Amy Karon

Two new studies underscore the important role of oral propranolol in the first-line treatment of infantile hemangioma (IH), as well as the need for better long-term data on the safety of the beta-blocker in very young children, according to the authors.

In the first study, an uncontrolled prospective analysis of 906 infants with IH, 84% of those who stopped propranolol did so because of “satisfactory efficacy” while only 6% discontinued because of adverse drug reactions (ADRs), reported Dr. Sorilla Prey at Bordeaux (France) University and her associates. The median dose of propranolol was 2 mg/kg per day for 198 days, with a median follow-up period of 396 days, in the study, which was published on Jan. 26, in a research letter (JAMA. 2016 Jan 26;315;413-5).

Almost 9% had ADRs; most involved respiratory infections. Serious ADRs affected 2.6% of patients; the most serious were cardiac and metabolic disorders. They included one episode of serious bradycardia, as well as one fatal episode of atrioventricular block considered probably unrelated to therapy.

In a separate meta-analysis of 18 studies published online in Pediatrics in January, treatment with propranolol cleared an average of 95% of IH cases, more than double the average clearance for corticosteroids (Pediatrics. 2016 Jan 15. pii: peds.2015-3896). Harms “were relatively well tolerated in the short term,” but needed longer-term study, especially of cardiovascular and metabolic effects and effects on cognition, memory, and the central nervous system, said the authors, Dr. Sivakumar Chinnadurai of Vanderbilt University, Nashville, Tenn., and his associates.

A linked comparative effectiveness review, based on this research and published by the Agency for Healthcare Research and Quality found a “moderate” strength of evidence for oral propranolol over steroids, alongside “moderate” evidence linking the beta-blocker to potential harms.

In an interview, Dr. Michael Cabana, who was not involved the studies, noted that historically, lesions were considered benign, but that management “has changed tremendously in the last few years.” Systematic reviews suggest that propranolol is “extremely effective” in treating IH, said Dr. Cabana, professor of pediatrics at the University of California, San Francisco. “But every child and every IH lesion is different. Usually, for thin, superficial IH lesions in low-risk areas, topical corticosteroids can still be useful.”

Because the early growth of IH is nonlinear and occurs fastest at about 1-2 months of age, high-risk patients should be referred to a pediatric dermatologist by age 4 weeks, Dr. Cabana said. These include patients with facial or ulcerated hemangiomas, lesions that could threaten vision or the airway, those associated with other anomalies, or lesions in the perineal area or lumbosacral area, he added. Propranolol can cause sleep disruption and cold hands and feet, he noted. Cardiovascular effects are “usually minor,” while hypoglycemia is usually the most serious ADR.

The overall rate of treatment-related hypoglycemia in the JAMA study was only 0.4%, but half these patients had hypoglycemic seizures. Hypoglycemia was “aggravated by the beta-adrenergic antagonist properties of propranolol, and worsening conditions of children who also had other concomitant diseases,” Dr. Prey and her associates said. Despite monitoring, bradycardia also occurred in patients with severe comorbidities.

“Prescribers must counsel parents at each follow-up visit to discontinue propranolol during fasting and intercurrent illness, especially in the setting of restricted oral intake and respiratory symptoms,” they emphasized.

The comparative effectiveness review included 148 studies and 15 randomized controlled trials. Few studies compared lasers and beta-blockers, but lasers historically have yielded much lower success rates than have more recent studies of propranolol, the researchers noted. Pulsed dye laser was generally more effective than were other laser modalities, with moderate strength of evidence for improvement in skin pigmentation and relatively low risk of pain.

A third study also published in January reported that infantile hemangiomas have become more common in recent decades in conjunction with declines in gestational age and birth weight (J Am Acad Dermatol. 2016 Jan;74 [1] 120-6).

Dr. Prey and her associates were funded by Pierre Fabre Dermatologie and the French Health Products Agency. She and one coinvestigator reported involvement in clinical trials of propranolol for infantile hemangioma. The other researchers had no disclosures. The systematic review was supported by the Agency for Healthcare Research and Quality, U.S. Department of Health & Human Services. The investigators had no disclosures.

Two new studies underscore the important role of oral propranolol in the first-line treatment of infantile hemangioma (IH), as well as the need for better long-term data on the safety of the beta-blocker in very young children, according to the authors.

In the first study, an uncontrolled prospective analysis of 906 infants with IH, 84% of those who stopped propranolol did so because of “satisfactory efficacy” while only 6% discontinued because of adverse drug reactions (ADRs), reported Dr. Sorilla Prey at Bordeaux (France) University and her associates. The median dose of propranolol was 2 mg/kg per day for 198 days, with a median follow-up period of 396 days, in the study, which was published on Jan. 26, in a research letter (JAMA. 2016 Jan 26;315;413-5).

Almost 9% had ADRs; most involved respiratory infections. Serious ADRs affected 2.6% of patients; the most serious were cardiac and metabolic disorders. They included one episode of serious bradycardia, as well as one fatal episode of atrioventricular block considered probably unrelated to therapy.

In a separate meta-analysis of 18 studies published online in Pediatrics in January, treatment with propranolol cleared an average of 95% of IH cases, more than double the average clearance for corticosteroids (Pediatrics. 2016 Jan 15. pii: peds.2015-3896). Harms “were relatively well tolerated in the short term,” but needed longer-term study, especially of cardiovascular and metabolic effects and effects on cognition, memory, and the central nervous system, said the authors, Dr. Sivakumar Chinnadurai of Vanderbilt University, Nashville, Tenn., and his associates.

A linked comparative effectiveness review, based on this research and published by the Agency for Healthcare Research and Quality found a “moderate” strength of evidence for oral propranolol over steroids, alongside “moderate” evidence linking the beta-blocker to potential harms.

In an interview, Dr. Michael Cabana, who was not involved the studies, noted that historically, lesions were considered benign, but that management “has changed tremendously in the last few years.” Systematic reviews suggest that propranolol is “extremely effective” in treating IH, said Dr. Cabana, professor of pediatrics at the University of California, San Francisco. “But every child and every IH lesion is different. Usually, for thin, superficial IH lesions in low-risk areas, topical corticosteroids can still be useful.”

Because the early growth of IH is nonlinear and occurs fastest at about 1-2 months of age, high-risk patients should be referred to a pediatric dermatologist by age 4 weeks, Dr. Cabana said. These include patients with facial or ulcerated hemangiomas, lesions that could threaten vision or the airway, those associated with other anomalies, or lesions in the perineal area or lumbosacral area, he added. Propranolol can cause sleep disruption and cold hands and feet, he noted. Cardiovascular effects are “usually minor,” while hypoglycemia is usually the most serious ADR.

The overall rate of treatment-related hypoglycemia in the JAMA study was only 0.4%, but half these patients had hypoglycemic seizures. Hypoglycemia was “aggravated by the beta-adrenergic antagonist properties of propranolol, and worsening conditions of children who also had other concomitant diseases,” Dr. Prey and her associates said. Despite monitoring, bradycardia also occurred in patients with severe comorbidities.

“Prescribers must counsel parents at each follow-up visit to discontinue propranolol during fasting and intercurrent illness, especially in the setting of restricted oral intake and respiratory symptoms,” they emphasized.

The comparative effectiveness review included 148 studies and 15 randomized controlled trials. Few studies compared lasers and beta-blockers, but lasers historically have yielded much lower success rates than have more recent studies of propranolol, the researchers noted. Pulsed dye laser was generally more effective than were other laser modalities, with moderate strength of evidence for improvement in skin pigmentation and relatively low risk of pain.

A third study also published in January reported that infantile hemangiomas have become more common in recent decades in conjunction with declines in gestational age and birth weight (J Am Acad Dermatol. 2016 Jan;74 [1] 120-6).

Dr. Prey and her associates were funded by Pierre Fabre Dermatologie and the French Health Products Agency. She and one coinvestigator reported involvement in clinical trials of propranolol for infantile hemangioma. The other researchers had no disclosures. The systematic review was supported by the Agency for Healthcare Research and Quality, U.S. Department of Health & Human Services. The investigators had no disclosures.

