Michele G. Sullivan

High-dose aspirin is just as effective as warfarin in treating intracranial arterial stenosis, and appears much safer, with significantly lower rates of death, myocardial infarction, and major hemorrhage over 2 years, Marc Chimowitz, M.B., and colleagues have reported.

“The common practice of administering warfarin rather than aspirin for symptomatic intracranial arterial stenosis is not supported by the results of this trial,” said Dr. Chimowitz of Emory University, Atlanta.

Enrollment in the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial ended early because of the high rate of serious adverse events in the warfarin patients. In addition to being safer for patients, the researchers said, aspirin therapy did not require constant monitoring of international normalized ratios (INRs) and treatment of warfarin-associated bleeding. Aspirin also is much cheaper, they noted (N. Engl. J. Med. 2005;352:1305–16).

Ralph Sacco, M.D., an investigator in the Northern Manhattan Stroke Study, noted in an interview that the WASID trial's findings add to existing data to dispel beliefs about the benefit of warfarin for certain stroke populations.

The conclusion that warfarin provides no survival benefit over aspirin, but confers added risk, is more expensive, and requires intensive monitoring, should reshape its risk-benefit profile for some patients, said Dr. Sacco, professor of neurology and epidemiology at Columbia University, New York.

Dr. Chimowitz and his associates reported on the trial's final analysis that included 569 patients with symptomatic intracranial arterial stenosis who were randomized to either warfarin 5 mg daily or aspirin 650 mg twice daily.

The patients' mean age was about 63 years; about 61% were men. All had a history of either stroke or transient ischemic attack caused by 50%–90% stenosis of a major intracranial artery. The mean follow-up was 1.8 years.

The primary outcome—stroke, brain hemorrhage, or death from vascular causes other than stroke—occurred in 22% (62) of the aspirin patients and 21.8% (63) of the warfarin patients. Myocardial infarction or sudden death occurred significantly more often in the warfarin group than in the aspirin group (7.3% vs. 2.9%).

The overall rate of death was significantly higher in the warfarin group than in the aspirin group: 5.9% (17) vs. 4.3% (12). However, chance probably accounted for some of the deaths that were higher in the warfarin group, especially the six cancers.

Major hemorrhages occurred significantly more often in the warfarin group (8.3% vs. 3.2%). Brain hemorrhage occurred in 2 warfarin patients and 1 aspirin patient; gastrointestinal hemorrhage in 10 warfarin patients and 6 aspirin patients; ocular hemorrhage in 4 warfarin patients and 1 aspirin patient; genitourinary hemorrhage in 3 warfarin patients; aortic aneurysm in 1 aspirin patient; and other bleeds in 4 warfarin patients.

In a post hoc analysis, INRs of less than 2.0 were associated with a significantly higher risk of ischemic stroke and major cardiac events, and INRs of 3.0 or greater were associated with a significantly higher risk of hemorrhage, than were INRs in the therapeutic range of 2.0–3.0.

In an accompanying editorial, Walter Koroshetz, M.D., said the observed mortality differences could be due to a failure to keep patients at a therapeutic level of anticoagulation. Warfarin subjects obtained optimal anticoagulation (INR 2.0–3.0) only 63% of the time. The rate of major cardiac events was 10.8 per 100 patient-years with a subtherapeutic INR, but only 0.4 per 100 patient-years with a therapeutic INR.

“Unfortunately, it is extremely difficult, if not impossible, to achieve a consistent therapeutic INR with warfarin in a population study or in routine practice,” said Dr. Koroshetz of Massachusetts General Hospital, Boston.

“Two large studies have been negative for warfarin in noncardioembolic stroke,” Dr. Sacco noted. “And one of these was also stopped early due to adverse events and no signal that warfarin's benefit was greater than aspirin.”

However, he said, warfarin is “clearly indicated” for cardioembolic stroke patients. “This has been made clear in multiple studies, which were actually so positive that they were the springboard for these other studies looking at warfarin in different populations.”

High-dose aspirin is just as effective as warfarin in treating intracranial arterial stenosis, and appears much safer, with significantly lower rates of death, myocardial infarction, and major hemorrhage over 2 years, Marc Chimowitz, M.B., and colleagues have reported.

“The common practice of administering warfarin rather than aspirin for symptomatic intracranial arterial stenosis is not supported by the results of this trial,” said Dr. Chimowitz of Emory University, Atlanta.

Enrollment in the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial ended early because of the high rate of serious adverse events in the warfarin patients. In addition to being safer for patients, the researchers said, aspirin therapy did not require constant monitoring of international normalized ratios (INRs) and treatment of warfarin-associated bleeding. Aspirin also is much cheaper, they noted (N. Engl. J. Med. 2005;352:1305–16).

Ralph Sacco, M.D., an investigator in the Northern Manhattan Stroke Study, noted in an interview that the WASID trial's findings add to existing data to dispel beliefs about the benefit of warfarin for certain stroke populations.

The conclusion that warfarin provides no survival benefit over aspirin, but confers added risk, is more expensive, and requires intensive monitoring, should reshape its risk-benefit profile for some patients, said Dr. Sacco, professor of neurology and epidemiology at Columbia University, New York.

Dr. Chimowitz and his associates reported on the trial's final analysis that included 569 patients with symptomatic intracranial arterial stenosis who were randomized to either warfarin 5 mg daily or aspirin 650 mg twice daily.

The patients' mean age was about 63 years; about 61% were men. All had a history of either stroke or transient ischemic attack caused by 50%–90% stenosis of a major intracranial artery. The mean follow-up was 1.8 years.

The primary outcome—stroke, brain hemorrhage, or death from vascular causes other than stroke—occurred in 22% (62) of the aspirin patients and 21.8% (63) of the warfarin patients. Myocardial infarction or sudden death occurred significantly more often in the warfarin group than in the aspirin group (7.3% vs. 2.9%).

The overall rate of death was significantly higher in the warfarin group than in the aspirin group: 5.9% (17) vs. 4.3% (12). However, chance probably accounted for some of the deaths that were higher in the warfarin group, especially the six cancers.

Major hemorrhages occurred significantly more often in the warfarin group (8.3% vs. 3.2%). Brain hemorrhage occurred in 2 warfarin patients and 1 aspirin patient; gastrointestinal hemorrhage in 10 warfarin patients and 6 aspirin patients; ocular hemorrhage in 4 warfarin patients and 1 aspirin patient; genitourinary hemorrhage in 3 warfarin patients; aortic aneurysm in 1 aspirin patient; and other bleeds in 4 warfarin patients.

In a post hoc analysis, INRs of less than 2.0 were associated with a significantly higher risk of ischemic stroke and major cardiac events, and INRs of 3.0 or greater were associated with a significantly higher risk of hemorrhage, than were INRs in the therapeutic range of 2.0–3.0.

In an accompanying editorial, Walter Koroshetz, M.D., said the observed mortality differences could be due to a failure to keep patients at a therapeutic level of anticoagulation. Warfarin subjects obtained optimal anticoagulation (INR 2.0–3.0) only 63% of the time. The rate of major cardiac events was 10.8 per 100 patient-years with a subtherapeutic INR, but only 0.4 per 100 patient-years with a therapeutic INR.

“Unfortunately, it is extremely difficult, if not impossible, to achieve a consistent therapeutic INR with warfarin in a population study or in routine practice,” said Dr. Koroshetz of Massachusetts General Hospital, Boston.

“Two large studies have been negative for warfarin in noncardioembolic stroke,” Dr. Sacco noted. “And one of these was also stopped early due to adverse events and no signal that warfarin's benefit was greater than aspirin.”

However, he said, warfarin is “clearly indicated” for cardioembolic stroke patients. “This has been made clear in multiple studies, which were actually so positive that they were the springboard for these other studies looking at warfarin in different populations.”

High-dose aspirin is just as effective as warfarin in treating intracranial arterial stenosis, and appears much safer, with significantly lower rates of death, myocardial infarction, and major hemorrhage over 2 years, Marc Chimowitz, M.B., and colleagues have reported.

“The common practice of administering warfarin rather than aspirin for symptomatic intracranial arterial stenosis is not supported by the results of this trial,” said Dr. Chimowitz of Emory University, Atlanta.

Enrollment in the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial ended early because of the high rate of serious adverse events in the warfarin patients. In addition to being safer for patients, the researchers said, aspirin therapy did not require constant monitoring of international normalized ratios (INRs) and treatment of warfarin-associated bleeding. Aspirin also is much cheaper, they noted (N. Engl. J. Med. 2005;352:1305–16).

Ralph Sacco, M.D., an investigator in the Northern Manhattan Stroke Study, noted in an interview that the WASID trial's findings add to existing data to dispel beliefs about the benefit of warfarin for certain stroke populations.

The conclusion that warfarin provides no survival benefit over aspirin, but confers added risk, is more expensive, and requires intensive monitoring, should reshape its risk-benefit profile for some patients, said Dr. Sacco, professor of neurology and epidemiology at Columbia University, New York.

Dr. Chimowitz and his associates reported on the trial's final analysis that included 569 patients with symptomatic intracranial arterial stenosis who were randomized to either warfarin 5 mg daily or aspirin 650 mg twice daily.

The patients' mean age was about 63 years; about 61% were men. All had a history of either stroke or transient ischemic attack caused by 50%–90% stenosis of a major intracranial artery. The mean follow-up was 1.8 years.

The primary outcome—stroke, brain hemorrhage, or death from vascular causes other than stroke—occurred in 22% (62) of the aspirin patients and 21.8% (63) of the warfarin patients. Myocardial infarction or sudden death occurred significantly more often in the warfarin group than in the aspirin group (7.3% vs. 2.9%).

The overall rate of death was significantly higher in the warfarin group than in the aspirin group: 5.9% (17) vs. 4.3% (12). However, chance probably accounted for some of the deaths that were higher in the warfarin group, especially the six cancers.

Major hemorrhages occurred significantly more often in the warfarin group (8.3% vs. 3.2%). Brain hemorrhage occurred in 2 warfarin patients and 1 aspirin patient; gastrointestinal hemorrhage in 10 warfarin patients and 6 aspirin patients; ocular hemorrhage in 4 warfarin patients and 1 aspirin patient; genitourinary hemorrhage in 3 warfarin patients; aortic aneurysm in 1 aspirin patient; and other bleeds in 4 warfarin patients.

