Heidi Splete

In October 2010, when a cholera outbreak erupted in Haiti, doctors from around the world responded to the outbreak, including Dr. Kwan Kew Lai. In December, she spent a week in the island nation, sponsored by Medical Teams International Disaster Response, treating cholera patients of all ages at the Northwest Haiti Christian Mission in St. Louis du Nord.

Photo credit: Dr. Kwan Kew Lai

Dr. Lai is no novice to providing medical relief services overseas. In 2009, she worked treating HIV/AIDS patients as part of the Global Medic Force. Here, Dr. Lai discusses her experience in Haiti.

How did you learn about Medical Teams International Disaster Response?

I found out about the group immediately after the earthquake last year, when I searched the Internet for a team to go to Haiti to help care for patients there. I was asked to go with Partners in Development (PID) as a physician for their response team. MTI required me to formally apply to be on their team, which I did. They asked for descriptions of my previous experience with international work, as well as letters of recommendation. Last April, I was interviewed by phone, and later I was accepted to join their disaster response team.

In October, when the cholera epidemic began in Haiti, MTI contacted team members to go. But I was in West Africa at the time, completing HIV/AIDS mentoring work for the Institute of Human Virology, Nigeria, and Global Medic Force, Abuja, Nigeria, so I could not respond immediately. In December, I heard from MTI again, and they asked me to be ready to go in a few days. Our team included six doctors and a nurse.

Did you have any previous experience in treating cholera?

I had no previous experience in treating cholera patients, except that when I was in South Africa in 2009, near the border of Zimbabwe, I arrived at the end of a cholera outbreak among the refugees. So I did see a few cases in the hospital then.

What steps did the medical team take to avoid becoming ill themselves?

We used a lot of hand sanitizer; there were no sinks at St. Louis du Nord. We were vigilant about cleaning our hands between patients and before meals. MTI provided gloves, but they were used only for starting IVs and in cases when there might be possible contact with body fluids. No masks were required because cholera is spread via the fecal-oral route through contaminated food or water.

What were some of the challenges of treating cholera in Haiti?

There seemed to be a difference in opinion between Haitian doctors and visiting doctors as to how vigorously a dehydrated patient should be resuscitated. The World Health Organization guidelines were posted on the walls and I believe in giving fluids aggressively, but our Haitian counterparts seemed to be more conservative and tended to turn the fluids down. So there was an ongoing battle. Our team would turn up the fluids only to find the fluids turned down shortly thereafter.

The language barrier is an issue, because we did not have an interpreter with us all the time. It was especially difficult to communicate with the Haitian nurses.

The lack of accessibility to clean water continues to be a concern, especially when patients are sent home to unsanitary conditions.

There were also cultural differences. Some Haitians believe in fate. If a patient seemed to them to be dying, they accepted it and thought that it was time for him to go, so there should not be any heroic measures. However, to us cholera is an extremely treatable condition. Vigorous hydration can generally save a life.

What was your basic treatment strategy for most patients?

Our standard treatment strategy was to do a quick assessment of the patient’s state of hydration. Patients with severe hydration generally received an IV immediately. Patients who were moderately or slightly dehydrated, with no persistent vomiting, were generally encouraged to drink oral rehydration solution (ORS).

The elderly and very young cholera patients are at the greatest risk of dying from extreme dehydration. Patients who arrived at the clinic from long distances, and those who had been ill for several days, were also at increased risk of dying. Lack of clean water plays a major role in the spread of cholera. Malnutrition, which is common in Haiti, certainly does not help the immune system to fight infections. Near Port-au-Prince, we saw people washing their clothes and bathing in dirty river water; we were not at all sure where their drinking water came from.

At St. Louis du Nord, we were lucky to have ample supplies of intravenous fluids provided by MTI and delivered by the United Nations Humanitarian Services. We also had a good supply of clean water. Space was limited, and patients were put on cots and even on the floor. The floor and the cots were constantly being washed with bleach. Patients were provided with basins to use as toilets for their diarrhea, since cholera cots were in short supply and constantly soiled.

What was the setup at the hospital where you worked?

From Dr. Lai’s blog: The cholera treatment area was divided into three areas: the so-called ICU, which held the sickest patients, all of whom were on IVs and encouraged to take ORS; the step-down unit (where patients were taking ORS and had been discharged from the ICU, but who still had diarrhea and some vomiting); and the ready-to-discharge unit (patients on ORS who were ready to be discharged).

In the units with the less severe cases, patients and their relatives slept on mats on the floor. After the first few days, we were told that the patient count had decreased by half. There were 20 or so patients in this area. In the ICU there were about 25 patients lying on cots, some of which were diarrheal cots, with holes in the center. The ward was surprisingly free from strong stench. Many of the patients had the classic glazed look, with sunken and listless eyes, and were either restless or motionless.

What were some of the specific cases that you managed?

From Dr. Lai’s blog: One day, two men carried a sick woman in on a bed-frame. She had been sick for 5 days with vomiting and diarrhea, and it was rumored that they had to travel for 2 hours to come to the mission. The woman was not able to answer questions; her eyes were glazed and she was dehydrated. I examined her and felt her belly and asked if she was pregnant. She turned out to be 7 months pregnant. I told my interpreter that we would need to put two IVs in her. She asked me why. I replied that she was very dry, having been sick for 5 days and that she was pregnant. My interpreter looked at me and said, "Is the second IV for the baby?" Her face brightened up at the idea. The woman improved within 2 hours, after initially only being able to whisper to us.

Another case was a baby being breast-fed by her mother. One of the doctors placed an intraosseous line in the tibia, but it wasn’t working, so we used a nasogastric tube. After 100 to 200 cc of fluids were pushed into her, she became quite feisty. IVs and ORS made a huge difference for so many of these patients.

Interview by Heidi Splete. Blog excerpts are from haiticholeraoutbreakkwankew.blogspot.com.

Think globally. Practice locally.

U.S.-trained internists who have practiced abroad will receive a $100 stipend for contributing to this column. For details, send an e-mail to imnews@elsevier.com.

In October 2010, when a cholera outbreak erupted in Haiti, doctors from around the world responded to the outbreak, including Dr. Kwan Kew Lai. In December, she spent a week in the island nation, sponsored by Medical Teams International Disaster Response, treating cholera patients of all ages at the Northwest Haiti Christian Mission in St. Louis du Nord.

Photo credit: Dr. Kwan Kew Lai

Dr. Lai is no novice to providing medical relief services overseas. In 2009, she worked treating HIV/AIDS patients as part of the Global Medic Force. Here, Dr. Lai discusses her experience in Haiti.

How did you learn about Medical Teams International Disaster Response?

I found out about the group immediately after the earthquake last year, when I searched the Internet for a team to go to Haiti to help care for patients there. I was asked to go with Partners in Development (PID) as a physician for their response team. MTI required me to formally apply to be on their team, which I did. They asked for descriptions of my previous experience with international work, as well as letters of recommendation. Last April, I was interviewed by phone, and later I was accepted to join their disaster response team.

In October, when the cholera epidemic began in Haiti, MTI contacted team members to go. But I was in West Africa at the time, completing HIV/AIDS mentoring work for the Institute of Human Virology, Nigeria, and Global Medic Force, Abuja, Nigeria, so I could not respond immediately. In December, I heard from MTI again, and they asked me to be ready to go in a few days. Our team included six doctors and a nurse.

Did you have any previous experience in treating cholera?

I had no previous experience in treating cholera patients, except that when I was in South Africa in 2009, near the border of Zimbabwe, I arrived at the end of a cholera outbreak among the refugees. So I did see a few cases in the hospital then.

What steps did the medical team take to avoid becoming ill themselves?

We used a lot of hand sanitizer; there were no sinks at St. Louis du Nord. We were vigilant about cleaning our hands between patients and before meals. MTI provided gloves, but they were used only for starting IVs and in cases when there might be possible contact with body fluids. No masks were required because cholera is spread via the fecal-oral route through contaminated food or water.

What were some of the challenges of treating cholera in Haiti?

There seemed to be a difference in opinion between Haitian doctors and visiting doctors as to how vigorously a dehydrated patient should be resuscitated. The World Health Organization guidelines were posted on the walls and I believe in giving fluids aggressively, but our Haitian counterparts seemed to be more conservative and tended to turn the fluids down. So there was an ongoing battle. Our team would turn up the fluids only to find the fluids turned down shortly thereafter.

The language barrier is an issue, because we did not have an interpreter with us all the time. It was especially difficult to communicate with the Haitian nurses.

The lack of accessibility to clean water continues to be a concern, especially when patients are sent home to unsanitary conditions.

There were also cultural differences. Some Haitians believe in fate. If a patient seemed to them to be dying, they accepted it and thought that it was time for him to go, so there should not be any heroic measures. However, to us cholera is an extremely treatable condition. Vigorous hydration can generally save a life.

What was your basic treatment strategy for most patients?

Our standard treatment strategy was to do a quick assessment of the patient’s state of hydration. Patients with severe hydration generally received an IV immediately. Patients who were moderately or slightly dehydrated, with no persistent vomiting, were generally encouraged to drink oral rehydration solution (ORS).

The elderly and very young cholera patients are at the greatest risk of dying from extreme dehydration. Patients who arrived at the clinic from long distances, and those who had been ill for several days, were also at increased risk of dying. Lack of clean water plays a major role in the spread of cholera. Malnutrition, which is common in Haiti, certainly does not help the immune system to fight infections. Near Port-au-Prince, we saw people washing their clothes and bathing in dirty river water; we were not at all sure where their drinking water came from.

At St. Louis du Nord, we were lucky to have ample supplies of intravenous fluids provided by MTI and delivered by the United Nations Humanitarian Services. We also had a good supply of clean water. Space was limited, and patients were put on cots and even on the floor. The floor and the cots were constantly being washed with bleach. Patients were provided with basins to use as toilets for their diarrhea, since cholera cots were in short supply and constantly soiled.

What was the setup at the hospital where you worked?

From Dr. Lai’s blog: The cholera treatment area was divided into three areas: the so-called ICU, which held the sickest patients, all of whom were on IVs and encouraged to take ORS; the step-down unit (where patients were taking ORS and had been discharged from the ICU, but who still had diarrhea and some vomiting); and the ready-to-discharge unit (patients on ORS who were ready to be discharged).

In the units with the less severe cases, patients and their relatives slept on mats on the floor. After the first few days, we were told that the patient count had decreased by half. There were 20 or so patients in this area. In the ICU there were about 25 patients lying on cots, some of which were diarrheal cots, with holes in the center. The ward was surprisingly free from strong stench. Many of the patients had the classic glazed look, with sunken and listless eyes, and were either restless or motionless.

What were some of the specific cases that you managed?

From Dr. Lai’s blog: One day, two men carried a sick woman in on a bed-frame. She had been sick for 5 days with vomiting and diarrhea, and it was rumored that they had to travel for 2 hours to come to the mission. The woman was not able to answer questions; her eyes were glazed and she was dehydrated. I examined her and felt her belly and asked if she was pregnant. She turned out to be 7 months pregnant. I told my interpreter that we would need to put two IVs in her. She asked me why. I replied that she was very dry, having been sick for 5 days and that she was pregnant. My interpreter looked at me and said, "Is the second IV for the baby?" Her face brightened up at the idea. The woman improved within 2 hours, after initially only being able to whisper to us.

