Doug Brunk

LA JOLLA, CALIF. – Children and adults with chronic tic disorders who were treated with levodopa did not experience a worsening of tics, Dr. Mollie Gordon reported during a poster session at the annual meeting of the American Neuropsychiatric Association.

Treated patients did experience significant improvements in attention and hyperactivity symptoms.

“I think this challenges the way we think about the dopamine pathways in the brain,” Dr. Gordon, of the department of psychiatry at Washington University School of Medicine, St. Louis, said in an interview. “We've always thought of Tourette as being in a sense an excess of dopamine that affects children with movement disorders and causes them to tic and have other sequelae. So when we block the dopamine, these patients do better. What we've shown here is that if we give them dopamine, we would expect them to get worse, since the medicines we've been using block dopamine. But they don't.”

In an 8-week pilot study, Dr. Gordon and her associates randomly assigned 12 children and 18 adults with Tourette syndrome or chronic tic disorder to receive 12.5 mg of carbidopa, 50 mg of levodopa, or matched placebo capsules. The researchers recorded tic severity, clinical status, and side effects at baseline, 4 weeks, and 8 weeks. Instruments used included the Yale Global Tic Severity scale, video recordings of tics, the Clinical Global Impressions scale, the Global Assessment of Functioning scale, and various questionnaires.

The researchers found that tic severity did not increase in patients who took levodopa. Patients who took levodopa also experienced improvements in attention and hyperreactivity symptoms (a 17% improvement vs. no improvement for those on placebo), and the drug was not associated with any significant side effects.

Limitations of the study as stated in the poster include the fact that serum prolactin did not decrease appreciably in patients who took levodopa and that the “limited number of subjects may have reduced statistical significance of any effect.”

Dr. Gordon hopes that future studies will shed more light on the pathophysiology of dopamine regulation. “We know that these patients have a dopamine abnormality in the brain,” she said. “If it's not a matter of being too much or too little [dopamine], the question is, how do we figure out what's wrong? Do these drugs affect auto inhibitory receptors? Is there something going on in the brain that has to do with the dopamine dysregulation? If we [have] more information about the pathophysiology of these diseases, then we can figure out the best management.”

The study was funded in part by the Tourette Syndrome Association.

LA JOLLA, CALIF. – Children and adults with chronic tic disorders who were treated with levodopa did not experience a worsening of tics, Dr. Mollie Gordon reported during a poster session at the annual meeting of the American Neuropsychiatric Association.

Treated patients did experience significant improvements in attention and hyperactivity symptoms.

“I think this challenges the way we think about the dopamine pathways in the brain,” Dr. Gordon, of the department of psychiatry at Washington University School of Medicine, St. Louis, said in an interview. “We've always thought of Tourette as being in a sense an excess of dopamine that affects children with movement disorders and causes them to tic and have other sequelae. So when we block the dopamine, these patients do better. What we've shown here is that if we give them dopamine, we would expect them to get worse, since the medicines we've been using block dopamine. But they don't.”

In an 8-week pilot study, Dr. Gordon and her associates randomly assigned 12 children and 18 adults with Tourette syndrome or chronic tic disorder to receive 12.5 mg of carbidopa, 50 mg of levodopa, or matched placebo capsules. The researchers recorded tic severity, clinical status, and side effects at baseline, 4 weeks, and 8 weeks. Instruments used included the Yale Global Tic Severity scale, video recordings of tics, the Clinical Global Impressions scale, the Global Assessment of Functioning scale, and various questionnaires.

The researchers found that tic severity did not increase in patients who took levodopa. Patients who took levodopa also experienced improvements in attention and hyperreactivity symptoms (a 17% improvement vs. no improvement for those on placebo), and the drug was not associated with any significant side effects.

Limitations of the study as stated in the poster include the fact that serum prolactin did not decrease appreciably in patients who took levodopa and that the “limited number of subjects may have reduced statistical significance of any effect.”

Dr. Gordon hopes that future studies will shed more light on the pathophysiology of dopamine regulation. “We know that these patients have a dopamine abnormality in the brain,” she said. “If it's not a matter of being too much or too little [dopamine], the question is, how do we figure out what's wrong? Do these drugs affect auto inhibitory receptors? Is there something going on in the brain that has to do with the dopamine dysregulation? If we [have] more information about the pathophysiology of these diseases, then we can figure out the best management.”

The study was funded in part by the Tourette Syndrome Association.

LA JOLLA, CALIF. – Children and adults with chronic tic disorders who were treated with levodopa did not experience a worsening of tics, Dr. Mollie Gordon reported during a poster session at the annual meeting of the American Neuropsychiatric Association.

Treated patients did experience significant improvements in attention and hyperactivity symptoms.

“I think this challenges the way we think about the dopamine pathways in the brain,” Dr. Gordon, of the department of psychiatry at Washington University School of Medicine, St. Louis, said in an interview. “We've always thought of Tourette as being in a sense an excess of dopamine that affects children with movement disorders and causes them to tic and have other sequelae. So when we block the dopamine, these patients do better. What we've shown here is that if we give them dopamine, we would expect them to get worse, since the medicines we've been using block dopamine. But they don't.”

In an 8-week pilot study, Dr. Gordon and her associates randomly assigned 12 children and 18 adults with Tourette syndrome or chronic tic disorder to receive 12.5 mg of carbidopa, 50 mg of levodopa, or matched placebo capsules. The researchers recorded tic severity, clinical status, and side effects at baseline, 4 weeks, and 8 weeks. Instruments used included the Yale Global Tic Severity scale, video recordings of tics, the Clinical Global Impressions scale, the Global Assessment of Functioning scale, and various questionnaires.

The researchers found that tic severity did not increase in patients who took levodopa. Patients who took levodopa also experienced improvements in attention and hyperreactivity symptoms (a 17% improvement vs. no improvement for those on placebo), and the drug was not associated with any significant side effects.

Limitations of the study as stated in the poster include the fact that serum prolactin did not decrease appreciably in patients who took levodopa and that the “limited number of subjects may have reduced statistical significance of any effect.”

Dr. Gordon hopes that future studies will shed more light on the pathophysiology of dopamine regulation. “We know that these patients have a dopamine abnormality in the brain,” she said. “If it's not a matter of being too much or too little [dopamine], the question is, how do we figure out what's wrong? Do these drugs affect auto inhibitory receptors? Is there something going on in the brain that has to do with the dopamine dysregulation? If we [have] more information about the pathophysiology of these diseases, then we can figure out the best management.”

The study was funded in part by the Tourette Syndrome Association.

SAN DIEGO – Treatment with antidepressants improved executive function in patients who had a recent stroke, results from a 2-year study of 47 patients demonstrated.

The finding suggests that “modulation of the monoaminergic neurotransmission by chronic administration of antidepressants after stroke might have positive effects on the reorganization of neuronal networks associated with prefrontal functions,” researchers led by Dr. Kenji Narushima wrote in a poster presented at the annual meeting of the American Neuropyschiatric Association.

The study was conducted because, while decline of executive function is common following stroke, “there is little empirical evidence of effective biological treatments to improve stroke-related executive dysfunction,” the researchers wrote. “Antidepressants administered after stroke are known to prevent subsequent depression, improve activities of daily living, and reduce mortality independent of depression.”

In a double-blind, placebo-controlled study, he and his associates in the department of psychiatry at the University of Iowa College of Medicine, Iowa City, enrolled 47 patients who had had a stroke in the prior 6 months to receive 12 weeks of therapy with nortriptyline, fluoxetine, or placebo, followed by tests of executive function at 3 months and 2 years.

Tests of executive function included the Controlled Oral Word Association Test, the Wisconsin Card Sorting Test, and the similarities, digit span, and arithmetic subtests of the Wechsler Adult Intelligence Scale-Revised.

The researchers observed no significant effect on executive function between treatment and placebo groups at 12 weeks. However, at 2 years, patients in the placebo group showed worsening of executive function while those in the treatment group demonstrated clear improvement of executive function independent of depressive symptoms.

Specifically, the treatment group showed significant improvements on the Controlled Oral Word Association Test and the Wisconsin Card Sorting Test, compared with the placebo group. Scores from the treatment group on the similarities, digit span, and arithmetic subtests of the Wechsler Adult Intelligence Scale-Revised, meanwhile, showed either improvement or resistance to worsening of executive function, but the differences did not reach statistical significance.

