Patrice Wendling

CHICAGO — Proton magnetic resonance spectroscopy could represent a fundamental, noninvasive diagnostic and monitoring tool for patients with brain concussions, Dr. Andre Ludovici said at the annual meeting of the Radiological Society of North America.

Current imaging with computed tomography or magnetic resonance imaging does not permit quantification of neural injury that occurs after a traumatic concussion. But proton magnetic resonance spectroscopic (1HMRS) imaging can be used to assess the neurochemical damage derived from a cerebral concussion by monitoring N-acetyl-L-aspartate (NAA) levels over time.

Current research indicates that NAA diminution appears to be linked to a general mitochondrial dysfunction, and therefore, NAA restoration can be considered a surrogate marker of metabolic recovery, said Dr. Ludovici of the University of Rome Tor Vergata.

He presented data from a pilot study in which 1HMRS was used to measure the levels of NAA and choline (Cho) relative to creatine (Cr) in the brains of 32 male contact sport players. Of these, 14 had suffered concussions, and had Glasgow Coma Scale scores between 13 and 15. The 1HMRS signal was collected from a single voxel placed bilaterally in the subcortical frontal white matter. Scans were performed after a 3-month period of inactivity, until the third day following a match, and at the 10th and 30th day after the injury had occurred.

The patients were boxers and kick boxers, with a mean age of 21 years. Three patients did not complete the study, and one was excluded because of a cerebral bleed.

The average NAA/Cr ratio was significantly lower at the first time point among concussive patients compared with healthy patients (1.83 vs. 2.11), he said. At 10 days, the NAA/Cr ratio showed a trend toward normalization, and at 30 days there was a complete recovery of baseline NAA values.

From baseline, there was a 35% reduction in NAA levels among concussive patients. There was no significant difference in the NAA/Cho ratio between groups at the three time points, he said. All patients were held back from sports until their NAA values normalized.

CHICAGO — Proton magnetic resonance spectroscopy could represent a fundamental, noninvasive diagnostic and monitoring tool for patients with brain concussions, Dr. Andre Ludovici said at the annual meeting of the Radiological Society of North America.

Current imaging with computed tomography or magnetic resonance imaging does not permit quantification of neural injury that occurs after a traumatic concussion. But proton magnetic resonance spectroscopic (1HMRS) imaging can be used to assess the neurochemical damage derived from a cerebral concussion by monitoring N-acetyl-L-aspartate (NAA) levels over time.

Current research indicates that NAA diminution appears to be linked to a general mitochondrial dysfunction, and therefore, NAA restoration can be considered a surrogate marker of metabolic recovery, said Dr. Ludovici of the University of Rome Tor Vergata.

He presented data from a pilot study in which 1HMRS was used to measure the levels of NAA and choline (Cho) relative to creatine (Cr) in the brains of 32 male contact sport players. Of these, 14 had suffered concussions, and had Glasgow Coma Scale scores between 13 and 15. The 1HMRS signal was collected from a single voxel placed bilaterally in the subcortical frontal white matter. Scans were performed after a 3-month period of inactivity, until the third day following a match, and at the 10th and 30th day after the injury had occurred.

The patients were boxers and kick boxers, with a mean age of 21 years. Three patients did not complete the study, and one was excluded because of a cerebral bleed.

The average NAA/Cr ratio was significantly lower at the first time point among concussive patients compared with healthy patients (1.83 vs. 2.11), he said. At 10 days, the NAA/Cr ratio showed a trend toward normalization, and at 30 days there was a complete recovery of baseline NAA values.

From baseline, there was a 35% reduction in NAA levels among concussive patients. There was no significant difference in the NAA/Cho ratio between groups at the three time points, he said. All patients were held back from sports until their NAA values normalized.

CHICAGO — Proton magnetic resonance spectroscopy could represent a fundamental, noninvasive diagnostic and monitoring tool for patients with brain concussions, Dr. Andre Ludovici said at the annual meeting of the Radiological Society of North America.

Current imaging with computed tomography or magnetic resonance imaging does not permit quantification of neural injury that occurs after a traumatic concussion. But proton magnetic resonance spectroscopic (1HMRS) imaging can be used to assess the neurochemical damage derived from a cerebral concussion by monitoring N-acetyl-L-aspartate (NAA) levels over time.

Current research indicates that NAA diminution appears to be linked to a general mitochondrial dysfunction, and therefore, NAA restoration can be considered a surrogate marker of metabolic recovery, said Dr. Ludovici of the University of Rome Tor Vergata.

He presented data from a pilot study in which 1HMRS was used to measure the levels of NAA and choline (Cho) relative to creatine (Cr) in the brains of 32 male contact sport players. Of these, 14 had suffered concussions, and had Glasgow Coma Scale scores between 13 and 15. The 1HMRS signal was collected from a single voxel placed bilaterally in the subcortical frontal white matter. Scans were performed after a 3-month period of inactivity, until the third day following a match, and at the 10th and 30th day after the injury had occurred.

The patients were boxers and kick boxers, with a mean age of 21 years. Three patients did not complete the study, and one was excluded because of a cerebral bleed.

The average NAA/Cr ratio was significantly lower at the first time point among concussive patients compared with healthy patients (1.83 vs. 2.11), he said. At 10 days, the NAA/Cr ratio showed a trend toward normalization, and at 30 days there was a complete recovery of baseline NAA values.

From baseline, there was a 35% reduction in NAA levels among concussive patients. There was no significant difference in the NAA/Cho ratio between groups at the three time points, he said. All patients were held back from sports until their NAA values normalized.

TUCSON, ARIZ. — Physicians are divided over whether it is ethical to use free sample medications in their practices, Nancy Sohler, Ph.D., and Dr. Diane McKee reported at the annual meeting of the North American Primary Care Research Group.

Accepting samples was viewed either as being ethically questionable or as a useful way of helping provide health care to low-income patients, according to findings from a study of 24 family medicine and general internal medicine physicians, nurses, and administrators in practices affiliated with a large urban medical center serving low- and middle-income patients in New York.

Interactions with pharmaceutical representatives were viewed as a direct conflict of interest, an influence that could be controlled, or a source of useful information. Of the total, 10 respondents felt that they could control the influence of drug firm representatives by keeping them away from residents, by setting limits on what gifts or favors could be accepted, or by always being mindful that representatives are selling a product, Dr. Sohler said in an interview.

For the respondents who drew a hard ethical line, “it wasn't that they thought giving out samples [to patients] was unethical, but that it wasn't good practice,” she said.

Those who accepted samples said inadequacies in the health care system forced them to rely on gifts to care for their most needy patients.

All the respondents evaluated marketing practices from the perspective of protecting and serving their patients, said Dr. Sohler, professor of community health and social medicine, City University of New York, New York. No one was concerned that physicians were ignoring clinical symptoms to prescribe the “right drugs.”

The study included in-depth, qualitative interviews and was prompted by an administrative decision at the medical center to ban samples and pharmaceutical representatives from the community practices. That decision left many providers uncertain about how to care for patients without adequate health care coverage. Others suggested that the policy was changed because the administration didn't want physicians taking the time to talk to sales representatives, didn't trust that staff would avoid entering into agreements with pharmaceutical firms, and did want a single policy, because teaching sites had a “no-rep” policy and other sites didn't need samples.

She said further study would be needed to determine whether samples help poor patients more than they harm them, and whether representatives influence prescribing practices in mostly helpful or harmful ways. “The empirical, quantitative evidence isn't good on whether free medications help or harm our patients,” she said.

TUCSON, ARIZ. — Physicians are divided over whether it is ethical to use free sample medications in their practices, Nancy Sohler, Ph.D., and Dr. Diane McKee reported at the annual meeting of the North American Primary Care Research Group.

Accepting samples was viewed either as being ethically questionable or as a useful way of helping provide health care to low-income patients, according to findings from a study of 24 family medicine and general internal medicine physicians, nurses, and administrators in practices affiliated with a large urban medical center serving low- and middle-income patients in New York.

Interactions with pharmaceutical representatives were viewed as a direct conflict of interest, an influence that could be controlled, or a source of useful information. Of the total, 10 respondents felt that they could control the influence of drug firm representatives by keeping them away from residents, by setting limits on what gifts or favors could be accepted, or by always being mindful that representatives are selling a product, Dr. Sohler said in an interview.

For the respondents who drew a hard ethical line, “it wasn't that they thought giving out samples [to patients] was unethical, but that it wasn't good practice,” she said.

Those who accepted samples said inadequacies in the health care system forced them to rely on gifts to care for their most needy patients.

All the respondents evaluated marketing practices from the perspective of protecting and serving their patients, said Dr. Sohler, professor of community health and social medicine, City University of New York, New York. No one was concerned that physicians were ignoring clinical symptoms to prescribe the “right drugs.”

