Sarah Pressman Lovinger

CHICAGO — As the prevalence of thyroid nodules diagnosed on ultrasound increases, clinicians trying to decide whether to biopsy a particular nodule should consider adding a serum TSH test to their work-up, Dr. R. Brooke Jeffrey Jr. said at the annual meeting of the Radiological Society of North America.

At the moment, “what is driving our approach to thyroid diagnosis is money and patient hysteria,” said Dr. Jeffrey of the department of radiology at Stanford (Calif.) University. In addition, the lack of clinical findings that indicate with certainty which nodules are more likely to be malignant contributes to a high biopsy rate.

Deciding which patients to biopsy is “a very contentious issue,” he added, noting that different medical societies have issued guidelines that often conflict. Though thyroid nodules are commonly detected, few thyroid cancers are diagnosed. But clinicians do not want to miss a cancer diagnosis, and thyroid biopsies can be lucrative.

A recent review indicated that thyroid cancer mortality has not changed in 30 years, despite the increased incidence of thyroid cancer, a result Dr. Jeffrey attributed to overdiagnosis (JAMA 2006;295:2164–7).

He also concluded that ultrasound, which has become much more widely available in the past 30 years, has not contributed to a decrease in mortality. Ultrasound gives information about many features of thyroid cancer, such as whether a mass is solid, hypoechoic, taller than it is wide, and whether it has microcalcifications and irregular margins. But because no single feature has a high sensitivity and specificity, clinicians cannot rely on ultrasound to rule out cancer, so they order biopsies.

However, recent data indicated that patients with clinically detected goiters and high normal TSH values had a higher incidence of thyroid cancer (J. Clin. Endocrinol. Metab. 2006;91:4295–301). By “combining ultrasound features and laboratory values, we might be able to come up with an algorithm,” Dr. Jeffrey said.

Even if TSH levels prove useful, clinicians will still confront difficult issues when deciding whether to biopsy thyroid nodules: how long to track the nodules before biopsy and what sort of interval growth might indicate a benign or a worrisome condition.

CHICAGO — As the prevalence of thyroid nodules diagnosed on ultrasound increases, clinicians trying to decide whether to biopsy a particular nodule should consider adding a serum TSH test to their work-up, Dr. R. Brooke Jeffrey Jr. said at the annual meeting of the Radiological Society of North America.

At the moment, “what is driving our approach to thyroid diagnosis is money and patient hysteria,” said Dr. Jeffrey of the department of radiology at Stanford (Calif.) University. In addition, the lack of clinical findings that indicate with certainty which nodules are more likely to be malignant contributes to a high biopsy rate.

Deciding which patients to biopsy is “a very contentious issue,” he added, noting that different medical societies have issued guidelines that often conflict. Though thyroid nodules are commonly detected, few thyroid cancers are diagnosed. But clinicians do not want to miss a cancer diagnosis, and thyroid biopsies can be lucrative.

A recent review indicated that thyroid cancer mortality has not changed in 30 years, despite the increased incidence of thyroid cancer, a result Dr. Jeffrey attributed to overdiagnosis (JAMA 2006;295:2164–7).

He also concluded that ultrasound, which has become much more widely available in the past 30 years, has not contributed to a decrease in mortality. Ultrasound gives information about many features of thyroid cancer, such as whether a mass is solid, hypoechoic, taller than it is wide, and whether it has microcalcifications and irregular margins. But because no single feature has a high sensitivity and specificity, clinicians cannot rely on ultrasound to rule out cancer, so they order biopsies.

However, recent data indicated that patients with clinically detected goiters and high normal TSH values had a higher incidence of thyroid cancer (J. Clin. Endocrinol. Metab. 2006;91:4295–301). By “combining ultrasound features and laboratory values, we might be able to come up with an algorithm,” Dr. Jeffrey said.

Even if TSH levels prove useful, clinicians will still confront difficult issues when deciding whether to biopsy thyroid nodules: how long to track the nodules before biopsy and what sort of interval growth might indicate a benign or a worrisome condition.

CHICAGO — As the prevalence of thyroid nodules diagnosed on ultrasound increases, clinicians trying to decide whether to biopsy a particular nodule should consider adding a serum TSH test to their work-up, Dr. R. Brooke Jeffrey Jr. said at the annual meeting of the Radiological Society of North America.

At the moment, “what is driving our approach to thyroid diagnosis is money and patient hysteria,” said Dr. Jeffrey of the department of radiology at Stanford (Calif.) University. In addition, the lack of clinical findings that indicate with certainty which nodules are more likely to be malignant contributes to a high biopsy rate.

Deciding which patients to biopsy is “a very contentious issue,” he added, noting that different medical societies have issued guidelines that often conflict. Though thyroid nodules are commonly detected, few thyroid cancers are diagnosed. But clinicians do not want to miss a cancer diagnosis, and thyroid biopsies can be lucrative.

A recent review indicated that thyroid cancer mortality has not changed in 30 years, despite the increased incidence of thyroid cancer, a result Dr. Jeffrey attributed to overdiagnosis (JAMA 2006;295:2164–7).

He also concluded that ultrasound, which has become much more widely available in the past 30 years, has not contributed to a decrease in mortality. Ultrasound gives information about many features of thyroid cancer, such as whether a mass is solid, hypoechoic, taller than it is wide, and whether it has microcalcifications and irregular margins. But because no single feature has a high sensitivity and specificity, clinicians cannot rely on ultrasound to rule out cancer, so they order biopsies.

