Robert Finn

Patients with diabetic neuropathy who monitor their foot temperature daily can reduce their risk of ulceration more than fourfold, according to an article by Lawrence A. Lavery, D.P.M., of Texas A&M University, College Station, and colleagues.

In a physician-blinded trial, 173 patients with a previous history of diabetic foot ulceration were randomly assigned to one of three groups: standard therapy, structured foot examination, or enhanced therapy (Diabetes Care 2007;30:14–20).

Patients who were assigned to standard therapy received a therapeutic insoles and footwear, participated in an educational program focused on foot complications and self-care, and had a lower extremity evaluation by a physician every 8 weeks. Those assigned to the structured foot examination group received the standard therapy as well as training to conduct a detailed self-examination with the assistance of a mirror to identify redness, discoloration, swelling, and local warmth.

The patients in the enhanced therapy group also received the standard therapy and in addition, were taught to use a digital infrared thermometer to measure and record daily temperatures at six sites on each foot.

Of the 59 patients in the enhanced therapy group, 5 experienced ulceration over the 15-month treatment period, compared with 17 of the 58 patients in the standard group and 17 of the 56 patients in the structured foot examination group, a significant difference. The mean time to ulcerate was 378.5 days in the standard therapy group, 377.3 days in the structured foot examination group, and 429.5 days in the enhanced therapy group. The enhanced therapy group was significantly better than each of the other two groups, and those two groups did not differ from each other.

Patients in the enhanced therapy group were 4.48 times less likely to develop foot ulceration than those in the standard therapy group and 4.71 times less likely to develop foot ulceration than those in the structured foot examination group.

Within the enhanced therapy group, patients who were compliant with recording foot temperatures at least 50% of the time were 50 times less likely to develop an ulcer than were patients who were not compliant. Four of the five foot ulcers were in patients who were not compliant.

Patients in the enhanced therapy group were taught to monitor temperatures on the great toe, the first, third, and fifth metatarsal head region, the midfoot, and the heel of each foot using a TempTouch digital infrared thermometer, available by prescription from Xilas Medical, San Antonio. They were instructed to contact the research nurse if skin temperatures were elevated by more than 4° F (2.2° C), compared with the corresponding side on the opposite foot for 2 consecutive days. They were also instructed to decrease their activity until temperatures normalized.

About 88% of the patients in the enhanced therapy group were compliant with daily temperature measurements. This compares quite favorably with published rates of compliance with daily glucose monitoring, which can be as low as 33%.

“It seems likely that the cost benefit of home temperature monitoring might be much better than that for use in glucose strips for home monitoring,” the investigators wrote. “In addition, a tool to adjust activity could help with the dilemma of exercising for better health versus the need to rest and protect the foot to avoid foot ulcers.”

Several of the study's authors disclosed close relationships with Xilas Medical. Dr. Lavery owns stock in the company, and is a consultant and a member of its clinical advisory board. Two of the other authors are members of the company's board of directors. The study was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases.

Patients with diabetic neuropathy who monitor their foot temperature daily can reduce their risk of ulceration more than fourfold, according to an article by Lawrence A. Lavery, D.P.M., of Texas A&M University, College Station, and colleagues.

In a physician-blinded trial, 173 patients with a previous history of diabetic foot ulceration were randomly assigned to one of three groups: standard therapy, structured foot examination, or enhanced therapy (Diabetes Care 2007;30:14–20).

Patients who were assigned to standard therapy received a therapeutic insoles and footwear, participated in an educational program focused on foot complications and self-care, and had a lower extremity evaluation by a physician every 8 weeks. Those assigned to the structured foot examination group received the standard therapy as well as training to conduct a detailed self-examination with the assistance of a mirror to identify redness, discoloration, swelling, and local warmth.

The patients in the enhanced therapy group also received the standard therapy and in addition, were taught to use a digital infrared thermometer to measure and record daily temperatures at six sites on each foot.

Of the 59 patients in the enhanced therapy group, 5 experienced ulceration over the 15-month treatment period, compared with 17 of the 58 patients in the standard group and 17 of the 56 patients in the structured foot examination group, a significant difference. The mean time to ulcerate was 378.5 days in the standard therapy group, 377.3 days in the structured foot examination group, and 429.5 days in the enhanced therapy group. The enhanced therapy group was significantly better than each of the other two groups, and those two groups did not differ from each other.

Patients in the enhanced therapy group were 4.48 times less likely to develop foot ulceration than those in the standard therapy group and 4.71 times less likely to develop foot ulceration than those in the structured foot examination group.

Within the enhanced therapy group, patients who were compliant with recording foot temperatures at least 50% of the time were 50 times less likely to develop an ulcer than were patients who were not compliant. Four of the five foot ulcers were in patients who were not compliant.

Patients in the enhanced therapy group were taught to monitor temperatures on the great toe, the first, third, and fifth metatarsal head region, the midfoot, and the heel of each foot using a TempTouch digital infrared thermometer, available by prescription from Xilas Medical, San Antonio. They were instructed to contact the research nurse if skin temperatures were elevated by more than 4° F (2.2° C), compared with the corresponding side on the opposite foot for 2 consecutive days. They were also instructed to decrease their activity until temperatures normalized.

About 88% of the patients in the enhanced therapy group were compliant with daily temperature measurements. This compares quite favorably with published rates of compliance with daily glucose monitoring, which can be as low as 33%.

“It seems likely that the cost benefit of home temperature monitoring might be much better than that for use in glucose strips for home monitoring,” the investigators wrote. “In addition, a tool to adjust activity could help with the dilemma of exercising for better health versus the need to rest and protect the foot to avoid foot ulcers.”

Several of the study's authors disclosed close relationships with Xilas Medical. Dr. Lavery owns stock in the company, and is a consultant and a member of its clinical advisory board. Two of the other authors are members of the company's board of directors. The study was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases.

Patients with diabetic neuropathy who monitor their foot temperature daily can reduce their risk of ulceration more than fourfold, according to an article by Lawrence A. Lavery, D.P.M., of Texas A&M University, College Station, and colleagues.

In a physician-blinded trial, 173 patients with a previous history of diabetic foot ulceration were randomly assigned to one of three groups: standard therapy, structured foot examination, or enhanced therapy (Diabetes Care 2007;30:14–20).

Patients who were assigned to standard therapy received a therapeutic insoles and footwear, participated in an educational program focused on foot complications and self-care, and had a lower extremity evaluation by a physician every 8 weeks. Those assigned to the structured foot examination group received the standard therapy as well as training to conduct a detailed self-examination with the assistance of a mirror to identify redness, discoloration, swelling, and local warmth.

The patients in the enhanced therapy group also received the standard therapy and in addition, were taught to use a digital infrared thermometer to measure and record daily temperatures at six sites on each foot.

Of the 59 patients in the enhanced therapy group, 5 experienced ulceration over the 15-month treatment period, compared with 17 of the 58 patients in the standard group and 17 of the 56 patients in the structured foot examination group, a significant difference. The mean time to ulcerate was 378.5 days in the standard therapy group, 377.3 days in the structured foot examination group, and 429.5 days in the enhanced therapy group. The enhanced therapy group was significantly better than each of the other two groups, and those two groups did not differ from each other.

Patients in the enhanced therapy group were 4.48 times less likely to develop foot ulceration than those in the standard therapy group and 4.71 times less likely to develop foot ulceration than those in the structured foot examination group.

Within the enhanced therapy group, patients who were compliant with recording foot temperatures at least 50% of the time were 50 times less likely to develop an ulcer than were patients who were not compliant. Four of the five foot ulcers were in patients who were not compliant.

