Sharon Worcester

ORLANDO, FLA. — Transcatheter arterial chemoinfusion without embolization is a safe and effective treatment in patients with unresectable stage I, II, or III hepatocellular carcinoma, and could serve as a safer alternative to transcatheter arterial chemoembolization, Mindie H. Nguyen, M.D., said at the annual meeting of the American College of Gastroenterology.

In a retrospective study of 165 patients who underwent transcatheter arterial chemoinfusion (TACI) between 1998 and 2002, the complete response rate among those with stage I, II, or III disease was about 50%, and the partial response and nonresponse rates were each about 25%. Among those with stage IV disease, complete response occurred in fewer than 15%, and partial response and nonresponse each occurred in fewer than 43%, said Dr. Nguyen of Stanford (Calif.) University.

Stage IV disease was the only predictor of nonresponse to TACI, she noted.

Patients all received chemoinfusion with cisplatin, doxorubicin, and lipiodol, and were observed overnight in the hospital. They were evaluated clinically at 2 weeks, and underwent radiologic evaluation at 3 months. Repeat TACI was conducted if residual or new tumors were detected; the average number of TACI procedures per patient was two.

The rate of serious complications among the TACI patients was 1.5%, with two patients experiencing hepatic failure. About 98% of patients required a hospital stay of less than 24 hours. Overall survival at 4 years was 66%.

ORLANDO, FLA. — Transcatheter arterial chemoinfusion without embolization is a safe and effective treatment in patients with unresectable stage I, II, or III hepatocellular carcinoma, and could serve as a safer alternative to transcatheter arterial chemoembolization, Mindie H. Nguyen, M.D., said at the annual meeting of the American College of Gastroenterology.

In a retrospective study of 165 patients who underwent transcatheter arterial chemoinfusion (TACI) between 1998 and 2002, the complete response rate among those with stage I, II, or III disease was about 50%, and the partial response and nonresponse rates were each about 25%. Among those with stage IV disease, complete response occurred in fewer than 15%, and partial response and nonresponse each occurred in fewer than 43%, said Dr. Nguyen of Stanford (Calif.) University.

Stage IV disease was the only predictor of nonresponse to TACI, she noted.

Patients all received chemoinfusion with cisplatin, doxorubicin, and lipiodol, and were observed overnight in the hospital. They were evaluated clinically at 2 weeks, and underwent radiologic evaluation at 3 months. Repeat TACI was conducted if residual or new tumors were detected; the average number of TACI procedures per patient was two.

The rate of serious complications among the TACI patients was 1.5%, with two patients experiencing hepatic failure. About 98% of patients required a hospital stay of less than 24 hours. Overall survival at 4 years was 66%.

ORLANDO, FLA. — Transcatheter arterial chemoinfusion without embolization is a safe and effective treatment in patients with unresectable stage I, II, or III hepatocellular carcinoma, and could serve as a safer alternative to transcatheter arterial chemoembolization, Mindie H. Nguyen, M.D., said at the annual meeting of the American College of Gastroenterology.

In a retrospective study of 165 patients who underwent transcatheter arterial chemoinfusion (TACI) between 1998 and 2002, the complete response rate among those with stage I, II, or III disease was about 50%, and the partial response and nonresponse rates were each about 25%. Among those with stage IV disease, complete response occurred in fewer than 15%, and partial response and nonresponse each occurred in fewer than 43%, said Dr. Nguyen of Stanford (Calif.) University.

Stage IV disease was the only predictor of nonresponse to TACI, she noted.

Patients all received chemoinfusion with cisplatin, doxorubicin, and lipiodol, and were observed overnight in the hospital. They were evaluated clinically at 2 weeks, and underwent radiologic evaluation at 3 months. Repeat TACI was conducted if residual or new tumors were detected; the average number of TACI procedures per patient was two.

The rate of serious complications among the TACI patients was 1.5%, with two patients experiencing hepatic failure. About 98% of patients required a hospital stay of less than 24 hours. Overall survival at 4 years was 66%.

TB Mortality Risks

Hospitalized tuberculosis patients have longer hospital stays and higher costs than other patients, and they have a high risk of in-hospital mortality, according to Nadia N. Hansel, M.D., and her colleagues at Johns Hopkins University, Baltimore.

The investigators reviewed 2,279 TB-related hospital admissions from the year 2000 and found that despite extensive public health efforts and the availability of curative therapy, the in-hospital mortality rate was 5%. Rates in other studies have been as high as 12%.

Length of stay was a mean of 14.2 days for those with TB admissions, compared with 4.2 days for other hospital admissions. And total charges for TB-related hospitalizations were almost 2.5 times higher than for all other hospital admissions (mean $34,000 vs. $14,000), they noted (Chest 2004;126:1079-86).

Independent predictors of mortality in this study were older age (odds ratio 1.03 per year of age), comorbid illness (OR 1.59), and emergency department admission (OR 2.38). More vigorous management and prevention strategies are needed to improve outcomes in hospitalized tuberculosis patients—especially in patients with these characteristics, they concluded.

Inpatient Vaccination

Computerized standing orders were more effective than computerized physician reminders for increasing the rate of influenza and pneumococcal vaccine administration among inpatients in a recent study.

In the randomized trial involving 3,777 general medicine patients discharged from one hospital over a 14-month period, patients eligible for vaccination were assigned to either a standing orders group or a physician reminder group. For those in the standing orders group, the hospital's computer system automatically produced vaccine orders for nurses when patients were discharged; for those in the physician reminder group, the system produced vaccine order reminders to physicians during order entry sessions, said Paul R. Dexter, M.D., of Indiana University, Indianapolis, and his colleagues.

Over about a 6-month period encompassing flu season, significantly more patients in the standing orders group, compared with the physician reminders group, received an influenza vaccine (42% of 385 vs. 30% of 463 eligible patients) and a pneumococcal vaccine (51% of 406 vs. 31% of 423 eligible patients), the investigators found (JAMA 2004;292:2366-71).

Hospitalized patients are among those most likely to benefit from influenza and pneumococcal vaccinations, and hospitalization provides an important opportunity for providing these vaccines, they concluded.

COPD Exacerbations

Patients with chronic obstructive pulmonary disease (COPD) who present with an exacerbation should be evaluated for the presence of three particular clinical characteristics that appear useful for determining if the exacerbation has a bacterial origin, according to Paul van der Valk, M.D., of Medisch Spectrum Twente, Nijmegen, the Netherlands, and his colleagues.

In a study of 116 patients presenting with an exacerbation of COPD, the combination of a negative sputum Gram stain, a nonclinical decrease in lung function, and fewer than two exacerbations in the previous 12 months was 100% predictive of a nonbacterial exacerbation. Conversely, a positive Gram stain, a clinically relevant decrease in lung function, and the occurrence of more than two exacerbations in the previous 12 months had a positive predictive value for bacterial exacerbation of 67%, they found (Clin. Infect. Dis. 2004;39:980-6).

A treatment protocol based on the presence or absence of these characteristics could reduce unnecessary antibiotic treatment in COPD patients with exacerbations by 5%-24%, they concluded.

TB Outbreak

A recent tuberculosis outbreak in Indiana—a typically low-incidence state—demonstrates the limitations of gains that have been made in TB control in recent years and underscores the need for ongoing resource commitment and preparedness for dealing with TB resurgences, according to the Centers for Disease Control and Prevention.

The rate of TB in Indiana per 100,000 population was 2.3 in 2003. One county had a higher than average rate of 2.9 per 100,000 in 2000-2002, and the rate in that county increased to 4.7 in 2003 and to 7.0 in the first half of 2004 (MMWR 2005;53:1134-5).

An ongoing investigation of the outbreak is focusing on identifying contacts of affected individuals, treating those with newly diagnosed TB, educating health care workers and the community, and closely managing patients.

TB Mortality Risks

Hospitalized tuberculosis patients have longer hospital stays and higher costs than other patients, and they have a high risk of in-hospital mortality, according to Nadia N. Hansel, M.D., and her colleagues at Johns Hopkins University, Baltimore.

The investigators reviewed 2,279 TB-related hospital admissions from the year 2000 and found that despite extensive public health efforts and the availability of curative therapy, the in-hospital mortality rate was 5%. Rates in other studies have been as high as 12%.

Length of stay was a mean of 14.2 days for those with TB admissions, compared with 4.2 days for other hospital admissions. And total charges for TB-related hospitalizations were almost 2.5 times higher than for all other hospital admissions (mean $34,000 vs. $14,000), they noted (Chest 2004;126:1079-86).

Independent predictors of mortality in this study were older age (odds ratio 1.03 per year of age), comorbid illness (OR 1.59), and emergency department admission (OR 2.38). More vigorous management and prevention strategies are needed to improve outcomes in hospitalized tuberculosis patients—especially in patients with these characteristics, they concluded.

Inpatient Vaccination

Computerized standing orders were more effective than computerized physician reminders for increasing the rate of influenza and pneumococcal vaccine administration among inpatients in a recent study.