Another case was a baby being breast-fed by her mother. One of the doctors placed an intraosseous line in the tibia, but it wasn’t working, so we used a nasogastric tube. After 100 to 200 cc of fluids were pushed into her, she became quite feisty. IVs and ORS made a huge difference for so many of these patients.

Interview by Heidi Splete. Blog excerpts are from haiticholeraoutbreakkwankew.blogspot.com.

Think globally. Practice locally.

U.S.-trained internists who have practiced abroad will receive a $100 stipend for contributing to this column. For details, send an e-mail to imnews@elsevier.com.

In October 2010, when a cholera outbreak erupted in Haiti, doctors from around the world responded to the outbreak, including Dr. Kwan Kew Lai. In December, she spent a week in the island nation, sponsored by Medical Teams International Disaster Response, treating cholera patients of all ages at the Northwest Haiti Christian Mission in St. Louis du Nord.

Photo credit: Dr. Kwan Kew Lai

Dr. Lai is no novice to providing medical relief services overseas. In 2009, she worked treating HIV/AIDS patients as part of the Global Medic Force. Here, Dr. Lai discusses her experience in Haiti.

How did you learn about Medical Teams International Disaster Response?

I found out about the group immediately after the earthquake last year, when I searched the Internet for a team to go to Haiti to help care for patients there. I was asked to go with Partners in Development (PID) as a physician for their response team. MTI required me to formally apply to be on their team, which I did. They asked for descriptions of my previous experience with international work, as well as letters of recommendation. Last April, I was interviewed by phone, and later I was accepted to join their disaster response team.

In October, when the cholera epidemic began in Haiti, MTI contacted team members to go. But I was in West Africa at the time, completing HIV/AIDS mentoring work for the Institute of Human Virology, Nigeria, and Global Medic Force, Abuja, Nigeria, so I could not respond immediately. In December, I heard from MTI again, and they asked me to be ready to go in a few days. Our team included six doctors and a nurse.

Did you have any previous experience in treating cholera?

I had no previous experience in treating cholera patients, except that when I was in South Africa in 2009, near the border of Zimbabwe, I arrived at the end of a cholera outbreak among the refugees. So I did see a few cases in the hospital then.

What steps did the medical team take to avoid becoming ill themselves?

We used a lot of hand sanitizer; there were no sinks at St. Louis du Nord. We were vigilant about cleaning our hands between patients and before meals. MTI provided gloves, but they were used only for starting IVs and in cases when there might be possible contact with body fluids. No masks were required because cholera is spread via the fecal-oral route through contaminated food or water.

What were some of the challenges of treating cholera in Haiti?

There seemed to be a difference in opinion between Haitian doctors and visiting doctors as to how vigorously a dehydrated patient should be resuscitated. The World Health Organization guidelines were posted on the walls and I believe in giving fluids aggressively, but our Haitian counterparts seemed to be more conservative and tended to turn the fluids down. So there was an ongoing battle. Our team would turn up the fluids only to find the fluids turned down shortly thereafter.

The language barrier is an issue, because we did not have an interpreter with us all the time. It was especially difficult to communicate with the Haitian nurses.

The lack of accessibility to clean water continues to be a concern, especially when patients are sent home to unsanitary conditions.

There were also cultural differences. Some Haitians believe in fate. If a patient seemed to them to be dying, they accepted it and thought that it was time for him to go, so there should not be any heroic measures. However, to us cholera is an extremely treatable condition. Vigorous hydration can generally save a life.

What was your basic treatment strategy for most patients?

Our standard treatment strategy was to do a quick assessment of the patient’s state of hydration. Patients with severe hydration generally received an IV immediately. Patients who were moderately or slightly dehydrated, with no persistent vomiting, were generally encouraged to drink oral rehydration solution (ORS).

The elderly and very young cholera patients are at the greatest risk of dying from extreme dehydration. Patients who arrived at the clinic from long distances, and those who had been ill for several days, were also at increased risk of dying. Lack of clean water plays a major role in the spread of cholera. Malnutrition, which is common in Haiti, certainly does not help the immune system to fight infections. Near Port-au-Prince, we saw people washing their clothes and bathing in dirty river water; we were not at all sure where their drinking water came from.

At St. Louis du Nord, we were lucky to have ample supplies of intravenous fluids provided by MTI and delivered by the United Nations Humanitarian Services. We also had a good supply of clean water. Space was limited, and patients were put on cots and even on the floor. The floor and the cots were constantly being washed with bleach. Patients were provided with basins to use as toilets for their diarrhea, since cholera cots were in short supply and constantly soiled.

What was the setup at the hospital where you worked?

From Dr. Lai’s blog: The cholera treatment area was divided into three areas: the so-called ICU, which held the sickest patients, all of whom were on IVs and encouraged to take ORS; the step-down unit (where patients were taking ORS and had been discharged from the ICU, but who still had diarrhea and some vomiting); and the ready-to-discharge unit (patients on ORS who were ready to be discharged).

In the units with the less severe cases, patients and their relatives slept on mats on the floor. After the first few days, we were told that the patient count had decreased by half. There were 20 or so patients in this area. In the ICU there were about 25 patients lying on cots, some of which were diarrheal cots, with holes in the center. The ward was surprisingly free from strong stench. Many of the patients had the classic glazed look, with sunken and listless eyes, and were either restless or motionless.

What were some of the specific cases that you managed?

From Dr. Lai’s blog: One day, two men carried a sick woman in on a bed-frame. She had been sick for 5 days with vomiting and diarrhea, and it was rumored that they had to travel for 2 hours to come to the mission. The woman was not able to answer questions; her eyes were glazed and she was dehydrated. I examined her and felt her belly and asked if she was pregnant. She turned out to be 7 months pregnant. I told my interpreter that we would need to put two IVs in her. She asked me why. I replied that she was very dry, having been sick for 5 days and that she was pregnant. My interpreter looked at me and said, "Is the second IV for the baby?" Her face brightened up at the idea. The woman improved within 2 hours, after initially only being able to whisper to us.

Another case was a baby being breast-fed by her mother. One of the doctors placed an intraosseous line in the tibia, but it wasn’t working, so we used a nasogastric tube. After 100 to 200 cc of fluids were pushed into her, she became quite feisty. IVs and ORS made a huge difference for so many of these patients.

Interview by Heidi Splete. Blog excerpts are from haiticholeraoutbreakkwankew.blogspot.com.

Think globally. Practice locally.

U.S.-trained internists who have practiced abroad will receive a $100 stipend for contributing to this column. For details, send an e-mail to imnews@elsevier.com.

ORLANDO – Foam sclerotherapy can be an effective treatment for varicose veins ranging from 1 mm to more than 5 mm in diameter, said Dr. Hema Sundaram, medical director of Sundaram Dermatology, Cosmetic & Laser Surgery in Rockville, Md.

As many as 20% of adults in the United States and Western Europe have varicose veins, and many of them can be successfully treated in a dermatology practice, Dr. Sundaram said at the Orlando Dermatology Aesthetic and Clinical Conference.

Her treatment of choice for sclerotherapy is polidocanol, which was approved by the Food and Drug Administration last year for treating varicose veins. Polidocanol has been studied more extensively than any other sclerosant, noted Dr. Sundaram, who is in private practice in Rockville. The adverse events are low, allergic reactions are rare, and patients report less pain compared with other sclerosants.

She said that she successfully uses polidocanol for foam sclerotherapy. The best candidates for this off-label use are patients who have veins with varicosities from 1 mm to greater than 5 mm in diameter. For telangiectatic veins up to 1 mm in diameter, she prefers liquid polidocanol. "The foam can be a bit traumatic for the smaller veins," she said.

To treat varicose veins with foam, mix air with the sclerosant in a sclerosant:air ratio of 1:3 or 1:4, said Dr. Sundaram. She uses a three-way stopcock and a double syringe to combine the air and sclerosant. The foam in the syringe should resemble shaving foam.

Maintain a maximum foam volume of 10 mL per leg per session to minimize the risk of deep vein thrombosis, she noted.

"The important thing is to use the foam quickly, because the air will dissipate," Dr. Sundaram said. Stop injecting the foam when the flow of sclerosant into superficial veins is no longer visible.

For the right-sized veins, foam sclerotherapy can displace the blood more efficiently and put more of the sclerosant in contact with the vascular endothelial wall, Dr. Sundaram said.

Foam sclerotherapy has demonstrated safety and efficacy. In a review of data from 325 patients who were treated at a single center over 7 years, patients rated improvement as 1.94 on a scale of 3, while rating pain at 0.22, ulceration at 0.06, and hyperpigmentation at 0.35 (Dermatol. Surg. 2010;36[suppl. 2]:1026-33).

Dr. Sundaram’s foam sclerotherapy procedure is as follows:

• Inject while the patient is lying down.

• Start proximally and move distally; some smaller veins can be filled through larger ones.

• Start with the largest veins and work down.

• After injecting the sclerosant and removing the needle, compress the entire vein.

• Direct the patient to used graduated leg compression with bandages or stockings for 3 days to 3 weeks after the procedure.

Because foam sclerotherapy is an off-label use, be sure to include this fact in the informed consent form that patients sign, Dr. Sundaram noted.

Pretreatment evaluation is as important for a sclerotherapy patient as it is for a patient undergoing any other type of aesthetic procedure. "The assessment determines how successful we are going to be," she said.

She recommended an ultrasound evaluation prior to sclerotherapy in order to locate the reflux areas and to identify any insufficiency in the greater saphenous vein. Patients with greater saphenous vein insufficiency tend not to respond well to sclerotherapy and are more likely to experience recurrence of varicosities, she explained. In addition, these patients are at increased risk of superficial thrombophlebitis. Dr. Sundaram refers these patients to a vascular surgeon for evaluation and treatment.

Contraindications for sclerotherapy include allergy to the sclerosing agent, acute deep vein thrombosis, infection, and significant leg swelling, as well as pregnancy, polyneuropathy, severe asthma, and hypercoagulability.

Dr. Sundaram serves as an advisor, consultant, and/or clinical investigator for the following companies: Johnson & Johnson, Merz Aesthetics, Biopelle, Colorescience, Medicis, Merz, SkinMedica, Suneva Medical, Syneron/Candela, and Ulthera.

ORLANDO – Foam sclerotherapy can be an effective treatment for varicose veins ranging from 1 mm to more than 5 mm in diameter, said Dr. Hema Sundaram, medical director of Sundaram Dermatology, Cosmetic & Laser Surgery in Rockville, Md.

As many as 20% of adults in the United States and Western Europe have varicose veins, and many of them can be successfully treated in a dermatology practice, Dr. Sundaram said at the Orlando Dermatology Aesthetic and Clinical Conference.

Her treatment of choice for sclerotherapy is polidocanol, which was approved by the Food and Drug Administration last year for treating varicose veins. Polidocanol has been studied more extensively than any other sclerosant, noted Dr. Sundaram, who is in private practice in Rockville. The adverse events are low, allergic reactions are rare, and patients report less pain compared with other sclerosants.

She said that she successfully uses polidocanol for foam sclerotherapy. The best candidates for this off-label use are patients who have veins with varicosities from 1 mm to greater than 5 mm in diameter. For telangiectatic veins up to 1 mm in diameter, she prefers liquid polidocanol. "The foam can be a bit traumatic for the smaller veins," she said.

