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Colchicine Halved MI Risk in Gout
NEW YORK – Patients with gout who took colchicine had less than one-half the risk of having a myocardial infarction that was seen in patients who were untreated for their gout. But this protective effect was not seen for patients taking allopurinol, Dr. Michael Pillinger, a coauthor of the study, said at a rheumatology meeting sponsored by New York University.
In this retrospective analysis of data from 1,300 patients from the New York Veterans Affairs Gout Cohort, about 0.5% of those taking colchicine had an MI, compared with 3% of those not taking any antigout medication (P less than .05). The MI rate for those taking allopurinol was slightly more than 2%, which was not significantly different from the rate in the untreated group. A significant reduction was seen for those taking both colchicine and allopurinol. Death rates were comparable among the groups.
"When we stepped out of the database and read the charts, we found [that] several of the patients who were categorized as having MIs on colchicine actually had been put on colchicine after their MI, so when we corrected for this, the difference was even greater," said Dr. Pillinger, director of the rheumatology fellowship program at New York University and director of rheumatology at the Manhattan campus of the VA New York Harbor Healthcare System.
"These are very provocative findings," he added. His group is currently undertaking more rigorous retrospective analyses and hopes to begin a prospective study.
Dr. Pillinger postulated that the lack of significant effect of allopurinol was due to its inconsistency in lowering urate levels. "In our hands, allopurinol does not always reduce urate levels," he noted.
These data confirm findings from an earlier study by Dr. Pillinger and his associates that looked at 45,000 Taiwanese men with hyperuricemia or gout. Those findings showed that treating hyperuricemia and gout could help control comorbid cardiovascular disease.
Dr. Pillinger reported financial relationships with Takeda (the study site) and URL Pharma (an investigator-initiated grant).
NEW YORK – Patients with gout who took colchicine had less than one-half the risk of having a myocardial infarction that was seen in patients who were untreated for their gout. But this protective effect was not seen for patients taking allopurinol, Dr. Michael Pillinger, a coauthor of the study, said at a rheumatology meeting sponsored by New York University.
In this retrospective analysis of data from 1,300 patients from the New York Veterans Affairs Gout Cohort, about 0.5% of those taking colchicine had an MI, compared with 3% of those not taking any antigout medication (P less than .05). The MI rate for those taking allopurinol was slightly more than 2%, which was not significantly different from the rate in the untreated group. A significant reduction was seen for those taking both colchicine and allopurinol. Death rates were comparable among the groups.
"When we stepped out of the database and read the charts, we found [that] several of the patients who were categorized as having MIs on colchicine actually had been put on colchicine after their MI, so when we corrected for this, the difference was even greater," said Dr. Pillinger, director of the rheumatology fellowship program at New York University and director of rheumatology at the Manhattan campus of the VA New York Harbor Healthcare System.
"These are very provocative findings," he added. His group is currently undertaking more rigorous retrospective analyses and hopes to begin a prospective study.
Dr. Pillinger postulated that the lack of significant effect of allopurinol was due to its inconsistency in lowering urate levels. "In our hands, allopurinol does not always reduce urate levels," he noted.
These data confirm findings from an earlier study by Dr. Pillinger and his associates that looked at 45,000 Taiwanese men with hyperuricemia or gout. Those findings showed that treating hyperuricemia and gout could help control comorbid cardiovascular disease.
Dr. Pillinger reported financial relationships with Takeda (the study site) and URL Pharma (an investigator-initiated grant).
NEW YORK – Patients with gout who took colchicine had less than one-half the risk of having a myocardial infarction that was seen in patients who were untreated for their gout. But this protective effect was not seen for patients taking allopurinol, Dr. Michael Pillinger, a coauthor of the study, said at a rheumatology meeting sponsored by New York University.
In this retrospective analysis of data from 1,300 patients from the New York Veterans Affairs Gout Cohort, about 0.5% of those taking colchicine had an MI, compared with 3% of those not taking any antigout medication (P less than .05). The MI rate for those taking allopurinol was slightly more than 2%, which was not significantly different from the rate in the untreated group. A significant reduction was seen for those taking both colchicine and allopurinol. Death rates were comparable among the groups.
"When we stepped out of the database and read the charts, we found [that] several of the patients who were categorized as having MIs on colchicine actually had been put on colchicine after their MI, so when we corrected for this, the difference was even greater," said Dr. Pillinger, director of the rheumatology fellowship program at New York University and director of rheumatology at the Manhattan campus of the VA New York Harbor Healthcare System.
"These are very provocative findings," he added. His group is currently undertaking more rigorous retrospective analyses and hopes to begin a prospective study.
Dr. Pillinger postulated that the lack of significant effect of allopurinol was due to its inconsistency in lowering urate levels. "In our hands, allopurinol does not always reduce urate levels," he noted.
These data confirm findings from an earlier study by Dr. Pillinger and his associates that looked at 45,000 Taiwanese men with hyperuricemia or gout. Those findings showed that treating hyperuricemia and gout could help control comorbid cardiovascular disease.
Dr. Pillinger reported financial relationships with Takeda (the study site) and URL Pharma (an investigator-initiated grant).
EXPERT ANALYSIS FROM A RHEUMATOLOGY MEETING SPONSORED BY NEW YORK UNIVERSITY
Major Finding: Fewer than 1% of gout patients taking colchicine had an MI, compared with 3% of untreated patients. No significant difference was found for allopurinol.
Data Source: This was a retrospective analysis of 1,300 patients in the New York VA Gout Cohort.
Disclosures: Dr. Pillinger reports financial relationships with URL Pharma (investigator-initiated grant) and Takeda (study site).
BEST PRACTICES IN: Extended-Regimen Oral Contraception:Modifying the Hormone-Free Interval
A supplement to Ob.Gyn. News. This supplement was sponsored by TEVA Women's Health.
•Topics
•Faculty/Faculty Disclosure
To view the supplement, click the image above.
Topics
• History of the Hormone-Free Interval
• Physiologic Effects of a Modified Hormone-Free Interval
• Safety and Efficacy of Extended-Regimen Oral Contraception
Faculty/Faculty Disclosure
David J. Portman, MD
Director and Principal Investigator
Columbus Center for Women's
Health Research
Columbus, Ohio
Dr. Portman is a consultant to Bayer Healthcare Pharmaceuticals, Boehringer Ingelheim GmbH, GlaxoSmithKline plc, and TEVA Women's Health. He has received funding for clinical grants from Bayer, Boehringer Ingelheim, Depomed, Inc., Pfizer Inc., TEVA Women's Health, and Warner Chilcott.
A supplement to Ob.Gyn. News. This supplement was sponsored by TEVA Women's Health.
•Topics
•Faculty/Faculty Disclosure
To view the supplement, click the image above.
Topics
• History of the Hormone-Free Interval
• Physiologic Effects of a Modified Hormone-Free Interval
• Safety and Efficacy of Extended-Regimen Oral Contraception
Faculty/Faculty Disclosure
David J. Portman, MD
Director and Principal Investigator
Columbus Center for Women's
Health Research
Columbus, Ohio
Dr. Portman is a consultant to Bayer Healthcare Pharmaceuticals, Boehringer Ingelheim GmbH, GlaxoSmithKline plc, and TEVA Women's Health. He has received funding for clinical grants from Bayer, Boehringer Ingelheim, Depomed, Inc., Pfizer Inc., TEVA Women's Health, and Warner Chilcott.
A supplement to Ob.Gyn. News. This supplement was sponsored by TEVA Women's Health.
•Topics
•Faculty/Faculty Disclosure
To view the supplement, click the image above.
Topics
• History of the Hormone-Free Interval
• Physiologic Effects of a Modified Hormone-Free Interval
• Safety and Efficacy of Extended-Regimen Oral Contraception
Faculty/Faculty Disclosure
David J. Portman, MD
Director and Principal Investigator
Columbus Center for Women's
Health Research
Columbus, Ohio
Dr. Portman is a consultant to Bayer Healthcare Pharmaceuticals, Boehringer Ingelheim GmbH, GlaxoSmithKline plc, and TEVA Women's Health. He has received funding for clinical grants from Bayer, Boehringer Ingelheim, Depomed, Inc., Pfizer Inc., TEVA Women's Health, and Warner Chilcott.
Clinical Perspectives on the Role of Hormone Therapy in Menopausal Management
A supplement to Ob.Gyn. News.
