John R. Bell

NEW YORK — A recently discovered chemical in the sap of a weed common to North America and much of the world appeared safe and effective in treating patients with superficial and nodular basal cell carcinoma, according to results presented as a poster at the American Academy of Dermatology's Academy 2007 meeting.

Using the PEP-005 extract of the petty spurge plant (Euphorbia peplus), Dr. Robert H. Rosen, a dermatologist in private practice in Sydney, Australia, and his colleagues, with sponsorship from Peplin Ltd., the manufacturer of the extract, conducted two separate multicenter, randomized, controlled, double-blinded, parallel phase-IIa trials for treatment of superficial basal cell carcinoma (sBCC) and nodular basal cell carcinoma (nBCC).

They recruited 58 patients with nBCC and 60 with sBCC. All participants were white adult women with one basal cell carcinoma on the arm, shoulder, chest, face, neck, abdomen, back, leg, or scalp.

Patients were given a gel vehicle containing one of three concentrations of the drug: 0.0025%, 0.01%, and 0.05%. Each patient received two doses, either on 2 consecutive days or with the second dose 1 week after the first.

Application of the 0.05% concentration PEP005 topical gel overall showed the greatest efficacy in both types of BCC after 85 days, regardless of dosing schedule, Dr. Rosen and colleagues reported.

In the nBCC group, the two dosing schedules combined achieved complete histologic clearance of 25% of lesions (in 4 of 16 patients) and complete or marked clinical clearance (defined as 50%-90% improvement) in 38% of lesions (6 of 16 patients). For sBCC, the two regimens of 0.05% PEP005 achieved complete histologic clearance in 50% (8 of 16 patients) and complete or marked clinical clearance in 69% (11 of 16 patients).

There were no significant differences in safety between the dosing schedules. Among patients with nBCC, the most common local skin response was erythema, with 50% of the 0.05%-strength patients reporting moderate levels and 19% reporting severe erythema. Other responses reported for the 0.05% concentration were itch (moderate in 31% and severe in 0%), edema (31% moderate and 0% severe), scabbing/crusting (31% and 0%), and flaking/scaling/dryness (38% and 6%).

In the patients with sBCC, local skin reactions for the 0.05% PEP005 gel were itch (19% moderate and 0% severe), erythema (63% and 0%), edema (13% and 0%), scabbing/crusting (50% and 6%), flaking/scaling/dryness (25% and 13%), and moderate hypopigmentation (an adverse effect not reported in the nBCC group) in 13%.

The sap of petty spurge (Euphorbia peplus) has been used in traditional medicine as a cure for warts. ©

NEW YORK — A recently discovered chemical in the sap of a weed common to North America and much of the world appeared safe and effective in treating patients with superficial and nodular basal cell carcinoma, according to results presented as a poster at the American Academy of Dermatology's Academy 2007 meeting.

Using the PEP-005 extract of the petty spurge plant (Euphorbia peplus), Dr. Robert H. Rosen, a dermatologist in private practice in Sydney, Australia, and his colleagues, with sponsorship from Peplin Ltd., the manufacturer of the extract, conducted two separate multicenter, randomized, controlled, double-blinded, parallel phase-IIa trials for treatment of superficial basal cell carcinoma (sBCC) and nodular basal cell carcinoma (nBCC).

They recruited 58 patients with nBCC and 60 with sBCC. All participants were white adult women with one basal cell carcinoma on the arm, shoulder, chest, face, neck, abdomen, back, leg, or scalp.

Patients were given a gel vehicle containing one of three concentrations of the drug: 0.0025%, 0.01%, and 0.05%. Each patient received two doses, either on 2 consecutive days or with the second dose 1 week after the first.

Application of the 0.05% concentration PEP005 topical gel overall showed the greatest efficacy in both types of BCC after 85 days, regardless of dosing schedule, Dr. Rosen and colleagues reported.

In the nBCC group, the two dosing schedules combined achieved complete histologic clearance of 25% of lesions (in 4 of 16 patients) and complete or marked clinical clearance (defined as 50%-90% improvement) in 38% of lesions (6 of 16 patients). For sBCC, the two regimens of 0.05% PEP005 achieved complete histologic clearance in 50% (8 of 16 patients) and complete or marked clinical clearance in 69% (11 of 16 patients).

There were no significant differences in safety between the dosing schedules. Among patients with nBCC, the most common local skin response was erythema, with 50% of the 0.05%-strength patients reporting moderate levels and 19% reporting severe erythema. Other responses reported for the 0.05% concentration were itch (moderate in 31% and severe in 0%), edema (31% moderate and 0% severe), scabbing/crusting (31% and 0%), and flaking/scaling/dryness (38% and 6%).

In the patients with sBCC, local skin reactions for the 0.05% PEP005 gel were itch (19% moderate and 0% severe), erythema (63% and 0%), edema (13% and 0%), scabbing/crusting (50% and 6%), flaking/scaling/dryness (25% and 13%), and moderate hypopigmentation (an adverse effect not reported in the nBCC group) in 13%.

The sap of petty spurge (Euphorbia peplus) has been used in traditional medicine as a cure for warts. ©

NEW YORK — A recently discovered chemical in the sap of a weed common to North America and much of the world appeared safe and effective in treating patients with superficial and nodular basal cell carcinoma, according to results presented as a poster at the American Academy of Dermatology's Academy 2007 meeting.

Using the PEP-005 extract of the petty spurge plant (Euphorbia peplus), Dr. Robert H. Rosen, a dermatologist in private practice in Sydney, Australia, and his colleagues, with sponsorship from Peplin Ltd., the manufacturer of the extract, conducted two separate multicenter, randomized, controlled, double-blinded, parallel phase-IIa trials for treatment of superficial basal cell carcinoma (sBCC) and nodular basal cell carcinoma (nBCC).

They recruited 58 patients with nBCC and 60 with sBCC. All participants were white adult women with one basal cell carcinoma on the arm, shoulder, chest, face, neck, abdomen, back, leg, or scalp.

Patients were given a gel vehicle containing one of three concentrations of the drug: 0.0025%, 0.01%, and 0.05%. Each patient received two doses, either on 2 consecutive days or with the second dose 1 week after the first.

Application of the 0.05% concentration PEP005 topical gel overall showed the greatest efficacy in both types of BCC after 85 days, regardless of dosing schedule, Dr. Rosen and colleagues reported.

In the nBCC group, the two dosing schedules combined achieved complete histologic clearance of 25% of lesions (in 4 of 16 patients) and complete or marked clinical clearance (defined as 50%-90% improvement) in 38% of lesions (6 of 16 patients). For sBCC, the two regimens of 0.05% PEP005 achieved complete histologic clearance in 50% (8 of 16 patients) and complete or marked clinical clearance in 69% (11 of 16 patients).

There were no significant differences in safety between the dosing schedules. Among patients with nBCC, the most common local skin response was erythema, with 50% of the 0.05%-strength patients reporting moderate levels and 19% reporting severe erythema. Other responses reported for the 0.05% concentration were itch (moderate in 31% and severe in 0%), edema (31% moderate and 0% severe), scabbing/crusting (31% and 0%), and flaking/scaling/dryness (38% and 6%).

In the patients with sBCC, local skin reactions for the 0.05% PEP005 gel were itch (19% moderate and 0% severe), erythema (63% and 0%), edema (13% and 0%), scabbing/crusting (50% and 6%), flaking/scaling/dryness (25% and 13%), and moderate hypopigmentation (an adverse effect not reported in the nBCC group) in 13%.

The sap of petty spurge (Euphorbia peplus) has been used in traditional medicine as a cure for warts. ©

The Centers for Disease Control and Prevention issued a health advisory urging families who adopt children from Ethiopia to make sure all family members are vaccinated for hepatitis A, which is endemic throughout the African continent.

The advisory, issued July 19 via the CDC's Clinician Outreach and Communication Activity (COCA) Listserv, said the agency had received an undisclosed number of reports of hepatitis A (HAV) in adults and children “linked” to children adopted from Ethiopia. “Other household members and caregivers of children adopted from Ethiopia should consider being vaccinated before adopted children are brought to the United States,” the advisory warned.

Most children younger than the age of 6 years do not get sick from hepatitis A virus infection, but they can spread it to older children and adults, who often become ill, the CDC says. Symptoms usually last up to 2 months, but there is no chronic disease. Older persons and those with chronic liver disease can have more serious illness. Overall mortality is 0.3%, but it is 1.8% in those aged 50 years and older.

If adopted children, household members, or others who have been in contact with them are experiencing symptoms of hepatitis A (fatigue, abdominal pain, loss of appetite, nausea, jaundice), they should contact a physician.

Persons exposed to hepatitis A who have not previously been immunized should contact their physician or local health department to see if they should receive an immunization or immunoglobulin that might prevent illness, the CDC said.

According to the U.S. Department of State, Ethiopia in 2003 was the 15th most common source country for foreign adoptions; in 2006, it was 5th. (See graphic.) Last year, Ethiopia accounted for 732 (4%) of 20,679 foreign adoptions overall into the United States.

The CDC also urged persons who were traveling to Ethiopia or other areas with a high incidence of hepatitis A to be vaccinated against the disease before travel.

According to the World Health Organization, Africa as a whole is considered to have “very high” endemicity of hepatitis A, and most hepatitis A patients on the continent are younger than 5 years. Most adults in endemic countries, however, are immune to the disease. (The report is available at www.who.int/csr/disease/hepatitis

In August 2004, a group of 351 European tourists visiting Egypt contracted the disease (Euro. Surveill. 2006;11:37–9).

A study in 1990 also found a higher than expected incidence of the disease among missionaries in sub-Saharan Africa (Am. J. Trop. Med. Hyg. 1990:43:527–33). An earlier study found that 84% of Ethiopians were positive for hepatitis A surface antigen (Am. J. Epidemiol. 1986;123:344–51).

“The Centers for Disease Control also recommends that all children [at least] 1 year of age receive the hepatitis A vaccine,” the advisory noted. This is part of the U.S. Childhood and Adolescent Immunization Schedule.

ELSEVIER GLOBAL MEDICAL NEWS

The Centers for Disease Control and Prevention issued a health advisory urging families who adopt children from Ethiopia to make sure all family members are vaccinated for hepatitis A, which is endemic throughout the African continent.

The advisory, issued July 19 via the CDC's Clinician Outreach and Communication Activity (COCA) Listserv, said the agency had received an undisclosed number of reports of hepatitis A (HAV) in adults and children “linked” to children adopted from Ethiopia. “Other household members and caregivers of children adopted from Ethiopia should consider being vaccinated before adopted children are brought to the United States,” the advisory warned.

