Susan Birk

CHICAGO — Atomoxetine for the treatment of attention-deficit/hyperactivity disorder is generally safe and well tolerated in children and adolescents for up to more than 4 years of treatment, results of two open-label extension studies show.

Dr. Craig L. Donnelly reported the findings, which were based on 714 children and adolescents who had been treated for more than 3 years and 508 who had been treated for more than 4 years.

No new or unexpected safety or tolerability concerns emerged during more than 4 years of treatment, said Dr. Donnelly, director of child and adolescent psychiatry at Dartmouth-Hitchcock Medical Center, Lebanon, N.H.

The study will be published in the February issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

Previous studies have found treatment of ADHD with atomoxetine to be safe and well tolerated by children and adolescents for 2 years (J. Am. Acad. Child Adolesc. Psychiatry 2006;45:919–27; J. Pediatr. 2006;149:112–9). The new studies were conducted to determine the safety and tolerability of atomoxetine (Strattera) in children and adolescents who had received treatment for more than 3 or 4 years.

As with previous safety and tolerability reports, “patients experienced significant changes in vitals and growth compared with their baseline; however, changes were within the range of normal development,” Dr. Donnelly wrote in a poster at the annual meeting of the American Academy of Child and Adolescent Psychiatry. No clinically significant abnormalities were found in height, weight, blood pressure, mean laboratory values, or electrocardiograms.

The participants (aged 6–17 years; mean age at baseline 10.5 years) came from 13 double-blind, placebo-controlled trials and 3 open-label extension studies. They met DSM-IV diagnostic criteria for ADHD at entry into their initial studies. Researchers measured vital signs, electrocardiogram, weight, growth, hepatic function, treatment-emergent adverse advents, and reasons for discontinuation, and compared changes from baseline to end point.

The most common treatment-emergent adverse event was headache, reported by 53.9% of patients who had been taking the medication for more than 3 years and 53.7% of patients who had been taking the medication for more than 4 years. Other common treatment-emergent adverse events included nasopharyngitis (37.8%, 37.6%), vomiting (37.4%, 37.8%), cough (33.6%, 37.0%), upper abdominal pain (32.8%, 33.9%), pharyngolaryngeal pain (32.1%, 34.8%), pyrexia (31.8%, 33.3%), and upper respiratory tract infection (30.8, 32.1).

Fewer than 2% of patients had potentially clinically significant changes in hepatic function test results; two patients discontinued treatment for this reason.

Suicidal ideation and behavior occurred in 1.5% and 0.4% of patients, respectively; no suicides occurred during these studies. Transient aggressive/hostile behavior occurred in less than 6% of patients.

Of the 1,553 patients in the long-term, open-label study, 839 (54%) discontinued treatment before 3 years, citing adverse event (8.5%), perceived lack of efficacy (26.2%), patient decision (49.3%), physician decision (4.5%), satisfactory response (1.9%), and other (9.5%).

The study was sponsored by Eli Lilly & Co. Dr. Donnelly is as a consultant and a member of the speakers bureau for Eli Lilly. He has conducted other research funded by the company.

CHICAGO — Atomoxetine for the treatment of attention-deficit/hyperactivity disorder is generally safe and well tolerated in children and adolescents for up to more than 4 years of treatment, results of two open-label extension studies show.

Dr. Craig L. Donnelly reported the findings, which were based on 714 children and adolescents who had been treated for more than 3 years and 508 who had been treated for more than 4 years.

No new or unexpected safety or tolerability concerns emerged during more than 4 years of treatment, said Dr. Donnelly, director of child and adolescent psychiatry at Dartmouth-Hitchcock Medical Center, Lebanon, N.H.

The study will be published in the February issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

Previous studies have found treatment of ADHD with atomoxetine to be safe and well tolerated by children and adolescents for 2 years (J. Am. Acad. Child Adolesc. Psychiatry 2006;45:919–27; J. Pediatr. 2006;149:112–9). The new studies were conducted to determine the safety and tolerability of atomoxetine (Strattera) in children and adolescents who had received treatment for more than 3 or 4 years.

As with previous safety and tolerability reports, “patients experienced significant changes in vitals and growth compared with their baseline; however, changes were within the range of normal development,” Dr. Donnelly wrote in a poster at the annual meeting of the American Academy of Child and Adolescent Psychiatry. No clinically significant abnormalities were found in height, weight, blood pressure, mean laboratory values, or electrocardiograms.

The participants (aged 6–17 years; mean age at baseline 10.5 years) came from 13 double-blind, placebo-controlled trials and 3 open-label extension studies. They met DSM-IV diagnostic criteria for ADHD at entry into their initial studies. Researchers measured vital signs, electrocardiogram, weight, growth, hepatic function, treatment-emergent adverse advents, and reasons for discontinuation, and compared changes from baseline to end point.

The most common treatment-emergent adverse event was headache, reported by 53.9% of patients who had been taking the medication for more than 3 years and 53.7% of patients who had been taking the medication for more than 4 years. Other common treatment-emergent adverse events included nasopharyngitis (37.8%, 37.6%), vomiting (37.4%, 37.8%), cough (33.6%, 37.0%), upper abdominal pain (32.8%, 33.9%), pharyngolaryngeal pain (32.1%, 34.8%), pyrexia (31.8%, 33.3%), and upper respiratory tract infection (30.8, 32.1).

Fewer than 2% of patients had potentially clinically significant changes in hepatic function test results; two patients discontinued treatment for this reason.

Suicidal ideation and behavior occurred in 1.5% and 0.4% of patients, respectively; no suicides occurred during these studies. Transient aggressive/hostile behavior occurred in less than 6% of patients.

Of the 1,553 patients in the long-term, open-label study, 839 (54%) discontinued treatment before 3 years, citing adverse event (8.5%), perceived lack of efficacy (26.2%), patient decision (49.3%), physician decision (4.5%), satisfactory response (1.9%), and other (9.5%).

The study was sponsored by Eli Lilly & Co. Dr. Donnelly is as a consultant and a member of the speakers bureau for Eli Lilly. He has conducted other research funded by the company.

CHICAGO — Atomoxetine for the treatment of attention-deficit/hyperactivity disorder is generally safe and well tolerated in children and adolescents for up to more than 4 years of treatment, results of two open-label extension studies show.

Dr. Craig L. Donnelly reported the findings, which were based on 714 children and adolescents who had been treated for more than 3 years and 508 who had been treated for more than 4 years.

No new or unexpected safety or tolerability concerns emerged during more than 4 years of treatment, said Dr. Donnelly, director of child and adolescent psychiatry at Dartmouth-Hitchcock Medical Center, Lebanon, N.H.

The study will be published in the February issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

Previous studies have found treatment of ADHD with atomoxetine to be safe and well tolerated by children and adolescents for 2 years (J. Am. Acad. Child Adolesc. Psychiatry 2006;45:919–27; J. Pediatr. 2006;149:112–9). The new studies were conducted to determine the safety and tolerability of atomoxetine (Strattera) in children and adolescents who had received treatment for more than 3 or 4 years.

As with previous safety and tolerability reports, “patients experienced significant changes in vitals and growth compared with their baseline; however, changes were within the range of normal development,” Dr. Donnelly wrote in a poster at the annual meeting of the American Academy of Child and Adolescent Psychiatry. No clinically significant abnormalities were found in height, weight, blood pressure, mean laboratory values, or electrocardiograms.

The participants (aged 6–17 years; mean age at baseline 10.5 years) came from 13 double-blind, placebo-controlled trials and 3 open-label extension studies. They met DSM-IV diagnostic criteria for ADHD at entry into their initial studies. Researchers measured vital signs, electrocardiogram, weight, growth, hepatic function, treatment-emergent adverse advents, and reasons for discontinuation, and compared changes from baseline to end point.

The most common treatment-emergent adverse event was headache, reported by 53.9% of patients who had been taking the medication for more than 3 years and 53.7% of patients who had been taking the medication for more than 4 years. Other common treatment-emergent adverse events included nasopharyngitis (37.8%, 37.6%), vomiting (37.4%, 37.8%), cough (33.6%, 37.0%), upper abdominal pain (32.8%, 33.9%), pharyngolaryngeal pain (32.1%, 34.8%), pyrexia (31.8%, 33.3%), and upper respiratory tract infection (30.8, 32.1).

Fewer than 2% of patients had potentially clinically significant changes in hepatic function test results; two patients discontinued treatment for this reason.

Suicidal ideation and behavior occurred in 1.5% and 0.4% of patients, respectively; no suicides occurred during these studies. Transient aggressive/hostile behavior occurred in less than 6% of patients.

Of the 1,553 patients in the long-term, open-label study, 839 (54%) discontinued treatment before 3 years, citing adverse event (8.5%), perceived lack of efficacy (26.2%), patient decision (49.3%), physician decision (4.5%), satisfactory response (1.9%), and other (9.5%).