This supplement is based on physician interviews. It is supported by Kenwood Therapeutics, a division of Bradley Pharmaceuticals, Inc.
To view the supplement, click the image above.
Topic Highlights
• Menopause and Hormone Therapy
• Current Recommendations for Postmenopausal Hormone Therapy
• Clinical Trial of Transdermal Estrogen
• Other Considerations of Transdermal Hormone Therapy
Faculty/Faculty Disclosures
Copyright © 2007 by Elsevier Inc.
A supplement to Ob.Gyn. News.
This supplement is based on physician interviews. It is supported by Kenwood Therapeutics, a division of Bradley Pharmaceuticals, Inc.
To view the supplement, click the image above.
Topic Highlights
• Menopause and Hormone Therapy
• Current Recommendations for Postmenopausal Hormone Therapy
• Clinical Trial of Transdermal Estrogen
• Other Considerations of Transdermal Hormone Therapy
Faculty/Faculty Disclosures
Copyright © 2007 by Elsevier Inc.
A supplement to Ob.Gyn. News.
This supplement is based on physician interviews. It is supported by Kenwood Therapeutics, a division of Bradley Pharmaceuticals, Inc.
To view the supplement, click the image above.
Topic Highlights
• Menopause and Hormone Therapy
• Current Recommendations for Postmenopausal Hormone Therapy
• Clinical Trial of Transdermal Estrogen
• Other Considerations of Transdermal Hormone Therapy
Faculty/Faculty Disclosures
Copyright © 2007 by Elsevier Inc.
Heparin-Coated Stent Graft Gave High SFA Patency
MIAMI BEACH – An investigational, peripheral artery stent graft with heparin bonding showed excellent 1-year performance as long as its size matched the treated vessel, in a multicenter, single-arm study of 119 patients.
The Viabahn heparin-bonded stent graft placed in superficial femoral arteries (SFA) and oversized at the proximal edge by no more than 20%, produced a 91% primary patency rate at 12 months after the intervention, compared with a 70% primary patency rate among patients who received the graft in vessels where proximal edge oversizing exceeded 20%, Dr. Richard Saxon said at the International Symposium on Endovascular Therapy (ISET) 2012.
The overall 12-month primary patency rate for the 119 patients in the study was 74%, including a 79% rate in patients who received the 5-mm diameter stent graft, which was "a marked improvement" compared with prior 5-mm devices, said Dr. Saxon, an interventional radiologist and director of research at the San Diego Cardiac and Vascular Institute.
"If we treat the correct subset of patients with this newer stent graft, patency will be excellent and reinterventions low. We need to measure [vessel diameters] and do it correctly, and we’ll get excellent results. Oversizing will lead to occlusions," Dr. Saxon said.
Oversizing compared with not oversizing led to "dramatically" different results.
The investigational stent graft used in the Gore Viabahn Endoprosthesis With Heparin Bioactive Surface in the Treatment of SFA Obstructive Disease (VIPER) trial appeared to perform substantially better than historical experience with the similar stent graft without a heparin-coated surface. The 12-month results in the pivotal study of the Viabahn stent graft without heparin showed a primary patency rate of 57%, suggesting that the heparin coating led to a 17% increase in primary patency, he reported.
In addition, the study achieved a 74% 1-year patency rate in patients with long, complex lesions that averaged 19 cm, and 60% of patients had stage III or IV disease based on classification by the Inter-Society Consensus Guidelines for the Management of PAD (TASC II). The heparin-coated stent graft also featured contoured edges, designed to minimize the stenoses at proximal edges that have posed a problem with prior models. But the results showed that the contoured edge failed to eliminate edge stenosis, Dr. Saxon said.
The new findings show that the Viabahn heparin-coated stent graft is comparable to the investigational Zilver PTX paclitaxel-eluting nitinol stent, said Dr. Gary M. Ansel, clinical director of peripheral vascular interventions at the Midwest Cardiology Research Foundation in Columbus, Ohio. who was a coinvestigator on the pivotal trials for both devices. He added that such stenting should become the new standard of treatment.
One-year patency data for the paclitaxel-coated nitinol stent, developed by Cook, were reported last year (Circ. Cardiovasc. Interv. 2011;4:495-504). Last October, a Food and Drug Administration advisory panel voted unanimously to recommend marketing approval of the paclitaxel-eluting nitinol stent, but as of late January, the FDA had not yet issued a decision. http://www.cookmedical.com/zilverptx/index.html
VIPER enrolled patients with SFA lesions greater than 5 cm long at 11 U.S. sites. Their average age was 66 years, 62% were men, one-third had diabetes, 87% had hypertension, and 47% had coronary artery disease.
Their average lesion length was 19 cm, and 61% of the SFA lesions had moderate or severe calcification. The study’s primary end point was primary patency in the treated SFA after 12 months, assessed by Doppler ultrasound.
The results showed no impact of lesion length on outcomes, with primary patency rates in patients with lesions 20 cm or longer similar to those of patients with shorter lesions.
Within 30 days of stenting treatment, one patient had a major adverse event, a need for bypass due to a target-lesion occlusion. The stent graft placed in this patient was considered "markedly oversized," according to Dr. Saxon.
A second patient had target lesion occlusion during follow-up to 1 year, again linked with stent graft oversizing compared with the vessel’s diameter.
Average ankle-brachial index was 0.61 at baseline and 0.9 at 12 months. At 12-month follow-up, 66 (74%) of the 89 patients assessed for their Rutherford-Becker class had class 0 disease, and 74 (83%) had experienced at least a two-class reduction in their Rutherford-Becker status.
Twelve patients had a stent graft thrombosis or occlusion, with 10 of these patients having a worsening of their baseline Rutherford-Becker class. Thirteen patients required revisions for stenoses detected by ultrasound; seven of these patients were asymptomatic at the time of stenosis detection.
"We can’t wait for patients to become symptomatic or have their ankle-brachial index drop. We have to follow patients closely with duplex ultrasound," after SFA revascularization, Dr. Saxon said.
The VIPER trial was sponsored by W.L. Gore. Dr. Saxon disclosed ties with W.L. Gore, Cook, Lutonix, Concentric Medical, Vascular Resources, Abbott Vascular, and Reva Medical. Dr. Ansel disclosed ties with Abbott Vascular, Boston Scientific, Access Closure, Angioslide, Arsenal Medical, Atheromed, Atrium Medical, Bard, and Biocardia.
While the results of the VIPER trial are exciting, our enthusiasm must be tempered by the relatively small size of the study and the even smaller size of the subset achieving the most remarkable results. We have been here before and to state that these heparin-coated stent-grafts are better than everything else [for treating SFA stenoses], and are the new standards clearly ignores the merits of some other therapies like the good old-fashioned saphenous vein bypass. This oversight is particularly important when one considers that the average age of the patients in this study was only 66. Call me old fashioned, or call me old-school, but 1-year follow up hasn’t quite convinced me. Sliced bread might still be good for something.
While I don’t doubt that this technology will have a place in SFA treatment, maybe even very prominent role, I, for one, will still be selective with its use. Finally, having removed a couple of heparin-bonded devices from HIT patients along the way, I can tell you that they aren’t for everyone.
Dr. Mark D. Morasch is a vascular surgeon at St. Vincent Healthcare’s Heart and Vascular Center, Billings Mont., and an associate medical editor of Vascular Specialist.
While the results of the VIPER trial are exciting, our enthusiasm must be tempered by the relatively small size of the study and the even smaller size of the subset achieving the most remarkable results. We have been here before and to state that these heparin-coated stent-grafts are better than everything else [for treating SFA stenoses], and are the new standards clearly ignores the merits of some other therapies like the good old-fashioned saphenous vein bypass. This oversight is particularly important when one considers that the average age of the patients in this study was only 66. Call me old fashioned, or call me old-school, but 1-year follow up hasn’t quite convinced me. Sliced bread might still be good for something.
While I don’t doubt that this technology will have a place in SFA treatment, maybe even very prominent role, I, for one, will still be selective with its use. Finally, having removed a couple of heparin-bonded devices from HIT patients along the way, I can tell you that they aren’t for everyone.
Dr. Mark D. Morasch is a vascular surgeon at St. Vincent Healthcare’s Heart and Vascular Center, Billings Mont., and an associate medical editor of Vascular Specialist.