Most children younger than the age of 6 years do not get sick from hepatitis A virus infection, but they can spread it to older children and adults, who often become ill, the CDC says. Symptoms usually last up to 2 months, but there is no chronic disease. Older persons and those with chronic liver disease can have more serious illness. Overall mortality is 0.3%, but it is 1.8% in those aged 50 years and older.

If adopted children, household members, or others who have been in contact with them are experiencing symptoms of hepatitis A (fatigue, abdominal pain, loss of appetite, nausea, jaundice), they should contact a physician.

Persons exposed to hepatitis A who have not previously been immunized should contact their physician or local health department to see if they should receive an immunization or immunoglobulin that might prevent illness, the CDC said.

According to the U.S. Department of State, Ethiopia in 2003 was the 15th most common source country for foreign adoptions; in 2006, it was 5th. (See graphic.) Last year, Ethiopia accounted for 732 (4%) of 20,679 foreign adoptions overall into the United States.

The CDC also urged persons who were traveling to Ethiopia or other areas with a high incidence of hepatitis A to be vaccinated against the disease before travel.

According to the World Health Organization, Africa as a whole is considered to have “very high” endemicity of hepatitis A, and most hepatitis A patients on the continent are younger than 5 years. Most adults in endemic countries, however, are immune to the disease. (The report is available at www.who.int/csr/disease/hepatitis

In August 2004, a group of 351 European tourists visiting Egypt contracted the disease (Euro. Surveill. 2006;11:37–9).

A study in 1990 also found a higher than expected incidence of the disease among missionaries in sub-Saharan Africa (Am. J. Trop. Med. Hyg. 1990:43:527–33). An earlier study found that 84% of Ethiopians were positive for hepatitis A surface antigen (Am. J. Epidemiol. 1986;123:344–51).

“The Centers for Disease Control also recommends that all children [at least] 1 year of age receive the hepatitis A vaccine,” the advisory noted. This is part of the U.S. Childhood and Adolescent Immunization Schedule.

ELSEVIER GLOBAL MEDICAL NEWS

The Centers for Disease Control and Prevention issued a health advisory urging families who adopt children from Ethiopia to make sure all family members are vaccinated for hepatitis A, which is endemic throughout the African continent.

The advisory, issued July 19 via the CDC's Clinician Outreach and Communication Activity (COCA) Listserv, said the agency had received an undisclosed number of reports of hepatitis A (HAV) in adults and children “linked” to children adopted from Ethiopia. “Other household members and caregivers of children adopted from Ethiopia should consider being vaccinated before adopted children are brought to the United States,” the advisory warned.

Most children younger than the age of 6 years do not get sick from hepatitis A virus infection, but they can spread it to older children and adults, who often become ill, the CDC says. Symptoms usually last up to 2 months, but there is no chronic disease. Older persons and those with chronic liver disease can have more serious illness. Overall mortality is 0.3%, but it is 1.8% in those aged 50 years and older.

If adopted children, household members, or others who have been in contact with them are experiencing symptoms of hepatitis A (fatigue, abdominal pain, loss of appetite, nausea, jaundice), they should contact a physician.

Persons exposed to hepatitis A who have not previously been immunized should contact their physician or local health department to see if they should receive an immunization or immunoglobulin that might prevent illness, the CDC said.

According to the U.S. Department of State, Ethiopia in 2003 was the 15th most common source country for foreign adoptions; in 2006, it was 5th. (See graphic.) Last year, Ethiopia accounted for 732 (4%) of 20,679 foreign adoptions overall into the United States.

The CDC also urged persons who were traveling to Ethiopia or other areas with a high incidence of hepatitis A to be vaccinated against the disease before travel.

According to the World Health Organization, Africa as a whole is considered to have “very high” endemicity of hepatitis A, and most hepatitis A patients on the continent are younger than 5 years. Most adults in endemic countries, however, are immune to the disease. (The report is available at www.who.int/csr/disease/hepatitis

In August 2004, a group of 351 European tourists visiting Egypt contracted the disease (Euro. Surveill. 2006;11:37–9).

A study in 1990 also found a higher than expected incidence of the disease among missionaries in sub-Saharan Africa (Am. J. Trop. Med. Hyg. 1990:43:527–33). An earlier study found that 84% of Ethiopians were positive for hepatitis A surface antigen (Am. J. Epidemiol. 1986;123:344–51).

“The Centers for Disease Control also recommends that all children [at least] 1 year of age receive the hepatitis A vaccine,” the advisory noted. This is part of the U.S. Childhood and Adolescent Immunization Schedule.

ELSEVIER GLOBAL MEDICAL NEWS

The Centers for Disease Control and Prevention issued a health advisory urging families who adopt children from Ethiopia to make sure all family members are vaccinated for hepatitis A, which is endemic throughout the African continent.

The advisory, issued July 19 via the CDC's Clinician Outreach and Communication Activity (COCA) Listserv, said the agency had received an undisclosed number of reports of hepatitis A in adults and children “linked” to children adopted from Ethiopia. “Other household members and caregivers of children adopted from Ethiopia should consider being vaccinated before adopted children are brought to the United States,” the advisory warned.

Most children younger than the age of 6 years do not get sick from hepatitis A virus infection, but they can spread it to older children and adults, who often become ill, the CDC says. Symptoms usually last up to 2 months, but there is no chronic disease. Older persons and those with chronic liver disease can have more serious illness. Overall mortality is 0.3%, but it is 1.8% in those aged 50 years and older.

If adopted children, household members, or others who have been in contact are experiencing symptoms of hepatitis A (fatigue, abdominal pain, loss of appetite, nausea, jaundice), they should contact a physician. Persons exposed to hepatitis A who have not previously been immunized should contact their physician or local health department to see if they should receive an immunization or immunoglobulin that might prevent illness, the CDC said.

According to the U.S. Department of State, Ethiopia in 2003 was the 15th most common source country for foreign adoptions; in 2006, it was 5th. (See box.) Last year, Ethiopia accounted for 732 (4%) of 20,679 foreign adoptions overall into the United States.

The CDC also urged persons traveling to Ethiopia or other areas with a high incidence of hepatitis A to be vaccinated against the disease before travel.

According to the World Health Organization, Africa as a whole is considered to have “very high” endemicity of hepatitis A, and most hepatitis A patients there are younger than 5 years. Most adults in endemic countries, however, are immune to the disease. (The report is available at www.who.int/csr/disease/hepatitis

A 1990 study found a higher than expected incidence of the disease among missionaries in sub-Saharan Africa (Am. J. Trop. Med. Hyg. 1990;43:527–33). An earlier study found that 84% of Ethiopians were positive for hepatitis A surface antigen (Am. J. Epidemiol. 1986;123:344–51).

“CDC also recommends that all children [at least] 1 year of age receive the hepatitis A vaccine,” the advisory noted. This is part of the U.S. Childhood and Adolescent Immunization Schedule.

ELSEVIER GLOBAL MEDICAL NEWS

The Centers for Disease Control and Prevention issued a health advisory urging families who adopt children from Ethiopia to make sure all family members are vaccinated for hepatitis A, which is endemic throughout the African continent.

The advisory, issued July 19 via the CDC's Clinician Outreach and Communication Activity (COCA) Listserv, said the agency had received an undisclosed number of reports of hepatitis A in adults and children “linked” to children adopted from Ethiopia. “Other household members and caregivers of children adopted from Ethiopia should consider being vaccinated before adopted children are brought to the United States,” the advisory warned.

Most children younger than the age of 6 years do not get sick from hepatitis A virus infection, but they can spread it to older children and adults, who often become ill, the CDC says. Symptoms usually last up to 2 months, but there is no chronic disease. Older persons and those with chronic liver disease can have more serious illness. Overall mortality is 0.3%, but it is 1.8% in those aged 50 years and older.

If adopted children, household members, or others who have been in contact are experiencing symptoms of hepatitis A (fatigue, abdominal pain, loss of appetite, nausea, jaundice), they should contact a physician. Persons exposed to hepatitis A who have not previously been immunized should contact their physician or local health department to see if they should receive an immunization or immunoglobulin that might prevent illness, the CDC said.

According to the U.S. Department of State, Ethiopia in 2003 was the 15th most common source country for foreign adoptions; in 2006, it was 5th. (See box.) Last year, Ethiopia accounted for 732 (4%) of 20,679 foreign adoptions overall into the United States.

The CDC also urged persons traveling to Ethiopia or other areas with a high incidence of hepatitis A to be vaccinated against the disease before travel.

According to the World Health Organization, Africa as a whole is considered to have “very high” endemicity of hepatitis A, and most hepatitis A patients there are younger than 5 years. Most adults in endemic countries, however, are immune to the disease. (The report is available at www.who.int/csr/disease/hepatitis

A 1990 study found a higher than expected incidence of the disease among missionaries in sub-Saharan Africa (Am. J. Trop. Med. Hyg. 1990;43:527–33). An earlier study found that 84% of Ethiopians were positive for hepatitis A surface antigen (Am. J. Epidemiol. 1986;123:344–51).

“CDC also recommends that all children [at least] 1 year of age receive the hepatitis A vaccine,” the advisory noted. This is part of the U.S. Childhood and Adolescent Immunization Schedule.

ELSEVIER GLOBAL MEDICAL NEWS

The Centers for Disease Control and Prevention issued a health advisory urging families who adopt children from Ethiopia to make sure all family members are vaccinated for hepatitis A, which is endemic throughout the African continent.

The advisory, issued July 19 via the CDC's Clinician Outreach and Communication Activity (COCA) Listserv, said the agency had received an undisclosed number of reports of hepatitis A in adults and children “linked” to children adopted from Ethiopia. “Other household members and caregivers of children adopted from Ethiopia should consider being vaccinated before adopted children are brought to the United States,” the advisory warned.

Most children younger than the age of 6 years do not get sick from hepatitis A virus infection, but they can spread it to older children and adults, who often become ill, the CDC says. Symptoms usually last up to 2 months, but there is no chronic disease. Older persons and those with chronic liver disease can have more serious illness. Overall mortality is 0.3%, but it is 1.8% in those aged 50 years and older.

If adopted children, household members, or others who have been in contact are experiencing symptoms of hepatitis A (fatigue, abdominal pain, loss of appetite, nausea, jaundice), they should contact a physician. Persons exposed to hepatitis A who have not previously been immunized should contact their physician or local health department to see if they should receive an immunization or immunoglobulin that might prevent illness, the CDC said.

