Doug Brunk

LA JOLLA, CALIF. — A 5.5-mm diameter cannulated screw was just as effective as a 4.5-mm diameter screw for fixation of fifth metatarsal Jones fractures, Dr. David Allen Porter reported at the annual meeting of the American Orthopaedic Foot and Ankle Society.

However, it remains unclear whether the wider screw is more effective for this type of fracture, which commonly occurs in competitive athletes.

Dr. Porter, an orthopedic surgeon with Indianapolis-based Methodist Sports Medical Center, and his associates evaluated 20 patients with fifth metatarsal Jones fractures who were treated postoperatively with a 5.5-mm stainless steel cannulated screw. They compared the outcomes with those previously reported by the researchers in a study of similar athletes fixed with a 4.5-mm stainless steel cannulated screw.

The athletes in the current study were rehabilitated in a walking boot with crutches before being transferred to a custom shoe insert. Subjective pain and function were measured in terms of the American Academy of Orthopaedic Surgeons foot and ankle outcomes questionnaire, which includes a 100-point scale for pain and a 100-point scale for function.

All but one athlete, who had an unrelated back injury, returned to sports participation in an average of 9.5 weeks after fixation.

The researchers determined clinical and radiographic evaluations at final follow-up, which was 22.5 months on average. All patients had complete clinical healing. Based on assessment of oblique and lateral images of the foot by an independent radiologist, injuries were healed in 97% of all patients. The mean subjective pain score was 97, and the mean function score was 97.

Dr. Porter said that to date none of the 5.5-mm screws has bent, broken, or had to be removed. One patient had slight penetration of the cortex at surgery, but that healed with no adverse events.

When the researchers compared the findings with those of the previous study, in which patients underwent fixation with the 4.5-mm screw, clinical and radiographic healing rates were similar, as was the time it took to return to competition.

One significant difference between the two groups was screw length. The average length of the 4.5-mm screw was 52.4 mm, compared with 48.2 mm for the 5.5-mm screw.

“There's a higher rate of bending with the 4.5-mm screw and a higher rate of bone penetration with the 5.5-mm screw,” Dr. Porter said.

Fixation with a 5.5-mm cannulated screw resulted in 100% healing at 3 months. Courtesy Dr. David Allen Porter

LA JOLLA, CALIF. — A 5.5-mm diameter cannulated screw was just as effective as a 4.5-mm diameter screw for fixation of fifth metatarsal Jones fractures, Dr. David Allen Porter reported at the annual meeting of the American Orthopaedic Foot and Ankle Society.

However, it remains unclear whether the wider screw is more effective for this type of fracture, which commonly occurs in competitive athletes.

Dr. Porter, an orthopedic surgeon with Indianapolis-based Methodist Sports Medical Center, and his associates evaluated 20 patients with fifth metatarsal Jones fractures who were treated postoperatively with a 5.5-mm stainless steel cannulated screw. They compared the outcomes with those previously reported by the researchers in a study of similar athletes fixed with a 4.5-mm stainless steel cannulated screw.

The athletes in the current study were rehabilitated in a walking boot with crutches before being transferred to a custom shoe insert. Subjective pain and function were measured in terms of the American Academy of Orthopaedic Surgeons foot and ankle outcomes questionnaire, which includes a 100-point scale for pain and a 100-point scale for function.

All but one athlete, who had an unrelated back injury, returned to sports participation in an average of 9.5 weeks after fixation.

The researchers determined clinical and radiographic evaluations at final follow-up, which was 22.5 months on average. All patients had complete clinical healing. Based on assessment of oblique and lateral images of the foot by an independent radiologist, injuries were healed in 97% of all patients. The mean subjective pain score was 97, and the mean function score was 97.

Dr. Porter said that to date none of the 5.5-mm screws has bent, broken, or had to be removed. One patient had slight penetration of the cortex at surgery, but that healed with no adverse events.

When the researchers compared the findings with those of the previous study, in which patients underwent fixation with the 4.5-mm screw, clinical and radiographic healing rates were similar, as was the time it took to return to competition.

One significant difference between the two groups was screw length. The average length of the 4.5-mm screw was 52.4 mm, compared with 48.2 mm for the 5.5-mm screw.

“There's a higher rate of bending with the 4.5-mm screw and a higher rate of bone penetration with the 5.5-mm screw,” Dr. Porter said.

Fixation with a 5.5-mm cannulated screw resulted in 100% healing at 3 months. Courtesy Dr. David Allen Porter

LA JOLLA, CALIF. — A 5.5-mm diameter cannulated screw was just as effective as a 4.5-mm diameter screw for fixation of fifth metatarsal Jones fractures, Dr. David Allen Porter reported at the annual meeting of the American Orthopaedic Foot and Ankle Society.

However, it remains unclear whether the wider screw is more effective for this type of fracture, which commonly occurs in competitive athletes.

Dr. Porter, an orthopedic surgeon with Indianapolis-based Methodist Sports Medical Center, and his associates evaluated 20 patients with fifth metatarsal Jones fractures who were treated postoperatively with a 5.5-mm stainless steel cannulated screw. They compared the outcomes with those previously reported by the researchers in a study of similar athletes fixed with a 4.5-mm stainless steel cannulated screw.

The athletes in the current study were rehabilitated in a walking boot with crutches before being transferred to a custom shoe insert. Subjective pain and function were measured in terms of the American Academy of Orthopaedic Surgeons foot and ankle outcomes questionnaire, which includes a 100-point scale for pain and a 100-point scale for function.

All but one athlete, who had an unrelated back injury, returned to sports participation in an average of 9.5 weeks after fixation.

The researchers determined clinical and radiographic evaluations at final follow-up, which was 22.5 months on average. All patients had complete clinical healing. Based on assessment of oblique and lateral images of the foot by an independent radiologist, injuries were healed in 97% of all patients. The mean subjective pain score was 97, and the mean function score was 97.

Dr. Porter said that to date none of the 5.5-mm screws has bent, broken, or had to be removed. One patient had slight penetration of the cortex at surgery, but that healed with no adverse events.

When the researchers compared the findings with those of the previous study, in which patients underwent fixation with the 4.5-mm screw, clinical and radiographic healing rates were similar, as was the time it took to return to competition.

One significant difference between the two groups was screw length. The average length of the 4.5-mm screw was 52.4 mm, compared with 48.2 mm for the 5.5-mm screw.

“There's a higher rate of bending with the 4.5-mm screw and a higher rate of bone penetration with the 5.5-mm screw,” Dr. Porter said.

Fixation with a 5.5-mm cannulated screw resulted in 100% healing at 3 months. Courtesy Dr. David Allen Porter

LOS ANGELES — After 6 months of treatment with tegaserod, patients with irritable bowel syndrome increased their work productivity by an average of more than 3 hours per week compared with those who did not take the drug.

Tegaserod users also showed a significant decrease in daily activity impairment compared with those who did not take the drug, Dr. Pierre Paré reported in a poster session at the annual Digestive Disease Week.

“We've known for a long time that the efficacy of this drug is demonstrated,” Dr. Paré, of the division of gastroenterology at St.-Sacrement Hospital, Quebec City, said in an interview. But this marks the first study of IBS patients in a usual care setting to show that tegaserod positively affects work productivity and daily activities.

He and his associates enrolled 1,372 patients with IBS symptoms from 147 medical practice sites across Canada. Most were family practice sites.

The researchers collected clinical and patient-reported outcomes at baseline and at months 1, 3, and 6. They used the Work Productivity and Activity Questionnaire (WPAI) for IBS to measure work activity. This questionnaire measures absenteeism, presenteeism, work productivity loss, and activity impairment resulting from IBS symptoms.

Dr. Paré reported that the mean age of the patients was 46 years, the mean length of disease duration was 12 years, and most of the patients (86%) were female.

Of the entire group, 360 patients were tegaserod users and 1,012 were not. At baseline, a similar portion of patients in each group was employed (61% of tegaserod users vs. 60% of nonusers).

By month 6, tegaserod users showed larger but nonsignificant improvements compared with nonusers on these aspects of the WPAI: absenteeism (3%), presenteeism (8%), and overall productivity impairment (8%). However, tegaserod users did show a significant improvement on the WPAI component of daily activity impairment (12%) compared with nonusers.

Using a 40-hour work week as an average, the researchers estimated that tegaserod users reduced productivity loss by an average of 3.3 hours per week compared with nonusers. In Canada, this translates into a societal savings of about $65 per tegaserod user per week, Dr. Paré said. In the United States, he estimated that the savings would be about $53 per tegaserod user per week.

A key limitation of the study, he added, was its nonrandomized design. Also, “we don't have data on outcome of clinical symptoms,” he said.