In an interview, Dr. Narushima said he expected the study to show that improvement of executive function would be related to improvement of depression. “But it didn't show that,” he said. “Even the patients who didn't get depressed after the stroke improved on executive dysfunction. That's amazing to me.”

He added that it remains unclear when the best time to start an SSRI in a stroke patient is and what the proper dose is. “We are trying to find that out,” he said.

A larger study is being planned.

The best time to start a stroke patient on an SSRI and the proper dose remain unclear. DR. NARUSHIMA

SAN DIEGO – Treatment with antidepressants improved executive function in patients who had a recent stroke, results from a 2-year study of 47 patients demonstrated.

The finding suggests that “modulation of the monoaminergic neurotransmission by chronic administration of antidepressants after stroke might have positive effects on the reorganization of neuronal networks associated with prefrontal functions,” researchers led by Dr. Kenji Narushima wrote in a poster presented at the annual meeting of the American Neuropyschiatric Association.

The study was conducted because, while decline of executive function is common following stroke, “there is little empirical evidence of effective biological treatments to improve stroke-related executive dysfunction,” the researchers wrote. “Antidepressants administered after stroke are known to prevent subsequent depression, improve activities of daily living, and reduce mortality independent of depression.”

In a double-blind, placebo-controlled study, he and his associates in the department of psychiatry at the University of Iowa College of Medicine, Iowa City, enrolled 47 patients who had had a stroke in the prior 6 months to receive 12 weeks of therapy with nortriptyline, fluoxetine, or placebo, followed by tests of executive function at 3 months and 2 years.

Tests of executive function included the Controlled Oral Word Association Test, the Wisconsin Card Sorting Test, and the similarities, digit span, and arithmetic subtests of the Wechsler Adult Intelligence Scale-Revised.

The researchers observed no significant effect on executive function between treatment and placebo groups at 12 weeks. However, at 2 years, patients in the placebo group showed worsening of executive function while those in the treatment group demonstrated clear improvement of executive function independent of depressive symptoms.

Specifically, the treatment group showed significant improvements on the Controlled Oral Word Association Test and the Wisconsin Card Sorting Test, compared with the placebo group. Scores from the treatment group on the similarities, digit span, and arithmetic subtests of the Wechsler Adult Intelligence Scale-Revised, meanwhile, showed either improvement or resistance to worsening of executive function, but the differences did not reach statistical significance.

In an interview, Dr. Narushima said he expected the study to show that improvement of executive function would be related to improvement of depression. “But it didn't show that,” he said. “Even the patients who didn't get depressed after the stroke improved on executive dysfunction. That's amazing to me.”

He added that it remains unclear when the best time to start an SSRI in a stroke patient is and what the proper dose is. “We are trying to find that out,” he said.

A larger study is being planned.

The best time to start a stroke patient on an SSRI and the proper dose remain unclear. DR. NARUSHIMA

SAN DIEGO – Treatment with antidepressants improved executive function in patients who had a recent stroke, results from a 2-year study of 47 patients demonstrated.

The finding suggests that “modulation of the monoaminergic neurotransmission by chronic administration of antidepressants after stroke might have positive effects on the reorganization of neuronal networks associated with prefrontal functions,” researchers led by Dr. Kenji Narushima wrote in a poster presented at the annual meeting of the American Neuropyschiatric Association.

The study was conducted because, while decline of executive function is common following stroke, “there is little empirical evidence of effective biological treatments to improve stroke-related executive dysfunction,” the researchers wrote. “Antidepressants administered after stroke are known to prevent subsequent depression, improve activities of daily living, and reduce mortality independent of depression.”

In a double-blind, placebo-controlled study, he and his associates in the department of psychiatry at the University of Iowa College of Medicine, Iowa City, enrolled 47 patients who had had a stroke in the prior 6 months to receive 12 weeks of therapy with nortriptyline, fluoxetine, or placebo, followed by tests of executive function at 3 months and 2 years.

Tests of executive function included the Controlled Oral Word Association Test, the Wisconsin Card Sorting Test, and the similarities, digit span, and arithmetic subtests of the Wechsler Adult Intelligence Scale-Revised.

The researchers observed no significant effect on executive function between treatment and placebo groups at 12 weeks. However, at 2 years, patients in the placebo group showed worsening of executive function while those in the treatment group demonstrated clear improvement of executive function independent of depressive symptoms.

Specifically, the treatment group showed significant improvements on the Controlled Oral Word Association Test and the Wisconsin Card Sorting Test, compared with the placebo group. Scores from the treatment group on the similarities, digit span, and arithmetic subtests of the Wechsler Adult Intelligence Scale-Revised, meanwhile, showed either improvement or resistance to worsening of executive function, but the differences did not reach statistical significance.

In an interview, Dr. Narushima said he expected the study to show that improvement of executive function would be related to improvement of depression. “But it didn't show that,” he said. “Even the patients who didn't get depressed after the stroke improved on executive dysfunction. That's amazing to me.”

He added that it remains unclear when the best time to start an SSRI in a stroke patient is and what the proper dose is. “We are trying to find that out,” he said.

A larger study is being planned.

The best time to start a stroke patient on an SSRI and the proper dose remain unclear. DR. NARUSHIMA

SAN DIEGO – Seizures in elderly patients may present as subtle changes or unexplained fluctuations in cognitive abilities, results from a small study demonstrated.

The finding suggests that physicians “need to consider subtle or subclinical seizures in the differential diagnosis of cognitive deficits in the elderly,” researchers led by Dr. Eliot A. Licht wrote in a poster presented at the annual meeting of the American Neuropyschiatric Association. “Epilepsy is a potentially reversible cause of dementia.”

In an interview, Dr. Licht of the department of neurology at the Veterans Affairs (VA) Greater Los Angeles Healthcare System, said the finding “introduces another possible treatment intervention for patients who might otherwise be receiving standard cholinesterase inhibitor therapy. We're trying to expand the window of investigation to identify alternative treatments that might help to improve their cognitive functions.”

Over a period of 6 months, he and his associates identified six patients aged 64–83 years who presented to the VA's memory disorders program for an evaluation of dementia.

All patients underwent clinical examinations for seizure activity and received standard awake and drowsy electroencephalograms (EEGs). One of the six was known to have epilepsy.

EEGs showed recurrent epileptiform activity in all six patients. “This is not to say that in every case the epileptiform activity was causing all of their cognitive deficits, but it's possible that it was contributing to it,” Dr. Licht said. “This is a source of information that would not been available had we not done EEG.”

Risk factors for seizures included stroke or ischemic changes, history of tumor, and history of electroconvulsive therapy.

Although Dr. Licht acknowledged that access to EEG may be easier for elderly patients in the VA system, “in non-VA facilities it would not be considered unreasonable for patients who come in with significant memory complaints or disturbed behavior to have an EEG included as part of the regular baseline workup,” he said. “Sometimes you may need to do more than one study to get an idea of what's going on in terms of the fluctuations. That is, on day 1 someone may come in and have a small amount of activity that's not too common. But on day 10 [the activity] may be much more common. You would not necessarily know that unless you have multiple studies.”

SAN DIEGO – Seizures in elderly patients may present as subtle changes or unexplained fluctuations in cognitive abilities, results from a small study demonstrated.

The finding suggests that physicians “need to consider subtle or subclinical seizures in the differential diagnosis of cognitive deficits in the elderly,” researchers led by Dr. Eliot A. Licht wrote in a poster presented at the annual meeting of the American Neuropyschiatric Association. “Epilepsy is a potentially reversible cause of dementia.”

In an interview, Dr. Licht of the department of neurology at the Veterans Affairs (VA) Greater Los Angeles Healthcare System, said the finding “introduces another possible treatment intervention for patients who might otherwise be receiving standard cholinesterase inhibitor therapy. We're trying to expand the window of investigation to identify alternative treatments that might help to improve their cognitive functions.”

Over a period of 6 months, he and his associates identified six patients aged 64–83 years who presented to the VA's memory disorders program for an evaluation of dementia.

All patients underwent clinical examinations for seizure activity and received standard awake and drowsy electroencephalograms (EEGs). One of the six was known to have epilepsy.

EEGs showed recurrent epileptiform activity in all six patients. “This is not to say that in every case the epileptiform activity was causing all of their cognitive deficits, but it's possible that it was contributing to it,” Dr. Licht said. “This is a source of information that would not been available had we not done EEG.”