Two new studies underscore the important role of oral propranolol in the first-line treatment of infantile hemangioma (IH), as well as the need for better long-term data on the safety of the beta-blocker in very young children, according to the authors.

In the first study, an uncontrolled prospective analysis of 906 infants with IH, 84% of those who stopped propranolol did so because of “satisfactory efficacy” while only 6% discontinued because of adverse drug reactions (ADRs), reported Dr. Sorilla Prey at Bordeaux (France) University and her associates. The median dose of propranolol was 2 mg/kg per day for 198 days, with a median follow-up period of 396 days, in the study, which was published on Jan. 26, in a research letter (JAMA. 2016 Jan 26;315;413-5).

Almost 9% had ADRs; most involved respiratory infections. Serious ADRs affected 2.6% of patients; the most serious were cardiac and metabolic disorders. They included one episode of serious bradycardia, as well as one fatal episode of atrioventricular block considered probably unrelated to therapy.

In a separate meta-analysis of 18 studies published online in Pediatrics in January, treatment with propranolol cleared an average of 95% of IH cases, more than double the average clearance for corticosteroids (Pediatrics. 2016 Jan 15. pii: peds.2015-3896). Harms “were relatively well tolerated in the short term,” but needed longer-term study, especially of cardiovascular and metabolic effects and effects on cognition, memory, and the central nervous system, said the authors, Dr. Sivakumar Chinnadurai of Vanderbilt University, Nashville, Tenn., and his associates.

A linked comparative effectiveness review, based on this research and published by the Agency for Healthcare Research and Quality found a “moderate” strength of evidence for oral propranolol over steroids, alongside “moderate” evidence linking the beta-blocker to potential harms.

In an interview, Dr. Michael Cabana, who was not involved the studies, noted that historically, lesions were considered benign, but that management “has changed tremendously in the last few years.” Systematic reviews suggest that propranolol is “extremely effective” in treating IH, said Dr. Cabana, professor of pediatrics at the University of California, San Francisco. “But every child and every IH lesion is different. Usually, for thin, superficial IH lesions in low-risk areas, topical corticosteroids can still be useful.”

Because the early growth of IH is nonlinear and occurs fastest at about 1-2 months of age, high-risk patients should be referred to a pediatric dermatologist by age 4 weeks, Dr. Cabana said. These include patients with facial or ulcerated hemangiomas, lesions that could threaten vision or the airway, those associated with other anomalies, or lesions in the perineal area or lumbosacral area, he added. Propranolol can cause sleep disruption and cold hands and feet, he noted. Cardiovascular effects are “usually minor,” while hypoglycemia is usually the most serious ADR.

The overall rate of treatment-related hypoglycemia in the JAMA study was only 0.4%, but half these patients had hypoglycemic seizures. Hypoglycemia was “aggravated by the beta-adrenergic antagonist properties of propranolol, and worsening conditions of children who also had other concomitant diseases,” Dr. Prey and her associates said. Despite monitoring, bradycardia also occurred in patients with severe comorbidities.

“Prescribers must counsel parents at each follow-up visit to discontinue propranolol during fasting and intercurrent illness, especially in the setting of restricted oral intake and respiratory symptoms,” they emphasized.

The comparative effectiveness review included 148 studies and 15 randomized controlled trials. Few studies compared lasers and beta-blockers, but lasers historically have yielded much lower success rates than have more recent studies of propranolol, the researchers noted. Pulsed dye laser was generally more effective than were other laser modalities, with moderate strength of evidence for improvement in skin pigmentation and relatively low risk of pain.

A third study also published in January reported that infantile hemangiomas have become more common in recent decades in conjunction with declines in gestational age and birth weight (J Am Acad Dermatol. 2016 Jan;74 [1] 120-6).

Dr. Prey and her associates were funded by Pierre Fabre Dermatologie and the French Health Products Agency. She and one coinvestigator reported involvement in clinical trials of propranolol for infantile hemangioma. The other researchers had no disclosures. The systematic review was supported by the Agency for Healthcare Research and Quality, U.S. Department of Health & Human Services. The investigators had no disclosures.

Ivacaftor, a cystic fibrosis transmembrane conductance regulator potentiator, appears generally safe for young children with cystic fibrosis and a CFTR gating mutation, an open-label, single-arm study shows.

The study, published online Jan. 20, is the first to assess ivacaftor in children aged 2-5 years, suggests that the drug is well tolerated, somewhat improves sweat chloride and nutritional measures, and also might improve pancreatic function, reported Dr. Jane C. Davies of the National Heart & Lung Institute of Imperial College London, and her associates. “Reported side effects are similar to those in the general cystic fibrosis population, although children with previous cystic fibrosis liver disease might have transient rises in transaminase concentrations,” they added.

© CTRPhotos / ThinkStockPhotos.com

Ivacaftor is approved by the Food and Drug Administration for children aged 6 years and older with cystic fibrosis, and it should be even more beneficial if given before patients develop infections and inflammation as a result of cystic fibrosis transmembrane conductance regulator (CFTR) dysfunction, the researchers noted.

The investigators enrolled children aged 2 to 5 years with cystic fibrosis and a CFTR gating mutation on at least one allele from 15 hospitals in the United States, the United Kingdom, and Canada. To establish short-term safety and pharmacokinetics of ivacaftor and its metabolites, nine patients received an oral dose of 50 mg (if they weighed less than 14 kg) or 75 mg (if they weighed 14 kg or more) every 12 hours for 4 days.

To assess longer-term safety, 34 patients received these doses for 24 weeks, followed by an open-label extension study that remains underway (Lancet Respir Med. 2016 Jan 20. doi: 10.1016/S2213-2600[15]00545-7).

The pharmacokinetic analyses indicated that exposure was similar to that reported in adults, the researchers reported. The median Cmin was 536 ng per mL for the 50-mg dose and 580 ng per mL for the 75-mg dose, and median ivacaftor AUC values were 9,840 ng×h/mL and 10,200 ngxh/mL, respectively. The most common adverse events over 6 weeks of treatment included cough (56% of patients) and vomiting (29%). In addition five (15%) patients had liver function test results that were more than eight-fold higher than the upper limit of normal. As a result, four had the study drug interrupted and one discontinued. Hypertransaminasemia was the only serious adverse event considered related to ivacaftor, and the only adverse event leading to treatment discontinuation. By week 24, sweat chloride levels had dropped an average of 47 mmol per L from baseline (standard deviation, 26.2, P less than .0001), weight had dropped by a z score factor of 0.2 (P less than .0001), and BMI had fallen by a factor of 0.4 (P less than .0001).

“Unfortunately, this study could not generate meaningful data on pulmonary function, because only three patients produced research-quality measurements, and we did not provide specific training or quality control in preschool lung function testing,” the investigators said. The results “confirmed a safe and tolerable dose of an acceptable formulation of ivacaftor in children aged 2 to 5 years with a CFTR gating mutation, although liver function seems to require closer monitoring in this age range than in adults, particularly among those with a history of elevated [liver function tests].”

Vertex Pharmaceuticals funded the study. Dr. Davies reported serving on advisory boards for Proteostasis, Pharmaxis, Pulmocide, Novartis, and Vertex Pharmaceuticals, and participating in educational activities for which her institution received payment. Seven coinvestigators also reported financial relationships with Vertex, including three who reported employment with the company.

Ivacaftor, a cystic fibrosis transmembrane conductance regulator potentiator, appears generally safe for young children with cystic fibrosis and a CFTR gating mutation, an open-label, single-arm study shows.

The study, published online Jan. 20, is the first to assess ivacaftor in children aged 2-5 years, suggests that the drug is well tolerated, somewhat improves sweat chloride and nutritional measures, and also might improve pancreatic function, reported Dr. Jane C. Davies of the National Heart & Lung Institute of Imperial College London, and her associates. “Reported side effects are similar to those in the general cystic fibrosis population, although children with previous cystic fibrosis liver disease might have transient rises in transaminase concentrations,” they added.