The study was sponsored by Eli Lilly & Co. Dr. Donnelly is as a consultant and a member of the speakers bureau for Eli Lilly. He has conducted other research funded by the company.

CHICAGO — CT colonography can screen as reliably for osteoporosis as dual-energy x-ray absorptiometry and can be used to screen simultaneously for bone loss and colorectal cancer, a study of 35 patients suggests.

Of the currently accepted tests for co-lorectal cancer—CT colonography (CTC), flexible sigmoidoscopy or barium enema every 5 years, and colonoscopy every 10 years—“virtual colonoscopy stands out as the only one that can look outside the colon,” study investigator Dr. Aslam Rizwan said at the annual meeting of the Radiological Society of North America.

The study found excellent agreement between retrospectively derived bone mineral density (BMD) and T scores from CTC data sets and BMD and T scores from dual-energy x-ray absorptiometry (DXA) in the same patients, reported Dr. Rizwan of the University of California, San Francisco.

The dual-purpose screening with CTC would provide information on osteoporosis risk with no additional radiation, Dr. Rizwan said. However, he emphasized that he is not suggesting that CTC replace DXA; rather, in patients who already are being screened for colorectal cancer, “the data [on BMD] is there; it's available, and we should use it.” He added that “both techniques have been proven individually. We're showing that it's feasible to do both tests on the same patient at the same time. These patients are going to be screened for polyps, so for no extra cost we can also screen for [bone loss].”

Use of CTC to screen simultaneously for osteoporosis and colorectal cancer offers “added value to a test you're going to give anyway. The added value is that it can give you information on BMD,” said study coauthor Dr. Judy Yee, also of the university. A total of 30 men and 5 women with a mean age of 66 years (age range 54–79) underwent both CTC and DXA. Two experienced readers independently calculated BMD and T scores from CTC data sets. CT bone density measurements were obtained with a bone mineral analysis software package at three vertebral bodies from T12 to L1. Density measurements also were obtained from fat and muscle to provide an internal reference for calculating BMD, T scores, and z scores.

The Centers for Medicare and Medicaid Services (CMS) do not now offer coverage for CTC, other than for diagnosis in symptomatic patients, said Dr. Yee, but “we hope there will be [screening] coverage in 2009.” Dr. Rizwan said that prospective studies are planned. He and Dr. Yee reported no financial conflicts of interest related to this study.

CT colonography was as reliable as DXA at screening for osteoporosis. Radiological Society of North America

CHICAGO — CT colonography can screen as reliably for osteoporosis as dual-energy x-ray absorptiometry and can be used to screen simultaneously for bone loss and colorectal cancer, a study of 35 patients suggests.

Of the currently accepted tests for co-lorectal cancer—CT colonography (CTC), flexible sigmoidoscopy or barium enema every 5 years, and colonoscopy every 10 years—“virtual colonoscopy stands out as the only one that can look outside the colon,” study investigator Dr. Aslam Rizwan said at the annual meeting of the Radiological Society of North America.

The study found excellent agreement between retrospectively derived bone mineral density (BMD) and T scores from CTC data sets and BMD and T scores from dual-energy x-ray absorptiometry (DXA) in the same patients, reported Dr. Rizwan of the University of California, San Francisco.

The dual-purpose screening with CTC would provide information on osteoporosis risk with no additional radiation, Dr. Rizwan said. However, he emphasized that he is not suggesting that CTC replace DXA; rather, in patients who already are being screened for colorectal cancer, “the data [on BMD] is there; it's available, and we should use it.” He added that “both techniques have been proven individually. We're showing that it's feasible to do both tests on the same patient at the same time. These patients are going to be screened for polyps, so for no extra cost we can also screen for [bone loss].”

Use of CTC to screen simultaneously for osteoporosis and colorectal cancer offers “added value to a test you're going to give anyway. The added value is that it can give you information on BMD,” said study coauthor Dr. Judy Yee, also of the university. A total of 30 men and 5 women with a mean age of 66 years (age range 54–79) underwent both CTC and DXA. Two experienced readers independently calculated BMD and T scores from CTC data sets. CT bone density measurements were obtained with a bone mineral analysis software package at three vertebral bodies from T12 to L1. Density measurements also were obtained from fat and muscle to provide an internal reference for calculating BMD, T scores, and z scores.

The Centers for Medicare and Medicaid Services (CMS) do not now offer coverage for CTC, other than for diagnosis in symptomatic patients, said Dr. Yee, but “we hope there will be [screening] coverage in 2009.” Dr. Rizwan said that prospective studies are planned. He and Dr. Yee reported no financial conflicts of interest related to this study.

CT colonography was as reliable as DXA at screening for osteoporosis. Radiological Society of North America

CHICAGO — CT colonography can screen as reliably for osteoporosis as dual-energy x-ray absorptiometry and can be used to screen simultaneously for bone loss and colorectal cancer, a study of 35 patients suggests.

Of the currently accepted tests for co-lorectal cancer—CT colonography (CTC), flexible sigmoidoscopy or barium enema every 5 years, and colonoscopy every 10 years—“virtual colonoscopy stands out as the only one that can look outside the colon,” study investigator Dr. Aslam Rizwan said at the annual meeting of the Radiological Society of North America.

The study found excellent agreement between retrospectively derived bone mineral density (BMD) and T scores from CTC data sets and BMD and T scores from dual-energy x-ray absorptiometry (DXA) in the same patients, reported Dr. Rizwan of the University of California, San Francisco.

The dual-purpose screening with CTC would provide information on osteoporosis risk with no additional radiation, Dr. Rizwan said. However, he emphasized that he is not suggesting that CTC replace DXA; rather, in patients who already are being screened for colorectal cancer, “the data [on BMD] is there; it's available, and we should use it.” He added that “both techniques have been proven individually. We're showing that it's feasible to do both tests on the same patient at the same time. These patients are going to be screened for polyps, so for no extra cost we can also screen for [bone loss].”

Use of CTC to screen simultaneously for osteoporosis and colorectal cancer offers “added value to a test you're going to give anyway. The added value is that it can give you information on BMD,” said study coauthor Dr. Judy Yee, also of the university. A total of 30 men and 5 women with a mean age of 66 years (age range 54–79) underwent both CTC and DXA. Two experienced readers independently calculated BMD and T scores from CTC data sets. CT bone density measurements were obtained with a bone mineral analysis software package at three vertebral bodies from T12 to L1. Density measurements also were obtained from fat and muscle to provide an internal reference for calculating BMD, T scores, and z scores.

The Centers for Medicare and Medicaid Services (CMS) do not now offer coverage for CTC, other than for diagnosis in symptomatic patients, said Dr. Yee, but “we hope there will be [screening] coverage in 2009.” Dr. Rizwan said that prospective studies are planned. He and Dr. Yee reported no financial conflicts of interest related to this study.

CT colonography was as reliable as DXA at screening for osteoporosis. Radiological Society of North America

CHICAGO — A retrospective study of 1,300 women at 24 weeks' gestation suggests that early preeclampsia and late preeclampsia may be two different hemodynamic forms of disease.

Early preeclampsia was associated with normal prepregnancy BMI, high total vascular resistance (TVR), and bilateral notching of the uterine artery on Doppler evaluation, and late preeclampsia was associated with high prepregnancy BMI and low TVR, Dr. Barbara Vasapollo of University of Rome Tor Vergata reported in a presentation at the World Congress on Ultrasound in Obstetrics and Gynecology.

“This is not the first study to suggest that early and late preeclampsia are two different entities, but it is the first to demonstrate that they are two different hemodynamic entities in the latent phase,” Dr. Vasapollo said in an interview.

Researchers reviewed data on 1,345 nulliparous normotensive women who had undergone uterine artery Doppler and maternal echocardiography to determine TVR at 24 weeks' gestation between 1999 and 2007.

Of these patients, 155 had bilateral notching of the uterine artery, and 107 of this group developed preeclampsia (defined as blood pressure greater than 140/90 mm Hg and proteinuria greater than 300 mg/dL).

Thirty-two patients developed late preeclampsia (more than 34 weeks' gestation), and 75 developed early preeclampsia (less than 34 weeks' gestation).

Significantly more early preeclampsia patients (60%) showed bilateral notching of the uterine artery than late preeclampsia patients (15.6%) at the 24 weeks' examination.

TVR was significantly lower in the group who subsequently developed late preeclampsia than in the group who developed early preeclampsia (741 dyn-s/cm

Dr. Vasapollo said the findings are consistent with other research that links late preeclampsia with maternal constitutional factors such as BMI and early preeclampsia with defective trophoblast invasion (Hypertension 2008; 51:970–5, 989–90).

TVR appears to be one of the most reliable predictors of early or late preeclampsia, she said.