Risk factors for seizures included stroke or ischemic changes, history of tumor, and history of electroconvulsive therapy.

Although Dr. Licht acknowledged that access to EEG may be easier for elderly patients in the VA system, “in non-VA facilities it would not be considered unreasonable for patients who come in with significant memory complaints or disturbed behavior to have an EEG included as part of the regular baseline workup,” he said. “Sometimes you may need to do more than one study to get an idea of what's going on in terms of the fluctuations. That is, on day 1 someone may come in and have a small amount of activity that's not too common. But on day 10 [the activity] may be much more common. You would not necessarily know that unless you have multiple studies.”

SAN DIEGO – Seizures in elderly patients may present as subtle changes or unexplained fluctuations in cognitive abilities, results from a small study demonstrated.

The finding suggests that physicians “need to consider subtle or subclinical seizures in the differential diagnosis of cognitive deficits in the elderly,” researchers led by Dr. Eliot A. Licht wrote in a poster presented at the annual meeting of the American Neuropyschiatric Association. “Epilepsy is a potentially reversible cause of dementia.”

In an interview, Dr. Licht of the department of neurology at the Veterans Affairs (VA) Greater Los Angeles Healthcare System, said the finding “introduces another possible treatment intervention for patients who might otherwise be receiving standard cholinesterase inhibitor therapy. We're trying to expand the window of investigation to identify alternative treatments that might help to improve their cognitive functions.”

Over a period of 6 months, he and his associates identified six patients aged 64–83 years who presented to the VA's memory disorders program for an evaluation of dementia.

All patients underwent clinical examinations for seizure activity and received standard awake and drowsy electroencephalograms (EEGs). One of the six was known to have epilepsy.

EEGs showed recurrent epileptiform activity in all six patients. “This is not to say that in every case the epileptiform activity was causing all of their cognitive deficits, but it's possible that it was contributing to it,” Dr. Licht said. “This is a source of information that would not been available had we not done EEG.”

Risk factors for seizures included stroke or ischemic changes, history of tumor, and history of electroconvulsive therapy.

Although Dr. Licht acknowledged that access to EEG may be easier for elderly patients in the VA system, “in non-VA facilities it would not be considered unreasonable for patients who come in with significant memory complaints or disturbed behavior to have an EEG included as part of the regular baseline workup,” he said. “Sometimes you may need to do more than one study to get an idea of what's going on in terms of the fluctuations. That is, on day 1 someone may come in and have a small amount of activity that's not too common. But on day 10 [the activity] may be much more common. You would not necessarily know that unless you have multiple studies.”

LOS ANGELES — Have a high index of suspicion for gastric lymphoma in a patient who presents with severe abdominal pain, weight loss, and melena, Dr. Ijeoma A. Azodo advised in a poster session at the annual Digestive Disease Week.

“They will have other symptoms, such as early satiety, heartburn, and things that would warrant upper endoscopy,” Dr. Azodo of the Mayo Clinic in Rochester, Minn., said in an interview. She based her comments on results from an analysis of 711 hospitals participating in the gastric cancer patient care evaluation study of the National Cancer Data Base, which is an alliance between the American College of Surgeons' Committee on Cancer and the American Cancer Society.

The analysis was limited to clinical data on the management of patients with gastric cancer collected between January 2001 and December 2001. Of the 7,084 gastric malignancies in 2001, 688 (10%) were lymphomas. Patients with gastric lymphoma were predominantly white (73%), and more than half (57%) were male. The mean age at diagnosis was 69 years, and the three most common symptoms at presentation were severe abdominal pain (74%), weight loss (61%), and melena (47%).

Upper endoscopy with tissue biopsy was used in 86% of cases, and the procedure identified a gastric lymphoma in nearly all (97%). Abdominal and pelvic CT scans were also used for staging purposes, but newer technologies such as endoscopic ultrasonography and laparoscopy were infrequently used.

Dr. Azodo also reported that the most common gastric lymphoma sites were unspecified/diffuse/multiple (50%) and distal (16%), and that 31% of patients had a history of Helicobacter pylori infection while 22% had negative test results.

Large-cell diffuse lymphoma was present in 49% of patients, and marginal zone B-cell lymphoma was present in 36%.

Fewer than half of all gastric lymphoma patients with H. pylori exposure received an adequate regimen of therapy for its eradication.

Most patients (89%) were treated without surgery, but those who underwent surgery had a 30-day mortality of 19%. Postsurgical adjuvant therapy was used in 5% of patients. Radiation was the stand-alone treatment in 9% of patients, and chemotherapy was administered in 51% of patients.

Symptoms include severe abdominal pain, weight loss, melena, early satiety, and heartburn. DR. AZODO

LOS ANGELES — Have a high index of suspicion for gastric lymphoma in a patient who presents with severe abdominal pain, weight loss, and melena, Dr. Ijeoma A. Azodo advised in a poster session at the annual Digestive Disease Week.

“They will have other symptoms, such as early satiety, heartburn, and things that would warrant upper endoscopy,” Dr. Azodo of the Mayo Clinic in Rochester, Minn., said in an interview. She based her comments on results from an analysis of 711 hospitals participating in the gastric cancer patient care evaluation study of the National Cancer Data Base, which is an alliance between the American College of Surgeons' Committee on Cancer and the American Cancer Society.

The analysis was limited to clinical data on the management of patients with gastric cancer collected between January 2001 and December 2001. Of the 7,084 gastric malignancies in 2001, 688 (10%) were lymphomas. Patients with gastric lymphoma were predominantly white (73%), and more than half (57%) were male. The mean age at diagnosis was 69 years, and the three most common symptoms at presentation were severe abdominal pain (74%), weight loss (61%), and melena (47%).

Upper endoscopy with tissue biopsy was used in 86% of cases, and the procedure identified a gastric lymphoma in nearly all (97%). Abdominal and pelvic CT scans were also used for staging purposes, but newer technologies such as endoscopic ultrasonography and laparoscopy were infrequently used.

Dr. Azodo also reported that the most common gastric lymphoma sites were unspecified/diffuse/multiple (50%) and distal (16%), and that 31% of patients had a history of Helicobacter pylori infection while 22% had negative test results.

Large-cell diffuse lymphoma was present in 49% of patients, and marginal zone B-cell lymphoma was present in 36%.

Fewer than half of all gastric lymphoma patients with H. pylori exposure received an adequate regimen of therapy for its eradication.

Most patients (89%) were treated without surgery, but those who underwent surgery had a 30-day mortality of 19%. Postsurgical adjuvant therapy was used in 5% of patients. Radiation was the stand-alone treatment in 9% of patients, and chemotherapy was administered in 51% of patients.

Symptoms include severe abdominal pain, weight loss, melena, early satiety, and heartburn. DR. AZODO

LOS ANGELES — Have a high index of suspicion for gastric lymphoma in a patient who presents with severe abdominal pain, weight loss, and melena, Dr. Ijeoma A. Azodo advised in a poster session at the annual Digestive Disease Week.

“They will have other symptoms, such as early satiety, heartburn, and things that would warrant upper endoscopy,” Dr. Azodo of the Mayo Clinic in Rochester, Minn., said in an interview. She based her comments on results from an analysis of 711 hospitals participating in the gastric cancer patient care evaluation study of the National Cancer Data Base, which is an alliance between the American College of Surgeons' Committee on Cancer and the American Cancer Society.

The analysis was limited to clinical data on the management of patients with gastric cancer collected between January 2001 and December 2001. Of the 7,084 gastric malignancies in 2001, 688 (10%) were lymphomas. Patients with gastric lymphoma were predominantly white (73%), and more than half (57%) were male. The mean age at diagnosis was 69 years, and the three most common symptoms at presentation were severe abdominal pain (74%), weight loss (61%), and melena (47%).

Upper endoscopy with tissue biopsy was used in 86% of cases, and the procedure identified a gastric lymphoma in nearly all (97%). Abdominal and pelvic CT scans were also used for staging purposes, but newer technologies such as endoscopic ultrasonography and laparoscopy were infrequently used.

Dr. Azodo also reported that the most common gastric lymphoma sites were unspecified/diffuse/multiple (50%) and distal (16%), and that 31% of patients had a history of Helicobacter pylori infection while 22% had negative test results.

Large-cell diffuse lymphoma was present in 49% of patients, and marginal zone B-cell lymphoma was present in 36%.

Fewer than half of all gastric lymphoma patients with H. pylori exposure received an adequate regimen of therapy for its eradication.

