The prevalence of pseudobulbar affect (PBA) in multiple sclerosis (MS) is low, according to a recent study, but similar symptoms may co-occur or overlap with depression, highlighting the importance of concomitant assessment of mood when evaluating potential PBA. Furthermore, PBA may be associated with cognitive impairment in people with MS. North American Research Committee on MS (NARCOMS) registry participants completed the Center for Neurologic Study-Lability Scale (CNS-LS), a validated 7-question self-report measure of PBA. Researchers categorized individuals as PBA-positive (PBA[+]) if they had a composite score ≥17 without current depression. Participants also reported their demographic characteristics and their clinical characteristics using Patient-Determined Disease Steps and Performance Scales. They found:

• Of the 8,136 responders, 574 (7%) had scores ≥17 on the CNS-LS; however, only 200 (2.5%) individuals had scores ≥17 without comorbid depression, of whom only 22 (11%) reported a diagnosis of PBA.
• PBA(+) individuals tended to be younger (mean [SD] 53.4 [11.0] vs 57.2 [10.3] years), non-white (13% vs 9%), and have lower socioeconomic status (≤$30,000 annual income: 28% vs 22%).
• In multivariable models, PBA(+) was associated with increased odds of more severe cognitive impairment.

Fitzgerald KC, Salter A, Tyry T, Fox RJ, Cutter G, Marrie RA. Pseudobulbar affect.

Prevalence and association with symptoms in multiple sclerosis. Neurol Clin Pract. 2018;8(6):472-481. doi:10.1212/CPJ.0000000000000523.

The prevalence of pseudobulbar affect (PBA) in multiple sclerosis (MS) is low, according to a recent study, but similar symptoms may co-occur or overlap with depression, highlighting the importance of concomitant assessment of mood when evaluating potential PBA. Furthermore, PBA may be associated with cognitive impairment in people with MS. North American Research Committee on MS (NARCOMS) registry participants completed the Center for Neurologic Study-Lability Scale (CNS-LS), a validated 7-question self-report measure of PBA. Researchers categorized individuals as PBA-positive (PBA[+]) if they had a composite score ≥17 without current depression. Participants also reported their demographic characteristics and their clinical characteristics using Patient-Determined Disease Steps and Performance Scales. They found:

• Of the 8,136 responders, 574 (7%) had scores ≥17 on the CNS-LS; however, only 200 (2.5%) individuals had scores ≥17 without comorbid depression, of whom only 22 (11%) reported a diagnosis of PBA.
• PBA(+) individuals tended to be younger (mean [SD] 53.4 [11.0] vs 57.2 [10.3] years), non-white (13% vs 9%), and have lower socioeconomic status (≤$30,000 annual income: 28% vs 22%).
• In multivariable models, PBA(+) was associated with increased odds of more severe cognitive impairment.

Fitzgerald KC, Salter A, Tyry T, Fox RJ, Cutter G, Marrie RA. Pseudobulbar affect.

Prevalence and association with symptoms in multiple sclerosis. Neurol Clin Pract. 2018;8(6):472-481. doi:10.1212/CPJ.0000000000000523.

The prevalence of pseudobulbar affect (PBA) in multiple sclerosis (MS) is low, according to a recent study, but similar symptoms may co-occur or overlap with depression, highlighting the importance of concomitant assessment of mood when evaluating potential PBA. Furthermore, PBA may be associated with cognitive impairment in people with MS. North American Research Committee on MS (NARCOMS) registry participants completed the Center for Neurologic Study-Lability Scale (CNS-LS), a validated 7-question self-report measure of PBA. Researchers categorized individuals as PBA-positive (PBA[+]) if they had a composite score ≥17 without current depression. Participants also reported their demographic characteristics and their clinical characteristics using Patient-Determined Disease Steps and Performance Scales. They found:

• Of the 8,136 responders, 574 (7%) had scores ≥17 on the CNS-LS; however, only 200 (2.5%) individuals had scores ≥17 without comorbid depression, of whom only 22 (11%) reported a diagnosis of PBA.
• PBA(+) individuals tended to be younger (mean [SD] 53.4 [11.0] vs 57.2 [10.3] years), non-white (13% vs 9%), and have lower socioeconomic status (≤$30,000 annual income: 28% vs 22%).
• In multivariable models, PBA(+) was associated with increased odds of more severe cognitive impairment.

Fitzgerald KC, Salter A, Tyry T, Fox RJ, Cutter G, Marrie RA. Pseudobulbar affect.

Prevalence and association with symptoms in multiple sclerosis. Neurol Clin Pract. 2018;8(6):472-481. doi:10.1212/CPJ.0000000000000523.

LAS VEGAS – Northern California’s Michael S. Baggish, MD, wants more gynecologists to feel comfortable treating disorders of the vulva.

In a presentation at the Pelvic Anatomy and Gynecologic Surgery Symposium, Dr. Baggish ran through some tips about diagnosing and treating vulvar conditions. He discussed routine disorders (such as pubic lice), potentially dangerous disorders (such as lichen sclerosis, an inflammatory skin condition that can develop into squamous cell carcinoma), and rare disorders (such as Behçet’s syndrome, an inflammation of the blood vessels that can cause genital sores, and Fox-Fordyce disease of the vulva, which produces intense itching).

Dr. Baggish, a professor at the University of California, San Francisco, who treats patients in the Wine Country town of Saint Helena, elaborated on the treatment of vulvar disease in an interview at the meeting jointly provided by Global Academy for Medical Education and the University of Cincinnati. Global Academy and this news organization are owned by the same company. The following are a few of his tips for gynecologists who want to expand their expertise and treat more patients with vulvar disorders.

• Get training in pathology. “That has made a big difference in my ability to intercept different kinds of vulvar and skin diseases,” he said. “You also need to see a lot of abnormalities so you can recognize the kinds of changes that you’re seeing.”
• Take a closer look with a microscope. “I have an operating microscope like an ophthalmologist would use, and it’s on a stand, not a table,” he said. “It always provides magnification with good light. This is a big advantage because misdiagnoses can be made when you can’t see the lesion well.” He added that he projects what he sees in the microscope onto a monitor so the patient can take a look herself. “I’ve found that very valuable,” he said.
• Be alert for chemical burns. “I’ve seen chemical burns when patients have had fungal infections and treated it with certain topical treatments like gentian violet. Somebody may also get a chemical burn from putting some kind of deodorant on their vulva,” Dr. Baggish said. “If you have a chemical burn, you’ll want to treat it with a cream to cover the lesion until it heals on its own. Silvadene is soothing, and patients find it very comfortable.”
• Get the right kind of biopsy. If you can’t identify a lesion, he said, “it’s better to do a biopsy.” He recommends asking pathologists for a reticulum stain. “It shows the support structure of the underlying tissue in the dermis of the layers of the skin, like the structure of a building before you put the covering on the girders,” he said. “The support structure is broken up in lichen planus [a common inflammatory condition that affects the skin and mucous membranes and can cause pain and itch]. You see that if you do a reticulum stain.” If a patient has an inflammatory condition, ask for relevant stains, he said. “For example, if there’s a question that this could be a viral disease like herpes simplex, I’m going to ask them to do a stain for viral inclusions,” he said. “Likewise, I will always ask for a stain for fungal particles, for yeast particles. Sometimes I’ll pick up something like an infection I otherwise would have missed.”
• Contact a specialist when needed. If a biopsy doesn’t help you identify a lesion, he said, “seek out an expert in this area who could be helpful.”

A number of gynecologists like Dr. Baggish specialize in vulvar disease, and several medical centers in the United States operate specialized vulvar clinics including Oregon Health & Science University, Portland; the University of Michigan, Ann Arbor; and Saint Louis University.

Dr. Baggish said he had no disclosures.

LAS VEGAS – Northern California’s Michael S. Baggish, MD, wants more gynecologists to feel comfortable treating disorders of the vulva.

In a presentation at the Pelvic Anatomy and Gynecologic Surgery Symposium, Dr. Baggish ran through some tips about diagnosing and treating vulvar conditions. He discussed routine disorders (such as pubic lice), potentially dangerous disorders (such as lichen sclerosis, an inflammatory skin condition that can develop into squamous cell carcinoma), and rare disorders (such as Behçet’s syndrome, an inflammation of the blood vessels that can cause genital sores, and Fox-Fordyce disease of the vulva, which produces intense itching).

Dr. Baggish, a professor at the University of California, San Francisco, who treats patients in the Wine Country town of Saint Helena, elaborated on the treatment of vulvar disease in an interview at the meeting jointly provided by Global Academy for Medical Education and the University of Cincinnati. Global Academy and this news organization are owned by the same company. The following are a few of his tips for gynecologists who want to expand their expertise and treat more patients with vulvar disorders.

• Get training in pathology. “That has made a big difference in my ability to intercept different kinds of vulvar and skin diseases,” he said. “You also need to see a lot of abnormalities so you can recognize the kinds of changes that you’re seeing.”
• Take a closer look with a microscope. “I have an operating microscope like an ophthalmologist would use, and it’s on a stand, not a table,” he said. “It always provides magnification with good light. This is a big advantage because misdiagnoses can be made when you can’t see the lesion well.” He added that he projects what he sees in the microscope onto a monitor so the patient can take a look herself. “I’ve found that very valuable,” he said.
• Be alert for chemical burns. “I’ve seen chemical burns when patients have had fungal infections and treated it with certain topical treatments like gentian violet. Somebody may also get a chemical burn from putting some kind of deodorant on their vulva,” Dr. Baggish said. “If you have a chemical burn, you’ll want to treat it with a cream to cover the lesion until it heals on its own. Silvadene is soothing, and patients find it very comfortable.”
• Get the right kind of biopsy. If you can’t identify a lesion, he said, “it’s better to do a biopsy.” He recommends asking pathologists for a reticulum stain. “It shows the support structure of the underlying tissue in the dermis of the layers of the skin, like the structure of a building before you put the covering on the girders,” he said. “The support structure is broken up in lichen planus [a common inflammatory condition that affects the skin and mucous membranes and can cause pain and itch]. You see that if you do a reticulum stain.” If a patient has an inflammatory condition, ask for relevant stains, he said. “For example, if there’s a question that this could be a viral disease like herpes simplex, I’m going to ask them to do a stain for viral inclusions,” he said. “Likewise, I will always ask for a stain for fungal particles, for yeast particles. Sometimes I’ll pick up something like an infection I otherwise would have missed.”
• Contact a specialist when needed. If a biopsy doesn’t help you identify a lesion, he said, “seek out an expert in this area who could be helpful.”