According to the U.S. Department of State, Ethiopia in 2003 was the 15th most common source country for foreign adoptions; in 2006, it was 5th. (See box.) Last year, Ethiopia accounted for 732 (4%) of 20,679 foreign adoptions overall into the United States.

The CDC also urged persons traveling to Ethiopia or other areas with a high incidence of hepatitis A to be vaccinated against the disease before travel.

According to the World Health Organization, Africa as a whole is considered to have “very high” endemicity of hepatitis A, and most hepatitis A patients there are younger than 5 years. Most adults in endemic countries, however, are immune to the disease. (The report is available at www.who.int/csr/disease/hepatitis

A 1990 study found a higher than expected incidence of the disease among missionaries in sub-Saharan Africa (Am. J. Trop. Med. Hyg. 1990;43:527–33). An earlier study found that 84% of Ethiopians were positive for hepatitis A surface antigen (Am. J. Epidemiol. 1986;123:344–51).

“CDC also recommends that all children [at least] 1 year of age receive the hepatitis A vaccine,” the advisory noted. This is part of the U.S. Childhood and Adolescent Immunization Schedule.

ELSEVIER GLOBAL MEDICAL NEWS

The Centers for Disease Control and Prevention issued a health advisory urging families who adopt children from Ethiopia to make sure all family members are vaccinated for hepatitis A, which is endemic throughout the African continent.

The advisory, issued July 19 via the CDC's Clinician Outreach and Communication Activity (COCA) Listserv, said the agency had received an undisclosed number of reports of hepatitis A in adults and children “linked” to children adopted from Ethiopia.

“Other household members and caregivers of children adopted from Ethiopia should consider being vaccinated before adopted children are brought to the United States,” the advisory warned.

Most children younger than the age of 6 years do not get sick from hepatitis A virus infection, but they can spread it to older children and adults, who often become ill, the CDC says.

Symptoms usually last up to 2 months, but there is no chronic disease. Older persons and those with chronic liver disease can have more serious illness. Overall mortality is 0.3%, but it is 1.8% in those aged 50 years and older.

If adopted children, household members, or others who have been in contact are experiencing symptoms of hepatitis A (fatigue, abdominal pain, loss of appetite, nausea, jaundice), they should contact a physician. Persons exposed to hepatitis A who have not previously been immunized should contact their physician or local health department to see if they should receive an immunization or immunoglobulin that might prevent illness, the CDC said.

According to the U.S. Department of State, Ethiopia in 2003 was the 15th most common source country for foreign adoptions; in 2006, it was 5th. (See graphic.) Last year, Ethiopia accounted for 732 (4%) of 20,679 foreign adoptions overall into the United States.

The CDC also urged persons traveling to Ethiopia or other areas with a high incidence of hepatitis A to be vaccinated against the disease before travel.

According to the World Health Organization, Africa as a whole is considered to have “very high” endemicity of hepatitis A, and most hepatitis A patients there are younger than 5 years. Most adults in endemic countries, however, are immune to the disease. (The report is available at www.who.int/csr/disease/hepatitis

“CDC also recommends that all children [at least] 1 year of age receive the hepatitis A vaccine,” the advisory noted. This is part of the U.S. Childhood and Adolescent Immunization Schedule.

ELSEVIER GLOBAL MEDICAL NEWS

The Centers for Disease Control and Prevention issued a health advisory urging families who adopt children from Ethiopia to make sure all family members are vaccinated for hepatitis A, which is endemic throughout the African continent.

The advisory, issued July 19 via the CDC's Clinician Outreach and Communication Activity (COCA) Listserv, said the agency had received an undisclosed number of reports of hepatitis A in adults and children “linked” to children adopted from Ethiopia.

“Other household members and caregivers of children adopted from Ethiopia should consider being vaccinated before adopted children are brought to the United States,” the advisory warned.

Most children younger than the age of 6 years do not get sick from hepatitis A virus infection, but they can spread it to older children and adults, who often become ill, the CDC says.

Symptoms usually last up to 2 months, but there is no chronic disease. Older persons and those with chronic liver disease can have more serious illness. Overall mortality is 0.3%, but it is 1.8% in those aged 50 years and older.

If adopted children, household members, or others who have been in contact are experiencing symptoms of hepatitis A (fatigue, abdominal pain, loss of appetite, nausea, jaundice), they should contact a physician. Persons exposed to hepatitis A who have not previously been immunized should contact their physician or local health department to see if they should receive an immunization or immunoglobulin that might prevent illness, the CDC said.

According to the U.S. Department of State, Ethiopia in 2003 was the 15th most common source country for foreign adoptions; in 2006, it was 5th. (See graphic.) Last year, Ethiopia accounted for 732 (4%) of 20,679 foreign adoptions overall into the United States.

The CDC also urged persons traveling to Ethiopia or other areas with a high incidence of hepatitis A to be vaccinated against the disease before travel.

According to the World Health Organization, Africa as a whole is considered to have “very high” endemicity of hepatitis A, and most hepatitis A patients there are younger than 5 years. Most adults in endemic countries, however, are immune to the disease. (The report is available at www.who.int/csr/disease/hepatitis

“CDC also recommends that all children [at least] 1 year of age receive the hepatitis A vaccine,” the advisory noted. This is part of the U.S. Childhood and Adolescent Immunization Schedule.

ELSEVIER GLOBAL MEDICAL NEWS

The Centers for Disease Control and Prevention issued a health advisory urging families who adopt children from Ethiopia to make sure all family members are vaccinated for hepatitis A, which is endemic throughout the African continent.

The advisory, issued July 19 via the CDC's Clinician Outreach and Communication Activity (COCA) Listserv, said the agency had received an undisclosed number of reports of hepatitis A in adults and children “linked” to children adopted from Ethiopia.

“Other household members and caregivers of children adopted from Ethiopia should consider being vaccinated before adopted children are brought to the United States,” the advisory warned.

Most children younger than the age of 6 years do not get sick from hepatitis A virus infection, but they can spread it to older children and adults, who often become ill, the CDC says.

Symptoms usually last up to 2 months, but there is no chronic disease. Older persons and those with chronic liver disease can have more serious illness. Overall mortality is 0.3%, but it is 1.8% in those aged 50 years and older.

If adopted children, household members, or others who have been in contact are experiencing symptoms of hepatitis A (fatigue, abdominal pain, loss of appetite, nausea, jaundice), they should contact a physician. Persons exposed to hepatitis A who have not previously been immunized should contact their physician or local health department to see if they should receive an immunization or immunoglobulin that might prevent illness, the CDC said.

According to the U.S. Department of State, Ethiopia in 2003 was the 15th most common source country for foreign adoptions; in 2006, it was 5th. (See graphic.) Last year, Ethiopia accounted for 732 (4%) of 20,679 foreign adoptions overall into the United States.

The CDC also urged persons traveling to Ethiopia or other areas with a high incidence of hepatitis A to be vaccinated against the disease before travel.

According to the World Health Organization, Africa as a whole is considered to have “very high” endemicity of hepatitis A, and most hepatitis A patients there are younger than 5 years. Most adults in endemic countries, however, are immune to the disease. (The report is available at www.who.int/csr/disease/hepatitis

“CDC also recommends that all children [at least] 1 year of age receive the hepatitis A vaccine,” the advisory noted. This is part of the U.S. Childhood and Adolescent Immunization Schedule.

ELSEVIER GLOBAL MEDICAL NEWS

Elderly men and women in nursing homes can benefit from resistance training, as can patients with heart failure, according an update on resistance exercise issued by the American Heart Association.

The update follows up AHA's first scientific advisory on the topic published in 2000 (Circulation 2000;101:828-33). The new advisory updates the information, discusses the benefits of resistance training in targeted populations, describes how to evaluate patients for participation in the training, and offers specific training methods.

For example, resistance training (RT) generally has been shown to have at least some benefit in patients with diabetes, hypertension, obesity, and dyslipidemia, although for some conditions, the benefit is dependent on patient age and/or the duration of the training.

The AHA's initial advisory reviewed the evidence showing a benefit for RT on various measures of cardiovascular health in the general population. The advisory discusses evidence that RT can be beneficial even in nursing home populations, as long as adjustments are made for “certain individuals and health limitations.” RT increases muscle mass across all age groups, though less so for women than for men. Findings regarding the effect of weight training on bone have been mixed, showing either no change or an increase in bone mineral density, the authors reported (Circulation 2007;epub ahead of print; DOI 10.1161/circulationaha.107.185214).

The new version “provides a much broader approach to the topic than the report from 7 years ago, when fewer data were available,” Mark Williams, Ph.D., director of cardiovascular disease prevention and rehabilitation at Creighton University, Omaha, Neb., and a cochair of the writing committee, said in an interview. He emphasized that, “while RT is a valuable modality for any number of reasons, it is to be used as a complement to, rather than replacement for, aerobic exercise such as walking, cycling, and swimming.”

Likewise, RT has been associated with improvements in nearly all of the conditions mentioned in the statement. In patients with diabetes, RT has been associated with increased glucose uptake and insulin sensitivity, the authors wrote, although it has not been shown to prevent type 2 diabetes or to affect glucose tolerance or glycemic control in normal individuals. RT also has been shown to achieve modest but clinically significant decreases in blood pressure, according to two meta-analyses; the effect was smaller (yet still significant) for older persons than for middle-age persons. Moreover, elderly women (as well as men) have been shown to achieve higher daily energy expenditure with RT. Resistance training also can prevent or reverse age-associated fat increases. Current findings on the effect of RT on cardiovascular disease remain equivocal; in one study of 8,499 men, only those who engaged in RT for at least 4 hr/wk showed a reduced risk for hypercholesterolemia. However, RT combined with aerobic exercise has shown clear benefit, particularly in older people, the statement said.

For women specifically, RT has been associated with improvements in daily activities, strength, balance and coordination, and walking, according to the statement. Findings also have shown that RT increases resting energy expenditure and metabolic rate in older women.

A notable conclusion of the new statement is its discussion of RT for persons with heart failure. Despite concerns that RT in such persons may exacerbate their condition because of potential adverse left ventricular modeling in the lifting phase, the new statement concludes that “at the intensity of RT performed by patients with [heart failure], the hemodynamic responses do not exceed levels attained during standard exercise testing. … Thus, it appears that RT can be incorporated safely into rehabilitation programs for patients with HF, although further study of this important area is needed.”

Resistance training generally is safe, the statement's authors concluded, and has not been linked to increases in anginal symptoms, ST-segment depression, or complex ventricular arrhythmias. This suggests that RT is “safe in clinically stable men with [coronary heart disease] who are actively participating in a supervised rehabilitation program.”