Year-long follow-up data on these patients should be available soon.

The study, which earned a “poster of distinction” designation from the meeting organizers, was funded by Novartis Pharma AG in Basel, Switzerland.

LOS ANGELES — After 6 months of treatment with tegaserod, patients with irritable bowel syndrome increased their work productivity by an average of more than 3 hours per week compared with those who did not take the drug.

Tegaserod users also showed a significant decrease in daily activity impairment compared with those who did not take the drug, Dr. Pierre Paré reported in a poster session at the annual Digestive Disease Week.

“We've known for a long time that the efficacy of this drug is demonstrated,” Dr. Paré, of the division of gastroenterology at St.-Sacrement Hospital, Quebec City, said in an interview. But this marks the first study of IBS patients in a usual care setting to show that tegaserod positively affects work productivity and daily activities.

He and his associates enrolled 1,372 patients with IBS symptoms from 147 medical practice sites across Canada. Most were family practice sites.

The researchers collected clinical and patient-reported outcomes at baseline and at months 1, 3, and 6. They used the Work Productivity and Activity Questionnaire (WPAI) for IBS to measure work activity. This questionnaire measures absenteeism, presenteeism, work productivity loss, and activity impairment resulting from IBS symptoms.

Dr. Paré reported that the mean age of the patients was 46 years, the mean length of disease duration was 12 years, and most of the patients (86%) were female.

Of the entire group, 360 patients were tegaserod users and 1,012 were not. At baseline, a similar portion of patients in each group was employed (61% of tegaserod users vs. 60% of nonusers).

By month 6, tegaserod users showed larger but nonsignificant improvements compared with nonusers on these aspects of the WPAI: absenteeism (3%), presenteeism (8%), and overall productivity impairment (8%). However, tegaserod users did show a significant improvement on the WPAI component of daily activity impairment (12%) compared with nonusers.

Using a 40-hour work week as an average, the researchers estimated that tegaserod users reduced productivity loss by an average of 3.3 hours per week compared with nonusers. In Canada, this translates into a societal savings of about $65 per tegaserod user per week, Dr. Paré said. In the United States, he estimated that the savings would be about $53 per tegaserod user per week.

A key limitation of the study, he added, was its nonrandomized design. Also, “we don't have data on outcome of clinical symptoms,” he said.

Year-long follow-up data on these patients should be available soon.

The study, which earned a “poster of distinction” designation from the meeting organizers, was funded by Novartis Pharma AG in Basel, Switzerland.

LOS ANGELES — After 6 months of treatment with tegaserod, patients with irritable bowel syndrome increased their work productivity by an average of more than 3 hours per week compared with those who did not take the drug.

Tegaserod users also showed a significant decrease in daily activity impairment compared with those who did not take the drug, Dr. Pierre Paré reported in a poster session at the annual Digestive Disease Week.

“We've known for a long time that the efficacy of this drug is demonstrated,” Dr. Paré, of the division of gastroenterology at St.-Sacrement Hospital, Quebec City, said in an interview. But this marks the first study of IBS patients in a usual care setting to show that tegaserod positively affects work productivity and daily activities.

He and his associates enrolled 1,372 patients with IBS symptoms from 147 medical practice sites across Canada. Most were family practice sites.

The researchers collected clinical and patient-reported outcomes at baseline and at months 1, 3, and 6. They used the Work Productivity and Activity Questionnaire (WPAI) for IBS to measure work activity. This questionnaire measures absenteeism, presenteeism, work productivity loss, and activity impairment resulting from IBS symptoms.

Dr. Paré reported that the mean age of the patients was 46 years, the mean length of disease duration was 12 years, and most of the patients (86%) were female.

Of the entire group, 360 patients were tegaserod users and 1,012 were not. At baseline, a similar portion of patients in each group was employed (61% of tegaserod users vs. 60% of nonusers).

By month 6, tegaserod users showed larger but nonsignificant improvements compared with nonusers on these aspects of the WPAI: absenteeism (3%), presenteeism (8%), and overall productivity impairment (8%). However, tegaserod users did show a significant improvement on the WPAI component of daily activity impairment (12%) compared with nonusers.

Using a 40-hour work week as an average, the researchers estimated that tegaserod users reduced productivity loss by an average of 3.3 hours per week compared with nonusers. In Canada, this translates into a societal savings of about $65 per tegaserod user per week, Dr. Paré said. In the United States, he estimated that the savings would be about $53 per tegaserod user per week.

A key limitation of the study, he added, was its nonrandomized design. Also, “we don't have data on outcome of clinical symptoms,” he said.

Year-long follow-up data on these patients should be available soon.

The study, which earned a “poster of distinction” designation from the meeting organizers, was funded by Novartis Pharma AG in Basel, Switzerland.

SAN DIEGO — The capsule urea breath test is more accurate than conventional endoscopic testing and serology for diagnosing Helicobacter pylori infection, results of a study of 100 patients showed.

The test “may become a good alternative to endoscopy for the diagnosis of H. pylori infection,” researchers led by Dr. Nan-Jing Peng wrote in a poster presented at the annual meeting of the Society of Nuclear Medicine. “This diagnostic method can avoid contamination of urea from oral urease.”

The finding confirms results of a smaller study published by Dr. Peng and her associates last year (World J. Gastroenterol. 2005;11:1361–4).

Dr. Peng, of the department of nuclear medicine at Kaohsiung (Taiwan) Veterans General Hospital, and her associates compared the capsule urea breath test (UBT) with conventional endoscopic testing for the diagnosis of H. pylori in 100 patients. They collected breath samples before and 15 minutes after consumption of capsules containing

The sensitivity of the capsule UBT was 96.4%, compared with 88.3% and 87.3%, respectively, for endoscopic testing and serology. The specificity of capsule UBT was 100%, compared with 100% and 88.9%, respectively, for conventional testing and serology, the investigators reported.

The accuracy of capsule UBT was 98%, which was higher than that of endoscopic testing (93%) and serology (88%).

ELSEVIER GLOBAL MEDICAL NEWS

SAN DIEGO — The capsule urea breath test is more accurate than conventional endoscopic testing and serology for diagnosing Helicobacter pylori infection, results of a study of 100 patients showed.

The test “may become a good alternative to endoscopy for the diagnosis of H. pylori infection,” researchers led by Dr. Nan-Jing Peng wrote in a poster presented at the annual meeting of the Society of Nuclear Medicine. “This diagnostic method can avoid contamination of urea from oral urease.”

The finding confirms results of a smaller study published by Dr. Peng and her associates last year (World J. Gastroenterol. 2005;11:1361–4).

Dr. Peng, of the department of nuclear medicine at Kaohsiung (Taiwan) Veterans General Hospital, and her associates compared the capsule urea breath test (UBT) with conventional endoscopic testing for the diagnosis of H. pylori in 100 patients. They collected breath samples before and 15 minutes after consumption of capsules containing

The sensitivity of the capsule UBT was 96.4%, compared with 88.3% and 87.3%, respectively, for endoscopic testing and serology. The specificity of capsule UBT was 100%, compared with 100% and 88.9%, respectively, for conventional testing and serology, the investigators reported.

The accuracy of capsule UBT was 98%, which was higher than that of endoscopic testing (93%) and serology (88%).

ELSEVIER GLOBAL MEDICAL NEWS

SAN DIEGO — The capsule urea breath test is more accurate than conventional endoscopic testing and serology for diagnosing Helicobacter pylori infection, results of a study of 100 patients showed.

The test “may become a good alternative to endoscopy for the diagnosis of H. pylori infection,” researchers led by Dr. Nan-Jing Peng wrote in a poster presented at the annual meeting of the Society of Nuclear Medicine. “This diagnostic method can avoid contamination of urea from oral urease.”

The finding confirms results of a smaller study published by Dr. Peng and her associates last year (World J. Gastroenterol. 2005;11:1361–4).

Dr. Peng, of the department of nuclear medicine at Kaohsiung (Taiwan) Veterans General Hospital, and her associates compared the capsule urea breath test (UBT) with conventional endoscopic testing for the diagnosis of H. pylori in 100 patients. They collected breath samples before and 15 minutes after consumption of capsules containing

The sensitivity of the capsule UBT was 96.4%, compared with 88.3% and 87.3%, respectively, for endoscopic testing and serology. The specificity of capsule UBT was 100%, compared with 100% and 88.9%, respectively, for conventional testing and serology, the investigators reported.

The accuracy of capsule UBT was 98%, which was higher than that of endoscopic testing (93%) and serology (88%).