A number of gynecologists like Dr. Baggish specialize in vulvar disease, and several medical centers in the United States operate specialized vulvar clinics including Oregon Health & Science University, Portland; the University of Michigan, Ann Arbor; and Saint Louis University.

Dr. Baggish said he had no disclosures.

LAS VEGAS – Northern California’s Michael S. Baggish, MD, wants more gynecologists to feel comfortable treating disorders of the vulva.

In a presentation at the Pelvic Anatomy and Gynecologic Surgery Symposium, Dr. Baggish ran through some tips about diagnosing and treating vulvar conditions. He discussed routine disorders (such as pubic lice), potentially dangerous disorders (such as lichen sclerosis, an inflammatory skin condition that can develop into squamous cell carcinoma), and rare disorders (such as Behçet’s syndrome, an inflammation of the blood vessels that can cause genital sores, and Fox-Fordyce disease of the vulva, which produces intense itching).

Dr. Baggish, a professor at the University of California, San Francisco, who treats patients in the Wine Country town of Saint Helena, elaborated on the treatment of vulvar disease in an interview at the meeting jointly provided by Global Academy for Medical Education and the University of Cincinnati. Global Academy and this news organization are owned by the same company. The following are a few of his tips for gynecologists who want to expand their expertise and treat more patients with vulvar disorders.

• Get training in pathology. “That has made a big difference in my ability to intercept different kinds of vulvar and skin diseases,” he said. “You also need to see a lot of abnormalities so you can recognize the kinds of changes that you’re seeing.”
• Take a closer look with a microscope. “I have an operating microscope like an ophthalmologist would use, and it’s on a stand, not a table,” he said. “It always provides magnification with good light. This is a big advantage because misdiagnoses can be made when you can’t see the lesion well.” He added that he projects what he sees in the microscope onto a monitor so the patient can take a look herself. “I’ve found that very valuable,” he said.
• Be alert for chemical burns. “I’ve seen chemical burns when patients have had fungal infections and treated it with certain topical treatments like gentian violet. Somebody may also get a chemical burn from putting some kind of deodorant on their vulva,” Dr. Baggish said. “If you have a chemical burn, you’ll want to treat it with a cream to cover the lesion until it heals on its own. Silvadene is soothing, and patients find it very comfortable.”
• Get the right kind of biopsy. If you can’t identify a lesion, he said, “it’s better to do a biopsy.” He recommends asking pathologists for a reticulum stain. “It shows the support structure of the underlying tissue in the dermis of the layers of the skin, like the structure of a building before you put the covering on the girders,” he said. “The support structure is broken up in lichen planus [a common inflammatory condition that affects the skin and mucous membranes and can cause pain and itch]. You see that if you do a reticulum stain.” If a patient has an inflammatory condition, ask for relevant stains, he said. “For example, if there’s a question that this could be a viral disease like herpes simplex, I’m going to ask them to do a stain for viral inclusions,” he said. “Likewise, I will always ask for a stain for fungal particles, for yeast particles. Sometimes I’ll pick up something like an infection I otherwise would have missed.”
• Contact a specialist when needed. If a biopsy doesn’t help you identify a lesion, he said, “seek out an expert in this area who could be helpful.”

A number of gynecologists like Dr. Baggish specialize in vulvar disease, and several medical centers in the United States operate specialized vulvar clinics including Oregon Health & Science University, Portland; the University of Michigan, Ann Arbor; and Saint Louis University.

Dr. Baggish said he had no disclosures.

LAS VEGAS – Gynecologist Michael S. Baggish, MD, offered tips about diagnosis and treatment of vulvar conditions at the Pelvic Anatomy and Gynecologic Surgery Symposium.

Pubic lice

Treat with malathion 0.5% lotion (Ovide), permethrin 1%-5% (Nix), or lindane 1% (Kwell). Be aware that the U.S. Library of Medicine cautions that lindane can cause serious side effects, and patients should use it only “if there is some reason you cannot use the other medications or if you have tried the other medications and they have not worked.”

Pruritus (itchy skin)

Eliminate possible contact allergens such as soaps, detergents, and undergarments. Swabs with 2% acetic acid solution can assist with general hygiene. It’s important to address secondary infections, and control of diet and stress may be helpful.

Folliculitis (inflammation of hair follicles)

A salt water bath can be helpful. Try 2 cups of “Instant Ocean” – a sea salt product for aquariums – in a shallow bath twice daily.

It can be treated with silver sulfadiazine (Silvadene) cream (three times daily and at bedtime) or clindamycin (Cleocin) cream (three times daily and at bedtime).

Consider a systemic drug after culture results come back if needed.
 

Lichen sclerosus (a skin inflammation also known as white spot disease)

“I see a lot of lichen sclerosus,” Dr. Baggish said. “Every single practice day, I’m seeing two or three [cases].”

Topical treatments include testosterone cream (which has low efficacy) and topical corticosteroid creams and ointments (the standard treatment).

Other treatments provide better and more consistent results: Etretinate (Tegison), a retinoid that is expensive and can produce serious side effects, and injectable dexamethasone (Decadron), which can stop progression.

Be aware that 10% of patients with this condition may develop squamous cell carcinoma. Monitor for any changes in appearance and biopsy if needed.

Behçet’s disease (a blood vessel inflammation disorder also known as silk road disease)

This rare condition can cause mouth and genital ulcers and uveitis (eye inflammation). For treatment, start 40 mg prednisone for 2-3 days, then 20 mg for 2 days, then 10 mg for 4 days, then stop. Start treatment immediately if there are signs of an oral lesion.

Fox-Fordyce disease (an inflammatory response that blocks sweat ducts and causes intense itching)

Treatment includes estrogen (2.5 mg per day) and tretinoin (Retin-A, apply once daily), usually given together. Suggest that patients try the Instant Ocean salt water treatment in the bath once daily (see details above under folliculitis entry).

Genital warts

Vaporize the warts via laser. “If they look like they’re recurring, I put them on interferon for 3 months because otherwise they just keep recurring,” Dr. Baggish said. “You could put topical treatments on them, but they’ll recur.”

Dr. Baggish, of the University of California, San Francisco, had no relevant financial disclosures. The meeting was jointly provided by Global Academy for Medical Education and the University of Cincinnati. Global Academy and this news organization are owned by the same company.

LAS VEGAS – Gynecologist Michael S. Baggish, MD, offered tips about diagnosis and treatment of vulvar conditions at the Pelvic Anatomy and Gynecologic Surgery Symposium.

Pubic lice

Treat with malathion 0.5% lotion (Ovide), permethrin 1%-5% (Nix), or lindane 1% (Kwell). Be aware that the U.S. Library of Medicine cautions that lindane can cause serious side effects, and patients should use it only “if there is some reason you cannot use the other medications or if you have tried the other medications and they have not worked.”

Pruritus (itchy skin)

Eliminate possible contact allergens such as soaps, detergents, and undergarments. Swabs with 2% acetic acid solution can assist with general hygiene. It’s important to address secondary infections, and control of diet and stress may be helpful.

Folliculitis (inflammation of hair follicles)

A salt water bath can be helpful. Try 2 cups of “Instant Ocean” – a sea salt product for aquariums – in a shallow bath twice daily.

It can be treated with silver sulfadiazine (Silvadene) cream (three times daily and at bedtime) or clindamycin (Cleocin) cream (three times daily and at bedtime).

Consider a systemic drug after culture results come back if needed.
 

Lichen sclerosus (a skin inflammation also known as white spot disease)

“I see a lot of lichen sclerosus,” Dr. Baggish said. “Every single practice day, I’m seeing two or three [cases].”

Topical treatments include testosterone cream (which has low efficacy) and topical corticosteroid creams and ointments (the standard treatment).

Other treatments provide better and more consistent results: Etretinate (Tegison), a retinoid that is expensive and can produce serious side effects, and injectable dexamethasone (Decadron), which can stop progression.

Be aware that 10% of patients with this condition may develop squamous cell carcinoma. Monitor for any changes in appearance and biopsy if needed.

Behçet’s disease (a blood vessel inflammation disorder also known as silk road disease)

This rare condition can cause mouth and genital ulcers and uveitis (eye inflammation). For treatment, start 40 mg prednisone for 2-3 days, then 20 mg for 2 days, then 10 mg for 4 days, then stop. Start treatment immediately if there are signs of an oral lesion.

Fox-Fordyce disease (an inflammatory response that blocks sweat ducts and causes intense itching)

Treatment includes estrogen (2.5 mg per day) and tretinoin (Retin-A, apply once daily), usually given together. Suggest that patients try the Instant Ocean salt water treatment in the bath once daily (see details above under folliculitis entry).

Genital warts

Vaporize the warts via laser. “If they look like they’re recurring, I put them on interferon for 3 months because otherwise they just keep recurring,” Dr. Baggish said. “You could put topical treatments on them, but they’ll recur.”