In the randomized trial involving 3,777 general medicine patients discharged from one hospital over a 14-month period, patients eligible for vaccination were assigned to either a standing orders group or a physician reminder group. For those in the standing orders group, the hospital's computer system automatically produced vaccine orders for nurses when patients were discharged; for those in the physician reminder group, the system produced vaccine order reminders to physicians during order entry sessions, said Paul R. Dexter, M.D., of Indiana University, Indianapolis, and his colleagues.

Over about a 6-month period encompassing flu season, significantly more patients in the standing orders group, compared with the physician reminders group, received an influenza vaccine (42% of 385 vs. 30% of 463 eligible patients) and a pneumococcal vaccine (51% of 406 vs. 31% of 423 eligible patients), the investigators found (JAMA 2004;292:2366-71).

Hospitalized patients are among those most likely to benefit from influenza and pneumococcal vaccinations, and hospitalization provides an important opportunity for providing these vaccines, they concluded.

COPD Exacerbations

Patients with chronic obstructive pulmonary disease (COPD) who present with an exacerbation should be evaluated for the presence of three particular clinical characteristics that appear useful for determining if the exacerbation has a bacterial origin, according to Paul van der Valk, M.D., of Medisch Spectrum Twente, Nijmegen, the Netherlands, and his colleagues.

In a study of 116 patients presenting with an exacerbation of COPD, the combination of a negative sputum Gram stain, a nonclinical decrease in lung function, and fewer than two exacerbations in the previous 12 months was 100% predictive of a nonbacterial exacerbation. Conversely, a positive Gram stain, a clinically relevant decrease in lung function, and the occurrence of more than two exacerbations in the previous 12 months had a positive predictive value for bacterial exacerbation of 67%, they found (Clin. Infect. Dis. 2004;39:980-6).

A treatment protocol based on the presence or absence of these characteristics could reduce unnecessary antibiotic treatment in COPD patients with exacerbations by 5%-24%, they concluded.

TB Outbreak

A recent tuberculosis outbreak in Indiana—a typically low-incidence state—demonstrates the limitations of gains that have been made in TB control in recent years and underscores the need for ongoing resource commitment and preparedness for dealing with TB resurgences, according to the Centers for Disease Control and Prevention.

The rate of TB in Indiana per 100,000 population was 2.3 in 2003. One county had a higher than average rate of 2.9 per 100,000 in 2000-2002, and the rate in that county increased to 4.7 in 2003 and to 7.0 in the first half of 2004 (MMWR 2005;53:1134-5).

An ongoing investigation of the outbreak is focusing on identifying contacts of affected individuals, treating those with newly diagnosed TB, educating health care workers and the community, and closely managing patients.

TB Mortality Risks

Hospitalized tuberculosis patients have longer hospital stays and higher costs than other patients, and they have a high risk of in-hospital mortality, according to Nadia N. Hansel, M.D., and her colleagues at Johns Hopkins University, Baltimore.

The investigators reviewed 2,279 TB-related hospital admissions from the year 2000 and found that despite extensive public health efforts and the availability of curative therapy, the in-hospital mortality rate was 5%. Rates in other studies have been as high as 12%.

Length of stay was a mean of 14.2 days for those with TB admissions, compared with 4.2 days for other hospital admissions. And total charges for TB-related hospitalizations were almost 2.5 times higher than for all other hospital admissions (mean $34,000 vs. $14,000), they noted (Chest 2004;126:1079-86).

Independent predictors of mortality in this study were older age (odds ratio 1.03 per year of age), comorbid illness (OR 1.59), and emergency department admission (OR 2.38). More vigorous management and prevention strategies are needed to improve outcomes in hospitalized tuberculosis patients—especially in patients with these characteristics, they concluded.

Inpatient Vaccination

Computerized standing orders were more effective than computerized physician reminders for increasing the rate of influenza and pneumococcal vaccine administration among inpatients in a recent study.

In the randomized trial involving 3,777 general medicine patients discharged from one hospital over a 14-month period, patients eligible for vaccination were assigned to either a standing orders group or a physician reminder group. For those in the standing orders group, the hospital's computer system automatically produced vaccine orders for nurses when patients were discharged; for those in the physician reminder group, the system produced vaccine order reminders to physicians during order entry sessions, said Paul R. Dexter, M.D., of Indiana University, Indianapolis, and his colleagues.

Over about a 6-month period encompassing flu season, significantly more patients in the standing orders group, compared with the physician reminders group, received an influenza vaccine (42% of 385 vs. 30% of 463 eligible patients) and a pneumococcal vaccine (51% of 406 vs. 31% of 423 eligible patients), the investigators found (JAMA 2004;292:2366-71).

Hospitalized patients are among those most likely to benefit from influenza and pneumococcal vaccinations, and hospitalization provides an important opportunity for providing these vaccines, they concluded.

COPD Exacerbations

Patients with chronic obstructive pulmonary disease (COPD) who present with an exacerbation should be evaluated for the presence of three particular clinical characteristics that appear useful for determining if the exacerbation has a bacterial origin, according to Paul van der Valk, M.D., of Medisch Spectrum Twente, Nijmegen, the Netherlands, and his colleagues.

In a study of 116 patients presenting with an exacerbation of COPD, the combination of a negative sputum Gram stain, a nonclinical decrease in lung function, and fewer than two exacerbations in the previous 12 months was 100% predictive of a nonbacterial exacerbation. Conversely, a positive Gram stain, a clinically relevant decrease in lung function, and the occurrence of more than two exacerbations in the previous 12 months had a positive predictive value for bacterial exacerbation of 67%, they found (Clin. Infect. Dis. 2004;39:980-6).

A treatment protocol based on the presence or absence of these characteristics could reduce unnecessary antibiotic treatment in COPD patients with exacerbations by 5%-24%, they concluded.

TB Outbreak

A recent tuberculosis outbreak in Indiana—a typically low-incidence state—demonstrates the limitations of gains that have been made in TB control in recent years and underscores the need for ongoing resource commitment and preparedness for dealing with TB resurgences, according to the Centers for Disease Control and Prevention.

The rate of TB in Indiana per 100,000 population was 2.3 in 2003. One county had a higher than average rate of 2.9 per 100,000 in 2000-2002, and the rate in that county increased to 4.7 in 2003 and to 7.0 in the first half of 2004 (MMWR 2005;53:1134-5).

An ongoing investigation of the outbreak is focusing on identifying contacts of affected individuals, treating those with newly diagnosed TB, educating health care workers and the community, and closely managing patients.

Bacterial vaginosis-associated organisms found frequently in women with pelvic inflammatory disease also were strongly associated with endometritis, Catherine L. Haggerty, Ph.D., of the University of Pittsburgh and her colleagues reported.

They looked at the associations between endometritis and Neisseria gonorrhoeae, Chlamydia trachomatis, anaerobic bacteria, facultative bacteria, lactobacilli, and bacterial vaginosis (BV) in 278 women from the PID Evaluation and Clinical Health Study. Those with acute endometritis were more likely to be infected in the endometrium with C. trachomatis (odds ratio [OR] 16.2), N. gonorrhoeae (OR 11.6), diphtheroids (OR 5.0), black-pigmented gram-negative rods (OR 3.1), and anaerobic gram-positive cocci (OR 2.1), the investigators found (Clin. Infect. Dis. 2004:39;990-5).

The associations between acute endometritis and black-pigmented gram-negative rods, anaerobic gram-positive cocci, and BV remained significant after excluding the 41% of women infected with N. gonorrhoeae and/or C. trachomatis.

Treatment in most PID patients is targeted at N. gonorrhoeae and C. trachomatis, but these account for fewer than half of all cases. The frequency of BV-associated organisms in PID patients suggests that a treatment regimen containing metronidazole to improve anaerobic coverage is warranted, the researchers said.

Bacterial vaginosis-associated organisms found frequently in women with pelvic inflammatory disease also were strongly associated with endometritis, Catherine L. Haggerty, Ph.D., of the University of Pittsburgh and her colleagues reported.

They looked at the associations between endometritis and Neisseria gonorrhoeae, Chlamydia trachomatis, anaerobic bacteria, facultative bacteria, lactobacilli, and bacterial vaginosis (BV) in 278 women from the PID Evaluation and Clinical Health Study. Those with acute endometritis were more likely to be infected in the endometrium with C. trachomatis (odds ratio [OR] 16.2), N. gonorrhoeae (OR 11.6), diphtheroids (OR 5.0), black-pigmented gram-negative rods (OR 3.1), and anaerobic gram-positive cocci (OR 2.1), the investigators found (Clin. Infect. Dis. 2004:39;990-5).

The associations between acute endometritis and black-pigmented gram-negative rods, anaerobic gram-positive cocci, and BV remained significant after excluding the 41% of women infected with N. gonorrhoeae and/or C. trachomatis.