The study included in-depth, qualitative interviews and was prompted by an administrative decision at the medical center to ban samples and pharmaceutical representatives from the community practices. That decision left many providers uncertain about how to care for patients without adequate health care coverage. Others suggested that the policy was changed because the administration didn't want physicians taking the time to talk to sales representatives, didn't trust that staff would avoid entering into agreements with pharmaceutical firms, and did want a single policy, because teaching sites had a “no-rep” policy and other sites didn't need samples.

She said further study would be needed to determine whether samples help poor patients more than they harm them, and whether representatives influence prescribing practices in mostly helpful or harmful ways. “The empirical, quantitative evidence isn't good on whether free medications help or harm our patients,” she said.

TUCSON, ARIZ. — Physicians are divided over whether it is ethical to use free sample medications in their practices, Nancy Sohler, Ph.D., and Dr. Diane McKee reported at the annual meeting of the North American Primary Care Research Group.

Accepting samples was viewed either as being ethically questionable or as a useful way of helping provide health care to low-income patients, according to findings from a study of 24 family medicine and general internal medicine physicians, nurses, and administrators in practices affiliated with a large urban medical center serving low- and middle-income patients in New York.

Interactions with pharmaceutical representatives were viewed as a direct conflict of interest, an influence that could be controlled, or a source of useful information. Of the total, 10 respondents felt that they could control the influence of drug firm representatives by keeping them away from residents, by setting limits on what gifts or favors could be accepted, or by always being mindful that representatives are selling a product, Dr. Sohler said in an interview.

For the respondents who drew a hard ethical line, “it wasn't that they thought giving out samples [to patients] was unethical, but that it wasn't good practice,” she said.

Those who accepted samples said inadequacies in the health care system forced them to rely on gifts to care for their most needy patients.

All the respondents evaluated marketing practices from the perspective of protecting and serving their patients, said Dr. Sohler, professor of community health and social medicine, City University of New York, New York. No one was concerned that physicians were ignoring clinical symptoms to prescribe the “right drugs.”

The study included in-depth, qualitative interviews and was prompted by an administrative decision at the medical center to ban samples and pharmaceutical representatives from the community practices. That decision left many providers uncertain about how to care for patients without adequate health care coverage. Others suggested that the policy was changed because the administration didn't want physicians taking the time to talk to sales representatives, didn't trust that staff would avoid entering into agreements with pharmaceutical firms, and did want a single policy, because teaching sites had a “no-rep” policy and other sites didn't need samples.

She said further study would be needed to determine whether samples help poor patients more than they harm them, and whether representatives influence prescribing practices in mostly helpful or harmful ways. “The empirical, quantitative evidence isn't good on whether free medications help or harm our patients,” she said.

MONTREAL — The use of palivizumab prophylaxis significantly decreased the hospitalization rate for acute respiratory illness in infants with cystic fibrosis, Dr. Karin Giebels said at the International Congress on Pediatric Pulmonology.

Infants with cystic fibrosis are at increased risk for hospitalization for lower respiratory tract infections caused by respiratory syncytial virus (RSV), and may suffer long-term airway inflammation and damage as a result of an RSV infection.

Palivizumab (Synagis), a humanized monoclonal antibody, is indicated for the prevention of serious lower respiratory tract disease caused by RSV in high-risk pediatric patients, but has not been recommended by advisory panels in the United States and Canada as a prophylaxis in infants with cystic fibrosis, said Dr. Giebels, of Sainte-Justine Hospital in Montreal.

She presented data from a retrospective study of 63 infants who were born between 1999 and 2005 and diagnosed with cystic fibrosis before 18 months of age.

MONTREAL — The use of palivizumab prophylaxis significantly decreased the hospitalization rate for acute respiratory illness in infants with cystic fibrosis, Dr. Karin Giebels said at the International Congress on Pediatric Pulmonology.

Infants with cystic fibrosis are at increased risk for hospitalization for lower respiratory tract infections caused by respiratory syncytial virus (RSV), and may suffer long-term airway inflammation and damage as a result of an RSV infection.

Palivizumab (Synagis), a humanized monoclonal antibody, is indicated for the prevention of serious lower respiratory tract disease caused by RSV in high-risk pediatric patients, but has not been recommended by advisory panels in the United States and Canada as a prophylaxis in infants with cystic fibrosis, said Dr. Giebels, of Sainte-Justine Hospital in Montreal.

She presented data from a retrospective study of 63 infants who were born between 1999 and 2005 and diagnosed with cystic fibrosis before 18 months of age.

MONTREAL — The use of palivizumab prophylaxis significantly decreased the hospitalization rate for acute respiratory illness in infants with cystic fibrosis, Dr. Karin Giebels said at the International Congress on Pediatric Pulmonology.

Infants with cystic fibrosis are at increased risk for hospitalization for lower respiratory tract infections caused by respiratory syncytial virus (RSV), and may suffer long-term airway inflammation and damage as a result of an RSV infection.

Palivizumab (Synagis), a humanized monoclonal antibody, is indicated for the prevention of serious lower respiratory tract disease caused by RSV in high-risk pediatric patients, but has not been recommended by advisory panels in the United States and Canada as a prophylaxis in infants with cystic fibrosis, said Dr. Giebels, of Sainte-Justine Hospital in Montreal.

She presented data from a retrospective study of 63 infants who were born between 1999 and 2005 and diagnosed with cystic fibrosis before 18 months of age.

CHICAGO — Focal cryoablation results in better local control of prostate cancer than other standard treatments, Dr. Gary Onik said at the annual meeting of the Radiological Society of North America.

“This is a very aggressive treatment, even though it is focal,” said Dr. Onik, director of surgical imaging, Celebration Health/Florida Hospital in Celebration.

Pathologic literature indicates that up to 25% of prostate cancers are unifocal, and that 80% of cases would be appropriate for lumpectomy, he said.

Dr. Onik has performed focal cryoablation on 96 patients with prostate cancer, and has obtained data on 55 patients with at least 1 year of follow-up (range 1–10 years). Prostate-specific antigen (PSA) tests were obtained every 3 months for 2 years, and every 6 months thereafter. Routine biopsies were obtained in the first 26 patients, and all were negative.

At an average of 3.5 years of follow-up, 52 (94.5%) of the 55 patients had stable PSA levels, and were disease-free according to American Society for Therapeutic Radiology and Oncology criteria. Although four patients had to be re-treated after cancer was found in another area of the prostate, there have been no recurrences in treated areas. The results are noteworthy as 29 of the 55 patients were at medium to high risk for recurrence, he said.

Before the procedure, 51 men were potent. After the lumpectomy, 44 (86%) of those 51 men were potent to their satisfaction. All patients were immediately continent.

Lumpectomy candidates are patients with a unifocal tumor or one large index tumor and another small tumor less than 5 mm in diameter. The procedure would not be advised for those with diffuse disease.

When asked by the audience if there is any volume of tumor that he would not treat, Dr. Onik said the critical point is that the disease should be focal, but added that 1 in 10 of the treatments now are for extracapsular disease in which the whole side of the gland is involved.

The key to prostate cryoablation is accurate identification of cancer stage, grade, and location. Standard transrectal ultrasound biopsy results are not sensitive enough, according to Dr. Onik, who has switched to a new 3D biopsy mapping technique.

A prostate cancer patient is shown before (left) and 2 years after focal therapy. Although half of his gland is gone, he is potent and continent 6 years later without evidence of disease. Photos couresty Dr. Gary Onik

CHICAGO — Focal cryoablation results in better local control of prostate cancer than other standard treatments, Dr. Gary Onik said at the annual meeting of the Radiological Society of North America.

“This is a very aggressive treatment, even though it is focal,” said Dr. Onik, director of surgical imaging, Celebration Health/Florida Hospital in Celebration.

Pathologic literature indicates that up to 25% of prostate cancers are unifocal, and that 80% of cases would be appropriate for lumpectomy, he said.

Dr. Onik has performed focal cryoablation on 96 patients with prostate cancer, and has obtained data on 55 patients with at least 1 year of follow-up (range 1–10 years). Prostate-specific antigen (PSA) tests were obtained every 3 months for 2 years, and every 6 months thereafter. Routine biopsies were obtained in the first 26 patients, and all were negative.

At an average of 3.5 years of follow-up, 52 (94.5%) of the 55 patients had stable PSA levels, and were disease-free according to American Society for Therapeutic Radiology and Oncology criteria. Although four patients had to be re-treated after cancer was found in another area of the prostate, there have been no recurrences in treated areas. The results are noteworthy as 29 of the 55 patients were at medium to high risk for recurrence, he said.

Before the procedure, 51 men were potent. After the lumpectomy, 44 (86%) of those 51 men were potent to their satisfaction. All patients were immediately continent.

Lumpectomy candidates are patients with a unifocal tumor or one large index tumor and another small tumor less than 5 mm in diameter. The procedure would not be advised for those with diffuse disease.

When asked by the audience if there is any volume of tumor that he would not treat, Dr. Onik said the critical point is that the disease should be focal, but added that 1 in 10 of the treatments now are for extracapsular disease in which the whole side of the gland is involved.

