From Staff Reports

Esophageal Manometry Found Useful

Esophageal manometry provided new information leading to a change in patient management in up to 60% of cases in a prospective study, Dr. Brian E. Lacy said at the annual meeting of the American College of Gastroenterology.

The clinical utility of esophageal manometry (EM) had never been formally examined, even though the test is ordered 100,000 times yearly in the United States, said Dr. Lacy of Dartmouth-Hitchcock Medical Center, Lebanon, N.H. During a recent 6-month period when 303 EMs were performed there, he and his colleagues sent pre- and postprocedure questionnaires to all ordering physicians and received 152 complete responses. The mean duration of symptoms prior to EM was 64 months. One-third of EMs were ordered for evaluation of dysphagia, 29% for assistance in placing a pH probe or Bravo monitoring capsule, 13% for reflux symptoms, and 10% for evaluation of chest pain.

Physicians reported that EM yielded new information in 100% of patients with reflux symptoms and in 86% of those with chest pain or dysphagia. The test results led to a change in diagnosis in 48% of patients with dysphagia, 21% of those with chest pain, and 20% of those with gastroesophageal reflux disease (GERD).

More importantly, the EM results led to a change in management for 60% of patients evaluated for dysphagia, 45% of those with GERD, and 43% of those evaluated primarily for chest pain, Dr. Lacy said. Most often this management change involved stopping medications that were not useful or adding a new drug.

Lanreotide Curbs Pancreatitis Pain

A single dose of the somatostatin analog lanreotide cut the incidence of pain relapse after an episode of acute, necrotizing pancreatitis in a randomized, controlled study with 77 patients.

Patients treated with lanreotide had a 3% rate of relapsing pain, compared with 15% in the placebo group, during the period from 8 to 28 days after treatment, reported Dr. Philippe Levy and his associates in a poster at the 13th United European Gastroenterology Week.

The study enrolled patients at several centers in France; patients had an average age of 53 years and were recovering from an episode of pancreatitis that had not required surgery or radiologic drainage. When oral feeding was judged possible, 38 patients received a 30-mg injection of lanreotide and 39 control patients received a placebo injection.

During the first 7 days after the injection, one lanreotide patient and no placebo patients reported a pain relapse. From day 8 to 28, one additional patient in the lanreotide group (3%) and six placebo patients (15%) had pain relapses, a statistically significant difference, reported Dr. Levy, chief of the gastroenterology service at Beaujon Hospital in Clichy, France.

The drug was well tolerated, with no treatment-related adverse effects reported. In the United States, lanreotide is not yet approved and is being tested in patients with acromegaly or neuroendocrine tumors in phase III studies.

Gum Boosts Motility After Colectomy

Chewing gum soon after open partial resection of the sigmoid colon stimulates bowel motility, markedly reducing the delay before full bowel function returns, reported Dr. Rob Schuster and his associates at Santa Barbara (Calif.) Cottage Hospital.

Previous studies showed that starting an oral diet soon after colon surgery can hasten recovery. In one study, bowel function returned sooner in patients who chewed gum after laparoscopic colectomy.

Based on these results, Dr. Schuster and his associates conducted a prospective, case-control study in 34 patients undergoing open sigmoid colon resection for recurrent diverticular disease or cancer. Half of the patients were randomly assigned to chew gum three times daily, starting the morning after surgery and continuing until bowel function returned. The other 17 patients served as controls.

Patients in the treatment group reported that their first hunger sensations, passage of flatus, and bowel movement occurred 63.5 hours, 65.4 hours, and 63.2 hours, respectively, after surgery. Those intervals were 72.8 hours, 80.2 hours, and 89.4 hours in the control group. Hospital stays were 4.3 days in the gum-chewing group and 6.8 days in controls. The researchers calculated that gum chewing after colectomy could conceivably save the nation $118,828,000 yearly, based on estimates of 79,219 colectomies performed annually and a mean daily hospital room fee of $1,500 (Arch. Surg. 2006;141:174–6).

It's not clear how gum chewing works in this situation. It most likely reverses postoperative ileus via “direct stimulation of the cephalic-vagal system and resultant increased levels of neural and humoral hormones that stimulate bowel motility in the stomach, small bowel, and colon,” the researchers said.

Esophageal Manometry Found Useful

Esophageal manometry provided new information leading to a change in patient management in up to 60% of cases in a prospective study, Dr. Brian E. Lacy said at the annual meeting of the American College of Gastroenterology.

The clinical utility of esophageal manometry (EM) had never been formally examined, even though the test is ordered 100,000 times yearly in the United States, said Dr. Lacy of Dartmouth-Hitchcock Medical Center, Lebanon, N.H. During a recent 6-month period when 303 EMs were performed there, he and his colleagues sent pre- and postprocedure questionnaires to all ordering physicians and received 152 complete responses. The mean duration of symptoms prior to EM was 64 months. One-third of EMs were ordered for evaluation of dysphagia, 29% for assistance in placing a pH probe or Bravo monitoring capsule, 13% for reflux symptoms, and 10% for evaluation of chest pain.

Physicians reported that EM yielded new information in 100% of patients with reflux symptoms and in 86% of those with chest pain or dysphagia. The test results led to a change in diagnosis in 48% of patients with dysphagia, 21% of those with chest pain, and 20% of those with gastroesophageal reflux disease (GERD).

More importantly, the EM results led to a change in management for 60% of patients evaluated for dysphagia, 45% of those with GERD, and 43% of those evaluated primarily for chest pain, Dr. Lacy said. Most often this management change involved stopping medications that were not useful or adding a new drug.

Lanreotide Curbs Pancreatitis Pain

A single dose of the somatostatin analog lanreotide cut the incidence of pain relapse after an episode of acute, necrotizing pancreatitis in a randomized, controlled study with 77 patients.

Patients treated with lanreotide had a 3% rate of relapsing pain, compared with 15% in the placebo group, during the period from 8 to 28 days after treatment, reported Dr. Philippe Levy and his associates in a poster at the 13th United European Gastroenterology Week.

The study enrolled patients at several centers in France; patients had an average age of 53 years and were recovering from an episode of pancreatitis that had not required surgery or radiologic drainage. When oral feeding was judged possible, 38 patients received a 30-mg injection of lanreotide and 39 control patients received a placebo injection.

During the first 7 days after the injection, one lanreotide patient and no placebo patients reported a pain relapse. From day 8 to 28, one additional patient in the lanreotide group (3%) and six placebo patients (15%) had pain relapses, a statistically significant difference, reported Dr. Levy, chief of the gastroenterology service at Beaujon Hospital in Clichy, France.

The drug was well tolerated, with no treatment-related adverse effects reported. In the United States, lanreotide is not yet approved and is being tested in patients with acromegaly or neuroendocrine tumors in phase III studies.

Gum Boosts Motility After Colectomy

Chewing gum soon after open partial resection of the sigmoid colon stimulates bowel motility, markedly reducing the delay before full bowel function returns, reported Dr. Rob Schuster and his associates at Santa Barbara (Calif.) Cottage Hospital.

Previous studies showed that starting an oral diet soon after colon surgery can hasten recovery. In one study, bowel function returned sooner in patients who chewed gum after laparoscopic colectomy.

Based on these results, Dr. Schuster and his associates conducted a prospective, case-control study in 34 patients undergoing open sigmoid colon resection for recurrent diverticular disease or cancer. Half of the patients were randomly assigned to chew gum three times daily, starting the morning after surgery and continuing until bowel function returned. The other 17 patients served as controls.

Patients in the treatment group reported that their first hunger sensations, passage of flatus, and bowel movement occurred 63.5 hours, 65.4 hours, and 63.2 hours, respectively, after surgery. Those intervals were 72.8 hours, 80.2 hours, and 89.4 hours in the control group. Hospital stays were 4.3 days in the gum-chewing group and 6.8 days in controls. The researchers calculated that gum chewing after colectomy could conceivably save the nation $118,828,000 yearly, based on estimates of 79,219 colectomies performed annually and a mean daily hospital room fee of $1,500 (Arch. Surg. 2006;141:174–6).

It's not clear how gum chewing works in this situation. It most likely reverses postoperative ileus via “direct stimulation of the cephalic-vagal system and resultant increased levels of neural and humoral hormones that stimulate bowel motility in the stomach, small bowel, and colon,” the researchers said.

Esophageal Manometry Found Useful

Esophageal manometry provided new information leading to a change in patient management in up to 60% of cases in a prospective study, Dr. Brian E. Lacy said at the annual meeting of the American College of Gastroenterology.

The clinical utility of esophageal manometry (EM) had never been formally examined, even though the test is ordered 100,000 times yearly in the United States, said Dr. Lacy of Dartmouth-Hitchcock Medical Center, Lebanon, N.H. During a recent 6-month period when 303 EMs were performed there, he and his colleagues sent pre- and postprocedure questionnaires to all ordering physicians and received 152 complete responses. The mean duration of symptoms prior to EM was 64 months. One-third of EMs were ordered for evaluation of dysphagia, 29% for assistance in placing a pH probe or Bravo monitoring capsule, 13% for reflux symptoms, and 10% for evaluation of chest pain.

Physicians reported that EM yielded new information in 100% of patients with reflux symptoms and in 86% of those with chest pain or dysphagia. The test results led to a change in diagnosis in 48% of patients with dysphagia, 21% of those with chest pain, and 20% of those with gastroesophageal reflux disease (GERD).

More importantly, the EM results led to a change in management for 60% of patients evaluated for dysphagia, 45% of those with GERD, and 43% of those evaluated primarily for chest pain, Dr. Lacy said. Most often this management change involved stopping medications that were not useful or adding a new drug.

Lanreotide Curbs Pancreatitis Pain

A single dose of the somatostatin analog lanreotide cut the incidence of pain relapse after an episode of acute, necrotizing pancreatitis in a randomized, controlled study with 77 patients.

Patients treated with lanreotide had a 3% rate of relapsing pain, compared with 15% in the placebo group, during the period from 8 to 28 days after treatment, reported Dr. Philippe Levy and his associates in a poster at the 13th United European Gastroenterology Week.

The study enrolled patients at several centers in France; patients had an average age of 53 years and were recovering from an episode of pancreatitis that had not required surgery or radiologic drainage. When oral feeding was judged possible, 38 patients received a 30-mg injection of lanreotide and 39 control patients received a placebo injection.

During the first 7 days after the injection, one lanreotide patient and no placebo patients reported a pain relapse. From day 8 to 28, one additional patient in the lanreotide group (3%) and six placebo patients (15%) had pain relapses, a statistically significant difference, reported Dr. Levy, chief of the gastroenterology service at Beaujon Hospital in Clichy, France.

The drug was well tolerated, with no treatment-related adverse effects reported. In the United States, lanreotide is not yet approved and is being tested in patients with acromegaly or neuroendocrine tumors in phase III studies.

Gum Boosts Motility After Colectomy

Chewing gum soon after open partial resection of the sigmoid colon stimulates bowel motility, markedly reducing the delay before full bowel function returns, reported Dr. Rob Schuster and his associates at Santa Barbara (Calif.) Cottage Hospital.

Previous studies showed that starting an oral diet soon after colon surgery can hasten recovery. In one study, bowel function returned sooner in patients who chewed gum after laparoscopic colectomy.

Based on these results, Dr. Schuster and his associates conducted a prospective, case-control study in 34 patients undergoing open sigmoid colon resection for recurrent diverticular disease or cancer. Half of the patients were randomly assigned to chew gum three times daily, starting the morning after surgery and continuing until bowel function returned. The other 17 patients served as controls.

Patients in the treatment group reported that their first hunger sensations, passage of flatus, and bowel movement occurred 63.5 hours, 65.4 hours, and 63.2 hours, respectively, after surgery. Those intervals were 72.8 hours, 80.2 hours, and 89.4 hours in the control group. Hospital stays were 4.3 days in the gum-chewing group and 6.8 days in controls. The researchers calculated that gum chewing after colectomy could conceivably save the nation $118,828,000 yearly, based on estimates of 79,219 colectomies performed annually and a mean daily hospital room fee of $1,500 (Arch. Surg. 2006;141:174–6).

It's not clear how gum chewing works in this situation. It most likely reverses postoperative ileus via “direct stimulation of the cephalic-vagal system and resultant increased levels of neural and humoral hormones that stimulate bowel motility in the stomach, small bowel, and colon,” the researchers said.

Morbid Obesity Complicates Intubation

Despite attempts at optimal positioning, it's significantly more difficult to intubate patients who are morbidly obese than those of normal weight, according to a poster presentation by Dr. Thomas C. Mort at the annual congress of the Society of Critical Care Medicine.

In a retrospective analysis of more than 1,200 patients, 72% of patients with body mass indexes below 25 kg/m

Accessory airway devices were required far more often in MO patients. Of MO patients, 58% required one of these devices, compared with 22% of normal-weight patients. Bougies were required 21% of the time in MO patients, compared with 10% of normal-weight patients. Similarly significant differences were noted for laryngeal mask airways (28% vs. 4%), but no significant differences were noted in the use of fiberoptic bronchoscopes or Combitubes.

The study involved 1,253 consecutive emergency intubations over a 12-year period from 1994 to 2005. Dr. Mort, of Hartford (Conn.) Hospital, isolated those cases in which emergency airway management took place outside the operating room. Fourteen percent of the cohort (174 patients) had BMIs greater than 40, and they were compared with a cohort of normal-weight patients.

Mild hypoxemia was found in 33% of the MO group, significantly greater than the 17% of the normal-weight patients. Likewise, severe hypoxemia was more common among MO patients (11% vs. 2%).

Birth Control and Weight Gain

Use of depot medroxyprogesterone acetate was associated with increasing weight gain in obese girls during an 18-month prospective study, reported Dr. Andrea E. Bonny of Case Western Reserve University, Cleveland.

Of 450 girls aged 12–18 years, most of whom were using hormonal contraception for the first time, 26% chose depot medroxyprogesterone acetate (DMPA), 39% chose oral contraceptives (OCs), and 36% acted as controls. The subjects attended one of four urban clinics; more than 62% were black (Arch. Pediatr. Adolesc. Med. 2006;160:40–5).

At baseline, obesity was significantly more prevalent in OC users (29%), compared with DMPA users (13%) and controls (18%), Dr. Bonny and her associates said.

Girls who were obese before starting DMPA (13%) showed significantly greater weight gain than did obese controls or girls who were obese when they started taking OCs. After adjustment for race, gynecologic age (subject's age minus age at menarche), and previous pregnancy, the mean weight change in obese DMPA users was 9.4 kg, compared with 4.0 kg in nonobese DMPA users.

For OC users, the mean weight gain was 0.2 kg in obese subjects versus 2.8 kg in nonobese subjects. “For nonobese subjects, contraceptive method was not significantly associated with weight,” they said.

Obesity and IUI Outcomes

Obese, ovulatory women can achieve similar pregnancy rates with intrauterine insemination, compared with women of normal weight, but obese women require higher doses of gonadotropins for adequate ovarian stimulation, according to Dr. William C. Dodson of Pennsylvania State University in Hershey.