Patients in the enhanced therapy group were taught to monitor temperatures on the great toe, the first, third, and fifth metatarsal head region, the midfoot, and the heel of each foot using a TempTouch digital infrared thermometer, available by prescription from Xilas Medical, San Antonio. They were instructed to contact the research nurse if skin temperatures were elevated by more than 4° F (2.2° C), compared with the corresponding side on the opposite foot for 2 consecutive days. They were also instructed to decrease their activity until temperatures normalized.

About 88% of the patients in the enhanced therapy group were compliant with daily temperature measurements. This compares quite favorably with published rates of compliance with daily glucose monitoring, which can be as low as 33%.

“It seems likely that the cost benefit of home temperature monitoring might be much better than that for use in glucose strips for home monitoring,” the investigators wrote. “In addition, a tool to adjust activity could help with the dilemma of exercising for better health versus the need to rest and protect the foot to avoid foot ulcers.”

Several of the study's authors disclosed close relationships with Xilas Medical. Dr. Lavery owns stock in the company, and is a consultant and a member of its clinical advisory board. Two of the other authors are members of the company's board of directors. The study was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases.

Older adults who took 800 mcg of folic acid daily for 3 years showed significantly less cognitive decline than those who took placebo, according to a randomized, double-blind trial.

Three years of folic acid supplementation gave an individual the performance of someone 4.7 years younger for memory, 2.1 years younger for information processing speed, and 1.5 years younger for global cognitive function, said Jane Durga, Ph.D., of Wageningen (the Netherlands) University and her associates (Lancet 2007;369:208–16).

According to the investigators, folic acid supplementation was associated with particularly good results in the most clinically relevant subtest, the one that measured delayed recall. After 3 years of supplementation, patients experienced an improvement in performance similar to that of an individual 6.9 years younger.

In an accompanying editorial comment, Martha Clare Morris, Sc.D., and Christine C. Tangney, Ph.D., of Rush University Medical Center, Chicago, noted that normal levels of folic acid intake vary greatly across different regions, ethnic groups, ages, and socioeconomic circumstances (Lancet 2007;369:166–7).

In the United States and Canada, for example, grain is fortified with folic acid, and now less than 1% of the U.S. population has an inadequate serum folate status. There is no such fortification in the Netherlands, where the study was conducted, and where the recommended dietary allowance (RDA) of folic acid is 300 mcg/day, lower than the U.S. RDA of 400 mcg/day.

In general, dietary folic acid intake is about 200 mcg/day in northern Europe but up to 559 mcg/day in Greece, where many eat the so-called Mediterranean diet. Before the fortification of grain began in the United States, mean folic acid intake was estimated at 275 mcg/day.

The study involved 818 individuals aged 50–70 years who are participating in the Folic Acid and Carotid Intima-Media Thickness (FACIT) trial, with a primary end point involving atherosclerotic progression. Age-related declines in cognitive performance were secondary outcomes. The patients were selected for high concentrations of plasma homocysteine, which is considered a risk factor for vascular disease. Folic acid supplementation is known to decrease homocysteine concentrations, Dr. Durga and her associates said.

Participants were excluded if they had plasma total homocysteine concentrations less than 13 micromol/L or greater than 26 micromol/L (which may have been due to factors other than folate concentration). Patients were also excluded if they had renal disease, thyroid disease, or intestinal disease, or if they regularly used vitamin D supplements or drugs that could affect atherosclerotic progression.

Participants were given five cognitive tests at baseline and again at the end of the study. Compared with those taking placebo, subjects taking folic acid scored significantly better on tests of memory and information-processing speed. There were no significant differences on sensorimotor speed, complex speed, or word fluency.

Global cognitive functioning, defined as an average of the five domains, improved significantly in the folic acid group. The groups did not differ on the Mini-Mental State Examination, a screening test for dementia.

It is unclear whether folic acid supplementation would result in a reduced incidence of dementia, the investigators noted. Some have argued that age-related cognitive decline is at the beginning of a continuum leading to dementia, but others have suggested that the cause of age-related cognitive decline differs from that of dementia. Similar trials in older populations, or in those with mild cognitive impairment or dementia, would be needed to address that question, Dr. Durga and her associates said.

Older adults who took 800 mcg of folic acid daily for 3 years showed significantly less cognitive decline than those who took placebo, according to a randomized, double-blind trial.

Three years of folic acid supplementation gave an individual the performance of someone 4.7 years younger for memory, 2.1 years younger for information processing speed, and 1.5 years younger for global cognitive function, said Jane Durga, Ph.D., of Wageningen (the Netherlands) University and her associates (Lancet 2007;369:208–16).

According to the investigators, folic acid supplementation was associated with particularly good results in the most clinically relevant subtest, the one that measured delayed recall. After 3 years of supplementation, patients experienced an improvement in performance similar to that of an individual 6.9 years younger.

In an accompanying editorial comment, Martha Clare Morris, Sc.D., and Christine C. Tangney, Ph.D., of Rush University Medical Center, Chicago, noted that normal levels of folic acid intake vary greatly across different regions, ethnic groups, ages, and socioeconomic circumstances (Lancet 2007;369:166–7).

In the United States and Canada, for example, grain is fortified with folic acid, and now less than 1% of the U.S. population has an inadequate serum folate status. There is no such fortification in the Netherlands, where the study was conducted, and where the recommended dietary allowance (RDA) of folic acid is 300 mcg/day, lower than the U.S. RDA of 400 mcg/day.

In general, dietary folic acid intake is about 200 mcg/day in northern Europe but up to 559 mcg/day in Greece, where many eat the so-called Mediterranean diet. Before the fortification of grain began in the United States, mean folic acid intake was estimated at 275 mcg/day.

The study involved 818 individuals aged 50–70 years who are participating in the Folic Acid and Carotid Intima-Media Thickness (FACIT) trial, with a primary end point involving atherosclerotic progression. Age-related declines in cognitive performance were secondary outcomes. The patients were selected for high concentrations of plasma homocysteine, which is considered a risk factor for vascular disease. Folic acid supplementation is known to decrease homocysteine concentrations, Dr. Durga and her associates said.

Participants were excluded if they had plasma total homocysteine concentrations less than 13 micromol/L or greater than 26 micromol/L (which may have been due to factors other than folate concentration). Patients were also excluded if they had renal disease, thyroid disease, or intestinal disease, or if they regularly used vitamin D supplements or drugs that could affect atherosclerotic progression.

Participants were given five cognitive tests at baseline and again at the end of the study. Compared with those taking placebo, subjects taking folic acid scored significantly better on tests of memory and information-processing speed. There were no significant differences on sensorimotor speed, complex speed, or word fluency.

Global cognitive functioning, defined as an average of the five domains, improved significantly in the folic acid group. The groups did not differ on the Mini-Mental State Examination, a screening test for dementia.

It is unclear whether folic acid supplementation would result in a reduced incidence of dementia, the investigators noted. Some have argued that age-related cognitive decline is at the beginning of a continuum leading to dementia, but others have suggested that the cause of age-related cognitive decline differs from that of dementia. Similar trials in older populations, or in those with mild cognitive impairment or dementia, would be needed to address that question, Dr. Durga and her associates said.

Older adults who took 800 mcg of folic acid daily for 3 years showed significantly less cognitive decline than those who took placebo, according to a randomized, double-blind trial.