The key to prostate cryoablation is accurate identification of cancer stage, grade, and location. Standard transrectal ultrasound biopsy results are not sensitive enough, according to Dr. Onik, who has switched to a new 3D biopsy mapping technique.

A prostate cancer patient is shown before (left) and 2 years after focal therapy. Although half of his gland is gone, he is potent and continent 6 years later without evidence of disease. Photos couresty Dr. Gary Onik

CHICAGO — Focal cryoablation results in better local control of prostate cancer than other standard treatments, Dr. Gary Onik said at the annual meeting of the Radiological Society of North America.

“This is a very aggressive treatment, even though it is focal,” said Dr. Onik, director of surgical imaging, Celebration Health/Florida Hospital in Celebration.

Pathologic literature indicates that up to 25% of prostate cancers are unifocal, and that 80% of cases would be appropriate for lumpectomy, he said.

Dr. Onik has performed focal cryoablation on 96 patients with prostate cancer, and has obtained data on 55 patients with at least 1 year of follow-up (range 1–10 years). Prostate-specific antigen (PSA) tests were obtained every 3 months for 2 years, and every 6 months thereafter. Routine biopsies were obtained in the first 26 patients, and all were negative.

At an average of 3.5 years of follow-up, 52 (94.5%) of the 55 patients had stable PSA levels, and were disease-free according to American Society for Therapeutic Radiology and Oncology criteria. Although four patients had to be re-treated after cancer was found in another area of the prostate, there have been no recurrences in treated areas. The results are noteworthy as 29 of the 55 patients were at medium to high risk for recurrence, he said.

Before the procedure, 51 men were potent. After the lumpectomy, 44 (86%) of those 51 men were potent to their satisfaction. All patients were immediately continent.

Lumpectomy candidates are patients with a unifocal tumor or one large index tumor and another small tumor less than 5 mm in diameter. The procedure would not be advised for those with diffuse disease.

When asked by the audience if there is any volume of tumor that he would not treat, Dr. Onik said the critical point is that the disease should be focal, but added that 1 in 10 of the treatments now are for extracapsular disease in which the whole side of the gland is involved.

The key to prostate cryoablation is accurate identification of cancer stage, grade, and location. Standard transrectal ultrasound biopsy results are not sensitive enough, according to Dr. Onik, who has switched to a new 3D biopsy mapping technique.

A prostate cancer patient is shown before (left) and 2 years after focal therapy. Although half of his gland is gone, he is potent and continent 6 years later without evidence of disease. Photos couresty Dr. Gary Onik

TUCSON, ARIZ. — Depression is a risk factor for poor glycemic control in diabetic patients infected with hepatitis C, according to an analysis of data from a preliminary cohort study in 462 patients.

The association between depression and glycemic control is noncausal at this point, but warrants further study and attention by family physicians, said Dr. Anthony Valdini, research director of the Greater Lawrence Family Health Center, Lawrence, Mass.

Diabetes mellitus type 2 (DM2) and depression are common comorbidities among patients infected with the hepatitis C virus (HCV). Interferon, a major component of HCV therapy, often is a cause of depression. But physicians have been hesitant to prescribe antidepressants in this population because of what Dr. Valdini believes are unfounded fears of liver complications.

“This is a group that is miserable,” Dr. Valdini said during a poster presentation at the annual meeting of the North American Primary Care Research Group. “In some series, you will get up to 58% of people who are depressed, so it's really cruel to treat them for hepatitis C and not offer them therapy for their depression.”

Dr. Valdini and colleagues used data from the hepatitis C registry to identify 462 patients with hepatitis C, aged 21 years or older, who had visited an inner-city community health center between April 2003 and April 2005.

Patients were coded as either depressed or diabetic if these diagnoses were found in their medical records. The most recent hemoglobin A_1c (HbA_1c) value was used for calculations. They compared hepatitis-positive diabetics with and without depression by using chi-squared statistics, after categorizing HbA_1c results into tertiles representing levels of glycemic control (<7%, 7%–9.5%, >9.5%).

Overall, 139 patients (30%) were depressed and 83 (18%) had DM2. Of the diabetic patients, 28 (34%) were depressed. Mean HbA_1c for the diabetic plus depressed group was 7.5%, compared with 7.2% for the nondepressed diabetic group. The mean ages were similar (54 years vs. 55 years).

Although there were more men than women in both the depressed and nondepressed groups, there were no significant differences in their proportions across the glycemic control categories. All of the diabetic patients received education on glycemic control and have access to dieticians and diabetes nurse educators, Dr. Valdini noted.

Full data available on 26 patients in the depressed group show that 12 patients (46%) at the target HbA_1c of <7%, whereas the nondepressed diabetics were at target in 31 of 52 (60%) cases, the authors reported. This difference was significant when tested with chi-squared statistics.

TUCSON, ARIZ. — Depression is a risk factor for poor glycemic control in diabetic patients infected with hepatitis C, according to an analysis of data from a preliminary cohort study in 462 patients.

The association between depression and glycemic control is noncausal at this point, but warrants further study and attention by family physicians, said Dr. Anthony Valdini, research director of the Greater Lawrence Family Health Center, Lawrence, Mass.

Diabetes mellitus type 2 (DM2) and depression are common comorbidities among patients infected with the hepatitis C virus (HCV). Interferon, a major component of HCV therapy, often is a cause of depression. But physicians have been hesitant to prescribe antidepressants in this population because of what Dr. Valdini believes are unfounded fears of liver complications.

“This is a group that is miserable,” Dr. Valdini said during a poster presentation at the annual meeting of the North American Primary Care Research Group. “In some series, you will get up to 58% of people who are depressed, so it's really cruel to treat them for hepatitis C and not offer them therapy for their depression.”

Dr. Valdini and colleagues used data from the hepatitis C registry to identify 462 patients with hepatitis C, aged 21 years or older, who had visited an inner-city community health center between April 2003 and April 2005.

Patients were coded as either depressed or diabetic if these diagnoses were found in their medical records. The most recent hemoglobin A_1c (HbA_1c) value was used for calculations. They compared hepatitis-positive diabetics with and without depression by using chi-squared statistics, after categorizing HbA_1c results into tertiles representing levels of glycemic control (<7%, 7%–9.5%, >9.5%).

Overall, 139 patients (30%) were depressed and 83 (18%) had DM2. Of the diabetic patients, 28 (34%) were depressed. Mean HbA_1c for the diabetic plus depressed group was 7.5%, compared with 7.2% for the nondepressed diabetic group. The mean ages were similar (54 years vs. 55 years).

Although there were more men than women in both the depressed and nondepressed groups, there were no significant differences in their proportions across the glycemic control categories. All of the diabetic patients received education on glycemic control and have access to dieticians and diabetes nurse educators, Dr. Valdini noted.

Full data available on 26 patients in the depressed group show that 12 patients (46%) at the target HbA_1c of <7%, whereas the nondepressed diabetics were at target in 31 of 52 (60%) cases, the authors reported. This difference was significant when tested with chi-squared statistics.

TUCSON, ARIZ. — Depression is a risk factor for poor glycemic control in diabetic patients infected with hepatitis C, according to an analysis of data from a preliminary cohort study in 462 patients.

The association between depression and glycemic control is noncausal at this point, but warrants further study and attention by family physicians, said Dr. Anthony Valdini, research director of the Greater Lawrence Family Health Center, Lawrence, Mass.

Diabetes mellitus type 2 (DM2) and depression are common comorbidities among patients infected with the hepatitis C virus (HCV). Interferon, a major component of HCV therapy, often is a cause of depression. But physicians have been hesitant to prescribe antidepressants in this population because of what Dr. Valdini believes are unfounded fears of liver complications.

“This is a group that is miserable,” Dr. Valdini said during a poster presentation at the annual meeting of the North American Primary Care Research Group. “In some series, you will get up to 58% of people who are depressed, so it's really cruel to treat them for hepatitis C and not offer them therapy for their depression.”

Dr. Valdini and colleagues used data from the hepatitis C registry to identify 462 patients with hepatitis C, aged 21 years or older, who had visited an inner-city community health center between April 2003 and April 2005.

Patients were coded as either depressed or diabetic if these diagnoses were found in their medical records. The most recent hemoglobin A_1c (HbA_1c) value was used for calculations. They compared hepatitis-positive diabetics with and without depression by using chi-squared statistics, after categorizing HbA_1c results into tertiles representing levels of glycemic control (<7%, 7%–9.5%, >9.5%).

Overall, 139 patients (30%) were depressed and 83 (18%) had DM2. Of the diabetic patients, 28 (34%) were depressed. Mean HbA_1c for the diabetic plus depressed group was 7.5%, compared with 7.2% for the nondepressed diabetic group. The mean ages were similar (54 years vs. 55 years).

Although there were more men than women in both the depressed and nondepressed groups, there were no significant differences in their proportions across the glycemic control categories. All of the diabetic patients received education on glycemic control and have access to dieticians and diabetes nurse educators, Dr. Valdini noted.