In a study presented at the joint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society, Dr. Dodson evaluated the effect of obesity on superovulation and intrauterine insemination (IUI) outcomes among 333 ovulatory women who had been infertile for a mean of 3.2 years.

A total of 206 of the women (62%) were of normal weight (18.5–25 kg/m

Of these women, 35% had idiopathic infertility, 31% had endometriosis, and 22% had various diagnoses, including pelvic adhesions, unilateral tubal occlusions, and leiomyomata. After adjustment for age, year of treatment, and the use of gonadotropin-releasing hormone agonists or antagonists, there were no significant differences in pregnancy rates between the women, regardless of BMI.

This trend was observed for pregnancy rates on the first cycle of IUI (which ranged from 6% to 15%), as well over all 814 treatment cycles (which ranged from 11% to 16%).

In addition, the number of large preovulatory follicles (measuring at least 17 mm) did not differ significantly between the different BMI categories (3.3 to 3.9). However, total gonadotropin dose was higher for obese women.

Morbid Obesity Complicates Intubation

Despite attempts at optimal positioning, it's significantly more difficult to intubate patients who are morbidly obese than those of normal weight, according to a poster presentation by Dr. Thomas C. Mort at the annual congress of the Society of Critical Care Medicine.

In a retrospective analysis of more than 1,200 patients, 72% of patients with body mass indexes below 25 kg/m

Accessory airway devices were required far more often in MO patients. Of MO patients, 58% required one of these devices, compared with 22% of normal-weight patients. Bougies were required 21% of the time in MO patients, compared with 10% of normal-weight patients. Similarly significant differences were noted for laryngeal mask airways (28% vs. 4%), but no significant differences were noted in the use of fiberoptic bronchoscopes or Combitubes.

The study involved 1,253 consecutive emergency intubations over a 12-year period from 1994 to 2005. Dr. Mort, of Hartford (Conn.) Hospital, isolated those cases in which emergency airway management took place outside the operating room. Fourteen percent of the cohort (174 patients) had BMIs greater than 40, and they were compared with a cohort of normal-weight patients.

Mild hypoxemia was found in 33% of the MO group, significantly greater than the 17% of the normal-weight patients. Likewise, severe hypoxemia was more common among MO patients (11% vs. 2%).

Birth Control and Weight Gain

Use of depot medroxyprogesterone acetate was associated with increasing weight gain in obese girls during an 18-month prospective study, reported Dr. Andrea E. Bonny of Case Western Reserve University, Cleveland.

Of 450 girls aged 12–18 years, most of whom were using hormonal contraception for the first time, 26% chose depot medroxyprogesterone acetate (DMPA), 39% chose oral contraceptives (OCs), and 36% acted as controls. The subjects attended one of four urban clinics; more than 62% were black (Arch. Pediatr. Adolesc. Med. 2006;160:40–5).

At baseline, obesity was significantly more prevalent in OC users (29%), compared with DMPA users (13%) and controls (18%), Dr. Bonny and her associates said.

Girls who were obese before starting DMPA (13%) showed significantly greater weight gain than did obese controls or girls who were obese when they started taking OCs. After adjustment for race, gynecologic age (subject's age minus age at menarche), and previous pregnancy, the mean weight change in obese DMPA users was 9.4 kg, compared with 4.0 kg in nonobese DMPA users.

For OC users, the mean weight gain was 0.2 kg in obese subjects versus 2.8 kg in nonobese subjects. “For nonobese subjects, contraceptive method was not significantly associated with weight,” they said.

Obesity and IUI Outcomes

Obese, ovulatory women can achieve similar pregnancy rates with intrauterine insemination, compared with women of normal weight, but obese women require higher doses of gonadotropins for adequate ovarian stimulation, according to Dr. William C. Dodson of Pennsylvania State University in Hershey.

In a study presented at the joint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society, Dr. Dodson evaluated the effect of obesity on superovulation and intrauterine insemination (IUI) outcomes among 333 ovulatory women who had been infertile for a mean of 3.2 years.

A total of 206 of the women (62%) were of normal weight (18.5–25 kg/m

Of these women, 35% had idiopathic infertility, 31% had endometriosis, and 22% had various diagnoses, including pelvic adhesions, unilateral tubal occlusions, and leiomyomata. After adjustment for age, year of treatment, and the use of gonadotropin-releasing hormone agonists or antagonists, there were no significant differences in pregnancy rates between the women, regardless of BMI.

This trend was observed for pregnancy rates on the first cycle of IUI (which ranged from 6% to 15%), as well over all 814 treatment cycles (which ranged from 11% to 16%).

In addition, the number of large preovulatory follicles (measuring at least 17 mm) did not differ significantly between the different BMI categories (3.3 to 3.9). However, total gonadotropin dose was higher for obese women.

Morbid Obesity Complicates Intubation

Despite attempts at optimal positioning, it's significantly more difficult to intubate patients who are morbidly obese than those of normal weight, according to a poster presentation by Dr. Thomas C. Mort at the annual congress of the Society of Critical Care Medicine.

In a retrospective analysis of more than 1,200 patients, 72% of patients with body mass indexes below 25 kg/m

Accessory airway devices were required far more often in MO patients. Of MO patients, 58% required one of these devices, compared with 22% of normal-weight patients. Bougies were required 21% of the time in MO patients, compared with 10% of normal-weight patients. Similarly significant differences were noted for laryngeal mask airways (28% vs. 4%), but no significant differences were noted in the use of fiberoptic bronchoscopes or Combitubes.

The study involved 1,253 consecutive emergency intubations over a 12-year period from 1994 to 2005. Dr. Mort, of Hartford (Conn.) Hospital, isolated those cases in which emergency airway management took place outside the operating room. Fourteen percent of the cohort (174 patients) had BMIs greater than 40, and they were compared with a cohort of normal-weight patients.

Mild hypoxemia was found in 33% of the MO group, significantly greater than the 17% of the normal-weight patients. Likewise, severe hypoxemia was more common among MO patients (11% vs. 2%).

Birth Control and Weight Gain

Use of depot medroxyprogesterone acetate was associated with increasing weight gain in obese girls during an 18-month prospective study, reported Dr. Andrea E. Bonny of Case Western Reserve University, Cleveland.

Of 450 girls aged 12–18 years, most of whom were using hormonal contraception for the first time, 26% chose depot medroxyprogesterone acetate (DMPA), 39% chose oral contraceptives (OCs), and 36% acted as controls. The subjects attended one of four urban clinics; more than 62% were black (Arch. Pediatr. Adolesc. Med. 2006;160:40–5).

At baseline, obesity was significantly more prevalent in OC users (29%), compared with DMPA users (13%) and controls (18%), Dr. Bonny and her associates said.

Girls who were obese before starting DMPA (13%) showed significantly greater weight gain than did obese controls or girls who were obese when they started taking OCs. After adjustment for race, gynecologic age (subject's age minus age at menarche), and previous pregnancy, the mean weight change in obese DMPA users was 9.4 kg, compared with 4.0 kg in nonobese DMPA users.

For OC users, the mean weight gain was 0.2 kg in obese subjects versus 2.8 kg in nonobese subjects. “For nonobese subjects, contraceptive method was not significantly associated with weight,” they said.

Obesity and IUI Outcomes

Obese, ovulatory women can achieve similar pregnancy rates with intrauterine insemination, compared with women of normal weight, but obese women require higher doses of gonadotropins for adequate ovarian stimulation, according to Dr. William C. Dodson of Pennsylvania State University in Hershey.

In a study presented at the joint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society, Dr. Dodson evaluated the effect of obesity on superovulation and intrauterine insemination (IUI) outcomes among 333 ovulatory women who had been infertile for a mean of 3.2 years.

A total of 206 of the women (62%) were of normal weight (18.5–25 kg/m

Of these women, 35% had idiopathic infertility, 31% had endometriosis, and 22% had various diagnoses, including pelvic adhesions, unilateral tubal occlusions, and leiomyomata. After adjustment for age, year of treatment, and the use of gonadotropin-releasing hormone agonists or antagonists, there were no significant differences in pregnancy rates between the women, regardless of BMI.

This trend was observed for pregnancy rates on the first cycle of IUI (which ranged from 6% to 15%), as well over all 814 treatment cycles (which ranged from 11% to 16%).

In addition, the number of large preovulatory follicles (measuring at least 17 mm) did not differ significantly between the different BMI categories (3.3 to 3.9). However, total gonadotropin dose was higher for obese women.

Atomoxetine vs. Methylphenidate

Once-daily atomoxetine is just as effective as twice-daily methylphenidate in reducing symptoms of attention-deficit hyperactivity disorder in children, Dr. Yufeng Wang of Beijing Medical University reported in a poster at the joint annual meeting of the American Academy of Child and Adolescent Psychiatry and the Canadian Academy of Child and Adolescent Psychiatry.

However, the study, funded by Eli Lilly & Co., concluded that treatment-emergent adverse events, including anorexia, nausea, somnolence, dizziness, and vomiting, were significantly more common among those taking atomoxetine.

The study involved a total of 330 children aged 6–16 years from China, Mexico, and Korea who were randomized to either once-daily atomoxetine (0.8–1.8 mg/kg per day) or twice-daily methylphenidate (0.2–0.5 mg/kg per day).

Responders were those who experienced at least a 40% reduction from baseline symptom scores as measured by the parents' ADHD Rating Scale.

Response rates were 77% for atomoxetine and 81% for methylphenidate–not a statistically significant difference.

The total score changes on the parents' ADHD Rating Scale were similar for both atomoxetine and methylphenidate (38 vs. 37, respectively), as were the score changes on the inattention and hyperactivity subscales. Changes on the Connors Parent Rating Scale and the Clinical Global Impressions scale also were similar for both groups.

Sleep Disturbance and Headache

Twenty percent of children with episodic headaches have at least one symptom of sleep disturbance, according to a poster presented by Dr. Lenora M. Lehwald at a conference on sleep disorders in infancy and childhood, sponsored by the Annenberg Center for Health Sciences.

The incidence of sleep disturbance rises to 67% among children with chronic daily headache. These findings suggest that sleep disturbance should be considered in any child with headache, wrote Dr. Lehwald and her colleagues at the Mayo Clinic, Rochester, Minn.

In several cases, the investigators noted a close temporal relationship between the appearance of a sleep difficulty and the transformation of episodic migraine to chronic daily headache. This suggests that attention to sleep hygiene and early identification of sleep difficulties in children with episodic migraine may prevent that transformation.

The study involved a comprehensive chart review of 200 consecutive patients from a pediatric neurology practice who were diagnosed with chronic daily headache, migraine with aura, or migraine without aura.

The average age of the chronic daily headache patients was 14.6 years, and that of the migraine patients was 11.8 years, Dr. Lehwald reported.

After the investigators controlled for age and gender, patients with chronic daily headache were 6.4-fold more likely to have a sleep disturbance than were patients with episodic migraine.

This odds ratio was statistically significant.

Impact of Parents on Teens

Parents with social anxiety and depressive symptoms are more likely to have adolescents with social phobia diagnoses, according to data on 471 adolescents and their parents reported by psychology graduate student Emily R. Anderson and her colleagues at the University of Nebraska, Lincoln.

Parents with high levels of social anxiety may overreport anxiety in their adolescents, although the children themselves may not endorse such symptoms, the investigators wrote in a poster presented at the annual meeting of the Association for Behavioral and Cognitive Therapies.

The study covered 223 boys and 248 girls aged 13–17 years living in the Midwest; 90% were white.

Investigators assessed the adolescents using several measures: the Brief Fear of Negative Evaluation scale, the Social Avoidance and Distress scale, the Social Phobia and Anxiety Inventory, the Beck Depression Inventory, and the Anxiety Disorders Interview Schedule for DSM-IV.

The young people were then subdivided into three groups based on how they were diagnosed for social phobia: parental interviews, adolescent interviews, and both parent and adolescent interviews.

About 50 adolescents in the study met criteria for social phobia on each diagnostic scale based on parental interviews and parental/adolescent interviews, and about 25 met these criteria based on adolescent interviews only, according to Ms. Anderson.

Parents whose adolescents were diagnosed with social phobia based only on parent interviews, or on both parent and adolescent interviews, scored significantly higher on three scales, compared with parents whose adolescents were not diagnosed with social phobia or diagnosed based on adolescent interviews alone, the investigators found.

Atomoxetine vs. Methylphenidate

Once-daily atomoxetine is just as effective as twice-daily methylphenidate in reducing symptoms of attention-deficit hyperactivity disorder in children, Dr. Yufeng Wang of Beijing Medical University reported in a poster at the joint annual meeting of the American Academy of Child and Adolescent Psychiatry and the Canadian Academy of Child and Adolescent Psychiatry.

However, the study, funded by Eli Lilly & Co., concluded that treatment-emergent adverse events, including anorexia, nausea, somnolence, dizziness, and vomiting, were significantly more common among those taking atomoxetine.

The study involved a total of 330 children aged 6–16 years from China, Mexico, and Korea who were randomized to either once-daily atomoxetine (0.8–1.8 mg/kg per day) or twice-daily methylphenidate (0.2–0.5 mg/kg per day).

Responders were those who experienced at least a 40% reduction from baseline symptom scores as measured by the parents' ADHD Rating Scale.

Response rates were 77% for atomoxetine and 81% for methylphenidate–not a statistically significant difference.

The total score changes on the parents' ADHD Rating Scale were similar for both atomoxetine and methylphenidate (38 vs. 37, respectively), as were the score changes on the inattention and hyperactivity subscales. Changes on the Connors Parent Rating Scale and the Clinical Global Impressions scale also were similar for both groups.

Sleep Disturbance and Headache

Twenty percent of children with episodic headaches have at least one symptom of sleep disturbance, according to a poster presented by Dr. Lenora M. Lehwald at a conference on sleep disorders in infancy and childhood, sponsored by the Annenberg Center for Health Sciences.

The incidence of sleep disturbance rises to 67% among children with chronic daily headache. These findings suggest that sleep disturbance should be considered in any child with headache, wrote Dr. Lehwald and her colleagues at the Mayo Clinic, Rochester, Minn.

In several cases, the investigators noted a close temporal relationship between the appearance of a sleep difficulty and the transformation of episodic migraine to chronic daily headache. This suggests that attention to sleep hygiene and early identification of sleep difficulties in children with episodic migraine may prevent that transformation.

The study involved a comprehensive chart review of 200 consecutive patients from a pediatric neurology practice who were diagnosed with chronic daily headache, migraine with aura, or migraine without aura.

The average age of the chronic daily headache patients was 14.6 years, and that of the migraine patients was 11.8 years, Dr. Lehwald reported.

After the investigators controlled for age and gender, patients with chronic daily headache were 6.4-fold more likely to have a sleep disturbance than were patients with episodic migraine.

This odds ratio was statistically significant.