To treat varicose veins with foam, mix air with the sclerosant in a sclerosant:air ratio of 1:3 or 1:4, said Dr. Sundaram. She uses a three-way stopcock and a double syringe to combine the air and sclerosant. The foam in the syringe should resemble shaving foam.

Maintain a maximum foam volume of 10 mL per leg per session to minimize the risk of deep vein thrombosis, she noted.

"The important thing is to use the foam quickly, because the air will dissipate," Dr. Sundaram said. Stop injecting the foam when the flow of sclerosant into superficial veins is no longer visible.

For the right-sized veins, foam sclerotherapy can displace the blood more efficiently and put more of the sclerosant in contact with the vascular endothelial wall, Dr. Sundaram said.

Foam sclerotherapy has demonstrated safety and efficacy. In a review of data from 325 patients who were treated at a single center over 7 years, patients rated improvement as 1.94 on a scale of 3, while rating pain at 0.22, ulceration at 0.06, and hyperpigmentation at 0.35 (Dermatol. Surg. 2010;36[suppl. 2]:1026-33).

Dr. Sundaram’s foam sclerotherapy procedure is as follows:

• Inject while the patient is lying down.

• Start proximally and move distally; some smaller veins can be filled through larger ones.

• Start with the largest veins and work down.

• After injecting the sclerosant and removing the needle, compress the entire vein.

• Direct the patient to used graduated leg compression with bandages or stockings for 3 days to 3 weeks after the procedure.

Because foam sclerotherapy is an off-label use, be sure to include this fact in the informed consent form that patients sign, Dr. Sundaram noted.

Pretreatment evaluation is as important for a sclerotherapy patient as it is for a patient undergoing any other type of aesthetic procedure. "The assessment determines how successful we are going to be," she said.

She recommended an ultrasound evaluation prior to sclerotherapy in order to locate the reflux areas and to identify any insufficiency in the greater saphenous vein. Patients with greater saphenous vein insufficiency tend not to respond well to sclerotherapy and are more likely to experience recurrence of varicosities, she explained. In addition, these patients are at increased risk of superficial thrombophlebitis. Dr. Sundaram refers these patients to a vascular surgeon for evaluation and treatment.

Contraindications for sclerotherapy include allergy to the sclerosing agent, acute deep vein thrombosis, infection, and significant leg swelling, as well as pregnancy, polyneuropathy, severe asthma, and hypercoagulability.

Dr. Sundaram serves as an advisor, consultant, and/or clinical investigator for the following companies: Johnson & Johnson, Merz Aesthetics, Biopelle, Colorescience, Medicis, Merz, SkinMedica, Suneva Medical, Syneron/Candela, and Ulthera.

ORLANDO – Foam sclerotherapy can be an effective treatment for varicose veins ranging from 1 mm to more than 5 mm in diameter, said Dr. Hema Sundaram, medical director of Sundaram Dermatology, Cosmetic & Laser Surgery in Rockville, Md.

As many as 20% of adults in the United States and Western Europe have varicose veins, and many of them can be successfully treated in a dermatology practice, Dr. Sundaram said at the Orlando Dermatology Aesthetic and Clinical Conference.

Her treatment of choice for sclerotherapy is polidocanol, which was approved by the Food and Drug Administration last year for treating varicose veins. Polidocanol has been studied more extensively than any other sclerosant, noted Dr. Sundaram, who is in private practice in Rockville. The adverse events are low, allergic reactions are rare, and patients report less pain compared with other sclerosants.

She said that she successfully uses polidocanol for foam sclerotherapy. The best candidates for this off-label use are patients who have veins with varicosities from 1 mm to greater than 5 mm in diameter. For telangiectatic veins up to 1 mm in diameter, she prefers liquid polidocanol. "The foam can be a bit traumatic for the smaller veins," she said.

To treat varicose veins with foam, mix air with the sclerosant in a sclerosant:air ratio of 1:3 or 1:4, said Dr. Sundaram. She uses a three-way stopcock and a double syringe to combine the air and sclerosant. The foam in the syringe should resemble shaving foam.

Maintain a maximum foam volume of 10 mL per leg per session to minimize the risk of deep vein thrombosis, she noted.

"The important thing is to use the foam quickly, because the air will dissipate," Dr. Sundaram said. Stop injecting the foam when the flow of sclerosant into superficial veins is no longer visible.

For the right-sized veins, foam sclerotherapy can displace the blood more efficiently and put more of the sclerosant in contact with the vascular endothelial wall, Dr. Sundaram said.

Foam sclerotherapy has demonstrated safety and efficacy. In a review of data from 325 patients who were treated at a single center over 7 years, patients rated improvement as 1.94 on a scale of 3, while rating pain at 0.22, ulceration at 0.06, and hyperpigmentation at 0.35 (Dermatol. Surg. 2010;36[suppl. 2]:1026-33).

Dr. Sundaram’s foam sclerotherapy procedure is as follows:

• Inject while the patient is lying down.

• Start proximally and move distally; some smaller veins can be filled through larger ones.

• Start with the largest veins and work down.

• After injecting the sclerosant and removing the needle, compress the entire vein.

• Direct the patient to used graduated leg compression with bandages or stockings for 3 days to 3 weeks after the procedure.

Because foam sclerotherapy is an off-label use, be sure to include this fact in the informed consent form that patients sign, Dr. Sundaram noted.

Pretreatment evaluation is as important for a sclerotherapy patient as it is for a patient undergoing any other type of aesthetic procedure. "The assessment determines how successful we are going to be," she said.

She recommended an ultrasound evaluation prior to sclerotherapy in order to locate the reflux areas and to identify any insufficiency in the greater saphenous vein. Patients with greater saphenous vein insufficiency tend not to respond well to sclerotherapy and are more likely to experience recurrence of varicosities, she explained. In addition, these patients are at increased risk of superficial thrombophlebitis. Dr. Sundaram refers these patients to a vascular surgeon for evaluation and treatment.

Contraindications for sclerotherapy include allergy to the sclerosing agent, acute deep vein thrombosis, infection, and significant leg swelling, as well as pregnancy, polyneuropathy, severe asthma, and hypercoagulability.

Dr. Sundaram serves as an advisor, consultant, and/or clinical investigator for the following companies: Johnson & Johnson, Merz Aesthetics, Biopelle, Colorescience, Medicis, Merz, SkinMedica, Suneva Medical, Syneron/Candela, and Ulthera.

ORLANDO - Foam sclerotherapy can be an effective treatment for varicose veins ranging from 1 mm to more than 5 mm in diameter, said Dr. Hema Sundaram, medical director of Sundaram Dermatology, Cosmetic & Laser Surgery in Rockville, Md.

As many as 20% of adults in the United States and Western Europe have varicose veins, and many of them can be successfully treated in a dermatology practice. Her treatment of choice for sclerotherapy is polidocanol, which was approved by the Food and Drug Administration last year for treating varicose veins. Polidocanol has been studied more extensively than any other sclerosant, noted Dr. Sundaram, who is in private practice in Rockville. The adverse events are low, allergic reactions are rare, and patients report less pain compared with other sclerosants.

She said that she successfully uses polidocanol for foam sclerotherapy. The best candidates for this off-label use are patients who have veins with varicosities from 1 mm to greater than 5 mm in diameter. For telangiectatic veins up to 1 mm in diameter, she prefers liquid polidocanol. "The foam can be a bit traumatic for the smaller veins," she said.

To treat varicose veins with foam, mix air with the sclerosant in a sclerosant:air ratio of 1:3 or 1:4, said Dr. Sundaram. She uses a three-way stopcock and a double syringe to combine the air and sclerosant. The foam in the syringe should resemble shaving foam.

Maintain a maximum foam volume of 10 mL per leg per session to minimize the risk of deep vein thrombosis, she noted.

"The important thing is to use the foam quickly, because the air will dissipate," Dr. Sundaram said. Stop injecting the foam when the flow of sclerosant into superficial veins is no longer visible.

For the right-sized veins, foam sclerotherapy can displace the blood more efficiently and put more of the sclerosant in contact with the vascular endothelial wall, Dr. Sundaram said.

Foam sclerotherapy has demonstrated safety and efficacy. In a review of data from 325 patients who were treated at a single center over 7 years, patients rated improvement as 1.94 on a scale of 3, while rating pain at 0.22, ulceration at 0.06, and hyperpigmentation at 0.35 (Dermatol. Surg. 2010;36[suppl. 2]:1026-33).

Dr. Sundaram’s foam sclerotherapy procedure is as follows:

• Inject while the patient is lying down.

• Start proximally and move distally; some smaller veins can be filled through larger ones.

• Start with the largest veins and work down.

• After injecting the sclerosant and removing the needle, compress the entire vein.

• Direct the patient to used graduated leg compression with bandages or stockings for 3 days to 3 weeks after the procedure.

Because foam sclerotherapy is an off-label use, be sure to include this fact in the informed consent form that patients sign, Dr. Sundaram noted.

Pretreatment evaluation is as important for a sclerotherapy patient as it is for a patient undergoing any other type of aesthetic procedure. "The assessment determines how successful we are going to be," she said.

She recommended an ultrasound evaluation prior to sclerotherapy in order to locate the reflux areas and to identify any insufficiency in the greater saphenous vein. Patients with greater saphenous vein insufficiency tend not to respond well to sclerotherapy and are more likely to experience recurrence of varicosities, she explained. In addition, these patients are at increased risk of superficial thrombophlebitis. Dr. Sundaram refers these patients to a vascular surgeon for evaluation and treatment.

Contraindications for sclerotherapy include allergy to the sclerosing agent, acute deep vein thrombosis, infection, and significant leg swelling, as well as pregnancy, polyneuropathy, severe asthma, and hypercoagulability.

Dr. Sundaram serves as an advisor, consultant, and/or clinical investigator for the following companies: Johnson & Johnson, Merz Aesthetics, Biopelle, Colorescience, Medicis, Merz, SkinMedica, Suneva Medical, Syneron/Candela, and Ulthera.

ORLANDO - Foam sclerotherapy can be an effective treatment for varicose veins ranging from 1 mm to more than 5 mm in diameter, said Dr. Hema Sundaram, medical director of Sundaram Dermatology, Cosmetic & Laser Surgery in Rockville, Md.

As many as 20% of adults in the United States and Western Europe have varicose veins, and many of them can be successfully treated in a dermatology practice. Her treatment of choice for sclerotherapy is polidocanol, which was approved by the Food and Drug Administration last year for treating varicose veins. Polidocanol has been studied more extensively than any other sclerosant, noted Dr. Sundaram, who is in private practice in Rockville. The adverse events are low, allergic reactions are rare, and patients report less pain compared with other sclerosants.

She said that she successfully uses polidocanol for foam sclerotherapy. The best candidates for this off-label use are patients who have veins with varicosities from 1 mm to greater than 5 mm in diameter. For telangiectatic veins up to 1 mm in diameter, she prefers liquid polidocanol. "The foam can be a bit traumatic for the smaller veins," she said.

To treat varicose veins with foam, mix air with the sclerosant in a sclerosant:air ratio of 1:3 or 1:4, said Dr. Sundaram. She uses a three-way stopcock and a double syringe to combine the air and sclerosant. The foam in the syringe should resemble shaving foam.

Maintain a maximum foam volume of 10 mL per leg per session to minimize the risk of deep vein thrombosis, she noted.