While the results of the VIPER trial are exciting, our enthusiasm must be tempered by the relatively small size of the study and the even smaller size of the subset achieving the most remarkable results. We have been here before and to state that these heparin-coated stent-grafts are better than everything else [for treating SFA stenoses], and are the new standards clearly ignores the merits of some other therapies like the good old-fashioned saphenous vein bypass. This oversight is particularly important when one considers that the average age of the patients in this study was only 66. Call me old fashioned, or call me old-school, but 1-year follow up hasn’t quite convinced me. Sliced bread might still be good for something.
While I don’t doubt that this technology will have a place in SFA treatment, maybe even very prominent role, I, for one, will still be selective with its use. Finally, having removed a couple of heparin-bonded devices from HIT patients along the way, I can tell you that they aren’t for everyone.
Dr. Mark D. Morasch is a vascular surgeon at St. Vincent Healthcare’s Heart and Vascular Center, Billings Mont., and an associate medical editor of Vascular Specialist.
MIAMI BEACH – An investigational, peripheral artery stent graft with heparin bonding showed excellent 1-year performance as long as its size matched the treated vessel, in a multicenter, single-arm study of 119 patients.
The Viabahn heparin-bonded stent graft placed in superficial femoral arteries (SFA) and oversized at the proximal edge by no more than 20%, produced a 91% primary patency rate at 12 months after the intervention, compared with a 70% primary patency rate among patients who received the graft in vessels where proximal edge oversizing exceeded 20%, Dr. Richard Saxon said at the International Symposium on Endovascular Therapy (ISET) 2012.
The overall 12-month primary patency rate for the 119 patients in the study was 74%, including a 79% rate in patients who received the 5-mm diameter stent graft, which was "a marked improvement" compared with prior 5-mm devices, said Dr. Saxon, an interventional radiologist and director of research at the San Diego Cardiac and Vascular Institute.
"If we treat the correct subset of patients with this newer stent graft, patency will be excellent and reinterventions low. We need to measure [vessel diameters] and do it correctly, and we’ll get excellent results. Oversizing will lead to occlusions," Dr. Saxon said.
Oversizing compared with not oversizing led to "dramatically" different results.
The investigational stent graft used in the Gore Viabahn Endoprosthesis With Heparin Bioactive Surface in the Treatment of SFA Obstructive Disease (VIPER) trial appeared to perform substantially better than historical experience with the similar stent graft without a heparin-coated surface. The 12-month results in the pivotal study of the Viabahn stent graft without heparin showed a primary patency rate of 57%, suggesting that the heparin coating led to a 17% increase in primary patency, he reported.
In addition, the study achieved a 74% 1-year patency rate in patients with long, complex lesions that averaged 19 cm, and 60% of patients had stage III or IV disease based on classification by the Inter-Society Consensus Guidelines for the Management of PAD (TASC II). The heparin-coated stent graft also featured contoured edges, designed to minimize the stenoses at proximal edges that have posed a problem with prior models. But the results showed that the contoured edge failed to eliminate edge stenosis, Dr. Saxon said.
The new findings show that the Viabahn heparin-coated stent graft is comparable to the investigational Zilver PTX paclitaxel-eluting nitinol stent, said Dr. Gary M. Ansel, clinical director of peripheral vascular interventions at the Midwest Cardiology Research Foundation in Columbus, Ohio. who was a coinvestigator on the pivotal trials for both devices. He added that such stenting should become the new standard of treatment.
One-year patency data for the paclitaxel-coated nitinol stent, developed by Cook, were reported last year (Circ. Cardiovasc. Interv. 2011;4:495-504). Last October, a Food and Drug Administration advisory panel voted unanimously to recommend marketing approval of the paclitaxel-eluting nitinol stent, but as of late January, the FDA had not yet issued a decision. http://www.cookmedical.com/zilverptx/index.html
VIPER enrolled patients with SFA lesions greater than 5 cm long at 11 U.S. sites. Their average age was 66 years, 62% were men, one-third had diabetes, 87% had hypertension, and 47% had coronary artery disease.
Their average lesion length was 19 cm, and 61% of the SFA lesions had moderate or severe calcification. The study’s primary end point was primary patency in the treated SFA after 12 months, assessed by Doppler ultrasound.
The results showed no impact of lesion length on outcomes, with primary patency rates in patients with lesions 20 cm or longer similar to those of patients with shorter lesions.
Within 30 days of stenting treatment, one patient had a major adverse event, a need for bypass due to a target-lesion occlusion. The stent graft placed in this patient was considered "markedly oversized," according to Dr. Saxon.
A second patient had target lesion occlusion during follow-up to 1 year, again linked with stent graft oversizing compared with the vessel’s diameter.
Average ankle-brachial index was 0.61 at baseline and 0.9 at 12 months. At 12-month follow-up, 66 (74%) of the 89 patients assessed for their Rutherford-Becker class had class 0 disease, and 74 (83%) had experienced at least a two-class reduction in their Rutherford-Becker status.
Twelve patients had a stent graft thrombosis or occlusion, with 10 of these patients having a worsening of their baseline Rutherford-Becker class. Thirteen patients required revisions for stenoses detected by ultrasound; seven of these patients were asymptomatic at the time of stenosis detection.
"We can’t wait for patients to become symptomatic or have their ankle-brachial index drop. We have to follow patients closely with duplex ultrasound," after SFA revascularization, Dr. Saxon said.
The VIPER trial was sponsored by W.L. Gore. Dr. Saxon disclosed ties with W.L. Gore, Cook, Lutonix, Concentric Medical, Vascular Resources, Abbott Vascular, and Reva Medical. Dr. Ansel disclosed ties with Abbott Vascular, Boston Scientific, Access Closure, Angioslide, Arsenal Medical, Atheromed, Atrium Medical, Bard, and Biocardia.
MIAMI BEACH – An investigational, peripheral artery stent graft with heparin bonding showed excellent 1-year performance as long as its size matched the treated vessel, in a multicenter, single-arm study of 119 patients.
The Viabahn heparin-bonded stent graft placed in superficial femoral arteries (SFA) and oversized at the proximal edge by no more than 20%, produced a 91% primary patency rate at 12 months after the intervention, compared with a 70% primary patency rate among patients who received the graft in vessels where proximal edge oversizing exceeded 20%, Dr. Richard Saxon said at the International Symposium on Endovascular Therapy (ISET) 2012.
The overall 12-month primary patency rate for the 119 patients in the study was 74%, including a 79% rate in patients who received the 5-mm diameter stent graft, which was "a marked improvement" compared with prior 5-mm devices, said Dr. Saxon, an interventional radiologist and director of research at the San Diego Cardiac and Vascular Institute.
"If we treat the correct subset of patients with this newer stent graft, patency will be excellent and reinterventions low. We need to measure [vessel diameters] and do it correctly, and we’ll get excellent results. Oversizing will lead to occlusions," Dr. Saxon said.
Oversizing compared with not oversizing led to "dramatically" different results.
The investigational stent graft used in the Gore Viabahn Endoprosthesis With Heparin Bioactive Surface in the Treatment of SFA Obstructive Disease (VIPER) trial appeared to perform substantially better than historical experience with the similar stent graft without a heparin-coated surface. The 12-month results in the pivotal study of the Viabahn stent graft without heparin showed a primary patency rate of 57%, suggesting that the heparin coating led to a 17% increase in primary patency, he reported.
In addition, the study achieved a 74% 1-year patency rate in patients with long, complex lesions that averaged 19 cm, and 60% of patients had stage III or IV disease based on classification by the Inter-Society Consensus Guidelines for the Management of PAD (TASC II). The heparin-coated stent graft also featured contoured edges, designed to minimize the stenoses at proximal edges that have posed a problem with prior models. But the results showed that the contoured edge failed to eliminate edge stenosis, Dr. Saxon said.
The new findings show that the Viabahn heparin-coated stent graft is comparable to the investigational Zilver PTX paclitaxel-eluting nitinol stent, said Dr. Gary M. Ansel, clinical director of peripheral vascular interventions at the Midwest Cardiology Research Foundation in Columbus, Ohio. who was a coinvestigator on the pivotal trials for both devices. He added that such stenting should become the new standard of treatment.