Impact of Parents on Teens

Parents with social anxiety and depressive symptoms are more likely to have adolescents with social phobia diagnoses, according to data on 471 adolescents and their parents reported by psychology graduate student Emily R. Anderson and her colleagues at the University of Nebraska, Lincoln.

Parents with high levels of social anxiety may overreport anxiety in their adolescents, although the children themselves may not endorse such symptoms, the investigators wrote in a poster presented at the annual meeting of the Association for Behavioral and Cognitive Therapies.

The study covered 223 boys and 248 girls aged 13–17 years living in the Midwest; 90% were white.

Investigators assessed the adolescents using several measures: the Brief Fear of Negative Evaluation scale, the Social Avoidance and Distress scale, the Social Phobia and Anxiety Inventory, the Beck Depression Inventory, and the Anxiety Disorders Interview Schedule for DSM-IV.

The young people were then subdivided into three groups based on how they were diagnosed for social phobia: parental interviews, adolescent interviews, and both parent and adolescent interviews.

About 50 adolescents in the study met criteria for social phobia on each diagnostic scale based on parental interviews and parental/adolescent interviews, and about 25 met these criteria based on adolescent interviews only, according to Ms. Anderson.

Parents whose adolescents were diagnosed with social phobia based only on parent interviews, or on both parent and adolescent interviews, scored significantly higher on three scales, compared with parents whose adolescents were not diagnosed with social phobia or diagnosed based on adolescent interviews alone, the investigators found.

Atomoxetine vs. Methylphenidate

Once-daily atomoxetine is just as effective as twice-daily methylphenidate in reducing symptoms of attention-deficit hyperactivity disorder in children, Dr. Yufeng Wang of Beijing Medical University reported in a poster at the joint annual meeting of the American Academy of Child and Adolescent Psychiatry and the Canadian Academy of Child and Adolescent Psychiatry.

However, the study, funded by Eli Lilly & Co., concluded that treatment-emergent adverse events, including anorexia, nausea, somnolence, dizziness, and vomiting, were significantly more common among those taking atomoxetine.

The study involved a total of 330 children aged 6–16 years from China, Mexico, and Korea who were randomized to either once-daily atomoxetine (0.8–1.8 mg/kg per day) or twice-daily methylphenidate (0.2–0.5 mg/kg per day).

Responders were those who experienced at least a 40% reduction from baseline symptom scores as measured by the parents' ADHD Rating Scale.

Response rates were 77% for atomoxetine and 81% for methylphenidate–not a statistically significant difference.

The total score changes on the parents' ADHD Rating Scale were similar for both atomoxetine and methylphenidate (38 vs. 37, respectively), as were the score changes on the inattention and hyperactivity subscales. Changes on the Connors Parent Rating Scale and the Clinical Global Impressions scale also were similar for both groups.

Sleep Disturbance and Headache

Twenty percent of children with episodic headaches have at least one symptom of sleep disturbance, according to a poster presented by Dr. Lenora M. Lehwald at a conference on sleep disorders in infancy and childhood, sponsored by the Annenberg Center for Health Sciences.

The incidence of sleep disturbance rises to 67% among children with chronic daily headache. These findings suggest that sleep disturbance should be considered in any child with headache, wrote Dr. Lehwald and her colleagues at the Mayo Clinic, Rochester, Minn.

In several cases, the investigators noted a close temporal relationship between the appearance of a sleep difficulty and the transformation of episodic migraine to chronic daily headache. This suggests that attention to sleep hygiene and early identification of sleep difficulties in children with episodic migraine may prevent that transformation.

The study involved a comprehensive chart review of 200 consecutive patients from a pediatric neurology practice who were diagnosed with chronic daily headache, migraine with aura, or migraine without aura.

The average age of the chronic daily headache patients was 14.6 years, and that of the migraine patients was 11.8 years, Dr. Lehwald reported.

After the investigators controlled for age and gender, patients with chronic daily headache were 6.4-fold more likely to have a sleep disturbance than were patients with episodic migraine.

This odds ratio was statistically significant.

Impact of Parents on Teens

Parents with social anxiety and depressive symptoms are more likely to have adolescents with social phobia diagnoses, according to data on 471 adolescents and their parents reported by psychology graduate student Emily R. Anderson and her colleagues at the University of Nebraska, Lincoln.

Parents with high levels of social anxiety may overreport anxiety in their adolescents, although the children themselves may not endorse such symptoms, the investigators wrote in a poster presented at the annual meeting of the Association for Behavioral and Cognitive Therapies.

The study covered 223 boys and 248 girls aged 13–17 years living in the Midwest; 90% were white.

Investigators assessed the adolescents using several measures: the Brief Fear of Negative Evaluation scale, the Social Avoidance and Distress scale, the Social Phobia and Anxiety Inventory, the Beck Depression Inventory, and the Anxiety Disorders Interview Schedule for DSM-IV.

The young people were then subdivided into three groups based on how they were diagnosed for social phobia: parental interviews, adolescent interviews, and both parent and adolescent interviews.

About 50 adolescents in the study met criteria for social phobia on each diagnostic scale based on parental interviews and parental/adolescent interviews, and about 25 met these criteria based on adolescent interviews only, according to Ms. Anderson.

Parents whose adolescents were diagnosed with social phobia based only on parent interviews, or on both parent and adolescent interviews, scored significantly higher on three scales, compared with parents whose adolescents were not diagnosed with social phobia or diagnosed based on adolescent interviews alone, the investigators found.

PPIs vs. Peptic Ulcer Bleeding

Proton pump inhibitors reduce the risk of bleeding and abdominal surgery in patients with peptic ulcers, and also reduce mortality among Asian patients with peptic ulcers, according to a metaanalysis of 24 randomized controlled trials.

Dr. Grigoris Leontiadis of the Democritus University of Thrace, General Hospital of Alexandroupolis, Greece, and his colleagues wrote that pooled data from all trials show no overall reduction in mortality (3.9% with PPI treatment vs. 3.8% with control treatment), but there were significant reductions in persistent bleeding (6.8% for PPI group vs. 16.2% for controls) and surgical interventions (6.1% and 9.3%, respectively). The data suggest that “mortality following an episode of ulcer bleeding may be unrelated to continued or recurrent bleeding but is more likely to be due to co-morbid disease being exacerbated because of the bleeding episode.”

The findings support using PPIs in patients with endoscopically documented peptic ulcer bleeding (Cochrane Database of Syst. Rev. 2006;DOI10.1002/14651858. CD002094.pub3).

Of the 24 trials included, 8 were conducted in Asia, and pooled mortality rates were significantly lower with PPI treatment (1.5%, vs. 4.4% for controls). Mortality rates for all non-Asian trials were higher with PPI therapy, although not significantly so (4.8% for PPI group vs. 3.6% for controls). None of the trials compared different PPIs head-to-head, so it could not be determined whether any one is more effective than the others.

Cancer Risk in Lynch Syndrome

Prophylactic surgery may help prevent gynecologic cancers in women with hereditary nonpolyposis colorectal cancer, reported Dr. Kathleen M. Schmeler of the University of Texas M.D. Anderson Cancer Center, Houston, and her associates.

In a retrospective study of patients who had germ-line mutations associated with hereditary nonpolyposis colorectal cancer (Lynch syndrome), significantly fewer endometrial cancers occurred in women who had a prophylactic hysterectomy (0 of 61) than in those who did not (69 of 210).

None of the 47 women who had undergone a bilateral salpingo-oophorectomy for cancer prevention or benign conditions at the same time as their hysterectomy developed ovarian cancer, but this was not significantly different from the number of controls who developed ovarian cancer (12 of 223). The women underwent hysterectomy or bilateral salpingo-oophorectomy at a median age of 41 years, whereas the median age at diagnosis was 46 years for endometrial cancer and 42 years for ovarian cancer, Dr. Schmeler and her colleagues wrote (N. Engl. J. Med. 2006;354:261–9).

Of the 107 women in the cohort who had colorectal cancer, endometrial or ovarian cancer occurred synchronously with colorectal cancer in 3 patients and at different times in 38 patients. In 21 of those patients, gynecologic cancer was diagnosed a median of 5 years after they underwent surgery for colorectal cancer. The gynecologic cancer in those 21 women “could have been prevented if prophylactic hysterectomy and bilateral salpingo-oophorectomy had been performed at the time of surgery for colorectal cancer,” the investigators noted.

Undetected Celiac Disease Rare in IBS

Routine serologic screening for undetected celiac disease in patients with irritable bowel syndrome is hard to justify in light of the low disease prevalence found in a large international study, Allison R. Northcutt asserted at the annual meeting of the American College of Gastroenterology.

Indeed, the prevalence of celiac disease in 1,334 screened patients with irritable bowel syndrome (IBS) in the United States and nine other countries was a mere 0.5%.

A positive test for serum IgA antibodies to tissue transglutaminase was used to diagnose celiac disease. None of the patients who participated in this study of a novel IBS drug were previously known to have had celiac disease, said Ms. Northcutt of GlaxoSmithKline in Research Triangle Park, N.C.

The gastrointestinal symptoms associated with celiac disease—abdominal pain, constipation, bloating, and diarrhea—are nonspecific. They are also characteristic of patients with IBS, the most common condition for which patients go to a gastroenterologist.

For this reason, it has been theorized that the prevalence of undetected celiac disease in IBS patients may be considerably enriched over the 1%–3% rate in the general population of North America and Europe. This theory is supported by a number of studies, mostly involving small numbers of IBS patients.

Some physicians have proposed that serologic screening for celiac disease should be routine in IBS patients, but Ms. Northcutt's data suggest that the cost may not be justified.

PPIs vs. Peptic Ulcer Bleeding

Proton pump inhibitors reduce the risk of bleeding and abdominal surgery in patients with peptic ulcers, and also reduce mortality among Asian patients with peptic ulcers, according to a metaanalysis of 24 randomized controlled trials.

Dr. Grigoris Leontiadis of the Democritus University of Thrace, General Hospital of Alexandroupolis, Greece, and his colleagues wrote that pooled data from all trials show no overall reduction in mortality (3.9% with PPI treatment vs. 3.8% with control treatment), but there were significant reductions in persistent bleeding (6.8% for PPI group vs. 16.2% for controls) and surgical interventions (6.1% and 9.3%, respectively). The data suggest that “mortality following an episode of ulcer bleeding may be unrelated to continued or recurrent bleeding but is more likely to be due to co-morbid disease being exacerbated because of the bleeding episode.”

The findings support using PPIs in patients with endoscopically documented peptic ulcer bleeding (Cochrane Database of Syst. Rev. 2006;DOI10.1002/14651858. CD002094.pub3).

Of the 24 trials included, 8 were conducted in Asia, and pooled mortality rates were significantly lower with PPI treatment (1.5%, vs. 4.4% for controls). Mortality rates for all non-Asian trials were higher with PPI therapy, although not significantly so (4.8% for PPI group vs. 3.6% for controls). None of the trials compared different PPIs head-to-head, so it could not be determined whether any one is more effective than the others.

Cancer Risk in Lynch Syndrome

Prophylactic surgery may help prevent gynecologic cancers in women with hereditary nonpolyposis colorectal cancer, reported Dr. Kathleen M. Schmeler of the University of Texas M.D. Anderson Cancer Center, Houston, and her associates.

In a retrospective study of patients who had germ-line mutations associated with hereditary nonpolyposis colorectal cancer (Lynch syndrome), significantly fewer endometrial cancers occurred in women who had a prophylactic hysterectomy (0 of 61) than in those who did not (69 of 210).

None of the 47 women who had undergone a bilateral salpingo-oophorectomy for cancer prevention or benign conditions at the same time as their hysterectomy developed ovarian cancer, but this was not significantly different from the number of controls who developed ovarian cancer (12 of 223). The women underwent hysterectomy or bilateral salpingo-oophorectomy at a median age of 41 years, whereas the median age at diagnosis was 46 years for endometrial cancer and 42 years for ovarian cancer, Dr. Schmeler and her colleagues wrote (N. Engl. J. Med. 2006;354:261–9).

Of the 107 women in the cohort who had colorectal cancer, endometrial or ovarian cancer occurred synchronously with colorectal cancer in 3 patients and at different times in 38 patients. In 21 of those patients, gynecologic cancer was diagnosed a median of 5 years after they underwent surgery for colorectal cancer. The gynecologic cancer in those 21 women “could have been prevented if prophylactic hysterectomy and bilateral salpingo-oophorectomy had been performed at the time of surgery for colorectal cancer,” the investigators noted.

Undetected Celiac Disease Rare in IBS

Routine serologic screening for undetected celiac disease in patients with irritable bowel syndrome is hard to justify in light of the low disease prevalence found in a large international study, Allison R. Northcutt asserted at the annual meeting of the American College of Gastroenterology.

Indeed, the prevalence of celiac disease in 1,334 screened patients with irritable bowel syndrome (IBS) in the United States and nine other countries was a mere 0.5%.

A positive test for serum IgA antibodies to tissue transglutaminase was used to diagnose celiac disease. None of the patients who participated in this study of a novel IBS drug were previously known to have had celiac disease, said Ms. Northcutt of GlaxoSmithKline in Research Triangle Park, N.C.

The gastrointestinal symptoms associated with celiac disease—abdominal pain, constipation, bloating, and diarrhea—are nonspecific. They are also characteristic of patients with IBS, the most common condition for which patients go to a gastroenterologist.

For this reason, it has been theorized that the prevalence of undetected celiac disease in IBS patients may be considerably enriched over the 1%–3% rate in the general population of North America and Europe. This theory is supported by a number of studies, mostly involving small numbers of IBS patients.

Some physicians have proposed that serologic screening for celiac disease should be routine in IBS patients, but Ms. Northcutt's data suggest that the cost may not be justified.

PPIs vs. Peptic Ulcer Bleeding

Proton pump inhibitors reduce the risk of bleeding and abdominal surgery in patients with peptic ulcers, and also reduce mortality among Asian patients with peptic ulcers, according to a metaanalysis of 24 randomized controlled trials.

Dr. Grigoris Leontiadis of the Democritus University of Thrace, General Hospital of Alexandroupolis, Greece, and his colleagues wrote that pooled data from all trials show no overall reduction in mortality (3.9% with PPI treatment vs. 3.8% with control treatment), but there were significant reductions in persistent bleeding (6.8% for PPI group vs. 16.2% for controls) and surgical interventions (6.1% and 9.3%, respectively). The data suggest that “mortality following an episode of ulcer bleeding may be unrelated to continued or recurrent bleeding but is more likely to be due to co-morbid disease being exacerbated because of the bleeding episode.”

The findings support using PPIs in patients with endoscopically documented peptic ulcer bleeding (Cochrane Database of Syst. Rev. 2006;DOI10.1002/14651858. CD002094.pub3).