However, recent data indicated that patients with clinically detected goiters and high normal TSH values had a higher incidence of thyroid cancer (J. Clin. Endocrinol. Metab. 2006;91:4295–301). By “combining ultrasound features and laboratory values, we might be able to come up with an algorithm,” Dr. Jeffrey said.

Even if TSH levels prove useful, clinicians will still confront difficult issues when deciding whether to biopsy thyroid nodules: how long to track the nodules before biopsy and what sort of interval growth might indicate a benign or a worrisome condition.

CHICAGO — Health anxiety is a prominent feature of all types of anxiety disorders, Jonathan S. Abramowitz, Ph.D., reported at the annual meeting of the Association for Behavioral and Cognitive Therapies.

“Health concerns are present across the anxiety disorders,” said Dr. Abramowitz, professor of psychology at the University of North Carolina at Chapel Hill and director of the obsessive-compulsive disorder/anxiety disorder treatment and research program there.

In a study of 157 adults who were patients at the Mayo Clinic in Rochester, Minn., where Dr. Abramowitz previously worked, 49 had panic disorder, 32 had social phobia, 21 had generalized anxiety disorder, 18 had obsessive-compulsive disorder (OCD), 21 had hypochondriasis, and 16 had specific phobias. The researchers made these diagnoses using the Structured Clinical Interview for DSM-IV-TR or the mini international neuropsychiatric interview. More than half the participants (58%) were women, 88% were white, 52% had at least a 2-year college degree, and 55% were married.

The results showed a positive relationship between health anxiety and most other anxiety disorders. Using self-report measures to assess individual anxiety, the researchers found a significant relationship between the Health Anxiety Inventory-Short Version (SHAI) and the Body Vigilance Scale, the Anxiety Sensitivity Index-Revised Respiratory, Cardiologic, and Cognitive subscales, the Penn State Worry Questionnaire, and the Beck Anxiety Inventory.

They found no significant relationship between the SHAI and the Anxiety Sensitivity Index-Revised Social subscale, the Obsessive-Compulsive Inventory-Revised, and the Social Interaction Anxiety Scale. When the results were analyzed by diagnostic group, patients with panic disorder and OCD had the highest SHAI scores.

Dr. Abramowitz said the results indicated several new findings about health anxiety and overall anxiety. “Patients with panic disorder and OCD have the strongest beliefs about the possibility of becoming ill,” he stated.

The findings underscore the importance of assessing for health-focused anxiety when treating people with anxiety, according to Dr. Abramowitz. But the study has limits, he readily admits. It relies entirely on self-reported measures of anxiety, which could introduce bias into the results.

CHICAGO — Health anxiety is a prominent feature of all types of anxiety disorders, Jonathan S. Abramowitz, Ph.D., reported at the annual meeting of the Association for Behavioral and Cognitive Therapies.

“Health concerns are present across the anxiety disorders,” said Dr. Abramowitz, professor of psychology at the University of North Carolina at Chapel Hill and director of the obsessive-compulsive disorder/anxiety disorder treatment and research program there.

In a study of 157 adults who were patients at the Mayo Clinic in Rochester, Minn., where Dr. Abramowitz previously worked, 49 had panic disorder, 32 had social phobia, 21 had generalized anxiety disorder, 18 had obsessive-compulsive disorder (OCD), 21 had hypochondriasis, and 16 had specific phobias. The researchers made these diagnoses using the Structured Clinical Interview for DSM-IV-TR or the mini international neuropsychiatric interview. More than half the participants (58%) were women, 88% were white, 52% had at least a 2-year college degree, and 55% were married.

The results showed a positive relationship between health anxiety and most other anxiety disorders. Using self-report measures to assess individual anxiety, the researchers found a significant relationship between the Health Anxiety Inventory-Short Version (SHAI) and the Body Vigilance Scale, the Anxiety Sensitivity Index-Revised Respiratory, Cardiologic, and Cognitive subscales, the Penn State Worry Questionnaire, and the Beck Anxiety Inventory.

They found no significant relationship between the SHAI and the Anxiety Sensitivity Index-Revised Social subscale, the Obsessive-Compulsive Inventory-Revised, and the Social Interaction Anxiety Scale. When the results were analyzed by diagnostic group, patients with panic disorder and OCD had the highest SHAI scores.

Dr. Abramowitz said the results indicated several new findings about health anxiety and overall anxiety. “Patients with panic disorder and OCD have the strongest beliefs about the possibility of becoming ill,” he stated.

The findings underscore the importance of assessing for health-focused anxiety when treating people with anxiety, according to Dr. Abramowitz. But the study has limits, he readily admits. It relies entirely on self-reported measures of anxiety, which could introduce bias into the results.

CHICAGO — Health anxiety is a prominent feature of all types of anxiety disorders, Jonathan S. Abramowitz, Ph.D., reported at the annual meeting of the Association for Behavioral and Cognitive Therapies.

“Health concerns are present across the anxiety disorders,” said Dr. Abramowitz, professor of psychology at the University of North Carolina at Chapel Hill and director of the obsessive-compulsive disorder/anxiety disorder treatment and research program there.