One-year patency data for the paclitaxel-coated nitinol stent, developed by Cook, were reported last year (Circ. Cardiovasc. Interv. 2011;4:495-504). Last October, a Food and Drug Administration advisory panel voted unanimously to recommend marketing approval of the paclitaxel-eluting nitinol stent, but as of late January, the FDA had not yet issued a decision. http://www.cookmedical.com/zilverptx/index.html
VIPER enrolled patients with SFA lesions greater than 5 cm long at 11 U.S. sites. Their average age was 66 years, 62% were men, one-third had diabetes, 87% had hypertension, and 47% had coronary artery disease.
Their average lesion length was 19 cm, and 61% of the SFA lesions had moderate or severe calcification. The study’s primary end point was primary patency in the treated SFA after 12 months, assessed by Doppler ultrasound.
The results showed no impact of lesion length on outcomes, with primary patency rates in patients with lesions 20 cm or longer similar to those of patients with shorter lesions.
Within 30 days of stenting treatment, one patient had a major adverse event, a need for bypass due to a target-lesion occlusion. The stent graft placed in this patient was considered "markedly oversized," according to Dr. Saxon.
A second patient had target lesion occlusion during follow-up to 1 year, again linked with stent graft oversizing compared with the vessel’s diameter.
Average ankle-brachial index was 0.61 at baseline and 0.9 at 12 months. At 12-month follow-up, 66 (74%) of the 89 patients assessed for their Rutherford-Becker class had class 0 disease, and 74 (83%) had experienced at least a two-class reduction in their Rutherford-Becker status.
Twelve patients had a stent graft thrombosis or occlusion, with 10 of these patients having a worsening of their baseline Rutherford-Becker class. Thirteen patients required revisions for stenoses detected by ultrasound; seven of these patients were asymptomatic at the time of stenosis detection.
"We can’t wait for patients to become symptomatic or have their ankle-brachial index drop. We have to follow patients closely with duplex ultrasound," after SFA revascularization, Dr. Saxon said.
The VIPER trial was sponsored by W.L. Gore. Dr. Saxon disclosed ties with W.L. Gore, Cook, Lutonix, Concentric Medical, Vascular Resources, Abbott Vascular, and Reva Medical. Dr. Ansel disclosed ties with Abbott Vascular, Boston Scientific, Access Closure, Angioslide, Arsenal Medical, Atheromed, Atrium Medical, Bard, and Biocardia.
Major Finding: At 12-month follow-up, superficial femoral arteries treated with a heparin-coated stent graft had a 74% primary patency rate.
Data Source: Results are from VIPER, a single-arm study of 119 patients with long SFA lesions enrolled at 11 U.S. centers.
Disclosures: The VIPER trial was sponsored by W.L. Gore. Dr. Saxon disclosed ties with W.L. Gore, Cook, Lutonix, Concentric Medical, Vascular Resources, Abbott Vascular, and Reva Medical. Dr. Ansel disclosed ties with Abbott Vascular, Boston Scientific, Access Closure, Angioslide, Arsenal Medical, Atheromed, Atrium Medical, Bard, and Biocardia.
Veith's Viewpoint: The Vascular Disease Paradox
Vascular patients who most need treatment are often difficult and risky to treat by open operation or an endovascular intervention. In contrast, patients who least need invasive treatment or need it not at all usually have lesions that are easy to treat with good results. Examples are patients with advanced gangrene versus those with intermittent claudication; symptomatic patients with carotid artery stenosis versus those who are asymptomatic; patients with large abdominal aortic aneurysms versus those with small lesions.
This paradoxical situation occurs because most vascular lesions, particularly those associated with atherosclerosis, are in their early phases benign, cause minimal or no symptoms, and are unassociated with widespread vascular disease.
Moreover, many of these lesions, particularly with statins and other good medical therapy, will remain stable for long periods. These early lesions are technically easy to treat invasively, although such treatment may provide little or no benefit to the patient.
In contrast, only when lesions advance, become more complex and are associated with a widely diseased arterial system do they become threatening to life, limb, and the brain. These latter lesions are usually much harder to treat both by transcatheter or open operative techniques. This situation gives rise to several consequences relating to physician judgment, procedural outcomes, physician and institutional incomes, health care costs and ethical considerations.
Everyone in the vascular field should recognize and face these issues.
To help do so, let us examine some of these issues as they relate to the common problem of carotid bifurcation stenosis. High grade stenosis at this site, even when asymptomatic, can cause some strokes. Level 1 evidence from the so-called landmark asymptomatic trials (ACAS, ACST), which randomized patients from 1990-2003, showed significant stroke prevention from carotid endarterectomy (CEA) compared to medical treatment.
However, the benefit was slight (stroke rates were reduced from about 2% per year to about 1% per year), and there have been substantial improvements in medical treatments over the last decade to prevent strokes with statins and other measures. Carotid artery stenting (CAS) has also become a commonly used treatment to prevent strokes in asymptomatic carotid stenosis patients, although there is no convincing evidence that such treatment is more effective than current medical treatment in most if not all of these patients.
In addition, there is no solid evidence that CEA in asymptomatic patients prevents strokes more effectively than current medical treatment. Yet in the United States, 70%-90% of CEAs and 70%-96% of CAS procedures are performed on asymptomatic patients.
Should this be and how does the vascular disease paradox relate to this situation?
Vascular surgeons and interventionalists from all specialties want to continue to intervene on most of these asymptomatic carotid stenosis patients for several reasons. These include gratifyingly good outcomes from treating these usually simple, low-risk asymptomatic lesions and provision of income to physicians and hospitals.
These good outcomes also provide many accessory benefits to the treating physicians and surgeons by improving their overall results, a desirable goal in view of looming audits and pay-for-performance incentives. Also, increasing case numbers help practitioners to meet credentialing requirements.
However, there are negatives to continuing to perform large numbers of invasive treatments on asymptomatic carotid stenosis patients. One is the high cost to our health care system of providing these large numbers of invasive treatments largely to a group of patients who will derive little or no benefit. Another is the possibility that more patients will be harmed than helped.
Clearly what is needed are better ways to detect the asymptomatic patient at high risk for having a stroke so only those patients can be treated invasively. Although no such method is universally accepted, there are glimmers of hope that one or more will be proven effective.
Also needed are trials to establish the effectiveness of current medical therapy for stroke prevention in patients with asymptomatic carotid stenosis. However, such trials will not be simple to design because of the benign nature of most asymptomatic lesions. Thus, such trials will have to be conducted in patients selected to have more risky lesions.
Until such information is available, all practitioners should exercise restraint in treating patients with asymptomatic carotid stenosis invasively. They should not be seduced into treating simply because of the ease of treatment or the good outcomes – the vascular disease paradox. It is risk-benefit ratio that is more important. Physicians and surgeons should recognize that the landmark trials on this subject are now outdated, and should restrict such invasive treatment in some way to fewer patients than in the past – perhaps those with an increasing or very high grade (pinhole) stenosis or a contralateral occlusion.
Finally, it should be noted that a proposal to provide reimbursement for performing CAS on standard and low-risk carotid stenosis patients, including asymptomatic patients, is currently being considered by Medicare.
It is likely that some support for this proposal stems from the facts that lesions in such patients are easy to treat and the results of treatment are excellent. This is the vascular disease paradox which should be recognized and dealt with by all in the field.n
Dr. Veith is Professor of Surgery at New York University Medical Center and the Cleveland Clinic. He is an associate medical editor for Vascular Specialist.
The ideas and opinions expressed in Vascular Specialist do not necessarily reflect those of the Society or Publisher.
Vascular patients who most need treatment are often difficult and risky to treat by open operation or an endovascular intervention. In contrast, patients who least need invasive treatment or need it not at all usually have lesions that are easy to treat with good results. Examples are patients with advanced gangrene versus those with intermittent claudication; symptomatic patients with carotid artery stenosis versus those who are asymptomatic; patients with large abdominal aortic aneurysms versus those with small lesions.
This paradoxical situation occurs because most vascular lesions, particularly those associated with atherosclerosis, are in their early phases benign, cause minimal or no symptoms, and are unassociated with widespread vascular disease.
Moreover, many of these lesions, particularly with statins and other good medical therapy, will remain stable for long periods. These early lesions are technically easy to treat invasively, although such treatment may provide little or no benefit to the patient.
In contrast, only when lesions advance, become more complex and are associated with a widely diseased arterial system do they become threatening to life, limb, and the brain. These latter lesions are usually much harder to treat both by transcatheter or open operative techniques. This situation gives rise to several consequences relating to physician judgment, procedural outcomes, physician and institutional incomes, health care costs and ethical considerations.