Full data available on 26 patients in the depressed group show that 12 patients (46%) at the target HbA_1c of <7%, whereas the nondepressed diabetics were at target in 31 of 52 (60%) cases, the authors reported. This difference was significant when tested with chi-squared statistics.

VERONA, ITALY — Newly developed consensus guidelines recommend thyroid-function screening in high-risk pregnant women, but stop short of calling for universal screening.

An international task force, under the auspices of the Endocrine Society, examined 10 key topics related to pregnancy and thyroid. The result was an 86-page document outlining 35 recommendations, many of which were reached after a diplomatic search for compromise, Dr. Daniel Glinoer said at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

The difficulty stemmed from the paucity of prospective randomized trials in the field, the contrasting approaches of various specialists on some issues, and the emergence of additional data even as the task force was writing the guidelines.

Despite compromises on many recommendations, the American College of Obstetricians and Gynecologists (ACOG) opted not to endorse the final guidelines. Dr. Sarah Kilpatrick, who represented ACOG on the task force, acknowledged the effort that went into the guidelines.

“The data available are not consistently good and there are still many differences of opinion between endocrinologists and perinatologists about how to interpret the data and best manage pregnant women,” Dr. Kilpatrick, professor and head of the department of ob.gyn. and vice dean of the college of medicine at the University of Illinois at Chicago, said in an interview.

For the purpose of screening, the task force identified high-risk women as those with a personal history of thyroid or autoimmune disorders; a family history of thyroid disorders; or a personal history of infertility or preterm delivery.

For maternal hypothyroidism, which affects 2.5%–3% of pregnant women, the task force recommends a targeted case-finding approach at the first prenatal visit or at diagnosis of pregnancy. The preconception thyroxine dosage should be adjusted to reach a serum thyroid-stimulating hormone (TSH) level no higher than 2.5 microIU/L. The thyroxine dosage usually needs to be incremented by 4–8 weeks of gestation, and these patients may require a 30%–50% increase in dosage, said Dr. Glinoer, who represented the European Thyroid Association on the task force and is chief of the thyroid investigation clinic at the Centre Hôpitalier Universitaire Saint-Pierre, Brussels.

If overt hypothyroidism is diagnosed during pregnancy, thyroid function tests should be normalized as rapidly as possible, in view of the potential obstetric complications and risks for the offspring associated with undisclosed prolonged hypothyroidism. Thyroxine dosage should be titrated to rapidly reach, and then maintain, serum TSH concentrations of less than 2.5 microIU/L in the first trimester or less than 3 microIU/L in the second and third trimesters, or to trimester-specific normal TSH ranges, which Dr. Glinoer admitted haven't been universally established.

There was a consensus against advising termination of pregnancy, even if overt hypothyroidism is diagnosed late, he said.

If a subnormal serum TSH concentration is detected, hyperthyroidism must be distinguished from both normal physiology and hyperemesis gravidarum because of the adverse effects of overt hyperthyroidism on mother and fetus. Antithyroid drug (ATD) therapy should be either initiated for those with a new diagnosis of hyperthyroidism resulting from Graves' disease or adjusted for those with a prior history to maintain maternal free thyroxine levels in the trimester-specific normal pregnancy range, if available, or near the upper limit of the nonpregnant reference range.

Data suggest methimazole may be associated with congenital anomalies, so the task force recommends propylthiouracil (PTU) as first-line medication, especially in the first trimester. Methimazole may be prescribed if PTU is unavailable, or a patient can't tolerate or has an adverse reaction to it.

The task force concluded that subtotal thyroidectomy may be indicated for maternal Graves' disease if there are severe adverse reactions to ATD therapy, if persistently high ATD doses are required, or if a patient is nonadherent to ATD therapy and has uncontrolled hyperthyroidism. Surgery is best in the second trimester. No data suggest treatment of subclinical hyperthyroidism improves pregnancy outcome, and it could adversely affect the fetus.

VERONA, ITALY — Newly developed consensus guidelines recommend thyroid-function screening in high-risk pregnant women, but stop short of calling for universal screening.

An international task force, under the auspices of the Endocrine Society, examined 10 key topics related to pregnancy and thyroid. The result was an 86-page document outlining 35 recommendations, many of which were reached after a diplomatic search for compromise, Dr. Daniel Glinoer said at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

The difficulty stemmed from the paucity of prospective randomized trials in the field, the contrasting approaches of various specialists on some issues, and the emergence of additional data even as the task force was writing the guidelines.

Despite compromises on many recommendations, the American College of Obstetricians and Gynecologists (ACOG) opted not to endorse the final guidelines. Dr. Sarah Kilpatrick, who represented ACOG on the task force, acknowledged the effort that went into the guidelines.

“The data available are not consistently good and there are still many differences of opinion between endocrinologists and perinatologists about how to interpret the data and best manage pregnant women,” Dr. Kilpatrick, professor and head of the department of ob.gyn. and vice dean of the college of medicine at the University of Illinois at Chicago, said in an interview.

For the purpose of screening, the task force identified high-risk women as those with a personal history of thyroid or autoimmune disorders; a family history of thyroid disorders; or a personal history of infertility or preterm delivery.

For maternal hypothyroidism, which affects 2.5%–3% of pregnant women, the task force recommends a targeted case-finding approach at the first prenatal visit or at diagnosis of pregnancy. The preconception thyroxine dosage should be adjusted to reach a serum thyroid-stimulating hormone (TSH) level no higher than 2.5 microIU/L. The thyroxine dosage usually needs to be incremented by 4–8 weeks of gestation, and these patients may require a 30%–50% increase in dosage, said Dr. Glinoer, who represented the European Thyroid Association on the task force and is chief of the thyroid investigation clinic at the Centre Hôpitalier Universitaire Saint-Pierre, Brussels.

If overt hypothyroidism is diagnosed during pregnancy, thyroid function tests should be normalized as rapidly as possible, in view of the potential obstetric complications and risks for the offspring associated with undisclosed prolonged hypothyroidism. Thyroxine dosage should be titrated to rapidly reach, and then maintain, serum TSH concentrations of less than 2.5 microIU/L in the first trimester or less than 3 microIU/L in the second and third trimesters, or to trimester-specific normal TSH ranges, which Dr. Glinoer admitted haven't been universally established.

There was a consensus against advising termination of pregnancy, even if overt hypothyroidism is diagnosed late, he said.

If a subnormal serum TSH concentration is detected, hyperthyroidism must be distinguished from both normal physiology and hyperemesis gravidarum because of the adverse effects of overt hyperthyroidism on mother and fetus. Antithyroid drug (ATD) therapy should be either initiated for those with a new diagnosis of hyperthyroidism resulting from Graves' disease or adjusted for those with a prior history to maintain maternal free thyroxine levels in the trimester-specific normal pregnancy range, if available, or near the upper limit of the nonpregnant reference range.

Data suggest methimazole may be associated with congenital anomalies, so the task force recommends propylthiouracil (PTU) as first-line medication, especially in the first trimester. Methimazole may be prescribed if PTU is unavailable, or a patient can't tolerate or has an adverse reaction to it.

The task force concluded that subtotal thyroidectomy may be indicated for maternal Graves' disease if there are severe adverse reactions to ATD therapy, if persistently high ATD doses are required, or if a patient is nonadherent to ATD therapy and has uncontrolled hyperthyroidism. Surgery is best in the second trimester. No data suggest treatment of subclinical hyperthyroidism improves pregnancy outcome, and it could adversely affect the fetus.

VERONA, ITALY — Newly developed consensus guidelines recommend thyroid-function screening in high-risk pregnant women, but stop short of calling for universal screening.

An international task force, under the auspices of the Endocrine Society, examined 10 key topics related to pregnancy and thyroid. The result was an 86-page document outlining 35 recommendations, many of which were reached after a diplomatic search for compromise, Dr. Daniel Glinoer said at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

The difficulty stemmed from the paucity of prospective randomized trials in the field, the contrasting approaches of various specialists on some issues, and the emergence of additional data even as the task force was writing the guidelines.

Despite compromises on many recommendations, the American College of Obstetricians and Gynecologists (ACOG) opted not to endorse the final guidelines. Dr. Sarah Kilpatrick, who represented ACOG on the task force, acknowledged the effort that went into the guidelines.

“The data available are not consistently good and there are still many differences of opinion between endocrinologists and perinatologists about how to interpret the data and best manage pregnant women,” Dr. Kilpatrick, professor and head of the department of ob.gyn. and vice dean of the college of medicine at the University of Illinois at Chicago, said in an interview.

For the purpose of screening, the task force identified high-risk women as those with a personal history of thyroid or autoimmune disorders; a family history of thyroid disorders; or a personal history of infertility or preterm delivery.