In a study of 157 adults who were patients at the Mayo Clinic in Rochester, Minn., where Dr. Abramowitz previously worked, 49 had panic disorder, 32 had social phobia, 21 had generalized anxiety disorder, 18 had obsessive-compulsive disorder (OCD), 21 had hypochondriasis, and 16 had specific phobias. The researchers made these diagnoses using the Structured Clinical Interview for DSM-IV-TR or the mini international neuropsychiatric interview. More than half the participants (58%) were women, 88% were white, 52% had at least a 2-year college degree, and 55% were married.

The results showed a positive relationship between health anxiety and most other anxiety disorders. Using self-report measures to assess individual anxiety, the researchers found a significant relationship between the Health Anxiety Inventory-Short Version (SHAI) and the Body Vigilance Scale, the Anxiety Sensitivity Index-Revised Respiratory, Cardiologic, and Cognitive subscales, the Penn State Worry Questionnaire, and the Beck Anxiety Inventory.

They found no significant relationship between the SHAI and the Anxiety Sensitivity Index-Revised Social subscale, the Obsessive-Compulsive Inventory-Revised, and the Social Interaction Anxiety Scale. When the results were analyzed by diagnostic group, patients with panic disorder and OCD had the highest SHAI scores.

Dr. Abramowitz said the results indicated several new findings about health anxiety and overall anxiety. “Patients with panic disorder and OCD have the strongest beliefs about the possibility of becoming ill,” he stated.

The findings underscore the importance of assessing for health-focused anxiety when treating people with anxiety, according to Dr. Abramowitz. But the study has limits, he readily admits. It relies entirely on self-reported measures of anxiety, which could introduce bias into the results.

Pass rates for the maintenance of certification exam have been declining in the past 5 years, and those who took the exam in spring 2006 had the lowest pass rate yet: Only 74% of physicians who took it made the grade.

“What we have been finding recently is that people are coming back sooner. That may lead to a lower pass rate,” said Dr. Christine Cassel, president and CEO of the American Board of Internal Medicine, which administers the exams. Because the maintenance of certification (MOC) cycle length is 10 years, physicians who take the exam 7 years into the cycle “may not be as well prepared as those who have more at stake,” she said.

The spring exam had the lowest pass rate in the history of the exam, which was established in 1995. According to the ABIM Web site, 92% of those taking the MOC for the first time passed the exam in 2001. The pass rate for first-timers declined steadily over the next few years, reaching 84% in 2005.

Some physicians may wonder if the lower pass rates reflect the exams. But Dr. Cassel emphasized that the exam has not become more difficult over the years. “We have studied these results very carefully,” she said, adding that the ABIM uses an elaborate statistical method to ensure that exam questions are fair and the level of testing does not change.

Louis Grasso, associate director for psychometrics at the ABIM, said the exam is validated by “a very rigorous process.” The board specifies what types of questions the exam should contain.

Groups of practicing internists also review the questions for relevance to everyday practice. The exam is somewhat self-validating; internal reviews show that physicians with greater medical knowledge tend to score higher, Dr. Grasso said.

Pass rates also might decline if the cohort of internists taking the exam is a less-robust group than previous cohorts. As Dr. Cassel points out, internists who took the original certifying exam about 10 years ago, when internal medicine was a less competitive specialty, did not perform as well on that exam, either. If indeed the lower pass rates were achieved by a less-competitive cohort overall, that validates the fact that the exam fairly reflects the abilities of a particular group of internists.

Dr. Chad Whelan, the director of the hospitalist program at the University of Chicago, shared his thoughts on the spring 2006 exam, which he passed. “I actually thought it was very fair. It felt similar to the [certifying exam] where, if you were up to date, and practicing a wide spectrum of internal medicine, then it was a reasonable task,” he said.

Dr. Cassel confirmed that the ABIM strives to include clinically relevant questions and focuses on the knowledge that physicians who are 10–20 years out of residency really should know.

'If you were up to date, and practicing a wide spectrum of internal medicine, then it was a reasonable task.' DR. WHELAN

Pass rates for the maintenance of certification exam have been declining in the past 5 years, and those who took the exam in spring 2006 had the lowest pass rate yet: Only 74% of physicians who took it made the grade.

“What we have been finding recently is that people are coming back sooner. That may lead to a lower pass rate,” said Dr. Christine Cassel, president and CEO of the American Board of Internal Medicine, which administers the exams. Because the maintenance of certification (MOC) cycle length is 10 years, physicians who take the exam 7 years into the cycle “may not be as well prepared as those who have more at stake,” she said.

The spring exam had the lowest pass rate in the history of the exam, which was established in 1995. According to the ABIM Web site, 92% of those taking the MOC for the first time passed the exam in 2001. The pass rate for first-timers declined steadily over the next few years, reaching 84% in 2005.

Some physicians may wonder if the lower pass rates reflect the exams. But Dr. Cassel emphasized that the exam has not become more difficult over the years. “We have studied these results very carefully,” she said, adding that the ABIM uses an elaborate statistical method to ensure that exam questions are fair and the level of testing does not change.

Louis Grasso, associate director for psychometrics at the ABIM, said the exam is validated by “a very rigorous process.” The board specifies what types of questions the exam should contain.

Groups of practicing internists also review the questions for relevance to everyday practice. The exam is somewhat self-validating; internal reviews show that physicians with greater medical knowledge tend to score higher, Dr. Grasso said.