Of the 24 trials included, 8 were conducted in Asia, and pooled mortality rates were significantly lower with PPI treatment (1.5%, vs. 4.4% for controls). Mortality rates for all non-Asian trials were higher with PPI therapy, although not significantly so (4.8% for PPI group vs. 3.6% for controls). None of the trials compared different PPIs head-to-head, so it could not be determined whether any one is more effective than the others.

Cancer Risk in Lynch Syndrome

Prophylactic surgery may help prevent gynecologic cancers in women with hereditary nonpolyposis colorectal cancer, reported Dr. Kathleen M. Schmeler of the University of Texas M.D. Anderson Cancer Center, Houston, and her associates.

In a retrospective study of patients who had germ-line mutations associated with hereditary nonpolyposis colorectal cancer (Lynch syndrome), significantly fewer endometrial cancers occurred in women who had a prophylactic hysterectomy (0 of 61) than in those who did not (69 of 210).

None of the 47 women who had undergone a bilateral salpingo-oophorectomy for cancer prevention or benign conditions at the same time as their hysterectomy developed ovarian cancer, but this was not significantly different from the number of controls who developed ovarian cancer (12 of 223). The women underwent hysterectomy or bilateral salpingo-oophorectomy at a median age of 41 years, whereas the median age at diagnosis was 46 years for endometrial cancer and 42 years for ovarian cancer, Dr. Schmeler and her colleagues wrote (N. Engl. J. Med. 2006;354:261–9).

Of the 107 women in the cohort who had colorectal cancer, endometrial or ovarian cancer occurred synchronously with colorectal cancer in 3 patients and at different times in 38 patients. In 21 of those patients, gynecologic cancer was diagnosed a median of 5 years after they underwent surgery for colorectal cancer. The gynecologic cancer in those 21 women “could have been prevented if prophylactic hysterectomy and bilateral salpingo-oophorectomy had been performed at the time of surgery for colorectal cancer,” the investigators noted.

Undetected Celiac Disease Rare in IBS

Routine serologic screening for undetected celiac disease in patients with irritable bowel syndrome is hard to justify in light of the low disease prevalence found in a large international study, Allison R. Northcutt asserted at the annual meeting of the American College of Gastroenterology.

Indeed, the prevalence of celiac disease in 1,334 screened patients with irritable bowel syndrome (IBS) in the United States and nine other countries was a mere 0.5%.

A positive test for serum IgA antibodies to tissue transglutaminase was used to diagnose celiac disease. None of the patients who participated in this study of a novel IBS drug were previously known to have had celiac disease, said Ms. Northcutt of GlaxoSmithKline in Research Triangle Park, N.C.

The gastrointestinal symptoms associated with celiac disease—abdominal pain, constipation, bloating, and diarrhea—are nonspecific. They are also characteristic of patients with IBS, the most common condition for which patients go to a gastroenterologist.

For this reason, it has been theorized that the prevalence of undetected celiac disease in IBS patients may be considerably enriched over the 1%–3% rate in the general population of North America and Europe. This theory is supported by a number of studies, mostly involving small numbers of IBS patients.

Some physicians have proposed that serologic screening for celiac disease should be routine in IBS patients, but Ms. Northcutt's data suggest that the cost may not be justified.

Statin Use and Macular Degeneration

No association appears to exist between age-related macular degeneration and the use of statins or other cholesterol-lowering drugs, according to findings from a case-control study of patients in the Cardiovascular Health Study.

It's been hypothesized that statins and other cholesterol-lowering drugs could slow or prevent age-related macular degeneration (AMD) by lowering serum or ocular concentrations of cholesterol, which is found in deposits within the extracellular lesions of AMD.

In a comparison between 390 patients with AMD and 2,365 control patients, Gerald McGwin Jr., Ph.D., and his colleagues at the University of Alabama at Birmingham did not find a significant association between AMD and the use of cholesterol-lowering drugs overall or statins in particular (Arch. Ophthalmol. 2006;124:33–7).

This lack of association persisted even after adjustment for a variety of demographic, behavioral, and medical variables. Participants were considered users if they reported using cholesterol-lowering drugs at one or more study visits.

Previous studies have reached conflicting conclusions. “Whether statins represent a viable mechanism for preventing or slowing AMD is still an issue of current debate that can best be resolved by designing adequately powered observational studies specifically to evaluate the impact of statins on the incidence of AMD,” the researchers wrote.

Short ICU Stay for Low-Risk CABG

A short stay in the intensive care unit is safe and cost effective for low-risk patients who have undergone coronary artery bypass grafting, according to Ghislaine van Mastrigt of Maastricht (the Netherlands) University Hospital and associates.

A “fast-track” ICU stay of 8 hours or less “can be considered as an alternative to conventional postoperative ICU treatment for low-risk CABG patients,” the researchers said.

A total of 300 subjects were randomly assigned to a short ICU stay and 300 to a conventional overnight stay in the ICU after CABG surgery at the university hospital between 2001 and 2003. Mean patient age was 62 years, and 80% were men.

The rate of readmission to the ICU was 2.7% (8 patients) in the short-stay group and 1.3% (4 patients) in the control group, a difference that was not statistically significant. There also were no significant differences between the two groups in postoperative morbidity, 30-day mortality, or total hospital stay, the investigators said (Crit. Care Med. 2006;34:65–75).

Hospital costs were significantly lower for the fast-track patients, mainly because of their stays in the high-cost ICU were a mean of 11 hours shorter than those of the conventional-care group. The short-stay group also underwent fewer of the laboratory tests that usually are performed in the ICU. Costs of other routine hospital care and outpatient procedures were comparable for the two groups.

Risk of Travel-Related Thrombosis

The risk for travel-related thrombosis appears to be greatest in people with other predisposing factors, Dr. Frits R. Rosendaal said at the annual meeting of the American Society of Hematology.

One controlled study showed that recent air travel doubled the overall risk of thrombosis, but risk was increased more than 14-fold in those with thrombophilia and in women who used oral contraceptives, said Dr. Rosendaal of Leiden (the Netherlands) University Medical Center.

This finding was confirmed in the MEGA (Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis) study, recently completed by Dr. Rosendaal and his colleagues. Data from 1,851 patients with a first deep vein thrombosis and 1,851 matched controls were analyzed. Recent travel of over 4 hour's duration was associated with a threefold increased risk of thrombosis.

The overall risk was similar for airplane, car, train, and bus travel, and was increased for those with factor V Leiden, obese persons, and women who used oral contraceptives. The risks were greater with longer duration of travel.

This study and several others are part of the World Health Organization Research into Global Hazards of Travel (WRIGHT) project. The studies are looking at risks, mechanisms, and prevention of travel-related thrombosis, including the role of airplane cabin conditions. Data thus far are conflicting with regard to whether hypobaric hypoxia in the airplane cabin leads to activation of the coagulation system, Dr. Rosendaal noted.

Together, the findings suggest that conditions of air travel may cause a hypercoagulant response in some individuals, but this occurs mainly in those with other risk factors, he said. Data on prevention of travel-related thrombosis are lacking, but some evidence suggests that wearing stockings may be of benefit, he noted.

Statin Use and Macular Degeneration

No association appears to exist between age-related macular degeneration and the use of statins or other cholesterol-lowering drugs, according to findings from a case-control study of patients in the Cardiovascular Health Study.

It's been hypothesized that statins and other cholesterol-lowering drugs could slow or prevent age-related macular degeneration (AMD) by lowering serum or ocular concentrations of cholesterol, which is found in deposits within the extracellular lesions of AMD.

In a comparison between 390 patients with AMD and 2,365 control patients, Gerald McGwin Jr., Ph.D., and his colleagues at the University of Alabama at Birmingham did not find a significant association between AMD and the use of cholesterol-lowering drugs overall or statins in particular (Arch. Ophthalmol. 2006;124:33–7).

This lack of association persisted even after adjustment for a variety of demographic, behavioral, and medical variables. Participants were considered users if they reported using cholesterol-lowering drugs at one or more study visits.

Previous studies have reached conflicting conclusions. “Whether statins represent a viable mechanism for preventing or slowing AMD is still an issue of current debate that can best be resolved by designing adequately powered observational studies specifically to evaluate the impact of statins on the incidence of AMD,” the researchers wrote.

Short ICU Stay for Low-Risk CABG

A short stay in the intensive care unit is safe and cost effective for low-risk patients who have undergone coronary artery bypass grafting, according to Ghislaine van Mastrigt of Maastricht (the Netherlands) University Hospital and associates.

A “fast-track” ICU stay of 8 hours or less “can be considered as an alternative to conventional postoperative ICU treatment for low-risk CABG patients,” the researchers said.

A total of 300 subjects were randomly assigned to a short ICU stay and 300 to a conventional overnight stay in the ICU after CABG surgery at the university hospital between 2001 and 2003. Mean patient age was 62 years, and 80% were men.

The rate of readmission to the ICU was 2.7% (8 patients) in the short-stay group and 1.3% (4 patients) in the control group, a difference that was not statistically significant. There also were no significant differences between the two groups in postoperative morbidity, 30-day mortality, or total hospital stay, the investigators said (Crit. Care Med. 2006;34:65–75).

Hospital costs were significantly lower for the fast-track patients, mainly because of their stays in the high-cost ICU were a mean of 11 hours shorter than those of the conventional-care group. The short-stay group also underwent fewer of the laboratory tests that usually are performed in the ICU. Costs of other routine hospital care and outpatient procedures were comparable for the two groups.

Risk of Travel-Related Thrombosis

The risk for travel-related thrombosis appears to be greatest in people with other predisposing factors, Dr. Frits R. Rosendaal said at the annual meeting of the American Society of Hematology.

One controlled study showed that recent air travel doubled the overall risk of thrombosis, but risk was increased more than 14-fold in those with thrombophilia and in women who used oral contraceptives, said Dr. Rosendaal of Leiden (the Netherlands) University Medical Center.

This finding was confirmed in the MEGA (Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis) study, recently completed by Dr. Rosendaal and his colleagues. Data from 1,851 patients with a first deep vein thrombosis and 1,851 matched controls were analyzed. Recent travel of over 4 hour's duration was associated with a threefold increased risk of thrombosis.

The overall risk was similar for airplane, car, train, and bus travel, and was increased for those with factor V Leiden, obese persons, and women who used oral contraceptives. The risks were greater with longer duration of travel.

This study and several others are part of the World Health Organization Research into Global Hazards of Travel (WRIGHT) project. The studies are looking at risks, mechanisms, and prevention of travel-related thrombosis, including the role of airplane cabin conditions. Data thus far are conflicting with regard to whether hypobaric hypoxia in the airplane cabin leads to activation of the coagulation system, Dr. Rosendaal noted.

Together, the findings suggest that conditions of air travel may cause a hypercoagulant response in some individuals, but this occurs mainly in those with other risk factors, he said. Data on prevention of travel-related thrombosis are lacking, but some evidence suggests that wearing stockings may be of benefit, he noted.

Statin Use and Macular Degeneration

No association appears to exist between age-related macular degeneration and the use of statins or other cholesterol-lowering drugs, according to findings from a case-control study of patients in the Cardiovascular Health Study.

It's been hypothesized that statins and other cholesterol-lowering drugs could slow or prevent age-related macular degeneration (AMD) by lowering serum or ocular concentrations of cholesterol, which is found in deposits within the extracellular lesions of AMD.

In a comparison between 390 patients with AMD and 2,365 control patients, Gerald McGwin Jr., Ph.D., and his colleagues at the University of Alabama at Birmingham did not find a significant association between AMD and the use of cholesterol-lowering drugs overall or statins in particular (Arch. Ophthalmol. 2006;124:33–7).

This lack of association persisted even after adjustment for a variety of demographic, behavioral, and medical variables. Participants were considered users if they reported using cholesterol-lowering drugs at one or more study visits.

Previous studies have reached conflicting conclusions. “Whether statins represent a viable mechanism for preventing or slowing AMD is still an issue of current debate that can best be resolved by designing adequately powered observational studies specifically to evaluate the impact of statins on the incidence of AMD,” the researchers wrote.

Short ICU Stay for Low-Risk CABG

A short stay in the intensive care unit is safe and cost effective for low-risk patients who have undergone coronary artery bypass grafting, according to Ghislaine van Mastrigt of Maastricht (the Netherlands) University Hospital and associates.

A “fast-track” ICU stay of 8 hours or less “can be considered as an alternative to conventional postoperative ICU treatment for low-risk CABG patients,” the researchers said.

A total of 300 subjects were randomly assigned to a short ICU stay and 300 to a conventional overnight stay in the ICU after CABG surgery at the university hospital between 2001 and 2003. Mean patient age was 62 years, and 80% were men.

The rate of readmission to the ICU was 2.7% (8 patients) in the short-stay group and 1.3% (4 patients) in the control group, a difference that was not statistically significant. There also were no significant differences between the two groups in postoperative morbidity, 30-day mortality, or total hospital stay, the investigators said (Crit. Care Med. 2006;34:65–75).

Hospital costs were significantly lower for the fast-track patients, mainly because of their stays in the high-cost ICU were a mean of 11 hours shorter than those of the conventional-care group. The short-stay group also underwent fewer of the laboratory tests that usually are performed in the ICU. Costs of other routine hospital care and outpatient procedures were comparable for the two groups.

Risk of Travel-Related Thrombosis

The risk for travel-related thrombosis appears to be greatest in people with other predisposing factors, Dr. Frits R. Rosendaal said at the annual meeting of the American Society of Hematology.

One controlled study showed that recent air travel doubled the overall risk of thrombosis, but risk was increased more than 14-fold in those with thrombophilia and in women who used oral contraceptives, said Dr. Rosendaal of Leiden (the Netherlands) University Medical Center.

This finding was confirmed in the MEGA (Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis) study, recently completed by Dr. Rosendaal and his colleagues. Data from 1,851 patients with a first deep vein thrombosis and 1,851 matched controls were analyzed. Recent travel of over 4 hour's duration was associated with a threefold increased risk of thrombosis.

The overall risk was similar for airplane, car, train, and bus travel, and was increased for those with factor V Leiden, obese persons, and women who used oral contraceptives. The risks were greater with longer duration of travel.

This study and several others are part of the World Health Organization Research into Global Hazards of Travel (WRIGHT) project. The studies are looking at risks, mechanisms, and prevention of travel-related thrombosis, including the role of airplane cabin conditions. Data thus far are conflicting with regard to whether hypobaric hypoxia in the airplane cabin leads to activation of the coagulation system, Dr. Rosendaal noted.

Together, the findings suggest that conditions of air travel may cause a hypercoagulant response in some individuals, but this occurs mainly in those with other risk factors, he said. Data on prevention of travel-related thrombosis are lacking, but some evidence suggests that wearing stockings may be of benefit, he noted.

Tegaserod Therapy in Women With IBS

A large, international trial found that tegaserod was significantly more effective than placebo for irritable bowel syndrome with constipation.

Dr. Jan Tack, of the Centre for Gastroenterological Research, University of Leuven (Belgium), and coauthors worked with physicians from 20 countries to randomize 2,660 female patients; 2,135 received tegaserod (6 mg twice daily) and 525 took the placebo for the initial treatment phase of 1 month.