For maternal hypothyroidism, which affects 2.5%–3% of pregnant women, the task force recommends a targeted case-finding approach at the first prenatal visit or at diagnosis of pregnancy. The preconception thyroxine dosage should be adjusted to reach a serum thyroid-stimulating hormone (TSH) level no higher than 2.5 microIU/L. The thyroxine dosage usually needs to be incremented by 4–8 weeks of gestation, and these patients may require a 30%–50% increase in dosage, said Dr. Glinoer, who represented the European Thyroid Association on the task force and is chief of the thyroid investigation clinic at the Centre Hôpitalier Universitaire Saint-Pierre, Brussels.

If overt hypothyroidism is diagnosed during pregnancy, thyroid function tests should be normalized as rapidly as possible, in view of the potential obstetric complications and risks for the offspring associated with undisclosed prolonged hypothyroidism. Thyroxine dosage should be titrated to rapidly reach, and then maintain, serum TSH concentrations of less than 2.5 microIU/L in the first trimester or less than 3 microIU/L in the second and third trimesters, or to trimester-specific normal TSH ranges, which Dr. Glinoer admitted haven't been universally established.

There was a consensus against advising termination of pregnancy, even if overt hypothyroidism is diagnosed late, he said.

If a subnormal serum TSH concentration is detected, hyperthyroidism must be distinguished from both normal physiology and hyperemesis gravidarum because of the adverse effects of overt hyperthyroidism on mother and fetus. Antithyroid drug (ATD) therapy should be either initiated for those with a new diagnosis of hyperthyroidism resulting from Graves' disease or adjusted for those with a prior history to maintain maternal free thyroxine levels in the trimester-specific normal pregnancy range, if available, or near the upper limit of the nonpregnant reference range.

Data suggest methimazole may be associated with congenital anomalies, so the task force recommends propylthiouracil (PTU) as first-line medication, especially in the first trimester. Methimazole may be prescribed if PTU is unavailable, or a patient can't tolerate or has an adverse reaction to it.

The task force concluded that subtotal thyroidectomy may be indicated for maternal Graves' disease if there are severe adverse reactions to ATD therapy, if persistently high ATD doses are required, or if a patient is nonadherent to ATD therapy and has uncontrolled hyperthyroidism. Surgery is best in the second trimester. No data suggest treatment of subclinical hyperthyroidism improves pregnancy outcome, and it could adversely affect the fetus.

TUCSON, ARIZ. — Patients with a parental history of stroke should be screened early for raised blood pressure, Dr. Nigel Hart said at the annual meeting of the North American Primary Care Research Group.

The recommendation was drawn from Dr. Hart's Stroke Offspring Study in which systolic and diastolic blood pressures were significantly higher in patients with a parental history of stroke, compared with matched controls. Stroke offspring also consumed more alcohol than their paired controls but did not differ significantly in body mass index, lipids, diabetes mellitus, diet, smoking status, or exercise.

“These results suggest higher blood pressure in stroke offspring may contribute to their increased risk of stroke,” said Dr. Hart of Queen's University, in Belfast, Ireland.

Questionnaires were sent to randomly selected individuals, aged 40–64 years, from 11 general practices representing 6% of the population of Northern Ireland. From the returns, those with a parental history of stroke (cases) were matched on age, gender, and socioeconomic status to those with no parental history of stroke (controls).

Matched pairs answered questions about smoking, alcohol, and medical history, and underwent a clinical evaluation. A total of 458 individuals were screened, and complete data were available on 398 individuals or 199 case-control pairs.

Systolic and diastolic blood pressures were significantly higher in cases than in controls; (systolic 146.2 mm Hg vs. 140.6 mm Hg) and (diastolic 87.7 mm Hg vs. 85.0 mm Hg). There were no significant differences between groups in total cholesterol, homosysteine levels, smoking status, or presence of diabetes, they reported.

The only variable that was statistically different between groups was alcohol consumption, with cases drinking 3.7 more alcohol units per week than controls (13.8 U vs. 10.1 U). A pint of beer is equal to 2 units, while a glass of wine or hard liquor is equal to 1 unit. The mean paired difference in diastolic (2.4 mm Hg) and systolic (5.5 mm Hg) blood pressures was statistically significant between groups even after adjusting for alcohol consumption using a stepwise logistic analysis, he said.

TUCSON, ARIZ. — Patients with a parental history of stroke should be screened early for raised blood pressure, Dr. Nigel Hart said at the annual meeting of the North American Primary Care Research Group.

The recommendation was drawn from Dr. Hart's Stroke Offspring Study in which systolic and diastolic blood pressures were significantly higher in patients with a parental history of stroke, compared with matched controls. Stroke offspring also consumed more alcohol than their paired controls but did not differ significantly in body mass index, lipids, diabetes mellitus, diet, smoking status, or exercise.

“These results suggest higher blood pressure in stroke offspring may contribute to their increased risk of stroke,” said Dr. Hart of Queen's University, in Belfast, Ireland.

Questionnaires were sent to randomly selected individuals, aged 40–64 years, from 11 general practices representing 6% of the population of Northern Ireland. From the returns, those with a parental history of stroke (cases) were matched on age, gender, and socioeconomic status to those with no parental history of stroke (controls).

Matched pairs answered questions about smoking, alcohol, and medical history, and underwent a clinical evaluation. A total of 458 individuals were screened, and complete data were available on 398 individuals or 199 case-control pairs.

Systolic and diastolic blood pressures were significantly higher in cases than in controls; (systolic 146.2 mm Hg vs. 140.6 mm Hg) and (diastolic 87.7 mm Hg vs. 85.0 mm Hg). There were no significant differences between groups in total cholesterol, homosysteine levels, smoking status, or presence of diabetes, they reported.

The only variable that was statistically different between groups was alcohol consumption, with cases drinking 3.7 more alcohol units per week than controls (13.8 U vs. 10.1 U). A pint of beer is equal to 2 units, while a glass of wine or hard liquor is equal to 1 unit. The mean paired difference in diastolic (2.4 mm Hg) and systolic (5.5 mm Hg) blood pressures was statistically significant between groups even after adjusting for alcohol consumption using a stepwise logistic analysis, he said.

TUCSON, ARIZ. — Patients with a parental history of stroke should be screened early for raised blood pressure, Dr. Nigel Hart said at the annual meeting of the North American Primary Care Research Group.

The recommendation was drawn from Dr. Hart's Stroke Offspring Study in which systolic and diastolic blood pressures were significantly higher in patients with a parental history of stroke, compared with matched controls. Stroke offspring also consumed more alcohol than their paired controls but did not differ significantly in body mass index, lipids, diabetes mellitus, diet, smoking status, or exercise.

“These results suggest higher blood pressure in stroke offspring may contribute to their increased risk of stroke,” said Dr. Hart of Queen's University, in Belfast, Ireland.

Questionnaires were sent to randomly selected individuals, aged 40–64 years, from 11 general practices representing 6% of the population of Northern Ireland. From the returns, those with a parental history of stroke (cases) were matched on age, gender, and socioeconomic status to those with no parental history of stroke (controls).

Matched pairs answered questions about smoking, alcohol, and medical history, and underwent a clinical evaluation. A total of 458 individuals were screened, and complete data were available on 398 individuals or 199 case-control pairs.

Systolic and diastolic blood pressures were significantly higher in cases than in controls; (systolic 146.2 mm Hg vs. 140.6 mm Hg) and (diastolic 87.7 mm Hg vs. 85.0 mm Hg). There were no significant differences between groups in total cholesterol, homosysteine levels, smoking status, or presence of diabetes, they reported.

The only variable that was statistically different between groups was alcohol consumption, with cases drinking 3.7 more alcohol units per week than controls (13.8 U vs. 10.1 U). A pint of beer is equal to 2 units, while a glass of wine or hard liquor is equal to 1 unit. The mean paired difference in diastolic (2.4 mm Hg) and systolic (5.5 mm Hg) blood pressures was statistically significant between groups even after adjusting for alcohol consumption using a stepwise logistic analysis, he said.

CHICAGO – Adolescents who play violent video games demonstrate distinct alterations in brain activation on functional magnetic resonance imaging, investigators have shown for the first time.

In a study of 44 healthy adolescents, the teenagers who played violent video games demonstrated less activation in the frontal lobes associated with inhibition, concentration, and self-control, and more activation in the amygdala, which governs emotional arousal, Dr. Vincent Mathews reported at the annual meeting of the Radiological Society of North America.

Additional research is needed to determine if this combination of effects could make these individuals more likely to engage in violent behavior. But for now, the study provides parents, physicians, and scientists with data proving that differences in brain function exist in teens who play violent video games, compared with those who don't.

“The fact [that] we are seeing something should at least alert people to the fact [that] something is going on, and that they should be concerned with the types and amount of media they and their children are exposed to,” said Dr. Mathews in an interview.

He and his colleagues at Indiana University, Indianapolis, randomly assigned the adolescents to play either “Medal of Honor,” a violent video game, or “Need for Speed,” an equally exciting but nonviolent game, for 30 minutes immediately before imaging.

Functional MRI data were acquired on a 3-Tesla scanner using a 2D gradient echo-planar imaging sequence during two modified Stroop paradigms.