Three years of folic acid supplementation gave an individual the performance of someone 4.7 years younger for memory, 2.1 years younger for information processing speed, and 1.5 years younger for global cognitive function, said Jane Durga, Ph.D., of Wageningen (the Netherlands) University and her associates (Lancet 2007;369:208–16).

According to the investigators, folic acid supplementation was associated with particularly good results in the most clinically relevant subtest, the one that measured delayed recall. After 3 years of supplementation, patients experienced an improvement in performance similar to that of an individual 6.9 years younger.

In an accompanying editorial comment, Martha Clare Morris, Sc.D., and Christine C. Tangney, Ph.D., of Rush University Medical Center, Chicago, noted that normal levels of folic acid intake vary greatly across different regions, ethnic groups, ages, and socioeconomic circumstances (Lancet 2007;369:166–7).

In the United States and Canada, for example, grain is fortified with folic acid, and now less than 1% of the U.S. population has an inadequate serum folate status. There is no such fortification in the Netherlands, where the study was conducted, and where the recommended dietary allowance (RDA) of folic acid is 300 mcg/day, lower than the U.S. RDA of 400 mcg/day.

In general, dietary folic acid intake is about 200 mcg/day in northern Europe but up to 559 mcg/day in Greece, where many eat the so-called Mediterranean diet. Before the fortification of grain began in the United States, mean folic acid intake was estimated at 275 mcg/day.

The study involved 818 individuals aged 50–70 years who are participating in the Folic Acid and Carotid Intima-Media Thickness (FACIT) trial, with a primary end point involving atherosclerotic progression. Age-related declines in cognitive performance were secondary outcomes. The patients were selected for high concentrations of plasma homocysteine, which is considered a risk factor for vascular disease. Folic acid supplementation is known to decrease homocysteine concentrations, Dr. Durga and her associates said.

Participants were excluded if they had plasma total homocysteine concentrations less than 13 micromol/L or greater than 26 micromol/L (which may have been due to factors other than folate concentration). Patients were also excluded if they had renal disease, thyroid disease, or intestinal disease, or if they regularly used vitamin D supplements or drugs that could affect atherosclerotic progression.

Participants were given five cognitive tests at baseline and again at the end of the study. Compared with those taking placebo, subjects taking folic acid scored significantly better on tests of memory and information-processing speed. There were no significant differences on sensorimotor speed, complex speed, or word fluency.

Global cognitive functioning, defined as an average of the five domains, improved significantly in the folic acid group. The groups did not differ on the Mini-Mental State Examination, a screening test for dementia.

It is unclear whether folic acid supplementation would result in a reduced incidence of dementia, the investigators noted. Some have argued that age-related cognitive decline is at the beginning of a continuum leading to dementia, but others have suggested that the cause of age-related cognitive decline differs from that of dementia. Similar trials in older populations, or in those with mild cognitive impairment or dementia, would be needed to address that question, Dr. Durga and her associates said.

SANTA MONICA, CALIF. — While hysteroscopy is the most accurate tool for evaluating abnormal uterine bleeding, the technique can cause the intraperitoneal spread of malignant endometrial cells. This has raised concerns that hysteroscopy might be responsible for a worse prognosis in women with endometrial cancer.

But in a poster presentation at the biennial meeting of the International Gynecologic Cancer Society, Dr. A. Ben Arie and colleagues found no evidence that hysteroscopy was associated with an increase in endometrial cancer recurrences.

The retrospective study involved 392 women provisionally diagnosed with stage I endometrial adenocarcinoma at five medical centers in Israel. Dr. Ben Arie of Kaplan Medical Center, Rehovot, Israel, and colleagues examined the women's medical records, retrieving data on mode of diagnosis, histologic type, grade and stage of the disease, and the patient's outcome.

Three different diagnostic methods were employed in the women—25% had an endometrial biopsy, 49% had uterine curettage, and 26% had hysteroscopy. Endometrial adenocarcinoma was found in 88.5% of the women, and the other 11.5% had uterine serous papillary cancer, clear cell cancer, or small cell cancer. The cancer was stage I in 81% of the women, stage II in 2% of the women, and stage III in 17% of the women.

At a mean follow-up time of 55 months (range 12–233 months), recurrences were found in 5% of the women who had hysteroscopy, 4.7% of the women who had curettage, and 13.1% of the women who had endometrial biopsy. There was no statistically significant difference in the recurrence rate among the three diagnostic methods.

The investigators concluded that hysteroscopy is safe in the assessment of abnormal uterine bleeding.

SANTA MONICA, CALIF. — While hysteroscopy is the most accurate tool for evaluating abnormal uterine bleeding, the technique can cause the intraperitoneal spread of malignant endometrial cells. This has raised concerns that hysteroscopy might be responsible for a worse prognosis in women with endometrial cancer.

But in a poster presentation at the biennial meeting of the International Gynecologic Cancer Society, Dr. A. Ben Arie and colleagues found no evidence that hysteroscopy was associated with an increase in endometrial cancer recurrences.

The retrospective study involved 392 women provisionally diagnosed with stage I endometrial adenocarcinoma at five medical centers in Israel. Dr. Ben Arie of Kaplan Medical Center, Rehovot, Israel, and colleagues examined the women's medical records, retrieving data on mode of diagnosis, histologic type, grade and stage of the disease, and the patient's outcome.

Three different diagnostic methods were employed in the women—25% had an endometrial biopsy, 49% had uterine curettage, and 26% had hysteroscopy. Endometrial adenocarcinoma was found in 88.5% of the women, and the other 11.5% had uterine serous papillary cancer, clear cell cancer, or small cell cancer. The cancer was stage I in 81% of the women, stage II in 2% of the women, and stage III in 17% of the women.

At a mean follow-up time of 55 months (range 12–233 months), recurrences were found in 5% of the women who had hysteroscopy, 4.7% of the women who had curettage, and 13.1% of the women who had endometrial biopsy. There was no statistically significant difference in the recurrence rate among the three diagnostic methods.

The investigators concluded that hysteroscopy is safe in the assessment of abnormal uterine bleeding.

SANTA MONICA, CALIF. — While hysteroscopy is the most accurate tool for evaluating abnormal uterine bleeding, the technique can cause the intraperitoneal spread of malignant endometrial cells. This has raised concerns that hysteroscopy might be responsible for a worse prognosis in women with endometrial cancer.

But in a poster presentation at the biennial meeting of the International Gynecologic Cancer Society, Dr. A. Ben Arie and colleagues found no evidence that hysteroscopy was associated with an increase in endometrial cancer recurrences.

The retrospective study involved 392 women provisionally diagnosed with stage I endometrial adenocarcinoma at five medical centers in Israel. Dr. Ben Arie of Kaplan Medical Center, Rehovot, Israel, and colleagues examined the women's medical records, retrieving data on mode of diagnosis, histologic type, grade and stage of the disease, and the patient's outcome.

Three different diagnostic methods were employed in the women—25% had an endometrial biopsy, 49% had uterine curettage, and 26% had hysteroscopy. Endometrial adenocarcinoma was found in 88.5% of the women, and the other 11.5% had uterine serous papillary cancer, clear cell cancer, or small cell cancer. The cancer was stage I in 81% of the women, stage II in 2% of the women, and stage III in 17% of the women.

At a mean follow-up time of 55 months (range 12–233 months), recurrences were found in 5% of the women who had hysteroscopy, 4.7% of the women who had curettage, and 13.1% of the women who had endometrial biopsy. There was no statistically significant difference in the recurrence rate among the three diagnostic methods.

The investigators concluded that hysteroscopy is safe in the assessment of abnormal uterine bleeding.