“The ROC curves built to predict early and late preeclampsia show a very good sensitivity and specificity,” according to a study by Dr. Vasapollo and her colleagues. “When considering early severe complications, almost all preeclamptic women show a TVR of greater than 1,400,” she noted (Hypertension 2008;51:1020–6).

Dr. Vasapollo and her colleagues plan to investigate a preventive pharmacologic approach to treatment that is guided by maternal hemodynamics.

CHICAGO — A retrospective study of 1,300 women at 24 weeks' gestation suggests that early preeclampsia and late preeclampsia may be two different hemodynamic forms of disease.

Early preeclampsia was associated with normal prepregnancy BMI, high total vascular resistance (TVR), and bilateral notching of the uterine artery on Doppler evaluation, and late preeclampsia was associated with high prepregnancy BMI and low TVR, Dr. Barbara Vasapollo of University of Rome Tor Vergata reported in a presentation at the World Congress on Ultrasound in Obstetrics and Gynecology.

“This is not the first study to suggest that early and late preeclampsia are two different entities, but it is the first to demonstrate that they are two different hemodynamic entities in the latent phase,” Dr. Vasapollo said in an interview.

Researchers reviewed data on 1,345 nulliparous normotensive women who had undergone uterine artery Doppler and maternal echocardiography to determine TVR at 24 weeks' gestation between 1999 and 2007.

Of these patients, 155 had bilateral notching of the uterine artery, and 107 of this group developed preeclampsia (defined as blood pressure greater than 140/90 mm Hg and proteinuria greater than 300 mg/dL).

Thirty-two patients developed late preeclampsia (more than 34 weeks' gestation), and 75 developed early preeclampsia (less than 34 weeks' gestation).

Significantly more early preeclampsia patients (60%) showed bilateral notching of the uterine artery than late preeclampsia patients (15.6%) at the 24 weeks' examination.

TVR was significantly lower in the group who subsequently developed late preeclampsia than in the group who developed early preeclampsia (741 dyn-s/cm

Dr. Vasapollo said the findings are consistent with other research that links late preeclampsia with maternal constitutional factors such as BMI and early preeclampsia with defective trophoblast invasion (Hypertension 2008; 51:970–5, 989–90).

TVR appears to be one of the most reliable predictors of early or late preeclampsia, she said.

“The ROC curves built to predict early and late preeclampsia show a very good sensitivity and specificity,” according to a study by Dr. Vasapollo and her colleagues. “When considering early severe complications, almost all preeclamptic women show a TVR of greater than 1,400,” she noted (Hypertension 2008;51:1020–6).

Dr. Vasapollo and her colleagues plan to investigate a preventive pharmacologic approach to treatment that is guided by maternal hemodynamics.

CHICAGO — A retrospective study of 1,300 women at 24 weeks' gestation suggests that early preeclampsia and late preeclampsia may be two different hemodynamic forms of disease.

Early preeclampsia was associated with normal prepregnancy BMI, high total vascular resistance (TVR), and bilateral notching of the uterine artery on Doppler evaluation, and late preeclampsia was associated with high prepregnancy BMI and low TVR, Dr. Barbara Vasapollo of University of Rome Tor Vergata reported in a presentation at the World Congress on Ultrasound in Obstetrics and Gynecology.

“This is not the first study to suggest that early and late preeclampsia are two different entities, but it is the first to demonstrate that they are two different hemodynamic entities in the latent phase,” Dr. Vasapollo said in an interview.

Researchers reviewed data on 1,345 nulliparous normotensive women who had undergone uterine artery Doppler and maternal echocardiography to determine TVR at 24 weeks' gestation between 1999 and 2007.

Of these patients, 155 had bilateral notching of the uterine artery, and 107 of this group developed preeclampsia (defined as blood pressure greater than 140/90 mm Hg and proteinuria greater than 300 mg/dL).

Thirty-two patients developed late preeclampsia (more than 34 weeks' gestation), and 75 developed early preeclampsia (less than 34 weeks' gestation).

Significantly more early preeclampsia patients (60%) showed bilateral notching of the uterine artery than late preeclampsia patients (15.6%) at the 24 weeks' examination.

TVR was significantly lower in the group who subsequently developed late preeclampsia than in the group who developed early preeclampsia (741 dyn-s/cm

Dr. Vasapollo said the findings are consistent with other research that links late preeclampsia with maternal constitutional factors such as BMI and early preeclampsia with defective trophoblast invasion (Hypertension 2008; 51:970–5, 989–90).

TVR appears to be one of the most reliable predictors of early or late preeclampsia, she said.

“The ROC curves built to predict early and late preeclampsia show a very good sensitivity and specificity,” according to a study by Dr. Vasapollo and her colleagues. “When considering early severe complications, almost all preeclamptic women show a TVR of greater than 1,400,” she noted (Hypertension 2008;51:1020–6).

Dr. Vasapollo and her colleagues plan to investigate a preventive pharmacologic approach to treatment that is guided by maternal hemodynamics.

CHICAGO — CT colonography can screen as reliably for osteoporosis as dual-energy x-ray absorptiometry and can be used to screen simultaneously for bone loss and colorectal cancer, a study of 35 patients suggests.

Of the currently accepted tests for colorectal cancer—CT colonography (CTC), flexible sigmoidoscopy or barium enema every 5 years, and colonoscopy every 10 years—”virtual colonoscopy stands out as the only one that can look outside the colon,” study investigator Dr. Aslam Rizwan said at the annual meeting of the Radiological Society of North America.

The investigation showed that there was excellent agreement between retrospectively derived bone mineral density (BMD) and T scores from CTC data sets and BMD and T scores from dual-energy x-ray absorptiometry (DXA) in the same patients, reported Dr. Rizwan of the University of California, San Francisco.

The dual-purpose screening with CTC would provide information on osteoporosis risk with no additional radiation, Dr. Rizwan said.

However, he emphasized that he is not suggesting that CTC replace DXA; rather, in patients who already are being screened for colorectal cancer, “the data [on BMD] is there; it's available, and we should use it.”

He added that “both techniques have been proven individually. We're showing that it's feasible to do both tests on the same patient at the same time. These patients are going to be screened for polyps … so for no extra cost we can also screen for [bone loss].”

Use of CTC to screen simultaneously for osteoporosis and colorectal cancer offers “added value to a test you're going to give anyway. … The added value is that it can give you information on BMD,” said study coauthor Dr. Judy Yee, who is also of the university.

A total of 30 men and 5 women with a mean age of 66 years (age range 54-79) underwent both CTC and DXA. Two experienced readers independently calculated BMD and T scores from CTC data sets. CT bone density measurements were obtained with a bone mineral analysis software package at three vertebral bodies from T12 to L1.

In addition, density measurements alwere obtained from fat and muscle to provide an internal reference for calculating BMD, T scores, and z scores, Dr. Yee explained.

For both readers, significant correlations were found between the CT and DXA BMD measurements for each vertebral body, and between the CT and DXA T scores for each vertebral body.

Significant correlations also were found between the CT and DXA BMD averages for all vertebrae for both readers.

The results revealed good agreement between the two readers as well, Dr. Rizwan said.

The Centers for Medicare and Medicaid Services (CMS) do not currently offer coverage for CTC, other than for diagnosis in symptomatic patients, said Dr. Yee, but “we hope there will be [screening] coverage in 2009.”

Dr. Rizwan said that prospective studies are planned. He and Dr. Yee reported no financial conflicts of interest related to this study.

Value is added to CT colonography by being able to detect osteoporosis. Radiological Society of North America

CHICAGO — CT colonography can screen as reliably for osteoporosis as dual-energy x-ray absorptiometry and can be used to screen simultaneously for bone loss and colorectal cancer, a study of 35 patients suggests.

Of the currently accepted tests for colorectal cancer—CT colonography (CTC), flexible sigmoidoscopy or barium enema every 5 years, and colonoscopy every 10 years—”virtual colonoscopy stands out as the only one that can look outside the colon,” study investigator Dr. Aslam Rizwan said at the annual meeting of the Radiological Society of North America.

The investigation showed that there was excellent agreement between retrospectively derived bone mineral density (BMD) and T scores from CTC data sets and BMD and T scores from dual-energy x-ray absorptiometry (DXA) in the same patients, reported Dr. Rizwan of the University of California, San Francisco.

The dual-purpose screening with CTC would provide information on osteoporosis risk with no additional radiation, Dr. Rizwan said.

However, he emphasized that he is not suggesting that CTC replace DXA; rather, in patients who already are being screened for colorectal cancer, “the data [on BMD] is there; it's available, and we should use it.”

He added that “both techniques have been proven individually. We're showing that it's feasible to do both tests on the same patient at the same time. These patients are going to be screened for polyps … so for no extra cost we can also screen for [bone loss].”