© CTRPhotos / ThinkStockPhotos.com

Ivacaftor is approved by the Food and Drug Administration for children aged 6 years and older with cystic fibrosis, and it should be even more beneficial if given before patients develop infections and inflammation as a result of cystic fibrosis transmembrane conductance regulator (CFTR) dysfunction, the researchers noted.

The investigators enrolled children aged 2 to 5 years with cystic fibrosis and a CFTR gating mutation on at least one allele from 15 hospitals in the United States, the United Kingdom, and Canada. To establish short-term safety and pharmacokinetics of ivacaftor and its metabolites, nine patients received an oral dose of 50 mg (if they weighed less than 14 kg) or 75 mg (if they weighed 14 kg or more) every 12 hours for 4 days.

To assess longer-term safety, 34 patients received these doses for 24 weeks, followed by an open-label extension study that remains underway (Lancet Respir Med. 2016 Jan 20. doi: 10.1016/S2213-2600[15]00545-7).

The pharmacokinetic analyses indicated that exposure was similar to that reported in adults, the researchers reported. The median Cmin was 536 ng per mL for the 50-mg dose and 580 ng per mL for the 75-mg dose, and median ivacaftor AUC values were 9,840 ng×h/mL and 10,200 ngxh/mL, respectively. The most common adverse events over 6 weeks of treatment included cough (56% of patients) and vomiting (29%). In addition five (15%) patients had liver function test results that were more than eight-fold higher than the upper limit of normal. As a result, four had the study drug interrupted and one discontinued. Hypertransaminasemia was the only serious adverse event considered related to ivacaftor, and the only adverse event leading to treatment discontinuation. By week 24, sweat chloride levels had dropped an average of 47 mmol per L from baseline (standard deviation, 26.2, P less than .0001), weight had dropped by a z score factor of 0.2 (P less than .0001), and BMI had fallen by a factor of 0.4 (P less than .0001).

“Unfortunately, this study could not generate meaningful data on pulmonary function, because only three patients produced research-quality measurements, and we did not provide specific training or quality control in preschool lung function testing,” the investigators said. The results “confirmed a safe and tolerable dose of an acceptable formulation of ivacaftor in children aged 2 to 5 years with a CFTR gating mutation, although liver function seems to require closer monitoring in this age range than in adults, particularly among those with a history of elevated [liver function tests].”

Vertex Pharmaceuticals funded the study. Dr. Davies reported serving on advisory boards for Proteostasis, Pharmaxis, Pulmocide, Novartis, and Vertex Pharmaceuticals, and participating in educational activities for which her institution received payment. Seven coinvestigators also reported financial relationships with Vertex, including three who reported employment with the company.

Ivacaftor, a cystic fibrosis transmembrane conductance regulator potentiator, appears generally safe for young children with cystic fibrosis and a CFTR gating mutation, an open-label, single-arm study shows.

The study, published online Jan. 20, is the first to assess ivacaftor in children aged 2-5 years, suggests that the drug is well tolerated, somewhat improves sweat chloride and nutritional measures, and also might improve pancreatic function, reported Dr. Jane C. Davies of the National Heart & Lung Institute of Imperial College London, and her associates. “Reported side effects are similar to those in the general cystic fibrosis population, although children with previous cystic fibrosis liver disease might have transient rises in transaminase concentrations,” they added.

© CTRPhotos / ThinkStockPhotos.com

Ivacaftor is approved by the Food and Drug Administration for children aged 6 years and older with cystic fibrosis, and it should be even more beneficial if given before patients develop infections and inflammation as a result of cystic fibrosis transmembrane conductance regulator (CFTR) dysfunction, the researchers noted.

The investigators enrolled children aged 2 to 5 years with cystic fibrosis and a CFTR gating mutation on at least one allele from 15 hospitals in the United States, the United Kingdom, and Canada. To establish short-term safety and pharmacokinetics of ivacaftor and its metabolites, nine patients received an oral dose of 50 mg (if they weighed less than 14 kg) or 75 mg (if they weighed 14 kg or more) every 12 hours for 4 days.

To assess longer-term safety, 34 patients received these doses for 24 weeks, followed by an open-label extension study that remains underway (Lancet Respir Med. 2016 Jan 20. doi: 10.1016/S2213-2600[15]00545-7).

The pharmacokinetic analyses indicated that exposure was similar to that reported in adults, the researchers reported. The median Cmin was 536 ng per mL for the 50-mg dose and 580 ng per mL for the 75-mg dose, and median ivacaftor AUC values were 9,840 ng×h/mL and 10,200 ngxh/mL, respectively. The most common adverse events over 6 weeks of treatment included cough (56% of patients) and vomiting (29%). In addition five (15%) patients had liver function test results that were more than eight-fold higher than the upper limit of normal. As a result, four had the study drug interrupted and one discontinued. Hypertransaminasemia was the only serious adverse event considered related to ivacaftor, and the only adverse event leading to treatment discontinuation. By week 24, sweat chloride levels had dropped an average of 47 mmol per L from baseline (standard deviation, 26.2, P less than .0001), weight had dropped by a z score factor of 0.2 (P less than .0001), and BMI had fallen by a factor of 0.4 (P less than .0001).

“Unfortunately, this study could not generate meaningful data on pulmonary function, because only three patients produced research-quality measurements, and we did not provide specific training or quality control in preschool lung function testing,” the investigators said. The results “confirmed a safe and tolerable dose of an acceptable formulation of ivacaftor in children aged 2 to 5 years with a CFTR gating mutation, although liver function seems to require closer monitoring in this age range than in adults, particularly among those with a history of elevated [liver function tests].”

Vertex Pharmaceuticals funded the study. Dr. Davies reported serving on advisory boards for Proteostasis, Pharmaxis, Pulmocide, Novartis, and Vertex Pharmaceuticals, and participating in educational activities for which her institution received payment. Seven coinvestigators also reported financial relationships with Vertex, including three who reported employment with the company.

Rates of anorectal melanoma rose substantially in the United States from 1992 to 2011, according to a study published in Dermatologic Surgery.

The increases affected men and women, said Dr. Adrienne Callahan of the department of dermatology, University Hospitals Case Medical Center, Cleveland, and her associates. Anorectal carcinoma was significantly more common among Hispanic whites than non-Hispanic whites (P = .02), “suggesting that this population may be targeted for screening interventions,” they added. (Dermatol Surg. 2016;42[1]:94-9). The highest rates were in Hispanic white elderly women.

Anorectal melanoma accounts for 1.3% of all melanomas and 16.5% of mucosal melanomas, and is most common among older women. The prognosis is often poor because the cancer tends to be asymptomatic until its late stages. To study the epidemiology of anorectal melanoma, the researchers analyzed data from the Surveillance, Epidemiology, and End Results 13 (SEER 13) Registries Database for 1992 through 2011.

The SEER database listed 260 cases for the study period. Most involved the rectum, 58% affected adults aged 65 years and older, and almost two-thirds occurred in women – a finding that dovetails with other studies, the researchers said. Notably, the estimated annual change in age-standardized incidence rates increased in both men (5.08%) and women (3.02%), which were statistically significant increases (P less than .05 for both trends).

Anorectal melanoma rates were significantly higher among Hispanic whites, compared with non-Hispanic whites. “Other studies have indicated that Hispanics are underscreened for skin cancer compared to other ethnic groups despite the increasing incidence of melanoma in this population,” said the researchers. “Although this may suggest a role for improved screening among those with Hispanic ethnicity, additional studies must be done to corroborate these results and further elucidate the association of Hispanic ethnicity with anorectal melanoma.”

As far as they know, this is the first study that has analyzed anorectal melanoma incidence in Hispanic whites and non-Hispanic whites, they added.

Ethnicity did not affect survival, which was generally poor. Anorectal melanoma is very rare, so the number of cases was relatively small and rates might have been unstable, the investigators noted. They added that it was not known whether the increases they found were related to improved detection.

The study was funded by the Char and Chuck Fowler Family Foundation, the Dermatology Foundation, and the National Cancer Institute. The researchers had no disclosures.