SANTA MONICA, CALIF. — Transvaginal ultrasound has a specificity as high as 97% in screening asymptomatic women for endometrial cancer, but its use in the general population would result in a substantial number of false positives, according to a poster presentation at the biennial meeting of the International Gynecologic Cancer Society.

Using an endometrial-thickness cutoff of 10 mm or greater results in a 97% specificity and a 56% sensitivity, wrote Dr. Ian Jacobs of University College London and his colleagues. A cutoff of 5 mm or greater would result in a specificity of 86% and a sensitivity of 82%.

Using different cutoffs, depending on whether or not a woman used hormone replacement therapy, did not appreciably change the overall sensitivity or specificity.

The risk of endometrial cancer is associated with increasing weight, a history of breast cancer, and a history of any other cancer, but the study showed that limiting screening with transvaginal ultrasound to a higher-risk group of the population would result in only a slight increase in specificity.

Incorporating information on endometrial abnormalities can increase sensitivity somewhat, but at the expense of specificity. The investigators defined endometrial abnormalities as including polyps, fluid in the cavity, and/or thickened, cystic, irregular, or heterogeneous endometrium. Using the 10-mm cutoff for endometrial thickness and/or the presence of an endometrial abnormality resulted in a sensitivity of 73% and a specificity of 90% (compared with 56% and 97% without considering abnormalities).

The study used results from the U.K. Collaborative Trial of Ovarian Cancer Screening. Among the 38,668 asymptomatic women for whom transvaginal ultrasound results were available, 82 women were found to have endometrial cancer, including 5 with complex hyperplasia and 4 with atypical hyperplasia.

The investigators noted that current recommendations call for screening only women at especially high risk because of hereditary cancer syndromes. There is only limited enthusiasm for screening the general population, because endometrial cancer is found in stage I about 70% of the time and these patients have a relatively high 5-year survival rate of 85%. On the other hand, women diagnosed with stage Ic have a 5-year survival of 42%, and those with stage IV have a 5-year survival of 25%.

Screening of the general population would be expected to benefit those women but at the expense of significant false-positive rates that would result in some women having unnecessary diagnostic procedures.

SANTA MONICA, CALIF. — Transvaginal ultrasound has a specificity as high as 97% in screening asymptomatic women for endometrial cancer, but its use in the general population would result in a substantial number of false positives, according to a poster presentation at the biennial meeting of the International Gynecologic Cancer Society.

Using an endometrial-thickness cutoff of 10 mm or greater results in a 97% specificity and a 56% sensitivity, wrote Dr. Ian Jacobs of University College London and his colleagues. A cutoff of 5 mm or greater would result in a specificity of 86% and a sensitivity of 82%.

Using different cutoffs, depending on whether or not a woman used hormone replacement therapy, did not appreciably change the overall sensitivity or specificity.

The risk of endometrial cancer is associated with increasing weight, a history of breast cancer, and a history of any other cancer, but the study showed that limiting screening with transvaginal ultrasound to a higher-risk group of the population would result in only a slight increase in specificity.

Incorporating information on endometrial abnormalities can increase sensitivity somewhat, but at the expense of specificity. The investigators defined endometrial abnormalities as including polyps, fluid in the cavity, and/or thickened, cystic, irregular, or heterogeneous endometrium. Using the 10-mm cutoff for endometrial thickness and/or the presence of an endometrial abnormality resulted in a sensitivity of 73% and a specificity of 90% (compared with 56% and 97% without considering abnormalities).

The study used results from the U.K. Collaborative Trial of Ovarian Cancer Screening. Among the 38,668 asymptomatic women for whom transvaginal ultrasound results were available, 82 women were found to have endometrial cancer, including 5 with complex hyperplasia and 4 with atypical hyperplasia.

The investigators noted that current recommendations call for screening only women at especially high risk because of hereditary cancer syndromes. There is only limited enthusiasm for screening the general population, because endometrial cancer is found in stage I about 70% of the time and these patients have a relatively high 5-year survival rate of 85%. On the other hand, women diagnosed with stage Ic have a 5-year survival of 42%, and those with stage IV have a 5-year survival of 25%.

Screening of the general population would be expected to benefit those women but at the expense of significant false-positive rates that would result in some women having unnecessary diagnostic procedures.

SANTA MONICA, CALIF. — Transvaginal ultrasound has a specificity as high as 97% in screening asymptomatic women for endometrial cancer, but its use in the general population would result in a substantial number of false positives, according to a poster presentation at the biennial meeting of the International Gynecologic Cancer Society.

Using an endometrial-thickness cutoff of 10 mm or greater results in a 97% specificity and a 56% sensitivity, wrote Dr. Ian Jacobs of University College London and his colleagues. A cutoff of 5 mm or greater would result in a specificity of 86% and a sensitivity of 82%.

Using different cutoffs, depending on whether or not a woman used hormone replacement therapy, did not appreciably change the overall sensitivity or specificity.

The risk of endometrial cancer is associated with increasing weight, a history of breast cancer, and a history of any other cancer, but the study showed that limiting screening with transvaginal ultrasound to a higher-risk group of the population would result in only a slight increase in specificity.

Incorporating information on endometrial abnormalities can increase sensitivity somewhat, but at the expense of specificity. The investigators defined endometrial abnormalities as including polyps, fluid in the cavity, and/or thickened, cystic, irregular, or heterogeneous endometrium. Using the 10-mm cutoff for endometrial thickness and/or the presence of an endometrial abnormality resulted in a sensitivity of 73% and a specificity of 90% (compared with 56% and 97% without considering abnormalities).

The study used results from the U.K. Collaborative Trial of Ovarian Cancer Screening. Among the 38,668 asymptomatic women for whom transvaginal ultrasound results were available, 82 women were found to have endometrial cancer, including 5 with complex hyperplasia and 4 with atypical hyperplasia.

The investigators noted that current recommendations call for screening only women at especially high risk because of hereditary cancer syndromes. There is only limited enthusiasm for screening the general population, because endometrial cancer is found in stage I about 70% of the time and these patients have a relatively high 5-year survival rate of 85%. On the other hand, women diagnosed with stage Ic have a 5-year survival of 42%, and those with stage IV have a 5-year survival of 25%.

Screening of the general population would be expected to benefit those women but at the expense of significant false-positive rates that would result in some women having unnecessary diagnostic procedures.

SANTA MONICA, CALIF. — Persistent abdominal distention, but not transient bloating, is associated with ovarian cancer, and clinicians should listen to their patients carefully to distinguish between the symptoms, according to a poster presentation by Dr. Clare R. Bankhead at the biennial meeting of the International Gynecologic Cancer Society.

Dr. Bankhead of the University of Oxford (England), and her colleagues conducted semistructured interviews with 124 women who were referred for evaluation of suspected ovarian malignancies. The investigators conducted a qualitative thematic analysis of the interviews to extract potential symptoms of ovarian cancer, and they conducted a multivariate quantitative analysis of the reported symptoms to determine which ones were associated with a diagnosis of ovarian cancer.

Of the 124 women, 44 were eventually diagnosed with malignancies. Forty of the malignancies were ovarian primary cancers (25 of which were at an advanced stage), two were peritoneal cancers, and the remaining two were gynecological cancers whose primary sites were unknown. Of the 80 women without cancer, 59 had benign gynecologic pathology and 21 had normal findings.

After adjusting for other symptoms, women with persistent abdominal distention with or without bloating were 5.2 times as likely to be diagnosed with ovarian cancer as women with neither bloating nor distention. This odds ratio was statistically significant.