In a post hoc analysis, INRs of less than 2.0 were associated with a significantly higher risk of ischemic stroke and major cardiac events, and INRs of 3.0 or greater were associated with a significantly higher risk of hemorrhage, than were INRs in the therapeutic range of 2.0–3.0.

In an accompanying editorial, Walter Koroshetz, M.D., said the observed mortality differences could be due to a failure to keep patients at a therapeutic level of anticoagulation. Warfarin subjects obtained optimal anticoagulation (INR 2.0–3.0) only 63% of the time. The rate of major cardiac events was 10.8 per 100 patient-years with a subtherapeutic INR, but only 0.4 per 100 patient-years with a therapeutic INR.

“Unfortunately, it is extremely difficult, if not impossible, to achieve a consistent therapeutic INR with warfarin in a population study or in routine practice,” said Dr. Koroshetz of Massachusetts General Hospital, Boston.

“Two large studies have been negative for warfarin in noncardioembolic stroke,” Dr. Sacco noted. “And one of these was also stopped early due to adverse events and no signal that warfarin's benefit was greater than aspirin.”

However, he said, warfarin is “clearly indicated” for cardioembolic stroke patients. “This has been made clear in multiple studies, which were actually so positive that they were the springboard for these other studies looking at warfarin in different populations.”

NEW ORLEANS — A 5% dapsone gel appears safe and effective in clearing both inflammatory and noninflammatory acne lesions and seems more effective with longer use, researchers said at the annual meeting of the American Academy of Dermatology.

Two phase III studies showed significant reductions in lesion count and very low rates of adverse events, all of which were mild and decreased with continued use of the medication. The most common application site side effects—sunburn, dryness, and rash—were reported by no more than 3% of patients.

The first study, by David C. Wilson, M.D., included 496 patients aged 12–44 years with mild to severe facial acne. The patients were randomized to either dapsone 5% gel (330 patients) or vehicle (166 patients), applied twice daily for 12 weeks. At baseline, the patients had a mean lesion count of 33 inflammatory lesions and 55 noninflammatory lesions.

Significant differences in lesion count reduction were apparent by week 4 of treatment, said Dr. Wilson, a dermatologist in private practice in Forest, Va. By week 12, success as measured by a Global Acne Assessment score of less than 2 occurred in about 28% of the treatment group and 19% of the placebo group.

“These results are similar to what we have seen in short-term trials of other agents,” Dr. Wilson said in a poster session at the meeting.

By the end of the study, patients treated with dapsone experienced greater mean reduction of both inflammatory lesions (37% vs. 26%) and noninflammatory lesions (32% vs. 22%) than did the vehicle-treated patients.

Pruritus, burning, and nonspecific site reaction were reported by less than 2% of patients and did not differ significantly between the groups. Headache, upper respiratory infection, and nasopharyngitis occurred in 6% or less of patients and did not differ significantly between groups.

An open-label study by Michael Maloney, M.D., examined the drug's long-term safety and efficacy in 506 patients with moderate to severe acne on the face, back, shoulders, and/or chest. The patients applied the gel twice daily to acne-involved areas for 12 months.

If acne cleared in one area, the gel was discontinued in that area. If it recurred, the gel was resumed.

At baseline, the mean lesion count was 48 inflammatory and 38 noninflammatory lesions.

Improvement was noted as early as 4 weeks. By 12 months, inflammatory lesions decreased a mean of 58%, noninflammatory lesions decreased a mean of 19.5%, and total lesion count decreased a mean of 49%.

Four patients (1%) dropped out of the study because of a lack of efficacy with the treatment.

The most common application site adverse events were dryness, rash, and sunburn; fewer than 3% of patients reported these.

The most common non-application site adverse events were headache (20%) and nasopharyngitis (15%).

A total of 11 patients (2%) dropped out because of adverse events.

Dapsone appears to exert both an anti-inflammatory and an antibiotic effect, said Dr. Mahoney, a dermatologist at Cherry Creek Research Inc., Denver, but its exact mechanism of action is unknown.

Both studies were sponsored by QLT USA Inc., of Fort Collins, Colo., and Astellas Pharma U.S. Inc., Deerfield, Ill. Neither investigator reported a financial interest in the product or company.

NEW ORLEANS — A 5% dapsone gel appears safe and effective in clearing both inflammatory and noninflammatory acne lesions and seems more effective with longer use, researchers said at the annual meeting of the American Academy of Dermatology.

Two phase III studies showed significant reductions in lesion count and very low rates of adverse events, all of which were mild and decreased with continued use of the medication. The most common application site side effects—sunburn, dryness, and rash—were reported by no more than 3% of patients.

The first study, by David C. Wilson, M.D., included 496 patients aged 12–44 years with mild to severe facial acne. The patients were randomized to either dapsone 5% gel (330 patients) or vehicle (166 patients), applied twice daily for 12 weeks. At baseline, the patients had a mean lesion count of 33 inflammatory lesions and 55 noninflammatory lesions.

Significant differences in lesion count reduction were apparent by week 4 of treatment, said Dr. Wilson, a dermatologist in private practice in Forest, Va. By week 12, success as measured by a Global Acne Assessment score of less than 2 occurred in about 28% of the treatment group and 19% of the placebo group.

“These results are similar to what we have seen in short-term trials of other agents,” Dr. Wilson said in a poster session at the meeting.

By the end of the study, patients treated with dapsone experienced greater mean reduction of both inflammatory lesions (37% vs. 26%) and noninflammatory lesions (32% vs. 22%) than did the vehicle-treated patients.

Pruritus, burning, and nonspecific site reaction were reported by less than 2% of patients and did not differ significantly between the groups. Headache, upper respiratory infection, and nasopharyngitis occurred in 6% or less of patients and did not differ significantly between groups.

An open-label study by Michael Maloney, M.D., examined the drug's long-term safety and efficacy in 506 patients with moderate to severe acne on the face, back, shoulders, and/or chest. The patients applied the gel twice daily to acne-involved areas for 12 months.

If acne cleared in one area, the gel was discontinued in that area. If it recurred, the gel was resumed.

At baseline, the mean lesion count was 48 inflammatory and 38 noninflammatory lesions.

Improvement was noted as early as 4 weeks. By 12 months, inflammatory lesions decreased a mean of 58%, noninflammatory lesions decreased a mean of 19.5%, and total lesion count decreased a mean of 49%.

Four patients (1%) dropped out of the study because of a lack of efficacy with the treatment.

The most common application site adverse events were dryness, rash, and sunburn; fewer than 3% of patients reported these.

The most common non-application site adverse events were headache (20%) and nasopharyngitis (15%).

A total of 11 patients (2%) dropped out because of adverse events.

Dapsone appears to exert both an anti-inflammatory and an antibiotic effect, said Dr. Mahoney, a dermatologist at Cherry Creek Research Inc., Denver, but its exact mechanism of action is unknown.

Both studies were sponsored by QLT USA Inc., of Fort Collins, Colo., and Astellas Pharma U.S. Inc., Deerfield, Ill. Neither investigator reported a financial interest in the product or company.

NEW ORLEANS — A 5% dapsone gel appears safe and effective in clearing both inflammatory and noninflammatory acne lesions and seems more effective with longer use, researchers said at the annual meeting of the American Academy of Dermatology.

Two phase III studies showed significant reductions in lesion count and very low rates of adverse events, all of which were mild and decreased with continued use of the medication. The most common application site side effects—sunburn, dryness, and rash—were reported by no more than 3% of patients.

The first study, by David C. Wilson, M.D., included 496 patients aged 12–44 years with mild to severe facial acne. The patients were randomized to either dapsone 5% gel (330 patients) or vehicle (166 patients), applied twice daily for 12 weeks. At baseline, the patients had a mean lesion count of 33 inflammatory lesions and 55 noninflammatory lesions.

Significant differences in lesion count reduction were apparent by week 4 of treatment, said Dr. Wilson, a dermatologist in private practice in Forest, Va. By week 12, success as measured by a Global Acne Assessment score of less than 2 occurred in about 28% of the treatment group and 19% of the placebo group.

“These results are similar to what we have seen in short-term trials of other agents,” Dr. Wilson said in a poster session at the meeting.

By the end of the study, patients treated with dapsone experienced greater mean reduction of both inflammatory lesions (37% vs. 26%) and noninflammatory lesions (32% vs. 22%) than did the vehicle-treated patients.

Pruritus, burning, and nonspecific site reaction were reported by less than 2% of patients and did not differ significantly between the groups. Headache, upper respiratory infection, and nasopharyngitis occurred in 6% or less of patients and did not differ significantly between groups.

An open-label study by Michael Maloney, M.D., examined the drug's long-term safety and efficacy in 506 patients with moderate to severe acne on the face, back, shoulders, and/or chest. The patients applied the gel twice daily to acne-involved areas for 12 months.

If acne cleared in one area, the gel was discontinued in that area. If it recurred, the gel was resumed.

At baseline, the mean lesion count was 48 inflammatory and 38 noninflammatory lesions.

Improvement was noted as early as 4 weeks. By 12 months, inflammatory lesions decreased a mean of 58%, noninflammatory lesions decreased a mean of 19.5%, and total lesion count decreased a mean of 49%.

Four patients (1%) dropped out of the study because of a lack of efficacy with the treatment.

The most common application site adverse events were dryness, rash, and sunburn; fewer than 3% of patients reported these.

The most common non-application site adverse events were headache (20%) and nasopharyngitis (15%).

A total of 11 patients (2%) dropped out because of adverse events.

Dapsone appears to exert both an anti-inflammatory and an antibiotic effect, said Dr. Mahoney, a dermatologist at Cherry Creek Research Inc., Denver, but its exact mechanism of action is unknown.

Both studies were sponsored by QLT USA Inc., of Fort Collins, Colo., and Astellas Pharma U.S. Inc., Deerfield, Ill. Neither investigator reported a financial interest in the product or company.

