Robert Finn

MONTEREY, CALIF. — Women with thyroid disease are 50% more likely to have a child with left ventricular outflow tract obstruction than women without thyroid disease, according to a study that compared about 6,000 women in each of the two groups.

In particular, the risk of aortic valve stenosis and/or coarctation of the aorta appeared to be elevated, Marilyn L. Browne of the New York State Department of Health and her colleagues wrote in a poster presentation at the annual meeting of the Teratology Society. There were no other statistically significant associations between maternal thyroid disease and congenital cardiovascular malformations.

The multicenter case control study was part of the National Birth Defects Prevention Study (NBDPS), which collects data from 10 regions in the United States. The investigators identified 6,068 women with a thyroid disease whose babies were born between October 1997 and December 2004 and compared them with 5,875 controls. There were no significant demographic differences between the case and control groups.

The odds ratios were adjusted for potential confounders, including maternal age, race/ethnicity, education, prepregnancy BMI, gestational diabetes, smoking, alcohol use, and the state of residence at time of delivery.

The investigators acknowledged that their study did not identify the women's underlying thyroid conditions. They recommended that additional studies should evaluate the risks of antithyroid medication and should examine risk by type of thyroid disorder.

Ms. Browne disclosed no conflicts of interest related to her presentation.

MONTEREY, CALIF. — Women with thyroid disease are 50% more likely to have a child with left ventricular outflow tract obstruction than women without thyroid disease, according to a study that compared about 6,000 women in each of the two groups.

In particular, the risk of aortic valve stenosis and/or coarctation of the aorta appeared to be elevated, Marilyn L. Browne of the New York State Department of Health and her colleagues wrote in a poster presentation at the annual meeting of the Teratology Society. There were no other statistically significant associations between maternal thyroid disease and congenital cardiovascular malformations.

The multicenter case control study was part of the National Birth Defects Prevention Study (NBDPS), which collects data from 10 regions in the United States. The investigators identified 6,068 women with a thyroid disease whose babies were born between October 1997 and December 2004 and compared them with 5,875 controls. There were no significant demographic differences between the case and control groups.

The odds ratios were adjusted for potential confounders, including maternal age, race/ethnicity, education, prepregnancy BMI, gestational diabetes, smoking, alcohol use, and the state of residence at time of delivery.

The investigators acknowledged that their study did not identify the women's underlying thyroid conditions. They recommended that additional studies should evaluate the risks of antithyroid medication and should examine risk by type of thyroid disorder.

Ms. Browne disclosed no conflicts of interest related to her presentation.

MONTEREY, CALIF. — Women with thyroid disease are 50% more likely to have a child with left ventricular outflow tract obstruction than women without thyroid disease, according to a study that compared about 6,000 women in each of the two groups.

In particular, the risk of aortic valve stenosis and/or coarctation of the aorta appeared to be elevated, Marilyn L. Browne of the New York State Department of Health and her colleagues wrote in a poster presentation at the annual meeting of the Teratology Society. There were no other statistically significant associations between maternal thyroid disease and congenital cardiovascular malformations.

The multicenter case control study was part of the National Birth Defects Prevention Study (NBDPS), which collects data from 10 regions in the United States. The investigators identified 6,068 women with a thyroid disease whose babies were born between October 1997 and December 2004 and compared them with 5,875 controls. There were no significant demographic differences between the case and control groups.

The odds ratios were adjusted for potential confounders, including maternal age, race/ethnicity, education, prepregnancy BMI, gestational diabetes, smoking, alcohol use, and the state of residence at time of delivery.

The investigators acknowledged that their study did not identify the women's underlying thyroid conditions. They recommended that additional studies should evaluate the risks of antithyroid medication and should examine risk by type of thyroid disorder.

Ms. Browne disclosed no conflicts of interest related to her presentation.

SAN FRANCISCO — Evidence continues to accumulate that periodontal disease is associated with insulin resistance and poor glycemic control, and there are tantalizing suggestions that treating periodontitis may lead to improvements in glycemic control.

That was the message delivered by the speakers at the first joint symposium of the two ADAs—the American Dental Association and the American Diabetes Association—at the annual scientific sessions of the American Diabetes Association.

The speakers agreed that systemic inflammation appears to form the critical link between periodontitis and diabetes, although the chicken-and-egg question has not yet been answered. Diabetes appears to induce periodontal disease or cause it to worsen in some patients, but periodontal disease seems to worsen glycemic control. Periodontal disease also seems to increase the risk of cardiovascular disease and stroke and, when present in pregnant women, to increase the risk of low-birth-weight babies.

Whatever the direction of causation, the clear message was that dentists must ask their patients about diabetes, and physicians must inquire about the oral health of their diabetes patients.

Some of the evidence comes from analyses of the third National Health and Nutrition Examination Survey (NHANES III—data compiled between 1988 and 1994) by George W. Taylor, D.M.D., of the University of Michigan, Ann Arbor. In one analysis that included individuals between the ages of 17 and 90, Dr. Taylor and his colleagues looked at the presence or absence of periodontitis and metabolic syndrome and their relationship to insulin resistance. Among patients with neither disorder, 10% demonstrated insulin resistance. The rate of insulin resistance increased significantly to 36% among patients who had only periodontitis, to 53% among patients who had only metabolic syndrome, and to 48% among patients who had both.

After adjustment for education, age, race/ethnicity, exercise, smoking history, white blood cell count, fibrinogen levels, and levels of C-reactive protein, those with periodontitis alone were 3.7 times as likely to have insulin resistance as were those with neither disorder. The risk increased 7.3-fold among patients with metabolic syndrome alone, and 6.8-fold among patients with both disorders.

The question remained, however, whether treating periodontitis would improve glycemic control. In a systematic review, Dr. Taylor found that 5 of 8 randomized controlled trials and 8 of 12 other studies returned positive answers to that question.

Periodontist Lewis F. Rose of the University of Pennsylvania, Philadelphia, was one of 18 physicians, dentists, and other independent experts who convened in Scottsdale, Ariz., in April 2007 to review the strength of the evidence for the associations among periodontitis, diabetes, and cardiovascular disease. The participants in the Scottsdale Project conducted a systematic review of 118 published articles in an attempt to answer eight focused questions.

Despite some uncertainty in the evidence, the panel agreed that it would be appropriate to develop guidelines to assist dental providers in identifying patients who are at risk for diabetes or cardiovascular disease and, conversely, to develop guidelines to assist medical providers in identifying patients who are at risk for periodontal disease.

Dr. Rose noted that one physician on the panel said, “I can't believe we're going to be asked to identify another problem in a 15-minute period in our patients.”

Dr. Rose acknowledged the difficulty of squeezing yet another item into limited appointment times. Even so, he said that it would not take much time simply to ask patients with diabetes whether they had seen a dentist within the last year.

Dr. Rose said that he had no conflicts of interest related to his presentation. Dr. Taylor acknowledged serving as a consultant to, and advisory board member for, Colgate-Palmolive, and the company sponsored the joint symposium with an unrestricted educational grant.