Bloating alone, on the other hand, was not associated with an increased or decreased chance of being diagnosed with ovarian cancer.

Four other symptoms emerged in the multivariate analysis as being significantly associated with ovarian cancer diagnoses. They were early satiety (odds ratio 5.0), loss of appetite (odds ratio 3.2), postmenopausal bleeding (odds ratio 9.2), and progressive worsening of symptoms (odds ratio 3.6).

“The findings emphasize the need to listen carefully to women's accounts of abdominal symptoms,” the investigators wrote. “Clinicians should clarify whether women are describing bloating [fluctuating discomfort] or distention, and whether the symptoms are transient or persistent, in order to distinguish between them.”

SANTA MONICA, CALIF. — Persistent abdominal distention, but not transient bloating, is associated with ovarian cancer, and clinicians should listen to their patients carefully to distinguish between the symptoms, according to a poster presentation by Dr. Clare R. Bankhead at the biennial meeting of the International Gynecologic Cancer Society.

Dr. Bankhead of the University of Oxford (England), and her colleagues conducted semistructured interviews with 124 women who were referred for evaluation of suspected ovarian malignancies. The investigators conducted a qualitative thematic analysis of the interviews to extract potential symptoms of ovarian cancer, and they conducted a multivariate quantitative analysis of the reported symptoms to determine which ones were associated with a diagnosis of ovarian cancer.

Of the 124 women, 44 were eventually diagnosed with malignancies. Forty of the malignancies were ovarian primary cancers (25 of which were at an advanced stage), two were peritoneal cancers, and the remaining two were gynecological cancers whose primary sites were unknown. Of the 80 women without cancer, 59 had benign gynecologic pathology and 21 had normal findings.

After adjusting for other symptoms, women with persistent abdominal distention with or without bloating were 5.2 times as likely to be diagnosed with ovarian cancer as women with neither bloating nor distention. This odds ratio was statistically significant.

Bloating alone, on the other hand, was not associated with an increased or decreased chance of being diagnosed with ovarian cancer.

Four other symptoms emerged in the multivariate analysis as being significantly associated with ovarian cancer diagnoses. They were early satiety (odds ratio 5.0), loss of appetite (odds ratio 3.2), postmenopausal bleeding (odds ratio 9.2), and progressive worsening of symptoms (odds ratio 3.6).

“The findings emphasize the need to listen carefully to women's accounts of abdominal symptoms,” the investigators wrote. “Clinicians should clarify whether women are describing bloating [fluctuating discomfort] or distention, and whether the symptoms are transient or persistent, in order to distinguish between them.”

SANTA MONICA, CALIF. — Persistent abdominal distention, but not transient bloating, is associated with ovarian cancer, and clinicians should listen to their patients carefully to distinguish between the symptoms, according to a poster presentation by Dr. Clare R. Bankhead at the biennial meeting of the International Gynecologic Cancer Society.

Dr. Bankhead of the University of Oxford (England), and her colleagues conducted semistructured interviews with 124 women who were referred for evaluation of suspected ovarian malignancies. The investigators conducted a qualitative thematic analysis of the interviews to extract potential symptoms of ovarian cancer, and they conducted a multivariate quantitative analysis of the reported symptoms to determine which ones were associated with a diagnosis of ovarian cancer.

Of the 124 women, 44 were eventually diagnosed with malignancies. Forty of the malignancies were ovarian primary cancers (25 of which were at an advanced stage), two were peritoneal cancers, and the remaining two were gynecological cancers whose primary sites were unknown. Of the 80 women without cancer, 59 had benign gynecologic pathology and 21 had normal findings.

After adjusting for other symptoms, women with persistent abdominal distention with or without bloating were 5.2 times as likely to be diagnosed with ovarian cancer as women with neither bloating nor distention. This odds ratio was statistically significant.

Bloating alone, on the other hand, was not associated with an increased or decreased chance of being diagnosed with ovarian cancer.

Four other symptoms emerged in the multivariate analysis as being significantly associated with ovarian cancer diagnoses. They were early satiety (odds ratio 5.0), loss of appetite (odds ratio 3.2), postmenopausal bleeding (odds ratio 9.2), and progressive worsening of symptoms (odds ratio 3.6).

“The findings emphasize the need to listen carefully to women's accounts of abdominal symptoms,” the investigators wrote. “Clinicians should clarify whether women are describing bloating [fluctuating discomfort] or distention, and whether the symptoms are transient or persistent, in order to distinguish between them.”

SANTA MONICA, CALIF. — Patients with gynecologic cancer who chose to participate in phase I clinical trials survived for twice as long as similar patients who did not participate in such trials, according to a poster presentation by Dr. Francesco Legge at the biennial meeting of the International Gynecologic Cancer Society.

These results are surprising because phase I clinical trials are intended only to assess safety and to establish dosage ranges. Any clinical benefit would be a secondary consideration.

The retrospective analysis involved patients with gynecologic cancer who were referred to phase I clinical trials at the Royal Marsden Hospital in Sutton, England, over a 2-year period. Dr. Legge, who is affiliated with the Catholic University of the Sacred Heart in Rome and in Campobasso, Italy, and his colleagues compared 32 patients who chose to participate in those clinical trials with 36 patients who were referred but chose not to participate.

Median survival time of the patients who enrolled was 8 months, compared with 4 months for the patients who did not enroll, a statistically significant difference. After a multivariate analysis that controlled for various demographic measures and disease characteristics, three factors emerged as being significantly associated with a patient's decision on whether to enroll in a clinical trial.

The longer the travel time from the patient's home to the hospital, the less likely she was to enroll. Of patients who lived within 1 hour of the hospital, 61% chose to participate, compared with 48% of the patients who lived 1–2 hours from the hospital, and 8% of patients who lived more than 2 hours from the hospital.

The better a patient's health was, as measured by her performance status, the more likely she was to participate. Of the patients with an initial Eastern Cooperative Oncology Group (ECOG) performance status of grade 0 (indicating a patient who is fully active), 59% chose to participate, compared with 51% of the patients with an initial performance status of grade 1 (indicating a patient who is able to carry out light or sedentary work). None of the patients with an initial performance status greater than grade 1 chose to participate in a trial.

Abnormal liver function tests also predicted nonenrollment in clinical trials.

Among the factors for which there was no significant relationship between enrollment or nonenrollment were age; marital status; occupation; ethnicity; interval from diagnosis; number of previous surgical procedures or previous courses of radiotherapy; and the junior or senior physician status of the individual discussing the phase I trial with the patient.

Ovarian cancer was the most common type of cancer among the patients in the study, accounting for 21 of 32 (66%) patients who chose to participate in the clinical trials and 21 of 36 (58%) patients who chose not to participate. The majority of the remaining patients had cervical cancer.

The patients participated in a wide variety of clinical trials, including those testing angiogenesis inhibitors, epidermal growth factor-receptor inhibitors, methyltransferase inhibitors, DNA-repair inhibitors, and new cytotoxics.

“The practical limitations imposed by long-distance travel, together with the potential clinical benefit due to the participation [in] these trials, should encourage more investigators to develop phase I units in major cancer centers,” the investigators concluded.

SANTA MONICA, CALIF. — Patients with gynecologic cancer who chose to participate in phase I clinical trials survived for twice as long as similar patients who did not participate in such trials, according to a poster presentation by Dr. Francesco Legge at the biennial meeting of the International Gynecologic Cancer Society.