Use of CTC to screen simultaneously for osteoporosis and colorectal cancer offers “added value to a test you're going to give anyway. … The added value is that it can give you information on BMD,” said study coauthor Dr. Judy Yee, who is also of the university.

A total of 30 men and 5 women with a mean age of 66 years (age range 54-79) underwent both CTC and DXA. Two experienced readers independently calculated BMD and T scores from CTC data sets. CT bone density measurements were obtained with a bone mineral analysis software package at three vertebral bodies from T12 to L1.

In addition, density measurements alwere obtained from fat and muscle to provide an internal reference for calculating BMD, T scores, and z scores, Dr. Yee explained.

For both readers, significant correlations were found between the CT and DXA BMD measurements for each vertebral body, and between the CT and DXA T scores for each vertebral body.

Significant correlations also were found between the CT and DXA BMD averages for all vertebrae for both readers.

The results revealed good agreement between the two readers as well, Dr. Rizwan said.

The Centers for Medicare and Medicaid Services (CMS) do not currently offer coverage for CTC, other than for diagnosis in symptomatic patients, said Dr. Yee, but “we hope there will be [screening] coverage in 2009.”

Dr. Rizwan said that prospective studies are planned. He and Dr. Yee reported no financial conflicts of interest related to this study.

Value is added to CT colonography by being able to detect osteoporosis. Radiological Society of North America

CHICAGO — CT colonography can screen as reliably for osteoporosis as dual-energy x-ray absorptiometry and can be used to screen simultaneously for bone loss and colorectal cancer, a study of 35 patients suggests.

Of the currently accepted tests for colorectal cancer—CT colonography (CTC), flexible sigmoidoscopy or barium enema every 5 years, and colonoscopy every 10 years—”virtual colonoscopy stands out as the only one that can look outside the colon,” study investigator Dr. Aslam Rizwan said at the annual meeting of the Radiological Society of North America.

The investigation showed that there was excellent agreement between retrospectively derived bone mineral density (BMD) and T scores from CTC data sets and BMD and T scores from dual-energy x-ray absorptiometry (DXA) in the same patients, reported Dr. Rizwan of the University of California, San Francisco.

The dual-purpose screening with CTC would provide information on osteoporosis risk with no additional radiation, Dr. Rizwan said.

However, he emphasized that he is not suggesting that CTC replace DXA; rather, in patients who already are being screened for colorectal cancer, “the data [on BMD] is there; it's available, and we should use it.”

He added that “both techniques have been proven individually. We're showing that it's feasible to do both tests on the same patient at the same time. These patients are going to be screened for polyps … so for no extra cost we can also screen for [bone loss].”

Use of CTC to screen simultaneously for osteoporosis and colorectal cancer offers “added value to a test you're going to give anyway. … The added value is that it can give you information on BMD,” said study coauthor Dr. Judy Yee, who is also of the university.

A total of 30 men and 5 women with a mean age of 66 years (age range 54-79) underwent both CTC and DXA. Two experienced readers independently calculated BMD and T scores from CTC data sets. CT bone density measurements were obtained with a bone mineral analysis software package at three vertebral bodies from T12 to L1.

In addition, density measurements alwere obtained from fat and muscle to provide an internal reference for calculating BMD, T scores, and z scores, Dr. Yee explained.

For both readers, significant correlations were found between the CT and DXA BMD measurements for each vertebral body, and between the CT and DXA T scores for each vertebral body.

Significant correlations also were found between the CT and DXA BMD averages for all vertebrae for both readers.

The results revealed good agreement between the two readers as well, Dr. Rizwan said.

The Centers for Medicare and Medicaid Services (CMS) do not currently offer coverage for CTC, other than for diagnosis in symptomatic patients, said Dr. Yee, but “we hope there will be [screening] coverage in 2009.”

Dr. Rizwan said that prospective studies are planned. He and Dr. Yee reported no financial conflicts of interest related to this study.

Value is added to CT colonography by being able to detect osteoporosis. Radiological Society of North America

CHICAGO – Reports by radiologists showing multiple cases of self-mutilation by adolescents involving the deliberate embedding of foreign objects must be kept in perspective, according to Dr. Louis Kraus, chief of child psychiatry at Rush Medical Center, Chicago.

“This is not novel,” he said in an interview. “In my practice, I've seen kids self-embedding for more than 20 years. The important thing is to understand the psychopathology behind it and how best to intervene.”

In one such report by radiologist William Shiels II, a pattern of self-injury was discovered during an ongoing longitudinal study of a novel percutaneous, image-guided, minimally invasive technique to remove soft tissue foreign bodies (STFBs) in pediatric patients.

Data on 505 patients over 13 years of age have demonstrated the technique's safety and effectiveness in removing STFBs with minimal scarring. In the vast majority of patients treated with the procedure, the injuries were accidental (stepping on a piece of glass, for example); however, in 10 patients, the injuries clearly were self-inflicted. One patient had inserted unfolded paper clips measuring 16 cm in length bilaterally into her biceps muscles.

Dr. Shiels, who is chief of radiology at Nationwide Children's Hospital, Columbus, Ohio, presented the results of a study of 10 patients at the annual meeting of the Radiological Society of North America.

Of these patients, 90% demonstrated suicidal ideation or behavior, and all had multiple psychiatric comorbidities, such as bipolar disorder, borderline personality disorder, depression, posttraumatic stress disorder, attention-deficit/hyperactivity disorder, and obsessive compulsive disorder.

All of the children had histories of psychological, physical and/or sexual abuse, had been removed from their families, and were living in foster homes or group homes. The children crossed all socioeconomic strata and racial groups; 90% of the patients were girls. Seventy percent of the patients embedded objects more than once, and of these, 71% demonstrated an escalating pattern of self-injury with increasingly large, painful objects.

The patients presented to the emergency department for treatment for one of three reasons: pain, shame, or guilt about their embedding behavior, and complications (usually an infection).

For the most part, adolescents who engage in these behaviors are not suicidal, Dr. Kraus said. “Typically, this behavior is seen in kids who have difficulty expressing some type of psychic pain. This is essentially a superficial form of self-mutilation.”

Dr. John Campo, chief of child and adolescent psychiatry at Nationwide Children's Hospital and Ohio State University, also in Columbus, said in an interview that the self-embedding behaviors “might represent one extreme of nonsuicidal self-injury or perhaps even a distinct problem.”

However, he added, “This is a clinical case series–no more and no less–so we do need to be careful about making excessive generalizations.”

CHICAGO – Reports by radiologists showing multiple cases of self-mutilation by adolescents involving the deliberate embedding of foreign objects must be kept in perspective, according to Dr. Louis Kraus, chief of child psychiatry at Rush Medical Center, Chicago.

“This is not novel,” he said in an interview. “In my practice, I've seen kids self-embedding for more than 20 years. The important thing is to understand the psychopathology behind it and how best to intervene.”

In one such report by radiologist William Shiels II, a pattern of self-injury was discovered during an ongoing longitudinal study of a novel percutaneous, image-guided, minimally invasive technique to remove soft tissue foreign bodies (STFBs) in pediatric patients.

Data on 505 patients over 13 years of age have demonstrated the technique's safety and effectiveness in removing STFBs with minimal scarring. In the vast majority of patients treated with the procedure, the injuries were accidental (stepping on a piece of glass, for example); however, in 10 patients, the injuries clearly were self-inflicted. One patient had inserted unfolded paper clips measuring 16 cm in length bilaterally into her biceps muscles.

Dr. Shiels, who is chief of radiology at Nationwide Children's Hospital, Columbus, Ohio, presented the results of a study of 10 patients at the annual meeting of the Radiological Society of North America.

Of these patients, 90% demonstrated suicidal ideation or behavior, and all had multiple psychiatric comorbidities, such as bipolar disorder, borderline personality disorder, depression, posttraumatic stress disorder, attention-deficit/hyperactivity disorder, and obsessive compulsive disorder.

All of the children had histories of psychological, physical and/or sexual abuse, had been removed from their families, and were living in foster homes or group homes. The children crossed all socioeconomic strata and racial groups; 90% of the patients were girls. Seventy percent of the patients embedded objects more than once, and of these, 71% demonstrated an escalating pattern of self-injury with increasingly large, painful objects.

The patients presented to the emergency department for treatment for one of three reasons: pain, shame, or guilt about their embedding behavior, and complications (usually an infection).

For the most part, adolescents who engage in these behaviors are not suicidal, Dr. Kraus said. “Typically, this behavior is seen in kids who have difficulty expressing some type of psychic pain. This is essentially a superficial form of self-mutilation.”

Dr. John Campo, chief of child and adolescent psychiatry at Nationwide Children's Hospital and Ohio State University, also in Columbus, said in an interview that the self-embedding behaviors “might represent one extreme of nonsuicidal self-injury or perhaps even a distinct problem.”

However, he added, “This is a clinical case series–no more and no less–so we do need to be careful about making excessive generalizations.”