After a treatment-free interval, the researchers re-randomized 983 patients (488 tegaserod, 495 placebo) who qualified for repeated treatment because they responded to the first treatment and then had a recurrence of IBS symptoms (Gut 2005;54:1707–13).

The researchers found that patients treated with tegaserod had better work productivity and quality of life than did placebo patients during both the initial therapy and repeated treatment. The drug, marketed as Zelnorm by Novartis, was initially approved in 2002 for IBS with constipation in women.

Due to subsequent concerns about overuse, the label advises physicians and patients to “periodically assess the need for continued therapy.”

Drinking Tea May Cut Ovarian Ca Risk

Tea consumption appears to reduce a woman's risk of developing epithelial ovarian cancer, reported Dr. Susanna C. Larsson and Dr. Alicja Wolk of the Karolinska Institute, Stockholm.

The researchers used dietary data collected from 66,651 Swedish women between 1987 and 1990 to examine a possible link between tea consumption and later development of ovarian malignancy.

They identified incident cases of invasive epithelial ovarian cancer that occurred over the intervening 14–17 years using a national cancer registry. A total of 301 of the women developed ovarian cancer.

Tea drinking was inversely correlated with the disease, so that the incidence of ovarian cancer decreased as the quantity of tea drinking increased. Women who drank at least two cups of tea daily showed a 46% lower risk of ovarian cancer than did those who did not drink tea (Arch. Intern. Med. 2005;165:2683–6).

These results closely replicate the findings of the Iowa Women's Health Study, which reported a 47% lower risk of ovarian cancer in women who drank tea weekly. “To our knowledge, the Iowa Women's Health Study is the only other prospective study that has examined the relationship between tea consumption and ovarian cancer risk,” Dr. Larsson and Dr. Wolk said. Polyphenols that are abundant in both green and black teas “have been extensively studied as cancer chemopreventive agents,” they added.

Catechins, theaflavins, thearubigins, and flavonols have been shown to inhibit carcinogenesis in laboratory and animal studies. It is possible that these polyphenols protect against cancer by their antioxidant effects. Some researchers have posited that they may also inhibit cell growth, induce apoptosis, or inhibit tumor angiogenesis, the investigators noted.

Puberty Feeds Body Dissatisfaction

Pubertal changes were more likely to trigger body dissatisfaction in white girls than in African American girls in a study of 331 girls, reported Tiffany Floyd, Ph.D., in a poster presented at the annual meeting of the Association for Behavioral and Cognitive Therapies.

Previous studies have shown that body dissatisfaction during puberty is more common among girls than among boys—because pubertal changes conflict with the idealized image of the thin female—and that this increase in body dissatisfaction may promote depression.

However, additional research has shown that larger female body types are more desirable and acceptable among African Americans than they are among whites, wrote Dr. Floyd, of City College, New York, and her colleagues.

The study included girls in grades 4 through 9, with an average age of 12 years. Approximately 50% of the girls were African American.

Overall, white girls reported significantly more body dissatisfaction than did African American girls. Although pubertal status did not directly predict depression in either group, pubertal status significantly predicted body dissatisfaction among white girls in a linear regression analysis, which in turn predicted depressive symptoms.

Pubertal status failed to predict body dissatisfaction among African American girls, but body dissatisfaction significantly predicted depressive symptoms independent of pubertal status.

The girls were assessed using the Children's Depression Inventory, the Body Dissatisfaction Scale, and the Pubertal Development Scale.

Tegaserod Therapy in Women With IBS

A large, international trial found that tegaserod was significantly more effective than placebo for irritable bowel syndrome with constipation.

Dr. Jan Tack, of the Centre for Gastroenterological Research, University of Leuven (Belgium), and coauthors worked with physicians from 20 countries to randomize 2,660 female patients; 2,135 received tegaserod (6 mg twice daily) and 525 took the placebo for the initial treatment phase of 1 month.

After a treatment-free interval, the researchers re-randomized 983 patients (488 tegaserod, 495 placebo) who qualified for repeated treatment because they responded to the first treatment and then had a recurrence of IBS symptoms (Gut 2005;54:1707–13).

The researchers found that patients treated with tegaserod had better work productivity and quality of life than did placebo patients during both the initial therapy and repeated treatment. The drug, marketed as Zelnorm by Novartis, was initially approved in 2002 for IBS with constipation in women.

Due to subsequent concerns about overuse, the label advises physicians and patients to “periodically assess the need for continued therapy.”

Drinking Tea May Cut Ovarian Ca Risk

Tea consumption appears to reduce a woman's risk of developing epithelial ovarian cancer, reported Dr. Susanna C. Larsson and Dr. Alicja Wolk of the Karolinska Institute, Stockholm.

The researchers used dietary data collected from 66,651 Swedish women between 1987 and 1990 to examine a possible link between tea consumption and later development of ovarian malignancy.

They identified incident cases of invasive epithelial ovarian cancer that occurred over the intervening 14–17 years using a national cancer registry. A total of 301 of the women developed ovarian cancer.

Tea drinking was inversely correlated with the disease, so that the incidence of ovarian cancer decreased as the quantity of tea drinking increased. Women who drank at least two cups of tea daily showed a 46% lower risk of ovarian cancer than did those who did not drink tea (Arch. Intern. Med. 2005;165:2683–6).

These results closely replicate the findings of the Iowa Women's Health Study, which reported a 47% lower risk of ovarian cancer in women who drank tea weekly. “To our knowledge, the Iowa Women's Health Study is the only other prospective study that has examined the relationship between tea consumption and ovarian cancer risk,” Dr. Larsson and Dr. Wolk said. Polyphenols that are abundant in both green and black teas “have been extensively studied as cancer chemopreventive agents,” they added.

Catechins, theaflavins, thearubigins, and flavonols have been shown to inhibit carcinogenesis in laboratory and animal studies. It is possible that these polyphenols protect against cancer by their antioxidant effects. Some researchers have posited that they may also inhibit cell growth, induce apoptosis, or inhibit tumor angiogenesis, the investigators noted.

Puberty Feeds Body Dissatisfaction

Pubertal changes were more likely to trigger body dissatisfaction in white girls than in African American girls in a study of 331 girls, reported Tiffany Floyd, Ph.D., in a poster presented at the annual meeting of the Association for Behavioral and Cognitive Therapies.

Previous studies have shown that body dissatisfaction during puberty is more common among girls than among boys—because pubertal changes conflict with the idealized image of the thin female—and that this increase in body dissatisfaction may promote depression.

However, additional research has shown that larger female body types are more desirable and acceptable among African Americans than they are among whites, wrote Dr. Floyd, of City College, New York, and her colleagues.

The study included girls in grades 4 through 9, with an average age of 12 years. Approximately 50% of the girls were African American.

Overall, white girls reported significantly more body dissatisfaction than did African American girls. Although pubertal status did not directly predict depression in either group, pubertal status significantly predicted body dissatisfaction among white girls in a linear regression analysis, which in turn predicted depressive symptoms.

Pubertal status failed to predict body dissatisfaction among African American girls, but body dissatisfaction significantly predicted depressive symptoms independent of pubertal status.

The girls were assessed using the Children's Depression Inventory, the Body Dissatisfaction Scale, and the Pubertal Development Scale.

Tegaserod Therapy in Women With IBS

A large, international trial found that tegaserod was significantly more effective than placebo for irritable bowel syndrome with constipation.

Dr. Jan Tack, of the Centre for Gastroenterological Research, University of Leuven (Belgium), and coauthors worked with physicians from 20 countries to randomize 2,660 female patients; 2,135 received tegaserod (6 mg twice daily) and 525 took the placebo for the initial treatment phase of 1 month.

After a treatment-free interval, the researchers re-randomized 983 patients (488 tegaserod, 495 placebo) who qualified for repeated treatment because they responded to the first treatment and then had a recurrence of IBS symptoms (Gut 2005;54:1707–13).

The researchers found that patients treated with tegaserod had better work productivity and quality of life than did placebo patients during both the initial therapy and repeated treatment. The drug, marketed as Zelnorm by Novartis, was initially approved in 2002 for IBS with constipation in women.

Due to subsequent concerns about overuse, the label advises physicians and patients to “periodically assess the need for continued therapy.”

Drinking Tea May Cut Ovarian Ca Risk

Tea consumption appears to reduce a woman's risk of developing epithelial ovarian cancer, reported Dr. Susanna C. Larsson and Dr. Alicja Wolk of the Karolinska Institute, Stockholm.

The researchers used dietary data collected from 66,651 Swedish women between 1987 and 1990 to examine a possible link between tea consumption and later development of ovarian malignancy.

They identified incident cases of invasive epithelial ovarian cancer that occurred over the intervening 14–17 years using a national cancer registry. A total of 301 of the women developed ovarian cancer.

Tea drinking was inversely correlated with the disease, so that the incidence of ovarian cancer decreased as the quantity of tea drinking increased. Women who drank at least two cups of tea daily showed a 46% lower risk of ovarian cancer than did those who did not drink tea (Arch. Intern. Med. 2005;165:2683–6).

These results closely replicate the findings of the Iowa Women's Health Study, which reported a 47% lower risk of ovarian cancer in women who drank tea weekly. “To our knowledge, the Iowa Women's Health Study is the only other prospective study that has examined the relationship between tea consumption and ovarian cancer risk,” Dr. Larsson and Dr. Wolk said. Polyphenols that are abundant in both green and black teas “have been extensively studied as cancer chemopreventive agents,” they added.

Catechins, theaflavins, thearubigins, and flavonols have been shown to inhibit carcinogenesis in laboratory and animal studies. It is possible that these polyphenols protect against cancer by their antioxidant effects. Some researchers have posited that they may also inhibit cell growth, induce apoptosis, or inhibit tumor angiogenesis, the investigators noted.

Puberty Feeds Body Dissatisfaction

Pubertal changes were more likely to trigger body dissatisfaction in white girls than in African American girls in a study of 331 girls, reported Tiffany Floyd, Ph.D., in a poster presented at the annual meeting of the Association for Behavioral and Cognitive Therapies.

Previous studies have shown that body dissatisfaction during puberty is more common among girls than among boys—because pubertal changes conflict with the idealized image of the thin female—and that this increase in body dissatisfaction may promote depression.

However, additional research has shown that larger female body types are more desirable and acceptable among African Americans than they are among whites, wrote Dr. Floyd, of City College, New York, and her colleagues.

The study included girls in grades 4 through 9, with an average age of 12 years. Approximately 50% of the girls were African American.

Overall, white girls reported significantly more body dissatisfaction than did African American girls. Although pubertal status did not directly predict depression in either group, pubertal status significantly predicted body dissatisfaction among white girls in a linear regression analysis, which in turn predicted depressive symptoms.

Pubertal status failed to predict body dissatisfaction among African American girls, but body dissatisfaction significantly predicted depressive symptoms independent of pubertal status.

The girls were assessed using the Children's Depression Inventory, the Body Dissatisfaction Scale, and the Pubertal Development Scale.

Colorectal Ca in Asians With Diabetes

Chinese Singaporeans with diabetes have a 50% greater risk of developing colorectal cancer than nondiabetic, matched controls, Dr. Adeline Seow and her colleagues have reported.

Because the mean body mass index among Asians is 3 kg/m

The researchers examined the incidence of colorectal cancer from 1993 to 1998 in more than 63,000 ethnic Chinese persons in Singapore. All the subjects were cancer-free at baseline, and 9% had diabetes.

After an average follow-up period of 7 years, 636 subjects had developed colorectal cancer. After adjusting for age and gender, the incidence rates were 209/100,000 person-years among diabetics and 140/100,000 person-years among nondiabetics. Compared with nondiabetics, men with diabetes had a 50% higher risk of the cancers, and women with diabetes had a 40% increased risk.

When all subjects were stratified by BMI, diabetics with a BMI of 20–24 had a 70% higher risk of developing the cancer, but there was no trend suggesting an increasing risk with higher BMIs. There was also a significantly increased risk of cancer among diabetics with higher calorie intake (relative risk 1.8) and lower activity levels (RR 1.5), compared with nondiabetics.

T Cells vs. Metastasis in Colorectal Ca

High levels of T cells within tumors correlate with the absence of early metastasis and with prolonged survival of patients with colorectal cancer, a prospective analysis of resected tumors from 959 surgical patients indicates.

The presence of pathologic signs of early metastatic invasion—vascular emboli, lymphatic invasion, and perineural invasion (VELIPI)—was associated with adverse outcomes during a mean follow-up period of 44.5 months, reported Dr. Franck Pagès of the Cordeliers Biomedical Research Center, Paris, and associates (N. Engl. J. Med. 2005;353:2654–66).

The disease-free survival rate at 5 years was 32.4% in the 702 patients with VELIPI-negative tumors and 12.1% in the 257 patients with VELIPI-positive tumors. The median duration of disease-free survival was 26.9 months for patients with VELIPI-negative tumors and 3.3 months for patients with VELIPI-positive tumors.

VELIPI-positive tumors showed evidence of an impaired immune response as assessed by flow cytometry (39 tumors), low-density-array real-time polymerase-chain-reaction assay (75 tumors), and tissue microarrays (415 tumors). For the flow-cytometric analyses, the researchers extracted cells by mechanical dispersion from 39 randomly selected samples. For the PCR assays, the 75 samples analyzed were those of sufficient quality and quantity among 100 randomly selected frozen tumor specimens from the 959-patient cohort. For the tissue microarray analyses, the 415 randomly selected samples were deemed representative of the entire cohort.

Pancreatitis or Pancreatic Ca?

A serum assay that quantifies the MUC1 mucin-type glycoprotein is useful in differentiating between pancreatitis and pancreatic cancer, a study has shown.

The new assay is more sensitive and specific than the standard CA19–9 immunoassay, researchers at the Garden State Cancer Center in Belleville, N.J., reported. The CA19–9 antigen is an oligosaccharide present within the MUC1 mucin-type glycoprotein David V. Gold, Ph.D., and his colleagues used an in vitro enzyme immunoassay with monoclonal PAM4 as the capture reagent and a polyclonal MUC1 antibody as the probe to evaluate sera from 43 healthy subjects, 53 pancreatic cancer patients, and 87 patients with pancreatitis (J. Clin. Oncol. 2006;24:1–7).

Using a cutoff of 10.2 units/mL, 77% of cancer patients, 5% of patients with pancreatitis, and none of the healthy subjects tested positive with the PAM4-based assay.

The study also included 81 patients with malignancies other than pancreatic cancer that express the MUC1 antigen. Colorectal cancer most often tested positive with the PAM4-based assay; 5 of 36 patients with colorectal cancer tested positive.

The sensitivity and specificity of the assay for pancreatic cancer were 77% and 95%, respectively. A direct comparison of the ability of the PAM4 and CA19-9 immunoassays to discriminate between cancer and pancreatitis resulted in a significant difference, “with the PAM4 immunoassay demonstrating superior sensitivity and specificity.” This is because PAM4 “demonstrates a more restrictive reactivity for pancreatic cancer,” Dr. Gold and his associates wrote.