Pass rates also might decline if the cohort of internists taking the exam is a less-robust group than previous cohorts. As Dr. Cassel points out, internists who took the original certifying exam about 10 years ago, when internal medicine was a less competitive specialty, did not perform as well on that exam, either. If indeed the lower pass rates were achieved by a less-competitive cohort overall, that validates the fact that the exam fairly reflects the abilities of a particular group of internists.

Dr. Chad Whelan, the director of the hospitalist program at the University of Chicago, shared his thoughts on the spring 2006 exam, which he passed. “I actually thought it was very fair. It felt similar to the [certifying exam] where, if you were up to date, and practicing a wide spectrum of internal medicine, then it was a reasonable task,” he said.

Dr. Cassel confirmed that the ABIM strives to include clinically relevant questions and focuses on the knowledge that physicians who are 10–20 years out of residency really should know.

'If you were up to date, and practicing a wide spectrum of internal medicine, then it was a reasonable task.' DR. WHELAN

Pass rates for the maintenance of certification exam have been declining in the past 5 years, and those who took the exam in spring 2006 had the lowest pass rate yet: Only 74% of physicians who took it made the grade.

“What we have been finding recently is that people are coming back sooner. That may lead to a lower pass rate,” said Dr. Christine Cassel, president and CEO of the American Board of Internal Medicine, which administers the exams. Because the maintenance of certification (MOC) cycle length is 10 years, physicians who take the exam 7 years into the cycle “may not be as well prepared as those who have more at stake,” she said.

The spring exam had the lowest pass rate in the history of the exam, which was established in 1995. According to the ABIM Web site, 92% of those taking the MOC for the first time passed the exam in 2001. The pass rate for first-timers declined steadily over the next few years, reaching 84% in 2005.

Some physicians may wonder if the lower pass rates reflect the exams. But Dr. Cassel emphasized that the exam has not become more difficult over the years. “We have studied these results very carefully,” she said, adding that the ABIM uses an elaborate statistical method to ensure that exam questions are fair and the level of testing does not change.

Louis Grasso, associate director for psychometrics at the ABIM, said the exam is validated by “a very rigorous process.” The board specifies what types of questions the exam should contain.

Groups of practicing internists also review the questions for relevance to everyday practice. The exam is somewhat self-validating; internal reviews show that physicians with greater medical knowledge tend to score higher, Dr. Grasso said.

Pass rates also might decline if the cohort of internists taking the exam is a less-robust group than previous cohorts. As Dr. Cassel points out, internists who took the original certifying exam about 10 years ago, when internal medicine was a less competitive specialty, did not perform as well on that exam, either. If indeed the lower pass rates were achieved by a less-competitive cohort overall, that validates the fact that the exam fairly reflects the abilities of a particular group of internists.

Dr. Chad Whelan, the director of the hospitalist program at the University of Chicago, shared his thoughts on the spring 2006 exam, which he passed. “I actually thought it was very fair. It felt similar to the [certifying exam] where, if you were up to date, and practicing a wide spectrum of internal medicine, then it was a reasonable task,” he said.

Dr. Cassel confirmed that the ABIM strives to include clinically relevant questions and focuses on the knowledge that physicians who are 10–20 years out of residency really should know.

'If you were up to date, and practicing a wide spectrum of internal medicine, then it was a reasonable task.' DR. WHELAN

CHICAGO — Elastic imaging, a noninvasive ultrasound technique, can help radiologists improve the accuracy of breast cancer diagnosis in women with abnormal mammograms, according to a study of 99 women.

Elastic imaging works by combining ultrasound techniques with the principles of a manual breast exam. This technique evaluates how much breast tissue moves when an examiner pushes on the breast being examined with the transducer, giving an indication of how soft or stiff a particular lesion is.

Examiners use a standard ultrasound machine with additional software to also determine the relative darkness of the lesions as well as the size of each lesion. Stiff lesions that appear black on ultrasound are more likely to be malignant, and soft lesions that appear white are more likely to be benign, Dr. Richard G. Barr said at a press briefing during the annual meeting of the Radiological Society of North America.

“The ultrasound looks to see how the tissues move,” he said.

Using a real-time, free-hand elasticity imaging technique along with a routine ultrasound exam, Dr. Barr, a professor of radiology at Northeastern Ohio Universities, Rootstown, studied 166 breast lesions initially identified by mammogram in 99 women undergoing standard screening mammograms.

He measured the largest length in the lesions using both the standard ultrasound image and the elasticity image. If the lesion appeared smaller on the elasticity image than on the standard image, it was classified as benign; if it appeared larger on the elasticity image than on the standard image, it was considered malignant.

Dr. Barr subsequently performed ultrasound-guided biopsies on 80 patients with 123 lesions to verify the ultrasound findings. The biopsy results indicated that the elastic imaging identified all 17 malignant lesions correctly and 105 of the 106 benign lesions. These findings indicate that the elastic imaging had a sensitivity of 100% and a specificity of 99% in this study.

Citing American Cancer Society data, Dr. Barr noted that doctors perform about 1.4 million breast biopsies each year, and 80% of these biopsies are benign. This technique could help prevent unnecessary breast biopsies in women with suspicious lesions. “There is a potential for us to significantly decrease the number of breast biopsies performed,” Dr. Barr said.

He was satisfied that in the study, the lesion always appeared larger on the elasticity image than on the ultrasound image if it was considered malignant, no matter how he and the other researchers positioned the patient to do the ultrasound. “To be useful in a clinical setting, the procedure needs to be robust,” he said.