NEW ORLEANS — Nonablative laser therapy for acne doesn't kill Propionibacterium acnes or decrease sebum production but instead appears to work by inducing a rapid and dramatic increase in transforming growth factor β, Edward Seaton, M.D., said in a poster presented at the annual meeting of the American Academy of Dermatology.

“TGF-β is a very important anti-inflammatory cytokine that plays a pivotal role in decreasing inflammation and is the first stimulus of neocollagenesis,” Dr. Seaton of Hammersmith Hospital, London, said in an interview. “This is the first time a biologic explanation of lasers' effect on acne has been proposed.”

Dr. Seaton used nonablative laser therapy on the foreheads of 19 subjects with mild to moderate acne who had received no previous treatment. He took before and after measurements of P. acnes colony count, sebum production, and several cytokines and receptors: interleukin-1 (comedogenic), interleukin-1 receptor antagonist (anticomedogenic), interleukin-10 (anti-inflammatory), tumor necrosis factor (proinflammatory), TGF-β (anti-inflammatory), and melanocortin-1 receptor (expressed in healthy sebaceous glands). Each subject received one session of nonablative laser therapy (wavelength 585 nm, pulse duration 350 msec, 2 J/cm

After 24 hours, there was no decrease in the number of P. acnes colonies on the treated area; in fact, there was a non-statistically significant increase in the number of colonies. There was no significant decrease in the sebum excretion rate at 2, 4, 8, or 24 weeks post treatment. After 24 hours, there was a dramatic, fivefold increase in TGF-β but no significant changes in any other cytokine or receptor levels.

NEW ORLEANS — Nonablative laser therapy for acne doesn't kill Propionibacterium acnes or decrease sebum production but instead appears to work by inducing a rapid and dramatic increase in transforming growth factor β, Edward Seaton, M.D., said in a poster presented at the annual meeting of the American Academy of Dermatology.

“TGF-β is a very important anti-inflammatory cytokine that plays a pivotal role in decreasing inflammation and is the first stimulus of neocollagenesis,” Dr. Seaton of Hammersmith Hospital, London, said in an interview. “This is the first time a biologic explanation of lasers' effect on acne has been proposed.”

Dr. Seaton used nonablative laser therapy on the foreheads of 19 subjects with mild to moderate acne who had received no previous treatment. He took before and after measurements of P. acnes colony count, sebum production, and several cytokines and receptors: interleukin-1 (comedogenic), interleukin-1 receptor antagonist (anticomedogenic), interleukin-10 (anti-inflammatory), tumor necrosis factor (proinflammatory), TGF-β (anti-inflammatory), and melanocortin-1 receptor (expressed in healthy sebaceous glands). Each subject received one session of nonablative laser therapy (wavelength 585 nm, pulse duration 350 msec, 2 J/cm

After 24 hours, there was no decrease in the number of P. acnes colonies on the treated area; in fact, there was a non-statistically significant increase in the number of colonies. There was no significant decrease in the sebum excretion rate at 2, 4, 8, or 24 weeks post treatment. After 24 hours, there was a dramatic, fivefold increase in TGF-β but no significant changes in any other cytokine or receptor levels.

NEW ORLEANS — Nonablative laser therapy for acne doesn't kill Propionibacterium acnes or decrease sebum production but instead appears to work by inducing a rapid and dramatic increase in transforming growth factor β, Edward Seaton, M.D., said in a poster presented at the annual meeting of the American Academy of Dermatology.

“TGF-β is a very important anti-inflammatory cytokine that plays a pivotal role in decreasing inflammation and is the first stimulus of neocollagenesis,” Dr. Seaton of Hammersmith Hospital, London, said in an interview. “This is the first time a biologic explanation of lasers' effect on acne has been proposed.”

Dr. Seaton used nonablative laser therapy on the foreheads of 19 subjects with mild to moderate acne who had received no previous treatment. He took before and after measurements of P. acnes colony count, sebum production, and several cytokines and receptors: interleukin-1 (comedogenic), interleukin-1 receptor antagonist (anticomedogenic), interleukin-10 (anti-inflammatory), tumor necrosis factor (proinflammatory), TGF-β (anti-inflammatory), and melanocortin-1 receptor (expressed in healthy sebaceous glands). Each subject received one session of nonablative laser therapy (wavelength 585 nm, pulse duration 350 msec, 2 J/cm

After 24 hours, there was no decrease in the number of P. acnes colonies on the treated area; in fact, there was a non-statistically significant increase in the number of colonies. There was no significant decrease in the sebum excretion rate at 2, 4, 8, or 24 weeks post treatment. After 24 hours, there was a dramatic, fivefold increase in TGF-β but no significant changes in any other cytokine or receptor levels.

NEW ORLEANS — Abnormal antinuclear antibody, antistreptolysin O titer, and rapid plasma reagin tests were all negative. A chest x-ray showed mild cardiomegaly, but was otherwise unremarkable. A purified protein derivative (PPD) was reactive at 48 hours. Histology showed a lobular infiltrate and vasculitis, with a substantial amount of extravasated red blood cells.

The diagnosis was erythema induratum. The earlier negative PPD test could have been incorrectly read, or she could have been exposed and seroconverted after the initial test. The patient received combination therapy with isoniazid, rifampin, and pyrazinamide for 9 months. Within 3 months, she had considerable reduction in induration, erythema, and discomfort. By the end of treatment, all symptoms had resolved.

However, 3 years later, she presented with a new painful, erythematous plaque on her left ankle. She denied any systemic complaints including fever, chills, cough, or weight loss. Histology was consistent with nodular vasculitis and similar to the first lesion. She was successfully treated with prednisone at a starting dose of 60 mg, tapered over 12 days.

The nodular vasculitis diagnosis was something of a surprise because erythema induratum was expected, said Jennifer Dempsey, M.D., of Vanderbilt University, Nashville, Tenn., at the annual meeting of the American Academy of Dermatology. “We know that inadequately treated cases of erythema induratum may recur,” she said.

The recurrence could have been related to the TB therapy, she noted.

Nodular vasculitis and erythema induratum were initially considered one entity, Dr. Dempsey said. More recently, the disorders have been divided based on their association with TB: Nodular vasculitis is not associated with the infection, while 30%–80% of erythema induratum is associated.

A healthy 63-year-old Vietnamese woman presented with a painful, swollen left ankle for 3 months but had no trauma to the area. She had a 5-by-10-cm erythematous, warm, indurated, mildly tender plaque. She also had a mild, nonproductive cough of 3 years' duration; a previous PPD was negative. She had been treated with oral antibiotics and systemic potassium iodide without improvement. What's your diagnosis?

Photos courtesy Dr. Jennifer Dempsey

NEW ORLEANS — Abnormal antinuclear antibody, antistreptolysin O titer, and rapid plasma reagin tests were all negative. A chest x-ray showed mild cardiomegaly, but was otherwise unremarkable. A purified protein derivative (PPD) was reactive at 48 hours. Histology showed a lobular infiltrate and vasculitis, with a substantial amount of extravasated red blood cells.

The diagnosis was erythema induratum. The earlier negative PPD test could have been incorrectly read, or she could have been exposed and seroconverted after the initial test. The patient received combination therapy with isoniazid, rifampin, and pyrazinamide for 9 months. Within 3 months, she had considerable reduction in induration, erythema, and discomfort. By the end of treatment, all symptoms had resolved.

However, 3 years later, she presented with a new painful, erythematous plaque on her left ankle. She denied any systemic complaints including fever, chills, cough, or weight loss. Histology was consistent with nodular vasculitis and similar to the first lesion. She was successfully treated with prednisone at a starting dose of 60 mg, tapered over 12 days.

The nodular vasculitis diagnosis was something of a surprise because erythema induratum was expected, said Jennifer Dempsey, M.D., of Vanderbilt University, Nashville, Tenn., at the annual meeting of the American Academy of Dermatology. “We know that inadequately treated cases of erythema induratum may recur,” she said.

The recurrence could have been related to the TB therapy, she noted.

Nodular vasculitis and erythema induratum were initially considered one entity, Dr. Dempsey said. More recently, the disorders have been divided based on their association with TB: Nodular vasculitis is not associated with the infection, while 30%–80% of erythema induratum is associated.

A healthy 63-year-old Vietnamese woman presented with a painful, swollen left ankle for 3 months but had no trauma to the area. She had a 5-by-10-cm erythematous, warm, indurated, mildly tender plaque. She also had a mild, nonproductive cough of 3 years' duration; a previous PPD was negative. She had been treated with oral antibiotics and systemic potassium iodide without improvement. What's your diagnosis?

Photos courtesy Dr. Jennifer Dempsey

NEW ORLEANS — Abnormal antinuclear antibody, antistreptolysin O titer, and rapid plasma reagin tests were all negative. A chest x-ray showed mild cardiomegaly, but was otherwise unremarkable. A purified protein derivative (PPD) was reactive at 48 hours. Histology showed a lobular infiltrate and vasculitis, with a substantial amount of extravasated red blood cells.

The diagnosis was erythema induratum. The earlier negative PPD test could have been incorrectly read, or she could have been exposed and seroconverted after the initial test. The patient received combination therapy with isoniazid, rifampin, and pyrazinamide for 9 months. Within 3 months, she had considerable reduction in induration, erythema, and discomfort. By the end of treatment, all symptoms had resolved.

However, 3 years later, she presented with a new painful, erythematous plaque on her left ankle. She denied any systemic complaints including fever, chills, cough, or weight loss. Histology was consistent with nodular vasculitis and similar to the first lesion. She was successfully treated with prednisone at a starting dose of 60 mg, tapered over 12 days.

The nodular vasculitis diagnosis was something of a surprise because erythema induratum was expected, said Jennifer Dempsey, M.D., of Vanderbilt University, Nashville, Tenn., at the annual meeting of the American Academy of Dermatology. “We know that inadequately treated cases of erythema induratum may recur,” she said.

The recurrence could have been related to the TB therapy, she noted.

Nodular vasculitis and erythema induratum were initially considered one entity, Dr. Dempsey said. More recently, the disorders have been divided based on their association with TB: Nodular vasculitis is not associated with the infection, while 30%–80% of erythema induratum is associated.