In the emotional Stroop task, participants pressed different buttons according to the color of the visually presented words. Words indicating violent actions such as “hit” or “harm” were interspersed with nonviolent action words such as “run” or “walk.”

In the counting Stroop task, participants were required to press buttons to indicate the number of displayed objects, with X's used as control events and numerals presented as activation stimulation, Dr. Mathews said.

There was no difference between groups in age, gender, IQ, video playing expertise, or overall violent media exposure. Their mean age was 15 years, and the average IQ was 110 in the nonviolent game group and 108 in the violent game group.

There was no significant difference between groups in accuracy or reaction time during the tasks.

The group that played the nonviolent game showed more activation in the frontal lobes, including the anterior cingulate and dorsolateral prefrontal cortex, during both Stroop tasks, reported Dr. Mathews, professor of radiology at the university.

The group that played the violent game demonstrated less activation in prefrontal lobes during both tasks and increased activation in the right amygdala during the emotional Stroop task. These differences remained after controlling for previous violent media exposure and gender, he said.

There have been numerous studies since the 1970s demonstrating that adolescents exposed to violent media demonstrate aggressive behavior. But because the adolescents in this study were randomized into two similar groups, the findings go more directly to the question of causation than did previous research, Dr. Mathews said.

“There is a little bit more credence to [physicians] recommending limiting this activity,” he said, adding that further study is needed to examine behavior and duration of effect in adolescents who watch violent videos.

Functional MRI findings show less brain activation in the frontal lobes and more activation in the amygdala in teens playing violent versus nonviolent video games. Radiological Society of North America

CHICAGO – Adolescents who play violent video games demonstrate distinct alterations in brain activation on functional magnetic resonance imaging, investigators have shown for the first time.

In a study of 44 healthy adolescents, the teenagers who played violent video games demonstrated less activation in the frontal lobes associated with inhibition, concentration, and self-control, and more activation in the amygdala, which governs emotional arousal, Dr. Vincent Mathews reported at the annual meeting of the Radiological Society of North America.

Additional research is needed to determine if this combination of effects could make these individuals more likely to engage in violent behavior. But for now, the study provides parents, physicians, and scientists with data proving that differences in brain function exist in teens who play violent video games, compared with those who don't.

“The fact [that] we are seeing something should at least alert people to the fact [that] something is going on, and that they should be concerned with the types and amount of media they and their children are exposed to,” said Dr. Mathews in an interview.

He and his colleagues at Indiana University, Indianapolis, randomly assigned the adolescents to play either “Medal of Honor,” a violent video game, or “Need for Speed,” an equally exciting but nonviolent game, for 30 minutes immediately before imaging.

Functional MRI data were acquired on a 3-Tesla scanner using a 2D gradient echo-planar imaging sequence during two modified Stroop paradigms.

In the emotional Stroop task, participants pressed different buttons according to the color of the visually presented words. Words indicating violent actions such as “hit” or “harm” were interspersed with nonviolent action words such as “run” or “walk.”

In the counting Stroop task, participants were required to press buttons to indicate the number of displayed objects, with X's used as control events and numerals presented as activation stimulation, Dr. Mathews said.

There was no difference between groups in age, gender, IQ, video playing expertise, or overall violent media exposure. Their mean age was 15 years, and the average IQ was 110 in the nonviolent game group and 108 in the violent game group.

There was no significant difference between groups in accuracy or reaction time during the tasks.

The group that played the nonviolent game showed more activation in the frontal lobes, including the anterior cingulate and dorsolateral prefrontal cortex, during both Stroop tasks, reported Dr. Mathews, professor of radiology at the university.

The group that played the violent game demonstrated less activation in prefrontal lobes during both tasks and increased activation in the right amygdala during the emotional Stroop task. These differences remained after controlling for previous violent media exposure and gender, he said.

There have been numerous studies since the 1970s demonstrating that adolescents exposed to violent media demonstrate aggressive behavior. But because the adolescents in this study were randomized into two similar groups, the findings go more directly to the question of causation than did previous research, Dr. Mathews said.

“There is a little bit more credence to [physicians] recommending limiting this activity,” he said, adding that further study is needed to examine behavior and duration of effect in adolescents who watch violent videos.

Functional MRI findings show less brain activation in the frontal lobes and more activation in the amygdala in teens playing violent versus nonviolent video games. Radiological Society of North America

CHICAGO – Adolescents who play violent video games demonstrate distinct alterations in brain activation on functional magnetic resonance imaging, investigators have shown for the first time.

In a study of 44 healthy adolescents, the teenagers who played violent video games demonstrated less activation in the frontal lobes associated with inhibition, concentration, and self-control, and more activation in the amygdala, which governs emotional arousal, Dr. Vincent Mathews reported at the annual meeting of the Radiological Society of North America.

Additional research is needed to determine if this combination of effects could make these individuals more likely to engage in violent behavior. But for now, the study provides parents, physicians, and scientists with data proving that differences in brain function exist in teens who play violent video games, compared with those who don't.

“The fact [that] we are seeing something should at least alert people to the fact [that] something is going on, and that they should be concerned with the types and amount of media they and their children are exposed to,” said Dr. Mathews in an interview.

He and his colleagues at Indiana University, Indianapolis, randomly assigned the adolescents to play either “Medal of Honor,” a violent video game, or “Need for Speed,” an equally exciting but nonviolent game, for 30 minutes immediately before imaging.

Functional MRI data were acquired on a 3-Tesla scanner using a 2D gradient echo-planar imaging sequence during two modified Stroop paradigms.

In the emotional Stroop task, participants pressed different buttons according to the color of the visually presented words. Words indicating violent actions such as “hit” or “harm” were interspersed with nonviolent action words such as “run” or “walk.”

In the counting Stroop task, participants were required to press buttons to indicate the number of displayed objects, with X's used as control events and numerals presented as activation stimulation, Dr. Mathews said.

There was no difference between groups in age, gender, IQ, video playing expertise, or overall violent media exposure. Their mean age was 15 years, and the average IQ was 110 in the nonviolent game group and 108 in the violent game group.

There was no significant difference between groups in accuracy or reaction time during the tasks.

The group that played the nonviolent game showed more activation in the frontal lobes, including the anterior cingulate and dorsolateral prefrontal cortex, during both Stroop tasks, reported Dr. Mathews, professor of radiology at the university.

The group that played the violent game demonstrated less activation in prefrontal lobes during both tasks and increased activation in the right amygdala during the emotional Stroop task. These differences remained after controlling for previous violent media exposure and gender, he said.

There have been numerous studies since the 1970s demonstrating that adolescents exposed to violent media demonstrate aggressive behavior. But because the adolescents in this study were randomized into two similar groups, the findings go more directly to the question of causation than did previous research, Dr. Mathews said.

“There is a little bit more credence to [physicians] recommending limiting this activity,” he said, adding that further study is needed to examine behavior and duration of effect in adolescents who watch violent videos.

Functional MRI findings show less brain activation in the frontal lobes and more activation in the amygdala in teens playing violent versus nonviolent video games. Radiological Society of North America

VERONA, ITALY — Newly developed consensus guidelines recommend thyroid-function screening in high-risk pregnant women, but stop short of calling for universal screening.

An international task force, under the auspices of the Endocrine Society, examined 10 key topics related to pregnancy and thyroid. The end result was an 86-page, single-spaced document encompassing 35 recommendations, many of which were reached after a diplomatic search for compromise, Dr. Daniel Glinoer said at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

The difficulty stemmed from the paucity of prospective randomized trials in the field, the contrasting approaches of endocrinologists and ob.gyns. on some controversial issues, and the appearance of additional data even as the task force was writing the guidelines. “Altogether, this effort represented a tremendous challenge that was much more difficult than anticipated,” said Dr. Glinoer, who represented the European Thyroid Association on the task force and is chief of the thyroid investigation clinic at the Centre Hôpitalier Universitaire Saint-Pierre, Brussels.

Despite compromises on many recommendations, the American College of Obstetricians and Gynecologists (ACOG) opted not to endorse the final guidelines. Dr. Sarah Kilpatrick, who represented ACOG on the task force, acknowledged that a great deal of time and work went into the guidelines.

“Unfortunately, the data available are not consistently good, and there are still many differences of opinion between endocrinologists and perinatologists about how to interpret the data and best manage pregnant women,” Dr. Kilpatrick, professor and head of the department of ob.gyn. and vice dean of the college of medicine at the University of Illinois at Chicago, said in an interview. “ACOG did not endorse these guidelines because many of the recommendations made by the guidelines were based on poor evidence with a recommendation level of inconclusive.”

For screening purposes, the task force identified high-risk women as those with a personal history of thyroid or autoimmune disorders; a family history of thyroid disorders; or a personal history of infertility or preterm delivery.