The potential role of the PAM4-based immunoassay in detection of early pancreatic tumors remains to be determined.

Colorectal Ca in Asians With Diabetes

Chinese Singaporeans with diabetes have a 50% greater risk of developing colorectal cancer than nondiabetic, matched controls, Dr. Adeline Seow and her colleagues have reported.

Because the mean body mass index among Asians is 3 kg/m

The researchers examined the incidence of colorectal cancer from 1993 to 1998 in more than 63,000 ethnic Chinese persons in Singapore. All the subjects were cancer-free at baseline, and 9% had diabetes.

After an average follow-up period of 7 years, 636 subjects had developed colorectal cancer. After adjusting for age and gender, the incidence rates were 209/100,000 person-years among diabetics and 140/100,000 person-years among nondiabetics. Compared with nondiabetics, men with diabetes had a 50% higher risk of the cancers, and women with diabetes had a 40% increased risk.

When all subjects were stratified by BMI, diabetics with a BMI of 20–24 had a 70% higher risk of developing the cancer, but there was no trend suggesting an increasing risk with higher BMIs. There was also a significantly increased risk of cancer among diabetics with higher calorie intake (relative risk 1.8) and lower activity levels (RR 1.5), compared with nondiabetics.

T Cells vs. Metastasis in Colorectal Ca

High levels of T cells within tumors correlate with the absence of early metastasis and with prolonged survival of patients with colorectal cancer, a prospective analysis of resected tumors from 959 surgical patients indicates.

The presence of pathologic signs of early metastatic invasion—vascular emboli, lymphatic invasion, and perineural invasion (VELIPI)—was associated with adverse outcomes during a mean follow-up period of 44.5 months, reported Dr. Franck Pagès of the Cordeliers Biomedical Research Center, Paris, and associates (N. Engl. J. Med. 2005;353:2654–66).

The disease-free survival rate at 5 years was 32.4% in the 702 patients with VELIPI-negative tumors and 12.1% in the 257 patients with VELIPI-positive tumors. The median duration of disease-free survival was 26.9 months for patients with VELIPI-negative tumors and 3.3 months for patients with VELIPI-positive tumors.

VELIPI-positive tumors showed evidence of an impaired immune response as assessed by flow cytometry (39 tumors), low-density-array real-time polymerase-chain-reaction assay (75 tumors), and tissue microarrays (415 tumors). For the flow-cytometric analyses, the researchers extracted cells by mechanical dispersion from 39 randomly selected samples. For the PCR assays, the 75 samples analyzed were those of sufficient quality and quantity among 100 randomly selected frozen tumor specimens from the 959-patient cohort. For the tissue microarray analyses, the 415 randomly selected samples were deemed representative of the entire cohort.

Pancreatitis or Pancreatic Ca?

A serum assay that quantifies the MUC1 mucin-type glycoprotein is useful in differentiating between pancreatitis and pancreatic cancer, a study has shown.

The new assay is more sensitive and specific than the standard CA19–9 immunoassay, researchers at the Garden State Cancer Center in Belleville, N.J., reported. The CA19–9 antigen is an oligosaccharide present within the MUC1 mucin-type glycoprotein David V. Gold, Ph.D., and his colleagues used an in vitro enzyme immunoassay with monoclonal PAM4 as the capture reagent and a polyclonal MUC1 antibody as the probe to evaluate sera from 43 healthy subjects, 53 pancreatic cancer patients, and 87 patients with pancreatitis (J. Clin. Oncol. 2006;24:1–7).

Using a cutoff of 10.2 units/mL, 77% of cancer patients, 5% of patients with pancreatitis, and none of the healthy subjects tested positive with the PAM4-based assay.

The study also included 81 patients with malignancies other than pancreatic cancer that express the MUC1 antigen. Colorectal cancer most often tested positive with the PAM4-based assay; 5 of 36 patients with colorectal cancer tested positive.

The sensitivity and specificity of the assay for pancreatic cancer were 77% and 95%, respectively. A direct comparison of the ability of the PAM4 and CA19-9 immunoassays to discriminate between cancer and pancreatitis resulted in a significant difference, “with the PAM4 immunoassay demonstrating superior sensitivity and specificity.” This is because PAM4 “demonstrates a more restrictive reactivity for pancreatic cancer,” Dr. Gold and his associates wrote.

The potential role of the PAM4-based immunoassay in detection of early pancreatic tumors remains to be determined.

Colorectal Ca in Asians With Diabetes

Chinese Singaporeans with diabetes have a 50% greater risk of developing colorectal cancer than nondiabetic, matched controls, Dr. Adeline Seow and her colleagues have reported.

Because the mean body mass index among Asians is 3 kg/m

The researchers examined the incidence of colorectal cancer from 1993 to 1998 in more than 63,000 ethnic Chinese persons in Singapore. All the subjects were cancer-free at baseline, and 9% had diabetes.

After an average follow-up period of 7 years, 636 subjects had developed colorectal cancer. After adjusting for age and gender, the incidence rates were 209/100,000 person-years among diabetics and 140/100,000 person-years among nondiabetics. Compared with nondiabetics, men with diabetes had a 50% higher risk of the cancers, and women with diabetes had a 40% increased risk.

When all subjects were stratified by BMI, diabetics with a BMI of 20–24 had a 70% higher risk of developing the cancer, but there was no trend suggesting an increasing risk with higher BMIs. There was also a significantly increased risk of cancer among diabetics with higher calorie intake (relative risk 1.8) and lower activity levels (RR 1.5), compared with nondiabetics.

T Cells vs. Metastasis in Colorectal Ca

High levels of T cells within tumors correlate with the absence of early metastasis and with prolonged survival of patients with colorectal cancer, a prospective analysis of resected tumors from 959 surgical patients indicates.

The presence of pathologic signs of early metastatic invasion—vascular emboli, lymphatic invasion, and perineural invasion (VELIPI)—was associated with adverse outcomes during a mean follow-up period of 44.5 months, reported Dr. Franck Pagès of the Cordeliers Biomedical Research Center, Paris, and associates (N. Engl. J. Med. 2005;353:2654–66).

The disease-free survival rate at 5 years was 32.4% in the 702 patients with VELIPI-negative tumors and 12.1% in the 257 patients with VELIPI-positive tumors. The median duration of disease-free survival was 26.9 months for patients with VELIPI-negative tumors and 3.3 months for patients with VELIPI-positive tumors.

VELIPI-positive tumors showed evidence of an impaired immune response as assessed by flow cytometry (39 tumors), low-density-array real-time polymerase-chain-reaction assay (75 tumors), and tissue microarrays (415 tumors). For the flow-cytometric analyses, the researchers extracted cells by mechanical dispersion from 39 randomly selected samples. For the PCR assays, the 75 samples analyzed were those of sufficient quality and quantity among 100 randomly selected frozen tumor specimens from the 959-patient cohort. For the tissue microarray analyses, the 415 randomly selected samples were deemed representative of the entire cohort.

Pancreatitis or Pancreatic Ca?

A serum assay that quantifies the MUC1 mucin-type glycoprotein is useful in differentiating between pancreatitis and pancreatic cancer, a study has shown.

The new assay is more sensitive and specific than the standard CA19–9 immunoassay, researchers at the Garden State Cancer Center in Belleville, N.J., reported. The CA19–9 antigen is an oligosaccharide present within the MUC1 mucin-type glycoprotein David V. Gold, Ph.D., and his colleagues used an in vitro enzyme immunoassay with monoclonal PAM4 as the capture reagent and a polyclonal MUC1 antibody as the probe to evaluate sera from 43 healthy subjects, 53 pancreatic cancer patients, and 87 patients with pancreatitis (J. Clin. Oncol. 2006;24:1–7).

Using a cutoff of 10.2 units/mL, 77% of cancer patients, 5% of patients with pancreatitis, and none of the healthy subjects tested positive with the PAM4-based assay.

The study also included 81 patients with malignancies other than pancreatic cancer that express the MUC1 antigen. Colorectal cancer most often tested positive with the PAM4-based assay; 5 of 36 patients with colorectal cancer tested positive.

The sensitivity and specificity of the assay for pancreatic cancer were 77% and 95%, respectively. A direct comparison of the ability of the PAM4 and CA19-9 immunoassays to discriminate between cancer and pancreatitis resulted in a significant difference, “with the PAM4 immunoassay demonstrating superior sensitivity and specificity.” This is because PAM4 “demonstrates a more restrictive reactivity for pancreatic cancer,” Dr. Gold and his associates wrote.

The potential role of the PAM4-based immunoassay in detection of early pancreatic tumors remains to be determined.

Risks of Episodic HIV Therapy

A large, international HIV-1 trial was stopped prematurely because patients who received episodic antiretroviral therapy had more than twice the risk of disease progression and a higher rate of major complications as those who received continuous antiretroviral therapy, according to the National Institute of Allergy and Infectious Diseases.

The NIAID originally started the trial because the results of smaller studies had suggested that episodic use of antiretroviral therapy (ART) would yield a rate of progression to clinical AIDS or death that was lower than or similar to that of patients who received continuous ART. It was thought that patients who received episodic ART would have fewer drug side effects, lower costs, and more treatment options in the future because of less viral resistance.

When the Data and Safety Monitoring Board of the NIAID halted the trial on January 11, a total of 5,472 patients had been randomized to one of two groups. One group received continuous ART to suppress HIV viral load. A drug-conservation strategy was used in the other group: These patients received ART only when their level of CD4-positive cells dropped below 250 cells/mm

The trial involved a collaboration of 318 clinical centers in 33 countries. Most patients were from the United States (55%) and European countries (26%). Overseers of the trial told local study investigators that patients in the drug-conservation arm who had received ART in the past should restart ART if they were not already taking it. Investigators will continue to collect data on all patients at follow-up visits.

Sustiva-Viread-Emtriva Combo for HIV

Combination therapy with Sustiva, Viread, and Emtriva was superior to combined Sustiva and Combivir for treating HIV in treatment-naive patients enrolled in a phase III trial.

The prospective, 67-site, noninferiority trial included 517 patients randomized to receive once-daily Sustiva (600 mg efavirenz), Viread (300 mg tenofovir DF), and Emtriva (200 mg emtricitabine) or Sustiva (600 mg) once daily and a fixed dose of Combivir (300 mg zidovudine and 150 mg lamivudine). At 48 weeks, significantly more patients in the Sustiva-Viread-Emtriva group, compared with the Sustiva-Combivir group, reached and maintained HIV RNA levels of fewer than 400 copies/mL (84% vs. 73%), and fewer than 50 copies/mL (80% vs. 70%), reported Dr. Joel E. Gallant of Johns Hopkins University, Baltimore, and his colleagues.

CD4 counts also increased significantly more from baseline in the Sustiva-Viread-Emtriva group (mean increases of 190 cells/μL vs. 158 cells/μL), and fewer patients in that group had adverse events leading to treatment discontinuation (4% vs. 9%), the investigators noted (N. Engl. J. Med. 2006;354:251–60).

Both regimens used in this study are listed in treatment guidelines from the Department of Health and Human Services as “preferred” for managing HIV infection.

Gilead Sciences, which makes Viread and Emtriva, and Bristol-Myers Squibb Co., which makes Sustiva, are working together to develop a once-daily pill combining all three drugs, and in January announced plans to file a new drug application in the second quarter of this year.

Fluoroquinolones Common in Hospitals

About 60% of hospitalized adult patients receive at least one antimicrobial agent during their hospital stays, reported Dr. Conan MacDougall and his colleagues in a poster presented at the annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy.

Fluoroquinolones were the most commonly administered agents, followed by cephalosporins, in an analysis of 1,798,084 patients at 130 hospitals, said Dr. MacDougall of Virginia Commonwealth University, Richmond, and his colleagues.

The study was conducted between August 2002 and July 2003. Most of the study hospitals were in the southern and northern central United States, with an average bed size of 288; 115 of the hospitals were nonteaching facilities.

Greater use of antibacterial agents was associated with a higher case-mix index, more ICU patient-days per 1,000 patient-days, more cases of pneumonia and septicemia per 1,000 patient-days, and being located in the southern United States. Neither bed size nor hospital teaching status was a significant predictor of antibacterial use.

Overall, the average use rate for any antibacterial agent (total antibacterials) was 790 days of therapy per 1,000 patient-days. The average use rate for the most commonly used individual agent, levofloxacin, was 122 days of therapy per 1,000 patient-days. Cefazolin was the next most popular agent, averaging 94 therapy days per 1,000 patient-days.

Risks of Episodic HIV Therapy

A large, international HIV-1 trial was stopped prematurely because patients who received episodic antiretroviral therapy had more than twice the risk of disease progression and a higher rate of major complications as those who received continuous antiretroviral therapy, according to the National Institute of Allergy and Infectious Diseases.

The NIAID originally started the trial because the results of smaller studies had suggested that episodic use of antiretroviral therapy (ART) would yield a rate of progression to clinical AIDS or death that was lower than or similar to that of patients who received continuous ART. It was thought that patients who received episodic ART would have fewer drug side effects, lower costs, and more treatment options in the future because of less viral resistance.

When the Data and Safety Monitoring Board of the NIAID halted the trial on January 11, a total of 5,472 patients had been randomized to one of two groups. One group received continuous ART to suppress HIV viral load. A drug-conservation strategy was used in the other group: These patients received ART only when their level of CD4-positive cells dropped below 250 cells/mm

The trial involved a collaboration of 318 clinical centers in 33 countries. Most patients were from the United States (55%) and European countries (26%). Overseers of the trial told local study investigators that patients in the drug-conservation arm who had received ART in the past should restart ART if they were not already taking it. Investigators will continue to collect data on all patients at follow-up visits.

Sustiva-Viread-Emtriva Combo for HIV

Combination therapy with Sustiva, Viread, and Emtriva was superior to combined Sustiva and Combivir for treating HIV in treatment-naive patients enrolled in a phase III trial.

The prospective, 67-site, noninferiority trial included 517 patients randomized to receive once-daily Sustiva (600 mg efavirenz), Viread (300 mg tenofovir DF), and Emtriva (200 mg emtricitabine) or Sustiva (600 mg) once daily and a fixed dose of Combivir (300 mg zidovudine and 150 mg lamivudine). At 48 weeks, significantly more patients in the Sustiva-Viread-Emtriva group, compared with the Sustiva-Combivir group, reached and maintained HIV RNA levels of fewer than 400 copies/mL (84% vs. 73%), and fewer than 50 copies/mL (80% vs. 70%), reported Dr. Joel E. Gallant of Johns Hopkins University, Baltimore, and his colleagues.

CD4 counts also increased significantly more from baseline in the Sustiva-Viread-Emtriva group (mean increases of 190 cells/μL vs. 158 cells/μL), and fewer patients in that group had adverse events leading to treatment discontinuation (4% vs. 9%), the investigators noted (N. Engl. J. Med. 2006;354:251–60).