Despite the promising results, Dr. Barr admits that no one is sure exactly why malignant lesions appear larger than benign ones on this specialized ultrasound. “I don't know [why this works],” he said. He added, “I don't think anyone else does.”

The FDA recently approved elastic ultrasound imaging, and radiologists will probably begin using this technique within the next 6 months. Dr. Barr noted that a much larger study will be needed to confirm the sensitivity and specificity of this technique.

A lesion that was shown to be invasive ductal carcinoma appears much smaller in a conventional ultrasound image (left) than in an elastic ultrasound image (right). Radiological Society of North America

CHICAGO — Elastic imaging, a noninvasive ultrasound technique, can help radiologists improve the accuracy of breast cancer diagnosis in women with abnormal mammograms, according to a study of 99 women.

Elastic imaging works by combining ultrasound techniques with the principles of a manual breast exam. This technique evaluates how much breast tissue moves when an examiner pushes on the breast being examined with the transducer, giving an indication of how soft or stiff a particular lesion is.

Examiners use a standard ultrasound machine with additional software to also determine the relative darkness of the lesions as well as the size of each lesion. Stiff lesions that appear black on ultrasound are more likely to be malignant, and soft lesions that appear white are more likely to be benign, Dr. Richard G. Barr said at a press briefing during the annual meeting of the Radiological Society of North America.

“The ultrasound looks to see how the tissues move,” he said.

Using a real-time, free-hand elasticity imaging technique along with a routine ultrasound exam, Dr. Barr, a professor of radiology at Northeastern Ohio Universities, Rootstown, studied 166 breast lesions initially identified by mammogram in 99 women undergoing standard screening mammograms.

He measured the largest length in the lesions using both the standard ultrasound image and the elasticity image. If the lesion appeared smaller on the elasticity image than on the standard image, it was classified as benign; if it appeared larger on the elasticity image than on the standard image, it was considered malignant.

Dr. Barr subsequently performed ultrasound-guided biopsies on 80 patients with 123 lesions to verify the ultrasound findings. The biopsy results indicated that the elastic imaging identified all 17 malignant lesions correctly and 105 of the 106 benign lesions. These findings indicate that the elastic imaging had a sensitivity of 100% and a specificity of 99% in this study.

Citing American Cancer Society data, Dr. Barr noted that doctors perform about 1.4 million breast biopsies each year, and 80% of these biopsies are benign. This technique could help prevent unnecessary breast biopsies in women with suspicious lesions. “There is a potential for us to significantly decrease the number of breast biopsies performed,” Dr. Barr said.

He was satisfied that in the study, the lesion always appeared larger on the elasticity image than on the ultrasound image if it was considered malignant, no matter how he and the other researchers positioned the patient to do the ultrasound. “To be useful in a clinical setting, the procedure needs to be robust,” he said.

Despite the promising results, Dr. Barr admits that no one is sure exactly why malignant lesions appear larger than benign ones on this specialized ultrasound. “I don't know [why this works],” he said. He added, “I don't think anyone else does.”

The FDA recently approved elastic ultrasound imaging, and radiologists will probably begin using this technique within the next 6 months. Dr. Barr noted that a much larger study will be needed to confirm the sensitivity and specificity of this technique.

A lesion that was shown to be invasive ductal carcinoma appears much smaller in a conventional ultrasound image (left) than in an elastic ultrasound image (right). Radiological Society of North America

CHICAGO — Elastic imaging, a noninvasive ultrasound technique, can help radiologists improve the accuracy of breast cancer diagnosis in women with abnormal mammograms, according to a study of 99 women.

Elastic imaging works by combining ultrasound techniques with the principles of a manual breast exam. This technique evaluates how much breast tissue moves when an examiner pushes on the breast being examined with the transducer, giving an indication of how soft or stiff a particular lesion is.

Examiners use a standard ultrasound machine with additional software to also determine the relative darkness of the lesions as well as the size of each lesion. Stiff lesions that appear black on ultrasound are more likely to be malignant, and soft lesions that appear white are more likely to be benign, Dr. Richard G. Barr said at a press briefing during the annual meeting of the Radiological Society of North America.

“The ultrasound looks to see how the tissues move,” he said.

Using a real-time, free-hand elasticity imaging technique along with a routine ultrasound exam, Dr. Barr, a professor of radiology at Northeastern Ohio Universities, Rootstown, studied 166 breast lesions initially identified by mammogram in 99 women undergoing standard screening mammograms.

He measured the largest length in the lesions using both the standard ultrasound image and the elasticity image. If the lesion appeared smaller on the elasticity image than on the standard image, it was classified as benign; if it appeared larger on the elasticity image than on the standard image, it was considered malignant.

Dr. Barr subsequently performed ultrasound-guided biopsies on 80 patients with 123 lesions to verify the ultrasound findings. The biopsy results indicated that the elastic imaging identified all 17 malignant lesions correctly and 105 of the 106 benign lesions. These findings indicate that the elastic imaging had a sensitivity of 100% and a specificity of 99% in this study.

Citing American Cancer Society data, Dr. Barr noted that doctors perform about 1.4 million breast biopsies each year, and 80% of these biopsies are benign. This technique could help prevent unnecessary breast biopsies in women with suspicious lesions. “There is a potential for us to significantly decrease the number of breast biopsies performed,” Dr. Barr said.