"The important thing is to use the foam quickly, because the air will dissipate," Dr. Sundaram said. Stop injecting the foam when the flow of sclerosant into superficial veins is no longer visible.

For the right-sized veins, foam sclerotherapy can displace the blood more efficiently and put more of the sclerosant in contact with the vascular endothelial wall, Dr. Sundaram said.

Foam sclerotherapy has demonstrated safety and efficacy. In a review of data from 325 patients who were treated at a single center over 7 years, patients rated improvement as 1.94 on a scale of 3, while rating pain at 0.22, ulceration at 0.06, and hyperpigmentation at 0.35 (Dermatol. Surg. 2010;36[suppl. 2]:1026-33).

Dr. Sundaram’s foam sclerotherapy procedure is as follows:

• Inject while the patient is lying down.

• Start proximally and move distally; some smaller veins can be filled through larger ones.

• Start with the largest veins and work down.

• After injecting the sclerosant and removing the needle, compress the entire vein.

• Direct the patient to used graduated leg compression with bandages or stockings for 3 days to 3 weeks after the procedure.

Because foam sclerotherapy is an off-label use, be sure to include this fact in the informed consent form that patients sign, Dr. Sundaram noted.

Pretreatment evaluation is as important for a sclerotherapy patient as it is for a patient undergoing any other type of aesthetic procedure. "The assessment determines how successful we are going to be," she said.

She recommended an ultrasound evaluation prior to sclerotherapy in order to locate the reflux areas and to identify any insufficiency in the greater saphenous vein. Patients with greater saphenous vein insufficiency tend not to respond well to sclerotherapy and are more likely to experience recurrence of varicosities, she explained. In addition, these patients are at increased risk of superficial thrombophlebitis. Dr. Sundaram refers these patients to a vascular surgeon for evaluation and treatment.

Contraindications for sclerotherapy include allergy to the sclerosing agent, acute deep vein thrombosis, infection, and significant leg swelling, as well as pregnancy, polyneuropathy, severe asthma, and hypercoagulability.

Dr. Sundaram serves as an advisor, consultant, and/or clinical investigator for the following companies: Johnson & Johnson, Merz Aesthetics, Biopelle, Colorescience, Medicis, Merz, SkinMedica, Suneva Medical, Syneron/Candela, and Ulthera.

ORLANDO - Foam sclerotherapy can be an effective treatment for varicose veins ranging from 1 mm to more than 5 mm in diameter, said Dr. Hema Sundaram, medical director of Sundaram Dermatology, Cosmetic & Laser Surgery in Rockville, Md.

As many as 20% of adults in the United States and Western Europe have varicose veins, and many of them can be successfully treated in a dermatology practice. Her treatment of choice for sclerotherapy is polidocanol, which was approved by the Food and Drug Administration last year for treating varicose veins. Polidocanol has been studied more extensively than any other sclerosant, noted Dr. Sundaram, who is in private practice in Rockville. The adverse events are low, allergic reactions are rare, and patients report less pain compared with other sclerosants.

She said that she successfully uses polidocanol for foam sclerotherapy. The best candidates for this off-label use are patients who have veins with varicosities from 1 mm to greater than 5 mm in diameter. For telangiectatic veins up to 1 mm in diameter, she prefers liquid polidocanol. "The foam can be a bit traumatic for the smaller veins," she said.

To treat varicose veins with foam, mix air with the sclerosant in a sclerosant:air ratio of 1:3 or 1:4, said Dr. Sundaram. She uses a three-way stopcock and a double syringe to combine the air and sclerosant. The foam in the syringe should resemble shaving foam.

Maintain a maximum foam volume of 10 mL per leg per session to minimize the risk of deep vein thrombosis, she noted.

"The important thing is to use the foam quickly, because the air will dissipate," Dr. Sundaram said. Stop injecting the foam when the flow of sclerosant into superficial veins is no longer visible.

For the right-sized veins, foam sclerotherapy can displace the blood more efficiently and put more of the sclerosant in contact with the vascular endothelial wall, Dr. Sundaram said.

Foam sclerotherapy has demonstrated safety and efficacy. In a review of data from 325 patients who were treated at a single center over 7 years, patients rated improvement as 1.94 on a scale of 3, while rating pain at 0.22, ulceration at 0.06, and hyperpigmentation at 0.35 (Dermatol. Surg. 2010;36[suppl. 2]:1026-33).

Dr. Sundaram’s foam sclerotherapy procedure is as follows:

• Inject while the patient is lying down.

• Start proximally and move distally; some smaller veins can be filled through larger ones.

• Start with the largest veins and work down.

• After injecting the sclerosant and removing the needle, compress the entire vein.

• Direct the patient to used graduated leg compression with bandages or stockings for 3 days to 3 weeks after the procedure.

Because foam sclerotherapy is an off-label use, be sure to include this fact in the informed consent form that patients sign, Dr. Sundaram noted.

Pretreatment evaluation is as important for a sclerotherapy patient as it is for a patient undergoing any other type of aesthetic procedure. "The assessment determines how successful we are going to be," she said.

She recommended an ultrasound evaluation prior to sclerotherapy in order to locate the reflux areas and to identify any insufficiency in the greater saphenous vein. Patients with greater saphenous vein insufficiency tend not to respond well to sclerotherapy and are more likely to experience recurrence of varicosities, she explained. In addition, these patients are at increased risk of superficial thrombophlebitis. Dr. Sundaram refers these patients to a vascular surgeon for evaluation and treatment.

Contraindications for sclerotherapy include allergy to the sclerosing agent, acute deep vein thrombosis, infection, and significant leg swelling, as well as pregnancy, polyneuropathy, severe asthma, and hypercoagulability.

Dr. Sundaram serves as an advisor, consultant, and/or clinical investigator for the following companies: Johnson & Johnson, Merz Aesthetics, Biopelle, Colorescience, Medicis, Merz, SkinMedica, Suneva Medical, Syneron/Candela, and Ulthera.

ORLANDO - A 0.04% tretinoin microsphere gel pump significantly reduced the number of acne lesions in preteens, based on data from a small pilot study of children aged 9-11 years. The findings were presented in a poster at the Orlando Dermatology Aesthetic & Clinical Conference.

Currently, no drug is approved in the United States for treating acne in children younger than 10 years, noted Dr. Lawrence Eichenfield, chief of pediatric dermatology at the University of California, San Diego, and his colleagues. However, identification and treatment of acne in younger children might prevent more severe acne in adolescence, thus reducing the physical and emotional scars of acne, as well as the financial cost to patients, the researchers wrote.

Dr. Eichenfield and his colleagues randomized 55 children to use either a 0.04% tretinoin microsphere gel (TMG) pump or a placebo pump. Two pumps of the medication or placebo were applied to the face after washing each evening for 12 weeks.

The children had moderate acne (grade III or higher) and a minimum of 30 facial lesions (including a minimum of 20 inflammatory lesions) at baseline, based on the IGA (Investigator's Global Assessment) scale of acne severity. The patients were assessed at baseline and weeks 2, 4, 6, 8, 10, and 12.

At week 12, TMG patients had lesion counts reduced by an average of 44%, compared with 31% in the placebo group. This difference was statistically significant.

In addition, significantly more TMG patients than placebo patients achieved "excellent" results, (26% vs. 13%). More TMG patients than placebo patients achieved "clear" or "almost clear" status based on other scales, but these differences were not significant.

No significant differences in erythema, dryness, peeling, itching, or burning/stinging were observed between the two groups at any of the study visits.

A total of nine children discontinued the study. Of these, four TMG patients and one placebo patient discontinued because of adverse events, two TMG patients were lost to follow-up, and two TMG patients discontinued for personal reasons. The per-protocol study population excluded these 9 patients and 2 additional patients, for a total of 46 patients in the TMG group and 53 in the placebo group.

The findings were limited by the small size of the study. But the results suggest that TMG 0.04% was safe and well tolerated in preteen children with acne, and larger studies are warranted, the researchers said.

The study was sponsored by Johnson & Johnson. Dr. Eichenfield disclosed that he has served as an investigator without personal compensation, a consultant, or an adviser for the following companies: Astellas Pharma, Coria Laboratories, Galderma, Ortho Dermatologics, GlaxoSmithKline (Stiefel), Sanofi-Aventis, and Johnson & Johnson.

ORLANDO - A 0.04% tretinoin microsphere gel pump significantly reduced the number of acne lesions in preteens, based on data from a small pilot study of children aged 9-11 years. The findings were presented in a poster at the Orlando Dermatology Aesthetic & Clinical Conference.

Currently, no drug is approved in the United States for treating acne in children younger than 10 years, noted Dr. Lawrence Eichenfield, chief of pediatric dermatology at the University of California, San Diego, and his colleagues. However, identification and treatment of acne in younger children might prevent more severe acne in adolescence, thus reducing the physical and emotional scars of acne, as well as the financial cost to patients, the researchers wrote.

Dr. Eichenfield and his colleagues randomized 55 children to use either a 0.04% tretinoin microsphere gel (TMG) pump or a placebo pump. Two pumps of the medication or placebo were applied to the face after washing each evening for 12 weeks.

The children had moderate acne (grade III or higher) and a minimum of 30 facial lesions (including a minimum of 20 inflammatory lesions) at baseline, based on the IGA (Investigator's Global Assessment) scale of acne severity. The patients were assessed at baseline and weeks 2, 4, 6, 8, 10, and 12.

At week 12, TMG patients had lesion counts reduced by an average of 44%, compared with 31% in the placebo group. This difference was statistically significant.

In addition, significantly more TMG patients than placebo patients achieved "excellent" results, (26% vs. 13%). More TMG patients than placebo patients achieved "clear" or "almost clear" status based on other scales, but these differences were not significant.

No significant differences in erythema, dryness, peeling, itching, or burning/stinging were observed between the two groups at any of the study visits.

A total of nine children discontinued the study. Of these, four TMG patients and one placebo patient discontinued because of adverse events, two TMG patients were lost to follow-up, and two TMG patients discontinued for personal reasons. The per-protocol study population excluded these 9 patients and 2 additional patients, for a total of 46 patients in the TMG group and 53 in the placebo group.

The findings were limited by the small size of the study. But the results suggest that TMG 0.04% was safe and well tolerated in preteen children with acne, and larger studies are warranted, the researchers said.

The study was sponsored by Johnson & Johnson. Dr. Eichenfield disclosed that he has served as an investigator without personal compensation, a consultant, or an adviser for the following companies: Astellas Pharma, Coria Laboratories, Galderma, Ortho Dermatologics, GlaxoSmithKline (Stiefel), Sanofi-Aventis, and Johnson & Johnson.

ORLANDO - A 0.04% tretinoin microsphere gel pump significantly reduced the number of acne lesions in preteens, based on data from a small pilot study of children aged 9-11 years. The findings were presented in a poster at the Orlando Dermatology Aesthetic & Clinical Conference.

Currently, no drug is approved in the United States for treating acne in children younger than 10 years, noted Dr. Lawrence Eichenfield, chief of pediatric dermatology at the University of California, San Diego, and his colleagues. However, identification and treatment of acne in younger children might prevent more severe acne in adolescence, thus reducing the physical and emotional scars of acne, as well as the financial cost to patients, the researchers wrote.