A healthy 63-year-old Vietnamese woman presented with a painful, swollen left ankle for 3 months but had no trauma to the area. She had a 5-by-10-cm erythematous, warm, indurated, mildly tender plaque. She also had a mild, nonproductive cough of 3 years' duration; a previous PPD was negative. She had been treated with oral antibiotics and systemic potassium iodide without improvement. What's your diagnosis?

Photos courtesy Dr. Jennifer Dempsey

NEW ORLEANS — Adalimumab appears to be an extremely effective treatment for both psoriasis and psoriatic arthritis, producing improvements of up to 80% in body surface area affected, Jennifer Cather, M.D., reported in a poster at the annual meeting of the American Academy of Dermatology.

“It is by far one of the best drugs we have tried for our refractory psoriasis patients,” Dr. Cather said in an interview. “We are still waiting for the long-term safety data, though, so we have only used it on patients who didn't respond to other therapies.”

Adalimumab (Humira) is approved for refractory rheumatoid arthritis. Early trials of the drug's usefulness in psoriasis were promising; several phase III studies are now underway. Dr. Cather of Baylor College of Medicine, Houston, participated in some of these trials, but presented data on her clinic's current experience with adalimumab in 24 psoriasis patients. “None of the people in this study were part of any clinical trials, because we didn't want to bias the results by only including responders,” she said.

All of the patients had either psoriasis or psoriatic arthritis, and all had failed at least one previous form of therapy, including cyclosporine PUVA, methotrexate, alefacept, acitretin, hydroxyurea, sulfasalazine, isotretinoin, narrowband UVB, etanercept, prednisone, bexarotene, and infliximab.

At baseline, every patient underwent testing for HIV virus and hepatitis B and C, and every patient got a tuberculin skin test. Other baseline studies included electrolytes, liver function, and complete blood count.

Twelve patients are on adalimumab monotherapy. Their average age is 44 years, and average body surface area (BSA) at baseline was 25%. Six began monotherapy with 40 mg/wk; one patient decreased dosing to 40 mg every 3 weeks as maintenance therapy. Six patients started with 40 mg every other week; two of them escalated to weekly dosing for optimal disease control and one went to 40 mg every 3 weeks as maintenance therapy.

This group has received adalimumab for an average of 30 weeks (9–48 weeks). Their current average BSA is 7%, a 72% reduction from baseline.

Twelve patients are on adalimumab combination therapy. Their average age is 50 years and average BSA at baseline was 22%. Concomitant therapies include cyclosporine (6), methotrexate (4), narrowband UVB (10), methotrexate and cyclosporine (1), and acitretin and cyclosporine (1).

Nine patients began combination therapy with 40 mg/week adalimumab. One patient decreased dosing to every other week, and two patients failed to taper to every other week.

The two patients on triple combination therapy successfully transitioned to adalimumab as monotherapy for maintenance. One patient transitioned off cyclosporine to adalimumab as maintenance monotherapy.

Three other patients started combination therapy with 40 mg adalimumab every other week; two escalated to weekly dosing for optimal disease control. One patient decreased dosing to every 3 weeks as maintenance therapy.

Combination therapy patients have received adalimumab for an average of 24 weeks (6–81 weeks). Their current average BSA is 3.6%—an 80% reduction from baseline.

Adalimumab appears most effective in patients who have not previously been heavily treated, especially with biologics, Dr. Cather noted.

NEW ORLEANS — Adalimumab appears to be an extremely effective treatment for both psoriasis and psoriatic arthritis, producing improvements of up to 80% in body surface area affected, Jennifer Cather, M.D., reported in a poster at the annual meeting of the American Academy of Dermatology.

“It is by far one of the best drugs we have tried for our refractory psoriasis patients,” Dr. Cather said in an interview. “We are still waiting for the long-term safety data, though, so we have only used it on patients who didn't respond to other therapies.”

Adalimumab (Humira) is approved for refractory rheumatoid arthritis. Early trials of the drug's usefulness in psoriasis were promising; several phase III studies are now underway. Dr. Cather of Baylor College of Medicine, Houston, participated in some of these trials, but presented data on her clinic's current experience with adalimumab in 24 psoriasis patients. “None of the people in this study were part of any clinical trials, because we didn't want to bias the results by only including responders,” she said.

All of the patients had either psoriasis or psoriatic arthritis, and all had failed at least one previous form of therapy, including cyclosporine PUVA, methotrexate, alefacept, acitretin, hydroxyurea, sulfasalazine, isotretinoin, narrowband UVB, etanercept, prednisone, bexarotene, and infliximab.

At baseline, every patient underwent testing for HIV virus and hepatitis B and C, and every patient got a tuberculin skin test. Other baseline studies included electrolytes, liver function, and complete blood count.

Twelve patients are on adalimumab monotherapy. Their average age is 44 years, and average body surface area (BSA) at baseline was 25%. Six began monotherapy with 40 mg/wk; one patient decreased dosing to 40 mg every 3 weeks as maintenance therapy. Six patients started with 40 mg every other week; two of them escalated to weekly dosing for optimal disease control and one went to 40 mg every 3 weeks as maintenance therapy.

This group has received adalimumab for an average of 30 weeks (9–48 weeks). Their current average BSA is 7%, a 72% reduction from baseline.

Twelve patients are on adalimumab combination therapy. Their average age is 50 years and average BSA at baseline was 22%. Concomitant therapies include cyclosporine (6), methotrexate (4), narrowband UVB (10), methotrexate and cyclosporine (1), and acitretin and cyclosporine (1).

Nine patients began combination therapy with 40 mg/week adalimumab. One patient decreased dosing to every other week, and two patients failed to taper to every other week.

The two patients on triple combination therapy successfully transitioned to adalimumab as monotherapy for maintenance. One patient transitioned off cyclosporine to adalimumab as maintenance monotherapy.

Three other patients started combination therapy with 40 mg adalimumab every other week; two escalated to weekly dosing for optimal disease control. One patient decreased dosing to every 3 weeks as maintenance therapy.

Combination therapy patients have received adalimumab for an average of 24 weeks (6–81 weeks). Their current average BSA is 3.6%—an 80% reduction from baseline.

Adalimumab appears most effective in patients who have not previously been heavily treated, especially with biologics, Dr. Cather noted.

NEW ORLEANS — Adalimumab appears to be an extremely effective treatment for both psoriasis and psoriatic arthritis, producing improvements of up to 80% in body surface area affected, Jennifer Cather, M.D., reported in a poster at the annual meeting of the American Academy of Dermatology.

“It is by far one of the best drugs we have tried for our refractory psoriasis patients,” Dr. Cather said in an interview. “We are still waiting for the long-term safety data, though, so we have only used it on patients who didn't respond to other therapies.”

Adalimumab (Humira) is approved for refractory rheumatoid arthritis. Early trials of the drug's usefulness in psoriasis were promising; several phase III studies are now underway. Dr. Cather of Baylor College of Medicine, Houston, participated in some of these trials, but presented data on her clinic's current experience with adalimumab in 24 psoriasis patients. “None of the people in this study were part of any clinical trials, because we didn't want to bias the results by only including responders,” she said.

All of the patients had either psoriasis or psoriatic arthritis, and all had failed at least one previous form of therapy, including cyclosporine PUVA, methotrexate, alefacept, acitretin, hydroxyurea, sulfasalazine, isotretinoin, narrowband UVB, etanercept, prednisone, bexarotene, and infliximab.

At baseline, every patient underwent testing for HIV virus and hepatitis B and C, and every patient got a tuberculin skin test. Other baseline studies included electrolytes, liver function, and complete blood count.

Twelve patients are on adalimumab monotherapy. Their average age is 44 years, and average body surface area (BSA) at baseline was 25%. Six began monotherapy with 40 mg/wk; one patient decreased dosing to 40 mg every 3 weeks as maintenance therapy. Six patients started with 40 mg every other week; two of them escalated to weekly dosing for optimal disease control and one went to 40 mg every 3 weeks as maintenance therapy.

This group has received adalimumab for an average of 30 weeks (9–48 weeks). Their current average BSA is 7%, a 72% reduction from baseline.

Twelve patients are on adalimumab combination therapy. Their average age is 50 years and average BSA at baseline was 22%. Concomitant therapies include cyclosporine (6), methotrexate (4), narrowband UVB (10), methotrexate and cyclosporine (1), and acitretin and cyclosporine (1).

Nine patients began combination therapy with 40 mg/week adalimumab. One patient decreased dosing to every other week, and two patients failed to taper to every other week.

The two patients on triple combination therapy successfully transitioned to adalimumab as monotherapy for maintenance. One patient transitioned off cyclosporine to adalimumab as maintenance monotherapy.

Three other patients started combination therapy with 40 mg adalimumab every other week; two escalated to weekly dosing for optimal disease control. One patient decreased dosing to every 3 weeks as maintenance therapy.

Combination therapy patients have received adalimumab for an average of 24 weeks (6–81 weeks). Their current average BSA is 3.6%—an 80% reduction from baseline.

Adalimumab appears most effective in patients who have not previously been heavily treated, especially with biologics, Dr. Cather noted.

Six preventable conditions—pneumonia, diarrhea, malaria, neonatal infections, preterm delivery, and asphyxia at birth—account for nearly 75% of the 10.6 million annual deaths of younger children, the World Health Organization has concluded.

The vast majority of these deaths occurred in developing countries and could be prevented easily and inexpensively, said Robert Black, M.D., chair of WHO's Child Health Epidemiology Reference Group (Lancet 2005;365:1147–52).

“Virtually all of these causes can be addressed right now with interventions that work and are inexpensive and easy to deliver,” he told FAMILY PRACTICE NEWS. “This information should be enough to wake us up and say 'We haven't been doing enough on this issue.' We hope this report can be used to guide policy and direct programs aimed at saving these children. If countries realize 50% of child death is from infectious diseases, that's where the program efforts and funds should go.”