These results are surprising because phase I clinical trials are intended only to assess safety and to establish dosage ranges. Any clinical benefit would be a secondary consideration.

The retrospective analysis involved patients with gynecologic cancer who were referred to phase I clinical trials at the Royal Marsden Hospital in Sutton, England, over a 2-year period. Dr. Legge, who is affiliated with the Catholic University of the Sacred Heart in Rome and in Campobasso, Italy, and his colleagues compared 32 patients who chose to participate in those clinical trials with 36 patients who were referred but chose not to participate.

Median survival time of the patients who enrolled was 8 months, compared with 4 months for the patients who did not enroll, a statistically significant difference. After a multivariate analysis that controlled for various demographic measures and disease characteristics, three factors emerged as being significantly associated with a patient's decision on whether to enroll in a clinical trial.

The longer the travel time from the patient's home to the hospital, the less likely she was to enroll. Of patients who lived within 1 hour of the hospital, 61% chose to participate, compared with 48% of the patients who lived 1–2 hours from the hospital, and 8% of patients who lived more than 2 hours from the hospital.

The better a patient's health was, as measured by her performance status, the more likely she was to participate. Of the patients with an initial Eastern Cooperative Oncology Group (ECOG) performance status of grade 0 (indicating a patient who is fully active), 59% chose to participate, compared with 51% of the patients with an initial performance status of grade 1 (indicating a patient who is able to carry out light or sedentary work). None of the patients with an initial performance status greater than grade 1 chose to participate in a trial.

Abnormal liver function tests also predicted nonenrollment in clinical trials.

Among the factors for which there was no significant relationship between enrollment or nonenrollment were age; marital status; occupation; ethnicity; interval from diagnosis; number of previous surgical procedures or previous courses of radiotherapy; and the junior or senior physician status of the individual discussing the phase I trial with the patient.

Ovarian cancer was the most common type of cancer among the patients in the study, accounting for 21 of 32 (66%) patients who chose to participate in the clinical trials and 21 of 36 (58%) patients who chose not to participate. The majority of the remaining patients had cervical cancer.

The patients participated in a wide variety of clinical trials, including those testing angiogenesis inhibitors, epidermal growth factor-receptor inhibitors, methyltransferase inhibitors, DNA-repair inhibitors, and new cytotoxics.

“The practical limitations imposed by long-distance travel, together with the potential clinical benefit due to the participation [in] these trials, should encourage more investigators to develop phase I units in major cancer centers,” the investigators concluded.

SANTA MONICA, CALIF. — Patients with gynecologic cancer who chose to participate in phase I clinical trials survived for twice as long as similar patients who did not participate in such trials, according to a poster presentation by Dr. Francesco Legge at the biennial meeting of the International Gynecologic Cancer Society.

These results are surprising because phase I clinical trials are intended only to assess safety and to establish dosage ranges. Any clinical benefit would be a secondary consideration.

The retrospective analysis involved patients with gynecologic cancer who were referred to phase I clinical trials at the Royal Marsden Hospital in Sutton, England, over a 2-year period. Dr. Legge, who is affiliated with the Catholic University of the Sacred Heart in Rome and in Campobasso, Italy, and his colleagues compared 32 patients who chose to participate in those clinical trials with 36 patients who were referred but chose not to participate.

Median survival time of the patients who enrolled was 8 months, compared with 4 months for the patients who did not enroll, a statistically significant difference. After a multivariate analysis that controlled for various demographic measures and disease characteristics, three factors emerged as being significantly associated with a patient's decision on whether to enroll in a clinical trial.

The longer the travel time from the patient's home to the hospital, the less likely she was to enroll. Of patients who lived within 1 hour of the hospital, 61% chose to participate, compared with 48% of the patients who lived 1–2 hours from the hospital, and 8% of patients who lived more than 2 hours from the hospital.

The better a patient's health was, as measured by her performance status, the more likely she was to participate. Of the patients with an initial Eastern Cooperative Oncology Group (ECOG) performance status of grade 0 (indicating a patient who is fully active), 59% chose to participate, compared with 51% of the patients with an initial performance status of grade 1 (indicating a patient who is able to carry out light or sedentary work). None of the patients with an initial performance status greater than grade 1 chose to participate in a trial.

Abnormal liver function tests also predicted nonenrollment in clinical trials.

Among the factors for which there was no significant relationship between enrollment or nonenrollment were age; marital status; occupation; ethnicity; interval from diagnosis; number of previous surgical procedures or previous courses of radiotherapy; and the junior or senior physician status of the individual discussing the phase I trial with the patient.

Ovarian cancer was the most common type of cancer among the patients in the study, accounting for 21 of 32 (66%) patients who chose to participate in the clinical trials and 21 of 36 (58%) patients who chose not to participate. The majority of the remaining patients had cervical cancer.

The patients participated in a wide variety of clinical trials, including those testing angiogenesis inhibitors, epidermal growth factor-receptor inhibitors, methyltransferase inhibitors, DNA-repair inhibitors, and new cytotoxics.

“The practical limitations imposed by long-distance travel, together with the potential clinical benefit due to the participation [in] these trials, should encourage more investigators to develop phase I units in major cancer centers,” the investigators concluded.

SANTA MONICA, CALIF. — A combination of patent blue dye and technetium-99m radiocolloid appears to be more accurate than patent blue dye alone in mapping sentinel lymph nodes in vulvar cancer, according to a study presented by Dr. Lukas Rob at the biennial meeting of the International Gynecologic Cancer Society.

Furthermore, a handheld gamma probe appeared to be more accurate and more convenient than lymphoscintigraphy in detecting “hot” nodes, said Dr. Rob of Charles University in Prague.

The nonrandomized study involved 59 women with stage T1 or T2 squamous cell cancers smaller than 4 cm in diameter. The investigators used blue dye alone in the first 16 women, and the combination of technetium-99m and blue dye in the remaining 43. Patients with suspicious or bulky lymph nodes were excluded from the study.

Of the 16 patients mapped with blue dye alone, sentinel lymph nodes were detected in 11 (69%), and there was one false negative (6%). In contrast, sentinel lymph nodes were detected in all of the patients mapped with the combination of blue dye and technetium-99m, and there were no false negatives. These differences were statistically significant.

In this second group of patients, investigators found a total of 98 sentinel lymph nodes. Of those, 82 were detected by both technetium and blue dye, 15 were detected by technetium alone, and one was detected by blue dye alone.

The investigators determined that the best time for injecting the radiocolloid was 3–4 hours before surgery. They performed the injection intradermally, peritumorally, and without local anesthesia. They used 0.2–0.4 mL of Sentiscint (15 MBq). About an hour before the operation, they conducted lymphoscintigraphy. They injected 2 mL of 2.5% Bleu Patente V 3–5 minutes before incision by the same route.

Although the handheld gamma probe showed a relatively good correlation with lymphoscintigraphy, the probe identified 14 “hot” nodes not seen in lymphoscintigraphy among the 43 women in the combination group. The investigators concluded that eliminating preoperative lymphoscintigraphy and using only the handheld probe during surgery would simplify management and result in lower costs without compromising the detection rate.

In all, the investigators detected 118 sentinel lymph nodes in 59 women. Of these sentinel nodes, 84% were in the superficial medial and intermedial inguinal chain, none were in the superficial lateral groin, and 16% were deep inguinal nodes. Dr. Rob said that one important message of the study was that it's crucial not to neglect a search for these deep inguinal nodes.