Dr. Baggish, of the University of California, San Francisco, had no relevant financial disclosures. The meeting was jointly provided by Global Academy for Medical Education and the University of Cincinnati. Global Academy and this news organization are owned by the same company.

LAS VEGAS – Gynecologist Michael S. Baggish, MD, offered tips about diagnosis and treatment of vulvar conditions at the Pelvic Anatomy and Gynecologic Surgery Symposium.

Pubic lice

Treat with malathion 0.5% lotion (Ovide), permethrin 1%-5% (Nix), or lindane 1% (Kwell). Be aware that the U.S. Library of Medicine cautions that lindane can cause serious side effects, and patients should use it only “if there is some reason you cannot use the other medications or if you have tried the other medications and they have not worked.”

Pruritus (itchy skin)

Eliminate possible contact allergens such as soaps, detergents, and undergarments. Swabs with 2% acetic acid solution can assist with general hygiene. It’s important to address secondary infections, and control of diet and stress may be helpful.

Folliculitis (inflammation of hair follicles)

A salt water bath can be helpful. Try 2 cups of “Instant Ocean” – a sea salt product for aquariums – in a shallow bath twice daily.

It can be treated with silver sulfadiazine (Silvadene) cream (three times daily and at bedtime) or clindamycin (Cleocin) cream (three times daily and at bedtime).

Consider a systemic drug after culture results come back if needed.
 

Lichen sclerosus (a skin inflammation also known as white spot disease)

“I see a lot of lichen sclerosus,” Dr. Baggish said. “Every single practice day, I’m seeing two or three [cases].”

Topical treatments include testosterone cream (which has low efficacy) and topical corticosteroid creams and ointments (the standard treatment).

Other treatments provide better and more consistent results: Etretinate (Tegison), a retinoid that is expensive and can produce serious side effects, and injectable dexamethasone (Decadron), which can stop progression.

Be aware that 10% of patients with this condition may develop squamous cell carcinoma. Monitor for any changes in appearance and biopsy if needed.

Behçet’s disease (a blood vessel inflammation disorder also known as silk road disease)

This rare condition can cause mouth and genital ulcers and uveitis (eye inflammation). For treatment, start 40 mg prednisone for 2-3 days, then 20 mg for 2 days, then 10 mg for 4 days, then stop. Start treatment immediately if there are signs of an oral lesion.

Fox-Fordyce disease (an inflammatory response that blocks sweat ducts and causes intense itching)

Treatment includes estrogen (2.5 mg per day) and tretinoin (Retin-A, apply once daily), usually given together. Suggest that patients try the Instant Ocean salt water treatment in the bath once daily (see details above under folliculitis entry).

Genital warts

Vaporize the warts via laser. “If they look like they’re recurring, I put them on interferon for 3 months because otherwise they just keep recurring,” Dr. Baggish said. “You could put topical treatments on them, but they’ll recur.”

Dr. Baggish, of the University of California, San Francisco, had no relevant financial disclosures. The meeting was jointly provided by Global Academy for Medical Education and the University of Cincinnati. Global Academy and this news organization are owned by the same company.

Sagar Lonial, MD, an expert in the biology and treatment of multiple myeloma, was recently named as the Anne and Bernard Gray Family Chair in Cancer at Winship Cancer Institute of Emory University, Atlanta.

The endowment was created in honor of Mrs. Gray’s sister, Karen Ammons Howell, who died of breast cancer. Dr. Lonial, who joined Emory more than 20 years ago, is also the chief medical officer for Winship Cancer Institute and the chairman of the department of hematology and medical oncology. He is currently leading a global genome sequencing study for patients with newly diagnosed myeloma.

The Moffitt Cancer Center, Tampa, is taking a step toward precision medicine. They recently created the position of artificial intelligence officer. J. Ross Mitchell, PhD, is taking on the new role and is tasked with using computer science – and, specifically, artificial intelligence applications – to improve efficiency and quality of care at the center. Dr. Mitchell previously worked at the Mayo Clinic in Scottsdale, Ariz., leading medical imaging information projects, including the application of machine learning in brain tumor imaging.

Oren Cahlon, MD, a radiation oncologist at Memorial Sloan Kettering Cancer Center, New York, has been tapped as associate deputy physician in chief for the institution’s Regional Care Network. This puts Dr. Cahlon, an expert in proton therapy, in a new role overseeing outpatient clinical programs across seven locations in New York and New Jersey. Dr. Cahlon will continue in his position as vice chair of the department of radiation oncology, in which he has served since 2016.

John Barrett, MD, is the new editor in chief of the British Journal of Haematology. He begins his term in January 2019. Dr. Barrett, who is a clinical professor of medicine at George Washington University Cancer Center in Washington takes over from Finbarr E. Cotter, MBBS, PhD, who had served in the role since 2006.

The cancer community is mourning the passage of Bertrand Coiffier, MD, PhD, who died in January 2019 at the age of 71. The well-known lymphoma researcher led the team that first described the use of the R-CHOP chemotherapy regimen for the treatment of diffuse large B-cell lymphoma in 2002. Dr. Coiffier also was a founding member of the Groupe d’Etude des Lymphomes de l’Adulte (GELA), which began in Europe in 1984 to advance basic and clinical research on lymphoma in adults, and later became LYSA (Lymphoma Study Association).

mschneider@mdedge.com

Sagar Lonial, MD, an expert in the biology and treatment of multiple myeloma, was recently named as the Anne and Bernard Gray Family Chair in Cancer at Winship Cancer Institute of Emory University, Atlanta.

The endowment was created in honor of Mrs. Gray’s sister, Karen Ammons Howell, who died of breast cancer. Dr. Lonial, who joined Emory more than 20 years ago, is also the chief medical officer for Winship Cancer Institute and the chairman of the department of hematology and medical oncology. He is currently leading a global genome sequencing study for patients with newly diagnosed myeloma.

The Moffitt Cancer Center, Tampa, is taking a step toward precision medicine. They recently created the position of artificial intelligence officer. J. Ross Mitchell, PhD, is taking on the new role and is tasked with using computer science – and, specifically, artificial intelligence applications – to improve efficiency and quality of care at the center. Dr. Mitchell previously worked at the Mayo Clinic in Scottsdale, Ariz., leading medical imaging information projects, including the application of machine learning in brain tumor imaging.

Oren Cahlon, MD, a radiation oncologist at Memorial Sloan Kettering Cancer Center, New York, has been tapped as associate deputy physician in chief for the institution’s Regional Care Network. This puts Dr. Cahlon, an expert in proton therapy, in a new role overseeing outpatient clinical programs across seven locations in New York and New Jersey. Dr. Cahlon will continue in his position as vice chair of the department of radiation oncology, in which he has served since 2016.

John Barrett, MD, is the new editor in chief of the British Journal of Haematology. He begins his term in January 2019. Dr. Barrett, who is a clinical professor of medicine at George Washington University Cancer Center in Washington takes over from Finbarr E. Cotter, MBBS, PhD, who had served in the role since 2006.

The cancer community is mourning the passage of Bertrand Coiffier, MD, PhD, who died in January 2019 at the age of 71. The well-known lymphoma researcher led the team that first described the use of the R-CHOP chemotherapy regimen for the treatment of diffuse large B-cell lymphoma in 2002. Dr. Coiffier also was a founding member of the Groupe d’Etude des Lymphomes de l’Adulte (GELA), which began in Europe in 1984 to advance basic and clinical research on lymphoma in adults, and later became LYSA (Lymphoma Study Association).

mschneider@mdedge.com

Sagar Lonial, MD, an expert in the biology and treatment of multiple myeloma, was recently named as the Anne and Bernard Gray Family Chair in Cancer at Winship Cancer Institute of Emory University, Atlanta.

The endowment was created in honor of Mrs. Gray’s sister, Karen Ammons Howell, who died of breast cancer. Dr. Lonial, who joined Emory more than 20 years ago, is also the chief medical officer for Winship Cancer Institute and the chairman of the department of hematology and medical oncology. He is currently leading a global genome sequencing study for patients with newly diagnosed myeloma.

The Moffitt Cancer Center, Tampa, is taking a step toward precision medicine. They recently created the position of artificial intelligence officer. J. Ross Mitchell, PhD, is taking on the new role and is tasked with using computer science – and, specifically, artificial intelligence applications – to improve efficiency and quality of care at the center. Dr. Mitchell previously worked at the Mayo Clinic in Scottsdale, Ariz., leading medical imaging information projects, including the application of machine learning in brain tumor imaging.

Oren Cahlon, MD, a radiation oncologist at Memorial Sloan Kettering Cancer Center, New York, has been tapped as associate deputy physician in chief for the institution’s Regional Care Network. This puts Dr. Cahlon, an expert in proton therapy, in a new role overseeing outpatient clinical programs across seven locations in New York and New Jersey. Dr. Cahlon will continue in his position as vice chair of the department of radiation oncology, in which he has served since 2016.

John Barrett, MD, is the new editor in chief of the British Journal of Haematology. He begins his term in January 2019. Dr. Barrett, who is a clinical professor of medicine at George Washington University Cancer Center in Washington takes over from Finbarr E. Cotter, MBBS, PhD, who had served in the role since 2006.

The cancer community is mourning the passage of Bertrand Coiffier, MD, PhD, who died in January 2019 at the age of 71. The well-known lymphoma researcher led the team that first described the use of the R-CHOP chemotherapy regimen for the treatment of diffuse large B-cell lymphoma in 2002. Dr. Coiffier also was a founding member of the Groupe d’Etude des Lymphomes de l’Adulte (GELA), which began in Europe in 1984 to advance basic and clinical research on lymphoma in adults, and later became LYSA (Lymphoma Study Association).

mschneider@mdedge.com

Click here to read the supplement. 