ELSEVIER GLOBAL MEDICAL NEWS

TUCSON, ARIZ. — Recent published data suggest a risk of birth defects among live-born infants of mothers infected with West Nile virus, but much more work is needed to confirm the association, Dr. Dawn M. Wesson said at the annual meeting of the Teratology Society.

“There appears to be a slightly higher frequency of major birth defects in the West Nile-infected group as compared to the general population, but … even though this is suggestive it's certainly not proof,” cautioned Dr. Wesson, of the department of tropical medicine at Tulane University School of Public Health and Tropical Medicine in New Orleans.

She based her remarks on a clinical study of 77 women infected with West Nile virus (WNV) during pregnancy in 2003 and 2004 who were followed in 16 states. Of the 77 women, 71 delivered 72 live infants. Four women had miscarriages and two had abortions (Pediatrics 2006;117:e537–45).

Of the 72 live infants, 67 were born at term, 4 were born preterm, and the gestational age of 1 infant was unknown.

The researchers, led by Daniel R. O'Leary, D.V.M., of the division of vector-borne infectious diseases at the Centers for Disease Control and Prevention, found that nearly 11% of infants born to mothers infected with West Nile virus during pregnancy had major birth defects, compared with almost 6% of infants born to uninfected mothers in the general population.

Of the 72 infants followed to date, nearly all appeared to be normal, and none had conclusive laboratory evidence of congenital WNV infection. Seven infants had major malformations, but “only three had defects that could have been caused by maternal WNV infection, based on the timing of the infections and the sensitive developmental period for the specific malformations, and none had any conclusive evidence of WNV etiology,” Dr. O'Leary and his associates wrote.

At the meeting, Dr. Wesson said one of the key reasons researchers are unable to determine with certainty whether WNV is a teratogen is that the sensitivity and specificity of IgM testing of cord blood to detect WNV are really unknown. “Also, congenital WNV infection among newborns with IgM-negative serology cannot be ruled out,” she said. “We need more studies.”

In a partnership between the Centers for Disease Control and Prevention and Tulane University, researchers are studying the effect of WNV on pregnancy outcomes in two groups: retrospectively in women infected while pregnant during 2003 and 2004, and prospectively in those infected while pregnant between 2005 and 2008.

In addition to performing all recommended tests during and after pregnancy, the researchers plan to follow case and control infants with ophthalmologic and developmental exams as well as a CT scan if indicated, and a dysmorphology exam in infected infants.

The final part of the effort is to perform morphologic, endocrine, and molecular assessments of the villous placenta, trophoblast, conceptus membranes, and maternal decidua.

“We don't know the answer to the question [about WNV's possible role as a teratogen], but I think the pieces we have in place and the collaborators we have in line should help us to answer those questions in the future,” Dr. Wesson concluded.

The sensitivity and specificity of IgM testing of cord blood for detection of WNV are unknown. The virus is shown here in an electron micrograph. CDC

TUCSON, ARIZ. — Recent published data suggest a risk of birth defects among live-born infants of mothers infected with West Nile virus, but much more work is needed to confirm the association, Dr. Dawn M. Wesson said at the annual meeting of the Teratology Society.

“There appears to be a slightly higher frequency of major birth defects in the West Nile-infected group as compared to the general population, but … even though this is suggestive it's certainly not proof,” cautioned Dr. Wesson, of the department of tropical medicine at Tulane University School of Public Health and Tropical Medicine in New Orleans.

She based her remarks on a clinical study of 77 women infected with West Nile virus (WNV) during pregnancy in 2003 and 2004 who were followed in 16 states. Of the 77 women, 71 delivered 72 live infants. Four women had miscarriages and two had abortions (Pediatrics 2006;117:e537–45).

Of the 72 live infants, 67 were born at term, 4 were born preterm, and the gestational age of 1 infant was unknown.

The researchers, led by Daniel R. O'Leary, D.V.M., of the division of vector-borne infectious diseases at the Centers for Disease Control and Prevention, found that nearly 11% of infants born to mothers infected with West Nile virus during pregnancy had major birth defects, compared with almost 6% of infants born to uninfected mothers in the general population.

Of the 72 infants followed to date, nearly all appeared to be normal, and none had conclusive laboratory evidence of congenital WNV infection. Seven infants had major malformations, but “only three had defects that could have been caused by maternal WNV infection, based on the timing of the infections and the sensitive developmental period for the specific malformations, and none had any conclusive evidence of WNV etiology,” Dr. O'Leary and his associates wrote.

At the meeting, Dr. Wesson said one of the key reasons researchers are unable to determine with certainty whether WNV is a teratogen is that the sensitivity and specificity of IgM testing of cord blood to detect WNV are really unknown. “Also, congenital WNV infection among newborns with IgM-negative serology cannot be ruled out,” she said. “We need more studies.”

In a partnership between the Centers for Disease Control and Prevention and Tulane University, researchers are studying the effect of WNV on pregnancy outcomes in two groups: retrospectively in women infected while pregnant during 2003 and 2004, and prospectively in those infected while pregnant between 2005 and 2008.

In addition to performing all recommended tests during and after pregnancy, the researchers plan to follow case and control infants with ophthalmologic and developmental exams as well as a CT scan if indicated, and a dysmorphology exam in infected infants.

The final part of the effort is to perform morphologic, endocrine, and molecular assessments of the villous placenta, trophoblast, conceptus membranes, and maternal decidua.

“We don't know the answer to the question [about WNV's possible role as a teratogen], but I think the pieces we have in place and the collaborators we have in line should help us to answer those questions in the future,” Dr. Wesson concluded.

The sensitivity and specificity of IgM testing of cord blood for detection of WNV are unknown. The virus is shown here in an electron micrograph. CDC

TUCSON, ARIZ. — Recent published data suggest a risk of birth defects among live-born infants of mothers infected with West Nile virus, but much more work is needed to confirm the association, Dr. Dawn M. Wesson said at the annual meeting of the Teratology Society.

“There appears to be a slightly higher frequency of major birth defects in the West Nile-infected group as compared to the general population, but … even though this is suggestive it's certainly not proof,” cautioned Dr. Wesson, of the department of tropical medicine at Tulane University School of Public Health and Tropical Medicine in New Orleans.

She based her remarks on a clinical study of 77 women infected with West Nile virus (WNV) during pregnancy in 2003 and 2004 who were followed in 16 states. Of the 77 women, 71 delivered 72 live infants. Four women had miscarriages and two had abortions (Pediatrics 2006;117:e537–45).

Of the 72 live infants, 67 were born at term, 4 were born preterm, and the gestational age of 1 infant was unknown.

The researchers, led by Daniel R. O'Leary, D.V.M., of the division of vector-borne infectious diseases at the Centers for Disease Control and Prevention, found that nearly 11% of infants born to mothers infected with West Nile virus during pregnancy had major birth defects, compared with almost 6% of infants born to uninfected mothers in the general population.

Of the 72 infants followed to date, nearly all appeared to be normal, and none had conclusive laboratory evidence of congenital WNV infection. Seven infants had major malformations, but “only three had defects that could have been caused by maternal WNV infection, based on the timing of the infections and the sensitive developmental period for the specific malformations, and none had any conclusive evidence of WNV etiology,” Dr. O'Leary and his associates wrote.

At the meeting, Dr. Wesson said one of the key reasons researchers are unable to determine with certainty whether WNV is a teratogen is that the sensitivity and specificity of IgM testing of cord blood to detect WNV are really unknown. “Also, congenital WNV infection among newborns with IgM-negative serology cannot be ruled out,” she said. “We need more studies.”

In a partnership between the Centers for Disease Control and Prevention and Tulane University, researchers are studying the effect of WNV on pregnancy outcomes in two groups: retrospectively in women infected while pregnant during 2003 and 2004, and prospectively in those infected while pregnant between 2005 and 2008.

In addition to performing all recommended tests during and after pregnancy, the researchers plan to follow case and control infants with ophthalmologic and developmental exams as well as a CT scan if indicated, and a dysmorphology exam in infected infants.

The final part of the effort is to perform morphologic, endocrine, and molecular assessments of the villous placenta, trophoblast, conceptus membranes, and maternal decidua.

“We don't know the answer to the question [about WNV's possible role as a teratogen], but I think the pieces we have in place and the collaborators we have in line should help us to answer those questions in the future,” Dr. Wesson concluded.

The sensitivity and specificity of IgM testing of cord blood for detection of WNV are unknown. The virus is shown here in an electron micrograph. CDC

TUCSON, ARIZ. — Although only 49 cases of lymphocytic choriomeningitis virus have been reported in the medical literature worldwide, Dr. Marilyn Baird Mets has a hunch that the prevalence could be much higher.