SAN FRANCISCO — Evidence continues to accumulate that periodontal disease is associated with insulin resistance and poor glycemic control, and there are tantalizing suggestions that treating periodontitis may lead to improvements in glycemic control.

That was the message delivered by the speakers at the first joint symposium of the two ADAs—the American Dental Association and the American Diabetes Association—at the annual scientific sessions of the American Diabetes Association.

The speakers agreed that systemic inflammation appears to form the critical link between periodontitis and diabetes, although the chicken-and-egg question has not yet been answered. Diabetes appears to induce periodontal disease or cause it to worsen in some patients, but periodontal disease seems to worsen glycemic control. Periodontal disease also seems to increase the risk of cardiovascular disease and stroke and, when present in pregnant women, to increase the risk of low-birth-weight babies.

Whatever the direction of causation, the clear message was that dentists must ask their patients about diabetes, and physicians must inquire about the oral health of their diabetes patients.

Some of the evidence comes from analyses of the third National Health and Nutrition Examination Survey (NHANES III—data compiled between 1988 and 1994) by George W. Taylor, D.M.D., of the University of Michigan, Ann Arbor. In one analysis that included individuals between the ages of 17 and 90, Dr. Taylor and his colleagues looked at the presence or absence of periodontitis and metabolic syndrome and their relationship to insulin resistance. Among patients with neither disorder, 10% demonstrated insulin resistance. The rate of insulin resistance increased significantly to 36% among patients who had only periodontitis, to 53% among patients who had only metabolic syndrome, and to 48% among patients who had both.

After adjustment for education, age, race/ethnicity, exercise, smoking history, white blood cell count, fibrinogen levels, and levels of C-reactive protein, those with periodontitis alone were 3.7 times as likely to have insulin resistance as were those with neither disorder. The risk increased 7.3-fold among patients with metabolic syndrome alone, and 6.8-fold among patients with both disorders.

The question remained, however, whether treating periodontitis would improve glycemic control. In a systematic review, Dr. Taylor found that 5 of 8 randomized controlled trials and 8 of 12 other studies returned positive answers to that question.

Periodontist Lewis F. Rose of the University of Pennsylvania, Philadelphia, was one of 18 physicians, dentists, and other independent experts who convened in Scottsdale, Ariz., in April 2007 to review the strength of the evidence for the associations among periodontitis, diabetes, and cardiovascular disease. The participants in the Scottsdale Project conducted a systematic review of 118 published articles in an attempt to answer eight focused questions.

Despite some uncertainty in the evidence, the panel agreed that it would be appropriate to develop guidelines to assist dental providers in identifying patients who are at risk for diabetes or cardiovascular disease and, conversely, to develop guidelines to assist medical providers in identifying patients who are at risk for periodontal disease.

Dr. Rose noted that one physician on the panel said, “I can't believe we're going to be asked to identify another problem in a 15-minute period in our patients.”

Dr. Rose acknowledged the difficulty of squeezing yet another item into limited appointment times. Even so, he said that it would not take much time simply to ask patients with diabetes whether they had seen a dentist within the last year.

Dr. Rose said that he had no conflicts of interest related to his presentation. Dr. Taylor acknowledged serving as a consultant to, and advisory board member for, Colgate-Palmolive, and the company sponsored the joint symposium with an unrestricted educational grant.

SAN FRANCISCO — Evidence continues to accumulate that periodontal disease is associated with insulin resistance and poor glycemic control, and there are tantalizing suggestions that treating periodontitis may lead to improvements in glycemic control.

That was the message delivered by the speakers at the first joint symposium of the two ADAs—the American Dental Association and the American Diabetes Association—at the annual scientific sessions of the American Diabetes Association.

The speakers agreed that systemic inflammation appears to form the critical link between periodontitis and diabetes, although the chicken-and-egg question has not yet been answered. Diabetes appears to induce periodontal disease or cause it to worsen in some patients, but periodontal disease seems to worsen glycemic control. Periodontal disease also seems to increase the risk of cardiovascular disease and stroke and, when present in pregnant women, to increase the risk of low-birth-weight babies.

Whatever the direction of causation, the clear message was that dentists must ask their patients about diabetes, and physicians must inquire about the oral health of their diabetes patients.

Some of the evidence comes from analyses of the third National Health and Nutrition Examination Survey (NHANES III—data compiled between 1988 and 1994) by George W. Taylor, D.M.D., of the University of Michigan, Ann Arbor. In one analysis that included individuals between the ages of 17 and 90, Dr. Taylor and his colleagues looked at the presence or absence of periodontitis and metabolic syndrome and their relationship to insulin resistance. Among patients with neither disorder, 10% demonstrated insulin resistance. The rate of insulin resistance increased significantly to 36% among patients who had only periodontitis, to 53% among patients who had only metabolic syndrome, and to 48% among patients who had both.

After adjustment for education, age, race/ethnicity, exercise, smoking history, white blood cell count, fibrinogen levels, and levels of C-reactive protein, those with periodontitis alone were 3.7 times as likely to have insulin resistance as were those with neither disorder. The risk increased 7.3-fold among patients with metabolic syndrome alone, and 6.8-fold among patients with both disorders.

The question remained, however, whether treating periodontitis would improve glycemic control. In a systematic review, Dr. Taylor found that 5 of 8 randomized controlled trials and 8 of 12 other studies returned positive answers to that question.

Periodontist Lewis F. Rose of the University of Pennsylvania, Philadelphia, was one of 18 physicians, dentists, and other independent experts who convened in Scottsdale, Ariz., in April 2007 to review the strength of the evidence for the associations among periodontitis, diabetes, and cardiovascular disease. The participants in the Scottsdale Project conducted a systematic review of 118 published articles in an attempt to answer eight focused questions.

Despite some uncertainty in the evidence, the panel agreed that it would be appropriate to develop guidelines to assist dental providers in identifying patients who are at risk for diabetes or cardiovascular disease and, conversely, to develop guidelines to assist medical providers in identifying patients who are at risk for periodontal disease.

Dr. Rose noted that one physician on the panel said, “I can't believe we're going to be asked to identify another problem in a 15-minute period in our patients.”

Dr. Rose acknowledged the difficulty of squeezing yet another item into limited appointment times. Even so, he said that it would not take much time simply to ask patients with diabetes whether they had seen a dentist within the last year.

Dr. Rose said that he had no conflicts of interest related to his presentation. Dr. Taylor acknowledged serving as a consultant to, and advisory board member for, Colgate-Palmolive, and the company sponsored the joint symposium with an unrestricted educational grant.

SAN FRANCISCO — Consider the partners of diabetes patients when talking about sexual problems in diabetes, a research specialist in the field suggests.

Although only one member of a couple may have diabetes, “Partners are very often hidden patients,” said Lawrence Fisher, Ph.D., at the annual scientific sessions of the American Diabetes Association. “Diabetes [exists] in interpersonal settings. It doesn't happen in social isolation. The most powerful and emotionally charged interpersonal setting is the adult couple.” He listed six issues related to sexual intimacy that affect patients with diabetes:

Clinical depression is very common among people with diabetes, and even in patients without a formal diagnosis of depression, it's typical to find high levels of depressive affect and diabetes distress. Many of these patients are taking antidepressants, which have well-known sexual side effects. On top of that, “Being in a lousy mood is not the greatest time to have sex,” said Dr. Fisher, professor in residency at the University of California, San Francisco.