Iron deficiency anemia (IDA) is one of the most common causes of anemia in women, and affects women of all ages. In this supplement, you will read about:

• How to identify IDA in women
• How to treat IDA
• A patient case study

Click here to read the supplement. 

Click here to read the supplement. 

Iron deficiency anemia (IDA) is one of the most common causes of anemia in women, and affects women of all ages. In this supplement, you will read about:

• How to identify IDA in women
• How to treat IDA
• A patient case study

Click here to read the supplement. 

Click here to read the supplement. 

Iron deficiency anemia (IDA) is one of the most common causes of anemia in women, and affects women of all ages. In this supplement, you will read about:

• How to identify IDA in women
• How to treat IDA
• A patient case study

Click here to read the supplement. 

LAS VEGAS – Bilateral deep brain stimulation (DBS) of the globus pallidus internus (GPI) significantly improves genitourinary symptoms in patients with Parkinson’s disease, according to a small study presented at the annual meeting of the North American Neuromodulation Society. DBS of the subthalamic nucleus (STN), however, does not significantly improve these symptoms.

“Further work will be needed to confirm whether DBS needs to be bilateral ... and whether demographic differences are significant,” said Michael Gillogly, RN, clinical research nurse in the department of neurosurgery at Albany (New York) Medical Center. “The pilot data suggest that, if all else is equal, and the patient has significant urinary dysfunction as a major complaint, GPI DBS may be preferentially considered.”

The benefits of DBS on motor symptoms in Parkinson’s disease are well documented in the literature, but the technique’s effects on nonmotor symptoms are less clear. Nonmotor symptoms – such as cognitive deficits, gastrointestinal dysfunction, genitourinary dysfunction, and sleep disturbance – are common in all stages of Parkinson’s disease and significantly impair quality of life. Data indicate that speech and neuropsychological symptoms worsen with DBS of the STN, but research into the effect of DBS of the GPI on nonmotor symptoms is limited.

Mr. Gillogly and his colleagues considered all surgical candidates at their facility for enrollment into a study evaluating nonmotor outcomes in Parkinson’s disease at baseline, before implantation, and at 6 months after DBS. Study outcomes were patient perception of urinary, swallowing, and gastrointestinal function at 6 months after DBS of the GPI, compared with DBS of the STN.

The researchers chose two tools each to measure sialorrhea, dysphagia, and genitourinary dysfunction. These tools included the Drooling Severity and Frequency Scale (DSFS), the Swallowing Disturbance Questionnaire, and the International Prostate Symptom Score (IPSS). The investigators also collected demographic information, including sex, age at the time of surgery, duration of illness, neuropsychological profile, and medication inventory.

In all, 34 patients (12 women) were enrolled in the study and completed each outcome measure preoperatively and at 6 months postoperatively. The mean age of our subjects at the time of surgery was 64 years. Eight received DBS of the GPI, and 26 received DBS of the STN. Mr. Gillogly and his colleagues observed a significant 31% improvement in DSFS score and a significant 24% improvement on the IPSS among GPI-targeted patients. They found no significant improvements among patients who had STN targeting. When the investigators compared patients with unilateral lead placement and those with bilateral lead placement, they observed that all of the significant improvement among patients with GPI targeting occurred when treatment was bilateral.

The small sample size is a notable limitation of the study, and subset analyses were limited, said Mr. Gillogly. In addition, it was difficult to determine whether the symptoms studied were directly related to Parkinson’s disease, because they often arise as part of the natural aging process. “Other limitations of the study include lack of objective measurements, as these are all patient perception, and the innate limitations of self-reported questionnaires,” said Mr. Gillogly.

Two of the researchers reported having consulted for Medtronic, which markets a DBS system. One author received grant funding and consulting fees from Boston Scientific, Medtronic, and Abbott, all of which make DBS devices.

egreb@mdedge.com

LAS VEGAS – Bilateral deep brain stimulation (DBS) of the globus pallidus internus (GPI) significantly improves genitourinary symptoms in patients with Parkinson’s disease, according to a small study presented at the annual meeting of the North American Neuromodulation Society. DBS of the subthalamic nucleus (STN), however, does not significantly improve these symptoms.

“Further work will be needed to confirm whether DBS needs to be bilateral ... and whether demographic differences are significant,” said Michael Gillogly, RN, clinical research nurse in the department of neurosurgery at Albany (New York) Medical Center. “The pilot data suggest that, if all else is equal, and the patient has significant urinary dysfunction as a major complaint, GPI DBS may be preferentially considered.”

The benefits of DBS on motor symptoms in Parkinson’s disease are well documented in the literature, but the technique’s effects on nonmotor symptoms are less clear. Nonmotor symptoms – such as cognitive deficits, gastrointestinal dysfunction, genitourinary dysfunction, and sleep disturbance – are common in all stages of Parkinson’s disease and significantly impair quality of life. Data indicate that speech and neuropsychological symptoms worsen with DBS of the STN, but research into the effect of DBS of the GPI on nonmotor symptoms is limited.

Mr. Gillogly and his colleagues considered all surgical candidates at their facility for enrollment into a study evaluating nonmotor outcomes in Parkinson’s disease at baseline, before implantation, and at 6 months after DBS. Study outcomes were patient perception of urinary, swallowing, and gastrointestinal function at 6 months after DBS of the GPI, compared with DBS of the STN.

The researchers chose two tools each to measure sialorrhea, dysphagia, and genitourinary dysfunction. These tools included the Drooling Severity and Frequency Scale (DSFS), the Swallowing Disturbance Questionnaire, and the International Prostate Symptom Score (IPSS). The investigators also collected demographic information, including sex, age at the time of surgery, duration of illness, neuropsychological profile, and medication inventory.

In all, 34 patients (12 women) were enrolled in the study and completed each outcome measure preoperatively and at 6 months postoperatively. The mean age of our subjects at the time of surgery was 64 years. Eight received DBS of the GPI, and 26 received DBS of the STN. Mr. Gillogly and his colleagues observed a significant 31% improvement in DSFS score and a significant 24% improvement on the IPSS among GPI-targeted patients. They found no significant improvements among patients who had STN targeting. When the investigators compared patients with unilateral lead placement and those with bilateral lead placement, they observed that all of the significant improvement among patients with GPI targeting occurred when treatment was bilateral.

The small sample size is a notable limitation of the study, and subset analyses were limited, said Mr. Gillogly. In addition, it was difficult to determine whether the symptoms studied were directly related to Parkinson’s disease, because they often arise as part of the natural aging process. “Other limitations of the study include lack of objective measurements, as these are all patient perception, and the innate limitations of self-reported questionnaires,” said Mr. Gillogly.

Two of the researchers reported having consulted for Medtronic, which markets a DBS system. One author received grant funding and consulting fees from Boston Scientific, Medtronic, and Abbott, all of which make DBS devices.

egreb@mdedge.com

LAS VEGAS – Bilateral deep brain stimulation (DBS) of the globus pallidus internus (GPI) significantly improves genitourinary symptoms in patients with Parkinson’s disease, according to a small study presented at the annual meeting of the North American Neuromodulation Society. DBS of the subthalamic nucleus (STN), however, does not significantly improve these symptoms.

“Further work will be needed to confirm whether DBS needs to be bilateral ... and whether demographic differences are significant,” said Michael Gillogly, RN, clinical research nurse in the department of neurosurgery at Albany (New York) Medical Center. “The pilot data suggest that, if all else is equal, and the patient has significant urinary dysfunction as a major complaint, GPI DBS may be preferentially considered.”

The benefits of DBS on motor symptoms in Parkinson’s disease are well documented in the literature, but the technique’s effects on nonmotor symptoms are less clear. Nonmotor symptoms – such as cognitive deficits, gastrointestinal dysfunction, genitourinary dysfunction, and sleep disturbance – are common in all stages of Parkinson’s disease and significantly impair quality of life. Data indicate that speech and neuropsychological symptoms worsen with DBS of the STN, but research into the effect of DBS of the GPI on nonmotor symptoms is limited.

Mr. Gillogly and his colleagues considered all surgical candidates at their facility for enrollment into a study evaluating nonmotor outcomes in Parkinson’s disease at baseline, before implantation, and at 6 months after DBS. Study outcomes were patient perception of urinary, swallowing, and gastrointestinal function at 6 months after DBS of the GPI, compared with DBS of the STN.

The researchers chose two tools each to measure sialorrhea, dysphagia, and genitourinary dysfunction. These tools included the Drooling Severity and Frequency Scale (DSFS), the Swallowing Disturbance Questionnaire, and the International Prostate Symptom Score (IPSS). The investigators also collected demographic information, including sex, age at the time of surgery, duration of illness, neuropsychological profile, and medication inventory.

In all, 34 patients (12 women) were enrolled in the study and completed each outcome measure preoperatively and at 6 months postoperatively. The mean age of our subjects at the time of surgery was 64 years. Eight received DBS of the GPI, and 26 received DBS of the STN. Mr. Gillogly and his colleagues observed a significant 31% improvement in DSFS score and a significant 24% improvement on the IPSS among GPI-targeted patients. They found no significant improvements among patients who had STN targeting. When the investigators compared patients with unilateral lead placement and those with bilateral lead placement, they observed that all of the significant improvement among patients with GPI targeting occurred when treatment was bilateral.

The small sample size is a notable limitation of the study, and subset analyses were limited, said Mr. Gillogly. In addition, it was difficult to determine whether the symptoms studied were directly related to Parkinson’s disease, because they often arise as part of the natural aging process. “Other limitations of the study include lack of objective measurements, as these are all patient perception, and the innate limitations of self-reported questionnaires,” said Mr. Gillogly.