Everyone in the vascular field should recognize and face these issues.
To help do so, let us examine some of these issues as they relate to the common problem of carotid bifurcation stenosis. High grade stenosis at this site, even when asymptomatic, can cause some strokes. Level 1 evidence from the so-called landmark asymptomatic trials (ACAS, ACST), which randomized patients from 1990-2003, showed significant stroke prevention from carotid endarterectomy (CEA) compared to medical treatment.
However, the benefit was slight (stroke rates were reduced from about 2% per year to about 1% per year), and there have been substantial improvements in medical treatments over the last decade to prevent strokes with statins and other measures. Carotid artery stenting (CAS) has also become a commonly used treatment to prevent strokes in asymptomatic carotid stenosis patients, although there is no convincing evidence that such treatment is more effective than current medical treatment in most if not all of these patients.
In addition, there is no solid evidence that CEA in asymptomatic patients prevents strokes more effectively than current medical treatment. Yet in the United States, 70%-90% of CEAs and 70%-96% of CAS procedures are performed on asymptomatic patients.
Should this be and how does the vascular disease paradox relate to this situation?
Vascular surgeons and interventionalists from all specialties want to continue to intervene on most of these asymptomatic carotid stenosis patients for several reasons. These include gratifyingly good outcomes from treating these usually simple, low-risk asymptomatic lesions and provision of income to physicians and hospitals.
These good outcomes also provide many accessory benefits to the treating physicians and surgeons by improving their overall results, a desirable goal in view of looming audits and pay-for-performance incentives. Also, increasing case numbers help practitioners to meet credentialing requirements.
However, there are negatives to continuing to perform large numbers of invasive treatments on asymptomatic carotid stenosis patients. One is the high cost to our health care system of providing these large numbers of invasive treatments largely to a group of patients who will derive little or no benefit. Another is the possibility that more patients will be harmed than helped.
Clearly what is needed are better ways to detect the asymptomatic patient at high risk for having a stroke so only those patients can be treated invasively. Although no such method is universally accepted, there are glimmers of hope that one or more will be proven effective.
Also needed are trials to establish the effectiveness of current medical therapy for stroke prevention in patients with asymptomatic carotid stenosis. However, such trials will not be simple to design because of the benign nature of most asymptomatic lesions. Thus, such trials will have to be conducted in patients selected to have more risky lesions.
Until such information is available, all practitioners should exercise restraint in treating patients with asymptomatic carotid stenosis invasively. They should not be seduced into treating simply because of the ease of treatment or the good outcomes – the vascular disease paradox. It is risk-benefit ratio that is more important. Physicians and surgeons should recognize that the landmark trials on this subject are now outdated, and should restrict such invasive treatment in some way to fewer patients than in the past – perhaps those with an increasing or very high grade (pinhole) stenosis or a contralateral occlusion.
Finally, it should be noted that a proposal to provide reimbursement for performing CAS on standard and low-risk carotid stenosis patients, including asymptomatic patients, is currently being considered by Medicare.
It is likely that some support for this proposal stems from the facts that lesions in such patients are easy to treat and the results of treatment are excellent. This is the vascular disease paradox which should be recognized and dealt with by all in the field.n
Dr. Veith is Professor of Surgery at New York University Medical Center and the Cleveland Clinic. He is an associate medical editor for Vascular Specialist.
The ideas and opinions expressed in Vascular Specialist do not necessarily reflect those of the Society or Publisher.
Vascular patients who most need treatment are often difficult and risky to treat by open operation or an endovascular intervention. In contrast, patients who least need invasive treatment or need it not at all usually have lesions that are easy to treat with good results. Examples are patients with advanced gangrene versus those with intermittent claudication; symptomatic patients with carotid artery stenosis versus those who are asymptomatic; patients with large abdominal aortic aneurysms versus those with small lesions.
This paradoxical situation occurs because most vascular lesions, particularly those associated with atherosclerosis, are in their early phases benign, cause minimal or no symptoms, and are unassociated with widespread vascular disease.
Moreover, many of these lesions, particularly with statins and other good medical therapy, will remain stable for long periods. These early lesions are technically easy to treat invasively, although such treatment may provide little or no benefit to the patient.
In contrast, only when lesions advance, become more complex and are associated with a widely diseased arterial system do they become threatening to life, limb, and the brain. These latter lesions are usually much harder to treat both by transcatheter or open operative techniques. This situation gives rise to several consequences relating to physician judgment, procedural outcomes, physician and institutional incomes, health care costs and ethical considerations.
Everyone in the vascular field should recognize and face these issues.
To help do so, let us examine some of these issues as they relate to the common problem of carotid bifurcation stenosis. High grade stenosis at this site, even when asymptomatic, can cause some strokes. Level 1 evidence from the so-called landmark asymptomatic trials (ACAS, ACST), which randomized patients from 1990-2003, showed significant stroke prevention from carotid endarterectomy (CEA) compared to medical treatment.
However, the benefit was slight (stroke rates were reduced from about 2% per year to about 1% per year), and there have been substantial improvements in medical treatments over the last decade to prevent strokes with statins and other measures. Carotid artery stenting (CAS) has also become a commonly used treatment to prevent strokes in asymptomatic carotid stenosis patients, although there is no convincing evidence that such treatment is more effective than current medical treatment in most if not all of these patients.
In addition, there is no solid evidence that CEA in asymptomatic patients prevents strokes more effectively than current medical treatment. Yet in the United States, 70%-90% of CEAs and 70%-96% of CAS procedures are performed on asymptomatic patients.
Should this be and how does the vascular disease paradox relate to this situation?
Vascular surgeons and interventionalists from all specialties want to continue to intervene on most of these asymptomatic carotid stenosis patients for several reasons. These include gratifyingly good outcomes from treating these usually simple, low-risk asymptomatic lesions and provision of income to physicians and hospitals.
These good outcomes also provide many accessory benefits to the treating physicians and surgeons by improving their overall results, a desirable goal in view of looming audits and pay-for-performance incentives. Also, increasing case numbers help practitioners to meet credentialing requirements.
However, there are negatives to continuing to perform large numbers of invasive treatments on asymptomatic carotid stenosis patients. One is the high cost to our health care system of providing these large numbers of invasive treatments largely to a group of patients who will derive little or no benefit. Another is the possibility that more patients will be harmed than helped.
Clearly what is needed are better ways to detect the asymptomatic patient at high risk for having a stroke so only those patients can be treated invasively. Although no such method is universally accepted, there are glimmers of hope that one or more will be proven effective.
Also needed are trials to establish the effectiveness of current medical therapy for stroke prevention in patients with asymptomatic carotid stenosis. However, such trials will not be simple to design because of the benign nature of most asymptomatic lesions. Thus, such trials will have to be conducted in patients selected to have more risky lesions.
Until such information is available, all practitioners should exercise restraint in treating patients with asymptomatic carotid stenosis invasively. They should not be seduced into treating simply because of the ease of treatment or the good outcomes – the vascular disease paradox. It is risk-benefit ratio that is more important. Physicians and surgeons should recognize that the landmark trials on this subject are now outdated, and should restrict such invasive treatment in some way to fewer patients than in the past – perhaps those with an increasing or very high grade (pinhole) stenosis or a contralateral occlusion.
Finally, it should be noted that a proposal to provide reimbursement for performing CAS on standard and low-risk carotid stenosis patients, including asymptomatic patients, is currently being considered by Medicare.
It is likely that some support for this proposal stems from the facts that lesions in such patients are easy to treat and the results of treatment are excellent. This is the vascular disease paradox which should be recognized and dealt with by all in the field.n
Dr. Veith is Professor of Surgery at New York University Medical Center and the Cleveland Clinic. He is an associate medical editor for Vascular Specialist.
The ideas and opinions expressed in Vascular Specialist do not necessarily reflect those of the Society or Publisher.
BEST PRACTICES IN: Prenatal Screening & Cord Blood Banking
A supplement to Ob.Gyn. News. This supplement was sponsored by PerkinElmer.
•Topics
•Faculty/Faculty Disclosure
To view the supplement, click the image above.