Most patients (89%) were treated without surgery, but those who underwent surgery had a 30-day mortality of 19%. Postsurgical adjuvant therapy was used in 5% of patients. Radiation was the stand-alone treatment in 9% of patients, and chemotherapy was administered in 51% of patients.

Symptoms include severe abdominal pain, weight loss, melena, early satiety, and heartburn. DR. AZODO

PALM SPRINGS, CALIF. — Routine vaginal cytology as a surveillance test for endometrial cancer recurrence is costly, inefficient, and benefits less than 1% of patients, Dr. Robert E. Bristow and his associates reported in a poster session at the annual meeting of the Society of Gynecologic Oncologists.

“The rationale for intensive surveillance of endometrial cancer patients in clinical remission is based on the premise that early detection of an asymptomatic recurrence will translate into improved survival outcomes,” the researchers, who are affiliated with the Kelly Gynecologic Oncology Service at Johns Hopkins Medical Institutions, Baltimore, wrote in their poster.

Although this premise is widely held, studies have not demonstrated a significant survival advantage for patients whose recurrences are detected during routine follow-up, compared with symptomatic patients presenting for interval evaluation, they noted.

The researchers reviewed the medical records of 377 endometrial cancer patients who were treated at the Kelly Gynecologic Oncology Service between July of 1997 and June of 2005.

They calculated the total number of Pap tests performed during surveillance or until the time of recurrence. Costs were assigned based on 2005 Pap test costs adjusted retroactively using the consumer price index.

Of the 337 patients, the majority (63.7%) had stage I cancer; 10.1% had stage II; 18.8% had stage III; and 7.4% had stage IV. The median follow-up was 30 months. A median of five Pap samples per patient were collected during the study period, for a total of 2,134 Pap tests.

The researchers found that endometrial cancer recurred in 61 patients (16.2%), while 11 (2.9%) had an isolated vaginal recurrence.

Of the isolated vaginal recurrences, seven were detected by physical examination alone, two were detected by interval computed tomography, and two asymptomatic vaginal recurrences were detected by routine vaginal cytology, for a rate of 0.5%.

“Detection of each asymptomatic vaginal recurrence required 1,067 Pap tests, generating $44,049 in cumulative charges,” the researchers noted in their poster.

They concluded that “elimination or reduction in the use of vaginal cytology for this purpose offers an opportunity for significant cost savings in gynecologic oncology health care.”

Dr. Bristow directs the Kelly Gynecologic Oncology Service.

PALM SPRINGS, CALIF. — Routine vaginal cytology as a surveillance test for endometrial cancer recurrence is costly, inefficient, and benefits less than 1% of patients, Dr. Robert E. Bristow and his associates reported in a poster session at the annual meeting of the Society of Gynecologic Oncologists.

“The rationale for intensive surveillance of endometrial cancer patients in clinical remission is based on the premise that early detection of an asymptomatic recurrence will translate into improved survival outcomes,” the researchers, who are affiliated with the Kelly Gynecologic Oncology Service at Johns Hopkins Medical Institutions, Baltimore, wrote in their poster.

Although this premise is widely held, studies have not demonstrated a significant survival advantage for patients whose recurrences are detected during routine follow-up, compared with symptomatic patients presenting for interval evaluation, they noted.

The researchers reviewed the medical records of 377 endometrial cancer patients who were treated at the Kelly Gynecologic Oncology Service between July of 1997 and June of 2005.

They calculated the total number of Pap tests performed during surveillance or until the time of recurrence. Costs were assigned based on 2005 Pap test costs adjusted retroactively using the consumer price index.

Of the 337 patients, the majority (63.7%) had stage I cancer; 10.1% had stage II; 18.8% had stage III; and 7.4% had stage IV. The median follow-up was 30 months. A median of five Pap samples per patient were collected during the study period, for a total of 2,134 Pap tests.

The researchers found that endometrial cancer recurred in 61 patients (16.2%), while 11 (2.9%) had an isolated vaginal recurrence.

Of the isolated vaginal recurrences, seven were detected by physical examination alone, two were detected by interval computed tomography, and two asymptomatic vaginal recurrences were detected by routine vaginal cytology, for a rate of 0.5%.

“Detection of each asymptomatic vaginal recurrence required 1,067 Pap tests, generating $44,049 in cumulative charges,” the researchers noted in their poster.

They concluded that “elimination or reduction in the use of vaginal cytology for this purpose offers an opportunity for significant cost savings in gynecologic oncology health care.”

Dr. Bristow directs the Kelly Gynecologic Oncology Service.

PALM SPRINGS, CALIF. — Routine vaginal cytology as a surveillance test for endometrial cancer recurrence is costly, inefficient, and benefits less than 1% of patients, Dr. Robert E. Bristow and his associates reported in a poster session at the annual meeting of the Society of Gynecologic Oncologists.

“The rationale for intensive surveillance of endometrial cancer patients in clinical remission is based on the premise that early detection of an asymptomatic recurrence will translate into improved survival outcomes,” the researchers, who are affiliated with the Kelly Gynecologic Oncology Service at Johns Hopkins Medical Institutions, Baltimore, wrote in their poster.

Although this premise is widely held, studies have not demonstrated a significant survival advantage for patients whose recurrences are detected during routine follow-up, compared with symptomatic patients presenting for interval evaluation, they noted.

The researchers reviewed the medical records of 377 endometrial cancer patients who were treated at the Kelly Gynecologic Oncology Service between July of 1997 and June of 2005.

They calculated the total number of Pap tests performed during surveillance or until the time of recurrence. Costs were assigned based on 2005 Pap test costs adjusted retroactively using the consumer price index.

Of the 337 patients, the majority (63.7%) had stage I cancer; 10.1% had stage II; 18.8% had stage III; and 7.4% had stage IV. The median follow-up was 30 months. A median of five Pap samples per patient were collected during the study period, for a total of 2,134 Pap tests.

The researchers found that endometrial cancer recurred in 61 patients (16.2%), while 11 (2.9%) had an isolated vaginal recurrence.

Of the isolated vaginal recurrences, seven were detected by physical examination alone, two were detected by interval computed tomography, and two asymptomatic vaginal recurrences were detected by routine vaginal cytology, for a rate of 0.5%.

“Detection of each asymptomatic vaginal recurrence required 1,067 Pap tests, generating $44,049 in cumulative charges,” the researchers noted in their poster.

They concluded that “elimination or reduction in the use of vaginal cytology for this purpose offers an opportunity for significant cost savings in gynecologic oncology health care.”

Dr. Bristow directs the Kelly Gynecologic Oncology Service.

Inhaled corticosteroids are better than sodium cromoglycate in measures of lung function and asthma control in children and adults with chronic asthma, the first-ever systematic review of its kind has concluded.

“The results suggest that the superiority of ICS over SCG may be independent of asthma severity, since results were generally similar among those with milder and more severe asthma,” wrote the researchers, who were led by Dr. James P. Guevara of the department of pediatrics at the University of Pennsylvania, Philadelphia. The superiority of ICS over SCG may depend on the dosage of inhaled steroid, since results in favor of ICS were generally stronger among studies with moderate doses than among those with low doses.

However, no conclusions could be made about possible differences in adverse events between ICS and SCG because adverse events in the trials chosen for analysis “were reported inconsistently, and most trials were short-term,” they noted.

The researchers reviewed 25 randomized, controlled trials that compared the effects of ICS with those of SCG in children and adults with chronic asthma. Of the 25 trials, 17 included 1,279 children and 8 included 321 adults (Cochrane Database System. Rev. 2006; DOI:10.1002/14651858.CD003558.pub2).

In the trials of children, use of ICS was associated with a higher mean forced expiratory volume in 1 second (FEV₁) (a mean weighted difference of 0.07 L) and a higher final end-point peak expiratory flow (PEF) rate (a mean weighted difference of 17.3 L/minute), compared with use of SCG. Use of ICS was also associated with fewer exacerbations (a mean weighted difference of −1.18 per patient year), lower asthma symptom scores, and less bronchodilator use, compared with use of SCG.

In the trials of adults, use of ICS was associated with a higher mean FEV₁ (a mean weighted difference of 0.21 L) and a higher final end-point PEF rate (a mean weighted difference of 28.2 L/minute), compared with use of SCG. Use of ICS also was associated with fewer exacerbations (a mean weighted difference of −3.30 per patient year) and less bronchodilator use, compared with use of SCG. Use of ICS was associated with lower asthma symptom scores than was SCG in the three crossover trials reviewed as part of the analysis, but not in the one parallel group trial reviewed.