Dr. Eichenfield and his colleagues randomized 55 children to use either a 0.04% tretinoin microsphere gel (TMG) pump or a placebo pump. Two pumps of the medication or placebo were applied to the face after washing each evening for 12 weeks.

The children had moderate acne (grade III or higher) and a minimum of 30 facial lesions (including a minimum of 20 inflammatory lesions) at baseline, based on the IGA (Investigator's Global Assessment) scale of acne severity. The patients were assessed at baseline and weeks 2, 4, 6, 8, 10, and 12.

At week 12, TMG patients had lesion counts reduced by an average of 44%, compared with 31% in the placebo group. This difference was statistically significant.

In addition, significantly more TMG patients than placebo patients achieved "excellent" results, (26% vs. 13%). More TMG patients than placebo patients achieved "clear" or "almost clear" status based on other scales, but these differences were not significant.

No significant differences in erythema, dryness, peeling, itching, or burning/stinging were observed between the two groups at any of the study visits.

A total of nine children discontinued the study. Of these, four TMG patients and one placebo patient discontinued because of adverse events, two TMG patients were lost to follow-up, and two TMG patients discontinued for personal reasons. The per-protocol study population excluded these 9 patients and 2 additional patients, for a total of 46 patients in the TMG group and 53 in the placebo group.

The findings were limited by the small size of the study. But the results suggest that TMG 0.04% was safe and well tolerated in preteen children with acne, and larger studies are warranted, the researchers said.

The study was sponsored by Johnson & Johnson. Dr. Eichenfield disclosed that he has served as an investigator without personal compensation, a consultant, or an adviser for the following companies: Astellas Pharma, Coria Laboratories, Galderma, Ortho Dermatologics, GlaxoSmithKline (Stiefel), Sanofi-Aventis, and Johnson & Johnson.

ORLANDO – A 0.04% tretinoin microsphere gel pump significantly reduced the number of acne lesions in preteens, based on data from a small pilot study of children aged 9-11 years. The findings were presented in a poster at the Orlando Dermatology Aesthetic & Clinical Conference.

Currently, no drug is approved in the United States for treating acne in children younger than 10 years, noted Dr. Lawrence Eichenfield, chief of pediatric dermatology at the University of California, San Diego, and his colleagues. However, identification and treatment of acne in younger children might prevent more severe acne in adolescence, thus reducing the physical and emotional scars of acne, as well as the financial cost to patients, the researchers wrote.

Dr. Eichenfield and his colleagues randomized 55 children to use either a 0.04% tretinoin microsphere gel (TMG) pump or a placebo pump. Two pumps of the medication or placebo were applied to the face after washing each evening for 12 weeks.

The children had moderate acne (grade III or higher) and a minimum of 30 facial lesions (including a minimum of 20 inflammatory lesions) at baseline, based on the IGA (Investigator’s Global Assessment) scale of acne severity. The patients were assessed at baseline and weeks 2, 4, 6, 8, 10, and 12.

At week 12, TMG patients had lesion counts reduced by an average of 44%, compared with 31% in the placebo group. This difference was statistically significant.

In addition, significantly more TMG patients than placebo patients achieved "excellent" results, (26% vs. 13%). More TMG patients than placebo patients achieved "clear" or "almost clear" status based on other scales, but these differences were not significant.

No significant differences in erythema, dryness, peeling, itching, or burning/stinging were observed between the two groups at any of the study visits.

A total of nine children discontinued the study. Of these, four TMG patients and one placebo patient discontinued because of adverse events, two TMG patients were lost to follow-up, and two TMG patients discontinued for personal reasons. The per-protocol study population excluded these 9 patients and 2 additional patients, for a total of 46 patients in the TMG group and 53 in the placebo group.

The findings were limited by the small size of the study. But the results suggest that TMG 0.04% was safe and well tolerated in preteen children with acne, and larger studies are warranted, the researchers said.

The study was sponsored by Johnson & Johnson. Dr. Eichenfield disclosed that he has served as an investigator without personal compensation, a consultant, or an adviser for the following companies: Astellas Pharma, Coria Laboratories, Galderma, Ortho Dermatologics, GlaxoSmithKline (Stiefel), Sanofi-Aventis, and Johnson & Johnson.

ORLANDO – A 0.04% tretinoin microsphere gel pump significantly reduced the number of acne lesions in preteens, based on data from a small pilot study of children aged 9-11 years. The findings were presented in a poster at the Orlando Dermatology Aesthetic & Clinical Conference.

Currently, no drug is approved in the United States for treating acne in children younger than 10 years, noted Dr. Lawrence Eichenfield, chief of pediatric dermatology at the University of California, San Diego, and his colleagues. However, identification and treatment of acne in younger children might prevent more severe acne in adolescence, thus reducing the physical and emotional scars of acne, as well as the financial cost to patients, the researchers wrote.

Dr. Eichenfield and his colleagues randomized 55 children to use either a 0.04% tretinoin microsphere gel (TMG) pump or a placebo pump. Two pumps of the medication or placebo were applied to the face after washing each evening for 12 weeks.

The children had moderate acne (grade III or higher) and a minimum of 30 facial lesions (including a minimum of 20 inflammatory lesions) at baseline, based on the IGA (Investigator’s Global Assessment) scale of acne severity. The patients were assessed at baseline and weeks 2, 4, 6, 8, 10, and 12.

At week 12, TMG patients had lesion counts reduced by an average of 44%, compared with 31% in the placebo group. This difference was statistically significant.

In addition, significantly more TMG patients than placebo patients achieved "excellent" results, (26% vs. 13%). More TMG patients than placebo patients achieved "clear" or "almost clear" status based on other scales, but these differences were not significant.

No significant differences in erythema, dryness, peeling, itching, or burning/stinging were observed between the two groups at any of the study visits.

A total of nine children discontinued the study. Of these, four TMG patients and one placebo patient discontinued because of adverse events, two TMG patients were lost to follow-up, and two TMG patients discontinued for personal reasons. The per-protocol study population excluded these 9 patients and 2 additional patients, for a total of 46 patients in the TMG group and 53 in the placebo group.

The findings were limited by the small size of the study. But the results suggest that TMG 0.04% was safe and well tolerated in preteen children with acne, and larger studies are warranted, the researchers said.

The study was sponsored by Johnson & Johnson. Dr. Eichenfield disclosed that he has served as an investigator without personal compensation, a consultant, or an adviser for the following companies: Astellas Pharma, Coria Laboratories, Galderma, Ortho Dermatologics, GlaxoSmithKline (Stiefel), Sanofi-Aventis, and Johnson & Johnson.

ORLANDO – A 0.04% tretinoin microsphere gel pump significantly reduced the number of acne lesions in preteens, based on data from a small pilot study of children aged 9-11 years. The findings were presented in a poster at the Orlando Dermatology Aesthetic & Clinical Conference.

Currently, no drug is approved in the United States for treating acne in children younger than 10 years, noted Dr. Lawrence Eichenfield, chief of pediatric dermatology at the University of California, San Diego, and his colleagues. However, identification and treatment of acne in younger children might prevent more severe acne in adolescence, thus reducing the physical and emotional scars of acne, as well as the financial cost to patients, the researchers wrote.

Dr. Eichenfield and his colleagues randomized 55 children to use either a 0.04% tretinoin microsphere gel (TMG) pump or a placebo pump. Two pumps of the medication or placebo were applied to the face after washing each evening for 12 weeks.

The children had moderate acne (grade III or higher) and a minimum of 30 facial lesions (including a minimum of 20 inflammatory lesions) at baseline, based on the IGA (Investigator’s Global Assessment) scale of acne severity. The patients were assessed at baseline and weeks 2, 4, 6, 8, 10, and 12.

At week 12, TMG patients had lesion counts reduced by an average of 44%, compared with 31% in the placebo group. This difference was statistically significant.

In addition, significantly more TMG patients than placebo patients achieved "excellent" results, (26% vs. 13%). More TMG patients than placebo patients achieved "clear" or "almost clear" status based on other scales, but these differences were not significant.

No significant differences in erythema, dryness, peeling, itching, or burning/stinging were observed between the two groups at any of the study visits.

A total of nine children discontinued the study. Of these, four TMG patients and one placebo patient discontinued because of adverse events, two TMG patients were lost to follow-up, and two TMG patients discontinued for personal reasons. The per-protocol study population excluded these 9 patients and 2 additional patients, for a total of 46 patients in the TMG group and 53 in the placebo group.

The findings were limited by the small size of the study. But the results suggest that TMG 0.04% was safe and well tolerated in preteen children with acne, and larger studies are warranted, the researchers said.

The study was sponsored by Johnson & Johnson. Dr. Eichenfield disclosed that he has served as an investigator without personal compensation, a consultant, or an adviser for the following companies: Astellas Pharma, Coria Laboratories, Galderma, Ortho Dermatologics, GlaxoSmithKline (Stiefel), Sanofi-Aventis, and Johnson & Johnson.

ORLANDO – Mohs surgery is an appropriate choice for lentigo maligna patients because advances in immunostaining allow easier and more efficient identification of melanocytes on frozen sections, said Dr. Basil S. Cherpelis.

Recent literature shows the recommended 5-mm margin for melanoma is often inadequate, Dr. Cherpelis said at the Orlando Dermatology Aesthetic and Clinical conference.

The margins needed for successful treatment of lentigo maligna vary – 5 mm is enough for some melanomas, while others might need a 1-cm margin.

"It makes sense to use a method of intraoperative margin control," said Dr. Cherpelis, of the Moffitt Cancer Center at the University of South Florida in Tampa. "That’s what gives you the flexibility to adjust your margins based on the melanoma that you happen to be treating."

One option for intraoperative margin control is traditional frozen sections, Dr. Cherpelis said. But frozen sections offer a limited view of the margin, and they pose the problem of freeze artifacts, which can make the distinction between melanocytes and keratinocytes difficult. A second option is the square or perimeter method, but this method involves a 1-2 week wait for complete results, which is inconvenient for doctors and patients.

A third option is Mohs surgery. Literature shows that Mohs is effective for melanoma, with the benefits of entire visualization and same-day reconstruction, but it is not widely used, Dr. Cherpelis said. One reason: Melanomas on permanent sections have halos around them, making identification easy, but frozen sections have similar halos around keratinocytes and melanocytes.

Using immunostaining as part of Mohs surgery can solve the identification problem, but until recently immunostain protocols could take at least an hour.

Dr. Cherpelis and his colleagues have streamlined the process.

"We have been able to shorten our protocols down to 19 minutes for MART-1 [melanoma-associated antigen recognized by T cells] and 35 minutes for MITF [microphthalmia-associated transcription factor]," Dr. Cherpelis said (Derm. Surg. 2009;35:207-13; Am. J. Dermatopath. 2010; 32:319-25, respectively). The protocols make Mohs surgery easier because the immunostain helps clinicians easily identify melanocytes.

MART-1 (a cytoplasmic stain) is the most common immunostain, but some data suggest it can falsely label keratinocytes in inflamed skin or in pigmented actinic keratoses, Dr. Cherpelis said. It also can cause pseudo-confluence (the appearance of touching melanocytes). By contrast, MITF is a nuclear stain, so it does not have the problem of pseudo-confluence.

Dr. Cherpelis said he had no relevant financial disclosures.

ORLANDO – Mohs surgery is an appropriate choice for lentigo maligna patients because advances in immunostaining allow easier and more efficient identification of melanocytes on frozen sections, said Dr. Basil S. Cherpelis.