Topics
• Introduction
• Screening for Fetal Chromosomal Abnormalities
• UCB Banking
• Conclusions
Faculty/Faculty Disclosure
Joanne Stone, MD
Director, Perinatal Ultrasound
Division Director, Maternal Fetal Medicine
Department of Obstetrics, Gynecology, and Reproductive Medicine
Mt. Sinai School of Medicine
New York, NY
University of California, San Diego
La Jolla, California
Dr. Stone has nothing to disclose.
Copyright © 2009 by Elsevier Inc.
A supplement to Ob.Gyn. News. This supplement was sponsored by PerkinElmer.
•Topics
•Faculty/Faculty Disclosure
To view the supplement, click the image above.
Topics
• Introduction
• Screening for Fetal Chromosomal Abnormalities
• UCB Banking
• Conclusions
Faculty/Faculty Disclosure
Joanne Stone, MD
Director, Perinatal Ultrasound
Division Director, Maternal Fetal Medicine
Department of Obstetrics, Gynecology, and Reproductive Medicine
Mt. Sinai School of Medicine
New York, NY
University of California, San Diego
La Jolla, California
Dr. Stone has nothing to disclose.
Copyright © 2009 by Elsevier Inc.
A supplement to Ob.Gyn. News. This supplement was sponsored by PerkinElmer.
•Topics
•Faculty/Faculty Disclosure
To view the supplement, click the image above.
Topics
• Introduction
• Screening for Fetal Chromosomal Abnormalities
• UCB Banking
• Conclusions
Faculty/Faculty Disclosure
Joanne Stone, MD
Director, Perinatal Ultrasound
Division Director, Maternal Fetal Medicine
Department of Obstetrics, Gynecology, and Reproductive Medicine
Mt. Sinai School of Medicine
New York, NY
University of California, San Diego
La Jolla, California
Dr. Stone has nothing to disclose.
Copyright © 2009 by Elsevier Inc.
Cervical Cancer Screening in the Era of Improved Technology and HPV Vaccines
A supplement to Ob.Gyn. News.
This supplement was supported by CYTYC Corporation.
The articles are based on interviews with the faculty.
To view the supplement, click the image above.
Topic Highlights/Faculty
Introduction
Mark H. Einstein, MD, MS, Chair
Director, Clinical Research
Division of Gynecologic Oncology
Department of Obstetrics and Gynecology and Women's Health
Montefiore Medical Center
Bronx, N.Y.
Dr Einstein has received clinical grants from GlaxoSmithKline, Merck & Co., Inc., and Tigris Pharmaceuticals, Inc.
Milestones in Cervical Cancer Detection and Prevention: Significance in Clinical Practice
Mark H. Einstein, MD, MS, Chair
Improving HSIL and Glandular Disease Detection: What the Recent Data Show
Richard Lozano, MD
Director of Cytology
Pathology and Cytology Laboratories, Inc.
Lexington, Ky.
Dr Lozano has nothing to disclose.
and
Harold J. Sauer, MD, FACOG
Associate Professor and Acting Chair
Department of Obstetrics and Gynecology and Reproductive Biology
Michigan State University
Lansing
Dr Sauer has nothing to disclose.
Weighing the Costs and Benefits: Technologic Advances in Cervical Cancer Screening
Warner K. Huh, MD, FACOG, FACS
Assistant Professor
Division of Gynecologic Oncology
University of Alabama at Birmingham
Dr Huh has received clinical grants from 3M Pharmaceuticals, Cytyc Corporation, GlaxoSmithKline, MGI PHARMA, Merck, Roche Molecular Systems, and Tigris Pharmaceuticals. He is a consultant to GlaxoSmithKline, MGI PHARMA, Roche Molecular Systems, and mtm laboratories AG.
Efficacy of HPV Screening Versus Liquid-Based Cervical Cytology and Imaging: What the Data Really Show
Michael Karram, MD, FACOG
President and Medical Director
Seven Hills Women's Health Centers
Cincinnati, Ohio
Dr Karram has nothing to disclose.
and
Michael L. Krychman, MD
Associate Clinical Attending
Sexual Medicine Program
Memorial Sloan-Kettering Cancer Center
New York, N.Y.
Dr Krychman is a consultant to Cytyc.
Copyright © 2007 by Elsevier Inc.
A supplement to Ob.Gyn. News.
This supplement was supported by CYTYC Corporation.
The articles are based on interviews with the faculty.
To view the supplement, click the image above.
Topic Highlights/Faculty
Introduction
Mark H. Einstein, MD, MS, Chair
Director, Clinical Research
Division of Gynecologic Oncology
Department of Obstetrics and Gynecology and Women's Health
Montefiore Medical Center
Bronx, N.Y.
Dr Einstein has received clinical grants from GlaxoSmithKline, Merck & Co., Inc., and Tigris Pharmaceuticals, Inc.
Milestones in Cervical Cancer Detection and Prevention: Significance in Clinical Practice
Mark H. Einstein, MD, MS, Chair
Improving HSIL and Glandular Disease Detection: What the Recent Data Show
Richard Lozano, MD
Director of Cytology
Pathology and Cytology Laboratories, Inc.
Lexington, Ky.
Dr Lozano has nothing to disclose.
and
Harold J. Sauer, MD, FACOG
Associate Professor and Acting Chair
Department of Obstetrics and Gynecology and Reproductive Biology
Michigan State University
Lansing
Dr Sauer has nothing to disclose.
Weighing the Costs and Benefits: Technologic Advances in Cervical Cancer Screening
Warner K. Huh, MD, FACOG, FACS
Assistant Professor
Division of Gynecologic Oncology
University of Alabama at Birmingham
Dr Huh has received clinical grants from 3M Pharmaceuticals, Cytyc Corporation, GlaxoSmithKline, MGI PHARMA, Merck, Roche Molecular Systems, and Tigris Pharmaceuticals. He is a consultant to GlaxoSmithKline, MGI PHARMA, Roche Molecular Systems, and mtm laboratories AG.
Efficacy of HPV Screening Versus Liquid-Based Cervical Cytology and Imaging: What the Data Really Show
Michael Karram, MD, FACOG
President and Medical Director
Seven Hills Women's Health Centers
Cincinnati, Ohio
Dr Karram has nothing to disclose.
and
Michael L. Krychman, MD
Associate Clinical Attending
Sexual Medicine Program
Memorial Sloan-Kettering Cancer Center
New York, N.Y.
Dr Krychman is a consultant to Cytyc.
Copyright © 2007 by Elsevier Inc.
A supplement to Ob.Gyn. News.
This supplement was supported by CYTYC Corporation.
The articles are based on interviews with the faculty.
To view the supplement, click the image above.
Topic Highlights/Faculty
Introduction
Mark H. Einstein, MD, MS, Chair
Director, Clinical Research
Division of Gynecologic Oncology
Department of Obstetrics and Gynecology and Women's Health
Montefiore Medical Center
Bronx, N.Y.
Dr Einstein has received clinical grants from GlaxoSmithKline, Merck & Co., Inc., and Tigris Pharmaceuticals, Inc.
Milestones in Cervical Cancer Detection and Prevention: Significance in Clinical Practice
Mark H. Einstein, MD, MS, Chair
Improving HSIL and Glandular Disease Detection: What the Recent Data Show
Richard Lozano, MD
Director of Cytology
Pathology and Cytology Laboratories, Inc.
Lexington, Ky.
Dr Lozano has nothing to disclose.
and
Harold J. Sauer, MD, FACOG
Associate Professor and Acting Chair
Department of Obstetrics and Gynecology and Reproductive Biology
Michigan State University
Lansing
Dr Sauer has nothing to disclose.
Weighing the Costs and Benefits: Technologic Advances in Cervical Cancer Screening
Warner K. Huh, MD, FACOG, FACS
Assistant Professor
Division of Gynecologic Oncology
University of Alabama at Birmingham
Dr Huh has received clinical grants from 3M Pharmaceuticals, Cytyc Corporation, GlaxoSmithKline, MGI PHARMA, Merck, Roche Molecular Systems, and Tigris Pharmaceuticals. He is a consultant to GlaxoSmithKline, MGI PHARMA, Roche Molecular Systems, and mtm laboratories AG.
Efficacy of HPV Screening Versus Liquid-Based Cervical Cytology and Imaging: What the Data Really Show
Michael Karram, MD, FACOG
President and Medical Director
Seven Hills Women's Health Centers
Cincinnati, Ohio
Dr Karram has nothing to disclose.
and
Michael L. Krychman, MD
Associate Clinical Attending
Sexual Medicine Program
Memorial Sloan-Kettering Cancer Center
New York, N.Y.