For maternal hypothyroidism, which affects 2.5%–3% of pregnant women, the task force recommends a targeted case-finding approach at the first prenatal visit or at diagnosis of pregnancy. The preconception thyroxine dosage should be adjusted to reach a serum thyroid-stimulating hormone (TSH) level no higher than 2.5 microIU/L. The thyroxine dosage usually needs to be incremented by 4–8 weeks of gestation, and these patients may require a 30%–50% increase in dosage, said Dr. Glinoer.

If overt hypothyroidism is diagnosed during pregnancy, thyroid function tests should be normalized as rapidly as possible, in view of the potential obstetric complications and risks for the offspring associated with undisclosed prolonged hypothyroidism. Thyroxine dosage should be titrated to rapidly reach and thereafter maintain serum TSH concentrations of less than 2.5 microIU/L in the first trimester or less than 3 microIU/L in the second and third trimesters, or to trimester-specific normal TSH ranges, which Dr. Glinoer admitted haven't been universally established.

There was a consensus against advising termination of pregnancy, even if overt hypothyroidism is diagnosed late, he said.

If a subnormal serum TSH concentration is detected, hyperthyroidism must be distinguished from both normal physiology and hyperemesis gravidarum because of the adverse effects of overt hyperthyroidism on mother and fetus. Antithyroid drug (ATD) therapy should be either initiated for those with a new diagnosis of hyperthyroidism resulting from Graves' disease or adjusted for those with a prior history to maintain maternal free thyroxine levels in the trimester-specific normal pregnancy range, if available, or near the upper limit of the nonpregnant reference range, he said.

Because evidence suggests that methimazole may be associated with congenital anomalies, the task force recommends propylthiouracil (PTU) as first-line medication, especially during the first trimester. Methimazole may be prescribed if PTU is not available, or if a patient can't tolerate or has an adverse reaction to PTU.

The task force concluded that subtotal thyroidectomy may be indicated for maternal Graves' disease if there are severe adverse reactions to ATD therapy, if persistently high ATD doses are required, or if a patient is nonadherent to ATD therapy and has uncontrolled hyperthyroidism. The best time to perform surgery is the second trimester.

There is no evidence that treating subclinical hyperthyroidism improves pregnancy outcome, and it could potentially adversely affect the fetus, he said.

VERONA, ITALY — Newly developed consensus guidelines recommend thyroid-function screening in high-risk pregnant women, but stop short of calling for universal screening.

An international task force, under the auspices of the Endocrine Society, examined 10 key topics related to pregnancy and thyroid. The end result was an 86-page, single-spaced document encompassing 35 recommendations, many of which were reached after a diplomatic search for compromise, Dr. Daniel Glinoer said at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

The difficulty stemmed from the paucity of prospective randomized trials in the field, the contrasting approaches of endocrinologists and ob.gyns. on some controversial issues, and the appearance of additional data even as the task force was writing the guidelines. “Altogether, this effort represented a tremendous challenge that was much more difficult than anticipated,” said Dr. Glinoer, who represented the European Thyroid Association on the task force and is chief of the thyroid investigation clinic at the Centre Hôpitalier Universitaire Saint-Pierre, Brussels.

Despite compromises on many recommendations, the American College of Obstetricians and Gynecologists (ACOG) opted not to endorse the final guidelines. Dr. Sarah Kilpatrick, who represented ACOG on the task force, acknowledged that a great deal of time and work went into the guidelines.

“Unfortunately, the data available are not consistently good, and there are still many differences of opinion between endocrinologists and perinatologists about how to interpret the data and best manage pregnant women,” Dr. Kilpatrick, professor and head of the department of ob.gyn. and vice dean of the college of medicine at the University of Illinois at Chicago, said in an interview. “ACOG did not endorse these guidelines because many of the recommendations made by the guidelines were based on poor evidence with a recommendation level of inconclusive.”

For screening purposes, the task force identified high-risk women as those with a personal history of thyroid or autoimmune disorders; a family history of thyroid disorders; or a personal history of infertility or preterm delivery.

For maternal hypothyroidism, which affects 2.5%–3% of pregnant women, the task force recommends a targeted case-finding approach at the first prenatal visit or at diagnosis of pregnancy. The preconception thyroxine dosage should be adjusted to reach a serum thyroid-stimulating hormone (TSH) level no higher than 2.5 microIU/L. The thyroxine dosage usually needs to be incremented by 4–8 weeks of gestation, and these patients may require a 30%–50% increase in dosage, said Dr. Glinoer.

If overt hypothyroidism is diagnosed during pregnancy, thyroid function tests should be normalized as rapidly as possible, in view of the potential obstetric complications and risks for the offspring associated with undisclosed prolonged hypothyroidism. Thyroxine dosage should be titrated to rapidly reach and thereafter maintain serum TSH concentrations of less than 2.5 microIU/L in the first trimester or less than 3 microIU/L in the second and third trimesters, or to trimester-specific normal TSH ranges, which Dr. Glinoer admitted haven't been universally established.

There was a consensus against advising termination of pregnancy, even if overt hypothyroidism is diagnosed late, he said.

If a subnormal serum TSH concentration is detected, hyperthyroidism must be distinguished from both normal physiology and hyperemesis gravidarum because of the adverse effects of overt hyperthyroidism on mother and fetus. Antithyroid drug (ATD) therapy should be either initiated for those with a new diagnosis of hyperthyroidism resulting from Graves' disease or adjusted for those with a prior history to maintain maternal free thyroxine levels in the trimester-specific normal pregnancy range, if available, or near the upper limit of the nonpregnant reference range, he said.

Because evidence suggests that methimazole may be associated with congenital anomalies, the task force recommends propylthiouracil (PTU) as first-line medication, especially during the first trimester. Methimazole may be prescribed if PTU is not available, or if a patient can't tolerate or has an adverse reaction to PTU.

The task force concluded that subtotal thyroidectomy may be indicated for maternal Graves' disease if there are severe adverse reactions to ATD therapy, if persistently high ATD doses are required, or if a patient is nonadherent to ATD therapy and has uncontrolled hyperthyroidism. The best time to perform surgery is the second trimester.

There is no evidence that treating subclinical hyperthyroidism improves pregnancy outcome, and it could potentially adversely affect the fetus, he said.

VERONA, ITALY — Newly developed consensus guidelines recommend thyroid-function screening in high-risk pregnant women, but stop short of calling for universal screening.

An international task force, under the auspices of the Endocrine Society, examined 10 key topics related to pregnancy and thyroid. The end result was an 86-page, single-spaced document encompassing 35 recommendations, many of which were reached after a diplomatic search for compromise, Dr. Daniel Glinoer said at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

The difficulty stemmed from the paucity of prospective randomized trials in the field, the contrasting approaches of endocrinologists and ob.gyns. on some controversial issues, and the appearance of additional data even as the task force was writing the guidelines. “Altogether, this effort represented a tremendous challenge that was much more difficult than anticipated,” said Dr. Glinoer, who represented the European Thyroid Association on the task force and is chief of the thyroid investigation clinic at the Centre Hôpitalier Universitaire Saint-Pierre, Brussels.

Despite compromises on many recommendations, the American College of Obstetricians and Gynecologists (ACOG) opted not to endorse the final guidelines. Dr. Sarah Kilpatrick, who represented ACOG on the task force, acknowledged that a great deal of time and work went into the guidelines.

“Unfortunately, the data available are not consistently good, and there are still many differences of opinion between endocrinologists and perinatologists about how to interpret the data and best manage pregnant women,” Dr. Kilpatrick, professor and head of the department of ob.gyn. and vice dean of the college of medicine at the University of Illinois at Chicago, said in an interview. “ACOG did not endorse these guidelines because many of the recommendations made by the guidelines were based on poor evidence with a recommendation level of inconclusive.”

For screening purposes, the task force identified high-risk women as those with a personal history of thyroid or autoimmune disorders; a family history of thyroid disorders; or a personal history of infertility or preterm delivery.

For maternal hypothyroidism, which affects 2.5%–3% of pregnant women, the task force recommends a targeted case-finding approach at the first prenatal visit or at diagnosis of pregnancy. The preconception thyroxine dosage should be adjusted to reach a serum thyroid-stimulating hormone (TSH) level no higher than 2.5 microIU/L. The thyroxine dosage usually needs to be incremented by 4–8 weeks of gestation, and these patients may require a 30%–50% increase in dosage, said Dr. Glinoer.

If overt hypothyroidism is diagnosed during pregnancy, thyroid function tests should be normalized as rapidly as possible, in view of the potential obstetric complications and risks for the offspring associated with undisclosed prolonged hypothyroidism. Thyroxine dosage should be titrated to rapidly reach and thereafter maintain serum TSH concentrations of less than 2.5 microIU/L in the first trimester or less than 3 microIU/L in the second and third trimesters, or to trimester-specific normal TSH ranges, which Dr. Glinoer admitted haven't been universally established.

There was a consensus against advising termination of pregnancy, even if overt hypothyroidism is diagnosed late, he said.