SANTA MONICA, CALIF. — A combination of patent blue dye and technetium-99m radiocolloid appears to be more accurate than patent blue dye alone in mapping sentinel lymph nodes in vulvar cancer, according to a study presented by Dr. Lukas Rob at the biennial meeting of the International Gynecologic Cancer Society.

Furthermore, a handheld gamma probe appeared to be more accurate and more convenient than lymphoscintigraphy in detecting “hot” nodes, said Dr. Rob of Charles University in Prague.

The nonrandomized study involved 59 women with stage T1 or T2 squamous cell cancers smaller than 4 cm in diameter. The investigators used blue dye alone in the first 16 women, and the combination of technetium-99m and blue dye in the remaining 43. Patients with suspicious or bulky lymph nodes were excluded from the study.

Of the 16 patients mapped with blue dye alone, sentinel lymph nodes were detected in 11 (69%), and there was one false negative (6%). In contrast, sentinel lymph nodes were detected in all of the patients mapped with the combination of blue dye and technetium-99m, and there were no false negatives. These differences were statistically significant.

In this second group of patients, investigators found a total of 98 sentinel lymph nodes. Of those, 82 were detected by both technetium and blue dye, 15 were detected by technetium alone, and one was detected by blue dye alone.

The investigators determined that the best time for injecting the radiocolloid was 3–4 hours before surgery. They performed the injection intradermally, peritumorally, and without local anesthesia. They used 0.2–0.4 mL of Sentiscint (15 MBq). About an hour before the operation, they conducted lymphoscintigraphy. They injected 2 mL of 2.5% Bleu Patente V 3–5 minutes before incision by the same route.

Although the handheld gamma probe showed a relatively good correlation with lymphoscintigraphy, the probe identified 14 “hot” nodes not seen in lymphoscintigraphy among the 43 women in the combination group. The investigators concluded that eliminating preoperative lymphoscintigraphy and using only the handheld probe during surgery would simplify management and result in lower costs without compromising the detection rate.

In all, the investigators detected 118 sentinel lymph nodes in 59 women. Of these sentinel nodes, 84% were in the superficial medial and intermedial inguinal chain, none were in the superficial lateral groin, and 16% were deep inguinal nodes. Dr. Rob said that one important message of the study was that it's crucial not to neglect a search for these deep inguinal nodes.

SANTA MONICA, CALIF. — A combination of patent blue dye and technetium-99m radiocolloid appears to be more accurate than patent blue dye alone in mapping sentinel lymph nodes in vulvar cancer, according to a study presented by Dr. Lukas Rob at the biennial meeting of the International Gynecologic Cancer Society.

Furthermore, a handheld gamma probe appeared to be more accurate and more convenient than lymphoscintigraphy in detecting “hot” nodes, said Dr. Rob of Charles University in Prague.

The nonrandomized study involved 59 women with stage T1 or T2 squamous cell cancers smaller than 4 cm in diameter. The investigators used blue dye alone in the first 16 women, and the combination of technetium-99m and blue dye in the remaining 43. Patients with suspicious or bulky lymph nodes were excluded from the study.

Of the 16 patients mapped with blue dye alone, sentinel lymph nodes were detected in 11 (69%), and there was one false negative (6%). In contrast, sentinel lymph nodes were detected in all of the patients mapped with the combination of blue dye and technetium-99m, and there were no false negatives. These differences were statistically significant.

In this second group of patients, investigators found a total of 98 sentinel lymph nodes. Of those, 82 were detected by both technetium and blue dye, 15 were detected by technetium alone, and one was detected by blue dye alone.

The investigators determined that the best time for injecting the radiocolloid was 3–4 hours before surgery. They performed the injection intradermally, peritumorally, and without local anesthesia. They used 0.2–0.4 mL of Sentiscint (15 MBq). About an hour before the operation, they conducted lymphoscintigraphy. They injected 2 mL of 2.5% Bleu Patente V 3–5 minutes before incision by the same route.

Although the handheld gamma probe showed a relatively good correlation with lymphoscintigraphy, the probe identified 14 “hot” nodes not seen in lymphoscintigraphy among the 43 women in the combination group. The investigators concluded that eliminating preoperative lymphoscintigraphy and using only the handheld probe during surgery would simplify management and result in lower costs without compromising the detection rate.

In all, the investigators detected 118 sentinel lymph nodes in 59 women. Of these sentinel nodes, 84% were in the superficial medial and intermedial inguinal chain, none were in the superficial lateral groin, and 16% were deep inguinal nodes. Dr. Rob said that one important message of the study was that it's crucial not to neglect a search for these deep inguinal nodes.

SAN FRANCISCO — Modifications to equipment and playing style can be combined to decrease the chances of acquiring tennis elbow, a troublesome and painful disorder most commonly seen in the casual player, Dr. Marc R. Safran said at a meeting on sports medicine sponsored by the University of California, San Francisco.

Tennis elbow has been known more formally as lateral epicondylitis, but this is actually a misnomer, said Dr. Safran of the university, because the condition is not caused by inflammation, but rather by a degenerative process. So sports medicine experts are beginning to switch to the term “epicondylosis” or “tendinosis.”

It commonly affects weekend warriors aged 35–50 years, men more than women, and the dominant arm twice as often as the nondominant arm. The prevalence among tennis players is as high as 40%–50%.

Elite tennis players tend to develop medial epicondylitis (or epicondylosis), commonly called “golfer's elbow.” The casual tennis players (and others) who are most at risk of developing lateral epicondylosis are those who have inadequate conditioning, particularly weak wrist extensors; tight, inflexible muscles (which can be alleviated somewhat by stretching); and weak posterior shoulder muscles. The condition is caused by overuse in both time and intensity of play.

Poor technique also plays an important role. The one-handed backhand is a particular offender, said Dr. Safran, who advocates the two-handed backhand, which keeps the wrist steady and straight.

Choosing the correct racket can prevent a player from gripping too tightly. The grip should be neither too small nor too large. Cushioned grips can decrease vibration. And players should always use new balls to reduce stress on the elbow, he said.

The racket should be made of composite materials with good dampening characteristics. It should have a stiff head and a flexible shaft; large heads are better than small heads because there will be fewer off-center hits and less vibration.

The head should be relatively light to decrease the chances that the player will become fatigued, though it should have at least some weight so the player gets an assist from momentum, Dr. Safran advised, adding that regular-length rackets are better than longer rackets, which require more strength to swing.

SAN FRANCISCO — Modifications to equipment and playing style can be combined to decrease the chances of acquiring tennis elbow, a troublesome and painful disorder most commonly seen in the casual player, Dr. Marc R. Safran said at a meeting on sports medicine sponsored by the University of California, San Francisco.

Tennis elbow has been known more formally as lateral epicondylitis, but this is actually a misnomer, said Dr. Safran of the university, because the condition is not caused by inflammation, but rather by a degenerative process. So sports medicine experts are beginning to switch to the term “epicondylosis” or “tendinosis.”

It commonly affects weekend warriors aged 35–50 years, men more than women, and the dominant arm twice as often as the nondominant arm. The prevalence among tennis players is as high as 40%–50%.

Elite tennis players tend to develop medial epicondylitis (or epicondylosis), commonly called “golfer's elbow.” The casual tennis players (and others) who are most at risk of developing lateral epicondylosis are those who have inadequate conditioning, particularly weak wrist extensors; tight, inflexible muscles (which can be alleviated somewhat by stretching); and weak posterior shoulder muscles. The condition is caused by overuse in both time and intensity of play.

Poor technique also plays an important role. The one-handed backhand is a particular offender, said Dr. Safran, who advocates the two-handed backhand, which keeps the wrist steady and straight.