Self-blame and shame are often issues in patients with diabetes, especially those with type 2. Consciously or unconsciously, many people think, “If only I had taken care of myself better, I wouldn't be having these sexual problems.” Partners also may blame the patient with diabetes for sexual problems, further damaging the patient's self-esteem.

People with diabetes, especially with type 2, often feel socially and physically unattractive. An obese patient can have a poor body image that might inhibit him or her from initiating sexual activity. The other side of the coin is that partners may take it as a judgment about their own attractiveness when a man with diabetes is unable to achieve an erection.

Patients and partners often have specific worries about the effect of diabetes on sexual activity. Sexual intercourse can be physically demanding, and they worry about cardiovascular events and hypoglycemia. Having to plan for this, with blood testing before bed and snacks on the nightstand, for example, takes some of the spontaneity and fun out of sex. Furthermore, simply knowing that diabetes can lead to sexual failure can be a self-fulfilling prophecy.

Patients and their partners often suffer from a lack of knowledge about diabetes and its effects on sexual intimacy. And they also tend to be ignorant about the normal effects of aging on sexuality. “This creates what I like to call 'diabetes scapegoating,'” Dr. Fisher said. “Any time anything happens, it's [the fault of] diabetes. And it may not be. It may be normal functioning for people of that age.”

Cultural and personal beliefs, values, and sentiments about sexuality can often amplify the effects of diabetes. Some couples lack the language to talk about sexual difficulties. “In some cultures, even in long-standing relationships between partners, it is considered inappropriate for the partners to talk about their sexual activity,” Dr. Fisher explained.

SAN FRANCISCO — Consider the partners of diabetes patients when talking about sexual problems in diabetes, a research specialist in the field suggests.

Although only one member of a couple may have diabetes, “Partners are very often hidden patients,” said Lawrence Fisher, Ph.D., at the annual scientific sessions of the American Diabetes Association. “Diabetes [exists] in interpersonal settings. It doesn't happen in social isolation. The most powerful and emotionally charged interpersonal setting is the adult couple.” He listed six issues related to sexual intimacy that affect patients with diabetes:

Clinical depression is very common among people with diabetes, and even in patients without a formal diagnosis of depression, it's typical to find high levels of depressive affect and diabetes distress. Many of these patients are taking antidepressants, which have well-known sexual side effects. On top of that, “Being in a lousy mood is not the greatest time to have sex,” said Dr. Fisher, professor in residency at the University of California, San Francisco.

Self-blame and shame are often issues in patients with diabetes, especially those with type 2. Consciously or unconsciously, many people think, “If only I had taken care of myself better, I wouldn't be having these sexual problems.” Partners also may blame the patient with diabetes for sexual problems, further damaging the patient's self-esteem.

People with diabetes, especially with type 2, often feel socially and physically unattractive. An obese patient can have a poor body image that might inhibit him or her from initiating sexual activity. The other side of the coin is that partners may take it as a judgment about their own attractiveness when a man with diabetes is unable to achieve an erection.

Patients and partners often have specific worries about the effect of diabetes on sexual activity. Sexual intercourse can be physically demanding, and they worry about cardiovascular events and hypoglycemia. Having to plan for this, with blood testing before bed and snacks on the nightstand, for example, takes some of the spontaneity and fun out of sex. Furthermore, simply knowing that diabetes can lead to sexual failure can be a self-fulfilling prophecy.

Patients and their partners often suffer from a lack of knowledge about diabetes and its effects on sexual intimacy. And they also tend to be ignorant about the normal effects of aging on sexuality. “This creates what I like to call 'diabetes scapegoating,'” Dr. Fisher said. “Any time anything happens, it's [the fault of] diabetes. And it may not be. It may be normal functioning for people of that age.”

Cultural and personal beliefs, values, and sentiments about sexuality can often amplify the effects of diabetes. Some couples lack the language to talk about sexual difficulties. “In some cultures, even in long-standing relationships between partners, it is considered inappropriate for the partners to talk about their sexual activity,” Dr. Fisher explained.

SAN FRANCISCO — Consider the partners of diabetes patients when talking about sexual problems in diabetes, a research specialist in the field suggests.

Although only one member of a couple may have diabetes, “Partners are very often hidden patients,” said Lawrence Fisher, Ph.D., at the annual scientific sessions of the American Diabetes Association. “Diabetes [exists] in interpersonal settings. It doesn't happen in social isolation. The most powerful and emotionally charged interpersonal setting is the adult couple.” He listed six issues related to sexual intimacy that affect patients with diabetes:

Clinical depression is very common among people with diabetes, and even in patients without a formal diagnosis of depression, it's typical to find high levels of depressive affect and diabetes distress. Many of these patients are taking antidepressants, which have well-known sexual side effects. On top of that, “Being in a lousy mood is not the greatest time to have sex,” said Dr. Fisher, professor in residency at the University of California, San Francisco.

Self-blame and shame are often issues in patients with diabetes, especially those with type 2. Consciously or unconsciously, many people think, “If only I had taken care of myself better, I wouldn't be having these sexual problems.” Partners also may blame the patient with diabetes for sexual problems, further damaging the patient's self-esteem.

People with diabetes, especially with type 2, often feel socially and physically unattractive. An obese patient can have a poor body image that might inhibit him or her from initiating sexual activity. The other side of the coin is that partners may take it as a judgment about their own attractiveness when a man with diabetes is unable to achieve an erection.

Patients and partners often have specific worries about the effect of diabetes on sexual activity. Sexual intercourse can be physically demanding, and they worry about cardiovascular events and hypoglycemia. Having to plan for this, with blood testing before bed and snacks on the nightstand, for example, takes some of the spontaneity and fun out of sex. Furthermore, simply knowing that diabetes can lead to sexual failure can be a self-fulfilling prophecy.

Patients and their partners often suffer from a lack of knowledge about diabetes and its effects on sexual intimacy. And they also tend to be ignorant about the normal effects of aging on sexuality. “This creates what I like to call 'diabetes scapegoating,'” Dr. Fisher said. “Any time anything happens, it's [the fault of] diabetes. And it may not be. It may be normal functioning for people of that age.”

Cultural and personal beliefs, values, and sentiments about sexuality can often amplify the effects of diabetes. Some couples lack the language to talk about sexual difficulties. “In some cultures, even in long-standing relationships between partners, it is considered inappropriate for the partners to talk about their sexual activity,” Dr. Fisher explained.

MONTEREY, CALIF. — Women with thyroid disease are 50% more likely to have a child with left ventricular outflow tract obstruction than women without thyroid disease, according to a study that compared about 6,000 women in each of the two groups.

In particular, the risk of aortic valve stenosis and/or coarctation of the aorta appeared to be elevated, Marilyn L. Browne of the New York State Department of Health and her colleagues wrote in a poster presentation at the annual meeting of the Teratology Society.

There were no other statistically significant associations between maternal thyroid disease and congenital cardiovascular malformations.