Since 1997, she has seen seven children with the condition present to Children's Memorial Hospital, Chicago, where she is head of ophthalmology. Subsequently, three other clinicians have called her with reports of positive cases: one from the western suburbs of Chicago, one from Los Angeles, and one from Fort Collins, Colo.

“This virus is out there,” Dr. Mets said at the annual meeting of the Teratology Society. “Obstetricians should be telling their patients not to work around rats in medical labs during their pregnancy [and] not to get a hamster for their 4-year-old if they're going to have other children. It's a preventable disease, but people need to know about it.”

Discovered in 1933 and classified in the 1960s as a prototype for the arena virus, lymphocytic choriomeningitis virus (LCMV) is harbored in mice and transferred vertically by uterine infection. “There is documented infection to humans from wild mice, lab mice, rats, and hamsters,” said Dr. Mets, also professor of ophthalmology and surgery at Northwestern University, Chicago. “Transmission is thought to be airborne or contamination of food by infected mouse urine. There has also been experimental transmission demonstrated by ticks, fleas, mosquitos, and bedbugs.”

About one-third of adults who acquire LCMV are asymptomatic. Of the remaining two-thirds, about half have central nervous system disease. Illness occurs in a biphasic pattern. “First there's an acute febrile illness with myalgias and headache,” she said. “Later on, meningeal signs may develop, and rarely encephalitis, myocarditis, parotitis, orchitis, and pneumonia. Very rarely, fatal systemic disease is reported.”

It's the causative agent in about 10% of aseptic meningitis cases.

LCMV was first described as a fetal pathogen in Great Britain in 1955. The first case of congenital LCMV in the United States was reported in 1993. The baby was born with a birth weight of 2,898 grams. During pregnancy the mother lived in a well-maintained inner-city apartment. At 5 months' gestation, she had a febrile illness that lasted a week. The child was born with hydrocephalus and microphthalmos of the right eye. The right eye had leukocoria, a cloudy vitreous, and exudative retinitis.

A review of 26 infants with LCMV published in 1997 revealed that 88% had chorioretinopathy, 45% had hydrocephalus, and 13% had microcephaly.

Diagnosis is made by IgG indirect fluorescent antibody, which is commercially available. “Or you can get an IgG ELISA at the [Centers for Disease Control and Prevention],” Dr. Mets said. “Complement fixation testing lacks the sensitivity” of the other two tests.

The differential diagnosis includes toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, enteroviruses, syphilis, parvovirus B19, and West Nile virus.

There is documented human infection 'from wild mice, lab mice, rats, and hamsters.' DR. METS

Optical scan shows right eye of a 22-month-old child with congenital LCMV who was referred for marked visual delay. Courtesy Dr. Marilyn Baird Mets

TUCSON, ARIZ. — Although only 49 cases of lymphocytic choriomeningitis virus have been reported in the medical literature worldwide, Dr. Marilyn Baird Mets has a hunch that the prevalence could be much higher.

Since 1997, she has seen seven children with the condition present to Children's Memorial Hospital, Chicago, where she is head of ophthalmology. Subsequently, three other clinicians have called her with reports of positive cases: one from the western suburbs of Chicago, one from Los Angeles, and one from Fort Collins, Colo.

“This virus is out there,” Dr. Mets said at the annual meeting of the Teratology Society. “Obstetricians should be telling their patients not to work around rats in medical labs during their pregnancy [and] not to get a hamster for their 4-year-old if they're going to have other children. It's a preventable disease, but people need to know about it.”

Discovered in 1933 and classified in the 1960s as a prototype for the arena virus, lymphocytic choriomeningitis virus (LCMV) is harbored in mice and transferred vertically by uterine infection. “There is documented infection to humans from wild mice, lab mice, rats, and hamsters,” said Dr. Mets, also professor of ophthalmology and surgery at Northwestern University, Chicago. “Transmission is thought to be airborne or contamination of food by infected mouse urine. There has also been experimental transmission demonstrated by ticks, fleas, mosquitos, and bedbugs.”

About one-third of adults who acquire LCMV are asymptomatic. Of the remaining two-thirds, about half have central nervous system disease. Illness occurs in a biphasic pattern. “First there's an acute febrile illness with myalgias and headache,” she said. “Later on, meningeal signs may develop, and rarely encephalitis, myocarditis, parotitis, orchitis, and pneumonia. Very rarely, fatal systemic disease is reported.”

It's the causative agent in about 10% of aseptic meningitis cases.

LCMV was first described as a fetal pathogen in Great Britain in 1955. The first case of congenital LCMV in the United States was reported in 1993. The baby was born with a birth weight of 2,898 grams. During pregnancy the mother lived in a well-maintained inner-city apartment. At 5 months' gestation, she had a febrile illness that lasted a week. The child was born with hydrocephalus and microphthalmos of the right eye. The right eye had leukocoria, a cloudy vitreous, and exudative retinitis.

A review of 26 infants with LCMV published in 1997 revealed that 88% had chorioretinopathy, 45% had hydrocephalus, and 13% had microcephaly.

Diagnosis is made by IgG indirect fluorescent antibody, which is commercially available. “Or you can get an IgG ELISA at the [Centers for Disease Control and Prevention],” Dr. Mets said. “Complement fixation testing lacks the sensitivity” of the other two tests.

The differential diagnosis includes toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, enteroviruses, syphilis, parvovirus B19, and West Nile virus.

There is documented human infection 'from wild mice, lab mice, rats, and hamsters.' DR. METS

Optical scan shows right eye of a 22-month-old child with congenital LCMV who was referred for marked visual delay. Courtesy Dr. Marilyn Baird Mets

TUCSON, ARIZ. — Although only 49 cases of lymphocytic choriomeningitis virus have been reported in the medical literature worldwide, Dr. Marilyn Baird Mets has a hunch that the prevalence could be much higher.

Since 1997, she has seen seven children with the condition present to Children's Memorial Hospital, Chicago, where she is head of ophthalmology. Subsequently, three other clinicians have called her with reports of positive cases: one from the western suburbs of Chicago, one from Los Angeles, and one from Fort Collins, Colo.

“This virus is out there,” Dr. Mets said at the annual meeting of the Teratology Society. “Obstetricians should be telling their patients not to work around rats in medical labs during their pregnancy [and] not to get a hamster for their 4-year-old if they're going to have other children. It's a preventable disease, but people need to know about it.”

Discovered in 1933 and classified in the 1960s as a prototype for the arena virus, lymphocytic choriomeningitis virus (LCMV) is harbored in mice and transferred vertically by uterine infection. “There is documented infection to humans from wild mice, lab mice, rats, and hamsters,” said Dr. Mets, also professor of ophthalmology and surgery at Northwestern University, Chicago. “Transmission is thought to be airborne or contamination of food by infected mouse urine. There has also been experimental transmission demonstrated by ticks, fleas, mosquitos, and bedbugs.”

About one-third of adults who acquire LCMV are asymptomatic. Of the remaining two-thirds, about half have central nervous system disease. Illness occurs in a biphasic pattern. “First there's an acute febrile illness with myalgias and headache,” she said. “Later on, meningeal signs may develop, and rarely encephalitis, myocarditis, parotitis, orchitis, and pneumonia. Very rarely, fatal systemic disease is reported.”

It's the causative agent in about 10% of aseptic meningitis cases.

LCMV was first described as a fetal pathogen in Great Britain in 1955. The first case of congenital LCMV in the United States was reported in 1993. The baby was born with a birth weight of 2,898 grams. During pregnancy the mother lived in a well-maintained inner-city apartment. At 5 months' gestation, she had a febrile illness that lasted a week. The child was born with hydrocephalus and microphthalmos of the right eye. The right eye had leukocoria, a cloudy vitreous, and exudative retinitis.

A review of 26 infants with LCMV published in 1997 revealed that 88% had chorioretinopathy, 45% had hydrocephalus, and 13% had microcephaly.

Diagnosis is made by IgG indirect fluorescent antibody, which is commercially available. “Or you can get an IgG ELISA at the [Centers for Disease Control and Prevention],” Dr. Mets said. “Complement fixation testing lacks the sensitivity” of the other two tests.

The differential diagnosis includes toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, enteroviruses, syphilis, parvovirus B19, and West Nile virus.

There is documented human infection 'from wild mice, lab mice, rats, and hamsters.' DR. METS

Optical scan shows right eye of a 22-month-old child with congenital LCMV who was referred for marked visual delay. Courtesy Dr. Marilyn Baird Mets

LOS ANGELES — In patients with iron-deficiency anemia, significant ethnic differences were found in the frequency, type, and distribution of clinically important gastrointestinal lesions, Dr. Bani Chander reported during a poster session at the annual Digestive Disease Week.