Rates of anorectal melanoma rose substantially in the United States from 1992 to 2011, according to a study published in Dermatologic Surgery.

The increases affected men and women, said Dr. Adrienne Callahan of the department of dermatology, University Hospitals Case Medical Center, Cleveland, and her associates. Anorectal carcinoma was significantly more common among Hispanic whites than non-Hispanic whites (P = .02), “suggesting that this population may be targeted for screening interventions,” they added. (Dermatol Surg. 2016;42[1]:94-9). The highest rates were in Hispanic white elderly women.

Anorectal melanoma accounts for 1.3% of all melanomas and 16.5% of mucosal melanomas, and is most common among older women. The prognosis is often poor because the cancer tends to be asymptomatic until its late stages. To study the epidemiology of anorectal melanoma, the researchers analyzed data from the Surveillance, Epidemiology, and End Results 13 (SEER 13) Registries Database for 1992 through 2011.

The SEER database listed 260 cases for the study period. Most involved the rectum, 58% affected adults aged 65 years and older, and almost two-thirds occurred in women – a finding that dovetails with other studies, the researchers said. Notably, the estimated annual change in age-standardized incidence rates increased in both men (5.08%) and women (3.02%), which were statistically significant increases (P less than .05 for both trends).

Anorectal melanoma rates were significantly higher among Hispanic whites, compared with non-Hispanic whites. “Other studies have indicated that Hispanics are underscreened for skin cancer compared to other ethnic groups despite the increasing incidence of melanoma in this population,” said the researchers. “Although this may suggest a role for improved screening among those with Hispanic ethnicity, additional studies must be done to corroborate these results and further elucidate the association of Hispanic ethnicity with anorectal melanoma.”

As far as they know, this is the first study that has analyzed anorectal melanoma incidence in Hispanic whites and non-Hispanic whites, they added.

Ethnicity did not affect survival, which was generally poor. Anorectal melanoma is very rare, so the number of cases was relatively small and rates might have been unstable, the investigators noted. They added that it was not known whether the increases they found were related to improved detection.

The study was funded by the Char and Chuck Fowler Family Foundation, the Dermatology Foundation, and the National Cancer Institute. The researchers had no disclosures.

Rates of anorectal melanoma rose substantially in the United States from 1992 to 2011, according to a study published in Dermatologic Surgery.

The increases affected men and women, said Dr. Adrienne Callahan of the department of dermatology, University Hospitals Case Medical Center, Cleveland, and her associates. Anorectal carcinoma was significantly more common among Hispanic whites than non-Hispanic whites (P = .02), “suggesting that this population may be targeted for screening interventions,” they added. (Dermatol Surg. 2016;42[1]:94-9). The highest rates were in Hispanic white elderly women.

Anorectal melanoma accounts for 1.3% of all melanomas and 16.5% of mucosal melanomas, and is most common among older women. The prognosis is often poor because the cancer tends to be asymptomatic until its late stages. To study the epidemiology of anorectal melanoma, the researchers analyzed data from the Surveillance, Epidemiology, and End Results 13 (SEER 13) Registries Database for 1992 through 2011.

The SEER database listed 260 cases for the study period. Most involved the rectum, 58% affected adults aged 65 years and older, and almost two-thirds occurred in women – a finding that dovetails with other studies, the researchers said. Notably, the estimated annual change in age-standardized incidence rates increased in both men (5.08%) and women (3.02%), which were statistically significant increases (P less than .05 for both trends).

Anorectal melanoma rates were significantly higher among Hispanic whites, compared with non-Hispanic whites. “Other studies have indicated that Hispanics are underscreened for skin cancer compared to other ethnic groups despite the increasing incidence of melanoma in this population,” said the researchers. “Although this may suggest a role for improved screening among those with Hispanic ethnicity, additional studies must be done to corroborate these results and further elucidate the association of Hispanic ethnicity with anorectal melanoma.”

As far as they know, this is the first study that has analyzed anorectal melanoma incidence in Hispanic whites and non-Hispanic whites, they added.

Ethnicity did not affect survival, which was generally poor. Anorectal melanoma is very rare, so the number of cases was relatively small and rates might have been unstable, the investigators noted. They added that it was not known whether the increases they found were related to improved detection.

The study was funded by the Char and Chuck Fowler Family Foundation, the Dermatology Foundation, and the National Cancer Institute. The researchers had no disclosures.

Increased activation of the neural reward network occurred when patients with schizotypal personality disorder watched points-of-light animations of biological motion, according to a controlled functional MRI study published online Jan. 19.

“These findings may help to characterize the interaction between disturbed reward circuitry and the bizarre ways of perceiving and experiencing social stimuli observed in individuals with schizotypal personality disorder, whose condition tends to isolate them from everyday social interaction,” said Ji-Won Hur, Ph.D., of Seoul National University in South Korea, and associates.

©Thinkstock.com

Interpreting motion is key to social communication, and humans assign intentions and emotions to points of light depicting a moving body. Brain imaging during these animations shows that the posterior superior temporal sulcus (PSTS) works with the ventral lateral occipital cortex, lingual gyrus at the cuneus border, and cerebellum to form a “social cognition network,” the researchers noted. Patients with schizophrenia perceive biological motion abnormally and have abnormal PSTS activation. To understand the neural response in schizotypal personality disorder, the investigators asked 21 patients and 38 matched controls to distinguish biological point-light animations from scrambled sequences during functional MRI (JAMA Psychiatry. 2016 Jan 20. doi: 10.1001/jamapsychiatry.2015.2985).

Brain imaging of both groups showed neuronal activation specific to biological motion within the PSTS, the investigators reported. But participants with schizotypal personality disorder had abnormally high activation of brain regions that form the reward network, including the dorsal striatum and bilateral superior medial frontal cortex (P of clusters less than .002). Participants with schizotypal personality disorder also had less activation of the anterior and middle cingulate cortices, as well as the lingual and superior occipital gyri, which are normally involved in executive function (P of clusters less than .001). Furthermore, activation of dopaminergic regions of the brain correlated significantly with symptoms of schizotypal personality disorder (P less than .02).

Taken together, the findings “suggest that enhanced responses arise within the reward network in individuals with [schizotypal personality disorder], and are possibly related to the peculiar ways that individuals with [schizotypal personality disorder] behave in social contexts,” said the researchers. “We are reminded of the social deafferentation hypothesis, which states that social withdrawal may produce abnormal cognitive attributions in individuals with an unfulfilled desire for social contact. Perhaps abnormal neural activations seen in people within the spectrum of schizophrenia disorder promote misinterpretation of cues guiding social interactions.”

The study was supported by the Ministry of Science, ICT, and Future Planning, and by the Ministry of Education, Science, and Technology. The investigators had no disclosures.

[email protected]

Increased activation of the neural reward network occurred when patients with schizotypal personality disorder watched points-of-light animations of biological motion, according to a controlled functional MRI study published online Jan. 19.

“These findings may help to characterize the interaction between disturbed reward circuitry and the bizarre ways of perceiving and experiencing social stimuli observed in individuals with schizotypal personality disorder, whose condition tends to isolate them from everyday social interaction,” said Ji-Won Hur, Ph.D., of Seoul National University in South Korea, and associates.

©Thinkstock.com

Interpreting motion is key to social communication, and humans assign intentions and emotions to points of light depicting a moving body. Brain imaging during these animations shows that the posterior superior temporal sulcus (PSTS) works with the ventral lateral occipital cortex, lingual gyrus at the cuneus border, and cerebellum to form a “social cognition network,” the researchers noted. Patients with schizophrenia perceive biological motion abnormally and have abnormal PSTS activation. To understand the neural response in schizotypal personality disorder, the investigators asked 21 patients and 38 matched controls to distinguish biological point-light animations from scrambled sequences during functional MRI (JAMA Psychiatry. 2016 Jan 20. doi: 10.1001/jamapsychiatry.2015.2985).

