Michele G. Sullivan

ST. LOUIS — Bisphosphonates remain underutilized in the prevention of glucocorticoid-induced osteoporosis, despite national clinical guidelines that recommend their use in patients on long-term oral steroid therapy, Rosemarie Liu, M.D., said at the annual meeting of the Society of Investigative Dermatology.

“In 2001, the American College of Rheumatology published guidelines recommending that all patients beginning long-term oral steroid therapy of at least 5 mg/day should receive a prescription for a bisphosphonate, if not contraindicated,” said Dr. Liu of Eastern Virginia Medical School, Norfolk. “Despite these guidelines, the vast majority of patients in our study did not receive appropriate prophylaxis for glucocorticoid-induced osteoporosis.”

Dr. Liu and her colleagues conducted a cross-sectional study of 35 patients referred to the tertiary dermatology clinic at the Hospital of the University of Pennsylvania, Philadelphia, from 1995 to 2004. Of that group, 60% (21) were female and 83% (29) were white. Their mean age was 54 years (29–86). The mean daily dose of prednisone was 53 mg, with a range of 10–150 mg/day. The patients had been on steroids for a mean of 17 months, with the longest duration of use, 102 months.

Twenty-eight (80%) of the patients were taking prednisone for pemphigus vulgaris; other indications were lupus erythematosus (4), dermatomyositis (2), and arthritis with interstitial granulomatous dermatitis (1). The majority of the patients (80%) were not on any bisphosphonates at the time of their referral. The investigators found that the 2001 publication of the ACR Guidelines for Prevention and Treatment of Glucocorticoid-Induced Osteoporosis had no effect on bisphosphonate prescriptions in this group.

“The guidelines were published in July 2001, but we used January 2002 as the cut-off date, because we wanted to give adequate time for them to be incorporated into clinical practice,” Dr. Liu said. Among those referred before 2002, 75% were not on bisphosphonates; among these referred after 2002 (1 year after the guidelines were published), 81% were not on bisphosphonates.

Dual energy x-ray absorptiometry scans were available for 18 patients. The mean time on steroids before DXA scan was 13 months. Seven of those patients had a normal scan, eight had evidence of osteopenia, and three had evidence of osteoporosis. One patient had a vertebral fracture within 5 months of beginning prednisone.

“When patients are started on long-term oral steroids, a bisphosphonate should be prescribed unless contraindicated, Dr. Liu said. Also, a baseline DXA scan should be ordered to provide information about baseline bone health, and should be repeated whenever clinically indicated.”

ST. LOUIS — Bisphosphonates remain underutilized in the prevention of glucocorticoid-induced osteoporosis, despite national clinical guidelines that recommend their use in patients on long-term oral steroid therapy, Rosemarie Liu, M.D., said at the annual meeting of the Society of Investigative Dermatology.

“In 2001, the American College of Rheumatology published guidelines recommending that all patients beginning long-term oral steroid therapy of at least 5 mg/day should receive a prescription for a bisphosphonate, if not contraindicated,” said Dr. Liu of Eastern Virginia Medical School, Norfolk. “Despite these guidelines, the vast majority of patients in our study did not receive appropriate prophylaxis for glucocorticoid-induced osteoporosis.”

Dr. Liu and her colleagues conducted a cross-sectional study of 35 patients referred to the tertiary dermatology clinic at the Hospital of the University of Pennsylvania, Philadelphia, from 1995 to 2004. Of that group, 60% (21) were female and 83% (29) were white. Their mean age was 54 years (29–86). The mean daily dose of prednisone was 53 mg, with a range of 10–150 mg/day. The patients had been on steroids for a mean of 17 months, with the longest duration of use, 102 months.

Twenty-eight (80%) of the patients were taking prednisone for pemphigus vulgaris; other indications were lupus erythematosus (4), dermatomyositis (2), and arthritis with interstitial granulomatous dermatitis (1). The majority of the patients (80%) were not on any bisphosphonates at the time of their referral. The investigators found that the 2001 publication of the ACR Guidelines for Prevention and Treatment of Glucocorticoid-Induced Osteoporosis had no effect on bisphosphonate prescriptions in this group.

“The guidelines were published in July 2001, but we used January 2002 as the cut-off date, because we wanted to give adequate time for them to be incorporated into clinical practice,” Dr. Liu said. Among those referred before 2002, 75% were not on bisphosphonates; among these referred after 2002 (1 year after the guidelines were published), 81% were not on bisphosphonates.

Dual energy x-ray absorptiometry scans were available for 18 patients. The mean time on steroids before DXA scan was 13 months. Seven of those patients had a normal scan, eight had evidence of osteopenia, and three had evidence of osteoporosis. One patient had a vertebral fracture within 5 months of beginning prednisone.

“When patients are started on long-term oral steroids, a bisphosphonate should be prescribed unless contraindicated, Dr. Liu said. Also, a baseline DXA scan should be ordered to provide information about baseline bone health, and should be repeated whenever clinically indicated.”

ST. LOUIS — Bisphosphonates remain underutilized in the prevention of glucocorticoid-induced osteoporosis, despite national clinical guidelines that recommend their use in patients on long-term oral steroid therapy, Rosemarie Liu, M.D., said at the annual meeting of the Society of Investigative Dermatology.

“In 2001, the American College of Rheumatology published guidelines recommending that all patients beginning long-term oral steroid therapy of at least 5 mg/day should receive a prescription for a bisphosphonate, if not contraindicated,” said Dr. Liu of Eastern Virginia Medical School, Norfolk. “Despite these guidelines, the vast majority of patients in our study did not receive appropriate prophylaxis for glucocorticoid-induced osteoporosis.”

Dr. Liu and her colleagues conducted a cross-sectional study of 35 patients referred to the tertiary dermatology clinic at the Hospital of the University of Pennsylvania, Philadelphia, from 1995 to 2004. Of that group, 60% (21) were female and 83% (29) were white. Their mean age was 54 years (29–86). The mean daily dose of prednisone was 53 mg, with a range of 10–150 mg/day. The patients had been on steroids for a mean of 17 months, with the longest duration of use, 102 months.

Twenty-eight (80%) of the patients were taking prednisone for pemphigus vulgaris; other indications were lupus erythematosus (4), dermatomyositis (2), and arthritis with interstitial granulomatous dermatitis (1). The majority of the patients (80%) were not on any bisphosphonates at the time of their referral. The investigators found that the 2001 publication of the ACR Guidelines for Prevention and Treatment of Glucocorticoid-Induced Osteoporosis had no effect on bisphosphonate prescriptions in this group.

“The guidelines were published in July 2001, but we used January 2002 as the cut-off date, because we wanted to give adequate time for them to be incorporated into clinical practice,” Dr. Liu said. Among those referred before 2002, 75% were not on bisphosphonates; among these referred after 2002 (1 year after the guidelines were published), 81% were not on bisphosphonates.

Dual energy x-ray absorptiometry scans were available for 18 patients. The mean time on steroids before DXA scan was 13 months. Seven of those patients had a normal scan, eight had evidence of osteopenia, and three had evidence of osteoporosis. One patient had a vertebral fracture within 5 months of beginning prednisone.

“When patients are started on long-term oral steroids, a bisphosphonate should be prescribed unless contraindicated, Dr. Liu said. Also, a baseline DXA scan should be ordered to provide information about baseline bone health, and should be repeated whenever clinically indicated.”

Although a health department investigation was continuing at press time, new cases of gastrointestinal illness linked to exposure at a New York water park appeared to be leveling off, officials said.

A s of this writing, 4,000 reports of persons with gastrointestinal illness—728 of which were confirmed Cryptosporidium infection—had been reported in 37 New York counties as well as New York City. However, the numbers have remained stable and the outbreak has tapered off.

“Many of those who have reported illness have fully recovered, and our investigation is ongoing,” said Jeffrey Hammond, M.D., spokesperson for the New York State Department of Health.

“New onset of illness directly connected to the Seneca Lake spray park attraction is no longer occurring, and many people who reported illness have fully recovered,” State Health Commissioner Antonia C. Novello, M.D., said in a statement. “Our priority is to prevent any further spread of gastrointestinal illness from person to person.”

With the beginning of a new school year, person-to-person transmission could increase, especially among younger students who don't reliably practice good hand washing, Dr. Novello said.

The state health department issued letters to all schools and day care centers in the 35 affected counties, stressing the precautionary measures people should take to help stop any further spread of gastrointestinal illness.

“We want to stress that students, parents, and teachers should practice good hygiene and that those who are ill should refrain from attending school or day care, so they can recover more quickly and avoid getting others sick,” Dr. Novello said.