The multicenter case control study was part of the National Birth Defects Prevention Study (NBDPS), which collects data from 10 regions in the United States. The investigators identified 6,068 women with a thyroid disease whose babies were born between October 1997 and December 2004 and compared them with 5,875 controls.

There were no significant demographic differences between the case and control groups, they reported.

The odds ratios were adjusted for potential confounders, including maternal age, race/ethnicity, education, prepregnancy BMI, gestational diabetes, smoking, alcohol use, and the state of residence at time of delivery.

The investigators acknowledged that their study did not identify the women's underlying thyroid conditions. They recommended that additional studies should evaluate the risks of antithyroid medication and should examine risk by type of thyroid disorder.

Ms. Browne stated she had no conflicts of interest to disclose related to her presentation.

MONTEREY, CALIF. — Women with thyroid disease are 50% more likely to have a child with left ventricular outflow tract obstruction than women without thyroid disease, according to a study that compared about 6,000 women in each of the two groups.

In particular, the risk of aortic valve stenosis and/or coarctation of the aorta appeared to be elevated, Marilyn L. Browne of the New York State Department of Health and her colleagues wrote in a poster presentation at the annual meeting of the Teratology Society.

There were no other statistically significant associations between maternal thyroid disease and congenital cardiovascular malformations.

The multicenter case control study was part of the National Birth Defects Prevention Study (NBDPS), which collects data from 10 regions in the United States. The investigators identified 6,068 women with a thyroid disease whose babies were born between October 1997 and December 2004 and compared them with 5,875 controls.

There were no significant demographic differences between the case and control groups, they reported.

The odds ratios were adjusted for potential confounders, including maternal age, race/ethnicity, education, prepregnancy BMI, gestational diabetes, smoking, alcohol use, and the state of residence at time of delivery.

The investigators acknowledged that their study did not identify the women's underlying thyroid conditions. They recommended that additional studies should evaluate the risks of antithyroid medication and should examine risk by type of thyroid disorder.

Ms. Browne stated she had no conflicts of interest to disclose related to her presentation.

MONTEREY, CALIF. — Women with thyroid disease are 50% more likely to have a child with left ventricular outflow tract obstruction than women without thyroid disease, according to a study that compared about 6,000 women in each of the two groups.

In particular, the risk of aortic valve stenosis and/or coarctation of the aorta appeared to be elevated, Marilyn L. Browne of the New York State Department of Health and her colleagues wrote in a poster presentation at the annual meeting of the Teratology Society.

There were no other statistically significant associations between maternal thyroid disease and congenital cardiovascular malformations.

The multicenter case control study was part of the National Birth Defects Prevention Study (NBDPS), which collects data from 10 regions in the United States. The investigators identified 6,068 women with a thyroid disease whose babies were born between October 1997 and December 2004 and compared them with 5,875 controls.

There were no significant demographic differences between the case and control groups, they reported.

The odds ratios were adjusted for potential confounders, including maternal age, race/ethnicity, education, prepregnancy BMI, gestational diabetes, smoking, alcohol use, and the state of residence at time of delivery.

The investigators acknowledged that their study did not identify the women's underlying thyroid conditions. They recommended that additional studies should evaluate the risks of antithyroid medication and should examine risk by type of thyroid disorder.

Ms. Browne stated she had no conflicts of interest to disclose related to her presentation.

HONOLULU — The “digital divide” separating society's haves and have-nots may not be as deep as many fear, according to a study of 120 parents of adolescent patients and the patients themselves.

In a survey, more than 60% of parents and adolescents of low socioeconomic status from one Boston pediatric practice indicated a willingness to contact physicians via e-mail if given the option, according to Dr. Tarissa Mitchell of Boston Medical Center.

Among respondents, 66% said they had access to e-mail and/or computers at home. But only 19% of the parents had their health care provider's e-mail address, and only 3% had ever used e-mail to contact their provider.

Dr. Mitchell and Dr. Shikha G. Anand of the Whittier Street Health Center, Roxbury, Mass., conducted a convenience sample survey over a 4-month period at a community health center of 120 parents of adolescent patients and the adolescent patients.

All adolescent patients surveyed were above the age of 13. At that center, five pediatric providers serve 3,876 low socioeconomic status children, 84% of whom are publicly insured and 82% of whom self-identify as black or Hispanic.

Compared with respondents without e-mail availability at home, those with home e-mail availability were significantly more willing to contact their physicians: 77% vs. 33%. And respondents who used e-mail more frequently also were significantly more willing to contact their provider this way. For example, among respondents whose e-mail was always on, 89% were willing to e-mail their physicians. This declined to 60% among respondents who used e-mail only weekly and to 43% of those who used e-mail monthly or less frequently than that, Dr. Mitchell and Dr. Anand wrote in a poster presented at the annual meeting of the Pediatric Academic Societies.

Only 13% of the respondents stated that they would never use e-mail. The most common reason given was a desire to telephone the office, but they also cited lack of access to e-mail, difficulty with the English language, concerns over bothering the doctor with e-mails, and an expectation of slower response time.

In addition, 33% of the entire survey population expressed concern that e-mail may not be private and could be reviewed by individuals other than their health care provider.

Dr. Mitchell and Dr. Anand stated that they had no conflicts of interest related to this presentation.

HONOLULU — The “digital divide” separating society's haves and have-nots may not be as deep as many fear, according to a study of 120 parents of adolescent patients and the patients themselves.

In a survey, more than 60% of parents and adolescents of low socioeconomic status from one Boston pediatric practice indicated a willingness to contact physicians via e-mail if given the option, according to Dr. Tarissa Mitchell of Boston Medical Center.

Among respondents, 66% said they had access to e-mail and/or computers at home. But only 19% of the parents had their health care provider's e-mail address, and only 3% had ever used e-mail to contact their provider.

Dr. Mitchell and Dr. Shikha G. Anand of the Whittier Street Health Center, Roxbury, Mass., conducted a convenience sample survey over a 4-month period at a community health center of 120 parents of adolescent patients and the adolescent patients.

All adolescent patients surveyed were above the age of 13. At that center, five pediatric providers serve 3,876 low socioeconomic status children, 84% of whom are publicly insured and 82% of whom self-identify as black or Hispanic.

Compared with respondents without e-mail availability at home, those with home e-mail availability were significantly more willing to contact their physicians: 77% vs. 33%. And respondents who used e-mail more frequently also were significantly more willing to contact their provider this way. For example, among respondents whose e-mail was always on, 89% were willing to e-mail their physicians. This declined to 60% among respondents who used e-mail only weekly and to 43% of those who used e-mail monthly or less frequently than that, Dr. Mitchell and Dr. Anand wrote in a poster presented at the annual meeting of the Pediatric Academic Societies.

Only 13% of the respondents stated that they would never use e-mail. The most common reason given was a desire to telephone the office, but they also cited lack of access to e-mail, difficulty with the English language, concerns over bothering the doctor with e-mails, and an expectation of slower response time.

In addition, 33% of the entire survey population expressed concern that e-mail may not be private and could be reviewed by individuals other than their health care provider.