Two of the researchers reported having consulted for Medtronic, which markets a DBS system. One author received grant funding and consulting fees from Boston Scientific, Medtronic, and Abbott, all of which make DBS devices.

egreb@mdedge.com

SAN FRANCISCO – The cancer vaccine tecemotide (L-BLP25) does not improve outcomes when given after resection of isolated liver metastases of colorectal cancer, according to final results of the German and Austrian phase 2 randomized LICC trial. However, information gleaned from the results, which were reported at the 2019 GI Cancers Symposium, will help inform future research.

“Hepatic metastectomy … is deemed the only potential curative treatment for stage IV colorectal cancer with limited liver disease. However, high recurrence rates after resection remain a major challenge: They range up to 50%-75% within the first 2 years,” said lead investigator Carl C. Schimanski, MD, PhD, of the Klinikum Darmstadt GmbH in Darmstadt, Germany.

Tecemotide is a liposome carrying mucin 1 (MUC1) antigen and an adjuvant that is taken up by antigen-presenting cells, ultimately leading to production of MUC1-specific cytotoxic T lymphocytes that target tumors. “MUC1 has been described to be expressed in up to 100% of colorectal cancer metastasis, so we thought this might be a good target,” Dr. Schimanski explained.

All 121 patients in the LICC trial had recently undergone primary or secondary resection, with either R0 or R1 outcome, for liver-only metastases of colorectal cancer. They were treated on a double-blind basis with a single dose of cyclophosphamide to reduce regulatory T cells, followed by tecemotide (weekly for 8 weeks, then every 6 weeks for up to 2 years) or with placebo.

A good space for testing immune therapies

In 2009, a consensus panel of immunologists ranked MUC1 as the second-best cancer antigen for translational research, “so there was clearly a feeling that this was a good target at that time for going forward,” noted invited discussant Michael J. Overman, MD, a professor in the department of gastrointestinal medical oncology, division of cancer medicine, University of Texas MD Anderson Cancer Center, Houston.

He agreed with the LICC investigators’ conclusions that the trial was negative and that MUC1 expression does not appear to predict outcome. “Whether that’s the wrong target, or whether it was the wrong formulation in regards to cancer vaccine, I think we do not know. I do think that survival was encouraging,” he said.

“There’s many unanswered questions in regards to the LICC study and in regards to cancer vaccines in general,” Dr. Overman noted. Among them, what are the optimal antigens to target, what are the optimal vaccine formulations and adjuvant agents, what is the best way to address the immunosuppressive tumor microenvironment, and what is the correct disease setting for vaccine testing?

“The LICC study is very impressive in demonstrating that we can enroll in this posthepatectomy space, postmetastectomy space. It’s a very increasingly interesting space for, potentially, drug development and immunologic exploration,” he maintained. “One of the benefits of this space when we talk about a minimal residual disease setting is that you potentially do not have the suppressive effects from the tumor microenvironment that potentially are hindering success in regards to having immune therapy response. So I would say that this is a space we should consider for drug development going forward.”
 

Study details

In the LICC trial, tecemotide and placebo yielded a respective median recurrence-free survival of 6.1 months and 11.4 months (P = .1754) and a respective overall survival of 62.8 months and not reached (P = .2141), Dr. Schimanski reported at the symposium, sponsored by the American Gastroenterological Association, the American Society for Clinical Oncology, the American Society for Radiation Oncology, and the Society of Surgical Oncology. The 3-year overall survival rate was 69.1% with tecemotide and 79.1% with placebo.

That survival “was astonishing for us,” Dr. Schimanski said. “We think – but we cannot prove it – that has resulted from careful staging due to the retrospective radiological review and the initial staging, and a very tight surveillance program.”

Findings were similar regardless of whether patients had low, medium, or high tumor MUC1 expression; therefore, “we have to conclude that the target is not really validated.”

Patients in the tecemotide arm had higher rates of any-grade nausea, fatigue, diarrhea, and viral upper respiratory tract infections, at least some of which was likely attributable to the single dose of cyclophosphamide, according to Dr. Schimanski. They also had higher (but still low) rates of grade 3 or 4 back pain, anemia, ileus, cholestatic jaundice, and increased blood uric acid levels (2.5% for each). There was a single death in that arm from Merkel cell carcinoma that was deemed potentially related to the vaccine.

Dr. Schimanski disclosed that an immediate family member is employed by Merck and that he receives research funding from Merck KGaA (institutional). The trial was funded by Merck KGaA.

SOURCE: Schimanski CC et al. GI Cancers Symposium, Abstract 480.

SAN FRANCISCO – The cancer vaccine tecemotide (L-BLP25) does not improve outcomes when given after resection of isolated liver metastases of colorectal cancer, according to final results of the German and Austrian phase 2 randomized LICC trial. However, information gleaned from the results, which were reported at the 2019 GI Cancers Symposium, will help inform future research.

“Hepatic metastectomy … is deemed the only potential curative treatment for stage IV colorectal cancer with limited liver disease. However, high recurrence rates after resection remain a major challenge: They range up to 50%-75% within the first 2 years,” said lead investigator Carl C. Schimanski, MD, PhD, of the Klinikum Darmstadt GmbH in Darmstadt, Germany.

Tecemotide is a liposome carrying mucin 1 (MUC1) antigen and an adjuvant that is taken up by antigen-presenting cells, ultimately leading to production of MUC1-specific cytotoxic T lymphocytes that target tumors. “MUC1 has been described to be expressed in up to 100% of colorectal cancer metastasis, so we thought this might be a good target,” Dr. Schimanski explained.

All 121 patients in the LICC trial had recently undergone primary or secondary resection, with either R0 or R1 outcome, for liver-only metastases of colorectal cancer. They were treated on a double-blind basis with a single dose of cyclophosphamide to reduce regulatory T cells, followed by tecemotide (weekly for 8 weeks, then every 6 weeks for up to 2 years) or with placebo.

A good space for testing immune therapies

In 2009, a consensus panel of immunologists ranked MUC1 as the second-best cancer antigen for translational research, “so there was clearly a feeling that this was a good target at that time for going forward,” noted invited discussant Michael J. Overman, MD, a professor in the department of gastrointestinal medical oncology, division of cancer medicine, University of Texas MD Anderson Cancer Center, Houston.

He agreed with the LICC investigators’ conclusions that the trial was negative and that MUC1 expression does not appear to predict outcome. “Whether that’s the wrong target, or whether it was the wrong formulation in regards to cancer vaccine, I think we do not know. I do think that survival was encouraging,” he said.

“There’s many unanswered questions in regards to the LICC study and in regards to cancer vaccines in general,” Dr. Overman noted. Among them, what are the optimal antigens to target, what are the optimal vaccine formulations and adjuvant agents, what is the best way to address the immunosuppressive tumor microenvironment, and what is the correct disease setting for vaccine testing?

“The LICC study is very impressive in demonstrating that we can enroll in this posthepatectomy space, postmetastectomy space. It’s a very increasingly interesting space for, potentially, drug development and immunologic exploration,” he maintained. “One of the benefits of this space when we talk about a minimal residual disease setting is that you potentially do not have the suppressive effects from the tumor microenvironment that potentially are hindering success in regards to having immune therapy response. So I would say that this is a space we should consider for drug development going forward.”
 

Study details

In the LICC trial, tecemotide and placebo yielded a respective median recurrence-free survival of 6.1 months and 11.4 months (P = .1754) and a respective overall survival of 62.8 months and not reached (P = .2141), Dr. Schimanski reported at the symposium, sponsored by the American Gastroenterological Association, the American Society for Clinical Oncology, the American Society for Radiation Oncology, and the Society of Surgical Oncology. The 3-year overall survival rate was 69.1% with tecemotide and 79.1% with placebo.

That survival “was astonishing for us,” Dr. Schimanski said. “We think – but we cannot prove it – that has resulted from careful staging due to the retrospective radiological review and the initial staging, and a very tight surveillance program.”

Findings were similar regardless of whether patients had low, medium, or high tumor MUC1 expression; therefore, “we have to conclude that the target is not really validated.”

Patients in the tecemotide arm had higher rates of any-grade nausea, fatigue, diarrhea, and viral upper respiratory tract infections, at least some of which was likely attributable to the single dose of cyclophosphamide, according to Dr. Schimanski. They also had higher (but still low) rates of grade 3 or 4 back pain, anemia, ileus, cholestatic jaundice, and increased blood uric acid levels (2.5% for each). There was a single death in that arm from Merkel cell carcinoma that was deemed potentially related to the vaccine.

Dr. Schimanski disclosed that an immediate family member is employed by Merck and that he receives research funding from Merck KGaA (institutional). The trial was funded by Merck KGaA.

SOURCE: Schimanski CC et al. GI Cancers Symposium, Abstract 480.

SAN FRANCISCO – The cancer vaccine tecemotide (L-BLP25) does not improve outcomes when given after resection of isolated liver metastases of colorectal cancer, according to final results of the German and Austrian phase 2 randomized LICC trial. However, information gleaned from the results, which were reported at the 2019 GI Cancers Symposium, will help inform future research.

“Hepatic metastectomy … is deemed the only potential curative treatment for stage IV colorectal cancer with limited liver disease. However, high recurrence rates after resection remain a major challenge: They range up to 50%-75% within the first 2 years,” said lead investigator Carl C. Schimanski, MD, PhD, of the Klinikum Darmstadt GmbH in Darmstadt, Germany.

Tecemotide is a liposome carrying mucin 1 (MUC1) antigen and an adjuvant that is taken up by antigen-presenting cells, ultimately leading to production of MUC1-specific cytotoxic T lymphocytes that target tumors. “MUC1 has been described to be expressed in up to 100% of colorectal cancer metastasis, so we thought this might be a good target,” Dr. Schimanski explained.