She recommended the following measures to avoid disease spread:

▸ The school nurse should reinforce the need for students and staff to report any gastrointestinal illness to the nursing office at the first sign of such.

▸ Students and staff who are experiencing gastrointestinal illness should stay home from school until symptoms resolve.

▸ Students and staff should thoroughly wash hands after using restrooms and before handling food for themselves or others.

▸ Elementary grade students may need verbal reminders or staff supervision when washing hands.

▸ Schools should ensure that there are adequate supplies of liquid soap and paper towels for hand washing. Since waterless hand cleansers are not as effective in removing the Cryptosporidium parasite from hands, soap and water are preferred for hand washing.

▸ Schools should ensure restroom cleanliness is maintained.

The outbreak began in June, when people began reporting symptoms consistent with cryptosporidiosis: diarrhea, abdominal cramping, nausea, vomiting, fever, headache, and loss of appetite. A state health department investigation identified the source of infection as the “Sprayground” water feature at Seneca Lake State Park in Monroe County.

The parasite was found in two underground water storage tanks that supplied the water park's spray features, said Dr. Hammond. The park closed for the season on August 15.

Although a health department investigation was continuing at press time, new cases of gastrointestinal illness linked to exposure at a New York water park appeared to be leveling off, officials said.

A s of this writing, 4,000 reports of persons with gastrointestinal illness—728 of which were confirmed Cryptosporidium infection—had been reported in 37 New York counties as well as New York City. However, the numbers have remained stable and the outbreak has tapered off.

“Many of those who have reported illness have fully recovered, and our investigation is ongoing,” said Jeffrey Hammond, M.D., spokesperson for the New York State Department of Health.

“New onset of illness directly connected to the Seneca Lake spray park attraction is no longer occurring, and many people who reported illness have fully recovered,” State Health Commissioner Antonia C. Novello, M.D., said in a statement. “Our priority is to prevent any further spread of gastrointestinal illness from person to person.”

With the beginning of a new school year, person-to-person transmission could increase, especially among younger students who don't reliably practice good hand washing, Dr. Novello said.

The state health department issued letters to all schools and day care centers in the 35 affected counties, stressing the precautionary measures people should take to help stop any further spread of gastrointestinal illness.

“We want to stress that students, parents, and teachers should practice good hygiene and that those who are ill should refrain from attending school or day care, so they can recover more quickly and avoid getting others sick,” Dr. Novello said.

She recommended the following measures to avoid disease spread:

▸ The school nurse should reinforce the need for students and staff to report any gastrointestinal illness to the nursing office at the first sign of such.

▸ Students and staff who are experiencing gastrointestinal illness should stay home from school until symptoms resolve.

▸ Students and staff should thoroughly wash hands after using restrooms and before handling food for themselves or others.

▸ Elementary grade students may need verbal reminders or staff supervision when washing hands.

▸ Schools should ensure that there are adequate supplies of liquid soap and paper towels for hand washing. Since waterless hand cleansers are not as effective in removing the Cryptosporidium parasite from hands, soap and water are preferred for hand washing.

▸ Schools should ensure restroom cleanliness is maintained.

The outbreak began in June, when people began reporting symptoms consistent with cryptosporidiosis: diarrhea, abdominal cramping, nausea, vomiting, fever, headache, and loss of appetite. A state health department investigation identified the source of infection as the “Sprayground” water feature at Seneca Lake State Park in Monroe County.

The parasite was found in two underground water storage tanks that supplied the water park's spray features, said Dr. Hammond. The park closed for the season on August 15.

Although a health department investigation was continuing at press time, new cases of gastrointestinal illness linked to exposure at a New York water park appeared to be leveling off, officials said.

A s of this writing, 4,000 reports of persons with gastrointestinal illness—728 of which were confirmed Cryptosporidium infection—had been reported in 37 New York counties as well as New York City. However, the numbers have remained stable and the outbreak has tapered off.

“Many of those who have reported illness have fully recovered, and our investigation is ongoing,” said Jeffrey Hammond, M.D., spokesperson for the New York State Department of Health.

“New onset of illness directly connected to the Seneca Lake spray park attraction is no longer occurring, and many people who reported illness have fully recovered,” State Health Commissioner Antonia C. Novello, M.D., said in a statement. “Our priority is to prevent any further spread of gastrointestinal illness from person to person.”

With the beginning of a new school year, person-to-person transmission could increase, especially among younger students who don't reliably practice good hand washing, Dr. Novello said.

The state health department issued letters to all schools and day care centers in the 35 affected counties, stressing the precautionary measures people should take to help stop any further spread of gastrointestinal illness.

“We want to stress that students, parents, and teachers should practice good hygiene and that those who are ill should refrain from attending school or day care, so they can recover more quickly and avoid getting others sick,” Dr. Novello said.

She recommended the following measures to avoid disease spread:

▸ The school nurse should reinforce the need for students and staff to report any gastrointestinal illness to the nursing office at the first sign of such.

▸ Students and staff who are experiencing gastrointestinal illness should stay home from school until symptoms resolve.

▸ Students and staff should thoroughly wash hands after using restrooms and before handling food for themselves or others.

▸ Elementary grade students may need verbal reminders or staff supervision when washing hands.

▸ Schools should ensure that there are adequate supplies of liquid soap and paper towels for hand washing. Since waterless hand cleansers are not as effective in removing the Cryptosporidium parasite from hands, soap and water are preferred for hand washing.

▸ Schools should ensure restroom cleanliness is maintained.

The outbreak began in June, when people began reporting symptoms consistent with cryptosporidiosis: diarrhea, abdominal cramping, nausea, vomiting, fever, headache, and loss of appetite. A state health department investigation identified the source of infection as the “Sprayground” water feature at Seneca Lake State Park in Monroe County.

The parasite was found in two underground water storage tanks that supplied the water park's spray features, said Dr. Hammond. The park closed for the season on August 15.

A 3-day course of prednisolone appears effective in Kawasaki disease patients who are unresponsive to multiple infusions of intravenous immunoglobulin, Seiichiro Takeshita, M.D., and colleagues reported.

Their success in treating nonresponders with prednisolone infusion suggests that IVIG-resistant patients with Kawasaki disease may not require steroid pulse therapy, which has been associated with an increased risk of coronary aneurysm rupture, hypertension, seizures, and gastric erosion in this group (Clin. Pediatr. 2005;44:423–6).

Dr. Takeshita of the University of Shizuoka, Japan, and hiscolleagues administered 3-day courses of prednisolone every 8 hours (1–2 mg/kg per day) to six children, aged from 10 months to 9 years, who did not respond to repeated courses of IVIG for Kawasaki disease. Five of the children also received ulinastatin, a serine protease inhibitor not currently available in the United States.

Three patients had complications of the disease, including arthritis, myocarditis, and depressed left ventricular systolic function. All patients had dilated coronary arteries before prednisolone was administered.

Five of the children became afebrile and had a significant decrease in C-reactive protein (CRP) levels within 24 hours of their first course of prednisolone.

The sixth patient had a persistent low-grade fever and high-CRP level after the first course, and developed a high-grade fever and high-CRP level 3 days after the first course ended. He then received a second, 3-day course of prednisolone (1.5 mg/kg per day). Within 24 hours, he became afebrile and had a significant drop in CRP level. No patient experienced an adverse event related to the prednisolone. No patient experienced further progression of coronary artery dilation; all dilated arteries returned to normal diameters during the follow-up period that ranged from 16 months to 6 years.

A 3-day course of prednisolone appears effective in Kawasaki disease patients who are unresponsive to multiple infusions of intravenous immunoglobulin, Seiichiro Takeshita, M.D., and colleagues reported.

Their success in treating nonresponders with prednisolone infusion suggests that IVIG-resistant patients with Kawasaki disease may not require steroid pulse therapy, which has been associated with an increased risk of coronary aneurysm rupture, hypertension, seizures, and gastric erosion in this group (Clin. Pediatr. 2005;44:423–6).

Dr. Takeshita of the University of Shizuoka, Japan, and hiscolleagues administered 3-day courses of prednisolone every 8 hours (1–2 mg/kg per day) to six children, aged from 10 months to 9 years, who did not respond to repeated courses of IVIG for Kawasaki disease. Five of the children also received ulinastatin, a serine protease inhibitor not currently available in the United States.

Three patients had complications of the disease, including arthritis, myocarditis, and depressed left ventricular systolic function. All patients had dilated coronary arteries before prednisolone was administered.