In particular, whites with iron deficiency had lower rates of clinically important lesions in the lower GI tract, compared with blacks, Hispanics, and other ethnic groups, the results from a study of Veterans Affairs patients showed.

“Not only do [blacks and Hispanics] have more advanced lesions, but their lesions also tend to be proximal. Instead of doing a flexible sigmoidoscopy every 3–5 years, we might [need to do] only colonoscopy, to [get to] the proximal colon,” said Dr. Chander, a recent New York University graduate.

She and her colleagues evaluated demographic and clinical data from 1,081 consecutive patients referred to the VA New York Harbor Healthcare System for evaluation of iron-deficiency anemia. Of those, 406 were white, 442 were black, 168 were Hispanic, and 65 were from other ethnic groups. Iron deficiency was defined as a transferrin saturation of less than 15% and a ferritin level of less than 20 μg/L. Anemia was defined as a hemoglobin level of less than 13 g/dL in men and less than 12 g/dL in women. All of the patients had a same-day esophagogastroduodenoscopy and colonoscopy.

The researchers identified one or more clinically important GI lesions in 54% of whites, 65% of blacks, 63% of Hispanics, and 69% of those from other ethnic groups. About 33% of whites had clinically important lesions in the upper GI tract, compared with 32% of blacks, 43% of Hispanics, and 54% in other ethnic groups. In the lower GI tract, 32% of whites had clinically important lesions, compared with 48% of blacks, 43% of Hispanics, and 42% in other ethnic groups. Upper and lower GI lesions were identified in 11% of whites, 15% of blacks, 23% of Hispanics, and 26% in other ethnic groups.

They also noted that the frequency of clinically important lesions that were proximal to the splenic flexure was significantly higher in blacks (35%) and Hispanics (27%), compared with whites (13%) and those from other ethnic groups (8%).

Of those who had colorectal cancer, the prevalence of advanced lesions was significantly higher in blacks (86%) and Hispanics (100%) than it was in whites (63%) and patients from other ethnic groups (75%).

“Most likely Hispanics are seeking less health care than other groups,” said Dr. Chander, adding that diet and other lifestyle choices may also play a role.

LOS ANGELES — In patients with iron-deficiency anemia, significant ethnic differences were found in the frequency, type, and distribution of clinically important gastrointestinal lesions, Dr. Bani Chander reported during a poster session at the annual Digestive Disease Week.

In particular, whites with iron deficiency had lower rates of clinically important lesions in the lower GI tract, compared with blacks, Hispanics, and other ethnic groups, the results from a study of Veterans Affairs patients showed.

“Not only do [blacks and Hispanics] have more advanced lesions, but their lesions also tend to be proximal. Instead of doing a flexible sigmoidoscopy every 3–5 years, we might [need to do] only colonoscopy, to [get to] the proximal colon,” said Dr. Chander, a recent New York University graduate.

She and her colleagues evaluated demographic and clinical data from 1,081 consecutive patients referred to the VA New York Harbor Healthcare System for evaluation of iron-deficiency anemia. Of those, 406 were white, 442 were black, 168 were Hispanic, and 65 were from other ethnic groups. Iron deficiency was defined as a transferrin saturation of less than 15% and a ferritin level of less than 20 μg/L. Anemia was defined as a hemoglobin level of less than 13 g/dL in men and less than 12 g/dL in women. All of the patients had a same-day esophagogastroduodenoscopy and colonoscopy.

The researchers identified one or more clinically important GI lesions in 54% of whites, 65% of blacks, 63% of Hispanics, and 69% of those from other ethnic groups. About 33% of whites had clinically important lesions in the upper GI tract, compared with 32% of blacks, 43% of Hispanics, and 54% in other ethnic groups. In the lower GI tract, 32% of whites had clinically important lesions, compared with 48% of blacks, 43% of Hispanics, and 42% in other ethnic groups. Upper and lower GI lesions were identified in 11% of whites, 15% of blacks, 23% of Hispanics, and 26% in other ethnic groups.

They also noted that the frequency of clinically important lesions that were proximal to the splenic flexure was significantly higher in blacks (35%) and Hispanics (27%), compared with whites (13%) and those from other ethnic groups (8%).

Of those who had colorectal cancer, the prevalence of advanced lesions was significantly higher in blacks (86%) and Hispanics (100%) than it was in whites (63%) and patients from other ethnic groups (75%).

“Most likely Hispanics are seeking less health care than other groups,” said Dr. Chander, adding that diet and other lifestyle choices may also play a role.

LOS ANGELES — In patients with iron-deficiency anemia, significant ethnic differences were found in the frequency, type, and distribution of clinically important gastrointestinal lesions, Dr. Bani Chander reported during a poster session at the annual Digestive Disease Week.

In particular, whites with iron deficiency had lower rates of clinically important lesions in the lower GI tract, compared with blacks, Hispanics, and other ethnic groups, the results from a study of Veterans Affairs patients showed.

“Not only do [blacks and Hispanics] have more advanced lesions, but their lesions also tend to be proximal. Instead of doing a flexible sigmoidoscopy every 3–5 years, we might [need to do] only colonoscopy, to [get to] the proximal colon,” said Dr. Chander, a recent New York University graduate.

She and her colleagues evaluated demographic and clinical data from 1,081 consecutive patients referred to the VA New York Harbor Healthcare System for evaluation of iron-deficiency anemia. Of those, 406 were white, 442 were black, 168 were Hispanic, and 65 were from other ethnic groups. Iron deficiency was defined as a transferrin saturation of less than 15% and a ferritin level of less than 20 μg/L. Anemia was defined as a hemoglobin level of less than 13 g/dL in men and less than 12 g/dL in women. All of the patients had a same-day esophagogastroduodenoscopy and colonoscopy.

The researchers identified one or more clinically important GI lesions in 54% of whites, 65% of blacks, 63% of Hispanics, and 69% of those from other ethnic groups. About 33% of whites had clinically important lesions in the upper GI tract, compared with 32% of blacks, 43% of Hispanics, and 54% in other ethnic groups. In the lower GI tract, 32% of whites had clinically important lesions, compared with 48% of blacks, 43% of Hispanics, and 42% in other ethnic groups. Upper and lower GI lesions were identified in 11% of whites, 15% of blacks, 23% of Hispanics, and 26% in other ethnic groups.

They also noted that the frequency of clinically important lesions that were proximal to the splenic flexure was significantly higher in blacks (35%) and Hispanics (27%), compared with whites (13%) and those from other ethnic groups (8%).

Of those who had colorectal cancer, the prevalence of advanced lesions was significantly higher in blacks (86%) and Hispanics (100%) than it was in whites (63%) and patients from other ethnic groups (75%).

“Most likely Hispanics are seeking less health care than other groups,” said Dr. Chander, adding that diet and other lifestyle choices may also play a role.

TUCSON, ARIZ. — Recent published data suggest a risk of birth defects among live-born infants of mothers infected with West Nile virus, but much more work is needed to confirm the association, Dr. Dawn M. Wesson said at the annual meeting of the Teratology Society.

“There appears to be a slightly higher frequency of major birth defects in the West Nile-infected group as compared to the general population, but … even though this is suggestive it's certainly not proof,” cautioned Dr. Wesson, of the department of tropical medicine at Tulane University School of Public Health and Tropical Medicine in New Orleans.

She based her remarks on a clinical study of 77 women infected with West Nile virus (WNV) during pregnancy in 2003 and 2004 who were followed in 16 states. Of the 77 women, 71 delivered 72 live infants. Four women had miscarriages and two had abortions (Pediatrics 2006;117:e537–45).

Of the 72 live infants, 67 were born at term, 4 were born preterm, and the gestational age of 1 infant was unknown.

The researchers, led by Daniel R. O'Leary, D.V.M., of the division of vector-borne infectious diseases at the Centers for Disease Control and Prevention, found that nearly 11% of infants born to mothers infected with West Nile virus during pregnancy had major birth defects, compared with almost 6% of infants born to uninfected mothers in the general population.

The researchers cautioned that of the 72 infants followed to date, nearly all appeared to be normal, and none had conclusive laboratory evidence of congenital WNV infection. Seven infants had major malformations, but “only three had defects that could have been caused by maternal WNV infection based on the timing of the infections and the developmental period for the specific malformations, and none had any conclusive evidence of WNV etiology,” Dr. O'Leary and his associates wrote.

At the meeting, Dr. Wesson said one of the key reasons researchers are unable to determine with certainty whether WNV is a teratogen is that the sensitivity and specificity of IgM testing of cord blood to detect WNV is really unknown. “Also, congenital WNV infection among newborns with IgM-negative serology cannot be ruled out,” she said. “We need more studies.”