Treatment in most PID patients is targeted at N. gonorrhoeae and C. trachomatis, but these account for fewer than half of all cases. The frequency of BV-associated organisms in PID patients suggests that a treatment regimen containing metronidazole to improve anaerobic coverage is warranted, the researchers said.

Bacterial vaginosis-associated organisms found frequently in women with pelvic inflammatory disease also were strongly associated with endometritis, Catherine L. Haggerty, Ph.D., of the University of Pittsburgh and her colleagues reported.

They looked at the associations between endometritis and Neisseria gonorrhoeae, Chlamydia trachomatis, anaerobic bacteria, facultative bacteria, lactobacilli, and bacterial vaginosis (BV) in 278 women from the PID Evaluation and Clinical Health Study. Those with acute endometritis were more likely to be infected in the endometrium with C. trachomatis (odds ratio [OR] 16.2), N. gonorrhoeae (OR 11.6), diphtheroids (OR 5.0), black-pigmented gram-negative rods (OR 3.1), and anaerobic gram-positive cocci (OR 2.1), the investigators found (Clin. Infect. Dis. 2004:39;990-5).

The associations between acute endometritis and black-pigmented gram-negative rods, anaerobic gram-positive cocci, and BV remained significant after excluding the 41% of women infected with N. gonorrhoeae and/or C. trachomatis.

Treatment in most PID patients is targeted at N. gonorrhoeae and C. trachomatis, but these account for fewer than half of all cases. The frequency of BV-associated organisms in PID patients suggests that a treatment regimen containing metronidazole to improve anaerobic coverage is warranted, the researchers said.

ORLANDO, FLA. — Results from two studies shed new light on the medical and surgical management of patients with Crohn's disease.

Infliximab and other treatments used for Crohn's disease do not cause or worsen intestinal strictures, stenosis, or obstructions, data from a large prospective observational study suggest.

A second study showed that overweight patients with Crohn's disease have a disease course that differs from that seen in their nonoverweight counterparts, and they require surgical intervention significantly sooner after diagnosis than do those who are underweight.

The data on infliximab came from the Therapy, Resource, Evaluation, and Assessment Tool (TREAT) registry of more than 6,300 patients. Patients treated with infliximab had complications—intestinal strictures, stenosis, or obstructions—more often than did those treated with other therapies (2·1 vs. 1·2 events per 100 patient-years). But a multivariate analysis suggests that the difference was due to greater disease severity in the infliximab patients, G.R. Lichtenstein, M.D., reported at the annual meeting of the American College of Gastroenterology.

About half of the patients in the registry were treated with infliximab, and compared with those on other therapies, significantly more had moderate to severe disease (34% vs. 11%) and severe to fulminant disease (3% vs. 0·6%) at enrollment. Also, in the prior year significantly more were hospitalized (29% vs. 20%) or had surgery (19% vs. 14%). Also, significantly more infliximab patients were taking corticosteroids (28% vs. 17%) or immunomodulators (50% vs. 33%), said Dr. Lichtenstein of the University of Pennsylvania, Philadelphia.

Significant predictors of strictures, stenosis, or obstructions were moderate, severe, or fulminant disease at baseline (relative risk 1·99), disease duration (relative risk 1·03), and ileal disease (relative risk 1·87), but not prior infliximab therapy (relative risk 1·06), immunomodulator use (relative risk 1·40), or corticosteroid use (relative risk 1·62), he said.

The findings, based on more than 4,200 patient-years of follow-up for infliximab patients and more than 3,500 patient-years of follow-up for patients on other treatments, appear to debunk concerns that rapid mucosal healing with infliximab promotes strictures, stenosis, or obstructions.

The second, retrospective study included 148 Crohn's disease patients seen between 1997 and 2002, of whom 48 were overweight as defined by a body mass index of 25 kg/m2 or greater. Overweight patients were significantly older at diagnosis than those with a body mass index under 25 kg/m2 (35 years vs. 23 years). The median duration of disease at the time of the study was 213 months for the nonoverweight patients and 156 months for the overweight patients, reported David J. Hass, M.D., of the University of Pennsylvania, Philadelphia.

There were no significant differences between overweight and nonoverweight patients in time from symptom onset to disease diagnosis, number of surgeries, disease distribution, or escalation of medical therapy. But when overweight patients were compared with underweight patients (those with a body mass index less than 18·5 kg/m2), there was a significant difference in the median time to first surgery: 24 months among the overweight patients, compared with 252 months among the underweight patients.

The differences in disease course in overweight persons might be explained by the well-documented increase in TNF-α production in adipose tissue and the increased amount of adipose tissue in overweight patients. Inflammation plays a role in Crohn's disease; therefore patients who are overweight might have a more severe disease course, Dr. Haas said. The findings suggest that more aggressive therapy earlier in the disease course is indicated in those who are overweight, he added.

ORLANDO, FLA. — Results from two studies shed new light on the medical and surgical management of patients with Crohn's disease.

Infliximab and other treatments used for Crohn's disease do not cause or worsen intestinal strictures, stenosis, or obstructions, data from a large prospective observational study suggest.

A second study showed that overweight patients with Crohn's disease have a disease course that differs from that seen in their nonoverweight counterparts, and they require surgical intervention significantly sooner after diagnosis than do those who are underweight.

The data on infliximab came from the Therapy, Resource, Evaluation, and Assessment Tool (TREAT) registry of more than 6,300 patients. Patients treated with infliximab had complications—intestinal strictures, stenosis, or obstructions—more often than did those treated with other therapies (2·1 vs. 1·2 events per 100 patient-years). But a multivariate analysis suggests that the difference was due to greater disease severity in the infliximab patients, G.R. Lichtenstein, M.D., reported at the annual meeting of the American College of Gastroenterology.

About half of the patients in the registry were treated with infliximab, and compared with those on other therapies, significantly more had moderate to severe disease (34% vs. 11%) and severe to fulminant disease (3% vs. 0·6%) at enrollment. Also, in the prior year significantly more were hospitalized (29% vs. 20%) or had surgery (19% vs. 14%). Also, significantly more infliximab patients were taking corticosteroids (28% vs. 17%) or immunomodulators (50% vs. 33%), said Dr. Lichtenstein of the University of Pennsylvania, Philadelphia.

Significant predictors of strictures, stenosis, or obstructions were moderate, severe, or fulminant disease at baseline (relative risk 1·99), disease duration (relative risk 1·03), and ileal disease (relative risk 1·87), but not prior infliximab therapy (relative risk 1·06), immunomodulator use (relative risk 1·40), or corticosteroid use (relative risk 1·62), he said.

The findings, based on more than 4,200 patient-years of follow-up for infliximab patients and more than 3,500 patient-years of follow-up for patients on other treatments, appear to debunk concerns that rapid mucosal healing with infliximab promotes strictures, stenosis, or obstructions.

The second, retrospective study included 148 Crohn's disease patients seen between 1997 and 2002, of whom 48 were overweight as defined by a body mass index of 25 kg/m2 or greater. Overweight patients were significantly older at diagnosis than those with a body mass index under 25 kg/m2 (35 years vs. 23 years). The median duration of disease at the time of the study was 213 months for the nonoverweight patients and 156 months for the overweight patients, reported David J. Hass, M.D., of the University of Pennsylvania, Philadelphia.

There were no significant differences between overweight and nonoverweight patients in time from symptom onset to disease diagnosis, number of surgeries, disease distribution, or escalation of medical therapy. But when overweight patients were compared with underweight patients (those with a body mass index less than 18·5 kg/m2), there was a significant difference in the median time to first surgery: 24 months among the overweight patients, compared with 252 months among the underweight patients.

The differences in disease course in overweight persons might be explained by the well-documented increase in TNF-α production in adipose tissue and the increased amount of adipose tissue in overweight patients. Inflammation plays a role in Crohn's disease; therefore patients who are overweight might have a more severe disease course, Dr. Haas said. The findings suggest that more aggressive therapy earlier in the disease course is indicated in those who are overweight, he added.

ORLANDO, FLA. — Results from two studies shed new light on the medical and surgical management of patients with Crohn's disease.

Infliximab and other treatments used for Crohn's disease do not cause or worsen intestinal strictures, stenosis, or obstructions, data from a large prospective observational study suggest.

A second study showed that overweight patients with Crohn's disease have a disease course that differs from that seen in their nonoverweight counterparts, and they require surgical intervention significantly sooner after diagnosis than do those who are underweight.

The data on infliximab came from the Therapy, Resource, Evaluation, and Assessment Tool (TREAT) registry of more than 6,300 patients. Patients treated with infliximab had complications—intestinal strictures, stenosis, or obstructions—more often than did those treated with other therapies (2·1 vs. 1·2 events per 100 patient-years). But a multivariate analysis suggests that the difference was due to greater disease severity in the infliximab patients, G.R. Lichtenstein, M.D., reported at the annual meeting of the American College of Gastroenterology.