Dr Krychman is a consultant to Cytyc.
Copyright © 2007 by Elsevier Inc.
CLINICAL UPDATE: Women's Health and Nutrition: Demographic Challenges
A supplement to Ob.Gyn. News.
This supplement is supported by Xanodyne Pharmaceuticals, Inc.
•Topic Highlights
•Faculty/Faculty Disclosures
To view the supplement, click the image above.
Topic Highlights
• Nutritional Gaps for Women in the United States
• Role of Obstetricians and Gynecologists in Women's Health Care
Faculty/Faculty Disclosures
Linda D. Bradley MD
Vice Chair, Obstetrics
Gynecology & Women's Health Institute
Cleveland Clinic
Cleveland, OH
Dr. Bradley is a consultant for Xanodyne Pharmaceuticals, Inc.
Beth Reardon, MS, RD, LDN
Integrative Nutritionist
Duke Integrative Nutrition
Durham, NC
Dr. Reardon has nothing to disclose.
John M. Thorp, Jr., MD
McAllister Distinguished Professor
Department of Obstetrics and Gynecology
University of North Carolina at Chapel Hill
Chapel Hill, NC
Dr. Thorp has nothing to disclose.
Barbara A. Underwood, PhD
Adjunct Professor of Nutrition
Columbia University
Institute of Human Nutrition
New York, NY
Dr. Underwood has nothing to disclose.
Fernando E. Viteri, MD, ScD
Professor (Emeritus)
Department of Nutritional Sciences and Toxicology
University of California
Berkeley, CA
and
Scientist
Children's Hospital
Oakland Research Institute
Oakland, CA
Dr. Viteri has received clinical grant funding from the University of California Institute for Mexico and the United States.
Copyright © 2009 by Elsevier Inc.
A supplement to Ob.Gyn. News.
This supplement is supported by Xanodyne Pharmaceuticals, Inc.
•Topic Highlights
•Faculty/Faculty Disclosures
To view the supplement, click the image above.
Topic Highlights
• Nutritional Gaps for Women in the United States
• Role of Obstetricians and Gynecologists in Women's Health Care
Faculty/Faculty Disclosures
Linda D. Bradley MD
Vice Chair, Obstetrics
Gynecology & Women's Health Institute
Cleveland Clinic
Cleveland, OH
Dr. Bradley is a consultant for Xanodyne Pharmaceuticals, Inc.
Beth Reardon, MS, RD, LDN
Integrative Nutritionist
Duke Integrative Nutrition
Durham, NC
Dr. Reardon has nothing to disclose.
John M. Thorp, Jr., MD
McAllister Distinguished Professor
Department of Obstetrics and Gynecology
University of North Carolina at Chapel Hill
Chapel Hill, NC
Dr. Thorp has nothing to disclose.
Barbara A. Underwood, PhD
Adjunct Professor of Nutrition
Columbia University
Institute of Human Nutrition
New York, NY
Dr. Underwood has nothing to disclose.
Fernando E. Viteri, MD, ScD
Professor (Emeritus)
Department of Nutritional Sciences and Toxicology
University of California
Berkeley, CA
and
Scientist
Children's Hospital
Oakland Research Institute
Oakland, CA
Dr. Viteri has received clinical grant funding from the University of California Institute for Mexico and the United States.
Copyright © 2009 by Elsevier Inc.
A supplement to Ob.Gyn. News.
This supplement is supported by Xanodyne Pharmaceuticals, Inc.
•Topic Highlights
•Faculty/Faculty Disclosures
To view the supplement, click the image above.
Topic Highlights
• Nutritional Gaps for Women in the United States
• Role of Obstetricians and Gynecologists in Women's Health Care
Faculty/Faculty Disclosures
Linda D. Bradley MD
Vice Chair, Obstetrics
Gynecology & Women's Health Institute
Cleveland Clinic
Cleveland, OH
Dr. Bradley is a consultant for Xanodyne Pharmaceuticals, Inc.
Beth Reardon, MS, RD, LDN
Integrative Nutritionist
Duke Integrative Nutrition
Durham, NC
Dr. Reardon has nothing to disclose.
John M. Thorp, Jr., MD
McAllister Distinguished Professor
Department of Obstetrics and Gynecology
University of North Carolina at Chapel Hill
Chapel Hill, NC
Dr. Thorp has nothing to disclose.
Barbara A. Underwood, PhD
Adjunct Professor of Nutrition
Columbia University
Institute of Human Nutrition
New York, NY
Dr. Underwood has nothing to disclose.
Fernando E. Viteri, MD, ScD
Professor (Emeritus)
Department of Nutritional Sciences and Toxicology
University of California
Berkeley, CA
and
Scientist
Children's Hospital
Oakland Research Institute
Oakland, CA
Dr. Viteri has received clinical grant funding from the University of California Institute for Mexico and the United States.
Copyright © 2009 by Elsevier Inc.
The Changing Landscape of Cervical Cancer Screening and Implications for the Clinician
A supplement to Ob.Gyn. News.
This educational supplement was supported by an educational grant from CYTYC Corporation.
The articles are based on clinical dialogues with the faculty.
To view the supplement, click the image above.
Topic Highlights/Faculty
Implications of Computer-Assisted Cervical Screening for the Ob.Gyn. Clinician
Co-Chairs:
Randall K. Gibb, MD
Assistant Professor, Division of Gynecologic Oncology
Washington University School of Medicine
St. Louis, Mo.
Thomas J. Herzog, MD
Director, Division of Gynecologic Oncology
Columbia University College of Physicians and Surgeons
New York, N.Y.
Comparison of Manual and Image-Directed Screening of Liquid-Based Cervical Cytology in a Large Metropolitan Cytology Practice
James R. Lingle, MD
Lingle, Gore, and Harding, P.C.
Englewood, Colo.
Fern S. Miller, MSN, CT(ASCP)
Cytology Manager, Cytology Department
Metropolitan Pathologists
Denver, Colo.
Performance of a Computer-Assisted Imaging System in Detecting High-Grade Squamous Intraepithelial Lesions
Bruce R. Dziura, MD
Chief of Pathology
New England Pathology Associates
Mercy Medical Center
Springfield, Mass
Timothy Kelly Fitzpatrick, MD
Attending Physician
Mercy Medical Center
Springfield, Mass.
Evaluation of a Computer-Assisted Imaging System in Diagnosing Uncommon Malignancies
Andrea E. Dawson, MD
Staff Pathologist
Cleveland Clinic Foundation
Cleveland, Ohio
Holly L. Thacker, MD
Director, Women's Health Center
Cleveland Clinic Foundation
Cleveland, Ohio
The faculty report they have nothing to disclose.
Copyright © 2005 by International Medical News Group
A supplement to Ob.Gyn. News.
This educational supplement was supported by an educational grant from CYTYC Corporation.
The articles are based on clinical dialogues with the faculty.
To view the supplement, click the image above.
Topic Highlights/Faculty
Implications of Computer-Assisted Cervical Screening for the Ob.Gyn. Clinician
Co-Chairs:
Randall K. Gibb, MD
Assistant Professor, Division of Gynecologic Oncology
Washington University School of Medicine
St. Louis, Mo.
Thomas J. Herzog, MD
Director, Division of Gynecologic Oncology
Columbia University College of Physicians and Surgeons
New York, N.Y.
Comparison of Manual and Image-Directed Screening of Liquid-Based Cervical Cytology in a Large Metropolitan Cytology Practice
James R. Lingle, MD
Lingle, Gore, and Harding, P.C.
Englewood, Colo.
Fern S. Miller, MSN, CT(ASCP)
Cytology Manager, Cytology Department
Metropolitan Pathologists
Denver, Colo.
Performance of a Computer-Assisted Imaging System in Detecting High-Grade Squamous Intraepithelial Lesions
Bruce R. Dziura, MD
Chief of Pathology
New England Pathology Associates
Mercy Medical Center
Springfield, Mass
Timothy Kelly Fitzpatrick, MD
Attending Physician
Mercy Medical Center
Springfield, Mass.
Evaluation of a Computer-Assisted Imaging System in Diagnosing Uncommon Malignancies
Andrea E. Dawson, MD
Staff Pathologist
Cleveland Clinic Foundation
Cleveland, Ohio
Holly L. Thacker, MD
Director, Women's Health Center
Cleveland Clinic Foundation
Cleveland, Ohio
The faculty report they have nothing to disclose.