CHICAGO – Reports by radiologists showing multiple cases of self-mutilation by adolescents involving the deliberate embedding of foreign objects must be kept in perspective, according to Dr. Louis Kraus, chief of child psychiatry at Rush Medical Center, Chicago.

“This is not novel,” he said in an interview. “In my practice, I've seen kids self-embedding for more than 20 years. The important thing is to understand the psychopathology behind it and how best to intervene.”

In one such report by radiologist William Shiels II, a pattern of self-injury was discovered during an ongoing longitudinal study of a novel percutaneous, image-guided, minimally invasive technique to remove soft tissue foreign bodies (STFBs) in pediatric patients.

Data on 505 patients over 13 years of age have demonstrated the technique's safety and effectiveness in removing STFBs with minimal scarring. In the vast majority of patients treated with the procedure, the injuries were accidental (stepping on a piece of glass, for example); however, in 10 patients, the injuries clearly were self-inflicted. One patient had inserted unfolded paper clips measuring 16 cm in length bilaterally into her biceps muscles.

Dr. Shiels, who is chief of radiology at Nationwide Children's Hospital, Columbus, Ohio, presented the results of a study of 10 patients at the annual meeting of the Radiological Society of North America.

Of these patients, 90% demonstrated suicidal ideation or behavior, and all had multiple psychiatric comorbidities, such as bipolar disorder, borderline personality disorder, depression, posttraumatic stress disorder, attention-deficit/hyperactivity disorder, and obsessive compulsive disorder.

All of the children had histories of psychological, physical and/or sexual abuse, had been removed from their families, and were living in foster homes or group homes. The children crossed all socioeconomic strata and racial groups; 90% of the patients were girls. Seventy percent of the patients embedded objects more than once, and of these, 71% demonstrated an escalating pattern of self-injury with increasingly large, painful objects.

The patients presented to the emergency department for treatment for one of three reasons: pain, shame, or guilt about their embedding behavior, and complications (usually an infection).

For the most part, adolescents who engage in these behaviors are not suicidal, Dr. Kraus said. “Typically, this behavior is seen in kids who have difficulty expressing some type of psychic pain. This is essentially a superficial form of self-mutilation.”

Dr. John Campo, chief of child and adolescent psychiatry at Nationwide Children's Hospital and Ohio State University, also in Columbus, said in an interview that the self-embedding behaviors “might represent one extreme of nonsuicidal self-injury or perhaps even a distinct problem.”

However, he added, “This is a clinical case series–no more and no less–so we do need to be careful about making excessive generalizations.”

CHICAGO — Ultrasound-guided embryo transfer (US-ET) is associated with significantly higher implantation and clinical pregnancy rates than is the clinical touch method, a study of 1,700 embryo transfers at a tertiary in vitro fertilization clinic indicates.

“These data add to the available evidence supporting the use of US-ET in assisted reproductive technology,” said Dr. Rubina Ali of St. Mary's Hospital, Manchester, England, in a presentation at the World Congress on Ultrasound in Obstetrics and Gynecology.

Researchers compared implantation and clinical pregnancy rates for 881 consecutive fresh (385) and frozen (496) embryo transfers performed between 2003 and 2004 using the clinical touch method with 842 consecutive fresh (394) and frozen (448) transfers performed between 2004 and 2005 using US-ET.

The US-ET group showed a significantly higher rate of implantation, compared with the clinical touch group (fresh: 20% vs. 9.5%; frozen: 13% vs. 7%) and a significantly higher clinical pregnancy rate (fresh: 26.9% vs. 12.4%; frozen: 15.6% vs. 8.8%). Women in the two groups did not differ in demographic or clinical characteristics.

The US-ET group had a higher rate of miscarriage in the frozen embryo transfers (8.9% vs. 5.6%), but no other statistically significant differences were found.

“The practice of US-ET is associated with an increased likelihood of successful pregnancy outcome,” Dr. Ali concluded.

CHICAGO — Ultrasound-guided embryo transfer (US-ET) is associated with significantly higher implantation and clinical pregnancy rates than is the clinical touch method, a study of 1,700 embryo transfers at a tertiary in vitro fertilization clinic indicates.

“These data add to the available evidence supporting the use of US-ET in assisted reproductive technology,” said Dr. Rubina Ali of St. Mary's Hospital, Manchester, England, in a presentation at the World Congress on Ultrasound in Obstetrics and Gynecology.

Researchers compared implantation and clinical pregnancy rates for 881 consecutive fresh (385) and frozen (496) embryo transfers performed between 2003 and 2004 using the clinical touch method with 842 consecutive fresh (394) and frozen (448) transfers performed between 2004 and 2005 using US-ET.

The US-ET group showed a significantly higher rate of implantation, compared with the clinical touch group (fresh: 20% vs. 9.5%; frozen: 13% vs. 7%) and a significantly higher clinical pregnancy rate (fresh: 26.9% vs. 12.4%; frozen: 15.6% vs. 8.8%). Women in the two groups did not differ in demographic or clinical characteristics.

The US-ET group had a higher rate of miscarriage in the frozen embryo transfers (8.9% vs. 5.6%), but no other statistically significant differences were found.

“The practice of US-ET is associated with an increased likelihood of successful pregnancy outcome,” Dr. Ali concluded.

CHICAGO — Ultrasound-guided embryo transfer (US-ET) is associated with significantly higher implantation and clinical pregnancy rates than is the clinical touch method, a study of 1,700 embryo transfers at a tertiary in vitro fertilization clinic indicates.

“These data add to the available evidence supporting the use of US-ET in assisted reproductive technology,” said Dr. Rubina Ali of St. Mary's Hospital, Manchester, England, in a presentation at the World Congress on Ultrasound in Obstetrics and Gynecology.

Researchers compared implantation and clinical pregnancy rates for 881 consecutive fresh (385) and frozen (496) embryo transfers performed between 2003 and 2004 using the clinical touch method with 842 consecutive fresh (394) and frozen (448) transfers performed between 2004 and 2005 using US-ET.

The US-ET group showed a significantly higher rate of implantation, compared with the clinical touch group (fresh: 20% vs. 9.5%; frozen: 13% vs. 7%) and a significantly higher clinical pregnancy rate (fresh: 26.9% vs. 12.4%; frozen: 15.6% vs. 8.8%). Women in the two groups did not differ in demographic or clinical characteristics.

The US-ET group had a higher rate of miscarriage in the frozen embryo transfers (8.9% vs. 5.6%), but no other statistically significant differences were found.

“The practice of US-ET is associated with an increased likelihood of successful pregnancy outcome,” Dr. Ali concluded.

CHICAGO — Ten years after surgery, lower urinary tract symptoms, sexual function, incidence of prolapse, and quality of life did not differ between women randomized to total abdominal hysterectomy versus abdominal supracervical hysterectomy, according to a follow-up study of 54 participants in the Total or Supracervical Hysterectomy (TOSH) trial.

“No significant difference was found in any lower urinary tract or pelvic floor symptom, breast or menopausal symptoms, weight change, or need for treatment of urinary incontinence between the two groups,” reported Dr. Jerod Greer of the University of Alabama at Birmingham at the annual meeting of the American Urogynecologic Society.

“There appear to be no clinically important long-term differences in outcomes that would favor one method of hysterectomy over the other,” he added in a later interview. “However, an important minority of patients undergoing supracervical hysterectomy (SCH) experience continued vaginal bleeding and are at risk for needing future surgical procedures on the retained cervix, an essential point to discuss when counseling patients about hysterectomy.”

The original TOSH trial, published in 2003, followed patients for 2 years and found no differences between the two groups in pelvic floor symptoms (Obstet. Gynecol. 2003;102:453-62). “At the time of the original TOSH trial, some people felt that total abdominal hysterectomy [TAH] was associated with higher rates of sexual dysfunction, lower urinary tract symptoms, pelvic organ prolapse, and surgical complications when compared with abdominal supracervical hysterectomy,” Dr. Greer said. “This was found not to be the case after following patients randomized to TAH versus SCH for 2 years of follow-up. As there were no long-term data on this subject, we thought it would be interesting to see if any differences in the two groups had emerged 9 years after their surgeries.”

Thirty-seven of 54 TOSH participants (69%) returned questionnaires regarding quality of life, sexual function, and pelvic symptoms—the same questionnaires they had completed at the 2-year follow-up.

Of the respondents, 19 had received TAH and 18 had received SCH. Researchers reviewed patients' medical records in addition to analyzing the questionnaires. The two groups did not differ in baseline demographics.

There was a significant improvement within the TAH group in the ability to have and enjoy sex and a significant reduction in vaginal bleeding from baseline to the 9-year follow-up in both groups, Dr. Greer reported.