Brain imaging of both groups showed neuronal activation specific to biological motion within the PSTS, the investigators reported. But participants with schizotypal personality disorder had abnormally high activation of brain regions that form the reward network, including the dorsal striatum and bilateral superior medial frontal cortex (P of clusters less than .002). Participants with schizotypal personality disorder also had less activation of the anterior and middle cingulate cortices, as well as the lingual and superior occipital gyri, which are normally involved in executive function (P of clusters less than .001). Furthermore, activation of dopaminergic regions of the brain correlated significantly with symptoms of schizotypal personality disorder (P less than .02).

Taken together, the findings “suggest that enhanced responses arise within the reward network in individuals with [schizotypal personality disorder], and are possibly related to the peculiar ways that individuals with [schizotypal personality disorder] behave in social contexts,” said the researchers. “We are reminded of the social deafferentation hypothesis, which states that social withdrawal may produce abnormal cognitive attributions in individuals with an unfulfilled desire for social contact. Perhaps abnormal neural activations seen in people within the spectrum of schizophrenia disorder promote misinterpretation of cues guiding social interactions.”

The study was supported by the Ministry of Science, ICT, and Future Planning, and by the Ministry of Education, Science, and Technology. The investigators had no disclosures.

[email protected]

Increased activation of the neural reward network occurred when patients with schizotypal personality disorder watched points-of-light animations of biological motion, according to a controlled functional MRI study published online Jan. 19.

“These findings may help to characterize the interaction between disturbed reward circuitry and the bizarre ways of perceiving and experiencing social stimuli observed in individuals with schizotypal personality disorder, whose condition tends to isolate them from everyday social interaction,” said Ji-Won Hur, Ph.D., of Seoul National University in South Korea, and associates.

©Thinkstock.com

Interpreting motion is key to social communication, and humans assign intentions and emotions to points of light depicting a moving body. Brain imaging during these animations shows that the posterior superior temporal sulcus (PSTS) works with the ventral lateral occipital cortex, lingual gyrus at the cuneus border, and cerebellum to form a “social cognition network,” the researchers noted. Patients with schizophrenia perceive biological motion abnormally and have abnormal PSTS activation. To understand the neural response in schizotypal personality disorder, the investigators asked 21 patients and 38 matched controls to distinguish biological point-light animations from scrambled sequences during functional MRI (JAMA Psychiatry. 2016 Jan 20. doi: 10.1001/jamapsychiatry.2015.2985).

Brain imaging of both groups showed neuronal activation specific to biological motion within the PSTS, the investigators reported. But participants with schizotypal personality disorder had abnormally high activation of brain regions that form the reward network, including the dorsal striatum and bilateral superior medial frontal cortex (P of clusters less than .002). Participants with schizotypal personality disorder also had less activation of the anterior and middle cingulate cortices, as well as the lingual and superior occipital gyri, which are normally involved in executive function (P of clusters less than .001). Furthermore, activation of dopaminergic regions of the brain correlated significantly with symptoms of schizotypal personality disorder (P less than .02).

Taken together, the findings “suggest that enhanced responses arise within the reward network in individuals with [schizotypal personality disorder], and are possibly related to the peculiar ways that individuals with [schizotypal personality disorder] behave in social contexts,” said the researchers. “We are reminded of the social deafferentation hypothesis, which states that social withdrawal may produce abnormal cognitive attributions in individuals with an unfulfilled desire for social contact. Perhaps abnormal neural activations seen in people within the spectrum of schizophrenia disorder promote misinterpretation of cues guiding social interactions.”

The study was supported by the Ministry of Science, ICT, and Future Planning, and by the Ministry of Education, Science, and Technology. The investigators had no disclosures.

[email protected]

Youth who received at least 3 months of antipsychotics were about two to three times more likely to develop type 2 diabetes, compared with controls, a meta-analysis of 13 studies shows.

The risk was especially apparent for olanzapine, confirming “that [type 2 diabetes] risk with second-generation antipsychotics is not homogeneous, and that olanzapine treatment is a major modifiable risk factor,” said Dr. Britta Galling of Zucker Hillside Hospital in Glen Oaks, N.Y., and her associates. Youth should receive antipsychotics only if safer treatments have failed, for the shortest possible effective duration, with proactive monitoring of cardiovascular risk factors and counseling about possible adverse effects, healthy nutrition, and physical activity, according to the meta-analysis, published online Jan. 19.

©donskarpo/thinkstockphotos.com

The researchers searched PubMed and PsycINFO through May 2015 for longitudinal studies of antipsychotics and type 2 diabetes in children, adolescents, and young adults who did not have diabetes at baseline. The resulting studies included 185,105 individuals and 310,438 patient-years. Patients averaged 14.1 years of age (range, 2-24 years), were followed for an average of 1.7 years, and 60% were male (JAMA Psychiatry. 2016 Jan 20. doi: 10.1001/jamapsychiatry.2015.2923).

Antipsychotic exposure doubled the odds (95% confidence interval, 1.56-4.24; P less than .0001) and tripled the incidence (95% CI, 1.7-5.3; P less than .0001) of type 2 diabetes, compared with healthy controls. Antipsychotic-exposed youth also had double the odds and 1.8 times the incidence of type 2 diabetes, compared with psychiatric controls.

The multivariate analysis linked greater cumulative type 2 diabetes risk with longer follow-up (P less than .001), olanzapine exposure (P less than .001), and male sex (P = .002). However, the incidence of type 2 diabetes was lower in youth with autism spectrum disorders (P = .048), perhaps because of other medications or the fact that other psychiatric disorders have a higher type 2 diabetes risk, compared with ASDs, the researchers said.

“These risks should be considered in the clinical risk-benefit evaluation when initiating or continuing antipsychotic treatment in this age group,” they wrote.

The research was funded by the Zucker Hillside Hospital, the National Institute of Mental Health–funded Advanced Center for Interventions and Services Research in Schizophrenia, and the Agency for Healthcare Research & Quality. Dr. Galling had no disclosures. Senior author Dr. Christoph U. Correll, medical director of the recognition and prevention program at the Zucker Hillside Hospital, and his 11 coauthors reported financial relationships the numerous pharmaceutical companies and nonprofit institutions.

Youth who received at least 3 months of antipsychotics were about two to three times more likely to develop type 2 diabetes, compared with controls, a meta-analysis of 13 studies shows.

The risk was especially apparent for olanzapine, confirming “that [type 2 diabetes] risk with second-generation antipsychotics is not homogeneous, and that olanzapine treatment is a major modifiable risk factor,” said Dr. Britta Galling of Zucker Hillside Hospital in Glen Oaks, N.Y., and her associates. Youth should receive antipsychotics only if safer treatments have failed, for the shortest possible effective duration, with proactive monitoring of cardiovascular risk factors and counseling about possible adverse effects, healthy nutrition, and physical activity, according to the meta-analysis, published online Jan. 19.

©donskarpo/thinkstockphotos.com

The researchers searched PubMed and PsycINFO through May 2015 for longitudinal studies of antipsychotics and type 2 diabetes in children, adolescents, and young adults who did not have diabetes at baseline. The resulting studies included 185,105 individuals and 310,438 patient-years. Patients averaged 14.1 years of age (range, 2-24 years), were followed for an average of 1.7 years, and 60% were male (JAMA Psychiatry. 2016 Jan 20. doi: 10.1001/jamapsychiatry.2015.2923).

Antipsychotic exposure doubled the odds (95% confidence interval, 1.56-4.24; P less than .0001) and tripled the incidence (95% CI, 1.7-5.3; P less than .0001) of type 2 diabetes, compared with healthy controls. Antipsychotic-exposed youth also had double the odds and 1.8 times the incidence of type 2 diabetes, compared with psychiatric controls.

The multivariate analysis linked greater cumulative type 2 diabetes risk with longer follow-up (P less than .001), olanzapine exposure (P less than .001), and male sex (P = .002). However, the incidence of type 2 diabetes was lower in youth with autism spectrum disorders (P = .048), perhaps because of other medications or the fact that other psychiatric disorders have a higher type 2 diabetes risk, compared with ASDs, the researchers said.

“These risks should be considered in the clinical risk-benefit evaluation when initiating or continuing antipsychotic treatment in this age group,” they wrote.