Inhaled corticosteroids are better than sodium cromoglycate in measures of lung function and asthma control in children and adults with chronic asthma, the first-ever systematic review of its kind has concluded.

“The results suggest that the superiority of ICS over SCG may be independent of asthma severity, since results were generally similar among those with milder and more severe asthma,” wrote the researchers, who were led by Dr. James P. Guevara of the department of pediatrics at the University of Pennsylvania, Philadelphia. The superiority of ICS over SCG may depend on the dosage of inhaled steroid, since results in favor of ICS were generally stronger among studies with moderate doses than among those with low doses.

However, no conclusions could be made about possible differences in adverse events between ICS and SCG because adverse events in the trials chosen for analysis “were reported inconsistently, and most trials were short-term,” they noted.

The researchers reviewed 25 randomized, controlled trials that compared the effects of ICS with those of SCG in children and adults with chronic asthma. Of the 25 trials, 17 included 1,279 children and 8 included 321 adults (Cochrane Database System. Rev. 2006; DOI:10.1002/14651858.CD003558.pub2).

In the trials of children, use of ICS was associated with a higher mean forced expiratory volume in 1 second (FEV₁) (a mean weighted difference of 0.07 L) and a higher final end-point peak expiratory flow (PEF) rate (a mean weighted difference of 17.3 L/minute), compared with use of SCG. Use of ICS was also associated with fewer exacerbations (a mean weighted difference of −1.18 per patient year), lower asthma symptom scores, and less bronchodilator use, compared with use of SCG.

In the trials of adults, use of ICS was associated with a higher mean FEV₁ (a mean weighted difference of 0.21 L) and a higher final end-point PEF rate (a mean weighted difference of 28.2 L/minute), compared with use of SCG. Use of ICS also was associated with fewer exacerbations (a mean weighted difference of −3.30 per patient year) and less bronchodilator use, compared with use of SCG. Use of ICS was associated with lower asthma symptom scores than was SCG in the three crossover trials reviewed as part of the analysis, but not in the one parallel group trial reviewed.

Inhaled corticosteroids are better than sodium cromoglycate in measures of lung function and asthma control in children and adults with chronic asthma, the first-ever systematic review of its kind has concluded.

“The results suggest that the superiority of ICS over SCG may be independent of asthma severity, since results were generally similar among those with milder and more severe asthma,” wrote the researchers, who were led by Dr. James P. Guevara of the department of pediatrics at the University of Pennsylvania, Philadelphia. The superiority of ICS over SCG may depend on the dosage of inhaled steroid, since results in favor of ICS were generally stronger among studies with moderate doses than among those with low doses.

However, no conclusions could be made about possible differences in adverse events between ICS and SCG because adverse events in the trials chosen for analysis “were reported inconsistently, and most trials were short-term,” they noted.

The researchers reviewed 25 randomized, controlled trials that compared the effects of ICS with those of SCG in children and adults with chronic asthma. Of the 25 trials, 17 included 1,279 children and 8 included 321 adults (Cochrane Database System. Rev. 2006; DOI:10.1002/14651858.CD003558.pub2).

In the trials of children, use of ICS was associated with a higher mean forced expiratory volume in 1 second (FEV₁) (a mean weighted difference of 0.07 L) and a higher final end-point peak expiratory flow (PEF) rate (a mean weighted difference of 17.3 L/minute), compared with use of SCG. Use of ICS was also associated with fewer exacerbations (a mean weighted difference of −1.18 per patient year), lower asthma symptom scores, and less bronchodilator use, compared with use of SCG.

In the trials of adults, use of ICS was associated with a higher mean FEV₁ (a mean weighted difference of 0.21 L) and a higher final end-point PEF rate (a mean weighted difference of 28.2 L/minute), compared with use of SCG. Use of ICS also was associated with fewer exacerbations (a mean weighted difference of −3.30 per patient year) and less bronchodilator use, compared with use of SCG. Use of ICS was associated with lower asthma symptom scores than was SCG in the three crossover trials reviewed as part of the analysis, but not in the one parallel group trial reviewed.

SAN DIEGO — More than one-third of multiple sclerosis patients missed at least one injection of a first-line disease-modifying therapy over a 4-week period, results from a large multicenter study showed.

The most frequently reported reasons were forgetting to take the injection, not feeling like taking it, and being tired of the shot, Katherine A. Treadaway reported in a poster session at the annual meeting of the American Academy of Neurology.

The study marks the first time that adherence to all four first-line disease-modifying therapies (DMTs) approved for the management of multiple sclerosis—Avonex, Betaseron, Copaxone, and Rebif—were assessed in a multicenter patient population.

Patients who were most compliant with their medication schedule had a higher quality of life, lower rates of depression, and higher levels of hope. Neurologists “need to ask their patients if they're taking their medications and whether the medications are causing problems,” Ms. Treadaway, a licensed clinical social worker at the Multiple Sclerosis Program and Clinical Center, of the University of Texas Southwestern Medical Center at Dallas, said in an interview. “Depression might also be something neurologists can ask about, because we want people to stay on the medications.”

Ms. Treadaway and her associates at 17 sites nationwide recruited patients to participate in a Web-based survey to determine what factors influence adherence to DMT injection schedules. The survey included the Multiple Sclerosis Quality of Life-54 (MSQOL-54), the Beck Depression Inventory (BDI) Fast Screen, the Herth Hope Index, and questions about medication compliance. Study participants were surveyed at baseline, 4 weeks, and 8 weeks.

Adherence was defined as not missing an injection of a DMT in the last 4 weeks. Nonadherence was defined as missing at least one DMT injection in the last 4 weeks.

Of the 798 survey respondents, 77% were female and their median disease duration was 5 years.

Overall, more than one-third of patients were nonadherent, which remained consistent across all three time periods. Adherence rates were 61% at baseline, 63% at 4 weeks, and 64% at 8 weeks.

The top five reasons for nonadherence as reported by patients were forgetting to administer the injection (58%), not feeling like taking the injection (22%), being tired of taking the injection (16%), fatigue (12%), and inconvenience of the dosing schedule (8%). Study patients were allowed to report more than one reason for noncompliance.

Ms. Treadaway also reported that compared with adherent patients, nonadherent patients had significantly worse perceived quality of life based on the MSQOL-54, lower levels of hope based on the Herth Hope Index (39.5 vs. 38.2), and significantly higher depression scores based on the BDI Fast Screen (scores ranged from 2.5 to 3.4 on a scale of 1–21).

“I think education is a big key to keeping people on their [DMT] medications,” she commented. “If they're satisfied and they feel like it's working, they're going to be more adherent.”

Limitations of the study include its observational design and its reliance on patient self-reports, she noted.

The study was supported by an unrestricted grant from Biogen Idec Inc., which manufactures Avonex. Ms. Treadaway disclosed that she has received speaker honoraria from Biogen Idec and from Teva Neuroscience Inc., which manufactures Copaxone.

SAN DIEGO — More than one-third of multiple sclerosis patients missed at least one injection of a first-line disease-modifying therapy over a 4-week period, results from a large multicenter study showed.

The most frequently reported reasons were forgetting to take the injection, not feeling like taking it, and being tired of the shot, Katherine A. Treadaway reported in a poster session at the annual meeting of the American Academy of Neurology.

The study marks the first time that adherence to all four first-line disease-modifying therapies (DMTs) approved for the management of multiple sclerosis—Avonex, Betaseron, Copaxone, and Rebif—were assessed in a multicenter patient population.

Patients who were most compliant with their medication schedule had a higher quality of life, lower rates of depression, and higher levels of hope. Neurologists “need to ask their patients if they're taking their medications and whether the medications are causing problems,” Ms. Treadaway, a licensed clinical social worker at the Multiple Sclerosis Program and Clinical Center, of the University of Texas Southwestern Medical Center at Dallas, said in an interview. “Depression might also be something neurologists can ask about, because we want people to stay on the medications.”

Ms. Treadaway and her associates at 17 sites nationwide recruited patients to participate in a Web-based survey to determine what factors influence adherence to DMT injection schedules. The survey included the Multiple Sclerosis Quality of Life-54 (MSQOL-54), the Beck Depression Inventory (BDI) Fast Screen, the Herth Hope Index, and questions about medication compliance. Study participants were surveyed at baseline, 4 weeks, and 8 weeks.