Screening patients for RT helps identify those patients with contraindications and further identify whether the contraindications are absolute–such as unstable coronary heart disease, uncontrolled arrhythmias, and severe or symptomatic aortic stenosis–or relative–such as diabetes, uncontrolled hypertension, or having an implanted pacemaker or defibrillator–and tailor the RT regimen to an individual patient's ability and tolerance.

The initial RT prescription should be limited to a single set performed 2 days/week limited to no more than 8-12 repetitions for healthy sedentary adults or 10-15 repetitions at a lower level of resistance for cardiac or more frail patients. After the initial training period, patients can gradually increase the weight load and perform RT 3 days/week. RT should involve the major muscle groups of the upper and lower extremities and include exercises such as the shoulder press, leg press, and calf raise.

Resistance training can be incorporated into heart failure rehab programs. Brand X Pictures

Elderly men and women in nursing homes can benefit from resistance training, as can patients with heart failure, according an update on resistance exercise issued by the American Heart Association.

The update follows up AHA's first scientific advisory on the topic published in 2000 (Circulation 2000;101:828-33). The new advisory updates the information, discusses the benefits of resistance training in targeted populations, describes how to evaluate patients for participation in the training, and offers specific training methods.

For example, resistance training (RT) generally has been shown to have at least some benefit in patients with diabetes, hypertension, obesity, and dyslipidemia, although for some conditions, the benefit is dependent on patient age and/or the duration of the training.

The AHA's initial advisory reviewed the evidence showing a benefit for RT on various measures of cardiovascular health in the general population. The advisory discusses evidence that RT can be beneficial even in nursing home populations, as long as adjustments are made for “certain individuals and health limitations.” RT increases muscle mass across all age groups, though less so for women than for men. Findings regarding the effect of weight training on bone have been mixed, showing either no change or an increase in bone mineral density, the authors reported (Circulation 2007;epub ahead of print; DOI 10.1161/circulationaha.107.185214).

The new version “provides a much broader approach to the topic than the report from 7 years ago, when fewer data were available,” Mark Williams, Ph.D., director of cardiovascular disease prevention and rehabilitation at Creighton University, Omaha, Neb., and a cochair of the writing committee, said in an interview. He emphasized that, “while RT is a valuable modality for any number of reasons, it is to be used as a complement to, rather than replacement for, aerobic exercise such as walking, cycling, and swimming.”

Likewise, RT has been associated with improvements in nearly all of the conditions mentioned in the statement. In patients with diabetes, RT has been associated with increased glucose uptake and insulin sensitivity, the authors wrote, although it has not been shown to prevent type 2 diabetes or to affect glucose tolerance or glycemic control in normal individuals. RT also has been shown to achieve modest but clinically significant decreases in blood pressure, according to two meta-analyses; the effect was smaller (yet still significant) for older persons than for middle-age persons. Moreover, elderly women (as well as men) have been shown to achieve higher daily energy expenditure with RT. Resistance training also can prevent or reverse age-associated fat increases. Current findings on the effect of RT on cardiovascular disease remain equivocal; in one study of 8,499 men, only those who engaged in RT for at least 4 hr/wk showed a reduced risk for hypercholesterolemia. However, RT combined with aerobic exercise has shown clear benefit, particularly in older people, the statement said.

For women specifically, RT has been associated with improvements in daily activities, strength, balance and coordination, and walking, according to the statement. Findings also have shown that RT increases resting energy expenditure and metabolic rate in older women.

A notable conclusion of the new statement is its discussion of RT for persons with heart failure. Despite concerns that RT in such persons may exacerbate their condition because of potential adverse left ventricular modeling in the lifting phase, the new statement concludes that “at the intensity of RT performed by patients with [heart failure], the hemodynamic responses do not exceed levels attained during standard exercise testing. … Thus, it appears that RT can be incorporated safely into rehabilitation programs for patients with HF, although further study of this important area is needed.”

Resistance training generally is safe, the statement's authors concluded, and has not been linked to increases in anginal symptoms, ST-segment depression, or complex ventricular arrhythmias. This suggests that RT is “safe in clinically stable men with [coronary heart disease] who are actively participating in a supervised rehabilitation program.”

Screening patients for RT helps identify those patients with contraindications and further identify whether the contraindications are absolute–such as unstable coronary heart disease, uncontrolled arrhythmias, and severe or symptomatic aortic stenosis–or relative–such as diabetes, uncontrolled hypertension, or having an implanted pacemaker or defibrillator–and tailor the RT regimen to an individual patient's ability and tolerance.

The initial RT prescription should be limited to a single set performed 2 days/week limited to no more than 8-12 repetitions for healthy sedentary adults or 10-15 repetitions at a lower level of resistance for cardiac or more frail patients. After the initial training period, patients can gradually increase the weight load and perform RT 3 days/week. RT should involve the major muscle groups of the upper and lower extremities and include exercises such as the shoulder press, leg press, and calf raise.

Resistance training can be incorporated into heart failure rehab programs. Brand X Pictures

Elderly men and women in nursing homes can benefit from resistance training, as can patients with heart failure, according an update on resistance exercise issued by the American Heart Association.

The update follows up AHA's first scientific advisory on the topic published in 2000 (Circulation 2000;101:828-33). The new advisory updates the information, discusses the benefits of resistance training in targeted populations, describes how to evaluate patients for participation in the training, and offers specific training methods.

For example, resistance training (RT) generally has been shown to have at least some benefit in patients with diabetes, hypertension, obesity, and dyslipidemia, although for some conditions, the benefit is dependent on patient age and/or the duration of the training.

The AHA's initial advisory reviewed the evidence showing a benefit for RT on various measures of cardiovascular health in the general population. The advisory discusses evidence that RT can be beneficial even in nursing home populations, as long as adjustments are made for “certain individuals and health limitations.” RT increases muscle mass across all age groups, though less so for women than for men. Findings regarding the effect of weight training on bone have been mixed, showing either no change or an increase in bone mineral density, the authors reported (Circulation 2007;epub ahead of print; DOI 10.1161/circulationaha.107.185214).

The new version “provides a much broader approach to the topic than the report from 7 years ago, when fewer data were available,” Mark Williams, Ph.D., director of cardiovascular disease prevention and rehabilitation at Creighton University, Omaha, Neb., and a cochair of the writing committee, said in an interview. He emphasized that, “while RT is a valuable modality for any number of reasons, it is to be used as a complement to, rather than replacement for, aerobic exercise such as walking, cycling, and swimming.”

Likewise, RT has been associated with improvements in nearly all of the conditions mentioned in the statement. In patients with diabetes, RT has been associated with increased glucose uptake and insulin sensitivity, the authors wrote, although it has not been shown to prevent type 2 diabetes or to affect glucose tolerance or glycemic control in normal individuals. RT also has been shown to achieve modest but clinically significant decreases in blood pressure, according to two meta-analyses; the effect was smaller (yet still significant) for older persons than for middle-age persons. Moreover, elderly women (as well as men) have been shown to achieve higher daily energy expenditure with RT. Resistance training also can prevent or reverse age-associated fat increases. Current findings on the effect of RT on cardiovascular disease remain equivocal; in one study of 8,499 men, only those who engaged in RT for at least 4 hr/wk showed a reduced risk for hypercholesterolemia. However, RT combined with aerobic exercise has shown clear benefit, particularly in older people, the statement said.

For women specifically, RT has been associated with improvements in daily activities, strength, balance and coordination, and walking, according to the statement. Findings also have shown that RT increases resting energy expenditure and metabolic rate in older women.

A notable conclusion of the new statement is its discussion of RT for persons with heart failure. Despite concerns that RT in such persons may exacerbate their condition because of potential adverse left ventricular modeling in the lifting phase, the new statement concludes that “at the intensity of RT performed by patients with [heart failure], the hemodynamic responses do not exceed levels attained during standard exercise testing. … Thus, it appears that RT can be incorporated safely into rehabilitation programs for patients with HF, although further study of this important area is needed.”

Resistance training generally is safe, the statement's authors concluded, and has not been linked to increases in anginal symptoms, ST-segment depression, or complex ventricular arrhythmias. This suggests that RT is “safe in clinically stable men with [coronary heart disease] who are actively participating in a supervised rehabilitation program.”

Screening patients for RT helps identify those patients with contraindications and further identify whether the contraindications are absolute–such as unstable coronary heart disease, uncontrolled arrhythmias, and severe or symptomatic aortic stenosis–or relative–such as diabetes, uncontrolled hypertension, or having an implanted pacemaker or defibrillator–and tailor the RT regimen to an individual patient's ability and tolerance.

The initial RT prescription should be limited to a single set performed 2 days/week limited to no more than 8-12 repetitions for healthy sedentary adults or 10-15 repetitions at a lower level of resistance for cardiac or more frail patients. After the initial training period, patients can gradually increase the weight load and perform RT 3 days/week. RT should involve the major muscle groups of the upper and lower extremities and include exercises such as the shoulder press, leg press, and calf raise.

Resistance training can be incorporated into heart failure rehab programs. Brand X Pictures

AUSTIN, TEX. – A significant percentage of pregnant women are not accurately reporting their use of alcohol, cigarettes, or illegal drugs to their physicians, Dr. Mary Ellen Lynch said in a poster presented at the annual meeting of the Society for Research on Nicotine and Tobacco.

She and her coinvestigators recruited 347 new mothers from Atlanta-area hospitals, whom they interviewed soon after the women gave birth regarding their drug, alcohol, and tobacco use in the 3 months before conception and during pregnancy. The investigators administered the same interview to the mothers 6 months later and compared the results of the interviews against the women's medical records.

The investigators found discrepancies, with the medical records showing far less tobacco, alcohol, and illegal drug use than the interviews revealed, said Dr. Lynch of Emory University, Atlanta.

For example, the medical records of the 13% of the 132 women who at the first interview reported having smoked in the third trimester did not report this fact, and of the 195 mothers who in the hospital interview said they had smoked before pregnancy, 7% had medical records that did not reflect this. Moreover, at the 6-month interview, some mothers changed their stories. Of the 140 women who had reported smoking before pregnancy in the hospital interview and who were still enrolled in the study, 6% denied it at the 6-month interview.

These trends were similar for alcohol use. In the hospital interview, 158 mothers said that they had drunk alcohol before pregnancy, but 66% of them had no drinking recorded in the medical record. Of the 95 mothers who admitted drinking during pregnancy in the hospital interview, 91% had no alcohol use reported in the medical record.

Use of illegal drugs was surveyed in both interviews but was not reported in the abstracted medical records. However, the interviews showed a trend that was opposite that for tobacco use, in that the women were more likely to report drug use at the 6-month interview than at the hospital interview, Dr. Lynch reported.