About half of the patients in the registry were treated with infliximab, and compared with those on other therapies, significantly more had moderate to severe disease (34% vs. 11%) and severe to fulminant disease (3% vs. 0·6%) at enrollment. Also, in the prior year significantly more were hospitalized (29% vs. 20%) or had surgery (19% vs. 14%). Also, significantly more infliximab patients were taking corticosteroids (28% vs. 17%) or immunomodulators (50% vs. 33%), said Dr. Lichtenstein of the University of Pennsylvania, Philadelphia.

Significant predictors of strictures, stenosis, or obstructions were moderate, severe, or fulminant disease at baseline (relative risk 1·99), disease duration (relative risk 1·03), and ileal disease (relative risk 1·87), but not prior infliximab therapy (relative risk 1·06), immunomodulator use (relative risk 1·40), or corticosteroid use (relative risk 1·62), he said.

The findings, based on more than 4,200 patient-years of follow-up for infliximab patients and more than 3,500 patient-years of follow-up for patients on other treatments, appear to debunk concerns that rapid mucosal healing with infliximab promotes strictures, stenosis, or obstructions.

The second, retrospective study included 148 Crohn's disease patients seen between 1997 and 2002, of whom 48 were overweight as defined by a body mass index of 25 kg/m2 or greater. Overweight patients were significantly older at diagnosis than those with a body mass index under 25 kg/m2 (35 years vs. 23 years). The median duration of disease at the time of the study was 213 months for the nonoverweight patients and 156 months for the overweight patients, reported David J. Hass, M.D., of the University of Pennsylvania, Philadelphia.

There were no significant differences between overweight and nonoverweight patients in time from symptom onset to disease diagnosis, number of surgeries, disease distribution, or escalation of medical therapy. But when overweight patients were compared with underweight patients (those with a body mass index less than 18·5 kg/m2), there was a significant difference in the median time to first surgery: 24 months among the overweight patients, compared with 252 months among the underweight patients.

The differences in disease course in overweight persons might be explained by the well-documented increase in TNF-α production in adipose tissue and the increased amount of adipose tissue in overweight patients. Inflammation plays a role in Crohn's disease; therefore patients who are overweight might have a more severe disease course, Dr. Haas said. The findings suggest that more aggressive therapy earlier in the disease course is indicated in those who are overweight, he added.

Tamoxifen probably won't prevent many cases of breast cancer in women at risk for the disease because most are ineligible for treatment and those most likely to be eligible are the least likely to develop cancer, according to Carmen L. Lewis, M.D., of the University of North Carolina at Chapel Hill and colleagues.

Of 605 women studied, more than 90% of those found to be at risk for developing breast cancer (based on their responses to a questionnaire about their health and family history) would be ruled out for chemoprevention with tamoxifen due to the risk of adverse events such as blood clots and stroke associated with the drug, the investigators found.

Using the Gail model, they estimated that the percentage of white women in the study with an increased 5-year breast cancer risk (defined as a risk of at least 1·66%) was 9% among those in their 40s, 24% among those in their 50s, and 53% of those in their 60s. Among black women, 3% of those in their 40s, 7% of those in their 50s, and 13% of those in their 60s had this level of risk.

In a hypothetical cohort of 10,000 women similar to those in the study (calculations were made only for white women due to the small number of black women in the study) only 7% of those in their 40s, 6% of those in their 50s, and 10% of those in their 60s met the requirement for discussions about tamoxifen. It is recommended that discussion about chemoprevention take place only with those who have a high potential of benefit and a low potential of harm from using tamoxifen. Those with conditions, such as high blood pressure and diabetes, would be excluded from such discussions because of the increased risk of adverse effects.

With the same hypothetical cohort, and if it is assumed tamoxifen would result in a 49% reduction in the number of invasive breast cancers in high-risk women as demonstrated in the 1998 placebo-controlled National Surgical Adjuvant Breast and Bowel Project (NSABP) Breast Cancer Prevention Trial, a maximum of only 6%-8% of invasive cancers would be prevented (Arch. Intern. Med. 2004;164:1897-1903).

This is likely an inflated figure because it is based on the assumption that 100% of eligible women would use tamoxifen; studies have shown that 24%-40% of such women discontinue treatment, they noted.

The study, which was sponsored by the National Cancer Institute, doesn't question the drug's ability to prevent breast cancer, but does illustrate the limitations of its use for women in different age groups. For women in their 40s, the overall effect of chemoprevention is likely to be small because the proportion of breast cancers occurring in those with increased risk in this age group is small. For those in their 50s and 60s, the potentially larger number of women with increased risk for breast cancer who could benefit from chemoprevention is reduced by the increased number with a substantial likelihood of adverse effects associated with tamoxifen, the investigators explained.

The findings underscore the need for proper identification of chemoprevention candidates and for studies on how to improve the efficacy—and reduce the side effects—of chemopreventive drugs, Larry Wickerham, M.D., said in an interview.

Dr. Wickerham of the NSABP was an investigator and served as the protocol officer on the Breast Cancer Prevention Trial, which established the efficacy of tamoxifen for preventing invasive breast cancer in high-risk women.

For those who can benefit from chemoprevention with tamoxifen, the benefit is “real and impressive,” Dr. Wickerham said, stressing that the findings of the University of North Carolina study don't contradict those of the Breast Cancer Prevention Trial.

“The take-home message isn't to throw out tamoxifen—it's that clinicians should become familiar with how to identify women who can benefit from this drug,” he said.

Tamoxifen probably won't prevent many cases of breast cancer in women at risk for the disease because most are ineligible for treatment and those most likely to be eligible are the least likely to develop cancer, according to Carmen L. Lewis, M.D., of the University of North Carolina at Chapel Hill and colleagues.

Of 605 women studied, more than 90% of those found to be at risk for developing breast cancer (based on their responses to a questionnaire about their health and family history) would be ruled out for chemoprevention with tamoxifen due to the risk of adverse events such as blood clots and stroke associated with the drug, the investigators found.

Using the Gail model, they estimated that the percentage of white women in the study with an increased 5-year breast cancer risk (defined as a risk of at least 1·66%) was 9% among those in their 40s, 24% among those in their 50s, and 53% of those in their 60s. Among black women, 3% of those in their 40s, 7% of those in their 50s, and 13% of those in their 60s had this level of risk.

In a hypothetical cohort of 10,000 women similar to those in the study (calculations were made only for white women due to the small number of black women in the study) only 7% of those in their 40s, 6% of those in their 50s, and 10% of those in their 60s met the requirement for discussions about tamoxifen. It is recommended that discussion about chemoprevention take place only with those who have a high potential of benefit and a low potential of harm from using tamoxifen. Those with conditions, such as high blood pressure and diabetes, would be excluded from such discussions because of the increased risk of adverse effects.

With the same hypothetical cohort, and if it is assumed tamoxifen would result in a 49% reduction in the number of invasive breast cancers in high-risk women as demonstrated in the 1998 placebo-controlled National Surgical Adjuvant Breast and Bowel Project (NSABP) Breast Cancer Prevention Trial, a maximum of only 6%-8% of invasive cancers would be prevented (Arch. Intern. Med. 2004;164:1897-1903).

This is likely an inflated figure because it is based on the assumption that 100% of eligible women would use tamoxifen; studies have shown that 24%-40% of such women discontinue treatment, they noted.

The study, which was sponsored by the National Cancer Institute, doesn't question the drug's ability to prevent breast cancer, but does illustrate the limitations of its use for women in different age groups. For women in their 40s, the overall effect of chemoprevention is likely to be small because the proportion of breast cancers occurring in those with increased risk in this age group is small. For those in their 50s and 60s, the potentially larger number of women with increased risk for breast cancer who could benefit from chemoprevention is reduced by the increased number with a substantial likelihood of adverse effects associated with tamoxifen, the investigators explained.

The findings underscore the need for proper identification of chemoprevention candidates and for studies on how to improve the efficacy—and reduce the side effects—of chemopreventive drugs, Larry Wickerham, M.D., said in an interview.

Dr. Wickerham of the NSABP was an investigator and served as the protocol officer on the Breast Cancer Prevention Trial, which established the efficacy of tamoxifen for preventing invasive breast cancer in high-risk women.

For those who can benefit from chemoprevention with tamoxifen, the benefit is “real and impressive,” Dr. Wickerham said, stressing that the findings of the University of North Carolina study don't contradict those of the Breast Cancer Prevention Trial.

“The take-home message isn't to throw out tamoxifen—it's that clinicians should become familiar with how to identify women who can benefit from this drug,” he said.

Tamoxifen probably won't prevent many cases of breast cancer in women at risk for the disease because most are ineligible for treatment and those most likely to be eligible are the least likely to develop cancer, according to Carmen L. Lewis, M.D., of the University of North Carolina at Chapel Hill and colleagues.

Of 605 women studied, more than 90% of those found to be at risk for developing breast cancer (based on their responses to a questionnaire about their health and family history) would be ruled out for chemoprevention with tamoxifen due to the risk of adverse events such as blood clots and stroke associated with the drug, the investigators found.