Five of the children became afebrile and had a significant decrease in C-reactive protein (CRP) levels within 24 hours of their first course of prednisolone.

The sixth patient had a persistent low-grade fever and high-CRP level after the first course, and developed a high-grade fever and high-CRP level 3 days after the first course ended. He then received a second, 3-day course of prednisolone (1.5 mg/kg per day). Within 24 hours, he became afebrile and had a significant drop in CRP level. No patient experienced an adverse event related to the prednisolone. No patient experienced further progression of coronary artery dilation; all dilated arteries returned to normal diameters during the follow-up period that ranged from 16 months to 6 years.

A 3-day course of prednisolone appears effective in Kawasaki disease patients who are unresponsive to multiple infusions of intravenous immunoglobulin, Seiichiro Takeshita, M.D., and colleagues reported.

Their success in treating nonresponders with prednisolone infusion suggests that IVIG-resistant patients with Kawasaki disease may not require steroid pulse therapy, which has been associated with an increased risk of coronary aneurysm rupture, hypertension, seizures, and gastric erosion in this group (Clin. Pediatr. 2005;44:423–6).

Dr. Takeshita of the University of Shizuoka, Japan, and hiscolleagues administered 3-day courses of prednisolone every 8 hours (1–2 mg/kg per day) to six children, aged from 10 months to 9 years, who did not respond to repeated courses of IVIG for Kawasaki disease. Five of the children also received ulinastatin, a serine protease inhibitor not currently available in the United States.

Three patients had complications of the disease, including arthritis, myocarditis, and depressed left ventricular systolic function. All patients had dilated coronary arteries before prednisolone was administered.

Five of the children became afebrile and had a significant decrease in C-reactive protein (CRP) levels within 24 hours of their first course of prednisolone.

The sixth patient had a persistent low-grade fever and high-CRP level after the first course, and developed a high-grade fever and high-CRP level 3 days after the first course ended. He then received a second, 3-day course of prednisolone (1.5 mg/kg per day). Within 24 hours, he became afebrile and had a significant drop in CRP level. No patient experienced an adverse event related to the prednisolone. No patient experienced further progression of coronary artery dilation; all dilated arteries returned to normal diameters during the follow-up period that ranged from 16 months to 6 years.

A mosquito-eradication program is underway in storm-ravaged Gulf coast states, and federal officials hope that effort, combined with the hurricane's impact on the vector cycle, will prevent a surge in West Nile virus and other mosquito-borne diseases.

The aerial spray program began in mid-September and will continue as long as is necessary to control mosquito populations, according to the Louisiana State Department of Health.

Although the huge expanses of standing floodwaters are conducive to a mosquito population explosion, the total disruption of the region's normal ecology may discourage mosquito-borne epidemics, said Jennifer Morcone, a spokesperson for the Centers for Disease Control and Prevention.

“Historically, we have not seen increases in these diseases after a storm like this,” she said. “You need a bird population to fuel the transmission cycle and, right now, the bird population in these areas is almost nonexistent.”

However, she said, the CDC has deployed entomologists to monitor mosquito populations and to assist with vector control in the affected areas.

The Louisiana Department of Health and Hospitals—in coordination with the Louisiana Department of Agriculture and Forestry, the CDC, the Agency for Toxic Substances and Disease Registry, U.S. Environmental Protection Agency, the Department of Defense, and local mosquito control districts—is implementing a plan to reduce mosquitoes and flies in the areas affected by Hurricane Katrina.

The health and hospitals department had developed a management plan in anticipation of the hatching of mosquitoes and flies due to the massive flooding in the area. Mosquito control is needed to protect public health from the nuisances and diseases they transmit; flies will also be monitored. The plan will continue, based on field monitor of mosquitoes and flies in the region.

People face two types of increased risks for mosquito-borne diseases in the region: the rise in the number of mosquitos and increased exposure to the insects. “People are spending a lot more time outside, and even when inside, they may have broken windows and screens that let mosquitoes into the house,” Ms. Morcone said.

It's too soon to predict what impact Hurricane Katrina will have on West Nile virus in the Gulf region, she added. “What we do know is that the virus did exist in every one of these states before the storm and that it is still there. We want people to take precautions against exposure, and we will facilitate that as much as possible.”

As of early September, 821 cases of West Nile virus—of which 18 cases were fatal—had been reported in the United States, marking this as the slowest West Nile season since 2002.

By early September 2002, 737 cases had been reported, with 35 fatalities. Numbers soared in 2003 to almost 1,900, with 37 fatalities, and stayed high last year, with 1,191 cases and 30 fatalities.

As in previous years, the highest number of cases (268) occurred in California. Of those, 7 have been fatal; 93 showed neurologic complications (West Nile meningitis, encephalitis, or myelitis). Other hard-hit states include South Dakota (138 cases; 1 fatality; 25 neuroinvasive illnesses); Illinois (89 cases; 1 fatality; 52 neuroinvasive); and Louisiana (52 cases; 4 fatalities; 40 neuroinvasive). Texas has reported only 27 cases, but almost all of them (24) were neuroinvasive; there was 1 fatality.

The reason for the decline this year is unclear, Ms. Morcone said. “If there's one thing we know about West Nile, it's that there's no such thing as a typical season. We have seen areas with large epidemics 1 year and very small case counts the next. Weather and ecology are among the factors that play a part in West Nile prevalence.”

Even though the cases are relatively low, physicians should still stress prevention to their patients. Repellents with DEET(N, N-diethyl-m-toluamide) are most effective for those who are outdoors for extended periods. Repellents with oil of lemon eucalyptus and picaridin are probably sufficient for “backyard exposure,” she said.

West Nile virus has also been identified in blood from 163 blood donors, according to the CDC. Most of the donors (49) were from California. Other states with high numbers were Texas (32), Nebraska (22), South Dakota (14), and Louisiana (10).

Of these donors, 3 subsequently developed West Nile neuroinvasive illness, 38 developed West Nile fever, and 3 developed other illnesses.

A mosquito-eradication program is underway in storm-ravaged Gulf coast states, and federal officials hope that effort, combined with the hurricane's impact on the vector cycle, will prevent a surge in West Nile virus and other mosquito-borne diseases.

The aerial spray program began in mid-September and will continue as long as is necessary to control mosquito populations, according to the Louisiana State Department of Health.

Although the huge expanses of standing floodwaters are conducive to a mosquito population explosion, the total disruption of the region's normal ecology may discourage mosquito-borne epidemics, said Jennifer Morcone, a spokesperson for the Centers for Disease Control and Prevention.

“Historically, we have not seen increases in these diseases after a storm like this,” she said. “You need a bird population to fuel the transmission cycle and, right now, the bird population in these areas is almost nonexistent.”

However, she said, the CDC has deployed entomologists to monitor mosquito populations and to assist with vector control in the affected areas.

The Louisiana Department of Health and Hospitals—in coordination with the Louisiana Department of Agriculture and Forestry, the CDC, the Agency for Toxic Substances and Disease Registry, U.S. Environmental Protection Agency, the Department of Defense, and local mosquito control districts—is implementing a plan to reduce mosquitoes and flies in the areas affected by Hurricane Katrina.

The health and hospitals department had developed a management plan in anticipation of the hatching of mosquitoes and flies due to the massive flooding in the area. Mosquito control is needed to protect public health from the nuisances and diseases they transmit; flies will also be monitored. The plan will continue, based on field monitor of mosquitoes and flies in the region.

People face two types of increased risks for mosquito-borne diseases in the region: the rise in the number of mosquitos and increased exposure to the insects. “People are spending a lot more time outside, and even when inside, they may have broken windows and screens that let mosquitoes into the house,” Ms. Morcone said.

It's too soon to predict what impact Hurricane Katrina will have on West Nile virus in the Gulf region, she added. “What we do know is that the virus did exist in every one of these states before the storm and that it is still there. We want people to take precautions against exposure, and we will facilitate that as much as possible.”

As of early September, 821 cases of West Nile virus—of which 18 cases were fatal—had been reported in the United States, marking this as the slowest West Nile season since 2002.

By early September 2002, 737 cases had been reported, with 35 fatalities. Numbers soared in 2003 to almost 1,900, with 37 fatalities, and stayed high last year, with 1,191 cases and 30 fatalities.

As in previous years, the highest number of cases (268) occurred in California. Of those, 7 have been fatal; 93 showed neurologic complications (West Nile meningitis, encephalitis, or myelitis). Other hard-hit states include South Dakota (138 cases; 1 fatality; 25 neuroinvasive illnesses); Illinois (89 cases; 1 fatality; 52 neuroinvasive); and Louisiana (52 cases; 4 fatalities; 40 neuroinvasive). Texas has reported only 27 cases, but almost all of them (24) were neuroinvasive; there was 1 fatality.