Adherence was defined as not missing an injection of a DMT in the last 4 weeks. Nonadherence was defined as missing at least one DMT injection in the last 4 weeks.

Of the 798 survey respondents, 77% were female and their median disease duration was 5 years.

Overall, more than one-third of patients were nonadherent, which remained consistent across all three time periods. Adherence rates were 61% at baseline, 63% at 4 weeks, and 64% at 8 weeks.

The top five reasons for nonadherence as reported by patients were forgetting to administer the injection (58%), not feeling like taking the injection (22%), being tired of taking the injection (16%), fatigue (12%), and inconvenience of the dosing schedule (8%). Study patients were allowed to report more than one reason for noncompliance.

Ms. Treadaway also reported that compared with adherent patients, nonadherent patients had significantly worse perceived quality of life based on the MSQOL-54, lower levels of hope based on the Herth Hope Index (39.5 vs. 38.2), and significantly higher depression scores based on the BDI Fast Screen (scores ranged from 2.5 to 3.4 on a scale of 1–21).

“I think education is a big key to keeping people on their [DMT] medications,” she commented. “If they're satisfied and they feel like it's working, they're going to be more adherent.”

Limitations of the study include its observational design and its reliance on patient self-reports, she noted.

The study was supported by an unrestricted grant from Biogen Idec Inc., which manufactures Avonex. Ms. Treadaway disclosed that she has received speaker honoraria from Biogen Idec and from Teva Neuroscience Inc., which manufactures Copaxone.

SAN DIEGO — More than one-third of multiple sclerosis patients missed at least one injection of a first-line disease-modifying therapy over a 4-week period, results from a large multicenter study showed.

The most frequently reported reasons were forgetting to take the injection, not feeling like taking it, and being tired of the shot, Katherine A. Treadaway reported in a poster session at the annual meeting of the American Academy of Neurology.

The study marks the first time that adherence to all four first-line disease-modifying therapies (DMTs) approved for the management of multiple sclerosis—Avonex, Betaseron, Copaxone, and Rebif—were assessed in a multicenter patient population.

Patients who were most compliant with their medication schedule had a higher quality of life, lower rates of depression, and higher levels of hope. Neurologists “need to ask their patients if they're taking their medications and whether the medications are causing problems,” Ms. Treadaway, a licensed clinical social worker at the Multiple Sclerosis Program and Clinical Center, of the University of Texas Southwestern Medical Center at Dallas, said in an interview. “Depression might also be something neurologists can ask about, because we want people to stay on the medications.”

Ms. Treadaway and her associates at 17 sites nationwide recruited patients to participate in a Web-based survey to determine what factors influence adherence to DMT injection schedules. The survey included the Multiple Sclerosis Quality of Life-54 (MSQOL-54), the Beck Depression Inventory (BDI) Fast Screen, the Herth Hope Index, and questions about medication compliance. Study participants were surveyed at baseline, 4 weeks, and 8 weeks.

Adherence was defined as not missing an injection of a DMT in the last 4 weeks. Nonadherence was defined as missing at least one DMT injection in the last 4 weeks.

Of the 798 survey respondents, 77% were female and their median disease duration was 5 years.

Overall, more than one-third of patients were nonadherent, which remained consistent across all three time periods. Adherence rates were 61% at baseline, 63% at 4 weeks, and 64% at 8 weeks.

The top five reasons for nonadherence as reported by patients were forgetting to administer the injection (58%), not feeling like taking the injection (22%), being tired of taking the injection (16%), fatigue (12%), and inconvenience of the dosing schedule (8%). Study patients were allowed to report more than one reason for noncompliance.

Ms. Treadaway also reported that compared with adherent patients, nonadherent patients had significantly worse perceived quality of life based on the MSQOL-54, lower levels of hope based on the Herth Hope Index (39.5 vs. 38.2), and significantly higher depression scores based on the BDI Fast Screen (scores ranged from 2.5 to 3.4 on a scale of 1–21).

“I think education is a big key to keeping people on their [DMT] medications,” she commented. “If they're satisfied and they feel like it's working, they're going to be more adherent.”

Limitations of the study include its observational design and its reliance on patient self-reports, she noted.

The study was supported by an unrestricted grant from Biogen Idec Inc., which manufactures Avonex. Ms. Treadaway disclosed that she has received speaker honoraria from Biogen Idec and from Teva Neuroscience Inc., which manufactures Copaxone.

The mean direct cost for treating childhood-onset systemic lupus erythematosus per patient is $14,944 a year, which is roughly three times higher than the cost of treating an adult with the condition, results from the first analysis of its kind demonstrated.

“Whether this difference in cost between adults and children is due to differences in health care delivery systems, adherence to therapies, or differences in disease severity remains to be determined,” wrote the researchers, led by Dr. Hermine I. Brunner of the division of rheumatology at Cincinnati Children's Hospital Medical Center.

The researchers reviewed the clinical and administrative records of 119 patients with childhood-onset systemic lupus erythematosus (cSLE) who were diagnosed and treated at two large tertiary pediatric rheumatology centers in the United States between January 2001 and April 2004 (Arthritis & Rheum. 2006;55:184–8). They used health-related quality of life estimates for patients with cSLE as reported in the medical literature to calculate the direct cost per quality-adjusted life-year. These quality of life measures were based on the global health subscale of the Child Health Questionnaire.

Of the 119 patients, 87% were female. The mean duration of follow-up was 27 months, and the researchers reported on results of 3,184 patient-months of follow-up.

The cumulative cost of medical care during the study period was $3,965,048, which excluded the cost of outpatient medications. This translated into a mean per-patient monthly cost of $1,245, or $14,944 per year. In contrast, recent estimates of the per-patient annual cost of treating adult SLE put the figure at $4,170.

A breakdown of the direct costs revealed that most came from inpatient or day-patient care (28%), followed by laboratory testing (21%), inpatient or day-patient medication (13%), dialysis (11%), and outpatient clinic visits other than rheumatology outpatient visits (11%).

The researchers noted that only 3 of the 199 patients required dialysis, yet it was the fourth-largest cost entity. “Therefore, based on previous research in adults, dialysis expenses contribute to the direct cost of both SLE and cSLE in similar proportions,” they wrote.

“This finding suggests that prevention and aggressive therapy of renal diseases are not only of utmost importance for avoiding patient damage but also appear to be relevant for containing the cost of care of cSLE,” they noted.

The study was supported by the Robert Wood Johnson Foundation, the Arthritis Foundation of America, and the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

The mean direct cost for treating childhood-onset systemic lupus erythematosus per patient is $14,944 a year, which is roughly three times higher than the cost of treating an adult with the condition, results from the first analysis of its kind demonstrated.

“Whether this difference in cost between adults and children is due to differences in health care delivery systems, adherence to therapies, or differences in disease severity remains to be determined,” wrote the researchers, led by Dr. Hermine I. Brunner of the division of rheumatology at Cincinnati Children's Hospital Medical Center.

The researchers reviewed the clinical and administrative records of 119 patients with childhood-onset systemic lupus erythematosus (cSLE) who were diagnosed and treated at two large tertiary pediatric rheumatology centers in the United States between January 2001 and April 2004 (Arthritis & Rheum. 2006;55:184–8). They used health-related quality of life estimates for patients with cSLE as reported in the medical literature to calculate the direct cost per quality-adjusted life-year. These quality of life measures were based on the global health subscale of the Child Health Questionnaire.

Of the 119 patients, 87% were female. The mean duration of follow-up was 27 months, and the researchers reported on results of 3,184 patient-months of follow-up.

The cumulative cost of medical care during the study period was $3,965,048, which excluded the cost of outpatient medications. This translated into a mean per-patient monthly cost of $1,245, or $14,944 per year. In contrast, recent estimates of the per-patient annual cost of treating adult SLE put the figure at $4,170.

A breakdown of the direct costs revealed that most came from inpatient or day-patient care (28%), followed by laboratory testing (21%), inpatient or day-patient medication (13%), dialysis (11%), and outpatient clinic visits other than rheumatology outpatient visits (11%).

The researchers noted that only 3 of the 199 patients required dialysis, yet it was the fourth-largest cost entity. “Therefore, based on previous research in adults, dialysis expenses contribute to the direct cost of both SLE and cSLE in similar proportions,” they wrote.