WHO established the reference group in 2001 to estimate causes of death in young children worldwide. The 2004 report used vital registration data and published and unpublished epidemiologic data to create epidemiologic models in six global regions: Africa, the Americas, the Eastern Mediterranean, Europe, Southeast Asia, and the Western Pacific.

Four communicable diseases are responsible for more than half of deaths in children younger than 5 years: pneumonia (19%), diarrhea (18%), malaria (8%) and neonatal pneumonia or sepsis (10%), with malnourishment an underlying cause of 53% of these deaths. Preterm births accounted for 10% of mortality in the group, and asphyxia at birth another 8%: thus, 28% of deaths in children under 5 years occurred in the neonatal period. The report found that most of the deaths of children under 5 years occurred in Africa and Southeast Asia. Africa was especially hard-hit, with 94% of global child deaths from malaria, 46% of deaths from pneumonia, 40% of deaths from diarrhea, and 21% of deaths from neonatal pneumonia or sepsis.

This is the first time WHO has broken out neonatal death data from the general population, said Dr. Black of the Bloomberg School of Public Health, Johns Hopkins University, Baltimore. “Previously, this information was lumped into deaths in the perinatal period, which really makes no sense. We tried to get better estimates and present them in a more meaningful way.”

Measles, neonatal tetanus, and HIV/AIDS accounted for only a small proportion of deaths across the globe. The low number of measles deaths (less than 5% of deaths in young children) “is a success story,” the study said, but high immunization rates must be sustained for that success to continue.

HIV/AIDS accounted for only about 3% of global deaths in young children, but the infection remains a significant problem. “All countries need to take action against this growing threat,” the study said.

Neonatal tetanus deaths were halved in the 1990s. Although the report noted that “this is good news,” WHO will not meet its goal of eliminating this as a cause of death by 2005.

It's no surprise that the highest proportion of deaths occurred in the poorest countries, Peter Byass and Tedros A. Ghebreyesus said in an accompanying editorial. Poverty is the single most important risk factor for childhood death (Lancet 2005;365:1114–6).

“In terms of preventing children dying, the old adage that 'you get what you pay for' seems to apply. In today's world, an Ethiopian child is over 30 times more likely than a Western European to die before his or her fifth birthday,” said Mr. Byass of Umeå University (Sweden) and Mr. Ghebreyesus of the Federal Ministry of Health, Addis Ababa, Ethiopia.

Meanwhile, they noted, every day, the average citizen in any of the four countries that spend the most on health consumes the equivalent health resources available to a typical Ethiopian in an entire year.

Six preventable conditions—pneumonia, diarrhea, malaria, neonatal infections, preterm delivery, and asphyxia at birth—account for nearly 75% of the 10.6 million annual deaths of younger children, the World Health Organization has concluded.

The vast majority of these deaths occurred in developing countries and could be prevented easily and inexpensively, said Robert Black, M.D., chair of WHO's Child Health Epidemiology Reference Group (Lancet 2005;365:1147–52).

“Virtually all of these causes can be addressed right now with interventions that work and are inexpensive and easy to deliver,” he told FAMILY PRACTICE NEWS. “This information should be enough to wake us up and say 'We haven't been doing enough on this issue.' We hope this report can be used to guide policy and direct programs aimed at saving these children. If countries realize 50% of child death is from infectious diseases, that's where the program efforts and funds should go.”

WHO established the reference group in 2001 to estimate causes of death in young children worldwide. The 2004 report used vital registration data and published and unpublished epidemiologic data to create epidemiologic models in six global regions: Africa, the Americas, the Eastern Mediterranean, Europe, Southeast Asia, and the Western Pacific.

Four communicable diseases are responsible for more than half of deaths in children younger than 5 years: pneumonia (19%), diarrhea (18%), malaria (8%) and neonatal pneumonia or sepsis (10%), with malnourishment an underlying cause of 53% of these deaths. Preterm births accounted for 10% of mortality in the group, and asphyxia at birth another 8%: thus, 28% of deaths in children under 5 years occurred in the neonatal period. The report found that most of the deaths of children under 5 years occurred in Africa and Southeast Asia. Africa was especially hard-hit, with 94% of global child deaths from malaria, 46% of deaths from pneumonia, 40% of deaths from diarrhea, and 21% of deaths from neonatal pneumonia or sepsis.

This is the first time WHO has broken out neonatal death data from the general population, said Dr. Black of the Bloomberg School of Public Health, Johns Hopkins University, Baltimore. “Previously, this information was lumped into deaths in the perinatal period, which really makes no sense. We tried to get better estimates and present them in a more meaningful way.”

Measles, neonatal tetanus, and HIV/AIDS accounted for only a small proportion of deaths across the globe. The low number of measles deaths (less than 5% of deaths in young children) “is a success story,” the study said, but high immunization rates must be sustained for that success to continue.

HIV/AIDS accounted for only about 3% of global deaths in young children, but the infection remains a significant problem. “All countries need to take action against this growing threat,” the study said.

Neonatal tetanus deaths were halved in the 1990s. Although the report noted that “this is good news,” WHO will not meet its goal of eliminating this as a cause of death by 2005.

It's no surprise that the highest proportion of deaths occurred in the poorest countries, Peter Byass and Tedros A. Ghebreyesus said in an accompanying editorial. Poverty is the single most important risk factor for childhood death (Lancet 2005;365:1114–6).

“In terms of preventing children dying, the old adage that 'you get what you pay for' seems to apply. In today's world, an Ethiopian child is over 30 times more likely than a Western European to die before his or her fifth birthday,” said Mr. Byass of Umeå University (Sweden) and Mr. Ghebreyesus of the Federal Ministry of Health, Addis Ababa, Ethiopia.

Meanwhile, they noted, every day, the average citizen in any of the four countries that spend the most on health consumes the equivalent health resources available to a typical Ethiopian in an entire year.

Six preventable conditions—pneumonia, diarrhea, malaria, neonatal infections, preterm delivery, and asphyxia at birth—account for nearly 75% of the 10.6 million annual deaths of younger children, the World Health Organization has concluded.

The vast majority of these deaths occurred in developing countries and could be prevented easily and inexpensively, said Robert Black, M.D., chair of WHO's Child Health Epidemiology Reference Group (Lancet 2005;365:1147–52).

“Virtually all of these causes can be addressed right now with interventions that work and are inexpensive and easy to deliver,” he told FAMILY PRACTICE NEWS. “This information should be enough to wake us up and say 'We haven't been doing enough on this issue.' We hope this report can be used to guide policy and direct programs aimed at saving these children. If countries realize 50% of child death is from infectious diseases, that's where the program efforts and funds should go.”

WHO established the reference group in 2001 to estimate causes of death in young children worldwide. The 2004 report used vital registration data and published and unpublished epidemiologic data to create epidemiologic models in six global regions: Africa, the Americas, the Eastern Mediterranean, Europe, Southeast Asia, and the Western Pacific.

Four communicable diseases are responsible for more than half of deaths in children younger than 5 years: pneumonia (19%), diarrhea (18%), malaria (8%) and neonatal pneumonia or sepsis (10%), with malnourishment an underlying cause of 53% of these deaths. Preterm births accounted for 10% of mortality in the group, and asphyxia at birth another 8%: thus, 28% of deaths in children under 5 years occurred in the neonatal period. The report found that most of the deaths of children under 5 years occurred in Africa and Southeast Asia. Africa was especially hard-hit, with 94% of global child deaths from malaria, 46% of deaths from pneumonia, 40% of deaths from diarrhea, and 21% of deaths from neonatal pneumonia or sepsis.

This is the first time WHO has broken out neonatal death data from the general population, said Dr. Black of the Bloomberg School of Public Health, Johns Hopkins University, Baltimore. “Previously, this information was lumped into deaths in the perinatal period, which really makes no sense. We tried to get better estimates and present them in a more meaningful way.”

Measles, neonatal tetanus, and HIV/AIDS accounted for only a small proportion of deaths across the globe. The low number of measles deaths (less than 5% of deaths in young children) “is a success story,” the study said, but high immunization rates must be sustained for that success to continue.

HIV/AIDS accounted for only about 3% of global deaths in young children, but the infection remains a significant problem. “All countries need to take action against this growing threat,” the study said.

Neonatal tetanus deaths were halved in the 1990s. Although the report noted that “this is good news,” WHO will not meet its goal of eliminating this as a cause of death by 2005.

It's no surprise that the highest proportion of deaths occurred in the poorest countries, Peter Byass and Tedros A. Ghebreyesus said in an accompanying editorial. Poverty is the single most important risk factor for childhood death (Lancet 2005;365:1114–6).

“In terms of preventing children dying, the old adage that 'you get what you pay for' seems to apply. In today's world, an Ethiopian child is over 30 times more likely than a Western European to die before his or her fifth birthday,” said Mr. Byass of Umeå University (Sweden) and Mr. Ghebreyesus of the Federal Ministry of Health, Addis Ababa, Ethiopia.

Meanwhile, they noted, every day, the average citizen in any of the four countries that spend the most on health consumes the equivalent health resources available to a typical Ethiopian in an entire year.

Teens who take a sexual abstinence pledge delay their sexual debut for a few years, but they have just as many sexually transmitted infections as nonpledgers, probably because they are more likely to engage in noncoital sex and aren't as likely to use a condom during any sexual activity.

Hannah Brückner, Ph.D., and Peter Bearman, Ph.D., said their findings might put a new spin on programs that stress abstinence as the only way to avoid STDs and pregnancy. “The all-or-nothing approach … may create additional barriers to knowledge and protection for adolescents. For example, the emphasis on virginity may encourage adolescents to limit their sexual activity to noncoital behaviors, which may nevertheless expose them to risks of infection” (J. Adolesc. Health 2005;36:271–8).

Health care behavior by pledgers further complicates the problem, they noted. “It is important to know that pledgers are less likely than nonpledgers to be tested for STDs and to have ever seen a doctor because they are worried about an STD,” said the investigators of Yale University, New Haven, and Columbia University, New York.

The researchers extracted data gathered from 2001 to 2002, during the third wave of the National Longitudinal Study of Adolescent Health. During this wave, respondents were age 18–24 years. A total of 11,471 respondents provided urine samples for STD testing (chlamydia, gonorrhea, and trichomoniasis). An additional 3,317 sexually active female respondents were randomly selected for human papilloma virus (HPV) testing.