The reason for the decline this year is unclear, Ms. Morcone said. “If there's one thing we know about West Nile, it's that there's no such thing as a typical season. We have seen areas with large epidemics 1 year and very small case counts the next. Weather and ecology are among the factors that play a part in West Nile prevalence.”

Even though the cases are relatively low, physicians should still stress prevention to their patients. Repellents with DEET(N, N-diethyl-m-toluamide) are most effective for those who are outdoors for extended periods. Repellents with oil of lemon eucalyptus and picaridin are probably sufficient for “backyard exposure,” she said.

West Nile virus has also been identified in blood from 163 blood donors, according to the CDC. Most of the donors (49) were from California. Other states with high numbers were Texas (32), Nebraska (22), South Dakota (14), and Louisiana (10).

Of these donors, 3 subsequently developed West Nile neuroinvasive illness, 38 developed West Nile fever, and 3 developed other illnesses.

A mosquito-eradication program is underway in storm-ravaged Gulf coast states, and federal officials hope that effort, combined with the hurricane's impact on the vector cycle, will prevent a surge in West Nile virus and other mosquito-borne diseases.

The aerial spray program began in mid-September and will continue as long as is necessary to control mosquito populations, according to the Louisiana State Department of Health.

Although the huge expanses of standing floodwaters are conducive to a mosquito population explosion, the total disruption of the region's normal ecology may discourage mosquito-borne epidemics, said Jennifer Morcone, a spokesperson for the Centers for Disease Control and Prevention.

“Historically, we have not seen increases in these diseases after a storm like this,” she said. “You need a bird population to fuel the transmission cycle and, right now, the bird population in these areas is almost nonexistent.”

However, she said, the CDC has deployed entomologists to monitor mosquito populations and to assist with vector control in the affected areas.

The Louisiana Department of Health and Hospitals—in coordination with the Louisiana Department of Agriculture and Forestry, the CDC, the Agency for Toxic Substances and Disease Registry, U.S. Environmental Protection Agency, the Department of Defense, and local mosquito control districts—is implementing a plan to reduce mosquitoes and flies in the areas affected by Hurricane Katrina.

The health and hospitals department had developed a management plan in anticipation of the hatching of mosquitoes and flies due to the massive flooding in the area. Mosquito control is needed to protect public health from the nuisances and diseases they transmit; flies will also be monitored. The plan will continue, based on field monitor of mosquitoes and flies in the region.

People face two types of increased risks for mosquito-borne diseases in the region: the rise in the number of mosquitos and increased exposure to the insects. “People are spending a lot more time outside, and even when inside, they may have broken windows and screens that let mosquitoes into the house,” Ms. Morcone said.

It's too soon to predict what impact Hurricane Katrina will have on West Nile virus in the Gulf region, she added. “What we do know is that the virus did exist in every one of these states before the storm and that it is still there. We want people to take precautions against exposure, and we will facilitate that as much as possible.”

As of early September, 821 cases of West Nile virus—of which 18 cases were fatal—had been reported in the United States, marking this as the slowest West Nile season since 2002.

By early September 2002, 737 cases had been reported, with 35 fatalities. Numbers soared in 2003 to almost 1,900, with 37 fatalities, and stayed high last year, with 1,191 cases and 30 fatalities.

As in previous years, the highest number of cases (268) occurred in California. Of those, 7 have been fatal; 93 showed neurologic complications (West Nile meningitis, encephalitis, or myelitis). Other hard-hit states include South Dakota (138 cases; 1 fatality; 25 neuroinvasive illnesses); Illinois (89 cases; 1 fatality; 52 neuroinvasive); and Louisiana (52 cases; 4 fatalities; 40 neuroinvasive). Texas has reported only 27 cases, but almost all of them (24) were neuroinvasive; there was 1 fatality.

The reason for the decline this year is unclear, Ms. Morcone said. “If there's one thing we know about West Nile, it's that there's no such thing as a typical season. We have seen areas with large epidemics 1 year and very small case counts the next. Weather and ecology are among the factors that play a part in West Nile prevalence.”

Even though the cases are relatively low, physicians should still stress prevention to their patients. Repellents with DEET(N, N-diethyl-m-toluamide) are most effective for those who are outdoors for extended periods. Repellents with oil of lemon eucalyptus and picaridin are probably sufficient for “backyard exposure,” she said.

West Nile virus has also been identified in blood from 163 blood donors, according to the CDC. Most of the donors (49) were from California. Other states with high numbers were Texas (32), Nebraska (22), South Dakota (14), and Louisiana (10).

Of these donors, 3 subsequently developed West Nile neuroinvasive illness, 38 developed West Nile fever, and 3 developed other illnesses.

NASHVILLE, TENN. — Liver and spleen injuries account for most sports-related solid organ injuries, William Dexter, M.D., said at the annual meeting of the American College of Sports Medicine.

Liver injuries, which occur in about 5% of athletic abdominal traumas, can be occult, which makes them especially concerning, said Dr. Dexter of the Maine Medical Center, Portland. “While these aren't terribly common injuries, they can cause serious problems.”

“We have to have a game plan in mind for dealing with these folks, both on the field and after treatment,” he said.

Liver injuries are usually caused by blunt force to the abdomen. Symptoms include vomiting, pain in the abdomen or referred to the right shoulder or right side of the neck, and a rapid pulse.

Diagnosis must be made by both clinical assessment and diagnostic imaging. Ultrasound is becoming more popular, but remains second to computed axial tomography. “It's fairly clear that a CT scan is leading the way,” Dr. Dexter said.

“Ultrasound has become more popular, but a 2005 Cochrane review found insufficient evidence to promote an ultrasound-based treatment algorithm,” he said.

Oral contrast is unnecessary when CT scans are used, he said. “Oral contrast doesn't increase the sensitivity or predict outcome, but it does delay time of diagnosis by at least 30 minutes.”

Diagnostic peritoneal lavage has fallen out of favor because, while it is sensitive for intraperitoneal bleeding, it is invasive and does not predict outcome or the need for laparotomy.

Minor injuries (contusion or small laceration), in which the patient is clinically stable (no active bleeding or other peritoneal signs, no associated abdominal injury), heal without surgery with a success rate of up to 98%. These athletes can usually return to play 1 month after the injury.

Major injuries (large laceration, burst, or pedicle injury) usually require surgical intervention. “There are no consistent guidelines on return to play for these athletes, but most authors advise at least 3–6 months,” Dr. Dexter said.

The spleen is another commonly injured organ. The usual cause is a direct blow to the abdomen, though injury can be related to lower rib fracture. The diagnostic imaging method of choice is the CT scan.

Surgery is usually unnecessary if the patient is clinically and hemodynamically stable and if there are no other abdominal injuries. In these cases, rest with close monitoring is advised because late rupture can occur.

Most athletes with minor spleen injuries can return to play about 1 month after the injury. Surgery is advised if the patient is unstable or there is a pedicle injury. Athletes can return to play 6 weeks after a splenectomy.

There has been some speculation that splenomegaly associated with infectious mononucleosis increases the risk of splenic rupture in sports, especially among college-aged males.

“Splenic fragility is greatest on days 4–21 of the infection, when there is a profuse lymphocytic proliferation,” he said.

“Most ruptures occur on days 4–21 from symptom onset and most are spontaneous. They are rarely lethal.”

There is no consensus in the literature about return to play for athletes with mononucleosis, Dr. Dexter said. “In general, if there are no signs or symptoms, and the labs and ultrasound are normal, the athlete can return to contact sports within 3 weeks.”

A damaged solid organ, such as the lacerated spleen in this MRI, usually results from a direct blow to the abdomen. Courtesy Dr. William Dexter

NASHVILLE, TENN. — Liver and spleen injuries account for most sports-related solid organ injuries, William Dexter, M.D., said at the annual meeting of the American College of Sports Medicine.

Liver injuries, which occur in about 5% of athletic abdominal traumas, can be occult, which makes them especially concerning, said Dr. Dexter of the Maine Medical Center, Portland. “While these aren't terribly common injuries, they can cause serious problems.”

“We have to have a game plan in mind for dealing with these folks, both on the field and after treatment,” he said.

Liver injuries are usually caused by blunt force to the abdomen. Symptoms include vomiting, pain in the abdomen or referred to the right shoulder or right side of the neck, and a rapid pulse.