“Based on our results, there still appears to be no good evidence to favor SCH over TAH, as there were no between-group differences in sexual function scores, lower urinary tract or prolapse symptoms, or quality of life,” he said. “The TAH group showed an improvement in one aspect of sexual function and reported less back pain at 9 years, while two participants in the SCH group had experienced bleeding from the cervical stump and another underwent trachelectomy for persistent cervical dysplasia.”

CHICAGO — Ten years after surgery, lower urinary tract symptoms, sexual function, incidence of prolapse, and quality of life did not differ between women randomized to total abdominal hysterectomy versus abdominal supracervical hysterectomy, according to a follow-up study of 54 participants in the Total or Supracervical Hysterectomy (TOSH) trial.

“No significant difference was found in any lower urinary tract or pelvic floor symptom, breast or menopausal symptoms, weight change, or need for treatment of urinary incontinence between the two groups,” reported Dr. Jerod Greer of the University of Alabama at Birmingham at the annual meeting of the American Urogynecologic Society.

“There appear to be no clinically important long-term differences in outcomes that would favor one method of hysterectomy over the other,” he added in a later interview. “However, an important minority of patients undergoing supracervical hysterectomy (SCH) experience continued vaginal bleeding and are at risk for needing future surgical procedures on the retained cervix, an essential point to discuss when counseling patients about hysterectomy.”

The original TOSH trial, published in 2003, followed patients for 2 years and found no differences between the two groups in pelvic floor symptoms (Obstet. Gynecol. 2003;102:453-62). “At the time of the original TOSH trial, some people felt that total abdominal hysterectomy [TAH] was associated with higher rates of sexual dysfunction, lower urinary tract symptoms, pelvic organ prolapse, and surgical complications when compared with abdominal supracervical hysterectomy,” Dr. Greer said. “This was found not to be the case after following patients randomized to TAH versus SCH for 2 years of follow-up. As there were no long-term data on this subject, we thought it would be interesting to see if any differences in the two groups had emerged 9 years after their surgeries.”

Thirty-seven of 54 TOSH participants (69%) returned questionnaires regarding quality of life, sexual function, and pelvic symptoms—the same questionnaires they had completed at the 2-year follow-up.

Of the respondents, 19 had received TAH and 18 had received SCH. Researchers reviewed patients' medical records in addition to analyzing the questionnaires. The two groups did not differ in baseline demographics.

There was a significant improvement within the TAH group in the ability to have and enjoy sex and a significant reduction in vaginal bleeding from baseline to the 9-year follow-up in both groups, Dr. Greer reported.

“Based on our results, there still appears to be no good evidence to favor SCH over TAH, as there were no between-group differences in sexual function scores, lower urinary tract or prolapse symptoms, or quality of life,” he said. “The TAH group showed an improvement in one aspect of sexual function and reported less back pain at 9 years, while two participants in the SCH group had experienced bleeding from the cervical stump and another underwent trachelectomy for persistent cervical dysplasia.”

CHICAGO — Ten years after surgery, lower urinary tract symptoms, sexual function, incidence of prolapse, and quality of life did not differ between women randomized to total abdominal hysterectomy versus abdominal supracervical hysterectomy, according to a follow-up study of 54 participants in the Total or Supracervical Hysterectomy (TOSH) trial.

“No significant difference was found in any lower urinary tract or pelvic floor symptom, breast or menopausal symptoms, weight change, or need for treatment of urinary incontinence between the two groups,” reported Dr. Jerod Greer of the University of Alabama at Birmingham at the annual meeting of the American Urogynecologic Society.

“There appear to be no clinically important long-term differences in outcomes that would favor one method of hysterectomy over the other,” he added in a later interview. “However, an important minority of patients undergoing supracervical hysterectomy (SCH) experience continued vaginal bleeding and are at risk for needing future surgical procedures on the retained cervix, an essential point to discuss when counseling patients about hysterectomy.”

The original TOSH trial, published in 2003, followed patients for 2 years and found no differences between the two groups in pelvic floor symptoms (Obstet. Gynecol. 2003;102:453-62). “At the time of the original TOSH trial, some people felt that total abdominal hysterectomy [TAH] was associated with higher rates of sexual dysfunction, lower urinary tract symptoms, pelvic organ prolapse, and surgical complications when compared with abdominal supracervical hysterectomy,” Dr. Greer said. “This was found not to be the case after following patients randomized to TAH versus SCH for 2 years of follow-up. As there were no long-term data on this subject, we thought it would be interesting to see if any differences in the two groups had emerged 9 years after their surgeries.”

Thirty-seven of 54 TOSH participants (69%) returned questionnaires regarding quality of life, sexual function, and pelvic symptoms—the same questionnaires they had completed at the 2-year follow-up.

Of the respondents, 19 had received TAH and 18 had received SCH. Researchers reviewed patients' medical records in addition to analyzing the questionnaires. The two groups did not differ in baseline demographics.

There was a significant improvement within the TAH group in the ability to have and enjoy sex and a significant reduction in vaginal bleeding from baseline to the 9-year follow-up in both groups, Dr. Greer reported.

“Based on our results, there still appears to be no good evidence to favor SCH over TAH, as there were no between-group differences in sexual function scores, lower urinary tract or prolapse symptoms, or quality of life,” he said. “The TAH group showed an improvement in one aspect of sexual function and reported less back pain at 9 years, while two participants in the SCH group had experienced bleeding from the cervical stump and another underwent trachelectomy for persistent cervical dysplasia.”

CHICAGO — The most effective way for women to prevent the progression of pelvic organ prolapse might be to maintain a healthy weight, a retrospective analysis of data on 16,000 women suggests.

Being overweight or obese at baseline was highly associated with the progression of cystocele, rectocele, and uterine prolapse during a 5-year period, but women who lost weight did not experience a significant regression of pelvic organ prolapse (POP), Dr. Bela Kudish of Washington (D.C.) Hospital Center reported at the annual meeting of the American Urogynecologic Society.

She suggested that physicians counsel patients to avoid weight gain to prevent additive damage to the pelvic floor.

The fact that regression of POP does not appear to be significantly associated with weight loss suggests that “damage to the pelvic floor, related to weight gain, might not be reversible,” and that avoiding weight gain in the first place might be the best way to prevent the progression of POP, she said.

The results of the study were surprising because others have shown that weight loss improves urinary incontinence, she said in a later interview.

“We need to warn women that there are other pelvic floor issues related to being overweight and obese in addition to diabetes, heart disease, and certain cancers,” she said.

The study consisted of 16,608 women aged 50-79 years (mean age 63) who were enrolled in the Women's Health Initiative Estrogen Plus Progestin Clinical Trial between 1993 and 1998. Each woman had a uterus and received standardized annual examinations. Researchers controlled for age, parity, race, and other health/physical variables.

More than half (55.7%) of the participants gained weight (mean 4.43 kg) during the 5-year trial.

The prevalence of POP increased 4% from 40.9% at baseline to 44.7% at year 5. Women with a body mass index (BMI) of 25 or more, and with a BMI of 30 or more at baseline, had a significantly higher rate of POP at year 5 than did women with a BMI of under 25.

The risk of cystocele, rectocele, and uterine prolapse increased 30%-70% in overweight and obese women compared with women who had a normal BMI at baseline, Dr. Kudish reported.

Compared with being white, being black was found to be protective for all types of prolapse progression, while being Hispanic increased the risk of cystocele progression by 21%, and being Asian/Pacific Islander increased the risk of cystocele and rectocele progression by more than 200%.

The researchers conducted a second analysis, adjusting for BMI and the presence of POP at baseline, to assess the effect of a 10% weight loss on POP. This amount of weight loss “had no effect on prolapse at or beyond the hymen,” Dr. Kudish said.

“We chose a weight loss of 10% based on other studies showing a benefit [related to urinary incontinence],” she said. “It might be that a weight loss of more than 10% might be efficacious; we don't know. It also might take longer [than the 5 years of the clinical trial] for POP to reverse [with weight loss]; we don't know.”

The researchers also constructed a model that used a 5% weight loss for all types of prolapse, but this model did not reveal any effect on prolapse progression or regression.

Models that used greater than 10% weight losses were not constructed because “we wanted to look at weight loss that is doable and reasonable,” Dr. Kudish noted.

“Additional longitudinal studies are needed to elucidate the role of weight change on prolapse before and after menopause as well as during the postpartum period,” she said.

Dr. Kudish reported no financial conflicts of interest related to this study.

CHICAGO — The most effective way for women to prevent the progression of pelvic organ prolapse might be to maintain a healthy weight, a retrospective analysis of data on 16,000 women suggests.

Being overweight or obese at baseline was highly associated with the progression of cystocele, rectocele, and uterine prolapse during a 5-year period, but women who lost weight did not experience a significant regression of pelvic organ prolapse (POP), Dr. Bela Kudish of Washington (D.C.) Hospital Center reported at the annual meeting of the American Urogynecologic Society.