Recent literature shows the recommended 5-mm margin for melanoma is often inadequate, Dr. Cherpelis said at the Orlando Dermatology Aesthetic and Clinical conference.

The margins needed for successful treatment of lentigo maligna vary – 5 mm is enough for some melanomas, while others might need a 1-cm margin.

"It makes sense to use a method of intraoperative margin control," said Dr. Cherpelis, of the Moffitt Cancer Center at the University of South Florida in Tampa. "That’s what gives you the flexibility to adjust your margins based on the melanoma that you happen to be treating."

One option for intraoperative margin control is traditional frozen sections, Dr. Cherpelis said. But frozen sections offer a limited view of the margin, and they pose the problem of freeze artifacts, which can make the distinction between melanocytes and keratinocytes difficult. A second option is the square or perimeter method, but this method involves a 1-2 week wait for complete results, which is inconvenient for doctors and patients.

A third option is Mohs surgery. Literature shows that Mohs is effective for melanoma, with the benefits of entire visualization and same-day reconstruction, but it is not widely used, Dr. Cherpelis said. One reason: Melanomas on permanent sections have halos around them, making identification easy, but frozen sections have similar halos around keratinocytes and melanocytes.

Using immunostaining as part of Mohs surgery can solve the identification problem, but until recently immunostain protocols could take at least an hour.

Dr. Cherpelis and his colleagues have streamlined the process.

"We have been able to shorten our protocols down to 19 minutes for MART-1 [melanoma-associated antigen recognized by T cells] and 35 minutes for MITF [microphthalmia-associated transcription factor]," Dr. Cherpelis said (Derm. Surg. 2009;35:207-13; Am. J. Dermatopath. 2010; 32:319-25, respectively). The protocols make Mohs surgery easier because the immunostain helps clinicians easily identify melanocytes.

MART-1 (a cytoplasmic stain) is the most common immunostain, but some data suggest it can falsely label keratinocytes in inflamed skin or in pigmented actinic keratoses, Dr. Cherpelis said. It also can cause pseudo-confluence (the appearance of touching melanocytes). By contrast, MITF is a nuclear stain, so it does not have the problem of pseudo-confluence.

Dr. Cherpelis said he had no relevant financial disclosures.

ORLANDO – Mohs surgery is an appropriate choice for lentigo maligna patients because advances in immunostaining allow easier and more efficient identification of melanocytes on frozen sections, said Dr. Basil S. Cherpelis.

Recent literature shows the recommended 5-mm margin for melanoma is often inadequate, Dr. Cherpelis said at the Orlando Dermatology Aesthetic and Clinical conference.

The margins needed for successful treatment of lentigo maligna vary – 5 mm is enough for some melanomas, while others might need a 1-cm margin.

"It makes sense to use a method of intraoperative margin control," said Dr. Cherpelis, of the Moffitt Cancer Center at the University of South Florida in Tampa. "That’s what gives you the flexibility to adjust your margins based on the melanoma that you happen to be treating."

One option for intraoperative margin control is traditional frozen sections, Dr. Cherpelis said. But frozen sections offer a limited view of the margin, and they pose the problem of freeze artifacts, which can make the distinction between melanocytes and keratinocytes difficult. A second option is the square or perimeter method, but this method involves a 1-2 week wait for complete results, which is inconvenient for doctors and patients.

A third option is Mohs surgery. Literature shows that Mohs is effective for melanoma, with the benefits of entire visualization and same-day reconstruction, but it is not widely used, Dr. Cherpelis said. One reason: Melanomas on permanent sections have halos around them, making identification easy, but frozen sections have similar halos around keratinocytes and melanocytes.

Using immunostaining as part of Mohs surgery can solve the identification problem, but until recently immunostain protocols could take at least an hour.

Dr. Cherpelis and his colleagues have streamlined the process.

"We have been able to shorten our protocols down to 19 minutes for MART-1 [melanoma-associated antigen recognized by T cells] and 35 minutes for MITF [microphthalmia-associated transcription factor]," Dr. Cherpelis said (Derm. Surg. 2009;35:207-13; Am. J. Dermatopath. 2010; 32:319-25, respectively). The protocols make Mohs surgery easier because the immunostain helps clinicians easily identify melanocytes.

MART-1 (a cytoplasmic stain) is the most common immunostain, but some data suggest it can falsely label keratinocytes in inflamed skin or in pigmented actinic keratoses, Dr. Cherpelis said. It also can cause pseudo-confluence (the appearance of touching melanocytes). By contrast, MITF is a nuclear stain, so it does not have the problem of pseudo-confluence.

Dr. Cherpelis said he had no relevant financial disclosures.

ORLANDO – Mohs surgery is an appropriate choice for lentigo maligna patients because advances in immunostaining allow easier and more efficient identification of melanocytes on frozen sections, said Dr. Basil S. Cherpelis.

Recent literature shows the recommended 5-mm margin for melanoma is often inadequate, Dr. Cherpelis said at the Orlando Dermatology Aesthetic and Clinical conference.

The margins needed for successful treatment of lentigo maligna vary – 5 mm is enough for some melanomas, while others might need a 1-cm margin.

"It makes sense to use a method of intraoperative margin control," said Dr. Cherpelis, of the Moffitt Cancer Center at the University of South Florida in Tampa. "That’s what gives you the flexibility to adjust your margins based on the melanoma that you happen to be treating."

One option for intraoperative margin control is traditional frozen sections, Dr. Cherpelis said. But frozen sections offer a limited view of the margin, and they pose the problem of freeze artifacts, which can make the distinction between melanocytes and keratinocytes difficult. A second option is the square or perimeter method, but this method involves a 1-2 week wait for complete results, which is inconvenient for doctors and patients.

A third option is Mohs surgery. Literature shows that Mohs is effective for melanoma, with the benefits of entire visualization and same-day reconstruction, but it is not widely used, Dr. Cherpelis said. One reason: Melanomas on permanent sections have halos around them, making identification easy, but frozen sections have similar halos around keratinocytes and melanocytes.

Using immunostaining as part of Mohs surgery can solve the identification problem, but until recently immunostain protocols could take at least an hour.

Dr. Cherpelis and his colleagues have streamlined the process.

"We have been able to shorten our protocols down to 19 minutes for MART-1 [melanoma-associated antigen recognized by T cells] and 35 minutes for MITF [microphthalmia-associated transcription factor]," Dr. Cherpelis said (Derm. Surg. 2009;35:207-13; Am. J. Dermatopath. 2010; 32:319-25, respectively). The protocols make Mohs surgery easier because the immunostain helps clinicians easily identify melanocytes.

MART-1 (a cytoplasmic stain) is the most common immunostain, but some data suggest it can falsely label keratinocytes in inflamed skin or in pigmented actinic keratoses, Dr. Cherpelis said. It also can cause pseudo-confluence (the appearance of touching melanocytes). By contrast, MITF is a nuclear stain, so it does not have the problem of pseudo-confluence.

Dr. Cherpelis said he had no relevant financial disclosures.

ORLANDO – Mohs surgery is an appropriate choice for lentigo maligna patients because advances in immunostaining allow easier and more efficient identification of melanocytes on frozen sections, said Dr. Basil S. Cherpelis.

Recent literature shows the recommended 5-mm margin for melanoma is often inadequate, Dr. Cherpelis said at the Orlando Dermatology Aesthetic and Clinical conference.

The margins needed for successful treatment of lentigo maligna vary – 5 mm is enough for some melanomas, while others might need a 1-cm margin.

"It makes sense to use a method of intraoperative margin control," said Dr. Cherpelis, of the Moffitt Cancer Center at the University of South Florida in Tampa. "That’s what gives you the flexibility to adjust your margins based on the melanoma that you happen to be treating."

One option for intraoperative margin control is traditional frozen sections, Dr. Cherpelis said. But frozen sections offer a limited view of the margin, and they pose the problem of freeze artifacts, which can make the distinction between melanocytes and keratinocytes difficult. A second option is the square or perimeter method, but this method involves a 1-2 week wait for complete results, which is inconvenient for doctors and patients.

A third option is Mohs surgery. Literature shows that Mohs is effective for melanoma, with the benefits of entire visualization and same-day reconstruction, but it is not widely used, Dr. Cherpelis said. One reason: Melanomas on permanent sections have halos around them, making identification easy, but frozen sections have similar halos around keratinocytes and melanocytes.

Using immunostaining as part of Mohs surgery can solve the identification problem, but until recently immunostain protocols could take at least an hour.

Dr. Cherpelis and his colleagues have streamlined the process.

"We have been able to shorten our protocols down to 19 minutes for MART-1 [melanoma-associated antigen recognized by T cells] and 35 minutes for MITF [microphthalmia-associated transcription factor]," Dr. Cherpelis said (Derm. Surg. 2009;35:207-13; Am. J. Dermatopath. 2010; 32:319-25, respectively). The protocols make Mohs surgery easier because the immunostain helps clinicians easily identify melanocytes.

MART-1 (a cytoplasmic stain) is the most common immunostain, but some data suggest it can falsely label keratinocytes in inflamed skin or in pigmented actinic keratoses, Dr. Cherpelis said. It also can cause pseudo-confluence (the appearance of touching melanocytes). By contrast, MITF is a nuclear stain, so it does not have the problem of pseudo-confluence.

Dr. Cherpelis said he had no relevant financial disclosures.

ORLANDO – Mohs surgery is an appropriate choice for lentigo maligna patients because advances in immunostaining allow easier and more efficient identification of melanocytes on frozen sections, said Dr. Basil S. Cherpelis.

Recent literature shows the recommended 5-mm margin for melanoma is often inadequate, Dr. Cherpelis said at the Orlando Dermatology Aesthetic and Clinical conference.

The margins needed for successful treatment of lentigo maligna vary – 5 mm is enough for some melanomas, while others might need a 1-cm margin.

"It makes sense to use a method of intraoperative margin control," said Dr. Cherpelis, of the Moffitt Cancer Center at the University of South Florida in Tampa. "That’s what gives you the flexibility to adjust your margins based on the melanoma that you happen to be treating."

One option for intraoperative margin control is traditional frozen sections, Dr. Cherpelis said. But frozen sections offer a limited view of the margin, and they pose the problem of freeze artifacts, which can make the distinction between melanocytes and keratinocytes difficult. A second option is the square or perimeter method, but this method involves a 1-2 week wait for complete results, which is inconvenient for doctors and patients.

A third option is Mohs surgery. Literature shows that Mohs is effective for melanoma, with the benefits of entire visualization and same-day reconstruction, but it is not widely used, Dr. Cherpelis said. One reason: Melanomas on permanent sections have halos around them, making identification easy, but frozen sections have similar halos around keratinocytes and melanocytes.

Using immunostaining as part of Mohs surgery can solve the identification problem, but until recently immunostain protocols could take at least an hour.

Dr. Cherpelis and his colleagues have streamlined the process.

"We have been able to shorten our protocols down to 19 minutes for MART-1 [melanoma-associated antigen recognized by T cells] and 35 minutes for MITF [microphthalmia-associated transcription factor]," Dr. Cherpelis said (Derm. Surg. 2009;35:207-13; Am. J. Dermatopath. 2010; 32:319-25, respectively). The protocols make Mohs surgery easier because the immunostain helps clinicians easily identify melanocytes.