Pledge status was collected from all three waves of the survey. Nonpledgers reported no abstinence pledge during any of the waves. Consistent pledgers reported pledging during all waves or pledging for the first time during wave 3. Inconsistent pledgers reported pledging during an early wave but not a subsequent wave.

Most of the group (80%) were nonpledgers. Only 7% were consistent pledgers; 13% were inconsistent pledgers.

Consistent and inconsistent pledgers delayed their time to first coitus by several years, compared with nonpledgers. Among nonpledgers, 75% reported first intercourse by age 18 years. Inconsistent pledgers reached the 75th percentile by age 20 years, and consistent pledgers by age 24 years.

Male pledgers delayed intercourse the longest. By age 25, 25% of consistent male pledgers were still virgins, compared with 15% of inconsistent pledgers and 7% of nonpledgers. By age 25, 21% of female consistent pledgers were still virgins, compared with 10% of inconsistent pledgers and 6% of nonpledgers.

Delaying first intercourse had no significant effect on STD incidence in the groups, however. About 6.9% of nonpledgers, 6.4% of inconsistent pledgers, and 4.6% of consistent pledgers tested positive for trichomoniasis, chlamydia, and/or gonorrhea.

For HPV infection, the rates were 26.5% among nonpledgers, 28.5% among inconsistent pledgers, and 26.7% among consistent pledgers.

Pledgers did have fewer sexual partners than nonpledgers (average of 1.5 partners vs. 2.4 partners), and were not exposed as long to STD risk. However, they were more likely to engage in noncoital sexual contact.

About 3% of respondents reported oral sex but no vaginal sex. About 2% of nonpledgers fell into that group, compared with 13% of consistent pledgers and 5% of inconsistent pledgers. About 0.7% of nonpledgers reported anal sex but not vaginal sex, compared with 1.2% of pledgers.

About 1% of male nonpledgers reported anal, but not vaginal, sex, compared with 3% of male inconsistent pledgers and 4% of male consistent pledgers.

Condom use during these experiences was very low for all respondents: Only 4% reported using a condom during oral sex, and about 30% reported using one for anal sex.

“The combination of low condom use and overrepresentation of pledgers [in noncoital sex] provides some support for the hypothesis that this behavioral pattern is associated with greater than expected STD acquisition among pledgers, although the numbers are small and provide an insufficient basis from which to make inference,” the authors said.

Teens who take a sexual abstinence pledge delay their sexual debut for a few years, but they have just as many sexually transmitted infections as nonpledgers, probably because they are more likely to engage in noncoital sex and aren't as likely to use a condom during any sexual activity.

Hannah Brückner, Ph.D., and Peter Bearman, Ph.D., said their findings might put a new spin on programs that stress abstinence as the only way to avoid STDs and pregnancy. “The all-or-nothing approach … may create additional barriers to knowledge and protection for adolescents. For example, the emphasis on virginity may encourage adolescents to limit their sexual activity to noncoital behaviors, which may nevertheless expose them to risks of infection” (J. Adolesc. Health 2005;36:271–8).

Health care behavior by pledgers further complicates the problem, they noted. “It is important to know that pledgers are less likely than nonpledgers to be tested for STDs and to have ever seen a doctor because they are worried about an STD,” said the investigators of Yale University, New Haven, and Columbia University, New York.

The researchers extracted data gathered from 2001 to 2002, during the third wave of the National Longitudinal Study of Adolescent Health. During this wave, respondents were age 18–24 years. A total of 11,471 respondents provided urine samples for STD testing (chlamydia, gonorrhea, and trichomoniasis). An additional 3,317 sexually active female respondents were randomly selected for human papilloma virus (HPV) testing.

Pledge status was collected from all three waves of the survey. Nonpledgers reported no abstinence pledge during any of the waves. Consistent pledgers reported pledging during all waves or pledging for the first time during wave 3. Inconsistent pledgers reported pledging during an early wave but not a subsequent wave.

Most of the group (80%) were nonpledgers. Only 7% were consistent pledgers; 13% were inconsistent pledgers.

Consistent and inconsistent pledgers delayed their time to first coitus by several years, compared with nonpledgers. Among nonpledgers, 75% reported first intercourse by age 18 years. Inconsistent pledgers reached the 75th percentile by age 20 years, and consistent pledgers by age 24 years.

Male pledgers delayed intercourse the longest. By age 25, 25% of consistent male pledgers were still virgins, compared with 15% of inconsistent pledgers and 7% of nonpledgers. By age 25, 21% of female consistent pledgers were still virgins, compared with 10% of inconsistent pledgers and 6% of nonpledgers.

Delaying first intercourse had no significant effect on STD incidence in the groups, however. About 6.9% of nonpledgers, 6.4% of inconsistent pledgers, and 4.6% of consistent pledgers tested positive for trichomoniasis, chlamydia, and/or gonorrhea.

For HPV infection, the rates were 26.5% among nonpledgers, 28.5% among inconsistent pledgers, and 26.7% among consistent pledgers.

Pledgers did have fewer sexual partners than nonpledgers (average of 1.5 partners vs. 2.4 partners), and were not exposed as long to STD risk. However, they were more likely to engage in noncoital sexual contact.

About 3% of respondents reported oral sex but no vaginal sex. About 2% of nonpledgers fell into that group, compared with 13% of consistent pledgers and 5% of inconsistent pledgers. About 0.7% of nonpledgers reported anal sex but not vaginal sex, compared with 1.2% of pledgers.

About 1% of male nonpledgers reported anal, but not vaginal, sex, compared with 3% of male inconsistent pledgers and 4% of male consistent pledgers.

Condom use during these experiences was very low for all respondents: Only 4% reported using a condom during oral sex, and about 30% reported using one for anal sex.

“The combination of low condom use and overrepresentation of pledgers [in noncoital sex] provides some support for the hypothesis that this behavioral pattern is associated with greater than expected STD acquisition among pledgers, although the numbers are small and provide an insufficient basis from which to make inference,” the authors said.

Teens who take a sexual abstinence pledge delay their sexual debut for a few years, but they have just as many sexually transmitted infections as nonpledgers, probably because they are more likely to engage in noncoital sex and aren't as likely to use a condom during any sexual activity.

Hannah Brückner, Ph.D., and Peter Bearman, Ph.D., said their findings might put a new spin on programs that stress abstinence as the only way to avoid STDs and pregnancy. “The all-or-nothing approach … may create additional barriers to knowledge and protection for adolescents. For example, the emphasis on virginity may encourage adolescents to limit their sexual activity to noncoital behaviors, which may nevertheless expose them to risks of infection” (J. Adolesc. Health 2005;36:271–8).

Health care behavior by pledgers further complicates the problem, they noted. “It is important to know that pledgers are less likely than nonpledgers to be tested for STDs and to have ever seen a doctor because they are worried about an STD,” said the investigators of Yale University, New Haven, and Columbia University, New York.

The researchers extracted data gathered from 2001 to 2002, during the third wave of the National Longitudinal Study of Adolescent Health. During this wave, respondents were age 18–24 years. A total of 11,471 respondents provided urine samples for STD testing (chlamydia, gonorrhea, and trichomoniasis). An additional 3,317 sexually active female respondents were randomly selected for human papilloma virus (HPV) testing.

Pledge status was collected from all three waves of the survey. Nonpledgers reported no abstinence pledge during any of the waves. Consistent pledgers reported pledging during all waves or pledging for the first time during wave 3. Inconsistent pledgers reported pledging during an early wave but not a subsequent wave.

Most of the group (80%) were nonpledgers. Only 7% were consistent pledgers; 13% were inconsistent pledgers.

Consistent and inconsistent pledgers delayed their time to first coitus by several years, compared with nonpledgers. Among nonpledgers, 75% reported first intercourse by age 18 years. Inconsistent pledgers reached the 75th percentile by age 20 years, and consistent pledgers by age 24 years.

Male pledgers delayed intercourse the longest. By age 25, 25% of consistent male pledgers were still virgins, compared with 15% of inconsistent pledgers and 7% of nonpledgers. By age 25, 21% of female consistent pledgers were still virgins, compared with 10% of inconsistent pledgers and 6% of nonpledgers.

Delaying first intercourse had no significant effect on STD incidence in the groups, however. About 6.9% of nonpledgers, 6.4% of inconsistent pledgers, and 4.6% of consistent pledgers tested positive for trichomoniasis, chlamydia, and/or gonorrhea.

For HPV infection, the rates were 26.5% among nonpledgers, 28.5% among inconsistent pledgers, and 26.7% among consistent pledgers.

Pledgers did have fewer sexual partners than nonpledgers (average of 1.5 partners vs. 2.4 partners), and were not exposed as long to STD risk. However, they were more likely to engage in noncoital sexual contact.

About 3% of respondents reported oral sex but no vaginal sex. About 2% of nonpledgers fell into that group, compared with 13% of consistent pledgers and 5% of inconsistent pledgers. About 0.7% of nonpledgers reported anal sex but not vaginal sex, compared with 1.2% of pledgers.

About 1% of male nonpledgers reported anal, but not vaginal, sex, compared with 3% of male inconsistent pledgers and 4% of male consistent pledgers.

Condom use during these experiences was very low for all respondents: Only 4% reported using a condom during oral sex, and about 30% reported using one for anal sex.

“The combination of low condom use and overrepresentation of pledgers [in noncoital sex] provides some support for the hypothesis that this behavioral pattern is associated with greater than expected STD acquisition among pledgers, although the numbers are small and provide an insufficient basis from which to make inference,” the authors said.

High-dose aspirin is just as effective as warfarin in treating intracranial arterial stenosis, and appears much safer, with significantly lower rates of death, myocardial infarction, and major hemorrhage over 2 years, Marc Chimowitz, M.B., and colleagues have reported.

“The common practice of administering warfarin rather than aspirin for symptomatic intracranial arterial stenosis is not supported by the results of this trial,” said Dr. Chimowitz of Emory University, Atlanta.

Enrollment in the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial ended early because of the high rate of serious adverse events in the warfarin patients.