Both regimens used in this study are listed in treatment guidelines from the Department of Health and Human Services as “preferred” for managing HIV infection.

Gilead Sciences, which makes Viread and Emtriva, and Bristol-Myers Squibb Co., which makes Sustiva, are working together to develop a once-daily pill combining all three drugs, and in January announced plans to file a new drug application in the second quarter of this year.

Fluoroquinolones Common in Hospitals

About 60% of hospitalized adult patients receive at least one antimicrobial agent during their hospital stays, reported Dr. Conan MacDougall and his colleagues in a poster presented at the annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy.

Fluoroquinolones were the most commonly administered agents, followed by cephalosporins, in an analysis of 1,798,084 patients at 130 hospitals, said Dr. MacDougall of Virginia Commonwealth University, Richmond, and his colleagues.

The study was conducted between August 2002 and July 2003. Most of the study hospitals were in the southern and northern central United States, with an average bed size of 288; 115 of the hospitals were nonteaching facilities.

Greater use of antibacterial agents was associated with a higher case-mix index, more ICU patient-days per 1,000 patient-days, more cases of pneumonia and septicemia per 1,000 patient-days, and being located in the southern United States. Neither bed size nor hospital teaching status was a significant predictor of antibacterial use.

Overall, the average use rate for any antibacterial agent (total antibacterials) was 790 days of therapy per 1,000 patient-days. The average use rate for the most commonly used individual agent, levofloxacin, was 122 days of therapy per 1,000 patient-days. Cefazolin was the next most popular agent, averaging 94 therapy days per 1,000 patient-days.

Risks of Episodic HIV Therapy

A large, international HIV-1 trial was stopped prematurely because patients who received episodic antiretroviral therapy had more than twice the risk of disease progression and a higher rate of major complications as those who received continuous antiretroviral therapy, according to the National Institute of Allergy and Infectious Diseases.

The NIAID originally started the trial because the results of smaller studies had suggested that episodic use of antiretroviral therapy (ART) would yield a rate of progression to clinical AIDS or death that was lower than or similar to that of patients who received continuous ART. It was thought that patients who received episodic ART would have fewer drug side effects, lower costs, and more treatment options in the future because of less viral resistance.

When the Data and Safety Monitoring Board of the NIAID halted the trial on January 11, a total of 5,472 patients had been randomized to one of two groups. One group received continuous ART to suppress HIV viral load. A drug-conservation strategy was used in the other group: These patients received ART only when their level of CD4-positive cells dropped below 250 cells/mm

The trial involved a collaboration of 318 clinical centers in 33 countries. Most patients were from the United States (55%) and European countries (26%). Overseers of the trial told local study investigators that patients in the drug-conservation arm who had received ART in the past should restart ART if they were not already taking it. Investigators will continue to collect data on all patients at follow-up visits.

Sustiva-Viread-Emtriva Combo for HIV

Combination therapy with Sustiva, Viread, and Emtriva was superior to combined Sustiva and Combivir for treating HIV in treatment-naive patients enrolled in a phase III trial.

The prospective, 67-site, noninferiority trial included 517 patients randomized to receive once-daily Sustiva (600 mg efavirenz), Viread (300 mg tenofovir DF), and Emtriva (200 mg emtricitabine) or Sustiva (600 mg) once daily and a fixed dose of Combivir (300 mg zidovudine and 150 mg lamivudine). At 48 weeks, significantly more patients in the Sustiva-Viread-Emtriva group, compared with the Sustiva-Combivir group, reached and maintained HIV RNA levels of fewer than 400 copies/mL (84% vs. 73%), and fewer than 50 copies/mL (80% vs. 70%), reported Dr. Joel E. Gallant of Johns Hopkins University, Baltimore, and his colleagues.

CD4 counts also increased significantly more from baseline in the Sustiva-Viread-Emtriva group (mean increases of 190 cells/μL vs. 158 cells/μL), and fewer patients in that group had adverse events leading to treatment discontinuation (4% vs. 9%), the investigators noted (N. Engl. J. Med. 2006;354:251–60).

Both regimens used in this study are listed in treatment guidelines from the Department of Health and Human Services as “preferred” for managing HIV infection.

Gilead Sciences, which makes Viread and Emtriva, and Bristol-Myers Squibb Co., which makes Sustiva, are working together to develop a once-daily pill combining all three drugs, and in January announced plans to file a new drug application in the second quarter of this year.

Fluoroquinolones Common in Hospitals

About 60% of hospitalized adult patients receive at least one antimicrobial agent during their hospital stays, reported Dr. Conan MacDougall and his colleagues in a poster presented at the annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy.

Fluoroquinolones were the most commonly administered agents, followed by cephalosporins, in an analysis of 1,798,084 patients at 130 hospitals, said Dr. MacDougall of Virginia Commonwealth University, Richmond, and his colleagues.

The study was conducted between August 2002 and July 2003. Most of the study hospitals were in the southern and northern central United States, with an average bed size of 288; 115 of the hospitals were nonteaching facilities.

Greater use of antibacterial agents was associated with a higher case-mix index, more ICU patient-days per 1,000 patient-days, more cases of pneumonia and septicemia per 1,000 patient-days, and being located in the southern United States. Neither bed size nor hospital teaching status was a significant predictor of antibacterial use.

Overall, the average use rate for any antibacterial agent (total antibacterials) was 790 days of therapy per 1,000 patient-days. The average use rate for the most commonly used individual agent, levofloxacin, was 122 days of therapy per 1,000 patient-days. Cefazolin was the next most popular agent, averaging 94 therapy days per 1,000 patient-days.

Enzyme Levels in Barrett's Esophagus

Reduced expression of manganese superoxide dismutase may indicate increased vulnerability to oxidative stress and carcinogenesis in patients with Barrett's esophagus, reported Dr. Bruce F. Hermann and his associates at the University of Louisville (Ky.).

Endoscopic surveillance is the only clinical strategy available to evaluate the risk of Barrett's esophagus progressing to esophageal adenocarcinoma, so the investigators sought to determine whether measurement of tissue levels of manganese superoxide dismutase (MnSOD) could be a clinically useful marker for distinguishing low- and high-risk patients.

Dr. Hermann and his associates obtained endoscopic specimens from 92 patients—81 men and 11 women—including 22 patients with specialized intestinal metaplasia, 22 with low-grade dysplasia, 16 with high-grade dysplasia, and 15 with esophageal adenocarcinoma. The control group included 17 patients with normal esophagus, most of whom had reflux symptoms. MnSOD expression was evaluated using immunochemistry and graded on a scale ranging from 0 to 3 for the esophageal mucosa and submucosa of each specimen, yielding a total score of 0–6 for the two histoanatomic sites combined (Arch. Surg. 2005;140:1204–9).

The reduction in MnSOD expression was most pronounced in patients with specialized intestinal metaplasia, “but remained consistent from dysplasia to adenocarcinoma,” the investigators noted.

In an invited critique of the paper, Dr. John W. Harmon of Johns Hopkins Bayview Medical Center, Baltimore, and his colleagues stated that the study “is not completely convincing” because it focused only on MnSOD. Measurement of the other two forms of the enzyme might put in perspective the “unusual finding” that MnSOD levels were not elevated in the cancer specimens, they said (Arch. Surg. 2005;140:1209).

Mini-Laparoscopic Cholecystectomy

The use of miniaturized instruments during laparoscopic cholecystectomy reduced early postoperative incisional pain, prevented late incisional discomfort, and improved cosmetic results in a randomized trial of 79 patients scheduled for elective surgery.

Dr. Yuri W. Novitsky and his associates at the University of Massachusetts Medical School, Worcester, randomized 34 patients to mini-laparoscopic cholecystectomy (M-LC) and 33 patients to conventional laparoscopic cholecystectomy (C-LC); 12 of the 79 patients were excluded after randomization because of complications or logistical reasons. In the M-LC group, there were eight conversions to the C-LC procedure. Neither group had any intraoperative or major postoperative complications (Arch. Surg. 2005;140:1178–83).

The researchers modified C-LC by using 2-mm subcostal and lateral ports, a 10-mm umbilical port, and 2-mm graspers. Also, they used a 5-mm clip applier on the cystic artery and duct and a 5-mm 30° laparoscope through the epigastric port.

On postop days 1, 3, 7, and 28, patients rated postoperative incisional pain on a standard visual analog scale from 0 (no pain) to 10 (worst possible pain). On 1 day postop, the mean pain score was significantly less in the M-LC group (3.9) than in the C-LC group (4.9). There were no significant differences between groups on the remaining days, but at 28 days postop 90% of M-LC patients and 74% of C-LC patients had no pain.

At the 1-month follow-up visit, the patients and a nurse—all blinded to the type of instruments used—scored M-LC wounds as having significantly better cosmetic appearances than C-LC wounds.

Treatment for Zenker's Diverticula

Endoscopic treatment of Zenker's diverticula is safe and effective, requiring a short operating time and length of hospital stay, according to a small prospective study.

The study of 16 patients who required cricopharyngeal myotomy and Zenker's diverticuloplasty revealed that 9 patients could be successfully treated endoscopically, Dr. Dalilah Fortin reported at the annual meeting of the Canadian Association of Thoracic Surgery in Montreal. Dr. Fortin, a thoracic surgeon at the London Health Sciences Centre in London, Ont., added that an open procedure might be preferable for patients with smaller diverticula.

Three procedures were not attempted endoscopically because of the presence of very small diverticula, and four attempted endoscopic repairs had to be converted to open procedures because of poor visualization of the diverticula, she said. Among the nine successful endoscopic procedures, operative time was less than 1 hour in all cases and length of hospital stay was 24 hours, she said. The most serious apparent endoscopic complication was a mucosal tear, which was sutured endoscopically.

Enzyme Levels in Barrett's Esophagus

Reduced expression of manganese superoxide dismutase may indicate increased vulnerability to oxidative stress and carcinogenesis in patients with Barrett's esophagus, reported Dr. Bruce F. Hermann and his associates at the University of Louisville (Ky.).

Endoscopic surveillance is the only clinical strategy available to evaluate the risk of Barrett's esophagus progressing to esophageal adenocarcinoma, so the investigators sought to determine whether measurement of tissue levels of manganese superoxide dismutase (MnSOD) could be a clinically useful marker for distinguishing low- and high-risk patients.

Dr. Hermann and his associates obtained endoscopic specimens from 92 patients—81 men and 11 women—including 22 patients with specialized intestinal metaplasia, 22 with low-grade dysplasia, 16 with high-grade dysplasia, and 15 with esophageal adenocarcinoma. The control group included 17 patients with normal esophagus, most of whom had reflux symptoms. MnSOD expression was evaluated using immunochemistry and graded on a scale ranging from 0 to 3 for the esophageal mucosa and submucosa of each specimen, yielding a total score of 0–6 for the two histoanatomic sites combined (Arch. Surg. 2005;140:1204–9).

The reduction in MnSOD expression was most pronounced in patients with specialized intestinal metaplasia, “but remained consistent from dysplasia to adenocarcinoma,” the investigators noted.

In an invited critique of the paper, Dr. John W. Harmon of Johns Hopkins Bayview Medical Center, Baltimore, and his colleagues stated that the study “is not completely convincing” because it focused only on MnSOD. Measurement of the other two forms of the enzyme might put in perspective the “unusual finding” that MnSOD levels were not elevated in the cancer specimens, they said (Arch. Surg. 2005;140:1209).

Mini-Laparoscopic Cholecystectomy

The use of miniaturized instruments during laparoscopic cholecystectomy reduced early postoperative incisional pain, prevented late incisional discomfort, and improved cosmetic results in a randomized trial of 79 patients scheduled for elective surgery.

Dr. Yuri W. Novitsky and his associates at the University of Massachusetts Medical School, Worcester, randomized 34 patients to mini-laparoscopic cholecystectomy (M-LC) and 33 patients to conventional laparoscopic cholecystectomy (C-LC); 12 of the 79 patients were excluded after randomization because of complications or logistical reasons. In the M-LC group, there were eight conversions to the C-LC procedure. Neither group had any intraoperative or major postoperative complications (Arch. Surg. 2005;140:1178–83).

The researchers modified C-LC by using 2-mm subcostal and lateral ports, a 10-mm umbilical port, and 2-mm graspers. Also, they used a 5-mm clip applier on the cystic artery and duct and a 5-mm 30° laparoscope through the epigastric port.

On postop days 1, 3, 7, and 28, patients rated postoperative incisional pain on a standard visual analog scale from 0 (no pain) to 10 (worst possible pain). On 1 day postop, the mean pain score was significantly less in the M-LC group (3.9) than in the C-LC group (4.9). There were no significant differences between groups on the remaining days, but at 28 days postop 90% of M-LC patients and 74% of C-LC patients had no pain.

At the 1-month follow-up visit, the patients and a nurse—all blinded to the type of instruments used—scored M-LC wounds as having significantly better cosmetic appearances than C-LC wounds.

Treatment for Zenker's Diverticula

Endoscopic treatment of Zenker's diverticula is safe and effective, requiring a short operating time and length of hospital stay, according to a small prospective study.

The study of 16 patients who required cricopharyngeal myotomy and Zenker's diverticuloplasty revealed that 9 patients could be successfully treated endoscopically, Dr. Dalilah Fortin reported at the annual meeting of the Canadian Association of Thoracic Surgery in Montreal. Dr. Fortin, a thoracic surgeon at the London Health Sciences Centre in London, Ont., added that an open procedure might be preferable for patients with smaller diverticula.

Three procedures were not attempted endoscopically because of the presence of very small diverticula, and four attempted endoscopic repairs had to be converted to open procedures because of poor visualization of the diverticula, she said. Among the nine successful endoscopic procedures, operative time was less than 1 hour in all cases and length of hospital stay was 24 hours, she said. The most serious apparent endoscopic complication was a mucosal tear, which was sutured endoscopically.

Enzyme Levels in Barrett's Esophagus

Reduced expression of manganese superoxide dismutase may indicate increased vulnerability to oxidative stress and carcinogenesis in patients with Barrett's esophagus, reported Dr. Bruce F. Hermann and his associates at the University of Louisville (Ky.).

Endoscopic surveillance is the only clinical strategy available to evaluate the risk of Barrett's esophagus progressing to esophageal adenocarcinoma, so the investigators sought to determine whether measurement of tissue levels of manganese superoxide dismutase (MnSOD) could be a clinically useful marker for distinguishing low- and high-risk patients.

Dr. Hermann and his associates obtained endoscopic specimens from 92 patients—81 men and 11 women—including 22 patients with specialized intestinal metaplasia, 22 with low-grade dysplasia, 16 with high-grade dysplasia, and 15 with esophageal adenocarcinoma. The control group included 17 patients with normal esophagus, most of whom had reflux symptoms. MnSOD expression was evaluated using immunochemistry and graded on a scale ranging from 0 to 3 for the esophageal mucosa and submucosa of each specimen, yielding a total score of 0–6 for the two histoanatomic sites combined (Arch. Surg. 2005;140:1204–9).