Dr. Mitchell and Dr. Anand stated that they had no conflicts of interest related to this presentation.

HONOLULU — The “digital divide” separating society's haves and have-nots may not be as deep as many fear, according to a study of 120 parents of adolescent patients and the patients themselves.

In a survey, more than 60% of parents and adolescents of low socioeconomic status from one Boston pediatric practice indicated a willingness to contact physicians via e-mail if given the option, according to Dr. Tarissa Mitchell of Boston Medical Center.

Among respondents, 66% said they had access to e-mail and/or computers at home. But only 19% of the parents had their health care provider's e-mail address, and only 3% had ever used e-mail to contact their provider.

Dr. Mitchell and Dr. Shikha G. Anand of the Whittier Street Health Center, Roxbury, Mass., conducted a convenience sample survey over a 4-month period at a community health center of 120 parents of adolescent patients and the adolescent patients.

All adolescent patients surveyed were above the age of 13. At that center, five pediatric providers serve 3,876 low socioeconomic status children, 84% of whom are publicly insured and 82% of whom self-identify as black or Hispanic.

Compared with respondents without e-mail availability at home, those with home e-mail availability were significantly more willing to contact their physicians: 77% vs. 33%. And respondents who used e-mail more frequently also were significantly more willing to contact their provider this way. For example, among respondents whose e-mail was always on, 89% were willing to e-mail their physicians. This declined to 60% among respondents who used e-mail only weekly and to 43% of those who used e-mail monthly or less frequently than that, Dr. Mitchell and Dr. Anand wrote in a poster presented at the annual meeting of the Pediatric Academic Societies.

Only 13% of the respondents stated that they would never use e-mail. The most common reason given was a desire to telephone the office, but they also cited lack of access to e-mail, difficulty with the English language, concerns over bothering the doctor with e-mails, and an expectation of slower response time.

In addition, 33% of the entire survey population expressed concern that e-mail may not be private and could be reviewed by individuals other than their health care provider.

Dr. Mitchell and Dr. Anand stated that they had no conflicts of interest related to this presentation.

HONOLULU — Children adopted internationally by American parents often are accompanied by immunization records from their birth countries, but the records cannot be relied on, according to a study of more than 400 children. It's important to inform adoptive parents of this, Emaculate Verla-Tebit, Ph.D., of Case Western Reserve University, Cleveland, said in an interview. Parents then can decide whether to simply revaccinate or to order serum antibody testing and vaccinate based on those results.

The cross-sectional study involved 465 children seen at an adoption health clinic at Rainbow Babies and Children's Hospital in Cleveland. The investigators excluded children who had hepatitis B or C infections, those who presented more than 180 days after their arrival into the United States, and those who had received any vaccine in the United States.

The children came from Russia, China, Guatemala, Eastern Europe, Southeast Asia, the West Pacific, and Latin America; they were a mean 19.4 months at adoption. More than 85% had vaccine records available. The investigators obtained venous blood samples and measured antibody titers for diphtheria, tetanus, measles, hepatitis B, and polio.

The level of protective immunity was worst for polio. Of children reported to have received three or more polio vaccine doses, only about 60% had protective immunity to polio type 1, 85% had protective immunity to type 2, and just over 50% had protective immunity to type 3, Dr. Verla-Tebit reported in a poster presented at the annual meeting of the Pediatric Academic Societies.

Of children reported to have received two or more doses of hepatitis B vaccine, 95% had protective immunity. Of children reported to have received one or more doses of measles vaccine, about 80% had protective immunity.

Of children reported to have three or more doses of diphtheria vaccine, 95% had protective immunity, and of those who were reported to have three or more doses of tetanus vaccine, 90% had protective immunity.

Dr. Verla-Tebit said that several factors could explain the discordance between immunization records and protective immunity. It's possible that some records were falsified, but it's also possible that in some cases there may have been a break in the cold chain—a common occurrence in developing countries—which could have compromised vaccine strength.

Another possibility is that the child's nutritional status may have played a role. Investigators judged 79% of children in this study to be well nourished, 15% to have moderate to severe chronic malnutrition, and 6% to have moderate to severe acute malnutrition.

Dr. Verla-Tebit stated that she had no conflicts of interest related to her study.

HONOLULU — Children adopted internationally by American parents often are accompanied by immunization records from their birth countries, but the records cannot be relied on, according to a study of more than 400 children. It's important to inform adoptive parents of this, Emaculate Verla-Tebit, Ph.D., of Case Western Reserve University, Cleveland, said in an interview. Parents then can decide whether to simply revaccinate or to order serum antibody testing and vaccinate based on those results.

The cross-sectional study involved 465 children seen at an adoption health clinic at Rainbow Babies and Children's Hospital in Cleveland. The investigators excluded children who had hepatitis B or C infections, those who presented more than 180 days after their arrival into the United States, and those who had received any vaccine in the United States.

The children came from Russia, China, Guatemala, Eastern Europe, Southeast Asia, the West Pacific, and Latin America; they were a mean 19.4 months at adoption. More than 85% had vaccine records available. The investigators obtained venous blood samples and measured antibody titers for diphtheria, tetanus, measles, hepatitis B, and polio.

The level of protective immunity was worst for polio. Of children reported to have received three or more polio vaccine doses, only about 60% had protective immunity to polio type 1, 85% had protective immunity to type 2, and just over 50% had protective immunity to type 3, Dr. Verla-Tebit reported in a poster presented at the annual meeting of the Pediatric Academic Societies.

Of children reported to have received two or more doses of hepatitis B vaccine, 95% had protective immunity. Of children reported to have received one or more doses of measles vaccine, about 80% had protective immunity.

Of children reported to have three or more doses of diphtheria vaccine, 95% had protective immunity, and of those who were reported to have three or more doses of tetanus vaccine, 90% had protective immunity.

Dr. Verla-Tebit said that several factors could explain the discordance between immunization records and protective immunity. It's possible that some records were falsified, but it's also possible that in some cases there may have been a break in the cold chain—a common occurrence in developing countries—which could have compromised vaccine strength.

Another possibility is that the child's nutritional status may have played a role. Investigators judged 79% of children in this study to be well nourished, 15% to have moderate to severe chronic malnutrition, and 6% to have moderate to severe acute malnutrition.

Dr. Verla-Tebit stated that she had no conflicts of interest related to her study.

HONOLULU — Children adopted internationally by American parents often are accompanied by immunization records from their birth countries, but the records cannot be relied on, according to a study of more than 400 children. It's important to inform adoptive parents of this, Emaculate Verla-Tebit, Ph.D., of Case Western Reserve University, Cleveland, said in an interview. Parents then can decide whether to simply revaccinate or to order serum antibody testing and vaccinate based on those results.

The cross-sectional study involved 465 children seen at an adoption health clinic at Rainbow Babies and Children's Hospital in Cleveland. The investigators excluded children who had hepatitis B or C infections, those who presented more than 180 days after their arrival into the United States, and those who had received any vaccine in the United States.