She suggested that physicians counsel patients to avoid weight gain to prevent additive damage to the pelvic floor.

The fact that regression of POP does not appear to be significantly associated with weight loss suggests that “damage to the pelvic floor, related to weight gain, might not be reversible,” and that avoiding weight gain in the first place might be the best way to prevent the progression of POP, she said.

The results of the study were surprising because others have shown that weight loss improves urinary incontinence, she said in a later interview.

“We need to warn women that there are other pelvic floor issues related to being overweight and obese in addition to diabetes, heart disease, and certain cancers,” she said.

The study consisted of 16,608 women aged 50-79 years (mean age 63) who were enrolled in the Women's Health Initiative Estrogen Plus Progestin Clinical Trial between 1993 and 1998. Each woman had a uterus and received standardized annual examinations. Researchers controlled for age, parity, race, and other health/physical variables.

More than half (55.7%) of the participants gained weight (mean 4.43 kg) during the 5-year trial.

The prevalence of POP increased 4% from 40.9% at baseline to 44.7% at year 5. Women with a body mass index (BMI) of 25 or more, and with a BMI of 30 or more at baseline, had a significantly higher rate of POP at year 5 than did women with a BMI of under 25.

The risk of cystocele, rectocele, and uterine prolapse increased 30%-70% in overweight and obese women compared with women who had a normal BMI at baseline, Dr. Kudish reported.

Compared with being white, being black was found to be protective for all types of prolapse progression, while being Hispanic increased the risk of cystocele progression by 21%, and being Asian/Pacific Islander increased the risk of cystocele and rectocele progression by more than 200%.

The researchers conducted a second analysis, adjusting for BMI and the presence of POP at baseline, to assess the effect of a 10% weight loss on POP. This amount of weight loss “had no effect on prolapse at or beyond the hymen,” Dr. Kudish said.

“We chose a weight loss of 10% based on other studies showing a benefit [related to urinary incontinence],” she said. “It might be that a weight loss of more than 10% might be efficacious; we don't know. It also might take longer [than the 5 years of the clinical trial] for POP to reverse [with weight loss]; we don't know.”

The researchers also constructed a model that used a 5% weight loss for all types of prolapse, but this model did not reveal any effect on prolapse progression or regression.

Models that used greater than 10% weight losses were not constructed because “we wanted to look at weight loss that is doable and reasonable,” Dr. Kudish noted.

“Additional longitudinal studies are needed to elucidate the role of weight change on prolapse before and after menopause as well as during the postpartum period,” she said.

Dr. Kudish reported no financial conflicts of interest related to this study.

CHICAGO — The most effective way for women to prevent the progression of pelvic organ prolapse might be to maintain a healthy weight, a retrospective analysis of data on 16,000 women suggests.

Being overweight or obese at baseline was highly associated with the progression of cystocele, rectocele, and uterine prolapse during a 5-year period, but women who lost weight did not experience a significant regression of pelvic organ prolapse (POP), Dr. Bela Kudish of Washington (D.C.) Hospital Center reported at the annual meeting of the American Urogynecologic Society.

She suggested that physicians counsel patients to avoid weight gain to prevent additive damage to the pelvic floor.

The fact that regression of POP does not appear to be significantly associated with weight loss suggests that “damage to the pelvic floor, related to weight gain, might not be reversible,” and that avoiding weight gain in the first place might be the best way to prevent the progression of POP, she said.

The results of the study were surprising because others have shown that weight loss improves urinary incontinence, she said in a later interview.

“We need to warn women that there are other pelvic floor issues related to being overweight and obese in addition to diabetes, heart disease, and certain cancers,” she said.

The study consisted of 16,608 women aged 50-79 years (mean age 63) who were enrolled in the Women's Health Initiative Estrogen Plus Progestin Clinical Trial between 1993 and 1998. Each woman had a uterus and received standardized annual examinations. Researchers controlled for age, parity, race, and other health/physical variables.

More than half (55.7%) of the participants gained weight (mean 4.43 kg) during the 5-year trial.

The prevalence of POP increased 4% from 40.9% at baseline to 44.7% at year 5. Women with a body mass index (BMI) of 25 or more, and with a BMI of 30 or more at baseline, had a significantly higher rate of POP at year 5 than did women with a BMI of under 25.

The risk of cystocele, rectocele, and uterine prolapse increased 30%-70% in overweight and obese women compared with women who had a normal BMI at baseline, Dr. Kudish reported.

Compared with being white, being black was found to be protective for all types of prolapse progression, while being Hispanic increased the risk of cystocele progression by 21%, and being Asian/Pacific Islander increased the risk of cystocele and rectocele progression by more than 200%.

The researchers conducted a second analysis, adjusting for BMI and the presence of POP at baseline, to assess the effect of a 10% weight loss on POP. This amount of weight loss “had no effect on prolapse at or beyond the hymen,” Dr. Kudish said.

“We chose a weight loss of 10% based on other studies showing a benefit [related to urinary incontinence],” she said. “It might be that a weight loss of more than 10% might be efficacious; we don't know. It also might take longer [than the 5 years of the clinical trial] for POP to reverse [with weight loss]; we don't know.”

The researchers also constructed a model that used a 5% weight loss for all types of prolapse, but this model did not reveal any effect on prolapse progression or regression.

Models that used greater than 10% weight losses were not constructed because “we wanted to look at weight loss that is doable and reasonable,” Dr. Kudish noted.

“Additional longitudinal studies are needed to elucidate the role of weight change on prolapse before and after menopause as well as during the postpartum period,” she said.

Dr. Kudish reported no financial conflicts of interest related to this study.

CHICAGO — The prevalence of reported food allergies has risen 24% in children under age 5 years and 19% in children aged 5–17 years during the past decade, according to a study by the National Center for Health Statistics.

The study, based on statistics for 1997–2007, provides the first national estimates of food allergy prevalence, emergency department (ED) visits, and hospitalizations in the United States using multiple data sources, Amy M. Branum, an epidemiologist at the National Center for Health Statistics (NCHS), said in a poster presentation at the annual meeting of the Society for Pediatric and Perinatal Epidemiologic Research.

Food allergy prevalence rose from 3.7% to 4.6% in children under age 5 years, from 3.1% to 3.7% in those aged 5–17 years, and from 3.3% to 3.9% in children as a whole.

Although overall prevalence dipped from 4.4% in 2006 to 3.9% in 2007, the results are “still indicative of a trend,” Ms. Branum said in an interview.

Ms. Branum and her associates used National Health Interview Survey (NHIS), National Hospital Discharge Survey, and National Hospital Ambulatory Medical Care Survey data to produce estimates for the U.S. population.

Prevalence data were available only as early as 1997, the year the NHIS began asking specific questions about conditions such as asthma, eczema, respiratory allergies, and food and digestive allergies.

Ms. Branum said the NHIS data provide reliable estimates for the whole population because they are based on a nationally representative sample. For the first time, “we can say that of all children in the [United States], 4% have a food allergy because [the data] reflect the national experience.”

The study also revealed an estimated 122,000 food allergy-related ED visits and 2,005 hospitalizations with a primary diagnosis related to food allergy during 2003–2005 in children under age 17. Most of ED visits were for dermatitis, and 80% were among children under age 5. Most of hospitalizations were for anaphylaxis.

These numbers provide the first national estimates of food allergy-related ED visits and hospitalizations, said Ms. Branum, who stressed that additional public health education efforts will be necessary to continue to increase awareness among parents, schools, and health care professionals.

The NCHS will publish a data brief this fall on food allergy prevalence by age, race, sex, and other variables.

CHICAGO — The prevalence of reported food allergies has risen 24% in children under age 5 years and 19% in children aged 5–17 years during the past decade, according to a study by the National Center for Health Statistics.

The study, based on statistics for 1997–2007, provides the first national estimates of food allergy prevalence, emergency department (ED) visits, and hospitalizations in the United States using multiple data sources, Amy M. Branum, an epidemiologist at the National Center for Health Statistics (NCHS), said in a poster presentation at the annual meeting of the Society for Pediatric and Perinatal Epidemiologic Research.

Food allergy prevalence rose from 3.7% to 4.6% in children under age 5 years, from 3.1% to 3.7% in those aged 5–17 years, and from 3.3% to 3.9% in children as a whole.

Although overall prevalence dipped from 4.4% in 2006 to 3.9% in 2007, the results are “still indicative of a trend,” Ms. Branum said in an interview.

Ms. Branum and her associates used National Health Interview Survey (NHIS), National Hospital Discharge Survey, and National Hospital Ambulatory Medical Care Survey data to produce estimates for the U.S. population.

Prevalence data were available only as early as 1997, the year the NHIS began asking specific questions about conditions such as asthma, eczema, respiratory allergies, and food and digestive allergies.