For marijuana use, 13% admitted in the hospital interview to having used it at any time and 7% to using it during pregnancy–figures that rose to 66% and 15%, respectively, at 6 months. In a similar fashion, 1.1% initially reported any prior use of cocaine and 0.3% reported use while pregnant, but nearly 13% and 1% reported each, respectively, at the 6-month interview. This pattern was observed for reports of amphetamine and methamphetamine use as well.

“I think people are reluctant to say that they smoke to health care providers, due to the stigma that's involved,” Dr. Lynch said.

This suggests that someone not affiliated with the hospital should ask about these things, rather than a physician or a hospital employee.

AUSTIN, TEX. – A significant percentage of pregnant women are not accurately reporting their use of alcohol, cigarettes, or illegal drugs to their physicians, Dr. Mary Ellen Lynch said in a poster presented at the annual meeting of the Society for Research on Nicotine and Tobacco.

She and her coinvestigators recruited 347 new mothers from Atlanta-area hospitals, whom they interviewed soon after the women gave birth regarding their drug, alcohol, and tobacco use in the 3 months before conception and during pregnancy. The investigators administered the same interview to the mothers 6 months later and compared the results of the interviews against the women's medical records.

The investigators found discrepancies, with the medical records showing far less tobacco, alcohol, and illegal drug use than the interviews revealed, said Dr. Lynch of Emory University, Atlanta.

For example, the medical records of the 13% of the 132 women who at the first interview reported having smoked in the third trimester did not report this fact, and of the 195 mothers who in the hospital interview said they had smoked before pregnancy, 7% had medical records that did not reflect this. Moreover, at the 6-month interview, some mothers changed their stories. Of the 140 women who had reported smoking before pregnancy in the hospital interview and who were still enrolled in the study, 6% denied it at the 6-month interview.

These trends were similar for alcohol use. In the hospital interview, 158 mothers said that they had drunk alcohol before pregnancy, but 66% of them had no drinking recorded in the medical record. Of the 95 mothers who admitted drinking during pregnancy in the hospital interview, 91% had no alcohol use reported in the medical record.

Use of illegal drugs was surveyed in both interviews but was not reported in the abstracted medical records. However, the interviews showed a trend that was opposite that for tobacco use, in that the women were more likely to report drug use at the 6-month interview than at the hospital interview, Dr. Lynch reported.

For marijuana use, 13% admitted in the hospital interview to having used it at any time and 7% to using it during pregnancy–figures that rose to 66% and 15%, respectively, at 6 months. In a similar fashion, 1.1% initially reported any prior use of cocaine and 0.3% reported use while pregnant, but nearly 13% and 1% reported each, respectively, at the 6-month interview. This pattern was observed for reports of amphetamine and methamphetamine use as well.

“I think people are reluctant to say that they smoke to health care providers, due to the stigma that's involved,” Dr. Lynch said.

This suggests that someone not affiliated with the hospital should ask about these things, rather than a physician or a hospital employee.

AUSTIN, TEX. – A significant percentage of pregnant women are not accurately reporting their use of alcohol, cigarettes, or illegal drugs to their physicians, Dr. Mary Ellen Lynch said in a poster presented at the annual meeting of the Society for Research on Nicotine and Tobacco.

She and her coinvestigators recruited 347 new mothers from Atlanta-area hospitals, whom they interviewed soon after the women gave birth regarding their drug, alcohol, and tobacco use in the 3 months before conception and during pregnancy. The investigators administered the same interview to the mothers 6 months later and compared the results of the interviews against the women's medical records.

The investigators found discrepancies, with the medical records showing far less tobacco, alcohol, and illegal drug use than the interviews revealed, said Dr. Lynch of Emory University, Atlanta.

For example, the medical records of the 13% of the 132 women who at the first interview reported having smoked in the third trimester did not report this fact, and of the 195 mothers who in the hospital interview said they had smoked before pregnancy, 7% had medical records that did not reflect this. Moreover, at the 6-month interview, some mothers changed their stories. Of the 140 women who had reported smoking before pregnancy in the hospital interview and who were still enrolled in the study, 6% denied it at the 6-month interview.

These trends were similar for alcohol use. In the hospital interview, 158 mothers said that they had drunk alcohol before pregnancy, but 66% of them had no drinking recorded in the medical record. Of the 95 mothers who admitted drinking during pregnancy in the hospital interview, 91% had no alcohol use reported in the medical record.

Use of illegal drugs was surveyed in both interviews but was not reported in the abstracted medical records. However, the interviews showed a trend that was opposite that for tobacco use, in that the women were more likely to report drug use at the 6-month interview than at the hospital interview, Dr. Lynch reported.

For marijuana use, 13% admitted in the hospital interview to having used it at any time and 7% to using it during pregnancy–figures that rose to 66% and 15%, respectively, at 6 months. In a similar fashion, 1.1% initially reported any prior use of cocaine and 0.3% reported use while pregnant, but nearly 13% and 1% reported each, respectively, at the 6-month interview. This pattern was observed for reports of amphetamine and methamphetamine use as well.

“I think people are reluctant to say that they smoke to health care providers, due to the stigma that's involved,” Dr. Lynch said.

This suggests that someone not affiliated with the hospital should ask about these things, rather than a physician or a hospital employee.

WASHINGTON — Narrow-band imaging colonoscopy appears to offer no advantage over white-light colonoscopy in detecting colorectal neoplasia, according to clinical trial data presented at the annual Digestive Disease Week.

Modern colonoscopy can limit the miss rate for detection of adenomas to 13%, compared with the often-cited rate of 24%. But the use of narrow-band imaging (NBI) colonoscopy, which uses only blue (415-nm) and green (540-nm) wavelengths with the intent of making blood vessels and neoplasia stand out, does not lead to a lower miss rate, reported Dr. Tonya R. Kaltenbach and her colleagues at Stanford (Calif.) University.

They enrolled 284 patients over a 13-month period and performed two consecutive same-day colonoscopies in 240 of the patients. Patients were randomly assigned to undergo first either standard white-light colonoscopy (121 patients) or NBI colonoscopy (119 patients). Each patient then underwent a second white-light colonoscopy, to determine how many lesions had been missed on the first colonoscopy. All polyps were removed upon detection.

The investigators found a total of 259 neoplasias in 130 patients. The 12% rate of undetected adenomas with white-light colonoscopy did not differ significantly from the 13% rate with NBI colonoscopy.

Those rates stand in stark contrast to the 24% miss rate reported for colonoscopy by Dr. Douglas Rex and colleagues in 1997 (Gastroenterology 1997;112:24–8).

Coinvestigator Dr. Roy Soetikno noted at a press briefing that it is erroneous to compare results obtained using modern colonoscopes—which have a wider field of vision, improved resolution, and more flexibility—with results obtained with prior-generation scopes, and pointed out that there is now a better understanding of the morphology of colorectal lesions.

The investigators reported no potential conflicts of interest.

WASHINGTON — Narrow-band imaging colonoscopy appears to offer no advantage over white-light colonoscopy in detecting colorectal neoplasia, according to clinical trial data presented at the annual Digestive Disease Week.

Modern colonoscopy can limit the miss rate for detection of adenomas to 13%, compared with the often-cited rate of 24%. But the use of narrow-band imaging (NBI) colonoscopy, which uses only blue (415-nm) and green (540-nm) wavelengths with the intent of making blood vessels and neoplasia stand out, does not lead to a lower miss rate, reported Dr. Tonya R. Kaltenbach and her colleagues at Stanford (Calif.) University.

They enrolled 284 patients over a 13-month period and performed two consecutive same-day colonoscopies in 240 of the patients. Patients were randomly assigned to undergo first either standard white-light colonoscopy (121 patients) or NBI colonoscopy (119 patients). Each patient then underwent a second white-light colonoscopy, to determine how many lesions had been missed on the first colonoscopy. All polyps were removed upon detection.

The investigators found a total of 259 neoplasias in 130 patients. The 12% rate of undetected adenomas with white-light colonoscopy did not differ significantly from the 13% rate with NBI colonoscopy.

Those rates stand in stark contrast to the 24% miss rate reported for colonoscopy by Dr. Douglas Rex and colleagues in 1997 (Gastroenterology 1997;112:24–8).

Coinvestigator Dr. Roy Soetikno noted at a press briefing that it is erroneous to compare results obtained using modern colonoscopes—which have a wider field of vision, improved resolution, and more flexibility—with results obtained with prior-generation scopes, and pointed out that there is now a better understanding of the morphology of colorectal lesions.

The investigators reported no potential conflicts of interest.

WASHINGTON — Narrow-band imaging colonoscopy appears to offer no advantage over white-light colonoscopy in detecting colorectal neoplasia, according to clinical trial data presented at the annual Digestive Disease Week.

Modern colonoscopy can limit the miss rate for detection of adenomas to 13%, compared with the often-cited rate of 24%. But the use of narrow-band imaging (NBI) colonoscopy, which uses only blue (415-nm) and green (540-nm) wavelengths with the intent of making blood vessels and neoplasia stand out, does not lead to a lower miss rate, reported Dr. Tonya R. Kaltenbach and her colleagues at Stanford (Calif.) University.

They enrolled 284 patients over a 13-month period and performed two consecutive same-day colonoscopies in 240 of the patients. Patients were randomly assigned to undergo first either standard white-light colonoscopy (121 patients) or NBI colonoscopy (119 patients). Each patient then underwent a second white-light colonoscopy, to determine how many lesions had been missed on the first colonoscopy. All polyps were removed upon detection.

The investigators found a total of 259 neoplasias in 130 patients. The 12% rate of undetected adenomas with white-light colonoscopy did not differ significantly from the 13% rate with NBI colonoscopy.

Those rates stand in stark contrast to the 24% miss rate reported for colonoscopy by Dr. Douglas Rex and colleagues in 1997 (Gastroenterology 1997;112:24–8).

Coinvestigator Dr. Roy Soetikno noted at a press briefing that it is erroneous to compare results obtained using modern colonoscopes—which have a wider field of vision, improved resolution, and more flexibility—with results obtained with prior-generation scopes, and pointed out that there is now a better understanding of the morphology of colorectal lesions.

The investigators reported no potential conflicts of interest.

For more information on DR. BAUMANN'S book, "The Skin Type Solution," and her consumer blog on Yahoo! Health, visit www.skintypesolutions.comwww.dorishexsel.com.brwww.grablowitz.at

Although writing a book, hosting a Web site, and developing your own product line can be big practice-builders, there are several simple steps that can be taken to help keep the patients you have, motivate them to refer other patients to you, and increase the number of procedures your practice performs, according to dermatologists who have had much success in these areas.