“This finding suggests that prevention and aggressive therapy of renal diseases are not only of utmost importance for avoiding patient damage but also appear to be relevant for containing the cost of care of cSLE,” they noted.

The study was supported by the Robert Wood Johnson Foundation, the Arthritis Foundation of America, and the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

The mean direct cost for treating childhood-onset systemic lupus erythematosus per patient is $14,944 a year, which is roughly three times higher than the cost of treating an adult with the condition, results from the first analysis of its kind demonstrated.

“Whether this difference in cost between adults and children is due to differences in health care delivery systems, adherence to therapies, or differences in disease severity remains to be determined,” wrote the researchers, led by Dr. Hermine I. Brunner of the division of rheumatology at Cincinnati Children's Hospital Medical Center.

The researchers reviewed the clinical and administrative records of 119 patients with childhood-onset systemic lupus erythematosus (cSLE) who were diagnosed and treated at two large tertiary pediatric rheumatology centers in the United States between January 2001 and April 2004 (Arthritis & Rheum. 2006;55:184–8). They used health-related quality of life estimates for patients with cSLE as reported in the medical literature to calculate the direct cost per quality-adjusted life-year. These quality of life measures were based on the global health subscale of the Child Health Questionnaire.

Of the 119 patients, 87% were female. The mean duration of follow-up was 27 months, and the researchers reported on results of 3,184 patient-months of follow-up.

The cumulative cost of medical care during the study period was $3,965,048, which excluded the cost of outpatient medications. This translated into a mean per-patient monthly cost of $1,245, or $14,944 per year. In contrast, recent estimates of the per-patient annual cost of treating adult SLE put the figure at $4,170.

A breakdown of the direct costs revealed that most came from inpatient or day-patient care (28%), followed by laboratory testing (21%), inpatient or day-patient medication (13%), dialysis (11%), and outpatient clinic visits other than rheumatology outpatient visits (11%).

The researchers noted that only 3 of the 199 patients required dialysis, yet it was the fourth-largest cost entity. “Therefore, based on previous research in adults, dialysis expenses contribute to the direct cost of both SLE and cSLE in similar proportions,” they wrote.

“This finding suggests that prevention and aggressive therapy of renal diseases are not only of utmost importance for avoiding patient damage but also appear to be relevant for containing the cost of care of cSLE,” they noted.

The study was supported by the Robert Wood Johnson Foundation, the Arthritis Foundation of America, and the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

SAN DIEGO — The overall sensitivity of MRI to detect chondral lesions found during arthroscopic knee surgery was only 45%, results from a study of 190 patients demonstrated.

The finding suggests that knee arthroscopists should be prepared to intraoperatively detect and treat chondral lesions that have been previously undiagnosed by MRI, Dr. Alex Vaisman said at a symposium sponsored by the International Cartilage Repair Society.

“Based on our results, we recommend that the instrumentation for different cartilage repair techniques should always be available [at] the time of an arthroscopic knee procedure,” said Dr. Vaisman, of the Universidad Del Desarrollo, Santiago, Chile.

The purpose of the study was to prospectively evaluate the incidence and morphologic characteristics of chondral lesions following arthroscopic knee surgery and to establish the correlation between microscopic and MRI findings.

Dr. Vaisman and his associates evaluated 190 consecutive knee procedures performed between March 2003 and February 2004 by two surgeons with 15 years of knee surgery experience.

Two musculoskeletal radiologists with 10 years of experience generated the MRI reports.

The time between MRI exam and knee surgery did not exceed 1 year. The MRI report of at least one chondral lesion found at arthroscopy was considered to be a positive correlation between both diagnostic instruments.

The average age of the 190 patients in the study was 35 years, and 116 were male. Most indications for arthroscopic surgery were for anterior cruciate ligament tears and meniscal tears.

On arthroscopy, Dr. Vaisman and fellow researchers found 115 chondral lesions in 82 patients. Most (72%) were single lesions located on the medial femoral condyle (32%) or the medial patella (23%). The average size of these lesions was 1.99 cm

There was no correlation between patient age and the number of lesions, but there was a direct correlation between patient age and the size of the lesion.

On MRI, chondral lesions were reported in 37 out of 82 patients, which translated into a sensitivity of 45% and a specificity of 100%.

When researchers analyzed MRI sensitivity by location of the defect, they observed that MRI was most accurate for patellar defects (53%), followed by femoral defects (43%) and tibial defects (16%).

When they analyzed the MRI sensitivity by the ICRS classification system, significant differences emerged.

For example, the MRI sensitivity for ICRS grade 1 lesions was 13%, compared with 53% for grade 2 lesions, 64% for grade 3 lesions, and 73% for grade 4 lesions.

MRI detected this medial femoral condyle osteonecrosis and lesion.

The same medial femoral chondral lesion is shown in arthroscopic view. Photos courtesy Dr. Alex Vaisman

SAN DIEGO — The overall sensitivity of MRI to detect chondral lesions found during arthroscopic knee surgery was only 45%, results from a study of 190 patients demonstrated.

The finding suggests that knee arthroscopists should be prepared to intraoperatively detect and treat chondral lesions that have been previously undiagnosed by MRI, Dr. Alex Vaisman said at a symposium sponsored by the International Cartilage Repair Society.

“Based on our results, we recommend that the instrumentation for different cartilage repair techniques should always be available [at] the time of an arthroscopic knee procedure,” said Dr. Vaisman, of the Universidad Del Desarrollo, Santiago, Chile.

The purpose of the study was to prospectively evaluate the incidence and morphologic characteristics of chondral lesions following arthroscopic knee surgery and to establish the correlation between microscopic and MRI findings.

Dr. Vaisman and his associates evaluated 190 consecutive knee procedures performed between March 2003 and February 2004 by two surgeons with 15 years of knee surgery experience.

Two musculoskeletal radiologists with 10 years of experience generated the MRI reports.

The time between MRI exam and knee surgery did not exceed 1 year. The MRI report of at least one chondral lesion found at arthroscopy was considered to be a positive correlation between both diagnostic instruments.

The average age of the 190 patients in the study was 35 years, and 116 were male. Most indications for arthroscopic surgery were for anterior cruciate ligament tears and meniscal tears.

On arthroscopy, Dr. Vaisman and fellow researchers found 115 chondral lesions in 82 patients. Most (72%) were single lesions located on the medial femoral condyle (32%) or the medial patella (23%). The average size of these lesions was 1.99 cm

There was no correlation between patient age and the number of lesions, but there was a direct correlation between patient age and the size of the lesion.

On MRI, chondral lesions were reported in 37 out of 82 patients, which translated into a sensitivity of 45% and a specificity of 100%.

When researchers analyzed MRI sensitivity by location of the defect, they observed that MRI was most accurate for patellar defects (53%), followed by femoral defects (43%) and tibial defects (16%).

When they analyzed the MRI sensitivity by the ICRS classification system, significant differences emerged.

For example, the MRI sensitivity for ICRS grade 1 lesions was 13%, compared with 53% for grade 2 lesions, 64% for grade 3 lesions, and 73% for grade 4 lesions.

MRI detected this medial femoral condyle osteonecrosis and lesion.

The same medial femoral chondral lesion is shown in arthroscopic view. Photos courtesy Dr. Alex Vaisman

SAN DIEGO — The overall sensitivity of MRI to detect chondral lesions found during arthroscopic knee surgery was only 45%, results from a study of 190 patients demonstrated.

The finding suggests that knee arthroscopists should be prepared to intraoperatively detect and treat chondral lesions that have been previously undiagnosed by MRI, Dr. Alex Vaisman said at a symposium sponsored by the International Cartilage Repair Society.

“Based on our results, we recommend that the instrumentation for different cartilage repair techniques should always be available [at] the time of an arthroscopic knee procedure,” said Dr. Vaisman, of the Universidad Del Desarrollo, Santiago, Chile.

The purpose of the study was to prospectively evaluate the incidence and morphologic characteristics of chondral lesions following arthroscopic knee surgery and to establish the correlation between microscopic and MRI findings.

Dr. Vaisman and his associates evaluated 190 consecutive knee procedures performed between March 2003 and February 2004 by two surgeons with 15 years of knee surgery experience.

Two musculoskeletal radiologists with 10 years of experience generated the MRI reports.

The time between MRI exam and knee surgery did not exceed 1 year. The MRI report of at least one chondral lesion found at arthroscopy was considered to be a positive correlation between both diagnostic instruments.