In addition to being safer for patients, the researchers said, aspirin therapy did not require constant monitoring of international normalized ratios (INRs) and treatment of warfarin-associated bleeding. Aspirin also is much cheaper, the investigators noted (N. Engl. J. Med. 2005;352:1305–16).

Ralph Sacco, M.D., an investigator in the Northern Manhattan Stroke Study, noted in an interview that the WASID trial's findings add to existing data to dispel beliefs about the benefit of warfarin for certain stroke populations.

The conclusion that warfarin provides no survival benefit over aspirin, but confers added risk, is more expensive, and requires intensive monitoring, should reshape its risk/benefit profile for some patients, said Dr. Sacco, professor of neurology and epidemiology at Columbia University, New York.

Dr. Chimowitz and his associates reported on the trial's final analysis that included 569 patients with symptomatic intracranial arterial stenosis who were randomized to either warfarin 5 mg daily or aspirin 650 mg twice daily.

The patients' mean age was about 63 years; about 61% were men. All had a history of either stroke or transient ischemic attack caused by 50%–90% stenosis of a major intracranial artery. The mean follow-up was 1.8 years.

The primary outcome–stroke, brain hemorrhage, or death from vascular causes other than stroke–occurred in 22% (62) of the aspirin patients and 21.8% (63) of the warfarin patients. Myocardial infarction or sudden death occurred significantly more often in the warfarin group than in the aspirin group (7.3% vs. 2.9%).

The overall rate of death was significantly higher in the warfarin group than in the aspirin group: 5.9% (17) vs. 4.3% (12). However, chance probably accounted for some of the deaths that were higher in the warfarin group, especially the six cancers.

Major hemorrhages occurred significantly more often in the warfarin group (8.3% vs. 3.2%). Brain hemorrhage occurred in 2 warfarin patients and 1 aspirin patient; gastrointestinal hemorrhage in 10 warfarin patients and 6 aspirin patients; ocular hemorrhage in 4 warfarin patients and 1 aspirin patient; genitourinary hemorrhage in 3 warfarin patients; aortic aneurysm in 1 aspirin patient; and other bleeds in 4 warfarin patients.

In a posthoc analysis, INRs of less than 2.0 were associated with a significantly higher risk of ischemic stroke and major cardiac events, and INRs of 3.0 or greater were associated with a significantly higher risk of hemorrhage, than were INRs in the therapeutic range of 2.0–3.0.

In an accompanying editorial, Walter Koroshetz, M.D., said the observed mortality differences could be due to a failure to keep patients at a therapeutic level of anticoagulation. Warfarin subjects obtained optimal anticoagulation (INR 2.0–3.0) only 63% of the time. The rate of major cardiac events was 10.8 per 100 patient-years with a subtherapeutic INR, but only 0.4 per 100 patient-years with a therapeutic INR.

“Unfortunately, it is extremely difficult, if not impossible, to achieve a consistent therapeutic INR with warfarin in a population study or in routine practice,” said Dr. Koroshetz of Massachusetts General Hospital, Boston.

“Two large studies have been negative for warfarin in noncardioembolic stroke,” Dr. Sacco noted. “And one of these was also stopped early due to adverse events and no signal that warfarin's benefit was greater than aspirin.”

High-dose aspirin is just as effective as warfarin in treating intracranial arterial stenosis, and appears much safer, with significantly lower rates of death, myocardial infarction, and major hemorrhage over 2 years, Marc Chimowitz, M.B., and colleagues have reported.

“The common practice of administering warfarin rather than aspirin for symptomatic intracranial arterial stenosis is not supported by the results of this trial,” said Dr. Chimowitz of Emory University, Atlanta.

Enrollment in the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial ended early because of the high rate of serious adverse events in the warfarin patients.

In addition to being safer for patients, the researchers said, aspirin therapy did not require constant monitoring of international normalized ratios (INRs) and treatment of warfarin-associated bleeding. Aspirin also is much cheaper, the investigators noted (N. Engl. J. Med. 2005;352:1305–16).

Ralph Sacco, M.D., an investigator in the Northern Manhattan Stroke Study, noted in an interview that the WASID trial's findings add to existing data to dispel beliefs about the benefit of warfarin for certain stroke populations.

The conclusion that warfarin provides no survival benefit over aspirin, but confers added risk, is more expensive, and requires intensive monitoring, should reshape its risk/benefit profile for some patients, said Dr. Sacco, professor of neurology and epidemiology at Columbia University, New York.

Dr. Chimowitz and his associates reported on the trial's final analysis that included 569 patients with symptomatic intracranial arterial stenosis who were randomized to either warfarin 5 mg daily or aspirin 650 mg twice daily.

The patients' mean age was about 63 years; about 61% were men. All had a history of either stroke or transient ischemic attack caused by 50%–90% stenosis of a major intracranial artery. The mean follow-up was 1.8 years.

The primary outcome–stroke, brain hemorrhage, or death from vascular causes other than stroke–occurred in 22% (62) of the aspirin patients and 21.8% (63) of the warfarin patients. Myocardial infarction or sudden death occurred significantly more often in the warfarin group than in the aspirin group (7.3% vs. 2.9%).

The overall rate of death was significantly higher in the warfarin group than in the aspirin group: 5.9% (17) vs. 4.3% (12). However, chance probably accounted for some of the deaths that were higher in the warfarin group, especially the six cancers.

Major hemorrhages occurred significantly more often in the warfarin group (8.3% vs. 3.2%). Brain hemorrhage occurred in 2 warfarin patients and 1 aspirin patient; gastrointestinal hemorrhage in 10 warfarin patients and 6 aspirin patients; ocular hemorrhage in 4 warfarin patients and 1 aspirin patient; genitourinary hemorrhage in 3 warfarin patients; aortic aneurysm in 1 aspirin patient; and other bleeds in 4 warfarin patients.

In a posthoc analysis, INRs of less than 2.0 were associated with a significantly higher risk of ischemic stroke and major cardiac events, and INRs of 3.0 or greater were associated with a significantly higher risk of hemorrhage, than were INRs in the therapeutic range of 2.0–3.0.

In an accompanying editorial, Walter Koroshetz, M.D., said the observed mortality differences could be due to a failure to keep patients at a therapeutic level of anticoagulation. Warfarin subjects obtained optimal anticoagulation (INR 2.0–3.0) only 63% of the time. The rate of major cardiac events was 10.8 per 100 patient-years with a subtherapeutic INR, but only 0.4 per 100 patient-years with a therapeutic INR.

“Unfortunately, it is extremely difficult, if not impossible, to achieve a consistent therapeutic INR with warfarin in a population study or in routine practice,” said Dr. Koroshetz of Massachusetts General Hospital, Boston.

“Two large studies have been negative for warfarin in noncardioembolic stroke,” Dr. Sacco noted. “And one of these was also stopped early due to adverse events and no signal that warfarin's benefit was greater than aspirin.”

High-dose aspirin is just as effective as warfarin in treating intracranial arterial stenosis, and appears much safer, with significantly lower rates of death, myocardial infarction, and major hemorrhage over 2 years, Marc Chimowitz, M.B., and colleagues have reported.

“The common practice of administering warfarin rather than aspirin for symptomatic intracranial arterial stenosis is not supported by the results of this trial,” said Dr. Chimowitz of Emory University, Atlanta.

Enrollment in the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial ended early because of the high rate of serious adverse events in the warfarin patients.

In addition to being safer for patients, the researchers said, aspirin therapy did not require constant monitoring of international normalized ratios (INRs) and treatment of warfarin-associated bleeding. Aspirin also is much cheaper, the investigators noted (N. Engl. J. Med. 2005;352:1305–16).

Ralph Sacco, M.D., an investigator in the Northern Manhattan Stroke Study, noted in an interview that the WASID trial's findings add to existing data to dispel beliefs about the benefit of warfarin for certain stroke populations.

The conclusion that warfarin provides no survival benefit over aspirin, but confers added risk, is more expensive, and requires intensive monitoring, should reshape its risk/benefit profile for some patients, said Dr. Sacco, professor of neurology and epidemiology at Columbia University, New York.

Dr. Chimowitz and his associates reported on the trial's final analysis that included 569 patients with symptomatic intracranial arterial stenosis who were randomized to either warfarin 5 mg daily or aspirin 650 mg twice daily.

The patients' mean age was about 63 years; about 61% were men. All had a history of either stroke or transient ischemic attack caused by 50%–90% stenosis of a major intracranial artery. The mean follow-up was 1.8 years.

The primary outcome–stroke, brain hemorrhage, or death from vascular causes other than stroke–occurred in 22% (62) of the aspirin patients and 21.8% (63) of the warfarin patients. Myocardial infarction or sudden death occurred significantly more often in the warfarin group than in the aspirin group (7.3% vs. 2.9%).

The overall rate of death was significantly higher in the warfarin group than in the aspirin group: 5.9% (17) vs. 4.3% (12). However, chance probably accounted for some of the deaths that were higher in the warfarin group, especially the six cancers.

Major hemorrhages occurred significantly more often in the warfarin group (8.3% vs. 3.2%). Brain hemorrhage occurred in 2 warfarin patients and 1 aspirin patient; gastrointestinal hemorrhage in 10 warfarin patients and 6 aspirin patients; ocular hemorrhage in 4 warfarin patients and 1 aspirin patient; genitourinary hemorrhage in 3 warfarin patients; aortic aneurysm in 1 aspirin patient; and other bleeds in 4 warfarin patients.

In a posthoc analysis, INRs of less than 2.0 were associated with a significantly higher risk of ischemic stroke and major cardiac events, and INRs of 3.0 or greater were associated with a significantly higher risk of hemorrhage, than were INRs in the therapeutic range of 2.0–3.0.

In an accompanying editorial, Walter Koroshetz, M.D., said the observed mortality differences could be due to a failure to keep patients at a therapeutic level of anticoagulation. Warfarin subjects obtained optimal anticoagulation (INR 2.0–3.0) only 63% of the time. The rate of major cardiac events was 10.8 per 100 patient-years with a subtherapeutic INR, but only 0.4 per 100 patient-years with a therapeutic INR.