The research was funded by the Zucker Hillside Hospital, the National Institute of Mental Health–funded Advanced Center for Interventions and Services Research in Schizophrenia, and the Agency for Healthcare Research & Quality. Dr. Galling had no disclosures. Senior author Dr. Christoph U. Correll, medical director of the recognition and prevention program at the Zucker Hillside Hospital, and his 11 coauthors reported financial relationships the numerous pharmaceutical companies and nonprofit institutions.

Youth who received at least 3 months of antipsychotics were about two to three times more likely to develop type 2 diabetes, compared with controls, a meta-analysis of 13 studies shows.

The risk was especially apparent for olanzapine, confirming “that [type 2 diabetes] risk with second-generation antipsychotics is not homogeneous, and that olanzapine treatment is a major modifiable risk factor,” said Dr. Britta Galling of Zucker Hillside Hospital in Glen Oaks, N.Y., and her associates. Youth should receive antipsychotics only if safer treatments have failed, for the shortest possible effective duration, with proactive monitoring of cardiovascular risk factors and counseling about possible adverse effects, healthy nutrition, and physical activity, according to the meta-analysis, published online Jan. 19.

©donskarpo/thinkstockphotos.com

The researchers searched PubMed and PsycINFO through May 2015 for longitudinal studies of antipsychotics and type 2 diabetes in children, adolescents, and young adults who did not have diabetes at baseline. The resulting studies included 185,105 individuals and 310,438 patient-years. Patients averaged 14.1 years of age (range, 2-24 years), were followed for an average of 1.7 years, and 60% were male (JAMA Psychiatry. 2016 Jan 20. doi: 10.1001/jamapsychiatry.2015.2923).

Antipsychotic exposure doubled the odds (95% confidence interval, 1.56-4.24; P less than .0001) and tripled the incidence (95% CI, 1.7-5.3; P less than .0001) of type 2 diabetes, compared with healthy controls. Antipsychotic-exposed youth also had double the odds and 1.8 times the incidence of type 2 diabetes, compared with psychiatric controls.

The multivariate analysis linked greater cumulative type 2 diabetes risk with longer follow-up (P less than .001), olanzapine exposure (P less than .001), and male sex (P = .002). However, the incidence of type 2 diabetes was lower in youth with autism spectrum disorders (P = .048), perhaps because of other medications or the fact that other psychiatric disorders have a higher type 2 diabetes risk, compared with ASDs, the researchers said.

“These risks should be considered in the clinical risk-benefit evaluation when initiating or continuing antipsychotic treatment in this age group,” they wrote.

The research was funded by the Zucker Hillside Hospital, the National Institute of Mental Health–funded Advanced Center for Interventions and Services Research in Schizophrenia, and the Agency for Healthcare Research & Quality. Dr. Galling had no disclosures. Senior author Dr. Christoph U. Correll, medical director of the recognition and prevention program at the Zucker Hillside Hospital, and his 11 coauthors reported financial relationships the numerous pharmaceutical companies and nonprofit institutions.

Youth who received at least 3 months of antipsychotics were about two to three times more likely to develop type 2 diabetes, compared with controls, a meta-analysis of 13 studies shows.

The risk was especially apparent for olanzapine, confirming “that [type 2 diabetes] risk with second-generation antipsychotics is not homogeneous, and that olanzapine treatment is a major modifiable risk factor,” said Dr. Britta Galling of Zucker Hillside Hospital in Glen Oaks, N.Y., and her associates. Youth should receive antipsychotics only if safer treatments have failed, for the shortest possible effective duration, with proactive monitoring of cardiovascular risk factors and counseling about possible adverse effects, healthy nutrition, and physical activity, according to the meta-analysis, published online Jan. 19.

©donskarpo/thinkstockphotos.com

The researchers searched PubMed and PsycINFO through May 2015 for longitudinal studies of antipsychotics and type 2 diabetes in children, adolescents, and young adults who did not have diabetes at baseline. The resulting studies included 185,105 individuals and 310,438 patient-years. Patients averaged 14.1 years of age (range, 2-24 years), were followed for an average of 1.7 years, and 60% were male (JAMA Psychiatry. 2016 Jan 20. doi: 10.1001/jamapsychiatry.2015.2923).

Antipsychotic exposure doubled the odds (95% confidence interval, 1.56-4.24; P less than .0001) and tripled the incidence (95% CI, 1.7-5.3; P less than .0001) of type 2 diabetes, compared with healthy controls. Antipsychotic-exposed youth also had double the odds and 1.8 times the incidence of type 2 diabetes, compared with psychiatric controls.

The multivariate analysis linked greater cumulative type 2 diabetes risk with longer follow-up (P less than .001), olanzapine exposure (P less than .001), and male sex (P = .002). However, the incidence of type 2 diabetes was lower in youth with autism spectrum disorders (P = .048), perhaps because of other medications or the fact that other psychiatric disorders have a higher type 2 diabetes risk, compared with ASDs, the researchers said.

“These risks should be considered in the clinical risk-benefit evaluation when initiating or continuing antipsychotic treatment in this age group,” they wrote.

The research was funded by the Zucker Hillside Hospital, the National Institute of Mental Health–funded Advanced Center for Interventions and Services Research in Schizophrenia, and the Agency for Healthcare Research & Quality. Dr. Galling had no disclosures. Senior author Dr. Christoph U. Correll, medical director of the recognition and prevention program at the Zucker Hillside Hospital, and his 11 coauthors reported financial relationships the numerous pharmaceutical companies and nonprofit institutions.

Youth who received at least 3 months of antipsychotics were about two to three times more likely to develop type 2 diabetes, compared with controls, a meta-analysis of 13 studies shows.

The risk was especially apparent for olanzapine, confirming “that [type 2 diabetes] risk with second-generation antipsychotics is not homogeneous, and that olanzapine treatment is a major modifiable risk factor,” said Dr. Britta Galling of Zucker Hillside Hospital in Glen Oaks, N.Y., and her associates. Youth should receive antipsychotics only if safer treatments have failed, for the shortest possible effective duration, with proactive monitoring of cardiovascular risk factors and counseling about possible adverse effects, healthy nutrition, and physical activity, according to the meta-analysis, published online Jan. 19.

©donskarpo/thinkstockphotos.com

The researchers searched PubMed and PsycINFO through May 2015 for longitudinal studies of antipsychotics and type 2 diabetes in children, adolescents, and young adults who did not have diabetes at baseline. The resulting studies included 185,105 individuals and 310,438 patient-years. Patients averaged 14.1 years of age (range, 2-24 years), were followed for an average of 1.7 years, and 60% were male (JAMA Psychiatry. 2016 Jan 20. doi: 10.1001/jamapsychiatry.2015.2923).

Antipsychotic exposure doubled the odds (95% confidence interval, 1.56-4.24; P less than .0001) and tripled the incidence (95% CI, 1.7-5.3; P less than .0001) of type 2 diabetes, compared with healthy controls. Antipsychotic-exposed youth also had double the odds and 1.8 times the incidence of type 2 diabetes, compared with psychiatric controls.

The multivariate analysis linked greater cumulative type 2 diabetes risk with longer follow-up (P less than .001), olanzapine exposure (P less than .001), and male sex (P = .002). However, the incidence of type 2 diabetes was lower in youth with autism spectrum disorders (P = .048), perhaps because of other medications or the fact that other psychiatric disorders have a higher type 2 diabetes risk, compared with ASDs, the researchers said.

“These risks should be considered in the clinical risk-benefit evaluation when initiating or continuing antipsychotic treatment in this age group,” they wrote.

The research was funded by the Zucker Hillside Hospital, the National Institute of Mental Health–funded Advanced Center for Interventions and Services Research in Schizophrenia, and the Agency for Healthcare Research & Quality. Dr. Galling had no disclosures. Senior author Dr. Christoph U. Correll, medical director of the recognition and prevention program at the Zucker Hillside Hospital, and his 11 coauthors reported financial relationships the numerous pharmaceutical companies and nonprofit institutions.