He was satisfied that in the study, the lesion always appeared larger on the elasticity image than on the ultrasound image if it was considered malignant, no matter how he and the other researchers positioned the patient to do the ultrasound. “To be useful in a clinical setting, the procedure needs to be robust,” he said.

Despite the promising results, Dr. Barr admits that no one is sure exactly why malignant lesions appear larger than benign ones on this specialized ultrasound. “I don't know [why this works],” he said. He added, “I don't think anyone else does.”

The FDA recently approved elastic ultrasound imaging, and radiologists will probably begin using this technique within the next 6 months. Dr. Barr noted that a much larger study will be needed to confirm the sensitivity and specificity of this technique.

A lesion that was shown to be invasive ductal carcinoma appears much smaller in a conventional ultrasound image (left) than in an elastic ultrasound image (right). Radiological Society of North America

CHICAGO – Self-oriented and socially prescribed perfectionism in female college students who also have body dissatisfaction are important factors putting these women at risk for eating disorders, Christina A. Downey said at the annual meeting of the Association for Behavioral and Cognitive Therapies.

“Body dissatisfaction was the strongest predictor of eating disorders,” said Ms. Downey, a graduate student at the University of Michigan in Ann Arbor.

The study evaluated 310 women enrolled in a psychology class at a large university. Of the original sample, 307 turned in complete questionnaires.

The age of the participants ranged from 18 to 38 years, with a mean of 19 years. Of the 310 women, 189 (61%) were white, 36 (12%) were black, 9 (3%) were Hispanic, 53 (17%) were Asian American/Pacific Islander, 1 (0.3%) was in the category of Native American/Inuit/Alaska Native, 19 (6%) identified as being Other, and 3 (1%) gave no indication of racial/ethnic group. In the present sample, body mass index (BMI) ranged from 15.34 kg/m

The researchers used the Multidimensional Perfectionism Scale (MPS) to measure perfectionism. They also used items deemed by a panel to be related to weight from the Body Areas Satisfaction (BAS) scale from the Multidimensional Body-Self Relations Questionnaire to measure body dissatisfaction.

In addition to these scales, the researchers used the Positive and Negative Affect Scale to measure negative affect. To measure for eating disturbances, they used the bulimia scale of the Eating Disorders Inventory and the dieting scale of the Eating Attitudes Test.

The results, as measured by the EAT-Dieting and EDI-Bulimia scales, respectively, showed that both self-oriented and socially prescribed perfectionism were associated with greater dieting and bulimic symptoms. However, the association between MPS-Social and EDI-Bulimia scores was found to be greater than the association between MPS-Self and EDI-Bulimia scores (rs = .32 versus .20, respectively, z = 2.26, p = .01), indicating that socially prescribed perfectionism is more strongly involved in bulimic symptoms than is self-oriented perfectionism.

Moreover, the association between MPS-Social and EDI-Bulimia scores was found to be greater than the association between MPS-Social and EAT-Dieting scores.

The researchers also found that both self-oriented and socially prescribed perfectionism were found to be associated with greater negative affect and greater body dissatisfaction. They determined, however, that the association between MPS-Social and BAS-Weight scores was greater than the association between MPS-Self and BAS-Weight scores.

They also found that negative affect was associated with both more dieting and more bulimic symptoms.

Ms. Downey concluded that the interactions between perfectionism and body dissatisfaction were extremely important, and that the presence or lack of body dissatisfaction could be a clue to the presence of eating disorders in college-aged women. “We found no relationship between perfectionism and eating disorders in the highly bodily satisfied group,” she added.

On the other hand, clinicians should be aware of how powerfully perfectionism and body dissatisfaction can interact together in young women. “The interaction between socially prescribed perfectionism and eating disturbance was clinically important, as it points to a particularly dangerous combination of personality traits and cognition in predicting serious symptoms of an eating disorder,” Ms. Downey said in an interview.

CHICAGO – Self-oriented and socially prescribed perfectionism in female college students who also have body dissatisfaction are important factors putting these women at risk for eating disorders, Christina A. Downey said at the annual meeting of the Association for Behavioral and Cognitive Therapies.

“Body dissatisfaction was the strongest predictor of eating disorders,” said Ms. Downey, a graduate student at the University of Michigan in Ann Arbor.

The study evaluated 310 women enrolled in a psychology class at a large university. Of the original sample, 307 turned in complete questionnaires.

The age of the participants ranged from 18 to 38 years, with a mean of 19 years. Of the 310 women, 189 (61%) were white, 36 (12%) were black, 9 (3%) were Hispanic, 53 (17%) were Asian American/Pacific Islander, 1 (0.3%) was in the category of Native American/Inuit/Alaska Native, 19 (6%) identified as being Other, and 3 (1%) gave no indication of racial/ethnic group. In the present sample, body mass index (BMI) ranged from 15.34 kg/m

The researchers used the Multidimensional Perfectionism Scale (MPS) to measure perfectionism. They also used items deemed by a panel to be related to weight from the Body Areas Satisfaction (BAS) scale from the Multidimensional Body-Self Relations Questionnaire to measure body dissatisfaction.

In addition to these scales, the researchers used the Positive and Negative Affect Scale to measure negative affect. To measure for eating disturbances, they used the bulimia scale of the Eating Disorders Inventory and the dieting scale of the Eating Attitudes Test.