“Unfortunately, it is extremely difficult, if not impossible, to achieve a consistent therapeutic INR with warfarin in a population study or in routine practice,” said Dr. Koroshetz of Massachusetts General Hospital, Boston.

“Two large studies have been negative for warfarin in noncardioembolic stroke,” Dr. Sacco noted. “And one of these was also stopped early due to adverse events and no signal that warfarin's benefit was greater than aspirin.”

In-office testing of semantic memory may be an easy and quite sensitive early diagnostic tool for Alzheimer's disease, suggested Asmus Vogel, a Ph.D. student in the memory disorders research unit at Copenhagen University Hospital, and colleagues.

They concluded that semantic memory deficits occur even in predementia Alzheimer's patients, perhaps due to the early development of neurofibrillary tangles in the temporal neocortex. Short neuropsychological tests with semantic content may be a valuable tool for assessing patients with suspected AD, the investigators said (Dement. Geriatr. Cogn. Disord. 2005;19:75–81).

In their prospective study, the researchers administered five neuropsychological tests focusing on semantic memory to a total of 182 elderly subjects, including 58 healthy controls, 22 patients with predementia AD, and 102 patients with mild AD. The average age was 74 years.

The majority of mild AD patients had mild or moderate semantic impairment, and 25% had severe impairment (deficits on four of the five tests). Among predementia patients, 59% had below normal scores on at least one test, although only 9% were impaired on three or more tests.

The high frequency of semantic dysfunction in the earliest stages of AD has important clinical implications, they said. “First, semantic memory tests may be sensitive diagnostic tests in the assessment of patients suspected to have dementia. … Further, tests for semantic memory have been found to correlate strongly with patients' functional performance. This correlation highlights that assessment of semantic memory is important in early AD when trying to identify patients in need of professional assistance and care.”

In-office testing of semantic memory may be an easy and quite sensitive early diagnostic tool for Alzheimer's disease, suggested Asmus Vogel, a Ph.D. student in the memory disorders research unit at Copenhagen University Hospital, and colleagues.

They concluded that semantic memory deficits occur even in predementia Alzheimer's patients, perhaps due to the early development of neurofibrillary tangles in the temporal neocortex. Short neuropsychological tests with semantic content may be a valuable tool for assessing patients with suspected AD, the investigators said (Dement. Geriatr. Cogn. Disord. 2005;19:75–81).

In their prospective study, the researchers administered five neuropsychological tests focusing on semantic memory to a total of 182 elderly subjects, including 58 healthy controls, 22 patients with predementia AD, and 102 patients with mild AD. The average age was 74 years.

The majority of mild AD patients had mild or moderate semantic impairment, and 25% had severe impairment (deficits on four of the five tests). Among predementia patients, 59% had below normal scores on at least one test, although only 9% were impaired on three or more tests.

The high frequency of semantic dysfunction in the earliest stages of AD has important clinical implications, they said. “First, semantic memory tests may be sensitive diagnostic tests in the assessment of patients suspected to have dementia. … Further, tests for semantic memory have been found to correlate strongly with patients' functional performance. This correlation highlights that assessment of semantic memory is important in early AD when trying to identify patients in need of professional assistance and care.”

In-office testing of semantic memory may be an easy and quite sensitive early diagnostic tool for Alzheimer's disease, suggested Asmus Vogel, a Ph.D. student in the memory disorders research unit at Copenhagen University Hospital, and colleagues.

They concluded that semantic memory deficits occur even in predementia Alzheimer's patients, perhaps due to the early development of neurofibrillary tangles in the temporal neocortex. Short neuropsychological tests with semantic content may be a valuable tool for assessing patients with suspected AD, the investigators said (Dement. Geriatr. Cogn. Disord. 2005;19:75–81).

In their prospective study, the researchers administered five neuropsychological tests focusing on semantic memory to a total of 182 elderly subjects, including 58 healthy controls, 22 patients with predementia AD, and 102 patients with mild AD. The average age was 74 years.

The majority of mild AD patients had mild or moderate semantic impairment, and 25% had severe impairment (deficits on four of the five tests). Among predementia patients, 59% had below normal scores on at least one test, although only 9% were impaired on three or more tests.

The high frequency of semantic dysfunction in the earliest stages of AD has important clinical implications, they said. “First, semantic memory tests may be sensitive diagnostic tests in the assessment of patients suspected to have dementia. … Further, tests for semantic memory have been found to correlate strongly with patients' functional performance. This correlation highlights that assessment of semantic memory is important in early AD when trying to identify patients in need of professional assistance and care.”

Acupuncture and stabilizing exercises are effective adjuncts to standard treatment for pelvic girdle pain in pregnancy, Swedish researchers reported.

When combined with standard therapy, both acupuncture and stabilizing exercises provided more pain relief than standard therapy alone. Acupuncture combined with standard therapy produced the best pain relief, said Helen Elden, a midwife at East Hospital, Sahlgrenska Academy, Gothenburg, Sweden, and her associates.

“This study shows that methods other than structured physiotherapy may be effective in treating pelvic pain in pregnancy and that acupuncture presents an effective alternative,” the researchers said (BMJ 2005;330:761).

The study included 386 pregnant women with pelvic girdle pain. The average age was 30 years, and all were singleton pregnancies. About 54% said they had previously experienced low back pain.

The women were randomized to 6 weeks of standard treatment (education, pelvic belt, and abdominal and gluteal strengthening exercises); standard therapy plus 30-minute acupuncture treatments twice a week; or standard therapy plus 6 hours/week of exercises for stabilizing pelvis and back and increasing hip rotator circulation and massage and stretching of hip extensors.

Pain was assessed by a visual analog scale at baseline at 1 week following the conclusion of therapy.

Those on standard therapy plus acupuncture had the biggest decrease in pain; morning pain scores fell from 23 to 15, and evening scores fell from 65 to 31.

The group on standard therapy plus stabilizing exercises improved, but not as much; morning scores fell from 22 to 18. Evening scores fell from 60 to 45.

In the standard-therapy group, morning scores rose from 23 to 27. Evening scores fell from 63 to 58.

It's not clear how stabilizing exercises reduce pelvic pain, but research has shown that contraction of the transversus abdominis decreases laxity of the sacroiliac joint. Massage and stretching also may have contributed to relief, they noted.

They speculated that acupuncture relieved pain by activating the segmental pain inhibitory system and boosting secretion of endogenous opioids.

Acupuncture and stabilizing exercises are effective adjuncts to standard treatment for pelvic girdle pain in pregnancy, Swedish researchers reported.

When combined with standard therapy, both acupuncture and stabilizing exercises provided more pain relief than standard therapy alone. Acupuncture combined with standard therapy produced the best pain relief, said Helen Elden, a midwife at East Hospital, Sahlgrenska Academy, Gothenburg, Sweden, and her associates.

“This study shows that methods other than structured physiotherapy may be effective in treating pelvic pain in pregnancy and that acupuncture presents an effective alternative,” the researchers said (BMJ 2005;330:761).

The study included 386 pregnant women with pelvic girdle pain. The average age was 30 years, and all were singleton pregnancies. About 54% said they had previously experienced low back pain.

The women were randomized to 6 weeks of standard treatment (education, pelvic belt, and abdominal and gluteal strengthening exercises); standard therapy plus 30-minute acupuncture treatments twice a week; or standard therapy plus 6 hours/week of exercises for stabilizing pelvis and back and increasing hip rotator circulation and massage and stretching of hip extensors.

Pain was assessed by a visual analog scale at baseline at 1 week following the conclusion of therapy.

Those on standard therapy plus acupuncture had the biggest decrease in pain; morning pain scores fell from 23 to 15, and evening scores fell from 65 to 31.

The group on standard therapy plus stabilizing exercises improved, but not as much; morning scores fell from 22 to 18. Evening scores fell from 60 to 45.

In the standard-therapy group, morning scores rose from 23 to 27. Evening scores fell from 63 to 58.

It's not clear how stabilizing exercises reduce pelvic pain, but research has shown that contraction of the transversus abdominis decreases laxity of the sacroiliac joint. Massage and stretching also may have contributed to relief, they noted.

They speculated that acupuncture relieved pain by activating the segmental pain inhibitory system and boosting secretion of endogenous opioids.

Acupuncture and stabilizing exercises are effective adjuncts to standard treatment for pelvic girdle pain in pregnancy, Swedish researchers reported.

When combined with standard therapy, both acupuncture and stabilizing exercises provided more pain relief than standard therapy alone. Acupuncture combined with standard therapy produced the best pain relief, said Helen Elden, a midwife at East Hospital, Sahlgrenska Academy, Gothenburg, Sweden, and her associates.

“This study shows that methods other than structured physiotherapy may be effective in treating pelvic pain in pregnancy and that acupuncture presents an effective alternative,” the researchers said (BMJ 2005;330:761).

The study included 386 pregnant women with pelvic girdle pain. The average age was 30 years, and all were singleton pregnancies. About 54% said they had previously experienced low back pain.

The women were randomized to 6 weeks of standard treatment (education, pelvic belt, and abdominal and gluteal strengthening exercises); standard therapy plus 30-minute acupuncture treatments twice a week; or standard therapy plus 6 hours/week of exercises for stabilizing pelvis and back and increasing hip rotator circulation and massage and stretching of hip extensors.

Pain was assessed by a visual analog scale at baseline at 1 week following the conclusion of therapy.

Those on standard therapy plus acupuncture had the biggest decrease in pain; morning pain scores fell from 23 to 15, and evening scores fell from 65 to 31.

The group on standard therapy plus stabilizing exercises improved, but not as much; morning scores fell from 22 to 18. Evening scores fell from 60 to 45.

In the standard-therapy group, morning scores rose from 23 to 27. Evening scores fell from 63 to 58.

It's not clear how stabilizing exercises reduce pelvic pain, but research has shown that contraction of the transversus abdominis decreases laxity of the sacroiliac joint. Massage and stretching also may have contributed to relief, they noted.

They speculated that acupuncture relieved pain by activating the segmental pain inhibitory system and boosting secretion of endogenous opioids.