Youth who received at least 3 months of antipsychotics were about two to three times more likely to develop type 2 diabetes, compared with controls, a meta-analysis of 13 studies shows.

The risk was especially apparent for olanzapine, confirming “that [type 2 diabetes] risk with second-generation antipsychotics is not homogeneous, and that olanzapine treatment is a major modifiable risk factor,” said Dr. Britta Galling of Zucker Hillside Hospital in Glen Oaks, N.Y., and her associates. Youth should receive antipsychotics only if safer treatments have failed, for the shortest possible effective duration, with proactive monitoring of cardiovascular risk factors and counseling about possible adverse effects, healthy nutrition, and physical activity, according to the meta-analysis, published online Jan. 19.

©donskarpo/thinkstockphotos.com

The researchers searched PubMed and PsycINFO through May 2015 for longitudinal studies of antipsychotics and type 2 diabetes in children, adolescents, and young adults who did not have diabetes at baseline. The resulting studies included 185,105 individuals and 310,438 patient-years. Patients averaged 14.1 years of age (range, 2-24 years), were followed for an average of 1.7 years, and 60% were male (JAMA Psychiatry. 2016 Jan 20. doi: 10.1001/jamapsychiatry.2015.2923).

Antipsychotic exposure doubled the odds (95% confidence interval, 1.56-4.24; P less than .0001) and tripled the incidence (95% CI, 1.7-5.3; P less than .0001) of type 2 diabetes, compared with healthy controls. Antipsychotic-exposed youth also had double the odds and 1.8 times the incidence of type 2 diabetes, compared with psychiatric controls.

The multivariate analysis linked greater cumulative type 2 diabetes risk with longer follow-up (P less than .001), olanzapine exposure (P less than .001), and male sex (P = .002). However, the incidence of type 2 diabetes was lower in youth with autism spectrum disorders (P = .048), perhaps because of other medications or the fact that other psychiatric disorders have a higher type 2 diabetes risk, compared with ASDs, the researchers said.

“These risks should be considered in the clinical risk-benefit evaluation when initiating or continuing antipsychotic treatment in this age group,” they wrote.

The research was funded by the Zucker Hillside Hospital, the National Institute of Mental Health–funded Advanced Center for Interventions and Services Research in Schizophrenia, and the Agency for Healthcare Research & Quality. Dr. Galling had no disclosures. Senior author Dr. Christoph U. Correll, medical director of the recognition and prevention program at the Zucker Hillside Hospital, and his 11 coauthors reported financial relationships the numerous pharmaceutical companies and nonprofit institutions.

Neurological disease related to pediatric enterovirus 71 infection was fatal in 7% of cases, and 10% of survivors had persistent brainstem or motor dysfunction 12 months later, investigators reported online Jan. 19 in JAMA Neurology.

The findings underscore the potentially grave consequences of EV71, which “may be considered the new polio” because it causes long-term focal paresis by damaging brainstem and spinal cord grey matter, said Dr. Hooi-Ling Teoh at Sydney Children’s Hospital and her associates. Clinicians can use the World Health Organization guidelines to quickly identify cases and determine which patients need prompt supportive care and immunotherapy during outbreaks, they added.

©EyeMark/thinkstockphotos.com

Enterovirus 71 usually causes uncomplicated hand-foot-and-mouth disease, but patients can develop aseptic meningitis, acute flaccid paralysis, and fatal brainstem encephalitis. This prospective study included 61 children with EV71-related neurologic disease treated at two urban Australian hospitals during an EV71 outbreak in 2013. The 57 survivors were 3 months to 5 years old (median age, 1.5 years) and almost two-thirds were male. Common initial symptoms included fever (100% of cases), myoclonic jerks (86%), ataxia (54%), and vomiting (54%), the researchers said (JAMA Neurol. 2016 Jan 19. doi: 10.1001/jamaneurol.2015.4388).

The most common neurologic diagnoses included encephalomyelitis (40% of patients), brainstem encephalitis (35%), encephalitis (11%), acute flaccid paralysis (7%), and neurogenic pulmonary edema (7%), a particularly severe form of EV71 disease. Characteristic MRI signs included increased T2-weighted signal in the dorsal pons and spinal cord, but pulmonary edema also was associated with dorsal brainstem restricted diffusion (odds ratio, 2.0; 95% confidence interval, 1-4; P = .001). Brainstem or motor dysfunction resolved in 77% of cases by 2 months and in 90% of cases at 12 months. The most common long-term clinical and functional problem was focal paresis, which persisted in five of six patients at 12 months.

Notably, the odds of persistent motor dysfunction were about 15 times higher when patients presented with acute flaccid paralysis or pulmonary edema than when they had other syndromes (OR, 15; 95% CI, 3-79; P < .001). Also, EV RNA was identified far more often from fecal samples and rectal and throat swabs than from cerebrospinal fluid, Dr. Teoh and associates reported.

The research was supported by the Thyne Reid Foundation, National Health and Medical Research Council of Australia, Royal Australasian College of Physicians Paediatrics & Child Health Division, and by a Norah Theresa Hayes-Ratcliffe Paediatric Infectious Diseases fellowship award. The investigators had no disclosures.

Neurological disease related to pediatric enterovirus 71 infection was fatal in 7% of cases, and 10% of survivors had persistent brainstem or motor dysfunction 12 months later, investigators reported online Jan. 19 in JAMA Neurology.

The findings underscore the potentially grave consequences of EV71, which “may be considered the new polio” because it causes long-term focal paresis by damaging brainstem and spinal cord grey matter, said Dr. Hooi-Ling Teoh at Sydney Children’s Hospital and her associates. Clinicians can use the World Health Organization guidelines to quickly identify cases and determine which patients need prompt supportive care and immunotherapy during outbreaks, they added.

©EyeMark/thinkstockphotos.com

Enterovirus 71 usually causes uncomplicated hand-foot-and-mouth disease, but patients can develop aseptic meningitis, acute flaccid paralysis, and fatal brainstem encephalitis. This prospective study included 61 children with EV71-related neurologic disease treated at two urban Australian hospitals during an EV71 outbreak in 2013. The 57 survivors were 3 months to 5 years old (median age, 1.5 years) and almost two-thirds were male. Common initial symptoms included fever (100% of cases), myoclonic jerks (86%), ataxia (54%), and vomiting (54%), the researchers said (JAMA Neurol. 2016 Jan 19. doi: 10.1001/jamaneurol.2015.4388).

The most common neurologic diagnoses included encephalomyelitis (40% of patients), brainstem encephalitis (35%), encephalitis (11%), acute flaccid paralysis (7%), and neurogenic pulmonary edema (7%), a particularly severe form of EV71 disease. Characteristic MRI signs included increased T2-weighted signal in the dorsal pons and spinal cord, but pulmonary edema also was associated with dorsal brainstem restricted diffusion (odds ratio, 2.0; 95% confidence interval, 1-4; P = .001). Brainstem or motor dysfunction resolved in 77% of cases by 2 months and in 90% of cases at 12 months. The most common long-term clinical and functional problem was focal paresis, which persisted in five of six patients at 12 months.

Notably, the odds of persistent motor dysfunction were about 15 times higher when patients presented with acute flaccid paralysis or pulmonary edema than when they had other syndromes (OR, 15; 95% CI, 3-79; P < .001). Also, EV RNA was identified far more often from fecal samples and rectal and throat swabs than from cerebrospinal fluid, Dr. Teoh and associates reported.

The research was supported by the Thyne Reid Foundation, National Health and Medical Research Council of Australia, Royal Australasian College of Physicians Paediatrics & Child Health Division, and by a Norah Theresa Hayes-Ratcliffe Paediatric Infectious Diseases fellowship award. The investigators had no disclosures.

Neurological disease related to pediatric enterovirus 71 infection was fatal in 7% of cases, and 10% of survivors had persistent brainstem or motor dysfunction 12 months later, investigators reported online Jan. 19 in JAMA Neurology.