The results, as measured by the EAT-Dieting and EDI-Bulimia scales, respectively, showed that both self-oriented and socially prescribed perfectionism were associated with greater dieting and bulimic symptoms. However, the association between MPS-Social and EDI-Bulimia scores was found to be greater than the association between MPS-Self and EDI-Bulimia scores (rs = .32 versus .20, respectively, z = 2.26, p = .01), indicating that socially prescribed perfectionism is more strongly involved in bulimic symptoms than is self-oriented perfectionism.

Moreover, the association between MPS-Social and EDI-Bulimia scores was found to be greater than the association between MPS-Social and EAT-Dieting scores.

The researchers also found that both self-oriented and socially prescribed perfectionism were found to be associated with greater negative affect and greater body dissatisfaction. They determined, however, that the association between MPS-Social and BAS-Weight scores was greater than the association between MPS-Self and BAS-Weight scores.

They also found that negative affect was associated with both more dieting and more bulimic symptoms.

Ms. Downey concluded that the interactions between perfectionism and body dissatisfaction were extremely important, and that the presence or lack of body dissatisfaction could be a clue to the presence of eating disorders in college-aged women. “We found no relationship between perfectionism and eating disorders in the highly bodily satisfied group,” she added.

On the other hand, clinicians should be aware of how powerfully perfectionism and body dissatisfaction can interact together in young women. “The interaction between socially prescribed perfectionism and eating disturbance was clinically important, as it points to a particularly dangerous combination of personality traits and cognition in predicting serious symptoms of an eating disorder,” Ms. Downey said in an interview.

CHICAGO – Self-oriented and socially prescribed perfectionism in female college students who also have body dissatisfaction are important factors putting these women at risk for eating disorders, Christina A. Downey said at the annual meeting of the Association for Behavioral and Cognitive Therapies.

“Body dissatisfaction was the strongest predictor of eating disorders,” said Ms. Downey, a graduate student at the University of Michigan in Ann Arbor.

The study evaluated 310 women enrolled in a psychology class at a large university. Of the original sample, 307 turned in complete questionnaires.

The age of the participants ranged from 18 to 38 years, with a mean of 19 years. Of the 310 women, 189 (61%) were white, 36 (12%) were black, 9 (3%) were Hispanic, 53 (17%) were Asian American/Pacific Islander, 1 (0.3%) was in the category of Native American/Inuit/Alaska Native, 19 (6%) identified as being Other, and 3 (1%) gave no indication of racial/ethnic group. In the present sample, body mass index (BMI) ranged from 15.34 kg/m

The researchers used the Multidimensional Perfectionism Scale (MPS) to measure perfectionism. They also used items deemed by a panel to be related to weight from the Body Areas Satisfaction (BAS) scale from the Multidimensional Body-Self Relations Questionnaire to measure body dissatisfaction.

In addition to these scales, the researchers used the Positive and Negative Affect Scale to measure negative affect. To measure for eating disturbances, they used the bulimia scale of the Eating Disorders Inventory and the dieting scale of the Eating Attitudes Test.

The results, as measured by the EAT-Dieting and EDI-Bulimia scales, respectively, showed that both self-oriented and socially prescribed perfectionism were associated with greater dieting and bulimic symptoms. However, the association between MPS-Social and EDI-Bulimia scores was found to be greater than the association between MPS-Self and EDI-Bulimia scores (rs = .32 versus .20, respectively, z = 2.26, p = .01), indicating that socially prescribed perfectionism is more strongly involved in bulimic symptoms than is self-oriented perfectionism.

Moreover, the association between MPS-Social and EDI-Bulimia scores was found to be greater than the association between MPS-Social and EAT-Dieting scores.

The researchers also found that both self-oriented and socially prescribed perfectionism were found to be associated with greater negative affect and greater body dissatisfaction. They determined, however, that the association between MPS-Social and BAS-Weight scores was greater than the association between MPS-Self and BAS-Weight scores.

They also found that negative affect was associated with both more dieting and more bulimic symptoms.

Ms. Downey concluded that the interactions between perfectionism and body dissatisfaction were extremely important, and that the presence or lack of body dissatisfaction could be a clue to the presence of eating disorders in college-aged women. “We found no relationship between perfectionism and eating disorders in the highly bodily satisfied group,” she added.

On the other hand, clinicians should be aware of how powerfully perfectionism and body dissatisfaction can interact together in young women. “The interaction between socially prescribed perfectionism and eating disturbance was clinically important, as it points to a particularly dangerous combination of personality traits and cognition in predicting serious symptoms of an eating disorder,” Ms. Downey said in an interview.

The presence of an anxiety or depressive disorder in asthmatic children aged 11–17 years is associated with an increase in asthma symptoms, reported Dr. Laura P. Richardson of the University of Washington, Seattle, and her colleagues.

“We found that youth with an anxiety or depressive disorder reported significantly more asthma symptom days than youth without anxiety or depressive disorders after controlling for asthma severity,” reported Dr. Richardson and her associates.

The researchers conducted a telephone survey of 767 children and adolescents aged 11–17 with a history of asthma who belonged to a health maintenance organization in Washington State. The study participants were considered to have asthma if they met certain criteria for the number of office or emergency department visits, hospitalizations, and medication prescriptions for asthma in the 12− to 18-month period preceding the study (Pediatrics 2006;118:1042–51).