Ms. Branum said the NHIS data provide reliable estimates for the whole population because they are based on a nationally representative sample. For the first time, “we can say that of all children in the [United States], 4% have a food allergy because [the data] reflect the national experience.”

The study also revealed an estimated 122,000 food allergy-related ED visits and 2,005 hospitalizations with a primary diagnosis related to food allergy during 2003–2005 in children under age 17. Most of ED visits were for dermatitis, and 80% were among children under age 5. Most of hospitalizations were for anaphylaxis.

These numbers provide the first national estimates of food allergy-related ED visits and hospitalizations, said Ms. Branum, who stressed that additional public health education efforts will be necessary to continue to increase awareness among parents, schools, and health care professionals.

The NCHS will publish a data brief this fall on food allergy prevalence by age, race, sex, and other variables.

CHICAGO — The prevalence of reported food allergies has risen 24% in children under age 5 years and 19% in children aged 5–17 years during the past decade, according to a study by the National Center for Health Statistics.

The study, based on statistics for 1997–2007, provides the first national estimates of food allergy prevalence, emergency department (ED) visits, and hospitalizations in the United States using multiple data sources, Amy M. Branum, an epidemiologist at the National Center for Health Statistics (NCHS), said in a poster presentation at the annual meeting of the Society for Pediatric and Perinatal Epidemiologic Research.

Food allergy prevalence rose from 3.7% to 4.6% in children under age 5 years, from 3.1% to 3.7% in those aged 5–17 years, and from 3.3% to 3.9% in children as a whole.

Although overall prevalence dipped from 4.4% in 2006 to 3.9% in 2007, the results are “still indicative of a trend,” Ms. Branum said in an interview.

Ms. Branum and her associates used National Health Interview Survey (NHIS), National Hospital Discharge Survey, and National Hospital Ambulatory Medical Care Survey data to produce estimates for the U.S. population.

Prevalence data were available only as early as 1997, the year the NHIS began asking specific questions about conditions such as asthma, eczema, respiratory allergies, and food and digestive allergies.

Ms. Branum said the NHIS data provide reliable estimates for the whole population because they are based on a nationally representative sample. For the first time, “we can say that of all children in the [United States], 4% have a food allergy because [the data] reflect the national experience.”

The study also revealed an estimated 122,000 food allergy-related ED visits and 2,005 hospitalizations with a primary diagnosis related to food allergy during 2003–2005 in children under age 17. Most of ED visits were for dermatitis, and 80% were among children under age 5. Most of hospitalizations were for anaphylaxis.

These numbers provide the first national estimates of food allergy-related ED visits and hospitalizations, said Ms. Branum, who stressed that additional public health education efforts will be necessary to continue to increase awareness among parents, schools, and health care professionals.

The NCHS will publish a data brief this fall on food allergy prevalence by age, race, sex, and other variables.

CHICAGO — Obese and overweight women with urinary incontinence may be able to manage their condition by losing weight and maintaining the weight loss.

The more weight a woman had lost by the end of the 18-month Program to Reduce Incontinence by Diet and Exercise trial, the greater her likelihood of experiencing at least a 70% improvement in urinary incontinence (UI), Dr. Leslee L. Subak reported at the annual meeting of the American Urogynecologic Society.

The finding that even moderate weight loss yielded significant improvements indicates that “weight loss should be considered as a first-line treatment for overweight and obese women with UI,” added Dr. Subak of the University of California, San Francisco.

The multicenter study consisted of 338 overweight and obese women who had at least 10 episodes of urinary incontinence weekly, as indicated by a 7-day voiding diary. The patients were randomly assigned to an intensive 6-month weight-loss program and a 12-month weight-maintenance program, or to an education program that did not include weight-reduction intervention.

The weight-loss program incorporated diet, exercise, and behavior modification. All of the participants kept diaries of the number and type of UI episodes.

At baseline, the intervention and control groups did not differ in mean age (53 years), weight (97 kg), body mass index (36 kg/m

After 18 months, participants in the diet and exercise group had lost a mean of 6.5 kg, and those in the education group had lost a mean of 1.7 kg. Although the two groups did not differ in frequency of total, stress, or urge incontinence episodes at the end of the trial, the data showed a strong relationship between the amount of weight lost and the likelihood of a significant reduction in UI.

Comparisons of UI frequency among women who gained weight during the study and among those who lost less than 5%, 5% to less than 10%, or 10% or more of their initial body weight showed a significant association between degree of weight loss and reductions in total, stress, and urge incontinence. The association persisted independently of treatment group or baseline BMI.

Compared with the participants who gained weight during the trial, the odds of experiencing at least a 70% reduction in overall total UI episodes were 1.8 in women who lost less than 5%, 2.0 in those who lost 5% to less than 10%, and 2.6 in those who lost 10% or more of their weight.

The trial was funded by the National Institute of Diabetes and Digestive and Kidney Diseases.

CHICAGO — Obese and overweight women with urinary incontinence may be able to manage their condition by losing weight and maintaining the weight loss.

The more weight a woman had lost by the end of the 18-month Program to Reduce Incontinence by Diet and Exercise trial, the greater her likelihood of experiencing at least a 70% improvement in urinary incontinence (UI), Dr. Leslee L. Subak reported at the annual meeting of the American Urogynecologic Society.

The finding that even moderate weight loss yielded significant improvements indicates that “weight loss should be considered as a first-line treatment for overweight and obese women with UI,” added Dr. Subak of the University of California, San Francisco.

The multicenter study consisted of 338 overweight and obese women who had at least 10 episodes of urinary incontinence weekly, as indicated by a 7-day voiding diary. The patients were randomly assigned to an intensive 6-month weight-loss program and a 12-month weight-maintenance program, or to an education program that did not include weight-reduction intervention.

The weight-loss program incorporated diet, exercise, and behavior modification. All of the participants kept diaries of the number and type of UI episodes.

At baseline, the intervention and control groups did not differ in mean age (53 years), weight (97 kg), body mass index (36 kg/m

After 18 months, participants in the diet and exercise group had lost a mean of 6.5 kg, and those in the education group had lost a mean of 1.7 kg. Although the two groups did not differ in frequency of total, stress, or urge incontinence episodes at the end of the trial, the data showed a strong relationship between the amount of weight lost and the likelihood of a significant reduction in UI.

Comparisons of UI frequency among women who gained weight during the study and among those who lost less than 5%, 5% to less than 10%, or 10% or more of their initial body weight showed a significant association between degree of weight loss and reductions in total, stress, and urge incontinence. The association persisted independently of treatment group or baseline BMI.

Compared with the participants who gained weight during the trial, the odds of experiencing at least a 70% reduction in overall total UI episodes were 1.8 in women who lost less than 5%, 2.0 in those who lost 5% to less than 10%, and 2.6 in those who lost 10% or more of their weight.

The trial was funded by the National Institute of Diabetes and Digestive and Kidney Diseases.

CHICAGO — Obese and overweight women with urinary incontinence may be able to manage their condition by losing weight and maintaining the weight loss.

The more weight a woman had lost by the end of the 18-month Program to Reduce Incontinence by Diet and Exercise trial, the greater her likelihood of experiencing at least a 70% improvement in urinary incontinence (UI), Dr. Leslee L. Subak reported at the annual meeting of the American Urogynecologic Society.

The finding that even moderate weight loss yielded significant improvements indicates that “weight loss should be considered as a first-line treatment for overweight and obese women with UI,” added Dr. Subak of the University of California, San Francisco.

The multicenter study consisted of 338 overweight and obese women who had at least 10 episodes of urinary incontinence weekly, as indicated by a 7-day voiding diary. The patients were randomly assigned to an intensive 6-month weight-loss program and a 12-month weight-maintenance program, or to an education program that did not include weight-reduction intervention.

The weight-loss program incorporated diet, exercise, and behavior modification. All of the participants kept diaries of the number and type of UI episodes.

At baseline, the intervention and control groups did not differ in mean age (53 years), weight (97 kg), body mass index (36 kg/m

After 18 months, participants in the diet and exercise group had lost a mean of 6.5 kg, and those in the education group had lost a mean of 1.7 kg. Although the two groups did not differ in frequency of total, stress, or urge incontinence episodes at the end of the trial, the data showed a strong relationship between the amount of weight lost and the likelihood of a significant reduction in UI.

Comparisons of UI frequency among women who gained weight during the study and among those who lost less than 5%, 5% to less than 10%, or 10% or more of their initial body weight showed a significant association between degree of weight loss and reductions in total, stress, and urge incontinence. The association persisted independently of treatment group or baseline BMI.

Compared with the participants who gained weight during the trial, the odds of experiencing at least a 70% reduction in overall total UI episodes were 1.8 in women who lost less than 5%, 2.0 in those who lost 5% to less than 10%, and 2.6 in those who lost 10% or more of their weight.

The trial was funded by the National Institute of Diabetes and Digestive and Kidney Diseases.