Using the Gail model, they estimated that the percentage of white women in the study with an increased 5-year breast cancer risk (defined as a risk of at least 1·66%) was 9% among those in their 40s, 24% among those in their 50s, and 53% of those in their 60s. Among black women, 3% of those in their 40s, 7% of those in their 50s, and 13% of those in their 60s had this level of risk.

In a hypothetical cohort of 10,000 women similar to those in the study (calculations were made only for white women due to the small number of black women in the study) only 7% of those in their 40s, 6% of those in their 50s, and 10% of those in their 60s met the requirement for discussions about tamoxifen. It is recommended that discussion about chemoprevention take place only with those who have a high potential of benefit and a low potential of harm from using tamoxifen. Those with conditions, such as high blood pressure and diabetes, would be excluded from such discussions because of the increased risk of adverse effects.

With the same hypothetical cohort, and if it is assumed tamoxifen would result in a 49% reduction in the number of invasive breast cancers in high-risk women as demonstrated in the 1998 placebo-controlled National Surgical Adjuvant Breast and Bowel Project (NSABP) Breast Cancer Prevention Trial, a maximum of only 6%-8% of invasive cancers would be prevented (Arch. Intern. Med. 2004;164:1897-1903).

This is likely an inflated figure because it is based on the assumption that 100% of eligible women would use tamoxifen; studies have shown that 24%-40% of such women discontinue treatment, they noted.

The study, which was sponsored by the National Cancer Institute, doesn't question the drug's ability to prevent breast cancer, but does illustrate the limitations of its use for women in different age groups. For women in their 40s, the overall effect of chemoprevention is likely to be small because the proportion of breast cancers occurring in those with increased risk in this age group is small. For those in their 50s and 60s, the potentially larger number of women with increased risk for breast cancer who could benefit from chemoprevention is reduced by the increased number with a substantial likelihood of adverse effects associated with tamoxifen, the investigators explained.

The findings underscore the need for proper identification of chemoprevention candidates and for studies on how to improve the efficacy—and reduce the side effects—of chemopreventive drugs, Larry Wickerham, M.D., said in an interview.

Dr. Wickerham of the NSABP was an investigator and served as the protocol officer on the Breast Cancer Prevention Trial, which established the efficacy of tamoxifen for preventing invasive breast cancer in high-risk women.

For those who can benefit from chemoprevention with tamoxifen, the benefit is “real and impressive,” Dr. Wickerham said, stressing that the findings of the University of North Carolina study don't contradict those of the Breast Cancer Prevention Trial.

“The take-home message isn't to throw out tamoxifen—it's that clinicians should become familiar with how to identify women who can benefit from this drug,” he said.

ORLANDO, FLA. — Anorexia nervosa in males is often accompanied by compulsive exercising, which tends to be driven more by a desire for muscularity than a desire to lose weight, Theodore Weltzin, M.D., said at an international conference sponsored by the Academy for Eating Disorders.

Unlike most anorexic women with an exercise compulsion, very few men say their disease began with weight loss attempts, said Dr. Weltzin, medical director of the eating disorder programs at Rogers Memorial Hospital, Oconomowoc, Wisc.

With male patients, the focus is generally on developing upper body strength, and it often is fueled by an unrealistic desire to achieve the muscular male body type that is increasingly featured in advertisements and elsewhere in the popular media, he said during a workshop at the conference, which was cosponsored by the University of New Mexico.

Chief among the signs that a patient is exercising compulsively are following a rigid daily exercise schedule, exercising while injured, experiencing a negative mood when unable to exercise, harboring unrealistic expectations regarding exercise, and allowing exercise to take the place of other priorities.

Dr. Weltzin described a 19-year-old patient with comorbid obsessive-compulsive disorder who ran 8-10 miles twice each day, and a 45-year-old who had to exercise any time he ate.

“For this (latter) patient, the exercise was more about purging his feelings than about purging calories,” Dr. Weltzin said, explaining that through therapy, the patient pinpointed the start of his disease to high school football camp when his coach called him “fat ass.”

Treatment of male patients with a compulsive exercise component to their disease can be quite challenging.

In Dr. Weltzin's experience, there is a “higher level of intensity” in terms of the psychological withdrawal experienced by men, compared with women, who undergo treatment for eating disorders with such a compulsive exercise component.

Treatment initially requires abstinence from all exercise while eating and weight are normalized.

Noncardiovascular exercise in a controlled environment is gradually added back into the patient's routine as appropriate.

Exercise can continue to be added back to the routine as long as the amount of exercise is reasonable, the patient maintains normal nutritional status, and it is enjoyable rather than compulsive. A “health mentor” or exercise group can be helpful.

Meanwhile, the patient should be encouraged to develop nonexercise interests as well, Dr. Weltzin noted.

In males with anorexia and compulsive exercising, weight maintenance is a sign that treatment is working, he added.

Men Respond Differently to Treatment

Far less is known about eating disorders and their treatment in men than in women, but a recent pilot study looking at outcomes provides some insight.

Data from the follow-up study of 7 men and 26 women who were discharged from a residential treatment program at Rogers Memorial Hospital suggest that men are less concerned about weight loss and that they gain more weight following treatment than do women, Dr. Weltzin reported (J. Addict. Dis. 2004;23:83-94).

Men gained an average of 19 pounds during follow-up; women gained an average of 7 pounds. About 40% more women than men said their weight was too high.

Furthermore, when men were dissatisfied with their bodies, they said they should be more muscular, not thinner, Dr. Weltzin noted.

A finding that patients with a higher weight at follow-up had a higher weight at discharge was consistent with findings from another recent study, which showed that low discharge weight is a critical risk factor in eating disorder relapse, he said.

In this study, higher weight at follow-up was more likely in males than in females.

ORLANDO, FLA. — Anorexia nervosa in males is often accompanied by compulsive exercising, which tends to be driven more by a desire for muscularity than a desire to lose weight, Theodore Weltzin, M.D., said at an international conference sponsored by the Academy for Eating Disorders.

Unlike most anorexic women with an exercise compulsion, very few men say their disease began with weight loss attempts, said Dr. Weltzin, medical director of the eating disorder programs at Rogers Memorial Hospital, Oconomowoc, Wisc.

With male patients, the focus is generally on developing upper body strength, and it often is fueled by an unrealistic desire to achieve the muscular male body type that is increasingly featured in advertisements and elsewhere in the popular media, he said during a workshop at the conference, which was cosponsored by the University of New Mexico.

Chief among the signs that a patient is exercising compulsively are following a rigid daily exercise schedule, exercising while injured, experiencing a negative mood when unable to exercise, harboring unrealistic expectations regarding exercise, and allowing exercise to take the place of other priorities.

Dr. Weltzin described a 19-year-old patient with comorbid obsessive-compulsive disorder who ran 8-10 miles twice each day, and a 45-year-old who had to exercise any time he ate.

“For this (latter) patient, the exercise was more about purging his feelings than about purging calories,” Dr. Weltzin said, explaining that through therapy, the patient pinpointed the start of his disease to high school football camp when his coach called him “fat ass.”

Treatment of male patients with a compulsive exercise component to their disease can be quite challenging.

In Dr. Weltzin's experience, there is a “higher level of intensity” in terms of the psychological withdrawal experienced by men, compared with women, who undergo treatment for eating disorders with such a compulsive exercise component.

Treatment initially requires abstinence from all exercise while eating and weight are normalized.

Noncardiovascular exercise in a controlled environment is gradually added back into the patient's routine as appropriate.

Exercise can continue to be added back to the routine as long as the amount of exercise is reasonable, the patient maintains normal nutritional status, and it is enjoyable rather than compulsive. A “health mentor” or exercise group can be helpful.

Meanwhile, the patient should be encouraged to develop nonexercise interests as well, Dr. Weltzin noted.

In males with anorexia and compulsive exercising, weight maintenance is a sign that treatment is working, he added.

Men Respond Differently to Treatment

Far less is known about eating disorders and their treatment in men than in women, but a recent pilot study looking at outcomes provides some insight.

Data from the follow-up study of 7 men and 26 women who were discharged from a residential treatment program at Rogers Memorial Hospital suggest that men are less concerned about weight loss and that they gain more weight following treatment than do women, Dr. Weltzin reported (J. Addict. Dis. 2004;23:83-94).

Men gained an average of 19 pounds during follow-up; women gained an average of 7 pounds. About 40% more women than men said their weight was too high.

Furthermore, when men were dissatisfied with their bodies, they said they should be more muscular, not thinner, Dr. Weltzin noted.

A finding that patients with a higher weight at follow-up had a higher weight at discharge was consistent with findings from another recent study, which showed that low discharge weight is a critical risk factor in eating disorder relapse, he said.

In this study, higher weight at follow-up was more likely in males than in females.

ORLANDO, FLA. — Anorexia nervosa in males is often accompanied by compulsive exercising, which tends to be driven more by a desire for muscularity than a desire to lose weight, Theodore Weltzin, M.D., said at an international conference sponsored by the Academy for Eating Disorders.