MART-1 (a cytoplasmic stain) is the most common immunostain, but some data suggest it can falsely label keratinocytes in inflamed skin or in pigmented actinic keratoses, Dr. Cherpelis said. It also can cause pseudo-confluence (the appearance of touching melanocytes). By contrast, MITF is a nuclear stain, so it does not have the problem of pseudo-confluence.

Dr. Cherpelis said he had no relevant financial disclosures.

Approximately 68 million American adults have high blood pressure and 71 million have high cholesterol, and the conditions are uncontrolled in 37 million and 48 million, respectively, according to a Vital Signs report released by the Centers for Disease Control and Prevention on Feb. 1.

"Heart disease is the leading killer in America, and the bottom line is that high blood pressure and high cholesterol are out of control for most Americans who have these conditions," CDC director Dr. Thomas R. Frieden said during the teleconference accompanying the report’s release.

High blood pressure and high cholesterol remain top risk factors for life-threatening conditions including strokes, heart attacks, and vascular diseases, he added.

Dr. Frieden had a message for physicians: Controlling high blood pressure and cholesterol is one of the most important things you can do for your patients. Know how many of your patients have high blood pressure and high cholesterol, what proportion are controlled, and what can be done to help more patients get these conditions under control, he said.

"We have seen many examples of health systems, health programs, and doctors’ offices using information technology to support patients and drastically improve the levels of control, and that’s something that is needed throughout health care in this country," he added.

The report was based on data from the National Health and Nutrition Examination Survey (NHANES) on adults aged 18 years and older. The findings also indicate that approximately 20 million U.S. adults with high blood pressure and 37 million with high cholesterol are not being treated for these conditions.

The prevalence of control of high blood pressure was 29% among adults without health insurance, and the control of high cholesterol was less than 15% among those with limited access to health care. But at least 80% of individuals with uncontrolled high blood pressure and high cholesterol have health insurance, Dr. Frieden noted.

For those with health insurance, the characteristics of their specific plan are more likely to affect how likely they are to have high blood pressure or high cholesterol under control than are their personal characteristics, he said.

High blood pressure was defined as blood pressure greater than 140/90 mmHg or reported use of blood pressure–lowering medication. The national prevalence of high blood pressure remained stable over the past decade, although 70% of those with hypertension were being treated and 46% were being controlled, according to the report.

The criteria for high cholesterol included anyone taking cholesterol medication or having a LDL cholesterol level of 100 mg/dL or higher for high-risk individuals, 130 mg/dL or higher for intermediate-risk individuals, and 160 mg/dL for those at low risk.

The proportion of adults treated for high cholesterol increased from 28% to 48% over the past decade, and the proportion of those controlling their high cholesterol increased from less than 20% to more than 30%.

The findings were limited by the lack of data on individuals in nursing homes and other institutions that are not included in NHANES databases, the CDC researchers noted in the report.

About 100,000 deaths [in the U.S.] are preventable by simple, low-cost improvements in our ability to control high blood pressure and high cholesterol," said Dr. Frieden. "Better control can save lives and save money."

The report is available online at www.cdc.gov/vitalsigns. More detailed information can be found in the Feb. 1 issue of the weekly Morbidity and Mortality Report (MMWR early release/vol. 60; Feb. 1, 2011).

Approximately 68 million American adults have high blood pressure and 71 million have high cholesterol, and the conditions are uncontrolled in 37 million and 48 million, respectively, according to a Vital Signs report released by the Centers for Disease Control and Prevention on Feb. 1.

"Heart disease is the leading killer in America, and the bottom line is that high blood pressure and high cholesterol are out of control for most Americans who have these conditions," CDC director Dr. Thomas R. Frieden said during the teleconference accompanying the report’s release.

High blood pressure and high cholesterol remain top risk factors for life-threatening conditions including strokes, heart attacks, and vascular diseases, he added.

Dr. Frieden had a message for physicians: Controlling high blood pressure and cholesterol is one of the most important things you can do for your patients. Know how many of your patients have high blood pressure and high cholesterol, what proportion are controlled, and what can be done to help more patients get these conditions under control, he said.

"We have seen many examples of health systems, health programs, and doctors’ offices using information technology to support patients and drastically improve the levels of control, and that’s something that is needed throughout health care in this country," he added.

The report was based on data from the National Health and Nutrition Examination Survey (NHANES) on adults aged 18 years and older. The findings also indicate that approximately 20 million U.S. adults with high blood pressure and 37 million with high cholesterol are not being treated for these conditions.

The prevalence of control of high blood pressure was 29% among adults without health insurance, and the control of high cholesterol was less than 15% among those with limited access to health care. But at least 80% of individuals with uncontrolled high blood pressure and high cholesterol have health insurance, Dr. Frieden noted.

For those with health insurance, the characteristics of their specific plan are more likely to affect how likely they are to have high blood pressure or high cholesterol under control than are their personal characteristics, he said.

High blood pressure was defined as blood pressure greater than 140/90 mmHg or reported use of blood pressure–lowering medication. The national prevalence of high blood pressure remained stable over the past decade, although 70% of those with hypertension were being treated and 46% were being controlled, according to the report.

The criteria for high cholesterol included anyone taking cholesterol medication or having a LDL cholesterol level of 100 mg/dL or higher for high-risk individuals, 130 mg/dL or higher for intermediate-risk individuals, and 160 mg/dL for those at low risk.

The proportion of adults treated for high cholesterol increased from 28% to 48% over the past decade, and the proportion of those controlling their high cholesterol increased from less than 20% to more than 30%.

The findings were limited by the lack of data on individuals in nursing homes and other institutions that are not included in NHANES databases, the CDC researchers noted in the report.

About 100,000 deaths [in the U.S.] are preventable by simple, low-cost improvements in our ability to control high blood pressure and high cholesterol," said Dr. Frieden. "Better control can save lives and save money."

The report is available online at www.cdc.gov/vitalsigns. More detailed information can be found in the Feb. 1 issue of the weekly Morbidity and Mortality Report (MMWR early release/vol. 60; Feb. 1, 2011).

Approximately 68 million American adults have high blood pressure and 71 million have high cholesterol, and the conditions are uncontrolled in 37 million and 48 million, respectively, according to a Vital Signs report released by the Centers for Disease Control and Prevention on Feb. 1.

"Heart disease is the leading killer in America, and the bottom line is that high blood pressure and high cholesterol are out of control for most Americans who have these conditions," CDC director Dr. Thomas R. Frieden said during the teleconference accompanying the report’s release.

High blood pressure and high cholesterol remain top risk factors for life-threatening conditions including strokes, heart attacks, and vascular diseases, he added.

Dr. Frieden had a message for physicians: Controlling high blood pressure and cholesterol is one of the most important things you can do for your patients. Know how many of your patients have high blood pressure and high cholesterol, what proportion are controlled, and what can be done to help more patients get these conditions under control, he said.

"We have seen many examples of health systems, health programs, and doctors’ offices using information technology to support patients and drastically improve the levels of control, and that’s something that is needed throughout health care in this country," he added.

The report was based on data from the National Health and Nutrition Examination Survey (NHANES) on adults aged 18 years and older. The findings also indicate that approximately 20 million U.S. adults with high blood pressure and 37 million with high cholesterol are not being treated for these conditions.

The prevalence of control of high blood pressure was 29% among adults without health insurance, and the control of high cholesterol was less than 15% among those with limited access to health care. But at least 80% of individuals with uncontrolled high blood pressure and high cholesterol have health insurance, Dr. Frieden noted.

For those with health insurance, the characteristics of their specific plan are more likely to affect how likely they are to have high blood pressure or high cholesterol under control than are their personal characteristics, he said.

High blood pressure was defined as blood pressure greater than 140/90 mmHg or reported use of blood pressure–lowering medication. The national prevalence of high blood pressure remained stable over the past decade, although 70% of those with hypertension were being treated and 46% were being controlled, according to the report.

The criteria for high cholesterol included anyone taking cholesterol medication or having a LDL cholesterol level of 100 mg/dL or higher for high-risk individuals, 130 mg/dL or higher for intermediate-risk individuals, and 160 mg/dL for those at low risk.

The proportion of adults treated for high cholesterol increased from 28% to 48% over the past decade, and the proportion of those controlling their high cholesterol increased from less than 20% to more than 30%.

The findings were limited by the lack of data on individuals in nursing homes and other institutions that are not included in NHANES databases, the CDC researchers noted in the report.

About 100,000 deaths [in the U.S.] are preventable by simple, low-cost improvements in our ability to control high blood pressure and high cholesterol," said Dr. Frieden. "Better control can save lives and save money."

The report is available online at www.cdc.gov/vitalsigns. More detailed information can be found in the Feb. 1 issue of the weekly Morbidity and Mortality Report (MMWR early release/vol. 60; Feb. 1, 2011).

Approximately 68 million American adults have high blood pressure and 71 million have high cholesterol, and the conditions are uncontrolled in 37 million and 48 million, respectively, according to a Vital Signs report released by the Centers for Disease Control and Prevention on Feb. 1.

"Heart disease is the leading killer in America, and the bottom line is that high blood pressure and high cholesterol are out of control for most Americans who have these conditions," CDC director Dr. Thomas R. Frieden said during the teleconference accompanying the report’s release.

High blood pressure and high cholesterol remain top risk factors for life-threatening conditions including strokes, heart attacks, and vascular diseases, he added.

Dr. Frieden had a message for physicians: Controlling high blood pressure and cholesterol is one of the most important things you can do for your patients. Know how many of your patients have high blood pressure and high cholesterol, what proportion are controlled, and what can be done to help more patients get these conditions under control, he said.

"We have seen many examples of health systems, health programs, and doctors’ offices using information technology to support patients and drastically improve the levels of control, and that’s something that is needed throughout health care in this country," he added.

The report was based on data from the National Health and Nutrition Examination Survey (NHANES) on adults aged 18 years and older. The findings also indicate that approximately 20 million U.S. adults with high blood pressure and 37 million with high cholesterol are not being treated for these conditions.

The prevalence of control of high blood pressure was 29% among adults without health insurance, and the control of high cholesterol was less than 15% among those with limited access to health care. But at least 80% of individuals with uncontrolled high blood pressure and high cholesterol have health insurance, Dr. Frieden noted.

For those with health insurance, the characteristics of their specific plan are more likely to affect how likely they are to have high blood pressure or high cholesterol under control than are their personal characteristics, he said.

High blood pressure was defined as blood pressure greater than 140/90 mmHg or reported use of blood pressure–lowering medication. The national prevalence of high blood pressure remained stable over the past decade, although 70% of those with hypertension were being treated and 46% were being controlled, according to the report.

The criteria for high cholesterol included anyone taking cholesterol medication or having a LDL cholesterol level of 100 mg/dL or higher for high-risk individuals, 130 mg/dL or higher for intermediate-risk individuals, and 160 mg/dL for those at low risk.

The proportion of adults treated for high cholesterol increased from 28% to 48% over the past decade, and the proportion of those controlling their high cholesterol increased from less than 20% to more than 30%.

The findings were limited by the lack of data on individuals in nursing homes and other institutions that are not included in NHANES databases, the CDC researchers noted in the report.

About 100,000 deaths [in the U.S.] are preventable by simple, low-cost improvements in our ability to control high blood pressure and high cholesterol," said Dr. Frieden. "Better control can save lives and save money."