In a partnership between the Centers for Disease Control and Prevention and Tulane University, researchers are studying the effect of WNV on pregnancy outcomes in two groups of women: retrospectively in those infected while pregnant during 2003 and 2004, and prospectively in those infected while pregnant between 2005 and 2008.

In addition to performing all recommended tests during and after pregnancy, the researchers plan to follow case and control infants with ophthalmologic and developmental exams as well as a CT scan if indicated, and a dysmorphology exam in infected infants.

The final part of the effort is to perform morphologic, endocrine, and molecular assessments of the villous placenta, trophoblast, conceptus membranes, and maternal decidua. “We don't know the answer to the question [about WNV's possible role as a teratogen], but I think the pieces that we have in place and the collaborators we have in line should help us to answer those questions,” Dr. Wesson concluded.

The sensitivity and specificity of IgM testing of cord blood to detect WNV is really unknown. The virus is shown here by electron micrograph. CDC

TUCSON, ARIZ. — Recent published data suggest a risk of birth defects among live-born infants of mothers infected with West Nile virus, but much more work is needed to confirm the association, Dr. Dawn M. Wesson said at the annual meeting of the Teratology Society.

“There appears to be a slightly higher frequency of major birth defects in the West Nile-infected group as compared to the general population, but … even though this is suggestive it's certainly not proof,” cautioned Dr. Wesson, of the department of tropical medicine at Tulane University School of Public Health and Tropical Medicine in New Orleans.

She based her remarks on a clinical study of 77 women infected with West Nile virus (WNV) during pregnancy in 2003 and 2004 who were followed in 16 states. Of the 77 women, 71 delivered 72 live infants. Four women had miscarriages and two had abortions (Pediatrics 2006;117:e537–45).

Of the 72 live infants, 67 were born at term, 4 were born preterm, and the gestational age of 1 infant was unknown.

The researchers, led by Daniel R. O'Leary, D.V.M., of the division of vector-borne infectious diseases at the Centers for Disease Control and Prevention, found that nearly 11% of infants born to mothers infected with West Nile virus during pregnancy had major birth defects, compared with almost 6% of infants born to uninfected mothers in the general population.

The researchers cautioned that of the 72 infants followed to date, nearly all appeared to be normal, and none had conclusive laboratory evidence of congenital WNV infection. Seven infants had major malformations, but “only three had defects that could have been caused by maternal WNV infection based on the timing of the infections and the developmental period for the specific malformations, and none had any conclusive evidence of WNV etiology,” Dr. O'Leary and his associates wrote.

At the meeting, Dr. Wesson said one of the key reasons researchers are unable to determine with certainty whether WNV is a teratogen is that the sensitivity and specificity of IgM testing of cord blood to detect WNV is really unknown. “Also, congenital WNV infection among newborns with IgM-negative serology cannot be ruled out,” she said. “We need more studies.”

In a partnership between the Centers for Disease Control and Prevention and Tulane University, researchers are studying the effect of WNV on pregnancy outcomes in two groups of women: retrospectively in those infected while pregnant during 2003 and 2004, and prospectively in those infected while pregnant between 2005 and 2008.

In addition to performing all recommended tests during and after pregnancy, the researchers plan to follow case and control infants with ophthalmologic and developmental exams as well as a CT scan if indicated, and a dysmorphology exam in infected infants.

The final part of the effort is to perform morphologic, endocrine, and molecular assessments of the villous placenta, trophoblast, conceptus membranes, and maternal decidua. “We don't know the answer to the question [about WNV's possible role as a teratogen], but I think the pieces that we have in place and the collaborators we have in line should help us to answer those questions,” Dr. Wesson concluded.

The sensitivity and specificity of IgM testing of cord blood to detect WNV is really unknown. The virus is shown here by electron micrograph. CDC

TUCSON, ARIZ. — Recent published data suggest a risk of birth defects among live-born infants of mothers infected with West Nile virus, but much more work is needed to confirm the association, Dr. Dawn M. Wesson said at the annual meeting of the Teratology Society.

“There appears to be a slightly higher frequency of major birth defects in the West Nile-infected group as compared to the general population, but … even though this is suggestive it's certainly not proof,” cautioned Dr. Wesson, of the department of tropical medicine at Tulane University School of Public Health and Tropical Medicine in New Orleans.

She based her remarks on a clinical study of 77 women infected with West Nile virus (WNV) during pregnancy in 2003 and 2004 who were followed in 16 states. Of the 77 women, 71 delivered 72 live infants. Four women had miscarriages and two had abortions (Pediatrics 2006;117:e537–45).

Of the 72 live infants, 67 were born at term, 4 were born preterm, and the gestational age of 1 infant was unknown.

The researchers, led by Daniel R. O'Leary, D.V.M., of the division of vector-borne infectious diseases at the Centers for Disease Control and Prevention, found that nearly 11% of infants born to mothers infected with West Nile virus during pregnancy had major birth defects, compared with almost 6% of infants born to uninfected mothers in the general population.

The researchers cautioned that of the 72 infants followed to date, nearly all appeared to be normal, and none had conclusive laboratory evidence of congenital WNV infection. Seven infants had major malformations, but “only three had defects that could have been caused by maternal WNV infection based on the timing of the infections and the developmental period for the specific malformations, and none had any conclusive evidence of WNV etiology,” Dr. O'Leary and his associates wrote.

At the meeting, Dr. Wesson said one of the key reasons researchers are unable to determine with certainty whether WNV is a teratogen is that the sensitivity and specificity of IgM testing of cord blood to detect WNV is really unknown. “Also, congenital WNV infection among newborns with IgM-negative serology cannot be ruled out,” she said. “We need more studies.”

In a partnership between the Centers for Disease Control and Prevention and Tulane University, researchers are studying the effect of WNV on pregnancy outcomes in two groups of women: retrospectively in those infected while pregnant during 2003 and 2004, and prospectively in those infected while pregnant between 2005 and 2008.

In addition to performing all recommended tests during and after pregnancy, the researchers plan to follow case and control infants with ophthalmologic and developmental exams as well as a CT scan if indicated, and a dysmorphology exam in infected infants.

The final part of the effort is to perform morphologic, endocrine, and molecular assessments of the villous placenta, trophoblast, conceptus membranes, and maternal decidua. “We don't know the answer to the question [about WNV's possible role as a teratogen], but I think the pieces that we have in place and the collaborators we have in line should help us to answer those questions,” Dr. Wesson concluded.

The sensitivity and specificity of IgM testing of cord blood to detect WNV is really unknown. The virus is shown here by electron micrograph. CDC

TUCSON, ARIZ. — Maternal thyroid disease or its treatment may increase the risk of craniosynostosis in offspring by nearly threefold, preliminary results from an ongoing study suggest.

The finding is important because thyroid disease is the second most common endocrinopathy, after diabetes, in women of reproductive age, Dr. Sonja A. Rasmussen said at the annual meeting of the Teratology Society.

“Several case reports in the medical literature have linked craniosynostosis to postnatal hyperthyroidism and with maternal Graves' disease during pregnancy,” said Dr. Rasmussen of the division of birth defects at the Centers for Disease Control and Prevention, Atlanta.

“Congenital hypothyroidism is associated with delayed closure of the fontanelles. In addition, thyroid hormone is known to play a key role in normal bone metabolism, acting on both osteoblasts and osteoclasts. This information suggests that excess thyroid hormone might lead to premature cranial suture fusion,” she said.

To examine the relationship between maternal thyroid disease and craniosynostosis, Dr. Rasmussen and her associates used data from the National Birth Defects Prevention Study, an ongoing population-based case-control study of major birth defects. The data included maternal interviews and clinical information on 4,555 infants born between Oct. 1, 1997, and Dec. 31, 2002, in Arkansas, California, Georgia, Iowa, Massachusetts, New Jersey, New York, and Texas.

Maternal interviews were completed 6–24 months after estimated date of delivery. Infants born with a condition of known etiology, such as a chromosome abnormality or single gene condition, were excluded from the study.

Of the 4,555 infants, 433 had craniosynostosis verified by radiographic imaging and 4,122 live-born infants without major birth defects served as the control group.

Of the mothers of infants with craniosynostosis, 19 (4.4%) had maternal thyroid disease, compared with 67 (1.6%) of mothers in the control group. Odds ratio analysis revealed that mothers with thyroid disease were 2.8 times more likely to have an infant with craniosynostosis, compared with mothers in the control group.