Copyright © 2005 by International Medical News Group
A supplement to Ob.Gyn. News.
This educational supplement was supported by an educational grant from CYTYC Corporation.
The articles are based on clinical dialogues with the faculty.
To view the supplement, click the image above.
Topic Highlights/Faculty
Implications of Computer-Assisted Cervical Screening for the Ob.Gyn. Clinician
Co-Chairs:
Randall K. Gibb, MD
Assistant Professor, Division of Gynecologic Oncology
Washington University School of Medicine
St. Louis, Mo.
Thomas J. Herzog, MD
Director, Division of Gynecologic Oncology
Columbia University College of Physicians and Surgeons
New York, N.Y.
Comparison of Manual and Image-Directed Screening of Liquid-Based Cervical Cytology in a Large Metropolitan Cytology Practice
James R. Lingle, MD
Lingle, Gore, and Harding, P.C.
Englewood, Colo.
Fern S. Miller, MSN, CT(ASCP)
Cytology Manager, Cytology Department
Metropolitan Pathologists
Denver, Colo.
Performance of a Computer-Assisted Imaging System in Detecting High-Grade Squamous Intraepithelial Lesions
Bruce R. Dziura, MD
Chief of Pathology
New England Pathology Associates
Mercy Medical Center
Springfield, Mass
Timothy Kelly Fitzpatrick, MD
Attending Physician
Mercy Medical Center
Springfield, Mass.
Evaluation of a Computer-Assisted Imaging System in Diagnosing Uncommon Malignancies
Andrea E. Dawson, MD
Staff Pathologist
Cleveland Clinic Foundation
Cleveland, Ohio
Holly L. Thacker, MD
Director, Women's Health Center
Cleveland Clinic Foundation
Cleveland, Ohio
The faculty report they have nothing to disclose.
Copyright © 2005 by International Medical News Group
Chronic Dysfunctional Uterine Bleeding: Identifying Patients and Helping Them Understand Their Treatment Options
A supplement to Ob.Gyn. News.
Supported by an educational grant from Gynecare Worldwide, a division of Ethicon, Inc., a Johnson & Johnson Company.
The articles in this supplement are based on clinical dialogues with the faculty.
•Contents
•Faculty/Faculty Disclosure Statement
To view the supplement, click the image above.
Contents
Introduction
Consequences of Heavy Menstrual Bleeding
Types, Patterns, and Causes of Abnormal Uterine Bleeding
• Evaluating the Endometrial Cavity
Treatment Options: Entering the Dialogue
• Medical Therapy
• Surgical Interventions
• Endometrial Ablation Procedures
Considering Cases:
• An Overweight Patient
• A Patient Who Prefers to Avoid Hysterectomy
• A Patient With Postsurgical HMB
Helping Patients Choose
Conclusion
Faculty/Faculty Disclosure Statement
Mary Jane Minkin, MD, FACOG, Chair
Clinical Professor
Department of Obstetrics and Gynecology
Yale University School of Medicine
New Haven, Conn.
Developed a Web site for Gynecare; Speaker's Bureau: Berlex, Inc.
Charles E. Miller, MD, FACOG
Clinical Associate Professor
Department of Obstetrics and Gynecology
University of Illinois at Chicago
Clinical Associate
Department of Obstetrics and Gynecology
University of Chicago
Consultant: Gynecare Worldwide.
Malcolm G. Munro, MD, FRCS(c), FACOG
Professor
Department of Obstetrics and Gynecology
The David Geffen School of Medicine at UCLA
Los Angeles
Attending Staff
Department of Obstetrics and Gynecology
Kaiser Permanente Los Angeles Medical Center
Received Funding for Clinical Grants: Kaiser Research Foundation and Karl Storz Endoscopy-America, Inc.M
Consultant: Boston Scientific Corporation, Gynecare, and Karl Storz Endoscopy.
Robert K. Zurawin, MD, FACOG
Associate Professor
Department of Obstetrics and Gynecology
Baylor College of Medicine
Houston
Consultant/Speaker: Gynecare Worldwide.
Copyright © 2004 by International Medical News Group
A supplement to Ob.Gyn. News.
Supported by an educational grant from Gynecare Worldwide, a division of Ethicon, Inc., a Johnson & Johnson Company.
The articles in this supplement are based on clinical dialogues with the faculty.
•Contents
•Faculty/Faculty Disclosure Statement
To view the supplement, click the image above.
Contents
Introduction
Consequences of Heavy Menstrual Bleeding
Types, Patterns, and Causes of Abnormal Uterine Bleeding
• Evaluating the Endometrial Cavity
Treatment Options: Entering the Dialogue
• Medical Therapy
• Surgical Interventions
• Endometrial Ablation Procedures
Considering Cases:
• An Overweight Patient
• A Patient Who Prefers to Avoid Hysterectomy
• A Patient With Postsurgical HMB
Helping Patients Choose
Conclusion
Faculty/Faculty Disclosure Statement
Mary Jane Minkin, MD, FACOG, Chair
Clinical Professor
Department of Obstetrics and Gynecology
Yale University School of Medicine
New Haven, Conn.
Developed a Web site for Gynecare; Speaker's Bureau: Berlex, Inc.
Charles E. Miller, MD, FACOG
Clinical Associate Professor
Department of Obstetrics and Gynecology
University of Illinois at Chicago
Clinical Associate
Department of Obstetrics and Gynecology
University of Chicago
Consultant: Gynecare Worldwide.
Malcolm G. Munro, MD, FRCS(c), FACOG
Professor
Department of Obstetrics and Gynecology
The David Geffen School of Medicine at UCLA
Los Angeles
Attending Staff
Department of Obstetrics and Gynecology
Kaiser Permanente Los Angeles Medical Center
Received Funding for Clinical Grants: Kaiser Research Foundation and Karl Storz Endoscopy-America, Inc.M
Consultant: Boston Scientific Corporation, Gynecare, and Karl Storz Endoscopy.
Robert K. Zurawin, MD, FACOG
Associate Professor
Department of Obstetrics and Gynecology
Baylor College of Medicine
Houston
Consultant/Speaker: Gynecare Worldwide.
Copyright © 2004 by International Medical News Group
A supplement to Ob.Gyn. News.
Supported by an educational grant from Gynecare Worldwide, a division of Ethicon, Inc., a Johnson & Johnson Company.
The articles in this supplement are based on clinical dialogues with the faculty.
•Contents
•Faculty/Faculty Disclosure Statement
To view the supplement, click the image above.
Contents
Introduction
Consequences of Heavy Menstrual Bleeding
Types, Patterns, and Causes of Abnormal Uterine Bleeding
• Evaluating the Endometrial Cavity
Treatment Options: Entering the Dialogue
• Medical Therapy
• Surgical Interventions
• Endometrial Ablation Procedures
Considering Cases:
• An Overweight Patient
• A Patient Who Prefers to Avoid Hysterectomy
• A Patient With Postsurgical HMB
Helping Patients Choose
Conclusion
Faculty/Faculty Disclosure Statement
Mary Jane Minkin, MD, FACOG, Chair
Clinical Professor
Department of Obstetrics and Gynecology
Yale University School of Medicine
New Haven, Conn.
Developed a Web site for Gynecare; Speaker's Bureau: Berlex, Inc.
Charles E. Miller, MD, FACOG
Clinical Associate Professor
Department of Obstetrics and Gynecology
University of Illinois at Chicago
Clinical Associate
Department of Obstetrics and Gynecology
University of Chicago
Consultant: Gynecare Worldwide.
Malcolm G. Munro, MD, FRCS(c), FACOG
Professor
Department of Obstetrics and Gynecology
The David Geffen School of Medicine at UCLA
Los Angeles
Attending Staff
Department of Obstetrics and Gynecology
Kaiser Permanente Los Angeles Medical Center
Received Funding for Clinical Grants: Kaiser Research Foundation and Karl Storz Endoscopy-America, Inc.M
Consultant: Boston Scientific Corporation, Gynecare, and Karl Storz Endoscopy.
Robert K. Zurawin, MD, FACOG
Associate Professor
Department of Obstetrics and Gynecology
Baylor College of Medicine
Houston
Consultant/Speaker: Gynecare Worldwide.
Copyright © 2004 by International Medical News Group