The report is available online. More detailed information can be found in the Feb. 1 issue of the weekly Morbidity and Mortality Report (MMWR early release/vol. 60; Feb. 1, 2011).

Approximately 68 million American adults have high blood pressure and 71 million have high cholesterol, and the conditions are uncontrolled in 37 million and 48 million, respectively, according to a Vital Signs report released by the Centers for Disease Control and Prevention on Feb. 1.

"Heart disease is the leading killer in America, and the bottom line is that high blood pressure and high cholesterol are out of control for most Americans who have these conditions," CDC director Dr. Thomas R. Frieden said during the teleconference accompanying the report’s release.

High blood pressure and high cholesterol remain top risk factors for life-threatening conditions including strokes, heart attacks, and vascular diseases, he added.

Dr. Frieden had a message for physicians: Controlling high blood pressure and cholesterol is one of the most important things you can do for your patients. Know how many of your patients have high blood pressure and high cholesterol, what proportion are controlled, and what can be done to help more patients get these conditions under control, he said.

"We have seen many examples of health systems, health programs, and doctors’ offices using information technology to support patients and drastically improve the levels of control, and that’s something that is needed throughout health care in this country," he added.

The report was based on data from the National Health and Nutrition Examination Survey (NHANES) on adults aged 18 years and older. The findings also indicate that approximately 20 million U.S. adults with high blood pressure and 37 million with high cholesterol are not being treated for these conditions.

The prevalence of control of high blood pressure was 29% among adults without health insurance, and the control of high cholesterol was less than 15% among those with limited access to health care. But at least 80% of individuals with uncontrolled high blood pressure and high cholesterol have health insurance, Dr. Frieden noted.

For those with health insurance, the characteristics of their specific plan are more likely to affect how likely they are to have high blood pressure or high cholesterol under control than are their personal characteristics, he said.

High blood pressure was defined as blood pressure greater than 140/90 mmHg or reported use of blood pressure–lowering medication. The national prevalence of high blood pressure remained stable over the past decade, although 70% of those with hypertension were being treated and 46% were being controlled, according to the report.

The criteria for high cholesterol included anyone taking cholesterol medication or having a LDL cholesterol level of 100 mg/dL or higher for high-risk individuals, 130 mg/dL or higher for intermediate-risk individuals, and 160 mg/dL for those at low risk.

The proportion of adults treated for high cholesterol increased from 28% to 48% over the past decade, and the proportion of those controlling their high cholesterol increased from less than 20% to more than 30%.

The findings were limited by the lack of data on individuals in nursing homes and other institutions that are not included in NHANES databases, the CDC researchers noted in the report.

About 100,000 deaths [in the U.S.] are preventable by simple, low-cost improvements in our ability to control high blood pressure and high cholesterol," said Dr. Frieden. "Better control can save lives and save money."

The report is available online. More detailed information can be found in the Feb. 1 issue of the weekly Morbidity and Mortality Report (MMWR early release/vol. 60; Feb. 1, 2011).

Approximately 68 million American adults have high blood pressure and 71 million have high cholesterol, and the conditions are uncontrolled in 37 million and 48 million, respectively, according to a Vital Signs report released by the Centers for Disease Control and Prevention on Feb. 1.

"Heart disease is the leading killer in America, and the bottom line is that high blood pressure and high cholesterol are out of control for most Americans who have these conditions," CDC director Dr. Thomas R. Frieden said during the teleconference accompanying the report’s release.

High blood pressure and high cholesterol remain top risk factors for life-threatening conditions including strokes, heart attacks, and vascular diseases, he added.

Dr. Frieden had a message for physicians: Controlling high blood pressure and cholesterol is one of the most important things you can do for your patients. Know how many of your patients have high blood pressure and high cholesterol, what proportion are controlled, and what can be done to help more patients get these conditions under control, he said.

"We have seen many examples of health systems, health programs, and doctors’ offices using information technology to support patients and drastically improve the levels of control, and that’s something that is needed throughout health care in this country," he added.

The report was based on data from the National Health and Nutrition Examination Survey (NHANES) on adults aged 18 years and older. The findings also indicate that approximately 20 million U.S. adults with high blood pressure and 37 million with high cholesterol are not being treated for these conditions.

The prevalence of control of high blood pressure was 29% among adults without health insurance, and the control of high cholesterol was less than 15% among those with limited access to health care. But at least 80% of individuals with uncontrolled high blood pressure and high cholesterol have health insurance, Dr. Frieden noted.

For those with health insurance, the characteristics of their specific plan are more likely to affect how likely they are to have high blood pressure or high cholesterol under control than are their personal characteristics, he said.

High blood pressure was defined as blood pressure greater than 140/90 mmHg or reported use of blood pressure–lowering medication. The national prevalence of high blood pressure remained stable over the past decade, although 70% of those with hypertension were being treated and 46% were being controlled, according to the report.

The criteria for high cholesterol included anyone taking cholesterol medication or having a LDL cholesterol level of 100 mg/dL or higher for high-risk individuals, 130 mg/dL or higher for intermediate-risk individuals, and 160 mg/dL for those at low risk.

The proportion of adults treated for high cholesterol increased from 28% to 48% over the past decade, and the proportion of those controlling their high cholesterol increased from less than 20% to more than 30%.

The findings were limited by the lack of data on individuals in nursing homes and other institutions that are not included in NHANES databases, the CDC researchers noted in the report.

About 100,000 deaths [in the U.S.] are preventable by simple, low-cost improvements in our ability to control high blood pressure and high cholesterol," said Dr. Frieden. "Better control can save lives and save money."

The report is available online. More detailed information can be found in the Feb. 1 issue of the weekly Morbidity and Mortality Report (MMWR early release/vol. 60; Feb. 1, 2011).

The life expectancy of Americans falls short compared to that of their counterparts in other high-income countries, and smoking and obesity are key contributors to the difference, the National Research Council of the National Academies reported.

The life expectancy at birth for U.S. men increased from 65 years in 1950 to 76 years in 2006; for U.S. women, it increased from 71 to 81 years. Similarly, life expectancy at age 50 for men in the U.S. increased from 23 to 29 years. For American women, that figure rose from 27 to 33 years. Still, the improved life expectancy in the United States – the world's top spender on health care – fell below that of eight other rich countries, including Australia, Japan, and Canada (see chart).

The National Council on Aging commissioned the report, “Explaining Divergent Levels of Longevity in High-Income Countries,” to identify factors behind the differences in life expectancy. The report focused on life expectancy at age 50, because at least 90% of newborns in high-income countries now survive to age 50 years. The data were based primarily on an analysis of cause-of-death statistics.

“Smoking appears to be responsible for a good deal of the divergence in female life expectancy,” according to the report. The researchers estimated that 78% of the difference in life expectancy between American women and those in other high-income countries was attributable to smoking. Similarly, among men, smoking accounted for 41% of the difference.

The reduction in smoking in the United States over the past 20 years is likely to pay off in improved longevity trends in future decades, the researchers noted. A reduction or increase in smoking rates appears to take 20–30 years to impact mortality, they added.

Obesity also plays a significant role in the lagging U.S. longevity. Based on data from several studies, obesity accounts for approximately 20%–35% of the difference in longevity between Americans and residents of other countries.

Physical inactivity, social integration, and healthcare systems also likely contribute to increased mortality and differences in life expectancy among countries, but evaluation of these risk factors has been limited to observational studies, the researchers noted.

The National Research Council is the principal operating agency of the National Academy of Sciences and the National Academy of Engineering, which are private, nonprofit institutions. The report is available for purchase from the National Academies Press.

Vitals

Source Elsevier Global Medical News

The life expectancy of Americans falls short compared to that of their counterparts in other high-income countries, and smoking and obesity are key contributors to the difference, the National Research Council of the National Academies reported.

The life expectancy at birth for U.S. men increased from 65 years in 1950 to 76 years in 2006; for U.S. women, it increased from 71 to 81 years. Similarly, life expectancy at age 50 for men in the U.S. increased from 23 to 29 years. For American women, that figure rose from 27 to 33 years. Still, the improved life expectancy in the United States – the world's top spender on health care – fell below that of eight other rich countries, including Australia, Japan, and Canada (see chart).

The National Council on Aging commissioned the report, “Explaining Divergent Levels of Longevity in High-Income Countries,” to identify factors behind the differences in life expectancy. The report focused on life expectancy at age 50, because at least 90% of newborns in high-income countries now survive to age 50 years. The data were based primarily on an analysis of cause-of-death statistics.

“Smoking appears to be responsible for a good deal of the divergence in female life expectancy,” according to the report. The researchers estimated that 78% of the difference in life expectancy between American women and those in other high-income countries was attributable to smoking. Similarly, among men, smoking accounted for 41% of the difference.

The reduction in smoking in the United States over the past 20 years is likely to pay off in improved longevity trends in future decades, the researchers noted. A reduction or increase in smoking rates appears to take 20–30 years to impact mortality, they added.

Obesity also plays a significant role in the lagging U.S. longevity. Based on data from several studies, obesity accounts for approximately 20%–35% of the difference in longevity between Americans and residents of other countries.

Physical inactivity, social integration, and healthcare systems also likely contribute to increased mortality and differences in life expectancy among countries, but evaluation of these risk factors has been limited to observational studies, the researchers noted.

The National Research Council is the principal operating agency of the National Academy of Sciences and the National Academy of Engineering, which are private, nonprofit institutions. The report is available for purchase from the National Academies Press.

Vitals

Source Elsevier Global Medical News

The life expectancy of Americans falls short compared to that of their counterparts in other high-income countries, and smoking and obesity are key contributors to the difference, the National Research Council of the National Academies reported.

The life expectancy at birth for U.S. men increased from 65 years in 1950 to 76 years in 2006; for U.S. women, it increased from 71 to 81 years. Similarly, life expectancy at age 50 for men in the U.S. increased from 23 to 29 years. For American women, that figure rose from 27 to 33 years. Still, the improved life expectancy in the United States – the world's top spender on health care – fell below that of eight other rich countries, including Australia, Japan, and Canada (see chart).

The National Council on Aging commissioned the report, “Explaining Divergent Levels of Longevity in High-Income Countries,” to identify factors behind the differences in life expectancy. The report focused on life expectancy at age 50, because at least 90% of newborns in high-income countries now survive to age 50 years. The data were based primarily on an analysis of cause-of-death statistics.

“Smoking appears to be responsible for a good deal of the divergence in female life expectancy,” according to the report. The researchers estimated that 78% of the difference in life expectancy between American women and those in other high-income countries was attributable to smoking. Similarly, among men, smoking accounted for 41% of the difference.

The reduction in smoking in the United States over the past 20 years is likely to pay off in improved longevity trends in future decades, the researchers noted. A reduction or increase in smoking rates appears to take 20–30 years to impact mortality, they added.

Obesity also plays a significant role in the lagging U.S. longevity. Based on data from several studies, obesity accounts for approximately 20%–35% of the difference in longevity between Americans and residents of other countries.

Physical inactivity, social integration, and healthcare systems also likely contribute to increased mortality and differences in life expectancy among countries, but evaluation of these risk factors has been limited to observational studies, the researchers noted.

The National Research Council is the principal operating agency of the National Academy of Sciences and the National Academy of Engineering, which are private, nonprofit institutions. The report is available for purchase from the National Academies Press.

Vitals

Source Elsevier Global Medical News