The findings underscore the potentially grave consequences of EV71, which “may be considered the new polio” because it causes long-term focal paresis by damaging brainstem and spinal cord grey matter, said Dr. Hooi-Ling Teoh at Sydney Children’s Hospital and her associates. Clinicians can use the World Health Organization guidelines to quickly identify cases and determine which patients need prompt supportive care and immunotherapy during outbreaks, they added.

©EyeMark/thinkstockphotos.com

Enterovirus 71 usually causes uncomplicated hand-foot-and-mouth disease, but patients can develop aseptic meningitis, acute flaccid paralysis, and fatal brainstem encephalitis. This prospective study included 61 children with EV71-related neurologic disease treated at two urban Australian hospitals during an EV71 outbreak in 2013. The 57 survivors were 3 months to 5 years old (median age, 1.5 years) and almost two-thirds were male. Common initial symptoms included fever (100% of cases), myoclonic jerks (86%), ataxia (54%), and vomiting (54%), the researchers said (JAMA Neurol. 2016 Jan 19. doi: 10.1001/jamaneurol.2015.4388).

The most common neurologic diagnoses included encephalomyelitis (40% of patients), brainstem encephalitis (35%), encephalitis (11%), acute flaccid paralysis (7%), and neurogenic pulmonary edema (7%), a particularly severe form of EV71 disease. Characteristic MRI signs included increased T2-weighted signal in the dorsal pons and spinal cord, but pulmonary edema also was associated with dorsal brainstem restricted diffusion (odds ratio, 2.0; 95% confidence interval, 1-4; P = .001). Brainstem or motor dysfunction resolved in 77% of cases by 2 months and in 90% of cases at 12 months. The most common long-term clinical and functional problem was focal paresis, which persisted in five of six patients at 12 months.

Notably, the odds of persistent motor dysfunction were about 15 times higher when patients presented with acute flaccid paralysis or pulmonary edema than when they had other syndromes (OR, 15; 95% CI, 3-79; P < .001). Also, EV RNA was identified far more often from fecal samples and rectal and throat swabs than from cerebrospinal fluid, Dr. Teoh and associates reported.

The research was supported by the Thyne Reid Foundation, National Health and Medical Research Council of Australia, Royal Australasian College of Physicians Paediatrics & Child Health Division, and by a Norah Theresa Hayes-Ratcliffe Paediatric Infectious Diseases fellowship award. The investigators had no disclosures.

Mohs micrographic surgery (MMS) to remove digital melanomas of less than 2 mm Breslow thickness spared patients from amputation without undermining survival, according to a single-center retrospective study published in Dermatologic Surgery.

The overall recurrence rate was 8%, and there were no recurrences with use of the MART-1 (melanoma antigen recognized by T-cells 1 staining) immunostain, said Dr. Vitaly Terushkin of the Zitelli and Brodland Skin Cancer Center in Pittsburgh and his associates. “The use of MART-1 has revolutionized the value of MMS,” the researchers said, while cautioning that the sample size was too small to draw reliable conclusions about thicker tumors.

Digital melanoma historically eluded diagnosis until it was advanced and was treated with amputation. Amputation and wide local excision remain common, and particularly erode function and balance when the tumor involves the thumb or big toe, the researchers noted. In 35 years at their center, 62 patients underwent MMS for digital melanoma, two-thirds of which involved the nail unit. About 92% of tumors were primary, 8% were recurrent, 53% involved the fingers, and 47% involved the toes. About half of patients were women, and the average age at treatment was about 63 years (Dermatol Surg. 2016;42:83-93).

Nearly 97% of patients avoided amputation over an average of 6.5 years of follow-up, the investigators reported. Five-year and 10-year local recurrence-free survival rates for the primary melanomas were about 92% and 83%, respectively. Of the five local recurrences, three were salvaged with additional MMS and two were treated with an amputation; all five recurrences involved the nail unit. Failing to remove the entire nail unit apparatus probably led to false-negative MMS layers and subsequent recurrence in at least two cases, they pointed out.

This is only the fifth published study to describe the treatment of digital melanoma with MMS, according to Dr. Terushkin and his associates. Although the study lacked a comparison group, it suggested that MART-1 improved outcomes and that most recurrences could be retreated with MMS without amputation or negative effects on survival. These findings will hopefully help inform future melanoma guidelines, said the researchers.

The investigators reported no funding sources and had no disclosures.

Mohs micrographic surgery (MMS) to remove digital melanomas of less than 2 mm Breslow thickness spared patients from amputation without undermining survival, according to a single-center retrospective study published in Dermatologic Surgery.

The overall recurrence rate was 8%, and there were no recurrences with use of the MART-1 (melanoma antigen recognized by T-cells 1 staining) immunostain, said Dr. Vitaly Terushkin of the Zitelli and Brodland Skin Cancer Center in Pittsburgh and his associates. “The use of MART-1 has revolutionized the value of MMS,” the researchers said, while cautioning that the sample size was too small to draw reliable conclusions about thicker tumors.

Digital melanoma historically eluded diagnosis until it was advanced and was treated with amputation. Amputation and wide local excision remain common, and particularly erode function and balance when the tumor involves the thumb or big toe, the researchers noted. In 35 years at their center, 62 patients underwent MMS for digital melanoma, two-thirds of which involved the nail unit. About 92% of tumors were primary, 8% were recurrent, 53% involved the fingers, and 47% involved the toes. About half of patients were women, and the average age at treatment was about 63 years (Dermatol Surg. 2016;42:83-93).

Nearly 97% of patients avoided amputation over an average of 6.5 years of follow-up, the investigators reported. Five-year and 10-year local recurrence-free survival rates for the primary melanomas were about 92% and 83%, respectively. Of the five local recurrences, three were salvaged with additional MMS and two were treated with an amputation; all five recurrences involved the nail unit. Failing to remove the entire nail unit apparatus probably led to false-negative MMS layers and subsequent recurrence in at least two cases, they pointed out.

This is only the fifth published study to describe the treatment of digital melanoma with MMS, according to Dr. Terushkin and his associates. Although the study lacked a comparison group, it suggested that MART-1 improved outcomes and that most recurrences could be retreated with MMS without amputation or negative effects on survival. These findings will hopefully help inform future melanoma guidelines, said the researchers.

The investigators reported no funding sources and had no disclosures.

Mohs micrographic surgery (MMS) to remove digital melanomas of less than 2 mm Breslow thickness spared patients from amputation without undermining survival, according to a single-center retrospective study published in Dermatologic Surgery.

The overall recurrence rate was 8%, and there were no recurrences with use of the MART-1 (melanoma antigen recognized by T-cells 1 staining) immunostain, said Dr. Vitaly Terushkin of the Zitelli and Brodland Skin Cancer Center in Pittsburgh and his associates. “The use of MART-1 has revolutionized the value of MMS,” the researchers said, while cautioning that the sample size was too small to draw reliable conclusions about thicker tumors.

Digital melanoma historically eluded diagnosis until it was advanced and was treated with amputation. Amputation and wide local excision remain common, and particularly erode function and balance when the tumor involves the thumb or big toe, the researchers noted. In 35 years at their center, 62 patients underwent MMS for digital melanoma, two-thirds of which involved the nail unit. About 92% of tumors were primary, 8% were recurrent, 53% involved the fingers, and 47% involved the toes. About half of patients were women, and the average age at treatment was about 63 years (Dermatol Surg. 2016;42:83-93).

Nearly 97% of patients avoided amputation over an average of 6.5 years of follow-up, the investigators reported. Five-year and 10-year local recurrence-free survival rates for the primary melanomas were about 92% and 83%, respectively. Of the five local recurrences, three were salvaged with additional MMS and two were treated with an amputation; all five recurrences involved the nail unit. Failing to remove the entire nail unit apparatus probably led to false-negative MMS layers and subsequent recurrence in at least two cases, they pointed out.

This is only the fifth published study to describe the treatment of digital melanoma with MMS, according to Dr. Terushkin and his associates. Although the study lacked a comparison group, it suggested that MART-1 improved outcomes and that most recurrences could be retreated with MMS without amputation or negative effects on survival. These findings will hopefully help inform future melanoma guidelines, said the researchers.

The investigators reported no funding sources and had no disclosures.