviving fetus, which was exposed to infection at 24 weeks' gestation, showed brain atrophy with widespread dysplasia and focal destruction of spinal cord and piriform cells, among other abnormal findings.

One of the survivors was exposed to infection at 18 weeks' gestation. The child had cerebral palsy, developmental delay, and infantile spasms. Neuroimaging revealed enlarged ventricles with small periventricular calcifications, cortical dysplasia with polymicrogyria, and periventricular hypodensity.

The final case in that report involved a fetus exposed at 23 weeks' gestation. A CT scan of the brain revealed periventricular calcifications.

The second publication was a case report involving a fetus that was exposed at 15 weeks' gestation and died 7 hours after birth. Neuropathology showed multinucleated giant cells, macrophages, microglia, and many small calcifications around the vessels, predominantly in the cerebral white matter. Polymerase chain reaction amplification showed that parvovirus DNA was present in the nuclei of the multinucleated giant cells and endothelial cells, Dr. Jones said.

The final publication involved a series of 92 consecutive singleton pregnancies with serologic evidence of parvovirus B19 infection. There were 3 therapeutic abortions, 64 fetal deaths, 10 premature births (8 of the babies subsequently died), and 15 term births (1 baby subsequently died).

Of the 73 fetal or neonatal deaths, 21 had adequate histologic evaluation of the brain, and 9 of these showed CNS abnormalities. Of the 16 surviving babies, 5 had CNS abnormalities.

One of the 14 with CNS abnormalities had trisomy 13 syndrome; no etiology was determined in the remaining cases, but the findings suggested anemia might be an important mechanism for CNS abnormalities, Dr. Jones noted.

Based on the findings of the published reports, it appears three patterns of abnormalities are associated with maternal parvovirus B19 infection: positional limb deformities, radiographic evidence of intercranial calcifications, and dysplastic changes, including agyria, macrogyria, polymicrogyria, and dysgenesis of the corpus callosum, he said.

“CNS involvement is a rare occurrence following maternal parvovirus infection, but it clearly occurs, and when it does, it's clearly significant,” Dr. Jones said, noting that the mechanism of action most likely includes both infection of cells in the central nervous system and hypoxia secondary to severe anemia.

It is possible that subtle neurobehavioral effects in otherwise normal children result from a mild case of maternal parvovirus B19 infection, he added.