The average age of the 190 patients in the study was 35 years, and 116 were male. Most indications for arthroscopic surgery were for anterior cruciate ligament tears and meniscal tears.

On arthroscopy, Dr. Vaisman and fellow researchers found 115 chondral lesions in 82 patients. Most (72%) were single lesions located on the medial femoral condyle (32%) or the medial patella (23%). The average size of these lesions was 1.99 cm

There was no correlation between patient age and the number of lesions, but there was a direct correlation between patient age and the size of the lesion.

On MRI, chondral lesions were reported in 37 out of 82 patients, which translated into a sensitivity of 45% and a specificity of 100%.

When researchers analyzed MRI sensitivity by location of the defect, they observed that MRI was most accurate for patellar defects (53%), followed by femoral defects (43%) and tibial defects (16%).

When they analyzed the MRI sensitivity by the ICRS classification system, significant differences emerged.

For example, the MRI sensitivity for ICRS grade 1 lesions was 13%, compared with 53% for grade 2 lesions, 64% for grade 3 lesions, and 73% for grade 4 lesions.

MRI detected this medial femoral condyle osteonecrosis and lesion.

The same medial femoral chondral lesion is shown in arthroscopic view. Photos courtesy Dr. Alex Vaisman

Comparison of lipid levels at different points in the course of pediatric systemic lupus erythematosus and the effect of prednisone administration revealed that the association between the two is complex, a small retrospective study demonstrated.

“The significance of our findings should be put into the context of studies which have demonstrated that levels of LDL cholesterol and HDL cholesterol, and not levels of triglycerides or total cholesterol, are the lipids that are associated with the presence of fatty streaks and raised arterial lesions in the aorta as well as with increased carotid and femoral intima-media thickness and carotid plaque formation,” wrote the researchers, led by Talin Sarkissian of the division of rheumatology at the Hospital for Sick Children, Toronto. “Therefore, our findings have important implications when considering therapeutic interventions on pediatric patients with SLE” (Arthritis Rheum. 2006;54:1283–90).

The researchers obtained lipid measurements at diagnosis, and at 1, 2, and 3 years in 114 female and 25 male patients with pediatric systemic lupus erythematosus (SLE) who received care at the Hospital for Sick Children between October 1994 and April 2003. The researchers also obtained SLE Disease Activity Index scores and prednisone dosages at the same time periods. The mean patient age at the time of diagnosis was 14 years.

At the time of diagnosis, the mean levels of total cholesterol, LDL cholesterol, and triglycerides were highest, while the mean levels of HDL were lowest.

After diagnosis, “the mean total cholesterol levels decreased during year 1, then remained relatively constant, while the percentage of patients with abnormal total cholesterol values remained relatively constant,” the researchers wrote. The mean LDL cholesterol levels decreased during year 1 and then remained relatively constant during years 2 and 3, they reported.

When the researchers compared the lipid levels at different prednisone doses and disease activity levels, they observed that the changes in triglyceride levels were primarily associated with changes in disease activity.

Total cholesterol levels “were higher when patients were taking high-dose prednisone as compared with when they had active SLE but were taking low-dose prednisone, but were not higher than at the time of diagnosis of SLE,” the researchers wrote.

Mean HDL cholesterol levels “were significantly higher when patients were taking prednisone and the disease was inactive as compared with when patients were not taking prednisone but with active [SLE].”

Finally, mean LDL cholesterol levels “were significantly higher in patients with active disease who were taking prednisone as compared with the time when they had active disease but were not taking prednisone,” the wrote.

The researchers acknowledged that a major limitation of the study is its retrospective design but concluded that the findings suggest that “control of SLE appears to improve the levels of these important lipids.”

Comparison of lipid levels at different points in the course of pediatric systemic lupus erythematosus and the effect of prednisone administration revealed that the association between the two is complex, a small retrospective study demonstrated.

“The significance of our findings should be put into the context of studies which have demonstrated that levels of LDL cholesterol and HDL cholesterol, and not levels of triglycerides or total cholesterol, are the lipids that are associated with the presence of fatty streaks and raised arterial lesions in the aorta as well as with increased carotid and femoral intima-media thickness and carotid plaque formation,” wrote the researchers, led by Talin Sarkissian of the division of rheumatology at the Hospital for Sick Children, Toronto. “Therefore, our findings have important implications when considering therapeutic interventions on pediatric patients with SLE” (Arthritis Rheum. 2006;54:1283–90).

The researchers obtained lipid measurements at diagnosis, and at 1, 2, and 3 years in 114 female and 25 male patients with pediatric systemic lupus erythematosus (SLE) who received care at the Hospital for Sick Children between October 1994 and April 2003. The researchers also obtained SLE Disease Activity Index scores and prednisone dosages at the same time periods. The mean patient age at the time of diagnosis was 14 years.

At the time of diagnosis, the mean levels of total cholesterol, LDL cholesterol, and triglycerides were highest, while the mean levels of HDL were lowest.

After diagnosis, “the mean total cholesterol levels decreased during year 1, then remained relatively constant, while the percentage of patients with abnormal total cholesterol values remained relatively constant,” the researchers wrote. The mean LDL cholesterol levels decreased during year 1 and then remained relatively constant during years 2 and 3, they reported.

When the researchers compared the lipid levels at different prednisone doses and disease activity levels, they observed that the changes in triglyceride levels were primarily associated with changes in disease activity.

Total cholesterol levels “were higher when patients were taking high-dose prednisone as compared with when they had active SLE but were taking low-dose prednisone, but were not higher than at the time of diagnosis of SLE,” the researchers wrote.

Mean HDL cholesterol levels “were significantly higher when patients were taking prednisone and the disease was inactive as compared with when patients were not taking prednisone but with active [SLE].”

Finally, mean LDL cholesterol levels “were significantly higher in patients with active disease who were taking prednisone as compared with the time when they had active disease but were not taking prednisone,” the wrote.

The researchers acknowledged that a major limitation of the study is its retrospective design but concluded that the findings suggest that “control of SLE appears to improve the levels of these important lipids.”

Comparison of lipid levels at different points in the course of pediatric systemic lupus erythematosus and the effect of prednisone administration revealed that the association between the two is complex, a small retrospective study demonstrated.

“The significance of our findings should be put into the context of studies which have demonstrated that levels of LDL cholesterol and HDL cholesterol, and not levels of triglycerides or total cholesterol, are the lipids that are associated with the presence of fatty streaks and raised arterial lesions in the aorta as well as with increased carotid and femoral intima-media thickness and carotid plaque formation,” wrote the researchers, led by Talin Sarkissian of the division of rheumatology at the Hospital for Sick Children, Toronto. “Therefore, our findings have important implications when considering therapeutic interventions on pediatric patients with SLE” (Arthritis Rheum. 2006;54:1283–90).

The researchers obtained lipid measurements at diagnosis, and at 1, 2, and 3 years in 114 female and 25 male patients with pediatric systemic lupus erythematosus (SLE) who received care at the Hospital for Sick Children between October 1994 and April 2003. The researchers also obtained SLE Disease Activity Index scores and prednisone dosages at the same time periods. The mean patient age at the time of diagnosis was 14 years.

At the time of diagnosis, the mean levels of total cholesterol, LDL cholesterol, and triglycerides were highest, while the mean levels of HDL were lowest.

After diagnosis, “the mean total cholesterol levels decreased during year 1, then remained relatively constant, while the percentage of patients with abnormal total cholesterol values remained relatively constant,” the researchers wrote. The mean LDL cholesterol levels decreased during year 1 and then remained relatively constant during years 2 and 3, they reported.

When the researchers compared the lipid levels at different prednisone doses and disease activity levels, they observed that the changes in triglyceride levels were primarily associated with changes in disease activity.

Total cholesterol levels “were higher when patients were taking high-dose prednisone as compared with when they had active SLE but were taking low-dose prednisone, but were not higher than at the time of diagnosis of SLE,” the researchers wrote.

Mean HDL cholesterol levels “were significantly higher when patients were taking prednisone and the disease was inactive as compared with when patients were not taking prednisone but with active [SLE].”

Finally, mean LDL cholesterol levels “were significantly higher in patients with active disease who were taking prednisone as compared with the time when they had active disease but were not taking prednisone,” the wrote.

The researchers acknowledged that a major limitation of the study is its retrospective design but concluded that the findings suggest that “control of SLE appears to improve the levels of these important lipids.”