Dr. Leslie Baumann, director of cosmetic dermatology at the University of Miami, faced an enviable problem when her practice took off after her consumer book, "Skin Type Solutions," made the New York Times' best seller list.

"After the book came out, I had a 2-year waiting list for appointments, so my problem was not marketing. Our problem became how to get the patients to see another doctor in the practice. That was not easy. What we did was add doctors of other aesthetic specialties, such as oculoplastic surgery and facial plastic surgery. This was [an added value] to patients, because they would benefit from the increased knowledge of having various specialties with various expertises see them."

Dr. Susan Weinkle, a cosmetic surgeon in private practice in Bradenton, Fla., shared a similar tip: "You can also convert your medical dermatology patients into aesthetic patients," she noted. "Patients bring their child to your office for acne and then realize, 'Oh, you're doing all these cosmetic things as well. I didn't know that.'" Patients usually find out about available cosmetic procedures via word of mouth from other patients, she said.

Other office marketing tips noted by interviewed dermatologists included:

▸ Talk to the media so that your local community knows you as an expert. In Dr. Baumann's view, advertising a dermatology practice is counterproductive. "When we began 10 years ago, the best thing we did was never to advertise. We focused on public relations instead.

"Consumers are more likely to make an appointment with a doctor quoted in an article than with a doctor that they saw in an advertisement," she added.

This view is shared by Dr. Doris Hexsel, a dermatologist and cosmetic surgeon in Porto Alegre, Brazil, who helped pioneer the use of subcision for the removal of cellulite. Although she advertised her services when she first opened her practice, she has not done so in some time.

"Something that I think helped a lot to improve my practice was to give interviews for the media. I still give three or four interviews for magazines, newspapers, and TV every week. I now have more patients coming into my office than I'm able to see," she said. "I'm always overbooked, and my [practice] colleagues also have full schedules."

A cosmetic dermatologist in Vienna, Dr. Doris Grablowitz, said she has in her nearly 20 years of practice never paid for press coverage or hired a public relations agent. But times have changed, she said—at least in her part of the world. "Today, if a young dermatologist wants to become well known, [advertising] is the norm," she said.

Her practice, which is now in a renovated home near St. Stephen's Cathedral, began in one room of her home. She credits talking with a TV reporter and then answering skin care questions in a column in Austria's largest daily newspaper with helping to grow her practice.

Dr. Grablowitz estimates that 50% of her patients come to her from her media exposure, 20% from her Web site, and 30% from word-of-mouth referrals.

▸ Make sure your office staff are reading from the right script. Dr. Baumann's nurse-specialist, Susan Schaffer, said that she has seen Dr. Baumann's practice mushroom over a 10-year period, with the advent of Dr. Baumann's book and Web site.

She emphasized that in cosmetic dermatology, it's important to train the staff, because patients will often ask the staff what they think about a particular procedure or product. "It's very important that the staff and doctors are giving out the same information to the patients, because the patients ask everybody in the office.

"Cosmetic patients are very educated consumers. They come in, and they have articles and clippings." Thus it's important that the office staff be at least as familiar with the basics of each procedure as the patients are, she added.

▸ Surprise patients with how accessible you are. Dr. Weinkle gives her home phone number to her patients. "You have to be available," she said. "When I operate on a patient, I always give them my home number. But you know something? They rarely ever call me. But they love that I give them my number."

She added that her number is in the phone book, but the act of giving her number to the patient makes a strong impression. "I give them my number because I like them to know that I'm genuinely concerned—that if they have a problem, I'm there for them."

Although she has given her e-mail address to some patients, "I prefer to keep it to phone calls, but I do have patients who e-mail me when they travel abroad."

A team approach is especially important in an aesthetic practice, Dr. Weinkle advised. "The first posttreatment day … I have one of my assistants call to check on the patients and see how they are. … Care and concern for the patients you've treated are very important, so that the patients feel comfortable in coming back to see you."

▸ Respect your patients' time. Dr. Weinkle went on to note that timely scheduling is another important aspect of retaining patients and getting referrals. "We abuse our patients' time. They sit in our offices across the country, waiting to see the doctor. … I've been in practice for 25 years. If I [were] a dermatologist starting my practice, I would try very diligently not to make patients wait."

This can be difficult, she acknowledged—especially for surgeons. "You can't always totally predict how much time a surgery is going to take … [but] cosmetic procedures take longer than most dermatologists think. We're used to scheduling a lot of patients a day in dermatology—[it's a] high-volume practice. But as you transform your practice into a more aesthetic practice, you have to be aware that these procedures are more time consuming."

She noted that the injection of fillers tops the list of time-consuming procedures. "You have to take your time to do it, and the consultation [takes time], in terms of explaining and understanding what the patient's wants and desires are, what their needs are, and what you see, what you can offer to the patient—those are all important considerations."

▸ Try to keep pain to a minimum. Another key to building a successful practice is taking every measure to minimize patient discomfort, Dr. Weinkle noted. "The less you hurt patients, the more they're going to look forward to coming back to you. … Do any of us look forward to going to a dentist?"

▸ Let patients know you're on the cutting edge by staying up to date on the latest research. Dr. Hexsel believes that the cachet of offering cosmetic procedures can benefit the rest of the practice. "When I started my practice, I started as a general dermatologist. And I believe that the cosmetic procedures increased the dermatology practice," she said.

She emphasized the importance of letting patents know that their dermatologist is up to date on the newest procedures and research. "We let patients know that we go to the meetings and that we are doing only the procedures that we are sure are safe and that can give them good results."

Dr. Baumann agreed. "A great way to build a practice is to do research projects. … A clinical-trial business helps increase your visibility by generating interviews on new technology. Patients realize that you are cutting edge when you perform the clinical trials that lead to FDA approval."

The same sentiment was shared by Dr. Grablowitz, who noted that she spends a great deal of time traveling to medical meetings—which is stressful but necessary to become well known among your peers, she said. For her, this professional renown has led device manufacturers to come to her with new products so that she is often the first in her area to offer a new procedure—another factor, she believes, in bringing new patients to her practice.

'Something that Ithink helped a lot to improve my practice was to give interviews for the media.' DR. HEXSEL

Spending a lot of time traveling to medical meetings is necessary to become known among your peers. DR. GRABLOWITZ

For more information on DR. BAUMANN'S book, "The Skin Type Solution," and her consumer blog on Yahoo! Health, visit www.skintypesolutions.comwww.dorishexsel.com.brwww.grablowitz.at

Although writing a book, hosting a Web site, and developing your own product line can be big practice-builders, there are several simple steps that can be taken to help keep the patients you have, motivate them to refer other patients to you, and increase the number of procedures your practice performs, according to dermatologists who have had much success in these areas.

Dr. Leslie Baumann, director of cosmetic dermatology at the University of Miami, faced an enviable problem when her practice took off after her consumer book, "Skin Type Solutions," made the New York Times' best seller list.

"After the book came out, I had a 2-year waiting list for appointments, so my problem was not marketing. Our problem became how to get the patients to see another doctor in the practice. That was not easy. What we did was add doctors of other aesthetic specialties, such as oculoplastic surgery and facial plastic surgery. This was [an added value] to patients, because they would benefit from the increased knowledge of having various specialties with various expertises see them."

Dr. Susan Weinkle, a cosmetic surgeon in private practice in Bradenton, Fla., shared a similar tip: "You can also convert your medical dermatology patients into aesthetic patients," she noted. "Patients bring their child to your office for acne and then realize, 'Oh, you're doing all these cosmetic things as well. I didn't know that.'" Patients usually find out about available cosmetic procedures via word of mouth from other patients, she said.

Other office marketing tips noted by interviewed dermatologists included:

▸ Talk to the media so that your local community knows you as an expert. In Dr. Baumann's view, advertising a dermatology practice is counterproductive. "When we began 10 years ago, the best thing we did was never to advertise. We focused on public relations instead.

"Consumers are more likely to make an appointment with a doctor quoted in an article than with a doctor that they saw in an advertisement," she added.

This view is shared by Dr. Doris Hexsel, a dermatologist and cosmetic surgeon in Porto Alegre, Brazil, who helped pioneer the use of subcision for the removal of cellulite. Although she advertised her services when she first opened her practice, she has not done so in some time.

"Something that I think helped a lot to improve my practice was to give interviews for the media. I still give three or four interviews for magazines, newspapers, and TV every week. I now have more patients coming into my office than I'm able to see," she said. "I'm always overbooked, and my [practice] colleagues also have full schedules."

A cosmetic dermatologist in Vienna, Dr. Doris Grablowitz, said she has in her nearly 20 years of practice never paid for press coverage or hired a public relations agent. But times have changed, she said—at least in her part of the world. "Today, if a young dermatologist wants to become well known, [advertising] is the norm," she said.

Her practice, which is now in a renovated home near St. Stephen's Cathedral, began in one room of her home. She credits talking with a TV reporter and then answering skin care questions in a column in Austria's largest daily newspaper with helping to grow her practice.

Dr. Grablowitz estimates that 50% of her patients come to her from her media exposure, 20% from her Web site, and 30% from word-of-mouth referrals.

▸ Make sure your office staff are reading from the right script. Dr. Baumann's nurse-specialist, Susan Schaffer, said that she has seen Dr. Baumann's practice mushroom over a 10-year period, with the advent of Dr. Baumann's book and Web site.

She emphasized that in cosmetic dermatology, it's important to train the staff, because patients will often ask the staff what they think about a particular procedure or product. "It's very important that the staff and doctors are giving out the same information to the patients, because the patients ask everybody in the office.

"Cosmetic patients are very educated consumers. They come in, and they have articles and clippings." Thus it's important that the office staff be at least as familiar with the basics of each procedure as the patients are, she added.

▸ Surprise patients with how accessible you are. Dr. Weinkle gives her home phone number to her patients. "You have to be available," she said. "When I operate on a patient, I always give them my home number. But you know something? They rarely ever call me. But they love that I give them my number."

She added that her number is in the phone book, but the act of giving her number to the patient makes a strong impression. "I give them my number because I like them to know that I'm genuinely concerned—that if they have a problem, I'm there for them."

Although she has given her e-mail address to some patients, "I prefer to keep it to phone calls, but I do have patients who e-mail me when they travel abroad."

A team approach is especially important in an aesthetic practice, Dr. Weinkle advised. "The first posttreatment day … I have one of my assistants call to check on the patients and see how they are. … Care and concern for the patients you've treated are very important, so that the patients feel comfortable in coming back to see you."