If a subnormal serum TSH concentration is detected, hyperthyroidism must be distinguished from both normal physiology and hyperemesis gravidarum because of the adverse effects of overt hyperthyroidism on mother and fetus. Antithyroid drug (ATD) therapy should be either initiated for those with a new diagnosis of hyperthyroidism resulting from Graves' disease or adjusted for those with a prior history to maintain maternal free thyroxine levels in the trimester-specific normal pregnancy range, if available, or near the upper limit of the nonpregnant reference range, he said.

Because evidence suggests that methimazole may be associated with congenital anomalies, the task force recommends propylthiouracil (PTU) as first-line medication, especially during the first trimester. Methimazole may be prescribed if PTU is not available, or if a patient can't tolerate or has an adverse reaction to PTU.

The task force concluded that subtotal thyroidectomy may be indicated for maternal Graves' disease if there are severe adverse reactions to ATD therapy, if persistently high ATD doses are required, or if a patient is nonadherent to ATD therapy and has uncontrolled hyperthyroidism. The best time to perform surgery is the second trimester.

There is no evidence that treating subclinical hyperthyroidism improves pregnancy outcome, and it could potentially adversely affect the fetus, he said.

CHICAGO — Straight backed isn't the optimal sitting position for the spine, according to a study conducted in Scotland using positional magnetic resonance imaging.

The study demonstrated that a 135-degree body-thigh sitting posture, in which the hips are higher than the knees, causes less strain on the lumbar spine and most simulates the “relaxed” supine position, Dr. Waseem Amir Bashir said at a press briefing during the annual meeting of the Radiological Society of North America.

“I know we've always been told to sit up right with our backs straight, but our study shows that this position is not naturally favorable for your back at all,” he said. “The bottom line is that we don't have any chairs available to us that are appropriate for the best sitting position.”

The study included 22 healthy volunteers (mean age, 34 years; weight 67 kg; height 169 cm) with no history of back pain or surgery who underwent measurements of lumbar lordosis angles, intervertebral disc (IVD) heights, and translation of the nucleus pulposus using a 0.6 -tesla whole-body, positional MRI scanner.

The patients were scanned in three different positions: a slouching position in which the body was hunched forward, as if over a desk or video console; an upright 90-degree sitting position; and a relaxed position where the volunteer reclined backward 135 degrees while the feet remained on the floor.

Each scan was separated by a 10-minute supine rest period because at least 10 minutes is needed by the body to rehydrate intervertebral discs, Dr. Bashir said. Research has shown that as much as 75% of disc height, lost throughout the day, can be regained with a 20-minute supine rest.

The worst position for the spine—as reflected in disc height—was the slouching position, followed closely by the upright 90-degree position, the University of Aberdeen (Scotland) investigators reported.

Disc heights decreased as lumbar lordosis increased in each sitting position from reclining to forward flexion. The two lowest spinal disc levels, the L4/5 and L5/S1, showed the greatest loss of disc height. “Even if it's only 2 mm at the second lowest levels, if you add it all up, it's quite significant,” said Dr. Bashir, now a clinical fellow at the University of Alberta Hospital, Edmonton.

There was a significant difference for the upright and slouched positions, compared with the 135-degree and supine positions in disc height and movement of the nucleus pulposus, the gel-like mass that forms the middle of an intervertebral disc.

Disc movement was most pronounced with the forward slouching position, while the 90-degree position showed a slight movement backwards, he said. The 135-degree position was similar to a supine position, placing very little strain on the spinal discs and associated musculature, he said.

The 135-degree position has found its way into seat designs for luxury auto manufacturers. But until furniture makers take note, Dr. Bashir advocates the use of adjustable desks and chairs, and footrests.

The two worst positions: MR images show that disc height was most diminished amongthose slouching forward (left) and those sitting perfectly upright at 90 degrees. Photos courtesy Dr. Waseem Amir Bashir/RSNA

CHICAGO — Straight backed isn't the optimal sitting position for the spine, according to a study conducted in Scotland using positional magnetic resonance imaging.

The study demonstrated that a 135-degree body-thigh sitting posture, in which the hips are higher than the knees, causes less strain on the lumbar spine and most simulates the “relaxed” supine position, Dr. Waseem Amir Bashir said at a press briefing during the annual meeting of the Radiological Society of North America.

“I know we've always been told to sit up right with our backs straight, but our study shows that this position is not naturally favorable for your back at all,” he said. “The bottom line is that we don't have any chairs available to us that are appropriate for the best sitting position.”

The study included 22 healthy volunteers (mean age, 34 years; weight 67 kg; height 169 cm) with no history of back pain or surgery who underwent measurements of lumbar lordosis angles, intervertebral disc (IVD) heights, and translation of the nucleus pulposus using a 0.6 -tesla whole-body, positional MRI scanner.

The patients were scanned in three different positions: a slouching position in which the body was hunched forward, as if over a desk or video console; an upright 90-degree sitting position; and a relaxed position where the volunteer reclined backward 135 degrees while the feet remained on the floor.

Each scan was separated by a 10-minute supine rest period because at least 10 minutes is needed by the body to rehydrate intervertebral discs, Dr. Bashir said. Research has shown that as much as 75% of disc height, lost throughout the day, can be regained with a 20-minute supine rest.

The worst position for the spine—as reflected in disc height—was the slouching position, followed closely by the upright 90-degree position, the University of Aberdeen (Scotland) investigators reported.

Disc heights decreased as lumbar lordosis increased in each sitting position from reclining to forward flexion. The two lowest spinal disc levels, the L4/5 and L5/S1, showed the greatest loss of disc height. “Even if it's only 2 mm at the second lowest levels, if you add it all up, it's quite significant,” said Dr. Bashir, now a clinical fellow at the University of Alberta Hospital, Edmonton.

There was a significant difference for the upright and slouched positions, compared with the 135-degree and supine positions in disc height and movement of the nucleus pulposus, the gel-like mass that forms the middle of an intervertebral disc.

Disc movement was most pronounced with the forward slouching position, while the 90-degree position showed a slight movement backwards, he said. The 135-degree position was similar to a supine position, placing very little strain on the spinal discs and associated musculature, he said.

The 135-degree position has found its way into seat designs for luxury auto manufacturers. But until furniture makers take note, Dr. Bashir advocates the use of adjustable desks and chairs, and footrests.

The two worst positions: MR images show that disc height was most diminished amongthose slouching forward (left) and those sitting perfectly upright at 90 degrees. Photos courtesy Dr. Waseem Amir Bashir/RSNA

CHICAGO — Straight backed isn't the optimal sitting position for the spine, according to a study conducted in Scotland using positional magnetic resonance imaging.

The study demonstrated that a 135-degree body-thigh sitting posture, in which the hips are higher than the knees, causes less strain on the lumbar spine and most simulates the “relaxed” supine position, Dr. Waseem Amir Bashir said at a press briefing during the annual meeting of the Radiological Society of North America.

“I know we've always been told to sit up right with our backs straight, but our study shows that this position is not naturally favorable for your back at all,” he said. “The bottom line is that we don't have any chairs available to us that are appropriate for the best sitting position.”

The study included 22 healthy volunteers (mean age, 34 years; weight 67 kg; height 169 cm) with no history of back pain or surgery who underwent measurements of lumbar lordosis angles, intervertebral disc (IVD) heights, and translation of the nucleus pulposus using a 0.6 -tesla whole-body, positional MRI scanner.

The patients were scanned in three different positions: a slouching position in which the body was hunched forward, as if over a desk or video console; an upright 90-degree sitting position; and a relaxed position where the volunteer reclined backward 135 degrees while the feet remained on the floor.

Each scan was separated by a 10-minute supine rest period because at least 10 minutes is needed by the body to rehydrate intervertebral discs, Dr. Bashir said. Research has shown that as much as 75% of disc height, lost throughout the day, can be regained with a 20-minute supine rest.

The worst position for the spine—as reflected in disc height—was the slouching position, followed closely by the upright 90-degree position, the University of Aberdeen (Scotland) investigators reported.

Disc heights decreased as lumbar lordosis increased in each sitting position from reclining to forward flexion. The two lowest spinal disc levels, the L4/5 and L5/S1, showed the greatest loss of disc height. “Even if it's only 2 mm at the second lowest levels, if you add it all up, it's quite significant,” said Dr. Bashir, now a clinical fellow at the University of Alberta Hospital, Edmonton.

There was a significant difference for the upright and slouched positions, compared with the 135-degree and supine positions in disc height and movement of the nucleus pulposus, the gel-like mass that forms the middle of an intervertebral disc.

Disc movement was most pronounced with the forward slouching position, while the 90-degree position showed a slight movement backwards, he said. The 135-degree position was similar to a supine position, placing very little strain on the spinal discs and associated musculature, he said.

The 135-degree position has found its way into seat designs for luxury auto manufacturers. But until furniture makers take note, Dr. Bashir advocates the use of adjustable desks and chairs, and footrests.

The two worst positions: MR images show that disc height was most diminished amongthose slouching forward (left) and those sitting perfectly upright at 90 degrees. Photos courtesy Dr. Waseem Amir Bashir/RSNA