Diagnosis must be made by both clinical assessment and diagnostic imaging. Ultrasound is becoming more popular, but remains second to computed axial tomography. “It's fairly clear that a CT scan is leading the way,” Dr. Dexter said.

“Ultrasound has become more popular, but a 2005 Cochrane review found insufficient evidence to promote an ultrasound-based treatment algorithm,” he said.

Oral contrast is unnecessary when CT scans are used, he said. “Oral contrast doesn't increase the sensitivity or predict outcome, but it does delay time of diagnosis by at least 30 minutes.”

Diagnostic peritoneal lavage has fallen out of favor because, while it is sensitive for intraperitoneal bleeding, it is invasive and does not predict outcome or the need for laparotomy.

Minor injuries (contusion or small laceration), in which the patient is clinically stable (no active bleeding or other peritoneal signs, no associated abdominal injury), heal without surgery with a success rate of up to 98%. These athletes can usually return to play 1 month after the injury.

Major injuries (large laceration, burst, or pedicle injury) usually require surgical intervention. “There are no consistent guidelines on return to play for these athletes, but most authors advise at least 3–6 months,” Dr. Dexter said.

The spleen is another commonly injured organ. The usual cause is a direct blow to the abdomen, though injury can be related to lower rib fracture. The diagnostic imaging method of choice is the CT scan.

Surgery is usually unnecessary if the patient is clinically and hemodynamically stable and if there are no other abdominal injuries. In these cases, rest with close monitoring is advised because late rupture can occur.

Most athletes with minor spleen injuries can return to play about 1 month after the injury. Surgery is advised if the patient is unstable or there is a pedicle injury. Athletes can return to play 6 weeks after a splenectomy.

There has been some speculation that splenomegaly associated with infectious mononucleosis increases the risk of splenic rupture in sports, especially among college-aged males.

“Splenic fragility is greatest on days 4–21 of the infection, when there is a profuse lymphocytic proliferation,” he said.

“Most ruptures occur on days 4–21 from symptom onset and most are spontaneous. They are rarely lethal.”

There is no consensus in the literature about return to play for athletes with mononucleosis, Dr. Dexter said. “In general, if there are no signs or symptoms, and the labs and ultrasound are normal, the athlete can return to contact sports within 3 weeks.”

A damaged solid organ, such as the lacerated spleen in this MRI, usually results from a direct blow to the abdomen. Courtesy Dr. William Dexter

NASHVILLE, TENN. — Liver and spleen injuries account for most sports-related solid organ injuries, William Dexter, M.D., said at the annual meeting of the American College of Sports Medicine.

Liver injuries, which occur in about 5% of athletic abdominal traumas, can be occult, which makes them especially concerning, said Dr. Dexter of the Maine Medical Center, Portland. “While these aren't terribly common injuries, they can cause serious problems.”

“We have to have a game plan in mind for dealing with these folks, both on the field and after treatment,” he said.

Liver injuries are usually caused by blunt force to the abdomen. Symptoms include vomiting, pain in the abdomen or referred to the right shoulder or right side of the neck, and a rapid pulse.

Diagnosis must be made by both clinical assessment and diagnostic imaging. Ultrasound is becoming more popular, but remains second to computed axial tomography. “It's fairly clear that a CT scan is leading the way,” Dr. Dexter said.

“Ultrasound has become more popular, but a 2005 Cochrane review found insufficient evidence to promote an ultrasound-based treatment algorithm,” he said.

Oral contrast is unnecessary when CT scans are used, he said. “Oral contrast doesn't increase the sensitivity or predict outcome, but it does delay time of diagnosis by at least 30 minutes.”

Diagnostic peritoneal lavage has fallen out of favor because, while it is sensitive for intraperitoneal bleeding, it is invasive and does not predict outcome or the need for laparotomy.

Minor injuries (contusion or small laceration), in which the patient is clinically stable (no active bleeding or other peritoneal signs, no associated abdominal injury), heal without surgery with a success rate of up to 98%. These athletes can usually return to play 1 month after the injury.

Major injuries (large laceration, burst, or pedicle injury) usually require surgical intervention. “There are no consistent guidelines on return to play for these athletes, but most authors advise at least 3–6 months,” Dr. Dexter said.

The spleen is another commonly injured organ. The usual cause is a direct blow to the abdomen, though injury can be related to lower rib fracture. The diagnostic imaging method of choice is the CT scan.

Surgery is usually unnecessary if the patient is clinically and hemodynamically stable and if there are no other abdominal injuries. In these cases, rest with close monitoring is advised because late rupture can occur.

Most athletes with minor spleen injuries can return to play about 1 month after the injury. Surgery is advised if the patient is unstable or there is a pedicle injury. Athletes can return to play 6 weeks after a splenectomy.

There has been some speculation that splenomegaly associated with infectious mononucleosis increases the risk of splenic rupture in sports, especially among college-aged males.

“Splenic fragility is greatest on days 4–21 of the infection, when there is a profuse lymphocytic proliferation,” he said.

“Most ruptures occur on days 4–21 from symptom onset and most are spontaneous. They are rarely lethal.”

There is no consensus in the literature about return to play for athletes with mononucleosis, Dr. Dexter said. “In general, if there are no signs or symptoms, and the labs and ultrasound are normal, the athlete can return to contact sports within 3 weeks.”

A damaged solid organ, such as the lacerated spleen in this MRI, usually results from a direct blow to the abdomen. Courtesy Dr. William Dexter

Women whose breast cancers were detected by screening mammography were 53% less likely to die of breast cancer over a 10- to 15-year period than those whose cancers were detected symptomatically, Donald Berry, Ph.D., and his colleagues have reported.

The study of more than 150,000 women doesn't mean that screening mammography is beneficial, however, Dr. Berry told this newspaper. The real reason behind the survival shift, he said, is that mammography picks up tumors that grow more slowly and are less biologically lethal than those discovered symptomatically.

Dr. Berry, chairman of the department of biostatistics and applied mathematics at the University of Texas, Houston, and his coinvestigators examined survival outcomes in three large North American breast cancer screening trials containing about 152,000 women: the breast cancer screening trial of the Health Insurance Plan of Greater New York (HIP) and two Canadian National Breast Screening Studies (CNBSS-1 and CNBSS-2).

The HIP screening was carried out in the 1960s, while both CNBSS trials were conducted in the 1980s. Follow-up ranged from 15 to 20 years (J. Natl. Cancer Inst. 2005;97:1195–203). The researchers looked at the occurrence of screen-detected cancers, cancers detected in control groups (no screening mammography), and interval/incident cancers (cancers detected either less than 1 year or more than 1 year after the last negative screen).

There was a clear shift toward earlier stage cancers in the screening groups. In the HIP trial, 76% of screen-detected cancers were stage I, compared with 51% of interval/incident cancers and 49% of cancers in the control group. Control subjects and women who failed to attend their screenings had the highest percentage of stage III/IV cancers—14% and 22%, respectively.

In the CNBSS-1, 55% of screen-tested cancers, 40% of interval/incident cancers, and 47% of cancers in the control group were stage I. In the CNBSS-2, 62% of the screen-detected cancers, 44% of the interval/incident cancers, and 47% of the cancers in the control group were stage I. In both trials, the highest percentage of stage III/IV cancers occurred in the interval/incident group (about 20%). Tumor sizes were smaller in the screening groups in all three studies; there was a significantly higher proportion of negative lymph nodes among women with screen-detected cancers in all three studies.

These characteristics reflect lead-time bias, Dr. Berry said, and he adjusted the analysis to compensate for this. However, even after adjustment for tumor characteristics, women whose cancers were detected by screening had the longest survival time. The relative risk of breast cancer death was 53% greater for women with interval/incident cancers and 36% greater for those in the control group with cancer than for women with screen-detected cancers.

The survival advantage seems to arise from the mammogram's tendency to detect less-aggressive tumors, he said. “Cancers found via screening include a higher proportion of slowly growing tumors, some of which might never be found by other means.” Paradoxically, this “overdiagnosis bias” means that the study cannot discern whether screening mammography is beneficial.

“In addition to detecting the lethal tumors, screening also detects some [tumors] of the nonlethal variety,” Dr. Berry said. Some of the women with screen-detected nonlethal tumors may have unnecessary surgery or other treatment; still, the researchers said, “A woman whose nonmetastatic tumor was detected on a mammogram has reason to be happier than a woman who had a tumor with the same characteristics detected symptomatically.”