Unlike most anorexic women with an exercise compulsion, very few men say their disease began with weight loss attempts, said Dr. Weltzin, medical director of the eating disorder programs at Rogers Memorial Hospital, Oconomowoc, Wisc.

With male patients, the focus is generally on developing upper body strength, and it often is fueled by an unrealistic desire to achieve the muscular male body type that is increasingly featured in advertisements and elsewhere in the popular media, he said during a workshop at the conference, which was cosponsored by the University of New Mexico.

Chief among the signs that a patient is exercising compulsively are following a rigid daily exercise schedule, exercising while injured, experiencing a negative mood when unable to exercise, harboring unrealistic expectations regarding exercise, and allowing exercise to take the place of other priorities.

Dr. Weltzin described a 19-year-old patient with comorbid obsessive-compulsive disorder who ran 8-10 miles twice each day, and a 45-year-old who had to exercise any time he ate.

“For this (latter) patient, the exercise was more about purging his feelings than about purging calories,” Dr. Weltzin said, explaining that through therapy, the patient pinpointed the start of his disease to high school football camp when his coach called him “fat ass.”

Treatment of male patients with a compulsive exercise component to their disease can be quite challenging.

In Dr. Weltzin's experience, there is a “higher level of intensity” in terms of the psychological withdrawal experienced by men, compared with women, who undergo treatment for eating disorders with such a compulsive exercise component.

Treatment initially requires abstinence from all exercise while eating and weight are normalized.

Noncardiovascular exercise in a controlled environment is gradually added back into the patient's routine as appropriate.

Exercise can continue to be added back to the routine as long as the amount of exercise is reasonable, the patient maintains normal nutritional status, and it is enjoyable rather than compulsive. A “health mentor” or exercise group can be helpful.

Meanwhile, the patient should be encouraged to develop nonexercise interests as well, Dr. Weltzin noted.

In males with anorexia and compulsive exercising, weight maintenance is a sign that treatment is working, he added.

Men Respond Differently to Treatment

Far less is known about eating disorders and their treatment in men than in women, but a recent pilot study looking at outcomes provides some insight.

Data from the follow-up study of 7 men and 26 women who were discharged from a residential treatment program at Rogers Memorial Hospital suggest that men are less concerned about weight loss and that they gain more weight following treatment than do women, Dr. Weltzin reported (J. Addict. Dis. 2004;23:83-94).

Men gained an average of 19 pounds during follow-up; women gained an average of 7 pounds. About 40% more women than men said their weight was too high.

Furthermore, when men were dissatisfied with their bodies, they said they should be more muscular, not thinner, Dr. Weltzin noted.

A finding that patients with a higher weight at follow-up had a higher weight at discharge was consistent with findings from another recent study, which showed that low discharge weight is a critical risk factor in eating disorder relapse, he said.

In this study, higher weight at follow-up was more likely in males than in females.

ORLANDO, FLA. — Maternal obesity and depression play a significant role in the long-term recovery of patients with bulimia nervosa, Aimee J. Arikian reported at an international conference sponsored by the Academy for Eating Disorders.

In a follow-up study of 95 women with bulimia who were previously involved in a randomized controlled study of imipramine and cognitive-behavioral therapy, maternal obesity—defined as the obesity of the patients' mothers—was shown to be associated with reduced symptoms.

Severe maternal depression was shown to be an independent predictor of continued bingeing and purging symptoms at up to 10 years follow-up, said Ms. Arikian, community program assistant at the University of Minnesota, Minneapolis.

The presence of a lifetime affective disorder in the patient was also an independent predictor of continued bingeing and purging symptoms, she noted at the conference, cosponsored by the University of New Mexico.

Patients included in the initial study all had at least three weekly episodes of bingeing and purging for the previous 6 months. They completed a baseline questionnaire on family medical and psychiatric history, which revealed rates of maternal psychopathology as follows: 2·1% had an eating disorder, 6·3% were substance abusers, and 7·4% had severe depression. In addition, 12·7% of mothers were obese.

This rare, systematic assessment of parental pathology in eating disordered patients highlights the importance of maternal characteristics in recovery from bulimia, independent of patient psychopathology, Ms. Arikian said.

ORLANDO, FLA. — Maternal obesity and depression play a significant role in the long-term recovery of patients with bulimia nervosa, Aimee J. Arikian reported at an international conference sponsored by the Academy for Eating Disorders.

In a follow-up study of 95 women with bulimia who were previously involved in a randomized controlled study of imipramine and cognitive-behavioral therapy, maternal obesity—defined as the obesity of the patients' mothers—was shown to be associated with reduced symptoms.

Severe maternal depression was shown to be an independent predictor of continued bingeing and purging symptoms at up to 10 years follow-up, said Ms. Arikian, community program assistant at the University of Minnesota, Minneapolis.

The presence of a lifetime affective disorder in the patient was also an independent predictor of continued bingeing and purging symptoms, she noted at the conference, cosponsored by the University of New Mexico.

Patients included in the initial study all had at least three weekly episodes of bingeing and purging for the previous 6 months. They completed a baseline questionnaire on family medical and psychiatric history, which revealed rates of maternal psychopathology as follows: 2·1% had an eating disorder, 6·3% were substance abusers, and 7·4% had severe depression. In addition, 12·7% of mothers were obese.

This rare, systematic assessment of parental pathology in eating disordered patients highlights the importance of maternal characteristics in recovery from bulimia, independent of patient psychopathology, Ms. Arikian said.

ORLANDO, FLA. — Maternal obesity and depression play a significant role in the long-term recovery of patients with bulimia nervosa, Aimee J. Arikian reported at an international conference sponsored by the Academy for Eating Disorders.

In a follow-up study of 95 women with bulimia who were previously involved in a randomized controlled study of imipramine and cognitive-behavioral therapy, maternal obesity—defined as the obesity of the patients' mothers—was shown to be associated with reduced symptoms.

Severe maternal depression was shown to be an independent predictor of continued bingeing and purging symptoms at up to 10 years follow-up, said Ms. Arikian, community program assistant at the University of Minnesota, Minneapolis.

The presence of a lifetime affective disorder in the patient was also an independent predictor of continued bingeing and purging symptoms, she noted at the conference, cosponsored by the University of New Mexico.

Patients included in the initial study all had at least three weekly episodes of bingeing and purging for the previous 6 months. They completed a baseline questionnaire on family medical and psychiatric history, which revealed rates of maternal psychopathology as follows: 2·1% had an eating disorder, 6·3% were substance abusers, and 7·4% had severe depression. In addition, 12·7% of mothers were obese.

This rare, systematic assessment of parental pathology in eating disordered patients highlights the importance of maternal characteristics in recovery from bulimia, independent of patient psychopathology, Ms. Arikian said.

Daily treatment may be superior to the standard three-times-weekly treatment for preventing early relapse in tuberculosis patients.

In a nested case-control study of 12,183 patients with pulmonary tuberculosis who completed treatment in 1 year, the overall 30-month relapse rate was 0.9%. The rate in those treated three times weekly was increased, compared with the rate in those treated daily (odds ratio 3.92), reported Kwok C. Chang, M.D., of Grantham Hospital, Hong Kong, and colleagues.

The investigators also found that prolonging intensive-phase treatment and overall treatment by at least 50% reduced the relapse rate (odds ratio 0.24). They found significant associations between relapse and each of the following: extensive disease on chest radiograph, presence of conditions associated with active tuberculosis (such as diabetes), and coexisting tuberculosis lymphadenitis (Am. J. Respir. Crit. Care Med. 2004;170:1124-30).

Standard dosing might be cost effective in those without cavitation on initial radiograph, but further research to determine the best treatment strategy in other settings is warranted, they said.

Daily treatment may be superior to the standard three-times-weekly treatment for preventing early relapse in tuberculosis patients.

In a nested case-control study of 12,183 patients with pulmonary tuberculosis who completed treatment in 1 year, the overall 30-month relapse rate was 0.9%. The rate in those treated three times weekly was increased, compared with the rate in those treated daily (odds ratio 3.92), reported Kwok C. Chang, M.D., of Grantham Hospital, Hong Kong, and colleagues.

The investigators also found that prolonging intensive-phase treatment and overall treatment by at least 50% reduced the relapse rate (odds ratio 0.24). They found significant associations between relapse and each of the following: extensive disease on chest radiograph, presence of conditions associated with active tuberculosis (such as diabetes), and coexisting tuberculosis lymphadenitis (Am. J. Respir. Crit. Care Med. 2004;170:1124-30).

Standard dosing might be cost effective in those without cavitation on initial radiograph, but further research to determine the best treatment strategy in other settings is warranted, they said.

Daily treatment may be superior to the standard three-times-weekly treatment for preventing early relapse in tuberculosis patients.