Choosing the correct racket can prevent a player from gripping too tightly. The grip should be neither too small nor too large. Cushioned grips can decrease vibration. And players should always use new balls to reduce stress on the elbow, he said.

The racket should be made of composite materials with good dampening characteristics. It should have a stiff head and a flexible shaft; large heads are better than small heads because there will be fewer off-center hits and less vibration.

The head should be relatively light to decrease the chances that the player will become fatigued, though it should have at least some weight so the player gets an assist from momentum, Dr. Safran advised, adding that regular-length rackets are better than longer rackets, which require more strength to swing.

SAN FRANCISCO — Modifications to equipment and playing style can be combined to decrease the chances of acquiring tennis elbow, a troublesome and painful disorder most commonly seen in the casual player, Dr. Marc R. Safran said at a meeting on sports medicine sponsored by the University of California, San Francisco.

Tennis elbow has been known more formally as lateral epicondylitis, but this is actually a misnomer, said Dr. Safran of the university, because the condition is not caused by inflammation, but rather by a degenerative process. So sports medicine experts are beginning to switch to the term “epicondylosis” or “tendinosis.”

It commonly affects weekend warriors aged 35–50 years, men more than women, and the dominant arm twice as often as the nondominant arm. The prevalence among tennis players is as high as 40%–50%.

Elite tennis players tend to develop medial epicondylitis (or epicondylosis), commonly called “golfer's elbow.” The casual tennis players (and others) who are most at risk of developing lateral epicondylosis are those who have inadequate conditioning, particularly weak wrist extensors; tight, inflexible muscles (which can be alleviated somewhat by stretching); and weak posterior shoulder muscles. The condition is caused by overuse in both time and intensity of play.

Poor technique also plays an important role. The one-handed backhand is a particular offender, said Dr. Safran, who advocates the two-handed backhand, which keeps the wrist steady and straight.

Choosing the correct racket can prevent a player from gripping too tightly. The grip should be neither too small nor too large. Cushioned grips can decrease vibration. And players should always use new balls to reduce stress on the elbow, he said.

The racket should be made of composite materials with good dampening characteristics. It should have a stiff head and a flexible shaft; large heads are better than small heads because there will be fewer off-center hits and less vibration.

The head should be relatively light to decrease the chances that the player will become fatigued, though it should have at least some weight so the player gets an assist from momentum, Dr. Safran advised, adding that regular-length rackets are better than longer rackets, which require more strength to swing.

SANTA MONICA, CALIF. — It may not be necessary to refer women for colposcopy after a single, mildly dyskaryotic cervical smear, according to a poster presentation by A.S. Ahmed at the biennial meeting of the International Gynecologic Cancer Society.

In a retrospective analysis of 375 patients who had a single smear positive for mild dyskaryosis and were followed for 4 years, Mr. Ahmed of King's College, London, and his colleagues found that 50% of the follow-up smears were negative in the first year, and 87% stayed negative over the full 4 years. In all, 791 follow-up smears were performed and 477 (60%) were negative. After those negative smears, only 61 (13%) smears in 54 patients (14%) reverted to low-grade abnormalities. Of the 375 patients, 70 (19%) required an excisional biopsy. The prevalence of high-grade cervical intraepithelial neoplasia (CIN) was 11%, and no cases of cancer were detected.

The authors said a single mildly abnormal cervical smear need not trigger a referral to colposcopy.

SANTA MONICA, CALIF. — It may not be necessary to refer women for colposcopy after a single, mildly dyskaryotic cervical smear, according to a poster presentation by A.S. Ahmed at the biennial meeting of the International Gynecologic Cancer Society.

In a retrospective analysis of 375 patients who had a single smear positive for mild dyskaryosis and were followed for 4 years, Mr. Ahmed of King's College, London, and his colleagues found that 50% of the follow-up smears were negative in the first year, and 87% stayed negative over the full 4 years. In all, 791 follow-up smears were performed and 477 (60%) were negative. After those negative smears, only 61 (13%) smears in 54 patients (14%) reverted to low-grade abnormalities. Of the 375 patients, 70 (19%) required an excisional biopsy. The prevalence of high-grade cervical intraepithelial neoplasia (CIN) was 11%, and no cases of cancer were detected.

The authors said a single mildly abnormal cervical smear need not trigger a referral to colposcopy.

SANTA MONICA, CALIF. — It may not be necessary to refer women for colposcopy after a single, mildly dyskaryotic cervical smear, according to a poster presentation by A.S. Ahmed at the biennial meeting of the International Gynecologic Cancer Society.

In a retrospective analysis of 375 patients who had a single smear positive for mild dyskaryosis and were followed for 4 years, Mr. Ahmed of King's College, London, and his colleagues found that 50% of the follow-up smears were negative in the first year, and 87% stayed negative over the full 4 years. In all, 791 follow-up smears were performed and 477 (60%) were negative. After those negative smears, only 61 (13%) smears in 54 patients (14%) reverted to low-grade abnormalities. Of the 375 patients, 70 (19%) required an excisional biopsy. The prevalence of high-grade cervical intraepithelial neoplasia (CIN) was 11%, and no cases of cancer were detected.

The authors said a single mildly abnormal cervical smear need not trigger a referral to colposcopy.

SANTA MONICA, CALIF. — It may not be necessary to refer women for colposcopy after a single, mildly dyskaryotic cervical smear, according to a poster presentation by Mr. A.S. Ahmed at the biennial meeting of the International Gynecologic Cancer Society.

In a retrospective analysis of 375 patients who had a single smear positive for mild dyskaryosis and were followed for 4 years, Mr. Ahmed of King's College, London, and his colleagues found that 50% of the follow-up smears were negative in the first year, and of those 87% stayed negative over the full 4 years.

In all, 791 follow-up smears were performed and 477 (60%) were negative. After those negative smears, only 61 smears (13%) in 54 patients (14%) reverted back to low-grade abnormalities.

Of the 375 patients, 70 (19%) required an excisional biopsy.

SANTA MONICA, CALIF. — It may not be necessary to refer women for colposcopy after a single, mildly dyskaryotic cervical smear, according to a poster presentation by Mr. A.S. Ahmed at the biennial meeting of the International Gynecologic Cancer Society.

In a retrospective analysis of 375 patients who had a single smear positive for mild dyskaryosis and were followed for 4 years, Mr. Ahmed of King's College, London, and his colleagues found that 50% of the follow-up smears were negative in the first year, and of those 87% stayed negative over the full 4 years.

In all, 791 follow-up smears were performed and 477 (60%) were negative. After those negative smears, only 61 smears (13%) in 54 patients (14%) reverted back to low-grade abnormalities.

Of the 375 patients, 70 (19%) required an excisional biopsy.

SANTA MONICA, CALIF. — It may not be necessary to refer women for colposcopy after a single, mildly dyskaryotic cervical smear, according to a poster presentation by Mr. A.S. Ahmed at the biennial meeting of the International Gynecologic Cancer Society.

In a retrospective analysis of 375 patients who had a single smear positive for mild dyskaryosis and were followed for 4 years, Mr. Ahmed of King's College, London, and his colleagues found that 50% of the follow-up smears were negative in the first year, and of those 87% stayed negative over the full 4 years.

In all, 791 follow-up smears were performed and 477 (60%) were negative. After those negative smears, only 61 smears (13%) in 54 patients (14%) reverted back to low-grade abnormalities.

Of the 375 patients, 70 (19%) required an excisional biopsy.