All 121 patients in the LICC trial had recently undergone primary or secondary resection, with either R0 or R1 outcome, for liver-only metastases of colorectal cancer. They were treated on a double-blind basis with a single dose of cyclophosphamide to reduce regulatory T cells, followed by tecemotide (weekly for 8 weeks, then every 6 weeks for up to 2 years) or with placebo.

A good space for testing immune therapies

In 2009, a consensus panel of immunologists ranked MUC1 as the second-best cancer antigen for translational research, “so there was clearly a feeling that this was a good target at that time for going forward,” noted invited discussant Michael J. Overman, MD, a professor in the department of gastrointestinal medical oncology, division of cancer medicine, University of Texas MD Anderson Cancer Center, Houston.

He agreed with the LICC investigators’ conclusions that the trial was negative and that MUC1 expression does not appear to predict outcome. “Whether that’s the wrong target, or whether it was the wrong formulation in regards to cancer vaccine, I think we do not know. I do think that survival was encouraging,” he said.

“There’s many unanswered questions in regards to the LICC study and in regards to cancer vaccines in general,” Dr. Overman noted. Among them, what are the optimal antigens to target, what are the optimal vaccine formulations and adjuvant agents, what is the best way to address the immunosuppressive tumor microenvironment, and what is the correct disease setting for vaccine testing?

“The LICC study is very impressive in demonstrating that we can enroll in this posthepatectomy space, postmetastectomy space. It’s a very increasingly interesting space for, potentially, drug development and immunologic exploration,” he maintained. “One of the benefits of this space when we talk about a minimal residual disease setting is that you potentially do not have the suppressive effects from the tumor microenvironment that potentially are hindering success in regards to having immune therapy response. So I would say that this is a space we should consider for drug development going forward.”
 

Study details

In the LICC trial, tecemotide and placebo yielded a respective median recurrence-free survival of 6.1 months and 11.4 months (P = .1754) and a respective overall survival of 62.8 months and not reached (P = .2141), Dr. Schimanski reported at the symposium, sponsored by the American Gastroenterological Association, the American Society for Clinical Oncology, the American Society for Radiation Oncology, and the Society of Surgical Oncology. The 3-year overall survival rate was 69.1% with tecemotide and 79.1% with placebo.

That survival “was astonishing for us,” Dr. Schimanski said. “We think – but we cannot prove it – that has resulted from careful staging due to the retrospective radiological review and the initial staging, and a very tight surveillance program.”

Findings were similar regardless of whether patients had low, medium, or high tumor MUC1 expression; therefore, “we have to conclude that the target is not really validated.”

Patients in the tecemotide arm had higher rates of any-grade nausea, fatigue, diarrhea, and viral upper respiratory tract infections, at least some of which was likely attributable to the single dose of cyclophosphamide, according to Dr. Schimanski. They also had higher (but still low) rates of grade 3 or 4 back pain, anemia, ileus, cholestatic jaundice, and increased blood uric acid levels (2.5% for each). There was a single death in that arm from Merkel cell carcinoma that was deemed potentially related to the vaccine.

Dr. Schimanski disclosed that an immediate family member is employed by Merck and that he receives research funding from Merck KGaA (institutional). The trial was funded by Merck KGaA.

SOURCE: Schimanski CC et al. GI Cancers Symposium, Abstract 480.

Officials in Texas see their new “Dose of Reality” website as a tool that might help address the opioid crisis in their state.

Hailshadow/iStock/Getty Images

Dose of Reality, an initiative of the state attorney general, the Texas Department of State Health Services, and Texas Health and Human Services, offers for download material on opioids. People also can learn about risk factors of opioid abuse and how to safely store the medications. Drug disposal sites statewide also are included, according to an article published by the Dallas Morning News.

“The misuse of prescription opioids costs lives and devastates Texas families in every corner of our state. Dose of Reality is a one-stop shop of information on the opioid epidemic in Texas. [It] will pull back the curtain on opioids, educate Texans and save, hopefully, many lives,” Texas Attorney General Ken Paxton reportedly said at a press conference announcing the website launch.

Of the 42,249 deaths tied to opioid overdoses reported nationwide by the National Institute on Drug Abuse in 2016, 1,375 of those deaths reportedly occurred in Texas. According to Mr. Paxton, deceptive marketing and promotion by pharmaceutical companies have been part of the problem.

Efforts aimed at combating the opioid crisis by Mr. Paxton have included legal action against one drug manufacturer to force more realistic description of the risks of opioid use.

Generation Z and mental health

Gen Z’ers – young people born from the mid-1990s to the early 2000s – are the most likely age group to report mental health problems, according to a report from the American Psychological Association.

The findings from the group’s 12th annual Stress in America survey of 3,458 Americans aged 18 years or older and 300 teens aged 15-17 years showed that issues such as sexual harassment and gun violence are significant stressors for Gen Z. America’s youngest adults are most likely of all generations to report poor mental health, and Gen Z also is significantly more likely to seek professional help for mental health issues, the study authors wrote.

Adolescents and young adults aged 15-21 years are more concerned than are other generations about the state of the United States, and overall, 71% of the Gen Z’ers are more positive about the country’s future. About 60% had gotten politically involved in the past year.

But that optimism did not extend to Gen Z’ers of color. “For around 4 in 10 Gen Zs of color, personal debt [41%] and housing instability (40%) are significant sources of stress, while 3 in 10 white Gen Zs [30%] say the same about personal debt and less than one-quarter [24%] of this demographic cite housing instability,” the authors wrote.

“Solutions” center in the works

A new facility to be built in a Denver neighborhood will enable offenders with mental health issues to receive treatment instead of incarceration. Once up and running, the facility, dubbed a “solutions” or “stabilization” center, will be a go-to option for police officers who have picked up someone judged to be in the throes of a mental health crisis, instead of a trip to the police station and booking, the Denver Post reported.

People referred to the center will be eligible to stay for up to 5 days and referrals will be available for continued counseling. Walk-ins will not be admitted.

“In my heart, I’m committed to making this an addition to the neighborhood that will make the neighborhood a safer place and not a more difficult place,” said Jay Flynn, a vice president of the Mental Health Center of Denver, which helped spearhead the initiative.

Not everyone is on board. Residents near the center site have voiced their concern about neighborhood safety. “It’s not that we don’t understand the needs of homelessness in our community,” said one resident at a community meeting held to discuss the center. “The fact is that our community is extremely stressed and we need to preserve a safe environment.”

The center is scheduled to open in 2020.
 

Is masculinity really toxic?

A new ad by Gillette raises questions about what it means to be male. The ad initially presents a more traditional view of men as boors, bullies, and sexual oppressors, then morphs into a call for a sea change to males with empathy, compassion, and a need to help. The ad came a few months after the American Psychological Association issued new practice guidelines for boys and men, in which traditional masculinity ideology was conceptualized as limiting.

Those developments prompted an op-ed piece in the Los Angeles Times that considered whether masculinity really is toxic.

“Some of the angry responses to the [Gillette] ad were over the top, and yet the detractors have a point. Take the way the ad exhorts men to start doing and saying ‘the right thing,’ and then continues, ‘Some already are. But some is not enough.’ This suggests decent men are a minority while brutes are the norm,” wrote Cathy Young, a contributing editor at Reason magazine.

“What’s more, some of the ‘toxic’ behavior shown is pretty innocuous, such as teenage boys ogling bikini-clad babes on television. (Should we shame girls who drool over cute male pop stars?) The ad also blurs the line between fighting and roughhousing, implicitly condemning the physical play styles more common among boys,” she wrote.

Meanwhile, the psychologists pointed out that, in light of many factors, including higher death rates in the United States for boys and men – compared with those of girls and women – understanding “how boys and men experience masculinity is an important cultural competency.”

Dementia and an aging workforce

As the American workforce continues to age, employers are having tough conversations about dementia and other cognitive issues, according an article from the Associated Press.

“And it’s not just managing missed deadlines,” Sarah Wood, director of global work-life services at an organization called Workplace Options, said in the piece. “If this person has been a dependable employee for 40 years and is now missing meetings, they’ll be beating themselves up over this.”

According to the Bureau of Labor Statistics, the number of U.S. workers aged 65-74 years was expected to skyrocket by 55% between 2014 and 2024.

Those aged 65 years and older are more likely to face dementia diagnoses. Because of the Americans with Disabilities Act, employers with dementia – including Alzheimer’s – are protected, “depending on the employee’s position and level of impairment,” according to the article.

Employers can accommodate employees by taking steps such as writing instructions rather than communicating verbally and reassigning employees who operate heavy machines to desk work, according to David K. Fram, director of the Americans with Disabilities Act equal opportunity services at the National Employment Law Institute. But employees must be able to do the “essential functions of the job,” he said.

Officials in Texas see their new “Dose of Reality” website as a tool that might help address the opioid crisis in their state.

Hailshadow/iStock/Getty Images

Dose of Reality, an initiative of the state attorney general, the Texas Department of State Health Services, and Texas Health and Human Services, offers for download material on opioids. People also can learn about risk factors of opioid abuse and how to safely store the medications. Drug disposal sites statewide also are included, according to an article published by the Dallas Morning News.

“The misuse of prescription opioids costs lives and devastates Texas families in every corner of our state. Dose of Reality is a one-stop shop of information on the opioid epidemic in Texas. [It] will pull back the curtain on opioids, educate Texans and save, hopefully, many lives,” Texas Attorney General Ken Paxton reportedly said at a press conference announcing the website launch.