The investigators noted several limitations of the study. Since all women were screened in the 1960s or 1980s, the trials not only used less-sophisticated mammographic techniques, but they also did not reflect tumor grading with modern biomarkers.

Women whose breast cancers were detected by screening mammography were 53% less likely to die of breast cancer over a 10- to 15-year period than those whose cancers were detected symptomatically, Donald Berry, Ph.D., and his colleagues have reported.

The study of more than 150,000 women doesn't mean that screening mammography is beneficial, however, Dr. Berry told this newspaper. The real reason behind the survival shift, he said, is that mammography picks up tumors that grow more slowly and are less biologically lethal than those discovered symptomatically.

Dr. Berry, chairman of the department of biostatistics and applied mathematics at the University of Texas, Houston, and his coinvestigators examined survival outcomes in three large North American breast cancer screening trials containing about 152,000 women: the breast cancer screening trial of the Health Insurance Plan of Greater New York (HIP) and two Canadian National Breast Screening Studies (CNBSS-1 and CNBSS-2).

The HIP screening was carried out in the 1960s, while both CNBSS trials were conducted in the 1980s. Follow-up ranged from 15 to 20 years (J. Natl. Cancer Inst. 2005;97:1195–203). The researchers looked at the occurrence of screen-detected cancers, cancers detected in control groups (no screening mammography), and interval/incident cancers (cancers detected either less than 1 year or more than 1 year after the last negative screen).

There was a clear shift toward earlier stage cancers in the screening groups. In the HIP trial, 76% of screen-detected cancers were stage I, compared with 51% of interval/incident cancers and 49% of cancers in the control group. Control subjects and women who failed to attend their screenings had the highest percentage of stage III/IV cancers—14% and 22%, respectively.

In the CNBSS-1, 55% of screen-tested cancers, 40% of interval/incident cancers, and 47% of cancers in the control group were stage I. In the CNBSS-2, 62% of the screen-detected cancers, 44% of the interval/incident cancers, and 47% of the cancers in the control group were stage I. In both trials, the highest percentage of stage III/IV cancers occurred in the interval/incident group (about 20%). Tumor sizes were smaller in the screening groups in all three studies; there was a significantly higher proportion of negative lymph nodes among women with screen-detected cancers in all three studies.

These characteristics reflect lead-time bias, Dr. Berry said, and he adjusted the analysis to compensate for this. However, even after adjustment for tumor characteristics, women whose cancers were detected by screening had the longest survival time. The relative risk of breast cancer death was 53% greater for women with interval/incident cancers and 36% greater for those in the control group with cancer than for women with screen-detected cancers.

The survival advantage seems to arise from the mammogram's tendency to detect less-aggressive tumors, he said. “Cancers found via screening include a higher proportion of slowly growing tumors, some of which might never be found by other means.” Paradoxically, this “overdiagnosis bias” means that the study cannot discern whether screening mammography is beneficial.

“In addition to detecting the lethal tumors, screening also detects some [tumors] of the nonlethal variety,” Dr. Berry said. Some of the women with screen-detected nonlethal tumors may have unnecessary surgery or other treatment; still, the researchers said, “A woman whose nonmetastatic tumor was detected on a mammogram has reason to be happier than a woman who had a tumor with the same characteristics detected symptomatically.”

The investigators noted several limitations of the study. Since all women were screened in the 1960s or 1980s, the trials not only used less-sophisticated mammographic techniques, but they also did not reflect tumor grading with modern biomarkers.

Women whose breast cancers were detected by screening mammography were 53% less likely to die of breast cancer over a 10- to 15-year period than those whose cancers were detected symptomatically, Donald Berry, Ph.D., and his colleagues have reported.

The study of more than 150,000 women doesn't mean that screening mammography is beneficial, however, Dr. Berry told this newspaper. The real reason behind the survival shift, he said, is that mammography picks up tumors that grow more slowly and are less biologically lethal than those discovered symptomatically.

Dr. Berry, chairman of the department of biostatistics and applied mathematics at the University of Texas, Houston, and his coinvestigators examined survival outcomes in three large North American breast cancer screening trials containing about 152,000 women: the breast cancer screening trial of the Health Insurance Plan of Greater New York (HIP) and two Canadian National Breast Screening Studies (CNBSS-1 and CNBSS-2).

The HIP screening was carried out in the 1960s, while both CNBSS trials were conducted in the 1980s. Follow-up ranged from 15 to 20 years (J. Natl. Cancer Inst. 2005;97:1195–203). The researchers looked at the occurrence of screen-detected cancers, cancers detected in control groups (no screening mammography), and interval/incident cancers (cancers detected either less than 1 year or more than 1 year after the last negative screen).

There was a clear shift toward earlier stage cancers in the screening groups. In the HIP trial, 76% of screen-detected cancers were stage I, compared with 51% of interval/incident cancers and 49% of cancers in the control group. Control subjects and women who failed to attend their screenings had the highest percentage of stage III/IV cancers—14% and 22%, respectively.

In the CNBSS-1, 55% of screen-tested cancers, 40% of interval/incident cancers, and 47% of cancers in the control group were stage I. In the CNBSS-2, 62% of the screen-detected cancers, 44% of the interval/incident cancers, and 47% of the cancers in the control group were stage I. In both trials, the highest percentage of stage III/IV cancers occurred in the interval/incident group (about 20%). Tumor sizes were smaller in the screening groups in all three studies; there was a significantly higher proportion of negative lymph nodes among women with screen-detected cancers in all three studies.

These characteristics reflect lead-time bias, Dr. Berry said, and he adjusted the analysis to compensate for this. However, even after adjustment for tumor characteristics, women whose cancers were detected by screening had the longest survival time. The relative risk of breast cancer death was 53% greater for women with interval/incident cancers and 36% greater for those in the control group with cancer than for women with screen-detected cancers.

The survival advantage seems to arise from the mammogram's tendency to detect less-aggressive tumors, he said. “Cancers found via screening include a higher proportion of slowly growing tumors, some of which might never be found by other means.” Paradoxically, this “overdiagnosis bias” means that the study cannot discern whether screening mammography is beneficial.

“In addition to detecting the lethal tumors, screening also detects some [tumors] of the nonlethal variety,” Dr. Berry said. Some of the women with screen-detected nonlethal tumors may have unnecessary surgery or other treatment; still, the researchers said, “A woman whose nonmetastatic tumor was detected on a mammogram has reason to be happier than a woman who had a tumor with the same characteristics detected symptomatically.”

The investigators noted several limitations of the study. Since all women were screened in the 1960s or 1980s, the trials not only used less-sophisticated mammographic techniques, but they also did not reflect tumor grading with modern biomarkers.

A weight loss of at least 10 pounds will significantly decrease the risk of early-onset breast cancer in women who carry a BRCA mutation, results of a large case-control study suggest.

Early-adulthood weight loss is especially important for women with the BRCA1 mutation, wrote Joanne Kotsopoulos, a doctoral student at the University of Toronto, and her colleagues (Breast Cancer Res. 2005;7:R833–43; doi 10.1186/bcr1293, online at http://breast-cancer-research.com/content/7/5/R833

The investigators examined early-onset breast cancer in 1,073 matched case-control pairs; about 75% had mutations and 25% had BRCA2 mutations.

Weight loss of at least 10 pounds between age 18 and 30 resulted in an overall 34% reduction in breast cancer risk. The risk reduction was greater (63%) for breast cancers diagnosed between age 30 and 40, but not significant for breast cancer diagnosed after age 40. Women with the BRCA1 mutation experienced the greatest risk reduction with weight loss (65%). The risk reduction was nonsignificant (22%) for women with the BRCA2 mutation.

Weight gain of more than 10 pounds also canceled out any protective effect of parity. Gaining more than 10 pounds and having two full-term pregnancies increased the risk of early-onset breast cancer by 44%, compared with women who gained minimal weight and had at least two pregnancies.

About 40% of the women who lost 10 or more pounds had a body mass index of 25 kg/m

A weight loss of at least 10 pounds will significantly decrease the risk of early-onset breast cancer in women who carry a BRCA mutation, results of a large case-control study suggest.

Early-adulthood weight loss is especially important for women with the BRCA1 mutation, wrote Joanne Kotsopoulos, a doctoral student at the University of Toronto, and her colleagues (Breast Cancer Res. 2005;7:R833–43; doi 10.1186/bcr1293, online at http://breast-cancer-research.com/content/7/5/R833

The investigators examined early-onset breast cancer in 1,073 matched case-control pairs; about 75% had mutations and 25% had BRCA2 mutations.