The association remained the same from a statistical standpoint after the researchers adjusted for several potential confounding factors, including maternal age, education, race, smoking status, use of selective serotonin reuptake inhibitors, body mass index, and preexisting diabetes; infant sex, birth weight, and gestational age; and family history of craniosynostosis.

Odd ratios were increased for all types of craniosynostosis except for metopic. The highest odds ratio was for multiple sutures.

“There are several possible mechanisms for the findings we observed,” said Dr. Rasmussen. First, “mothers with hyperthyroidism may have received inadequate treatment, with passage of excess thyroid hormone across the placenta. Another possible mechanism is that a mother with hypothyroidism received overtreatment with exogenous thyroid hormone. Finally, the mother might have autoimmune thyroid disease that results in production of thyroid-stimulating antibodies that cross the placenta and stimulate the fetal thyroid to make excess thyroid hormone.”

Maternal thyroid disease was based on self-report, “so only limited information on the type of thyroid disease was available.” Dr. Rasmussen also noted that work-ups for genetic causes of craniosynostosis differed among the study sites. Some infants with genetic etiology might have been included.

TUCSON, ARIZ. — Maternal thyroid disease or its treatment may increase the risk of craniosynostosis in offspring by nearly threefold, preliminary results from an ongoing study suggest.

The finding is important because thyroid disease is the second most common endocrinopathy, after diabetes, in women of reproductive age, Dr. Sonja A. Rasmussen said at the annual meeting of the Teratology Society.

“Several case reports in the medical literature have linked craniosynostosis to postnatal hyperthyroidism and with maternal Graves' disease during pregnancy,” said Dr. Rasmussen of the division of birth defects at the Centers for Disease Control and Prevention, Atlanta.

“Congenital hypothyroidism is associated with delayed closure of the fontanelles. In addition, thyroid hormone is known to play a key role in normal bone metabolism, acting on both osteoblasts and osteoclasts. This information suggests that excess thyroid hormone might lead to premature cranial suture fusion,” she said.

To examine the relationship between maternal thyroid disease and craniosynostosis, Dr. Rasmussen and her associates used data from the National Birth Defects Prevention Study, an ongoing population-based case-control study of major birth defects. The data included maternal interviews and clinical information on 4,555 infants born between Oct. 1, 1997, and Dec. 31, 2002, in Arkansas, California, Georgia, Iowa, Massachusetts, New Jersey, New York, and Texas.

Maternal interviews were completed 6–24 months after estimated date of delivery. Infants born with a condition of known etiology, such as a chromosome abnormality or single gene condition, were excluded from the study.

Of the 4,555 infants, 433 had craniosynostosis verified by radiographic imaging and 4,122 live-born infants without major birth defects served as the control group.

Of the mothers of infants with craniosynostosis, 19 (4.4%) had maternal thyroid disease, compared with 67 (1.6%) of mothers in the control group. Odds ratio analysis revealed that mothers with thyroid disease were 2.8 times more likely to have an infant with craniosynostosis, compared with mothers in the control group.

The association remained the same from a statistical standpoint after the researchers adjusted for several potential confounding factors, including maternal age, education, race, smoking status, use of selective serotonin reuptake inhibitors, body mass index, and preexisting diabetes; infant sex, birth weight, and gestational age; and family history of craniosynostosis.

Odd ratios were increased for all types of craniosynostosis except for metopic. The highest odds ratio was for multiple sutures.

“There are several possible mechanisms for the findings we observed,” said Dr. Rasmussen. First, “mothers with hyperthyroidism may have received inadequate treatment, with passage of excess thyroid hormone across the placenta. Another possible mechanism is that a mother with hypothyroidism received overtreatment with exogenous thyroid hormone. Finally, the mother might have autoimmune thyroid disease that results in production of thyroid-stimulating antibodies that cross the placenta and stimulate the fetal thyroid to make excess thyroid hormone.”

Maternal thyroid disease was based on self-report, “so only limited information on the type of thyroid disease was available.” Dr. Rasmussen also noted that work-ups for genetic causes of craniosynostosis differed among the study sites. Some infants with genetic etiology might have been included.

TUCSON, ARIZ. — Maternal thyroid disease or its treatment may increase the risk of craniosynostosis in offspring by nearly threefold, preliminary results from an ongoing study suggest.

The finding is important because thyroid disease is the second most common endocrinopathy, after diabetes, in women of reproductive age, Dr. Sonja A. Rasmussen said at the annual meeting of the Teratology Society.

“Several case reports in the medical literature have linked craniosynostosis to postnatal hyperthyroidism and with maternal Graves' disease during pregnancy,” said Dr. Rasmussen of the division of birth defects at the Centers for Disease Control and Prevention, Atlanta.

“Congenital hypothyroidism is associated with delayed closure of the fontanelles. In addition, thyroid hormone is known to play a key role in normal bone metabolism, acting on both osteoblasts and osteoclasts. This information suggests that excess thyroid hormone might lead to premature cranial suture fusion,” she said.

To examine the relationship between maternal thyroid disease and craniosynostosis, Dr. Rasmussen and her associates used data from the National Birth Defects Prevention Study, an ongoing population-based case-control study of major birth defects. The data included maternal interviews and clinical information on 4,555 infants born between Oct. 1, 1997, and Dec. 31, 2002, in Arkansas, California, Georgia, Iowa, Massachusetts, New Jersey, New York, and Texas.

Maternal interviews were completed 6–24 months after estimated date of delivery. Infants born with a condition of known etiology, such as a chromosome abnormality or single gene condition, were excluded from the study.

Of the 4,555 infants, 433 had craniosynostosis verified by radiographic imaging and 4,122 live-born infants without major birth defects served as the control group.

Of the mothers of infants with craniosynostosis, 19 (4.4%) had maternal thyroid disease, compared with 67 (1.6%) of mothers in the control group. Odds ratio analysis revealed that mothers with thyroid disease were 2.8 times more likely to have an infant with craniosynostosis, compared with mothers in the control group.

The association remained the same from a statistical standpoint after the researchers adjusted for several potential confounding factors, including maternal age, education, race, smoking status, use of selective serotonin reuptake inhibitors, body mass index, and preexisting diabetes; infant sex, birth weight, and gestational age; and family history of craniosynostosis.

Odd ratios were increased for all types of craniosynostosis except for metopic. The highest odds ratio was for multiple sutures.

“There are several possible mechanisms for the findings we observed,” said Dr. Rasmussen. First, “mothers with hyperthyroidism may have received inadequate treatment, with passage of excess thyroid hormone across the placenta. Another possible mechanism is that a mother with hypothyroidism received overtreatment with exogenous thyroid hormone. Finally, the mother might have autoimmune thyroid disease that results in production of thyroid-stimulating antibodies that cross the placenta and stimulate the fetal thyroid to make excess thyroid hormone.”

Maternal thyroid disease was based on self-report, “so only limited information on the type of thyroid disease was available.” Dr. Rasmussen also noted that work-ups for genetic causes of craniosynostosis differed among the study sites. Some infants with genetic etiology might have been included.

LOS ANGELES — The rate of small-bowel findings on capsule endoscopy was the same whether or not patients were on anticoagulation or antiplatelet therapy, results from a single-center study showed.

The findings are important because many patients who undergo capsule endoscopy are on anticoagulation and/or antiplatelet agents, and “the findings and yield in these patients compared to others is not well documented,” a team of researchers from the University of Illinois Medical Center at Chicago wrote in a poster presented at the annual Digestive Disease Week.

They studied 196 patients referred to the medical center for capsule endoscopy between April 2004 and March 2006. They collected data on patients' use of aspirin, Plavix, or Coumadin, and both evidence of bleeding and types of lesions as shown in both gastric and small-bowel images.

Of the 196 patients, 26 (13%) had gastric bleeding as shown on capsule endoscopy. Of these 26 patients, 17 had the following gastric lesions: 8 had gastropathy, 7 had erosions, 1 had an ulcer, and 1 had an arteriovenous malformation (AVM). In addition, 18 patients (69%) had either no small-bowel lesion or a single, small, nonbleeding AVM. This suggests that the gastric site was the primary cause of the bleeding.

“We're noticing that lesions missed on the initial EGD [esophagogastroduodenoscopy] are found on capsule endoscopy,” one of the study authors, Dr. Apurv Varia, said in an interview at the meeting. “If you see blood, then you should look for a lesion, because that might be the source of the bleeding if it was not found on the initial EGD.”

No significant difference was seen in the prevalence of gastric blood in patients using antiplatelet or anticoagulation agents, compared with those who were not (11% vs. 15%, respectively). The prevalence of small-bowel lesions was similar in these two groups, regardless of the combination of agents used.