In a nested case-control study of 12,183 patients with pulmonary tuberculosis who completed treatment in 1 year, the overall 30-month relapse rate was 0.9%. The rate in those treated three times weekly was increased, compared with the rate in those treated daily (odds ratio 3.92), reported Kwok C. Chang, M.D., of Grantham Hospital, Hong Kong, and colleagues.

The investigators also found that prolonging intensive-phase treatment and overall treatment by at least 50% reduced the relapse rate (odds ratio 0.24). They found significant associations between relapse and each of the following: extensive disease on chest radiograph, presence of conditions associated with active tuberculosis (such as diabetes), and coexisting tuberculosis lymphadenitis (Am. J. Respir. Crit. Care Med. 2004;170:1124-30).

Standard dosing might be cost effective in those without cavitation on initial radiograph, but further research to determine the best treatment strategy in other settings is warranted, they said.

ATLANTA — Better cardiac disease awareness and prevention programs that target younger women are needed, according to at least two studies presented at a prevention conference on heart disease and stroke sponsored by the Centers for Disease Control and Prevention.

In one study, risk factors for cardiac disease were common among women aged 34-64 years presenting with myocardial infarction. Of 50 such women, with a mean age of 54 years, 18% had 1-3 risk factors, 42% had 4-6 risk factors, and 40% had 7-10 risk factors, Lucia Kamm-Steigelman, Ph.D., and colleagues at Emory University, Atlanta, reported in a poster.

Risk factors included menopause (78% of patients), family history of coronary artery disease (80%), previous diagnosis of coronary artery disease (38%), diabetes (44%), hypertension (64%), hyperlipidemia (56%), moderate depression (36%), lack of exercise (76%), body mass index over 24 kg/m2 (68%), and current smoking (58%).

Public health and clinical prevention programs are clearly needed in this population, the investigators concluded.

Aparna Sunderam, D.O., and colleagues from the CDC analyzed data from the Behavioral Risk Factor Surveillance System and came to a similar conclusion.

Of 28,271 women under age 65 who took part in the state-based telephone survey, 739 white women and 118 black women reported having heart disease.

Among those with reported heart disease, 44% of white women and 56% of black women had two or more risk factors for coronary heart disease, including hypertension (86% of blacks; 57% of whites), overweight status (63% of blacks; 33% of whites), sedentary lifestyle (50% of blacks; 40% of whites), and high cholesterol (53% of blacks; 56% of whites).

ATLANTA — Better cardiac disease awareness and prevention programs that target younger women are needed, according to at least two studies presented at a prevention conference on heart disease and stroke sponsored by the Centers for Disease Control and Prevention.

In one study, risk factors for cardiac disease were common among women aged 34-64 years presenting with myocardial infarction. Of 50 such women, with a mean age of 54 years, 18% had 1-3 risk factors, 42% had 4-6 risk factors, and 40% had 7-10 risk factors, Lucia Kamm-Steigelman, Ph.D., and colleagues at Emory University, Atlanta, reported in a poster.

Risk factors included menopause (78% of patients), family history of coronary artery disease (80%), previous diagnosis of coronary artery disease (38%), diabetes (44%), hypertension (64%), hyperlipidemia (56%), moderate depression (36%), lack of exercise (76%), body mass index over 24 kg/m2 (68%), and current smoking (58%).

Public health and clinical prevention programs are clearly needed in this population, the investigators concluded.

Aparna Sunderam, D.O., and colleagues from the CDC analyzed data from the Behavioral Risk Factor Surveillance System and came to a similar conclusion.

Of 28,271 women under age 65 who took part in the state-based telephone survey, 739 white women and 118 black women reported having heart disease.

Among those with reported heart disease, 44% of white women and 56% of black women had two or more risk factors for coronary heart disease, including hypertension (86% of blacks; 57% of whites), overweight status (63% of blacks; 33% of whites), sedentary lifestyle (50% of blacks; 40% of whites), and high cholesterol (53% of blacks; 56% of whites).

ATLANTA — Better cardiac disease awareness and prevention programs that target younger women are needed, according to at least two studies presented at a prevention conference on heart disease and stroke sponsored by the Centers for Disease Control and Prevention.

In one study, risk factors for cardiac disease were common among women aged 34-64 years presenting with myocardial infarction. Of 50 such women, with a mean age of 54 years, 18% had 1-3 risk factors, 42% had 4-6 risk factors, and 40% had 7-10 risk factors, Lucia Kamm-Steigelman, Ph.D., and colleagues at Emory University, Atlanta, reported in a poster.

Risk factors included menopause (78% of patients), family history of coronary artery disease (80%), previous diagnosis of coronary artery disease (38%), diabetes (44%), hypertension (64%), hyperlipidemia (56%), moderate depression (36%), lack of exercise (76%), body mass index over 24 kg/m2 (68%), and current smoking (58%).

Public health and clinical prevention programs are clearly needed in this population, the investigators concluded.

Aparna Sunderam, D.O., and colleagues from the CDC analyzed data from the Behavioral Risk Factor Surveillance System and came to a similar conclusion.

Of 28,271 women under age 65 who took part in the state-based telephone survey, 739 white women and 118 black women reported having heart disease.

Among those with reported heart disease, 44% of white women and 56% of black women had two or more risk factors for coronary heart disease, including hypertension (86% of blacks; 57% of whites), overweight status (63% of blacks; 33% of whites), sedentary lifestyle (50% of blacks; 40% of whites), and high cholesterol (53% of blacks; 56% of whites).

Bottled Water Not So Safe

Bacteria or fungi were found in 40% of bottled water samples in a recent study.

A total of 70 samples from 16 different countries were tested; 68 were commercial bottled mineral water, 1 was tap water, and 1 was water from a natural well, Rocus R. Klont, M.D., reported in a poster at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy in Washington.

“We found high levels of bacterial contamination in commercially bottled mineral water,” said Dr. Klont of University Medical Center, Nijmegen, the Netherlands.

The findings debunk the common belief that bottled water is purer than tap water—an important finding, because hospitals are increasingly providing bottled water to immunocompromised patients, he said.

Bacteria, including coagulase-negative staphylococci, nonfermenters, or gram-positive rods, grew from 21 samples. Legionella pneumophila DNA was detected in six samples, and Legionella antigen was detected in six samples, but only two of these were antigen- and polymerase chain reaction-positive. Fungi, including penicillium or nonspeciated fungi, grew from three samples, Dr. Klont said.

Endometritis and BV Linked

Bacterial vaginosis-associated organisms found frequently in women with pelvic inflammatory disease also were strongly associated with endometritis, Catherine L. Haggerty, Ph.D., of the University of Pittsburgh and her colleagues reported.

The investigators looked at associations between endometritis and Neisseria gonorrhoeae, Chlamydia trachomatis, anaerobic bacteria, facultative bacteria, lactobacilli, and bacterial vaginosis (BV) in 278 women from the PID Evaluation and Clinical Health Study. Those with acute endometritis were more likely to be infected with C. trachomatis (odds ratio [OR] 16.2), N. gonorrhoeae (OR 11.6), diphtheroids (OR 5.0), black-pigmented gram-negative rods (OR 3.1), and anaerobic gram-positive cocci (OR 2.1) (Clin. Infect. Dis. 2004:39;990-5).

The associations between acute endometritis and black-pigmented gram-negative rods, anaerobic gram-positive cocci, and BV remained significant after excluding the 41% of women infected with N. gonorrhoeae and/or C. trachomatis. Treatment in most PID patients is directed at N. gonorrhoeae and C. trachomatis, but these account for fewer than half of all cases. The frequency of BV-associated organisms in PID patients suggests that treatment with a regimen containing metronidazole to improve anaerobic coverage is warranted, the investigators said.

GBS Risk After Flu Vaccine

Guillain-Barré syndrome remains the neurologic condition most frequently reported following influenza vaccination in the United States, but the number of reported cases has declined significantly since 1990, Penina Haber, Ph.D., of the Centers for Disease Control and Prevention and colleagues reported.

The annual reporting rate for Guillain-Barré syndrome (GBS) decreased significantly from 0.17/100,000 at its high in 1993-1994 to 0.04/100,000 in 2002-2003. The onset interval (median 13 days) and the low prevalence of preexisting illnesses (seen in 24% of cases) suggest a possible causal relationship between flu vaccine and GBS, they said (JAMA 2004:292;2478-81).

They noted that the flu vaccine is typically made from chicken eggs, and campylobacter—known to cause GBS—is endemic among chickens. The decline in GBS cases coincided with stepped-up food safety interventions that led to a 28% decrease in campylobacter infections. During about the same time frame, there was a decline in GBS hospital discharges in the U.S. from 3.1 to 2.5 per 100,000 population.

Additional research is needed to explore the relationship between GBS and influenza vaccine, the investigators said.

Pertussis Vaccine Urged

Adolescents and certain adults should be vaccinated against Bordetella pertussis to better protect infants from this deadly organism, the Global Pertussis Initiative has said.

A vaccine suitable for booster vaccination in these groups was developed about 5 years ago, reported Kevin Forsyth, M.D., of Flinders University, Adelaide, Australia, and his colleagues.