The reduction in MnSOD expression was most pronounced in patients with specialized intestinal metaplasia, “but remained consistent from dysplasia to adenocarcinoma,” the investigators noted.

In an invited critique of the paper, Dr. John W. Harmon of Johns Hopkins Bayview Medical Center, Baltimore, and his colleagues stated that the study “is not completely convincing” because it focused only on MnSOD. Measurement of the other two forms of the enzyme might put in perspective the “unusual finding” that MnSOD levels were not elevated in the cancer specimens, they said (Arch. Surg. 2005;140:1209).

Mini-Laparoscopic Cholecystectomy

The use of miniaturized instruments during laparoscopic cholecystectomy reduced early postoperative incisional pain, prevented late incisional discomfort, and improved cosmetic results in a randomized trial of 79 patients scheduled for elective surgery.

Dr. Yuri W. Novitsky and his associates at the University of Massachusetts Medical School, Worcester, randomized 34 patients to mini-laparoscopic cholecystectomy (M-LC) and 33 patients to conventional laparoscopic cholecystectomy (C-LC); 12 of the 79 patients were excluded after randomization because of complications or logistical reasons. In the M-LC group, there were eight conversions to the C-LC procedure. Neither group had any intraoperative or major postoperative complications (Arch. Surg. 2005;140:1178–83).

The researchers modified C-LC by using 2-mm subcostal and lateral ports, a 10-mm umbilical port, and 2-mm graspers. Also, they used a 5-mm clip applier on the cystic artery and duct and a 5-mm 30° laparoscope through the epigastric port.

On postop days 1, 3, 7, and 28, patients rated postoperative incisional pain on a standard visual analog scale from 0 (no pain) to 10 (worst possible pain). On 1 day postop, the mean pain score was significantly less in the M-LC group (3.9) than in the C-LC group (4.9). There were no significant differences between groups on the remaining days, but at 28 days postop 90% of M-LC patients and 74% of C-LC patients had no pain.

At the 1-month follow-up visit, the patients and a nurse—all blinded to the type of instruments used—scored M-LC wounds as having significantly better cosmetic appearances than C-LC wounds.

Treatment for Zenker's Diverticula

Endoscopic treatment of Zenker's diverticula is safe and effective, requiring a short operating time and length of hospital stay, according to a small prospective study.

The study of 16 patients who required cricopharyngeal myotomy and Zenker's diverticuloplasty revealed that 9 patients could be successfully treated endoscopically, Dr. Dalilah Fortin reported at the annual meeting of the Canadian Association of Thoracic Surgery in Montreal. Dr. Fortin, a thoracic surgeon at the London Health Sciences Centre in London, Ont., added that an open procedure might be preferable for patients with smaller diverticula.

Three procedures were not attempted endoscopically because of the presence of very small diverticula, and four attempted endoscopic repairs had to be converted to open procedures because of poor visualization of the diverticula, she said. Among the nine successful endoscopic procedures, operative time was less than 1 hour in all cases and length of hospital stay was 24 hours, she said. The most serious apparent endoscopic complication was a mucosal tear, which was sutured endoscopically.

West Nile Virus Hits California Hard

California reported one-third of the annual U.S. total of West Nile virus cases through December 1, 2005, and 25% of the cases of the viral neuroinvasive disease, the Centers for Disease Control and Prevention reported.

A total of 2,744 human cases of West Nile virus (WNV) disease were reported in 42 states in 2005, compared with 2,359 in 2004. There was a spread of the disease in both humans and animals into counties not previously affected, as well as recurrence where the disease had previously been reported. “The increase … suggests that endemic transmission of WNV in the United States will continue for the foreseeable future,” the CDC said (MMWR 2005;54:1253–6).

WNV infections in humans, birds, mosquitoes, and nonhuman mammals are reported to the CDC through ArboNET, an Internet-based arbovirus surveillance system managed by state health departments and the CDC.

Of the cases reported, 1,165 (43%) were WNV neuroinvasive disease (WNND), which includes meningitis, encephalitis, or acute flaccid paralysis; 1,434 (52%) were West Nile fever (WNF); and 145 (5%) were unspecified illnesses. WNND had its highest incidence in the central United States, including South Dakota, Nebraska, and North Dakota, but there were also focal outbreaks in Illinois, Texas, and Louisiana.

Nongonococcal Urethritis in Men

Results from a case-control study involving both heterosexual and homosexual men indicate that the organism responsible for nongonococcal urethritis differs depending on the mode of transmission.

Adenoviruses and herpes simplex virus type 1 (HSV-1) were associated with nongonococcal urethritis (NGU) in men who have sex with men and in those who have insertive oral sex. On the other hand, Chlamydia trachomatis and Mycoplasma genitalium were associated with the infections in men who have sex with women and in those who have unprotected vaginal sex (J. Infect. Dis. 2006;193:336–45).

In addition, oral sex was associated with NGU in which no pathogen was detected, suggesting that some organisms that cause these infections have not yet been identified.

The study, conducted by Dr. Catriona S. Bradshaw of the University of Melbourne and her colleagues involved 329 men with NGU and 307 controls. All were tested for several possible causative agents with highly sensitive polymerase chain reaction or DNA strand-displacement assays.

In an editorial, Dr. H. Hunter Handsfield of the University of Washington, Seattle, noted that NGU is probably the most common sexually transmitted disease in both men and women. Despite that, the prevention and management of NGU have been impeded by a lack of basic knowledge about the syndrome (J. Infect. Dis. 2006;193:333–5).

Dr. Handsfield described the Australian study as the most comprehensive investigation yet reported and noted that the results have important implications for clinical management. For example, severe dysuria and meatitis are both associated with the presence of a viral pathogen, and the presence of both findings has a 31% positive predictive value for infections with adenoviruses or HSV.

U.S. Data: MRSA Colonization Is Rare

Nearly a third of the U.S. population aged 1 year and older are colonized with Staphylococcus aureus, but only about 1% are colonized with methicillin-resistant S. aureus (MRSA), according to prevalence estimates from the National Health and Nutrition Examination Survey, 2001–2002.

The estimates, based on nasal samples obtained from 9,622 persons, suggest that more than 89 million people in this country are colonized with S. aureus and more than 2 million are colonized with MRSA. The data also suggest that prevalence rates differ demographically, reported Dr. Matthew J. Kuehnert and his colleagues at the Centers for Disease Control and Prevention, Atlanta.

Individuals aged 6–11 years in this study had the highest prevalence of S. aureus nasal colonization (about 45%, compared with an estimated 32% overall), and MRSA colonization was shown on multivariate analysis to be associated with age of at least 60 years (odds ratio 4.3), and female gender (odds ratio 2.0). MRSA colonization was not associated with recent health care exposure (J. Infect. Dis. 2006;193:172–9).

The findings suggest that although S. aureus carriage is common, MRSA carriage is unusual in healthy persons, the investigators said. “Continued national surveillance of S. aureus carriage will help to determine future trends in the characteristics of carriage and the potential effectiveness of targeted population-based intervention,” they concluded.

West Nile Virus Hits California Hard

California reported one-third of the annual U.S. total of West Nile virus cases through December 1, 2005, and 25% of the cases of the viral neuroinvasive disease, the Centers for Disease Control and Prevention reported.

A total of 2,744 human cases of West Nile virus (WNV) disease were reported in 42 states in 2005, compared with 2,359 in 2004. There was a spread of the disease in both humans and animals into counties not previously affected, as well as recurrence where the disease had previously been reported. “The increase … suggests that endemic transmission of WNV in the United States will continue for the foreseeable future,” the CDC said (MMWR 2005;54:1253–6).

WNV infections in humans, birds, mosquitoes, and nonhuman mammals are reported to the CDC through ArboNET, an Internet-based arbovirus surveillance system managed by state health departments and the CDC.

Of the cases reported, 1,165 (43%) were WNV neuroinvasive disease (WNND), which includes meningitis, encephalitis, or acute flaccid paralysis; 1,434 (52%) were West Nile fever (WNF); and 145 (5%) were unspecified illnesses. WNND had its highest incidence in the central United States, including South Dakota, Nebraska, and North Dakota, but there were also focal outbreaks in Illinois, Texas, and Louisiana.

Nongonococcal Urethritis in Men

Results from a case-control study involving both heterosexual and homosexual men indicate that the organism responsible for nongonococcal urethritis differs depending on the mode of transmission.

Adenoviruses and herpes simplex virus type 1 (HSV-1) were associated with nongonococcal urethritis (NGU) in men who have sex with men and in those who have insertive oral sex. On the other hand, Chlamydia trachomatis and Mycoplasma genitalium were associated with the infections in men who have sex with women and in those who have unprotected vaginal sex (J. Infect. Dis. 2006;193:336–45).

In addition, oral sex was associated with NGU in which no pathogen was detected, suggesting that some organisms that cause these infections have not yet been identified.

The study, conducted by Dr. Catriona S. Bradshaw of the University of Melbourne and her colleagues involved 329 men with NGU and 307 controls. All were tested for several possible causative agents with highly sensitive polymerase chain reaction or DNA strand-displacement assays.

In an editorial, Dr. H. Hunter Handsfield of the University of Washington, Seattle, noted that NGU is probably the most common sexually transmitted disease in both men and women. Despite that, the prevention and management of NGU have been impeded by a lack of basic knowledge about the syndrome (J. Infect. Dis. 2006;193:333–5).

Dr. Handsfield described the Australian study as the most comprehensive investigation yet reported and noted that the results have important implications for clinical management. For example, severe dysuria and meatitis are both associated with the presence of a viral pathogen, and the presence of both findings has a 31% positive predictive value for infections with adenoviruses or HSV.

U.S. Data: MRSA Colonization Is Rare

Nearly a third of the U.S. population aged 1 year and older are colonized with Staphylococcus aureus, but only about 1% are colonized with methicillin-resistant S. aureus (MRSA), according to prevalence estimates from the National Health and Nutrition Examination Survey, 2001–2002.

The estimates, based on nasal samples obtained from 9,622 persons, suggest that more than 89 million people in this country are colonized with S. aureus and more than 2 million are colonized with MRSA. The data also suggest that prevalence rates differ demographically, reported Dr. Matthew J. Kuehnert and his colleagues at the Centers for Disease Control and Prevention, Atlanta.

Individuals aged 6–11 years in this study had the highest prevalence of S. aureus nasal colonization (about 45%, compared with an estimated 32% overall), and MRSA colonization was shown on multivariate analysis to be associated with age of at least 60 years (odds ratio 4.3), and female gender (odds ratio 2.0). MRSA colonization was not associated with recent health care exposure (J. Infect. Dis. 2006;193:172–9).

The findings suggest that although S. aureus carriage is common, MRSA carriage is unusual in healthy persons, the investigators said. “Continued national surveillance of S. aureus carriage will help to determine future trends in the characteristics of carriage and the potential effectiveness of targeted population-based intervention,” they concluded.

West Nile Virus Hits California Hard

California reported one-third of the annual U.S. total of West Nile virus cases through December 1, 2005, and 25% of the cases of the viral neuroinvasive disease, the Centers for Disease Control and Prevention reported.

A total of 2,744 human cases of West Nile virus (WNV) disease were reported in 42 states in 2005, compared with 2,359 in 2004. There was a spread of the disease in both humans and animals into counties not previously affected, as well as recurrence where the disease had previously been reported. “The increase … suggests that endemic transmission of WNV in the United States will continue for the foreseeable future,” the CDC said (MMWR 2005;54:1253–6).

WNV infections in humans, birds, mosquitoes, and nonhuman mammals are reported to the CDC through ArboNET, an Internet-based arbovirus surveillance system managed by state health departments and the CDC.

Of the cases reported, 1,165 (43%) were WNV neuroinvasive disease (WNND), which includes meningitis, encephalitis, or acute flaccid paralysis; 1,434 (52%) were West Nile fever (WNF); and 145 (5%) were unspecified illnesses. WNND had its highest incidence in the central United States, including South Dakota, Nebraska, and North Dakota, but there were also focal outbreaks in Illinois, Texas, and Louisiana.

Nongonococcal Urethritis in Men

Results from a case-control study involving both heterosexual and homosexual men indicate that the organism responsible for nongonococcal urethritis differs depending on the mode of transmission.

Adenoviruses and herpes simplex virus type 1 (HSV-1) were associated with nongonococcal urethritis (NGU) in men who have sex with men and in those who have insertive oral sex. On the other hand, Chlamydia trachomatis and Mycoplasma genitalium were associated with the infections in men who have sex with women and in those who have unprotected vaginal sex (J. Infect. Dis. 2006;193:336–45).

In addition, oral sex was associated with NGU in which no pathogen was detected, suggesting that some organisms that cause these infections have not yet been identified.

The study, conducted by Dr. Catriona S. Bradshaw of the University of Melbourne and her colleagues involved 329 men with NGU and 307 controls. All were tested for several possible causative agents with highly sensitive polymerase chain reaction or DNA strand-displacement assays.

In an editorial, Dr. H. Hunter Handsfield of the University of Washington, Seattle, noted that NGU is probably the most common sexually transmitted disease in both men and women. Despite that, the prevention and management of NGU have been impeded by a lack of basic knowledge about the syndrome (J. Infect. Dis. 2006;193:333–5).

Dr. Handsfield described the Australian study as the most comprehensive investigation yet reported and noted that the results have important implications for clinical management. For example, severe dysuria and meatitis are both associated with the presence of a viral pathogen, and the presence of both findings has a 31% positive predictive value for infections with adenoviruses or HSV.

U.S. Data: MRSA Colonization Is Rare

Nearly a third of the U.S. population aged 1 year and older are colonized with Staphylococcus aureus, but only about 1% are colonized with methicillin-resistant S. aureus (MRSA), according to prevalence estimates from the National Health and Nutrition Examination Survey, 2001–2002.

The estimates, based on nasal samples obtained from 9,622 persons, suggest that more than 89 million people in this country are colonized with S. aureus and more than 2 million are colonized with MRSA. The data also suggest that prevalence rates differ demographically, reported Dr. Matthew J. Kuehnert and his colleagues at the Centers for Disease Control and Prevention, Atlanta.

Individuals aged 6–11 years in this study had the highest prevalence of S. aureus nasal colonization (about 45%, compared with an estimated 32% overall), and MRSA colonization was shown on multivariate analysis to be associated with age of at least 60 years (odds ratio 4.3), and female gender (odds ratio 2.0). MRSA colonization was not associated with recent health care exposure (J. Infect. Dis. 2006;193:172–9).

The findings suggest that although S. aureus carriage is common, MRSA carriage is unusual in healthy persons, the investigators said. “Continued national surveillance of S. aureus carriage will help to determine future trends in the characteristics of carriage and the potential effectiveness of targeted population-based intervention,” they concluded.