▸ Respect your patients' time. Dr. Weinkle went on to note that timely scheduling is another important aspect of retaining patients and getting referrals. "We abuse our patients' time. They sit in our offices across the country, waiting to see the doctor. … I've been in practice for 25 years. If I [were] a dermatologist starting my practice, I would try very diligently not to make patients wait."

This can be difficult, she acknowledged—especially for surgeons. "You can't always totally predict how much time a surgery is going to take … [but] cosmetic procedures take longer than most dermatologists think. We're used to scheduling a lot of patients a day in dermatology—[it's a] high-volume practice. But as you transform your practice into a more aesthetic practice, you have to be aware that these procedures are more time consuming."

She noted that the injection of fillers tops the list of time-consuming procedures. "You have to take your time to do it, and the consultation [takes time], in terms of explaining and understanding what the patient's wants and desires are, what their needs are, and what you see, what you can offer to the patient—those are all important considerations."

▸ Try to keep pain to a minimum. Another key to building a successful practice is taking every measure to minimize patient discomfort, Dr. Weinkle noted. "The less you hurt patients, the more they're going to look forward to coming back to you. … Do any of us look forward to going to a dentist?"

▸ Let patients know you're on the cutting edge by staying up to date on the latest research. Dr. Hexsel believes that the cachet of offering cosmetic procedures can benefit the rest of the practice. "When I started my practice, I started as a general dermatologist. And I believe that the cosmetic procedures increased the dermatology practice," she said.

She emphasized the importance of letting patents know that their dermatologist is up to date on the newest procedures and research. "We let patients know that we go to the meetings and that we are doing only the procedures that we are sure are safe and that can give them good results."

Dr. Baumann agreed. "A great way to build a practice is to do research projects. … A clinical-trial business helps increase your visibility by generating interviews on new technology. Patients realize that you are cutting edge when you perform the clinical trials that lead to FDA approval."

The same sentiment was shared by Dr. Grablowitz, who noted that she spends a great deal of time traveling to medical meetings—which is stressful but necessary to become well known among your peers, she said. For her, this professional renown has led device manufacturers to come to her with new products so that she is often the first in her area to offer a new procedure—another factor, she believes, in bringing new patients to her practice.

'Something that Ithink helped a lot to improve my practice was to give interviews for the media.' DR. HEXSEL

Spending a lot of time traveling to medical meetings is necessary to become known among your peers. DR. GRABLOWITZ

For more information on DR. BAUMANN'S book, "The Skin Type Solution," and her consumer blog on Yahoo! Health, visit www.skintypesolutions.comwww.dorishexsel.com.brwww.grablowitz.at

Although writing a book, hosting a Web site, and developing your own product line can be big practice-builders, there are several simple steps that can be taken to help keep the patients you have, motivate them to refer other patients to you, and increase the number of procedures your practice performs, according to dermatologists who have had much success in these areas.

Dr. Leslie Baumann, director of cosmetic dermatology at the University of Miami, faced an enviable problem when her practice took off after her consumer book, "Skin Type Solutions," made the New York Times' best seller list.

"After the book came out, I had a 2-year waiting list for appointments, so my problem was not marketing. Our problem became how to get the patients to see another doctor in the practice. That was not easy. What we did was add doctors of other aesthetic specialties, such as oculoplastic surgery and facial plastic surgery. This was [an added value] to patients, because they would benefit from the increased knowledge of having various specialties with various expertises see them."

Dr. Susan Weinkle, a cosmetic surgeon in private practice in Bradenton, Fla., shared a similar tip: "You can also convert your medical dermatology patients into aesthetic patients," she noted. "Patients bring their child to your office for acne and then realize, 'Oh, you're doing all these cosmetic things as well. I didn't know that.'" Patients usually find out about available cosmetic procedures via word of mouth from other patients, she said.

Other office marketing tips noted by interviewed dermatologists included:

▸ Talk to the media so that your local community knows you as an expert. In Dr. Baumann's view, advertising a dermatology practice is counterproductive. "When we began 10 years ago, the best thing we did was never to advertise. We focused on public relations instead.

"Consumers are more likely to make an appointment with a doctor quoted in an article than with a doctor that they saw in an advertisement," she added.

This view is shared by Dr. Doris Hexsel, a dermatologist and cosmetic surgeon in Porto Alegre, Brazil, who helped pioneer the use of subcision for the removal of cellulite. Although she advertised her services when she first opened her practice, she has not done so in some time.

"Something that I think helped a lot to improve my practice was to give interviews for the media. I still give three or four interviews for magazines, newspapers, and TV every week. I now have more patients coming into my office than I'm able to see," she said. "I'm always overbooked, and my [practice] colleagues also have full schedules."

A cosmetic dermatologist in Vienna, Dr. Doris Grablowitz, said she has in her nearly 20 years of practice never paid for press coverage or hired a public relations agent. But times have changed, she said—at least in her part of the world. "Today, if a young dermatologist wants to become well known, [advertising] is the norm," she said.

Her practice, which is now in a renovated home near St. Stephen's Cathedral, began in one room of her home. She credits talking with a TV reporter and then answering skin care questions in a column in Austria's largest daily newspaper with helping to grow her practice.

Dr. Grablowitz estimates that 50% of her patients come to her from her media exposure, 20% from her Web site, and 30% from word-of-mouth referrals.

▸ Make sure your office staff are reading from the right script. Dr. Baumann's nurse-specialist, Susan Schaffer, said that she has seen Dr. Baumann's practice mushroom over a 10-year period, with the advent of Dr. Baumann's book and Web site.

She emphasized that in cosmetic dermatology, it's important to train the staff, because patients will often ask the staff what they think about a particular procedure or product. "It's very important that the staff and doctors are giving out the same information to the patients, because the patients ask everybody in the office.

"Cosmetic patients are very educated consumers. They come in, and they have articles and clippings." Thus it's important that the office staff be at least as familiar with the basics of each procedure as the patients are, she added.

▸ Surprise patients with how accessible you are. Dr. Weinkle gives her home phone number to her patients. "You have to be available," she said. "When I operate on a patient, I always give them my home number. But you know something? They rarely ever call me. But they love that I give them my number."

She added that her number is in the phone book, but the act of giving her number to the patient makes a strong impression. "I give them my number because I like them to know that I'm genuinely concerned—that if they have a problem, I'm there for them."

Although she has given her e-mail address to some patients, "I prefer to keep it to phone calls, but I do have patients who e-mail me when they travel abroad."

A team approach is especially important in an aesthetic practice, Dr. Weinkle advised. "The first posttreatment day … I have one of my assistants call to check on the patients and see how they are. … Care and concern for the patients you've treated are very important, so that the patients feel comfortable in coming back to see you."

▸ Respect your patients' time. Dr. Weinkle went on to note that timely scheduling is another important aspect of retaining patients and getting referrals. "We abuse our patients' time. They sit in our offices across the country, waiting to see the doctor. … I've been in practice for 25 years. If I [were] a dermatologist starting my practice, I would try very diligently not to make patients wait."

This can be difficult, she acknowledged—especially for surgeons. "You can't always totally predict how much time a surgery is going to take … [but] cosmetic procedures take longer than most dermatologists think. We're used to scheduling a lot of patients a day in dermatology—[it's a] high-volume practice. But as you transform your practice into a more aesthetic practice, you have to be aware that these procedures are more time consuming."

She noted that the injection of fillers tops the list of time-consuming procedures. "You have to take your time to do it, and the consultation [takes time], in terms of explaining and understanding what the patient's wants and desires are, what their needs are, and what you see, what you can offer to the patient—those are all important considerations."

▸ Try to keep pain to a minimum. Another key to building a successful practice is taking every measure to minimize patient discomfort, Dr. Weinkle noted. "The less you hurt patients, the more they're going to look forward to coming back to you. … Do any of us look forward to going to a dentist?"

▸ Let patients know you're on the cutting edge by staying up to date on the latest research. Dr. Hexsel believes that the cachet of offering cosmetic procedures can benefit the rest of the practice. "When I started my practice, I started as a general dermatologist. And I believe that the cosmetic procedures increased the dermatology practice," she said.

She emphasized the importance of letting patents know that their dermatologist is up to date on the newest procedures and research. "We let patients know that we go to the meetings and that we are doing only the procedures that we are sure are safe and that can give them good results."

Dr. Baumann agreed. "A great way to build a practice is to do research projects. … A clinical-trial business helps increase your visibility by generating interviews on new technology. Patients realize that you are cutting edge when you perform the clinical trials that lead to FDA approval."

The same sentiment was shared by Dr. Grablowitz, who noted that she spends a great deal of time traveling to medical meetings—which is stressful but necessary to become well known among your peers, she said. For her, this professional renown has led device manufacturers to come to her with new products so that she is often the first in her area to offer a new procedure—another factor, she believes, in bringing new patients to her practice.

'Something that Ithink helped a lot to improve my practice was to give interviews for the media.' DR. HEXSEL

Spending a lot of time traveling to medical meetings is necessary to become known among your peers. DR. GRABLOWITZ

WASHINGTON — Patients with diverticular disease can most likely eat high-fiber foods like corn, nuts, and popcorn without fear of symptom aggravation, a large prospective study suggests. In fact, some of these foods were associated with a protective effect against such symptoms.

The findings contradict the widely held assumption that foods like these, “being somewhat rougher or less well digested than other foods, would be more likely to traumatize the colon wall,” study investigator Dr. Lisa L. Strate of the division of gastroenterology at the University of Washington, Seattle, said at a press conference at the annual Digestive Disease Week.

Dr. Strate and colleagues reported findings from more than 47,000 male participants in the Health Professionals Follow-Up Study, which began in 1986. The men were aged 40–75 at baseline. The investigators analyzed data for participants who had reported newly diagnosed diverticulosis or diverticular complications at any of the intervening biennial follow-up points, through 2004.

They also examined data from a diet questionnaire sent to all participants and from a supplemental questionnaire to assess diagnosis and treatment sent to those with diverticular disease.

No multivariate associations existed between consumption of nuts, corn, popcorn, or all three and diverticular bleeding (383 incident cases) and diverticulitis (801 cases) over 18 years of follow-up after the team used a Cox proportional hazards model and controlled for dietary fiber, Dr. Strate reported at the press conference.

In addition, popcorn consumption appeared to confer a protective effect against these conditions. After adjustment for known or potential risk factors for diverticular complications, men with the highest level of popcorn consumption (at least twice a week), compared with men who ate the least popcorn (less than once per month), had a hazard ratio of 0.72 for diverticulitis, after adjustment for other potential risk factors for diverticular complications.