Of the 42,249 deaths tied to opioid overdoses reported nationwide by the National Institute on Drug Abuse in 2016, 1,375 of those deaths reportedly occurred in Texas. According to Mr. Paxton, deceptive marketing and promotion by pharmaceutical companies have been part of the problem.

Efforts aimed at combating the opioid crisis by Mr. Paxton have included legal action against one drug manufacturer to force more realistic description of the risks of opioid use.

Generation Z and mental health

Gen Z’ers – young people born from the mid-1990s to the early 2000s – are the most likely age group to report mental health problems, according to a report from the American Psychological Association.

The findings from the group’s 12th annual Stress in America survey of 3,458 Americans aged 18 years or older and 300 teens aged 15-17 years showed that issues such as sexual harassment and gun violence are significant stressors for Gen Z. America’s youngest adults are most likely of all generations to report poor mental health, and Gen Z also is significantly more likely to seek professional help for mental health issues, the study authors wrote.

Adolescents and young adults aged 15-21 years are more concerned than are other generations about the state of the United States, and overall, 71% of the Gen Z’ers are more positive about the country’s future. About 60% had gotten politically involved in the past year.

But that optimism did not extend to Gen Z’ers of color. “For around 4 in 10 Gen Zs of color, personal debt [41%] and housing instability (40%) are significant sources of stress, while 3 in 10 white Gen Zs [30%] say the same about personal debt and less than one-quarter [24%] of this demographic cite housing instability,” the authors wrote.

“Solutions” center in the works

A new facility to be built in a Denver neighborhood will enable offenders with mental health issues to receive treatment instead of incarceration. Once up and running, the facility, dubbed a “solutions” or “stabilization” center, will be a go-to option for police officers who have picked up someone judged to be in the throes of a mental health crisis, instead of a trip to the police station and booking, the Denver Post reported.

People referred to the center will be eligible to stay for up to 5 days and referrals will be available for continued counseling. Walk-ins will not be admitted.

“In my heart, I’m committed to making this an addition to the neighborhood that will make the neighborhood a safer place and not a more difficult place,” said Jay Flynn, a vice president of the Mental Health Center of Denver, which helped spearhead the initiative.

Not everyone is on board. Residents near the center site have voiced their concern about neighborhood safety. “It’s not that we don’t understand the needs of homelessness in our community,” said one resident at a community meeting held to discuss the center. “The fact is that our community is extremely stressed and we need to preserve a safe environment.”

The center is scheduled to open in 2020.
 

Is masculinity really toxic?

A new ad by Gillette raises questions about what it means to be male. The ad initially presents a more traditional view of men as boors, bullies, and sexual oppressors, then morphs into a call for a sea change to males with empathy, compassion, and a need to help. The ad came a few months after the American Psychological Association issued new practice guidelines for boys and men, in which traditional masculinity ideology was conceptualized as limiting.

Those developments prompted an op-ed piece in the Los Angeles Times that considered whether masculinity really is toxic.

“Some of the angry responses to the [Gillette] ad were over the top, and yet the detractors have a point. Take the way the ad exhorts men to start doing and saying ‘the right thing,’ and then continues, ‘Some already are. But some is not enough.’ This suggests decent men are a minority while brutes are the norm,” wrote Cathy Young, a contributing editor at Reason magazine.

“What’s more, some of the ‘toxic’ behavior shown is pretty innocuous, such as teenage boys ogling bikini-clad babes on television. (Should we shame girls who drool over cute male pop stars?) The ad also blurs the line between fighting and roughhousing, implicitly condemning the physical play styles more common among boys,” she wrote.

Meanwhile, the psychologists pointed out that, in light of many factors, including higher death rates in the United States for boys and men – compared with those of girls and women – understanding “how boys and men experience masculinity is an important cultural competency.”

Dementia and an aging workforce

As the American workforce continues to age, employers are having tough conversations about dementia and other cognitive issues, according an article from the Associated Press.

“And it’s not just managing missed deadlines,” Sarah Wood, director of global work-life services at an organization called Workplace Options, said in the piece. “If this person has been a dependable employee for 40 years and is now missing meetings, they’ll be beating themselves up over this.”

According to the Bureau of Labor Statistics, the number of U.S. workers aged 65-74 years was expected to skyrocket by 55% between 2014 and 2024.

Those aged 65 years and older are more likely to face dementia diagnoses. Because of the Americans with Disabilities Act, employers with dementia – including Alzheimer’s – are protected, “depending on the employee’s position and level of impairment,” according to the article.

Employers can accommodate employees by taking steps such as writing instructions rather than communicating verbally and reassigning employees who operate heavy machines to desk work, according to David K. Fram, director of the Americans with Disabilities Act equal opportunity services at the National Employment Law Institute. But employees must be able to do the “essential functions of the job,” he said.

Officials in Texas see their new “Dose of Reality” website as a tool that might help address the opioid crisis in their state.

Hailshadow/iStock/Getty Images

Dose of Reality, an initiative of the state attorney general, the Texas Department of State Health Services, and Texas Health and Human Services, offers for download material on opioids. People also can learn about risk factors of opioid abuse and how to safely store the medications. Drug disposal sites statewide also are included, according to an article published by the Dallas Morning News.

“The misuse of prescription opioids costs lives and devastates Texas families in every corner of our state. Dose of Reality is a one-stop shop of information on the opioid epidemic in Texas. [It] will pull back the curtain on opioids, educate Texans and save, hopefully, many lives,” Texas Attorney General Ken Paxton reportedly said at a press conference announcing the website launch.

Of the 42,249 deaths tied to opioid overdoses reported nationwide by the National Institute on Drug Abuse in 2016, 1,375 of those deaths reportedly occurred in Texas. According to Mr. Paxton, deceptive marketing and promotion by pharmaceutical companies have been part of the problem.

Efforts aimed at combating the opioid crisis by Mr. Paxton have included legal action against one drug manufacturer to force more realistic description of the risks of opioid use.

Generation Z and mental health

Gen Z’ers – young people born from the mid-1990s to the early 2000s – are the most likely age group to report mental health problems, according to a report from the American Psychological Association.

The findings from the group’s 12th annual Stress in America survey of 3,458 Americans aged 18 years or older and 300 teens aged 15-17 years showed that issues such as sexual harassment and gun violence are significant stressors for Gen Z. America’s youngest adults are most likely of all generations to report poor mental health, and Gen Z also is significantly more likely to seek professional help for mental health issues, the study authors wrote.

Adolescents and young adults aged 15-21 years are more concerned than are other generations about the state of the United States, and overall, 71% of the Gen Z’ers are more positive about the country’s future. About 60% had gotten politically involved in the past year.

But that optimism did not extend to Gen Z’ers of color. “For around 4 in 10 Gen Zs of color, personal debt [41%] and housing instability (40%) are significant sources of stress, while 3 in 10 white Gen Zs [30%] say the same about personal debt and less than one-quarter [24%] of this demographic cite housing instability,” the authors wrote.

“Solutions” center in the works

A new facility to be built in a Denver neighborhood will enable offenders with mental health issues to receive treatment instead of incarceration. Once up and running, the facility, dubbed a “solutions” or “stabilization” center, will be a go-to option for police officers who have picked up someone judged to be in the throes of a mental health crisis, instead of a trip to the police station and booking, the Denver Post reported.

People referred to the center will be eligible to stay for up to 5 days and referrals will be available for continued counseling. Walk-ins will not be admitted.

“In my heart, I’m committed to making this an addition to the neighborhood that will make the neighborhood a safer place and not a more difficult place,” said Jay Flynn, a vice president of the Mental Health Center of Denver, which helped spearhead the initiative.

Not everyone is on board. Residents near the center site have voiced their concern about neighborhood safety. “It’s not that we don’t understand the needs of homelessness in our community,” said one resident at a community meeting held to discuss the center. “The fact is that our community is extremely stressed and we need to preserve a safe environment.”

The center is scheduled to open in 2020.
 

Is masculinity really toxic?

A new ad by Gillette raises questions about what it means to be male. The ad initially presents a more traditional view of men as boors, bullies, and sexual oppressors, then morphs into a call for a sea change to males with empathy, compassion, and a need to help. The ad came a few months after the American Psychological Association issued new practice guidelines for boys and men, in which traditional masculinity ideology was conceptualized as limiting.

Those developments prompted an op-ed piece in the Los Angeles Times that considered whether masculinity really is toxic.

“Some of the angry responses to the [Gillette] ad were over the top, and yet the detractors have a point. Take the way the ad exhorts men to start doing and saying ‘the right thing,’ and then continues, ‘Some already are. But some is not enough.’ This suggests decent men are a minority while brutes are the norm,” wrote Cathy Young, a contributing editor at Reason magazine.

“What’s more, some of the ‘toxic’ behavior shown is pretty innocuous, such as teenage boys ogling bikini-clad babes on television. (Should we shame girls who drool over cute male pop stars?) The ad also blurs the line between fighting and roughhousing, implicitly condemning the physical play styles more common among boys,” she wrote.

Meanwhile, the psychologists pointed out that, in light of many factors, including higher death rates in the United States for boys and men – compared with those of girls and women – understanding “how boys and men experience masculinity is an important cultural competency.”

Dementia and an aging workforce

As the American workforce continues to age, employers are having tough conversations about dementia and other cognitive issues, according an article from the Associated Press.

“And it’s not just managing missed deadlines,” Sarah Wood, director of global work-life services at an organization called Workplace Options, said in the piece. “If this person has been a dependable employee for 40 years and is now missing meetings, they’ll be beating themselves up over this.”

According to the Bureau of Labor Statistics, the number of U.S. workers aged 65-74 years was expected to skyrocket by 55% between 2014 and 2024.