Weight loss of at least 10 pounds between age 18 and 30 resulted in an overall 34% reduction in breast cancer risk. The risk reduction was greater (63%) for breast cancers diagnosed between age 30 and 40, but not significant for breast cancer diagnosed after age 40. Women with the BRCA1 mutation experienced the greatest risk reduction with weight loss (65%). The risk reduction was nonsignificant (22%) for women with the BRCA2 mutation.

Weight gain of more than 10 pounds also canceled out any protective effect of parity. Gaining more than 10 pounds and having two full-term pregnancies increased the risk of early-onset breast cancer by 44%, compared with women who gained minimal weight and had at least two pregnancies.

About 40% of the women who lost 10 or more pounds had a body mass index of 25 kg/m

A weight loss of at least 10 pounds will significantly decrease the risk of early-onset breast cancer in women who carry a BRCA mutation, results of a large case-control study suggest.

Early-adulthood weight loss is especially important for women with the BRCA1 mutation, wrote Joanne Kotsopoulos, a doctoral student at the University of Toronto, and her colleagues (Breast Cancer Res. 2005;7:R833–43; doi 10.1186/bcr1293, online at http://breast-cancer-research.com/content/7/5/R833

The investigators examined early-onset breast cancer in 1,073 matched case-control pairs; about 75% had mutations and 25% had BRCA2 mutations.

Weight loss of at least 10 pounds between age 18 and 30 resulted in an overall 34% reduction in breast cancer risk. The risk reduction was greater (63%) for breast cancers diagnosed between age 30 and 40, but not significant for breast cancer diagnosed after age 40. Women with the BRCA1 mutation experienced the greatest risk reduction with weight loss (65%). The risk reduction was nonsignificant (22%) for women with the BRCA2 mutation.

Weight gain of more than 10 pounds also canceled out any protective effect of parity. Gaining more than 10 pounds and having two full-term pregnancies increased the risk of early-onset breast cancer by 44%, compared with women who gained minimal weight and had at least two pregnancies.

About 40% of the women who lost 10 or more pounds had a body mass index of 25 kg/m

ST. LOUIS — Family history is a strong risk factor for melanoma in women, while age appears to be the biggest risk for the development of basal cell carcinoma, Abrar Qureshi, M.D., said at the annual meeting of the Society for Investigative Dermatology.

Dr. Qureshi of Harvard University, Boston, used data from the ongoing Nurses' Health Study to examine independent risk factors for melanoma, squamous cell carcinoma, and basal cell carcinoma. His study examined incident cases of skin cancer among 113,333 women who were followed from 1984 to 2000.

Basal cell carcinoma was the most common cancer in the group, with 7,854 cases. There were 870 cases of squamous cell carcinoma and 370 cases of melanoma.

Based on a preliminary analysis of the data, Dr. Qureshi concluded that age was the biggest risk factor for basal cell carcinoma. Looking at age-specific incidence rates, between ages 55 and 59 years, the incidence rate was about 700 cases per 100,000 person-years, but after age 65, the rate rose to above 2,000. “You can see, it's quite different above age 65,” Dr. Qureshi said at the meeting.

The incidence rate for melanoma was 44 cases per 100,000 person-years, and the rate of squamous cell carcinoma was 104 cases per 100,000 person-years. Age did not significantly alter the rate of melanoma; there was a slight elevation in the rate of squamous cell carcinoma after 55 years of age.

The strongest risk factor for melanoma was high mole count on one upper extremity (3.5 times increased risk). A family history of a first-degree relative with melanoma and little or no ability to tan increased the risk of melanoma in women by a factor of 2.5. A susceptibility to burn was associated with a 70% increase in the risk of melanoma.

For squamous cell carcinoma, the strongest risk factor was little or no ability to tan and susceptibility to burn (twice the risk). Family history of melanoma was associated with a 1.5 times increased risk of squamous cell carcinoma.

Although the strongest risk factor for basal cell carcinoma in women was age, they had a doubling of risk associated with susceptibility to burn, a 70% higher risk for little or no ability to tan, and a 50% higher risk for a high mole count. Women who had a first-degree relative with melanoma were found to have a 50% higher risk of basal cell carcinoma.

Further multivariate analyses are ongoing, Dr. Qureshi said.

After age 65, the incidence rate of BCC in women was more than 2,000 cases per 100,000 person-years. ©Elsevier 2004. Abeloff: Clinical Oncology 3E

ST. LOUIS — Family history is a strong risk factor for melanoma in women, while age appears to be the biggest risk for the development of basal cell carcinoma, Abrar Qureshi, M.D., said at the annual meeting of the Society for Investigative Dermatology.

Dr. Qureshi of Harvard University, Boston, used data from the ongoing Nurses' Health Study to examine independent risk factors for melanoma, squamous cell carcinoma, and basal cell carcinoma. His study examined incident cases of skin cancer among 113,333 women who were followed from 1984 to 2000.

Basal cell carcinoma was the most common cancer in the group, with 7,854 cases. There were 870 cases of squamous cell carcinoma and 370 cases of melanoma.

Based on a preliminary analysis of the data, Dr. Qureshi concluded that age was the biggest risk factor for basal cell carcinoma. Looking at age-specific incidence rates, between ages 55 and 59 years, the incidence rate was about 700 cases per 100,000 person-years, but after age 65, the rate rose to above 2,000. “You can see, it's quite different above age 65,” Dr. Qureshi said at the meeting.

The incidence rate for melanoma was 44 cases per 100,000 person-years, and the rate of squamous cell carcinoma was 104 cases per 100,000 person-years. Age did not significantly alter the rate of melanoma; there was a slight elevation in the rate of squamous cell carcinoma after 55 years of age.

The strongest risk factor for melanoma was high mole count on one upper extremity (3.5 times increased risk). A family history of a first-degree relative with melanoma and little or no ability to tan increased the risk of melanoma in women by a factor of 2.5. A susceptibility to burn was associated with a 70% increase in the risk of melanoma.

For squamous cell carcinoma, the strongest risk factor was little or no ability to tan and susceptibility to burn (twice the risk). Family history of melanoma was associated with a 1.5 times increased risk of squamous cell carcinoma.

Although the strongest risk factor for basal cell carcinoma in women was age, they had a doubling of risk associated with susceptibility to burn, a 70% higher risk for little or no ability to tan, and a 50% higher risk for a high mole count. Women who had a first-degree relative with melanoma were found to have a 50% higher risk of basal cell carcinoma.

Further multivariate analyses are ongoing, Dr. Qureshi said.

After age 65, the incidence rate of BCC in women was more than 2,000 cases per 100,000 person-years. ©Elsevier 2004. Abeloff: Clinical Oncology 3E

ST. LOUIS — Family history is a strong risk factor for melanoma in women, while age appears to be the biggest risk for the development of basal cell carcinoma, Abrar Qureshi, M.D., said at the annual meeting of the Society for Investigative Dermatology.

Dr. Qureshi of Harvard University, Boston, used data from the ongoing Nurses' Health Study to examine independent risk factors for melanoma, squamous cell carcinoma, and basal cell carcinoma. His study examined incident cases of skin cancer among 113,333 women who were followed from 1984 to 2000.

Basal cell carcinoma was the most common cancer in the group, with 7,854 cases. There were 870 cases of squamous cell carcinoma and 370 cases of melanoma.

Based on a preliminary analysis of the data, Dr. Qureshi concluded that age was the biggest risk factor for basal cell carcinoma. Looking at age-specific incidence rates, between ages 55 and 59 years, the incidence rate was about 700 cases per 100,000 person-years, but after age 65, the rate rose to above 2,000. “You can see, it's quite different above age 65,” Dr. Qureshi said at the meeting.

The incidence rate for melanoma was 44 cases per 100,000 person-years, and the rate of squamous cell carcinoma was 104 cases per 100,000 person-years. Age did not significantly alter the rate of melanoma; there was a slight elevation in the rate of squamous cell carcinoma after 55 years of age.

The strongest risk factor for melanoma was high mole count on one upper extremity (3.5 times increased risk). A family history of a first-degree relative with melanoma and little or no ability to tan increased the risk of melanoma in women by a factor of 2.5. A susceptibility to burn was associated with a 70% increase in the risk of melanoma.

For squamous cell carcinoma, the strongest risk factor was little or no ability to tan and susceptibility to burn (twice the risk). Family history of melanoma was associated with a 1.5 times increased risk of squamous cell carcinoma.