Similarly, for men who ate nuts at least twice per week, the diverticulitis hazard ratio was 0.8.

Physicians have historically advised patients with diverticular disease to avoid eating foods that often are incompletely digested, Dr. Strate noted at the press conference. “The recommendation stems from a theory that trauma to or obstruction of a single diverticulum results in these complications,” she said. “But, in reality, we don't understand much about the pathogenesis of these complications. At the same time, nuts and seeds were particularly thought to result in these complications, because [it was thought] they might be more likely to lodge in or to injure the mucosa.”

Over 18 years, no association existed between consumption and bleeding. ©David Allen/FOTOLIA

WASHINGTON — Patients with diverticular disease can most likely eat high-fiber foods like corn, nuts, and popcorn without fear of symptom aggravation, a large prospective study suggests. In fact, some of these foods were associated with a protective effect against such symptoms.

The findings contradict the widely held assumption that foods like these, “being somewhat rougher or less well digested than other foods, would be more likely to traumatize the colon wall,” study investigator Dr. Lisa L. Strate of the division of gastroenterology at the University of Washington, Seattle, said at a press conference at the annual Digestive Disease Week.

Dr. Strate and colleagues reported findings from more than 47,000 male participants in the Health Professionals Follow-Up Study, which began in 1986. The men were aged 40–75 at baseline. The investigators analyzed data for participants who had reported newly diagnosed diverticulosis or diverticular complications at any of the intervening biennial follow-up points, through 2004.

They also examined data from a diet questionnaire sent to all participants and from a supplemental questionnaire to assess diagnosis and treatment sent to those with diverticular disease.

No multivariate associations existed between consumption of nuts, corn, popcorn, or all three and diverticular bleeding (383 incident cases) and diverticulitis (801 cases) over 18 years of follow-up after the team used a Cox proportional hazards model and controlled for dietary fiber, Dr. Strate reported at the press conference.

In addition, popcorn consumption appeared to confer a protective effect against these conditions. After adjustment for known or potential risk factors for diverticular complications, men with the highest level of popcorn consumption (at least twice a week), compared with men who ate the least popcorn (less than once per month), had a hazard ratio of 0.72 for diverticulitis, after adjustment for other potential risk factors for diverticular complications.

Similarly, for men who ate nuts at least twice per week, the diverticulitis hazard ratio was 0.8.

Physicians have historically advised patients with diverticular disease to avoid eating foods that often are incompletely digested, Dr. Strate noted at the press conference. “The recommendation stems from a theory that trauma to or obstruction of a single diverticulum results in these complications,” she said. “But, in reality, we don't understand much about the pathogenesis of these complications. At the same time, nuts and seeds were particularly thought to result in these complications, because [it was thought] they might be more likely to lodge in or to injure the mucosa.”

Over 18 years, no association existed between consumption and bleeding. ©David Allen/FOTOLIA

WASHINGTON — Patients with diverticular disease can most likely eat high-fiber foods like corn, nuts, and popcorn without fear of symptom aggravation, a large prospective study suggests. In fact, some of these foods were associated with a protective effect against such symptoms.

The findings contradict the widely held assumption that foods like these, “being somewhat rougher or less well digested than other foods, would be more likely to traumatize the colon wall,” study investigator Dr. Lisa L. Strate of the division of gastroenterology at the University of Washington, Seattle, said at a press conference at the annual Digestive Disease Week.

Dr. Strate and colleagues reported findings from more than 47,000 male participants in the Health Professionals Follow-Up Study, which began in 1986. The men were aged 40–75 at baseline. The investigators analyzed data for participants who had reported newly diagnosed diverticulosis or diverticular complications at any of the intervening biennial follow-up points, through 2004.

They also examined data from a diet questionnaire sent to all participants and from a supplemental questionnaire to assess diagnosis and treatment sent to those with diverticular disease.

No multivariate associations existed between consumption of nuts, corn, popcorn, or all three and diverticular bleeding (383 incident cases) and diverticulitis (801 cases) over 18 years of follow-up after the team used a Cox proportional hazards model and controlled for dietary fiber, Dr. Strate reported at the press conference.

In addition, popcorn consumption appeared to confer a protective effect against these conditions. After adjustment for known or potential risk factors for diverticular complications, men with the highest level of popcorn consumption (at least twice a week), compared with men who ate the least popcorn (less than once per month), had a hazard ratio of 0.72 for diverticulitis, after adjustment for other potential risk factors for diverticular complications.

Similarly, for men who ate nuts at least twice per week, the diverticulitis hazard ratio was 0.8.

Physicians have historically advised patients with diverticular disease to avoid eating foods that often are incompletely digested, Dr. Strate noted at the press conference. “The recommendation stems from a theory that trauma to or obstruction of a single diverticulum results in these complications,” she said. “But, in reality, we don't understand much about the pathogenesis of these complications. At the same time, nuts and seeds were particularly thought to result in these complications, because [it was thought] they might be more likely to lodge in or to injure the mucosa.”

Over 18 years, no association existed between consumption and bleeding. ©David Allen/FOTOLIA

WASHINGTON — Antioxidant supplementation was effective in curbing pain in patients with chronic pancreatitis in a double-blinded, randomized, controlled trial.

Measures of pain and oxidative stress were significantly lower in patients who took a daily antioxidant supplement for 6 months, compared with those who took a placebo pill, investigators reported at the annual Digestive Disease Week.

“It's very difficult to treat pain, so antioxidants are a simple treatment and a dietary constituent, and if it can reduce the pain, this is of immense benefit to these patients,” study investigator Dr. Payal Bhardwaj of the All India Institute of Medical Sciences, New Delhi, said at a press briefing during the meeting.

Roughly 90% of patients with chronic pancreatitis have abdominal pain, conventionally treated by surgery, nerve blocks, or endoscopic treatment. “These three procedures are very invasive,” she said. “What we have seen is a totally noninvasive dietary modulation.”

The study included 127 consecutive patients (mean age 31 years) with chronic pancreatitis and abdominal pain who were randomly assigned to receive a daily antioxidant supplement (71 patients) or placebo (56 patients) for 6 months. The supplement contained 600 mcg of selenium, 0.54 g of vitamin C, 9,000 IU of beta-carotene, 270 IU of vitamin E, and 2 g of methionine.

Pain relief was the primary outcome. Regression analysis at 6 months showed significantly decreased measures of pain in the supplement vs. the placebo group: mean number of painful days monthly (1.7 vs. 3.4), mean number of oral analgesics taken monthly (4.4 vs. 10.5), and patients who reported that they were pain free (33% vs. 13%).

Secondary outcomes included levels of two markers of oxidative stress, both of which were significantly lower in the supplement group vs. placebo after 6 months: thiobarbituric acid reactive substances (3.6 vs. 5.4 nmol/mL) and serum superoxide dismutase (1.9 vs. 3.5 U/mL).

Dr. Bhardwaj reported no potential conflicts of interest.

WASHINGTON — Antioxidant supplementation was effective in curbing pain in patients with chronic pancreatitis in a double-blinded, randomized, controlled trial.

Measures of pain and oxidative stress were significantly lower in patients who took a daily antioxidant supplement for 6 months, compared with those who took a placebo pill, investigators reported at the annual Digestive Disease Week.

“It's very difficult to treat pain, so antioxidants are a simple treatment and a dietary constituent, and if it can reduce the pain, this is of immense benefit to these patients,” study investigator Dr. Payal Bhardwaj of the All India Institute of Medical Sciences, New Delhi, said at a press briefing during the meeting.

Roughly 90% of patients with chronic pancreatitis have abdominal pain, conventionally treated by surgery, nerve blocks, or endoscopic treatment. “These three procedures are very invasive,” she said. “What we have seen is a totally noninvasive dietary modulation.”

The study included 127 consecutive patients (mean age 31 years) with chronic pancreatitis and abdominal pain who were randomly assigned to receive a daily antioxidant supplement (71 patients) or placebo (56 patients) for 6 months. The supplement contained 600 mcg of selenium, 0.54 g of vitamin C, 9,000 IU of beta-carotene, 270 IU of vitamin E, and 2 g of methionine.

Pain relief was the primary outcome. Regression analysis at 6 months showed significantly decreased measures of pain in the supplement vs. the placebo group: mean number of painful days monthly (1.7 vs. 3.4), mean number of oral analgesics taken monthly (4.4 vs. 10.5), and patients who reported that they were pain free (33% vs. 13%).

Secondary outcomes included levels of two markers of oxidative stress, both of which were significantly lower in the supplement group vs. placebo after 6 months: thiobarbituric acid reactive substances (3.6 vs. 5.4 nmol/mL) and serum superoxide dismutase (1.9 vs. 3.5 U/mL).

Dr. Bhardwaj reported no potential conflicts of interest.

WASHINGTON — Antioxidant supplementation was effective in curbing pain in patients with chronic pancreatitis in a double-blinded, randomized, controlled trial.

Measures of pain and oxidative stress were significantly lower in patients who took a daily antioxidant supplement for 6 months, compared with those who took a placebo pill, investigators reported at the annual Digestive Disease Week.

“It's very difficult to treat pain, so antioxidants are a simple treatment and a dietary constituent, and if it can reduce the pain, this is of immense benefit to these patients,” study investigator Dr. Payal Bhardwaj of the All India Institute of Medical Sciences, New Delhi, said at a press briefing during the meeting.

Roughly 90% of patients with chronic pancreatitis have abdominal pain, conventionally treated by surgery, nerve blocks, or endoscopic treatment. “These three procedures are very invasive,” she said. “What we have seen is a totally noninvasive dietary modulation.”

The study included 127 consecutive patients (mean age 31 years) with chronic pancreatitis and abdominal pain who were randomly assigned to receive a daily antioxidant supplement (71 patients) or placebo (56 patients) for 6 months. The supplement contained 600 mcg of selenium, 0.54 g of vitamin C, 9,000 IU of beta-carotene, 270 IU of vitamin E, and 2 g of methionine.

Pain relief was the primary outcome. Regression analysis at 6 months showed significantly decreased measures of pain in the supplement vs. the placebo group: mean number of painful days monthly (1.7 vs. 3.4), mean number of oral analgesics taken monthly (4.4 vs. 10.5), and patients who reported that they were pain free (33% vs. 13%).

Secondary outcomes included levels of two markers of oxidative stress, both of which were significantly lower in the supplement group vs. placebo after 6 months: thiobarbituric acid reactive substances (3.6 vs. 5.4 nmol/mL) and serum superoxide dismutase (1.9 vs. 3.5 U/mL).

Dr. Bhardwaj reported no potential conflicts of interest.