The children came from Russia, China, Guatemala, Eastern Europe, Southeast Asia, the West Pacific, and Latin America; they were a mean 19.4 months at adoption. More than 85% had vaccine records available. The investigators obtained venous blood samples and measured antibody titers for diphtheria, tetanus, measles, hepatitis B, and polio.

The level of protective immunity was worst for polio. Of children reported to have received three or more polio vaccine doses, only about 60% had protective immunity to polio type 1, 85% had protective immunity to type 2, and just over 50% had protective immunity to type 3, Dr. Verla-Tebit reported in a poster presented at the annual meeting of the Pediatric Academic Societies.

Of children reported to have received two or more doses of hepatitis B vaccine, 95% had protective immunity. Of children reported to have received one or more doses of measles vaccine, about 80% had protective immunity.

Of children reported to have three or more doses of diphtheria vaccine, 95% had protective immunity, and of those who were reported to have three or more doses of tetanus vaccine, 90% had protective immunity.

Dr. Verla-Tebit said that several factors could explain the discordance between immunization records and protective immunity. It's possible that some records were falsified, but it's also possible that in some cases there may have been a break in the cold chain—a common occurrence in developing countries—which could have compromised vaccine strength.

Another possibility is that the child's nutritional status may have played a role. Investigators judged 79% of children in this study to be well nourished, 15% to have moderate to severe chronic malnutrition, and 6% to have moderate to severe acute malnutrition.

Dr. Verla-Tebit stated that she had no conflicts of interest related to her study.

MONTEREY, CALIF. — Women who take the anticonvulsant lamotrigine during their first trimester of pregnancy have a 10-fold greater risk of having a baby with nonsyndromal cleft lip, cleft palate, or both, according to a peer-reviewed study.

Among 684 women enrolled in the North American Anti-Epileptic Drug (AED) Pregnancy Registry who reported taking lamotrigine monotherapy during their first trimester, there were 16 infants born with major malformations, Dr. Lewis B. Holmes said at the annual meeting of the Teratology Society. This translates to a rate of 2.3%, compared with a baseline rate of 1.6% in unexposed newborn infants (Neurology 2008;70:2152-8).

Although this difference in combined major malformation rates was not statistically significant, the investigators observed a significantly increased risk when they restricted the analysis to oral clefts.

Three of the infants had an isolated cleft palate, one had an isolated cleft lip, and one had bilateral cleft lip and palate, for an overall prevalence rate of 7.3/1,000 infants. In comparison, the rate was 0.7/1,000 for unexposed controls, yielding a significant relative risk of 10.4.

“That's a whopping increase,” said Dr. Holmes of Massachusetts General Hospital for Children, Boston. “You wonder if it's a sample size [effect], but it's certainly a point to be pursued in comparison to other databases.”

“A larger sample size is needed to see whether the rate of clefts is a 10-fold increase or as low as 4-fold, or somewhere in between,” Dr. Holmes said.

Dr. Holmes disclosed that he received a salary support from funds provided since 1997 by the six sponsors of the North American AED Registry: Abbott Laboratories, Eisai Co., GlaxoSmithKline Inc., Novartis, Ortho-McNeil Inc., and Pfizer Inc.

MONTEREY, CALIF. — Women who take the anticonvulsant lamotrigine during their first trimester of pregnancy have a 10-fold greater risk of having a baby with nonsyndromal cleft lip, cleft palate, or both, according to a peer-reviewed study.

Among 684 women enrolled in the North American Anti-Epileptic Drug (AED) Pregnancy Registry who reported taking lamotrigine monotherapy during their first trimester, there were 16 infants born with major malformations, Dr. Lewis B. Holmes said at the annual meeting of the Teratology Society. This translates to a rate of 2.3%, compared with a baseline rate of 1.6% in unexposed newborn infants (Neurology 2008;70:2152-8).

Although this difference in combined major malformation rates was not statistically significant, the investigators observed a significantly increased risk when they restricted the analysis to oral clefts.

Three of the infants had an isolated cleft palate, one had an isolated cleft lip, and one had bilateral cleft lip and palate, for an overall prevalence rate of 7.3/1,000 infants. In comparison, the rate was 0.7/1,000 for unexposed controls, yielding a significant relative risk of 10.4.

“That's a whopping increase,” said Dr. Holmes of Massachusetts General Hospital for Children, Boston. “You wonder if it's a sample size [effect], but it's certainly a point to be pursued in comparison to other databases.”

“A larger sample size is needed to see whether the rate of clefts is a 10-fold increase or as low as 4-fold, or somewhere in between,” Dr. Holmes said.

Dr. Holmes disclosed that he received a salary support from funds provided since 1997 by the six sponsors of the North American AED Registry: Abbott Laboratories, Eisai Co., GlaxoSmithKline Inc., Novartis, Ortho-McNeil Inc., and Pfizer Inc.

MONTEREY, CALIF. — Women who take the anticonvulsant lamotrigine during their first trimester of pregnancy have a 10-fold greater risk of having a baby with nonsyndromal cleft lip, cleft palate, or both, according to a peer-reviewed study.

Among 684 women enrolled in the North American Anti-Epileptic Drug (AED) Pregnancy Registry who reported taking lamotrigine monotherapy during their first trimester, there were 16 infants born with major malformations, Dr. Lewis B. Holmes said at the annual meeting of the Teratology Society. This translates to a rate of 2.3%, compared with a baseline rate of 1.6% in unexposed newborn infants (Neurology 2008;70:2152-8).

Although this difference in combined major malformation rates was not statistically significant, the investigators observed a significantly increased risk when they restricted the analysis to oral clefts.

Three of the infants had an isolated cleft palate, one had an isolated cleft lip, and one had bilateral cleft lip and palate, for an overall prevalence rate of 7.3/1,000 infants. In comparison, the rate was 0.7/1,000 for unexposed controls, yielding a significant relative risk of 10.4.

“That's a whopping increase,” said Dr. Holmes of Massachusetts General Hospital for Children, Boston. “You wonder if it's a sample size [effect], but it's certainly a point to be pursued in comparison to other databases.”

“A larger sample size is needed to see whether the rate of clefts is a 10-fold increase or as low as 4-fold, or somewhere in between,” Dr. Holmes said.

Dr. Holmes disclosed that he received a salary support from funds provided since 1997 by the six sponsors of the North American AED Registry: Abbott Laboratories, Eisai Co., GlaxoSmithKline Inc., Novartis, Ortho-McNeil Inc., and Pfizer Inc.

HONOLULU – Children who perceive the world in hostile ways are significantly more likely to have hypertension, according to a study of almost 900 children.

A style of interaction marked by hostility has long been known to be a risk factor for hypertension in adults, but with this study Dr. Désirée Seeyave of the University of Michigan, Ann Arbor, and her colleagues extended that observation to children as young as 9 years old.

Among 873 children, those who scored in the highest tertile of hostility were 13.5 times more likely to have a diastolic blood pressure at or above the 90th percentile than were children in the lowest tertile after the investigators controlled for race, gender, maternal education, and body mass index z score, Dr. Seeyave reported in a poster presentation at the annual meeting of the Pediatric Academic Societies.

The children were enrolled in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. When they were in the third, fourth, and fifth grades, investigators administered the Intent Attributions and Feelings of Distress Scale, Hostile Intent Instrumental Provocation Score.