Although the strongest risk factor for basal cell carcinoma in women was age, they had a doubling of risk associated with susceptibility to burn, a 70% higher risk for little or no ability to tan, and a 50% higher risk for a high mole count. Women who had a first-degree relative with melanoma were found to have a 50% higher risk of basal cell carcinoma.

Further multivariate analyses are ongoing, Dr. Qureshi said.

After age 65, the incidence rate of BCC in women was more than 2,000 cases per 100,000 person-years. ©Elsevier 2004. Abeloff: Clinical Oncology 3E

Hospitalizations for varicella have declined 88% since 1994–1995, with the biggest decrease seen among infants.

Because infants are not eligible to receive the vaccine, “The decline reflects reduced force of varicella infection in the population (i.e., herd immunity),” as do declining rates among adults and adolescents, reported Dr. Fangjun Zhou, Ph.D., and associates (JAMA 2005;295:797–802).

Dr. Zhou, of the Centers for Disease Control and Prevention, examined varicella treatment codes extracted from a national health plan database of about 4 million consumers, from 1994–2002. He found an overall decline in varicella hospitalization, from 2.3/100,000 to 0.3/100,000 (88%).

Hospitalization rates declined for every age group: 100% for infants; 91% for children aged 9 years and younger; 92% for children aged 10–19 years; and 78% for adults aged 20–49 years.

Ambulatory visits for varicella also decreased significantly, declining 59% over the period. Again, the decrease was most apparent among infants (90%). The rate declined 63% for children aged 9 years and younger; 42% for those aged 10–19 years; and 60% for adults aged 20–49 years.

National spending on varicella hospitalizations and ambulatory visits declined from $85 million in 1994 and 1995 to $22 million in 2002, a 74% decrease.

Hospitalizations for varicella have declined 88% since 1994–1995, with the biggest decrease seen among infants.

Because infants are not eligible to receive the vaccine, “The decline reflects reduced force of varicella infection in the population (i.e., herd immunity),” as do declining rates among adults and adolescents, reported Dr. Fangjun Zhou, Ph.D., and associates (JAMA 2005;295:797–802).

Dr. Zhou, of the Centers for Disease Control and Prevention, examined varicella treatment codes extracted from a national health plan database of about 4 million consumers, from 1994–2002. He found an overall decline in varicella hospitalization, from 2.3/100,000 to 0.3/100,000 (88%).

Hospitalization rates declined for every age group: 100% for infants; 91% for children aged 9 years and younger; 92% for children aged 10–19 years; and 78% for adults aged 20–49 years.

Ambulatory visits for varicella also decreased significantly, declining 59% over the period. Again, the decrease was most apparent among infants (90%). The rate declined 63% for children aged 9 years and younger; 42% for those aged 10–19 years; and 60% for adults aged 20–49 years.

National spending on varicella hospitalizations and ambulatory visits declined from $85 million in 1994 and 1995 to $22 million in 2002, a 74% decrease.

Hospitalizations for varicella have declined 88% since 1994–1995, with the biggest decrease seen among infants.

Because infants are not eligible to receive the vaccine, “The decline reflects reduced force of varicella infection in the population (i.e., herd immunity),” as do declining rates among adults and adolescents, reported Dr. Fangjun Zhou, Ph.D., and associates (JAMA 2005;295:797–802).

Dr. Zhou, of the Centers for Disease Control and Prevention, examined varicella treatment codes extracted from a national health plan database of about 4 million consumers, from 1994–2002. He found an overall decline in varicella hospitalization, from 2.3/100,000 to 0.3/100,000 (88%).

Hospitalization rates declined for every age group: 100% for infants; 91% for children aged 9 years and younger; 92% for children aged 10–19 years; and 78% for adults aged 20–49 years.

Ambulatory visits for varicella also decreased significantly, declining 59% over the period. Again, the decrease was most apparent among infants (90%). The rate declined 63% for children aged 9 years and younger; 42% for those aged 10–19 years; and 60% for adults aged 20–49 years.

National spending on varicella hospitalizations and ambulatory visits declined from $85 million in 1994 and 1995 to $22 million in 2002, a 74% decrease.

NASHVILLE, TENN. — Higher cardiorespiratory fitness is associated with lower all-cause mortality in hypertensive women, Carolyn E. Barlow said in a poster presented at the annual meeting of the American College of Sports Medicine.

Ms. Barlow, director of data management at the Cooper Institute, Dallas, presented the results of an open cohort study of almost 13,000 women who were followed for up to 26 years. The women were part of the Cooper Aerobics Center Longitudinal Study, a prospective observational study of lifestyle and health.

All the women who participated in the study were examined at the Cooper Aerobics Center in Dallas from 1971 to 1998, and they were followed up yearly for mortality.

At baseline, the women received a comprehensive medical examination and exercise prescription. They also took a treadmill test, which was used to determine their fitness level. The lowest 20% in each age group were considered “unfit,” while the upper 80% in each age group were considered “fit.” At baseline, their average age was 43 years. Of the cohort, 51% were normotensive, 31% were prehypertensive (120/80 mm Hg), and 18% were hypertensive (140/90 mm Hg or higher).

There were 298 deaths during the study period. After adjustment for age, exam year, and smoking, a trend toward lower mortality risk was seen in fit women, compared with unfit women in each blood pressure group, but only in the hypertensive group was the difference statistically significant. Fit hypertensive women were 54% less likely to die than unfit hypertensive women.

The decreased risk of death was 19% for normotensive fit women, compared with unfit ones, and 5% for prehypertensive fit women, compared with those who were unfit.

“We have shown a similarly decreased risk for hypertensive men,” Ms. Barlow added.

NASHVILLE, TENN. — Higher cardiorespiratory fitness is associated with lower all-cause mortality in hypertensive women, Carolyn E. Barlow said in a poster presented at the annual meeting of the American College of Sports Medicine.

Ms. Barlow, director of data management at the Cooper Institute, Dallas, presented the results of an open cohort study of almost 13,000 women who were followed for up to 26 years. The women were part of the Cooper Aerobics Center Longitudinal Study, a prospective observational study of lifestyle and health.

All the women who participated in the study were examined at the Cooper Aerobics Center in Dallas from 1971 to 1998, and they were followed up yearly for mortality.

At baseline, the women received a comprehensive medical examination and exercise prescription. They also took a treadmill test, which was used to determine their fitness level. The lowest 20% in each age group were considered “unfit,” while the upper 80% in each age group were considered “fit.” At baseline, their average age was 43 years. Of the cohort, 51% were normotensive, 31% were prehypertensive (120/80 mm Hg), and 18% were hypertensive (140/90 mm Hg or higher).

There were 298 deaths during the study period. After adjustment for age, exam year, and smoking, a trend toward lower mortality risk was seen in fit women, compared with unfit women in each blood pressure group, but only in the hypertensive group was the difference statistically significant. Fit hypertensive women were 54% less likely to die than unfit hypertensive women.

The decreased risk of death was 19% for normotensive fit women, compared with unfit ones, and 5% for prehypertensive fit women, compared with those who were unfit.

“We have shown a similarly decreased risk for hypertensive men,” Ms. Barlow added.

NASHVILLE, TENN. — Higher cardiorespiratory fitness is associated with lower all-cause mortality in hypertensive women, Carolyn E. Barlow said in a poster presented at the annual meeting of the American College of Sports Medicine.

Ms. Barlow, director of data management at the Cooper Institute, Dallas, presented the results of an open cohort study of almost 13,000 women who were followed for up to 26 years. The women were part of the Cooper Aerobics Center Longitudinal Study, a prospective observational study of lifestyle and health.

All the women who participated in the study were examined at the Cooper Aerobics Center in Dallas from 1971 to 1998, and they were followed up yearly for mortality.

At baseline, the women received a comprehensive medical examination and exercise prescription. They also took a treadmill test, which was used to determine their fitness level. The lowest 20% in each age group were considered “unfit,” while the upper 80% in each age group were considered “fit.” At baseline, their average age was 43 years. Of the cohort, 51% were normotensive, 31% were prehypertensive (120/80 mm Hg), and 18% were hypertensive (140/90 mm Hg or higher).

There were 298 deaths during the study period. After adjustment for age, exam year, and smoking, a trend toward lower mortality risk was seen in fit women, compared with unfit women in each blood pressure group, but only in the hypertensive group was the difference statistically significant. Fit hypertensive women were 54% less likely to die than unfit hypertensive women.

The decreased risk of death was 19% for normotensive fit women, compared with unfit ones, and 5% for prehypertensive fit women, compared with those who were unfit.

“We have shown a similarly decreased risk for hypertensive men,” Ms. Barlow added.