Such vaccinations could help prevent transmission of the infection—commonly known as whooping cough—to infants, they said (Clin. Infect. Dis. 2004;39:1802-9). About 300,000 people worldwide die each year from whooping cough; most are infants who have not yet completed their primary vaccination series.

Pertussis infections are increasing due to loss of immunity in previously vaccinated adolescents and adults who haven't received booster shots. Among the immediate goals for improving immunity are universal adolescent vaccination and vaccination of adult target groups, including parents and other close contacts of newborns.

Bottled Water Not So Safe

Bacteria or fungi were found in 40% of bottled water samples in a recent study.

A total of 70 samples from 16 different countries were tested; 68 were commercial bottled mineral water, 1 was tap water, and 1 was water from a natural well, Rocus R. Klont, M.D., reported in a poster at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy in Washington.

“We found high levels of bacterial contamination in commercially bottled mineral water,” said Dr. Klont of University Medical Center, Nijmegen, the Netherlands.

The findings debunk the common belief that bottled water is purer than tap water—an important finding, because hospitals are increasingly providing bottled water to immunocompromised patients, he said.

Bacteria, including coagulase-negative staphylococci, nonfermenters, or gram-positive rods, grew from 21 samples. Legionella pneumophila DNA was detected in six samples, and Legionella antigen was detected in six samples, but only two of these were antigen- and polymerase chain reaction-positive. Fungi, including penicillium or nonspeciated fungi, grew from three samples, Dr. Klont said.

Endometritis and BV Linked

Bacterial vaginosis-associated organisms found frequently in women with pelvic inflammatory disease also were strongly associated with endometritis, Catherine L. Haggerty, Ph.D., of the University of Pittsburgh and her colleagues reported.

The investigators looked at associations between endometritis and Neisseria gonorrhoeae, Chlamydia trachomatis, anaerobic bacteria, facultative bacteria, lactobacilli, and bacterial vaginosis (BV) in 278 women from the PID Evaluation and Clinical Health Study. Those with acute endometritis were more likely to be infected with C. trachomatis (odds ratio [OR] 16.2), N. gonorrhoeae (OR 11.6), diphtheroids (OR 5.0), black-pigmented gram-negative rods (OR 3.1), and anaerobic gram-positive cocci (OR 2.1) (Clin. Infect. Dis. 2004:39;990-5).

The associations between acute endometritis and black-pigmented gram-negative rods, anaerobic gram-positive cocci, and BV remained significant after excluding the 41% of women infected with N. gonorrhoeae and/or C. trachomatis. Treatment in most PID patients is directed at N. gonorrhoeae and C. trachomatis, but these account for fewer than half of all cases. The frequency of BV-associated organisms in PID patients suggests that treatment with a regimen containing metronidazole to improve anaerobic coverage is warranted, the investigators said.

GBS Risk After Flu Vaccine

Guillain-Barré syndrome remains the neurologic condition most frequently reported following influenza vaccination in the United States, but the number of reported cases has declined significantly since 1990, Penina Haber, Ph.D., of the Centers for Disease Control and Prevention and colleagues reported.

The annual reporting rate for Guillain-Barré syndrome (GBS) decreased significantly from 0.17/100,000 at its high in 1993-1994 to 0.04/100,000 in 2002-2003. The onset interval (median 13 days) and the low prevalence of preexisting illnesses (seen in 24% of cases) suggest a possible causal relationship between flu vaccine and GBS, they said (JAMA 2004:292;2478-81).

They noted that the flu vaccine is typically made from chicken eggs, and campylobacter—known to cause GBS—is endemic among chickens. The decline in GBS cases coincided with stepped-up food safety interventions that led to a 28% decrease in campylobacter infections. During about the same time frame, there was a decline in GBS hospital discharges in the U.S. from 3.1 to 2.5 per 100,000 population.

Additional research is needed to explore the relationship between GBS and influenza vaccine, the investigators said.

Pertussis Vaccine Urged

Adolescents and certain adults should be vaccinated against Bordetella pertussis to better protect infants from this deadly organism, the Global Pertussis Initiative has said.

A vaccine suitable for booster vaccination in these groups was developed about 5 years ago, reported Kevin Forsyth, M.D., of Flinders University, Adelaide, Australia, and his colleagues.

Such vaccinations could help prevent transmission of the infection—commonly known as whooping cough—to infants, they said (Clin. Infect. Dis. 2004;39:1802-9). About 300,000 people worldwide die each year from whooping cough; most are infants who have not yet completed their primary vaccination series.

Pertussis infections are increasing due to loss of immunity in previously vaccinated adolescents and adults who haven't received booster shots. Among the immediate goals for improving immunity are universal adolescent vaccination and vaccination of adult target groups, including parents and other close contacts of newborns.

Bottled Water Not So Safe

Bacteria or fungi were found in 40% of bottled water samples in a recent study.

A total of 70 samples from 16 different countries were tested; 68 were commercial bottled mineral water, 1 was tap water, and 1 was water from a natural well, Rocus R. Klont, M.D., reported in a poster at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy in Washington.

“We found high levels of bacterial contamination in commercially bottled mineral water,” said Dr. Klont of University Medical Center, Nijmegen, the Netherlands.

The findings debunk the common belief that bottled water is purer than tap water—an important finding, because hospitals are increasingly providing bottled water to immunocompromised patients, he said.

Bacteria, including coagulase-negative staphylococci, nonfermenters, or gram-positive rods, grew from 21 samples. Legionella pneumophila DNA was detected in six samples, and Legionella antigen was detected in six samples, but only two of these were antigen- and polymerase chain reaction-positive. Fungi, including penicillium or nonspeciated fungi, grew from three samples, Dr. Klont said.

Endometritis and BV Linked

Bacterial vaginosis-associated organisms found frequently in women with pelvic inflammatory disease also were strongly associated with endometritis, Catherine L. Haggerty, Ph.D., of the University of Pittsburgh and her colleagues reported.

The investigators looked at associations between endometritis and Neisseria gonorrhoeae, Chlamydia trachomatis, anaerobic bacteria, facultative bacteria, lactobacilli, and bacterial vaginosis (BV) in 278 women from the PID Evaluation and Clinical Health Study. Those with acute endometritis were more likely to be infected with C. trachomatis (odds ratio [OR] 16.2), N. gonorrhoeae (OR 11.6), diphtheroids (OR 5.0), black-pigmented gram-negative rods (OR 3.1), and anaerobic gram-positive cocci (OR 2.1) (Clin. Infect. Dis. 2004:39;990-5).

The associations between acute endometritis and black-pigmented gram-negative rods, anaerobic gram-positive cocci, and BV remained significant after excluding the 41% of women infected with N. gonorrhoeae and/or C. trachomatis. Treatment in most PID patients is directed at N. gonorrhoeae and C. trachomatis, but these account for fewer than half of all cases. The frequency of BV-associated organisms in PID patients suggests that treatment with a regimen containing metronidazole to improve anaerobic coverage is warranted, the investigators said.

GBS Risk After Flu Vaccine

Guillain-Barré syndrome remains the neurologic condition most frequently reported following influenza vaccination in the United States, but the number of reported cases has declined significantly since 1990, Penina Haber, Ph.D., of the Centers for Disease Control and Prevention and colleagues reported.

The annual reporting rate for Guillain-Barré syndrome (GBS) decreased significantly from 0.17/100,000 at its high in 1993-1994 to 0.04/100,000 in 2002-2003. The onset interval (median 13 days) and the low prevalence of preexisting illnesses (seen in 24% of cases) suggest a possible causal relationship between flu vaccine and GBS, they said (JAMA 2004:292;2478-81).

They noted that the flu vaccine is typically made from chicken eggs, and campylobacter—known to cause GBS—is endemic among chickens. The decline in GBS cases coincided with stepped-up food safety interventions that led to a 28% decrease in campylobacter infections. During about the same time frame, there was a decline in GBS hospital discharges in the U.S. from 3.1 to 2.5 per 100,000 population.

Additional research is needed to explore the relationship between GBS and influenza vaccine, the investigators said.

Pertussis Vaccine Urged

Adolescents and certain adults should be vaccinated against Bordetella pertussis to better protect infants from this deadly organism, the Global Pertussis Initiative has said.

A vaccine suitable for booster vaccination in these groups was developed about 5 years ago, reported Kevin Forsyth, M.D., of Flinders University, Adelaide, Australia, and his colleagues.

Such vaccinations could help prevent transmission of the infection—commonly known as whooping cough—to infants, they said (Clin. Infect. Dis. 2004;39:1802-9). About 300,000 people worldwide die each year from whooping cough; most are infants who have not yet completed their primary vaccination series.

Pertussis infections are increasing due to loss of immunity in previously vaccinated adolescents and adults who haven't received booster shots. Among the immediate goals for improving immunity are universal adolescent vaccination and vaccination of adult target groups, including parents and other close contacts of newborns.