This instrument assesses to what extent a child ascribes hostile intent to ambiguous situations. For example, the child is asked to imagine a scenario in which he or she lets another child play with a radio that then gets broken.

The interviewer will ask why the other child broke the toy and whether he or she was trying to be mean. The child will score high on hostile attribution if he or she assumes that the other child broke the toy intentionally in an effort to be mean.

A year later, when the children were in the fourth, fifth, and sixth grades, investigators measured blood pressure by standard protocols.

In the multivariate analysis, the investigators found no significant associations between high blood pressure and gender, race, or mother's education. Children whose BMIs were above average for their age were 3.8 times more likely to have diastolic blood pressure in the 90th percentile or above than were children whose BMIs were normal for their age.

These findings have implications for prevention of cardiovascular disease risk factors such as hostility and obesity beginning in childhood, the investigators wrote.

Dr. Seeyave stated that she had no conflicts of interest related to her presentation.

HONOLULU – Children who perceive the world in hostile ways are significantly more likely to have hypertension, according to a study of almost 900 children.

A style of interaction marked by hostility has long been known to be a risk factor for hypertension in adults, but with this study Dr. Désirée Seeyave of the University of Michigan, Ann Arbor, and her colleagues extended that observation to children as young as 9 years old.

Among 873 children, those who scored in the highest tertile of hostility were 13.5 times more likely to have a diastolic blood pressure at or above the 90th percentile than were children in the lowest tertile after the investigators controlled for race, gender, maternal education, and body mass index z score, Dr. Seeyave reported in a poster presentation at the annual meeting of the Pediatric Academic Societies.

The children were enrolled in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. When they were in the third, fourth, and fifth grades, investigators administered the Intent Attributions and Feelings of Distress Scale, Hostile Intent Instrumental Provocation Score.

This instrument assesses to what extent a child ascribes hostile intent to ambiguous situations. For example, the child is asked to imagine a scenario in which he or she lets another child play with a radio that then gets broken.

The interviewer will ask why the other child broke the toy and whether he or she was trying to be mean. The child will score high on hostile attribution if he or she assumes that the other child broke the toy intentionally in an effort to be mean.

A year later, when the children were in the fourth, fifth, and sixth grades, investigators measured blood pressure by standard protocols.

In the multivariate analysis, the investigators found no significant associations between high blood pressure and gender, race, or mother's education. Children whose BMIs were above average for their age were 3.8 times more likely to have diastolic blood pressure in the 90th percentile or above than were children whose BMIs were normal for their age.

These findings have implications for prevention of cardiovascular disease risk factors such as hostility and obesity beginning in childhood, the investigators wrote.

Dr. Seeyave stated that she had no conflicts of interest related to her presentation.

HONOLULU – Children who perceive the world in hostile ways are significantly more likely to have hypertension, according to a study of almost 900 children.

A style of interaction marked by hostility has long been known to be a risk factor for hypertension in adults, but with this study Dr. Désirée Seeyave of the University of Michigan, Ann Arbor, and her colleagues extended that observation to children as young as 9 years old.

Among 873 children, those who scored in the highest tertile of hostility were 13.5 times more likely to have a diastolic blood pressure at or above the 90th percentile than were children in the lowest tertile after the investigators controlled for race, gender, maternal education, and body mass index z score, Dr. Seeyave reported in a poster presentation at the annual meeting of the Pediatric Academic Societies.

The children were enrolled in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. When they were in the third, fourth, and fifth grades, investigators administered the Intent Attributions and Feelings of Distress Scale, Hostile Intent Instrumental Provocation Score.

This instrument assesses to what extent a child ascribes hostile intent to ambiguous situations. For example, the child is asked to imagine a scenario in which he or she lets another child play with a radio that then gets broken.

The interviewer will ask why the other child broke the toy and whether he or she was trying to be mean. The child will score high on hostile attribution if he or she assumes that the other child broke the toy intentionally in an effort to be mean.

A year later, when the children were in the fourth, fifth, and sixth grades, investigators measured blood pressure by standard protocols.

In the multivariate analysis, the investigators found no significant associations between high blood pressure and gender, race, or mother's education. Children whose BMIs were above average for their age were 3.8 times more likely to have diastolic blood pressure in the 90th percentile or above than were children whose BMIs were normal for their age.

These findings have implications for prevention of cardiovascular disease risk factors such as hostility and obesity beginning in childhood, the investigators wrote.

Dr. Seeyave stated that she had no conflicts of interest related to her presentation.

SAN FRANCISCO — Patients who received adjuvant radiotherapy following surgery for metastatic cutaneous squamous cell carcinoma survived more than twice as long as did those who did not receive radiotherapy in a small retrospective study.

The difference between median survival of 23 months with adjuvant radiotherapy and 10 months without the extra treatment was statistically significant, Dr. Babak Givi reported at the Seventh International Conference on Head and Neck Cancer.

Patients receiving adjuvant radiotherapy were more than 80% less likely to die than were those who did not receive this adjuvant treatment, said Dr. Givi of Oregon Health and Science University, Portland.

Surgery followed by radiotherapy has long been a standard treatment for metastatic squamous cell carcinoma of the head and neck, but Dr. Givi noted that there is a paucity of experimental data on its efficacy. Given the fact that this regimen is aggressive and carries a high degree of morbidity, he and his colleagues conducted a retrospective study involving 51 patients who received surgical treatment for metastatic squamous cell carcinoma between 1993 and 2008. Thirty of the patients received adjuvant radiotherapy.

The patients' median age was 73 years, and 47 patients were male. The disease was recurrent in 8 patients and previously untreated in 43. Those whose disease had recurred survived for a median of 14 months compared with 31 months among those who had not previously been treated.

After adjusting for age, immunosuppression, tumor characteristics, and recurrent disease in a multivariate analysis, the investigators found that patients with recurrent disease were almost three times as likely to die as were those without.

The conference was sponsored by the American Head and Neck Society.

SAN FRANCISCO — Patients who received adjuvant radiotherapy following surgery for metastatic cutaneous squamous cell carcinoma survived more than twice as long as did those who did not receive radiotherapy in a small retrospective study.

The difference between median survival of 23 months with adjuvant radiotherapy and 10 months without the extra treatment was statistically significant, Dr. Babak Givi reported at the Seventh International Conference on Head and Neck Cancer.

Patients receiving adjuvant radiotherapy were more than 80% less likely to die than were those who did not receive this adjuvant treatment, said Dr. Givi of Oregon Health and Science University, Portland.

Surgery followed by radiotherapy has long been a standard treatment for metastatic squamous cell carcinoma of the head and neck, but Dr. Givi noted that there is a paucity of experimental data on its efficacy. Given the fact that this regimen is aggressive and carries a high degree of morbidity, he and his colleagues conducted a retrospective study involving 51 patients who received surgical treatment for metastatic squamous cell carcinoma between 1993 and 2008. Thirty of the patients received adjuvant radiotherapy.