Those aged 65 years and older are more likely to face dementia diagnoses. Because of the Americans with Disabilities Act, employers with dementia – including Alzheimer’s – are protected, “depending on the employee’s position and level of impairment,” according to the article.

Employers can accommodate employees by taking steps such as writing instructions rather than communicating verbally and reassigning employees who operate heavy machines to desk work, according to David K. Fram, director of the Americans with Disabilities Act equal opportunity services at the National Employment Law Institute. But employees must be able to do the “essential functions of the job,” he said.

Insulin may be toxic to the placenta during early pregnancy, causing DNA damage, decreased cell survival, and apoptosis, but the toxic effects appear to be prevented with metformin, according to findings from an experimental in vitro study published in Fertility and Sterility.

iStock/ThinkStock

“Collectively these results demonstrate that insulin itself may be directly toxic to the early human placenta but that metformin can prevent these deleterious effects,” wrote Mario Vega, MD, of Columbia University Fertility Center, New York, and his colleagues. “If confirmed in animal and human studies, this would indicate that screening and treatment for insulin resistance should focus on hyperinsulinemia.”

Dr. Vega and his colleagues cultivated trophoblast cells from three healthy women scheduled for manual vacuum aspiration during the first trimester of pregnancy to study the effects of insulin exposure alone, while trophoblast cells were cultured from a different set of women for the insulin and metformin follow-up experiments. The researchers tested each experiment against a control group of cultivated lung fibroblast cells. Insulin was measured in doses of 0.2 nmol, 1 nmol, and 5 nmol, while metformin was measured at 10 micromol. The primary outcome measures examined were gamma-H2AX for DNA damage, cell proliferation assay for cell survival, and cleaved caspase-3 for apoptosis.

Within 48 hours, the cultures showed DNA damage and induction of apoptosis when exposed to 1 nmol of insulin, but researchers said pretreatment with metformin prevented these effects. Exposing cells to metformin after insulin reduced but did not eliminate the effects of insulin.

The researchers noted the study is limited because the effects of insulin and metformin have not been examined in vivo, and it is not known at what level insulin causes damage. In addition, they suggested downregulation of genes in trophoblasts caused by insulin could cause apoptosis and DNA damage to trophoblast cells.

“Although studies performed on kidney and colon cells suggest that one possible mechanism of action for insulin-mediated genotoxicity is through AKT activation of mitochondria and subsequent reactive oxygen species production, the exact mechanism is poorly understood,” Dr. Vega and colleagues said. “Future studies will be necessary to determine variability among subjects, as well as mechanisms of action through which insulin exerts its cytotoxicity and genotoxicity.”

This study was funded by a grant from the National Institutes of Health Human Placenta Project. The authors reported no relevant financial disclosures.
 

SOURCE: Vega M et al. Fertil Steril. 2019. doi: 10.1016/j.fertnstert.2018.11.032.

Insulin may be toxic to the placenta during early pregnancy, causing DNA damage, decreased cell survival, and apoptosis, but the toxic effects appear to be prevented with metformin, according to findings from an experimental in vitro study published in Fertility and Sterility.

iStock/ThinkStock

“Collectively these results demonstrate that insulin itself may be directly toxic to the early human placenta but that metformin can prevent these deleterious effects,” wrote Mario Vega, MD, of Columbia University Fertility Center, New York, and his colleagues. “If confirmed in animal and human studies, this would indicate that screening and treatment for insulin resistance should focus on hyperinsulinemia.”

Dr. Vega and his colleagues cultivated trophoblast cells from three healthy women scheduled for manual vacuum aspiration during the first trimester of pregnancy to study the effects of insulin exposure alone, while trophoblast cells were cultured from a different set of women for the insulin and metformin follow-up experiments. The researchers tested each experiment against a control group of cultivated lung fibroblast cells. Insulin was measured in doses of 0.2 nmol, 1 nmol, and 5 nmol, while metformin was measured at 10 micromol. The primary outcome measures examined were gamma-H2AX for DNA damage, cell proliferation assay for cell survival, and cleaved caspase-3 for apoptosis.

Within 48 hours, the cultures showed DNA damage and induction of apoptosis when exposed to 1 nmol of insulin, but researchers said pretreatment with metformin prevented these effects. Exposing cells to metformin after insulin reduced but did not eliminate the effects of insulin.

The researchers noted the study is limited because the effects of insulin and metformin have not been examined in vivo, and it is not known at what level insulin causes damage. In addition, they suggested downregulation of genes in trophoblasts caused by insulin could cause apoptosis and DNA damage to trophoblast cells.

“Although studies performed on kidney and colon cells suggest that one possible mechanism of action for insulin-mediated genotoxicity is through AKT activation of mitochondria and subsequent reactive oxygen species production, the exact mechanism is poorly understood,” Dr. Vega and colleagues said. “Future studies will be necessary to determine variability among subjects, as well as mechanisms of action through which insulin exerts its cytotoxicity and genotoxicity.”

This study was funded by a grant from the National Institutes of Health Human Placenta Project. The authors reported no relevant financial disclosures.
 

SOURCE: Vega M et al. Fertil Steril. 2019. doi: 10.1016/j.fertnstert.2018.11.032.

Insulin may be toxic to the placenta during early pregnancy, causing DNA damage, decreased cell survival, and apoptosis, but the toxic effects appear to be prevented with metformin, according to findings from an experimental in vitro study published in Fertility and Sterility.

iStock/ThinkStock

“Collectively these results demonstrate that insulin itself may be directly toxic to the early human placenta but that metformin can prevent these deleterious effects,” wrote Mario Vega, MD, of Columbia University Fertility Center, New York, and his colleagues. “If confirmed in animal and human studies, this would indicate that screening and treatment for insulin resistance should focus on hyperinsulinemia.”

Dr. Vega and his colleagues cultivated trophoblast cells from three healthy women scheduled for manual vacuum aspiration during the first trimester of pregnancy to study the effects of insulin exposure alone, while trophoblast cells were cultured from a different set of women for the insulin and metformin follow-up experiments. The researchers tested each experiment against a control group of cultivated lung fibroblast cells. Insulin was measured in doses of 0.2 nmol, 1 nmol, and 5 nmol, while metformin was measured at 10 micromol. The primary outcome measures examined were gamma-H2AX for DNA damage, cell proliferation assay for cell survival, and cleaved caspase-3 for apoptosis.

Within 48 hours, the cultures showed DNA damage and induction of apoptosis when exposed to 1 nmol of insulin, but researchers said pretreatment with metformin prevented these effects. Exposing cells to metformin after insulin reduced but did not eliminate the effects of insulin.

The researchers noted the study is limited because the effects of insulin and metformin have not been examined in vivo, and it is not known at what level insulin causes damage. In addition, they suggested downregulation of genes in trophoblasts caused by insulin could cause apoptosis and DNA damage to trophoblast cells.

“Although studies performed on kidney and colon cells suggest that one possible mechanism of action for insulin-mediated genotoxicity is through AKT activation of mitochondria and subsequent reactive oxygen species production, the exact mechanism is poorly understood,” Dr. Vega and colleagues said. “Future studies will be necessary to determine variability among subjects, as well as mechanisms of action through which insulin exerts its cytotoxicity and genotoxicity.”

This study was funded by a grant from the National Institutes of Health Human Placenta Project. The authors reported no relevant financial disclosures.
 

SOURCE: Vega M et al. Fertil Steril. 2019. doi: 10.1016/j.fertnstert.2018.11.032.

To the Editor:

We report an interesting clinical case of dermatomyositis (DM) that presented with an associated malignancy (small cell lung cancer). This patient also had an unusual clinical finding of predominantly unilateral, confluent, erythematous papules on the knee, a cutaneous sign that is seldom described in the DM literature. This case serves to reinforce the classic findings and associations of DM, in addition to the uncommon manifestation of predominantly unilateral papules on the knee.

A 68-year-old woman presented with several cutaneous manifestations including the classic findings of photo distributed erythema on the arms and face, a heliotrope rash, Gottron papules, and confluent pink papules on the left knee (Figure 1). The patient also had one of the more rare manifestations of DM, flagellate erythema on the back (Figure 2). She had a history of breast cancer and was found to have metastatic small cell lung cancer at the time of the DM diagnosis.

To the Editor:

We report an interesting clinical case of dermatomyositis (DM) that presented with an associated malignancy (small cell lung cancer). This patient also had an unusual clinical finding of predominantly unilateral, confluent, erythematous papules on the knee, a cutaneous sign that is seldom described in the DM literature. This case serves to reinforce the classic findings and associations of DM, in addition to the uncommon manifestation of predominantly unilateral papules on the knee.

A 68-year-old woman presented with several cutaneous manifestations including the classic findings of photo distributed erythema on the arms and face, a heliotrope rash, Gottron papules, and confluent pink papules on the left knee (Figure 1). The patient also had one of the more rare manifestations of DM, flagellate erythema on the back (Figure 2). She had a history of breast cancer and was found to have metastatic small cell lung cancer at the time of the DM diagnosis.

To the Editor:

We report an interesting clinical case of dermatomyositis (DM) that presented with an associated malignancy (small cell lung cancer). This patient also had an unusual clinical finding of predominantly unilateral, confluent, erythematous papules on the knee, a cutaneous sign that is seldom described in the DM literature. This case serves to reinforce the classic findings and associations of DM, in addition to the uncommon manifestation of predominantly unilateral papules on the knee.

A 68-year-old woman presented with several cutaneous manifestations including the classic findings of photo distributed erythema on the arms and face, a heliotrope rash, Gottron papules, and confluent pink papules on the left knee (Figure 1). The patient also had one of the more rare manifestations of DM, flagellate erythema on the back (Figure 2). She had a history of breast cancer and was found to have metastatic small cell lung cancer at the time of the DM diagnosis.