The researchers did note a significantly higher frequency of gastric bleeding in patients who underwent capsule endoscopy between April 2004 and March 2006, compared with those who underwent the procedure between April 2002 and March 2004 (20% vs. 5%, respectively).

“We anticipate that as capsule endoscopy is used earlier in the evaluation of obscure bleeding, gastric bleeding sources overlooked on routine endoscopy will be detected more frequently,” they concluded in their poster.

'We're noticing that lesions missed on the initial EGD are found on capsule endoscopy.' DR. VARIA

LOS ANGELES — The rate of small-bowel findings on capsule endoscopy was the same whether or not patients were on anticoagulation or antiplatelet therapy, results from a single-center study showed.

The findings are important because many patients who undergo capsule endoscopy are on anticoagulation and/or antiplatelet agents, and “the findings and yield in these patients compared to others is not well documented,” a team of researchers from the University of Illinois Medical Center at Chicago wrote in a poster presented at the annual Digestive Disease Week.

They studied 196 patients referred to the medical center for capsule endoscopy between April 2004 and March 2006. They collected data on patients' use of aspirin, Plavix, or Coumadin, and both evidence of bleeding and types of lesions as shown in both gastric and small-bowel images.

Of the 196 patients, 26 (13%) had gastric bleeding as shown on capsule endoscopy. Of these 26 patients, 17 had the following gastric lesions: 8 had gastropathy, 7 had erosions, 1 had an ulcer, and 1 had an arteriovenous malformation (AVM). In addition, 18 patients (69%) had either no small-bowel lesion or a single, small, nonbleeding AVM. This suggests that the gastric site was the primary cause of the bleeding.

“We're noticing that lesions missed on the initial EGD [esophagogastroduodenoscopy] are found on capsule endoscopy,” one of the study authors, Dr. Apurv Varia, said in an interview at the meeting. “If you see blood, then you should look for a lesion, because that might be the source of the bleeding if it was not found on the initial EGD.”

No significant difference was seen in the prevalence of gastric blood in patients using antiplatelet or anticoagulation agents, compared with those who were not (11% vs. 15%, respectively). The prevalence of small-bowel lesions was similar in these two groups, regardless of the combination of agents used.

The researchers did note a significantly higher frequency of gastric bleeding in patients who underwent capsule endoscopy between April 2004 and March 2006, compared with those who underwent the procedure between April 2002 and March 2004 (20% vs. 5%, respectively).

“We anticipate that as capsule endoscopy is used earlier in the evaluation of obscure bleeding, gastric bleeding sources overlooked on routine endoscopy will be detected more frequently,” they concluded in their poster.

'We're noticing that lesions missed on the initial EGD are found on capsule endoscopy.' DR. VARIA

LOS ANGELES — The rate of small-bowel findings on capsule endoscopy was the same whether or not patients were on anticoagulation or antiplatelet therapy, results from a single-center study showed.

The findings are important because many patients who undergo capsule endoscopy are on anticoagulation and/or antiplatelet agents, and “the findings and yield in these patients compared to others is not well documented,” a team of researchers from the University of Illinois Medical Center at Chicago wrote in a poster presented at the annual Digestive Disease Week.

They studied 196 patients referred to the medical center for capsule endoscopy between April 2004 and March 2006. They collected data on patients' use of aspirin, Plavix, or Coumadin, and both evidence of bleeding and types of lesions as shown in both gastric and small-bowel images.

Of the 196 patients, 26 (13%) had gastric bleeding as shown on capsule endoscopy. Of these 26 patients, 17 had the following gastric lesions: 8 had gastropathy, 7 had erosions, 1 had an ulcer, and 1 had an arteriovenous malformation (AVM). In addition, 18 patients (69%) had either no small-bowel lesion or a single, small, nonbleeding AVM. This suggests that the gastric site was the primary cause of the bleeding.

“We're noticing that lesions missed on the initial EGD [esophagogastroduodenoscopy] are found on capsule endoscopy,” one of the study authors, Dr. Apurv Varia, said in an interview at the meeting. “If you see blood, then you should look for a lesion, because that might be the source of the bleeding if it was not found on the initial EGD.”

No significant difference was seen in the prevalence of gastric blood in patients using antiplatelet or anticoagulation agents, compared with those who were not (11% vs. 15%, respectively). The prevalence of small-bowel lesions was similar in these two groups, regardless of the combination of agents used.

The researchers did note a significantly higher frequency of gastric bleeding in patients who underwent capsule endoscopy between April 2004 and March 2006, compared with those who underwent the procedure between April 2002 and March 2004 (20% vs. 5%, respectively).

“We anticipate that as capsule endoscopy is used earlier in the evaluation of obscure bleeding, gastric bleeding sources overlooked on routine endoscopy will be detected more frequently,” they concluded in their poster.

'We're noticing that lesions missed on the initial EGD are found on capsule endoscopy.' DR. VARIA

SAN DIEGO — Combining

The approach results in “a better definition of nodal disease and tumor extent, especially in cases of atelectasis,” Dr. Francesco Giammarile said at the annual meeting of the Society of Nuclear Medicine. “In our study, the approach to radiotherapy was modified in about 40% of patients.”

Dr. Giammarile, of the Centre Léon Bérard, Lyon, France, and associates evaluated 120 men and 28 women with NSCLC. The mean age of patients was 61 years, and 77% had stage IIIA or higher disease.

To define the gross clinical and target volumes, the researchers first used CT data only, followed by coregistered FDG-PET/CT data. They designed treatment plans with the CT data, but they left open the possibility for treatment modifications based on what the combined FDG-PET/CT data showed.

Dr. Giammarile reported that combined FDG-PET/CT provided additional diagnostic information in 61% of patients and showed unexpected tumor localization in 42%. Of these, 8% were at extrathoracic metastatic sites.

In 26% of cases, there was no pathologic uptake at known disease sites. “Four patients were thus shifted from radical to palliative radiotherapy for metastatic disease or very large tumor size,” the researchers wrote in their abstract. The switch resulted in an estimated per-patient savings of 490 euros in additional treatment costs, or about 616 U.S. dollars.

The study was supported by a grant from the French Ministry of Health.

SAN DIEGO — Combining

The approach results in “a better definition of nodal disease and tumor extent, especially in cases of atelectasis,” Dr. Francesco Giammarile said at the annual meeting of the Society of Nuclear Medicine. “In our study, the approach to radiotherapy was modified in about 40% of patients.”

Dr. Giammarile, of the Centre Léon Bérard, Lyon, France, and associates evaluated 120 men and 28 women with NSCLC. The mean age of patients was 61 years, and 77% had stage IIIA or higher disease.

To define the gross clinical and target volumes, the researchers first used CT data only, followed by coregistered FDG-PET/CT data. They designed treatment plans with the CT data, but they left open the possibility for treatment modifications based on what the combined FDG-PET/CT data showed.

Dr. Giammarile reported that combined FDG-PET/CT provided additional diagnostic information in 61% of patients and showed unexpected tumor localization in 42%. Of these, 8% were at extrathoracic metastatic sites.

In 26% of cases, there was no pathologic uptake at known disease sites. “Four patients were thus shifted from radical to palliative radiotherapy for metastatic disease or very large tumor size,” the researchers wrote in their abstract. The switch resulted in an estimated per-patient savings of 490 euros in additional treatment costs, or about 616 U.S. dollars.

The study was supported by a grant from the French Ministry of Health.

SAN DIEGO — Combining

The approach results in “a better definition of nodal disease and tumor extent, especially in cases of atelectasis,” Dr. Francesco Giammarile said at the annual meeting of the Society of Nuclear Medicine. “In our study, the approach to radiotherapy was modified in about 40% of patients.”

Dr. Giammarile, of the Centre Léon Bérard, Lyon, France, and associates evaluated 120 men and 28 women with NSCLC. The mean age of patients was 61 years, and 77% had stage IIIA or higher disease.

To define the gross clinical and target volumes, the researchers first used CT data only, followed by coregistered FDG-PET/CT data. They designed treatment plans with the CT data, but they left open the possibility for treatment modifications based on what the combined FDG-PET/CT data showed.

Dr. Giammarile reported that combined FDG-PET/CT provided additional diagnostic information in 61% of patients and showed unexpected tumor localization in 42%. Of these, 8% were at extrathoracic metastatic sites.

In 26% of cases, there was no pathologic uptake at known disease sites. “Four patients were thus shifted from radical to palliative radiotherapy for metastatic disease or very large tumor size,” the researchers wrote in their abstract. The switch resulted in an estimated per-patient savings of 490 euros in additional treatment costs, or about 616 U.S. dollars.

The study was supported by a grant from the French Ministry of Health.