The patients' median age was 73 years, and 47 patients were male. The disease was recurrent in 8 patients and previously untreated in 43. Those whose disease had recurred survived for a median of 14 months compared with 31 months among those who had not previously been treated.

After adjusting for age, immunosuppression, tumor characteristics, and recurrent disease in a multivariate analysis, the investigators found that patients with recurrent disease were almost three times as likely to die as were those without.

The conference was sponsored by the American Head and Neck Society.

SAN FRANCISCO — Patients who received adjuvant radiotherapy following surgery for metastatic cutaneous squamous cell carcinoma survived more than twice as long as did those who did not receive radiotherapy in a small retrospective study.

The difference between median survival of 23 months with adjuvant radiotherapy and 10 months without the extra treatment was statistically significant, Dr. Babak Givi reported at the Seventh International Conference on Head and Neck Cancer.

Patients receiving adjuvant radiotherapy were more than 80% less likely to die than were those who did not receive this adjuvant treatment, said Dr. Givi of Oregon Health and Science University, Portland.

Surgery followed by radiotherapy has long been a standard treatment for metastatic squamous cell carcinoma of the head and neck, but Dr. Givi noted that there is a paucity of experimental data on its efficacy. Given the fact that this regimen is aggressive and carries a high degree of morbidity, he and his colleagues conducted a retrospective study involving 51 patients who received surgical treatment for metastatic squamous cell carcinoma between 1993 and 2008. Thirty of the patients received adjuvant radiotherapy.

The patients' median age was 73 years, and 47 patients were male. The disease was recurrent in 8 patients and previously untreated in 43. Those whose disease had recurred survived for a median of 14 months compared with 31 months among those who had not previously been treated.

After adjusting for age, immunosuppression, tumor characteristics, and recurrent disease in a multivariate analysis, the investigators found that patients with recurrent disease were almost three times as likely to die as were those without.

The conference was sponsored by the American Head and Neck Society.

SAN FRANCISCO — A 5-year local control rate is possible with or without skin excision in squamous cell carcinoma of the buccal mucosa, according to a retrospective study of 331 patients.

When patients are properly selected for skin preservation or sacrifice on the basis of surgical margins more or less than 1 cm, there are no statistically significant differences in survival, Dr. Chun-Ta Liao and colleagues reported. In patients treated with surgery alone, the 5-year survival rate was 94% with skin excision and 91% without skin excision. In patients treated with surgery plus adjuvant radiotherapy or chemotherapy, the 5-year survival rate was 82% with skin excision and 85% without skin excision.

While it's generally accepted that bone excisions are often indicated in this form of cancer, controversy remains, said Dr. Liao. Skin excision significantly affects the patient's appearance and may contribute to oral incompetence, so physicians prefer to preserve the cheek skin if doing so would not increase mortality.

The study, by Dr. Liao of Chang Gung University, Taoyuan, Taiwan, and colleagues, was presented at the Seventh International Conference on Head and Neck Cancer.

The investigators examined records from 331 patients with squamous cell carcinoma of the buccal mucosa. Of those, 149 received surgery alone and 182 received surgery followed by adjuvant radiotherapy or radiotherapy plus chemotherapy.

Patients received skin-preserving procedures when the distance between the tumor and the skin was 13 mm or greater. This was possible for 69.5% of the patients, Dr. Liao reported at the meeting sponsored by the American Head and Neck Society.

In another part of the study, the investigators determined that a surgical margin of 4 mm or below was an independent predictor of adverse outcome, leading to an 81% increase in the risk of local recurrence in patients receiving surgery alone and a 33% increase in risk in patients receiving surgery plus adjuvant therapy.

Dr. Liao said the investigators had no conflicts of interest regarding the study.

SAN FRANCISCO — A 5-year local control rate is possible with or without skin excision in squamous cell carcinoma of the buccal mucosa, according to a retrospective study of 331 patients.

When patients are properly selected for skin preservation or sacrifice on the basis of surgical margins more or less than 1 cm, there are no statistically significant differences in survival, Dr. Chun-Ta Liao and colleagues reported. In patients treated with surgery alone, the 5-year survival rate was 94% with skin excision and 91% without skin excision. In patients treated with surgery plus adjuvant radiotherapy or chemotherapy, the 5-year survival rate was 82% with skin excision and 85% without skin excision.

While it's generally accepted that bone excisions are often indicated in this form of cancer, controversy remains, said Dr. Liao. Skin excision significantly affects the patient's appearance and may contribute to oral incompetence, so physicians prefer to preserve the cheek skin if doing so would not increase mortality.

The study, by Dr. Liao of Chang Gung University, Taoyuan, Taiwan, and colleagues, was presented at the Seventh International Conference on Head and Neck Cancer.

The investigators examined records from 331 patients with squamous cell carcinoma of the buccal mucosa. Of those, 149 received surgery alone and 182 received surgery followed by adjuvant radiotherapy or radiotherapy plus chemotherapy.

Patients received skin-preserving procedures when the distance between the tumor and the skin was 13 mm or greater. This was possible for 69.5% of the patients, Dr. Liao reported at the meeting sponsored by the American Head and Neck Society.

In another part of the study, the investigators determined that a surgical margin of 4 mm or below was an independent predictor of adverse outcome, leading to an 81% increase in the risk of local recurrence in patients receiving surgery alone and a 33% increase in risk in patients receiving surgery plus adjuvant therapy.

Dr. Liao said the investigators had no conflicts of interest regarding the study.

SAN FRANCISCO — A 5-year local control rate is possible with or without skin excision in squamous cell carcinoma of the buccal mucosa, according to a retrospective study of 331 patients.

When patients are properly selected for skin preservation or sacrifice on the basis of surgical margins more or less than 1 cm, there are no statistically significant differences in survival, Dr. Chun-Ta Liao and colleagues reported. In patients treated with surgery alone, the 5-year survival rate was 94% with skin excision and 91% without skin excision. In patients treated with surgery plus adjuvant radiotherapy or chemotherapy, the 5-year survival rate was 82% with skin excision and 85% without skin excision.

While it's generally accepted that bone excisions are often indicated in this form of cancer, controversy remains, said Dr. Liao. Skin excision significantly affects the patient's appearance and may contribute to oral incompetence, so physicians prefer to preserve the cheek skin if doing so would not increase mortality.

The study, by Dr. Liao of Chang Gung University, Taoyuan, Taiwan, and colleagues, was presented at the Seventh International Conference on Head and Neck Cancer.

The investigators examined records from 331 patients with squamous cell carcinoma of the buccal mucosa. Of those, 149 received surgery alone and 182 received surgery followed by adjuvant radiotherapy or radiotherapy plus chemotherapy.

Patients received skin-preserving procedures when the distance between the tumor and the skin was 13 mm or greater. This was possible for 69.5% of the patients, Dr. Liao reported at the meeting sponsored by the American Head and Neck Society.

In another part of the study, the investigators determined that a surgical margin of 4 mm or below was an independent predictor of adverse outcome, leading to an 81% increase in the risk of local recurrence in patients receiving surgery alone and a 33% increase in risk in patients receiving surgery plus adjuvant therapy.

Dr. Liao said the investigators had no conflicts of interest regarding the study.