Nine percent of the study participants had an anxiety disorder, 2.5% had a depressive disorder, and 4.8% had both.

The results showed that the youth with an anxiety or depressive disorder reported more asthma symptom days in a 2-week period, compared with youth without one of these disorders: 5.4 symptom days, compared with 3.5 symptom days. In addition, compared with youth without an anxiety or depressive disorder, youth with one of these disorders were more likely to be girls, to have a parent without a college education, to have a recent asthma diagnosis, and to be taking one medication to control asthma symptoms.

The presence of an anxiety or depressive disorder in asthmatic children aged 11–17 years is associated with an increase in asthma symptoms, reported Dr. Laura P. Richardson of the University of Washington, Seattle, and her colleagues.

“We found that youth with an anxiety or depressive disorder reported significantly more asthma symptom days than youth without anxiety or depressive disorders after controlling for asthma severity,” reported Dr. Richardson and her associates.

The researchers conducted a telephone survey of 767 children and adolescents aged 11–17 with a history of asthma who belonged to a health maintenance organization in Washington State. The study participants were considered to have asthma if they met certain criteria for the number of office or emergency department visits, hospitalizations, and medication prescriptions for asthma in the 12− to 18-month period preceding the study (Pediatrics 2006;118:1042–51).

Nine percent of the study participants had an anxiety disorder, 2.5% had a depressive disorder, and 4.8% had both.

The results showed that the youth with an anxiety or depressive disorder reported more asthma symptom days in a 2-week period, compared with youth without one of these disorders: 5.4 symptom days, compared with 3.5 symptom days. In addition, compared with youth without an anxiety or depressive disorder, youth with one of these disorders were more likely to be girls, to have a parent without a college education, to have a recent asthma diagnosis, and to be taking one medication to control asthma symptoms.

The presence of an anxiety or depressive disorder in asthmatic children aged 11–17 years is associated with an increase in asthma symptoms, reported Dr. Laura P. Richardson of the University of Washington, Seattle, and her colleagues.

“We found that youth with an anxiety or depressive disorder reported significantly more asthma symptom days than youth without anxiety or depressive disorders after controlling for asthma severity,” reported Dr. Richardson and her associates.

The researchers conducted a telephone survey of 767 children and adolescents aged 11–17 with a history of asthma who belonged to a health maintenance organization in Washington State. The study participants were considered to have asthma if they met certain criteria for the number of office or emergency department visits, hospitalizations, and medication prescriptions for asthma in the 12− to 18-month period preceding the study (Pediatrics 2006;118:1042–51).

Nine percent of the study participants had an anxiety disorder, 2.5% had a depressive disorder, and 4.8% had both.

The results showed that the youth with an anxiety or depressive disorder reported more asthma symptom days in a 2-week period, compared with youth without one of these disorders: 5.4 symptom days, compared with 3.5 symptom days. In addition, compared with youth without an anxiety or depressive disorder, youth with one of these disorders were more likely to be girls, to have a parent without a college education, to have a recent asthma diagnosis, and to be taking one medication to control asthma symptoms.

Sleep problems in school-aged children appear to be associated with depression but not with anxiety, reported Alice M. Gregory, Ph.D., of King's College of London, and her colleagues.

Their study of sleep problems in twins suggests that genetics also may play a role in these disorders. “Symptoms of depression in midchildhood are associated with a range of sleep difficulties, indicating that it may be useful to assess sleep difficulties in children who present with symptoms of depression and vice versa,” they said (Pediatrics 2006;118:1124–32).

The 300 twin pairs who participated in this study came from the Emotions, Cognitions, Hereditary, and Outcome (ECHO) study. The pairs had a mean age of 8 years, and there were more girls than boys (57% vs. 43%). Most families in the study were white (87%), and most parents in the study had completed education to at least age 18 years and were employed at the time of the study.

Children in the ECHO sample were screened for anxiety at age 8 using the Screen for Childhood Anxiety-Related Disorders. They were screened for depression with the Children's Depression Inventory. Parents reported on the sleep habits of their 8-year-olds with a version of the Child Sleep Habits Questionnaire.

Self-reported depression indicators were greater in children with bedtime resistance, sleep-onset delay, sleep anxiety, and sleep parasomnia. Self-reported anxiety was higher in children with parent-related bedtime resistance than in those without this condition.

Sleep problems in school-aged children appear to be associated with depression but not with anxiety, reported Alice M. Gregory, Ph.D., of King's College of London, and her colleagues.

Their study of sleep problems in twins suggests that genetics also may play a role in these disorders. “Symptoms of depression in midchildhood are associated with a range of sleep difficulties, indicating that it may be useful to assess sleep difficulties in children who present with symptoms of depression and vice versa,” they said (Pediatrics 2006;118:1124–32).

The 300 twin pairs who participated in this study came from the Emotions, Cognitions, Hereditary, and Outcome (ECHO) study. The pairs had a mean age of 8 years, and there were more girls than boys (57% vs. 43%). Most families in the study were white (87%), and most parents in the study had completed education to at least age 18 years and were employed at the time of the study.

Children in the ECHO sample were screened for anxiety at age 8 using the Screen for Childhood Anxiety-Related Disorders. They were screened for depression with the Children's Depression Inventory. Parents reported on the sleep habits of their 8-year-olds with a version of the Child Sleep Habits Questionnaire.

Self-reported depression indicators were greater in children with bedtime resistance, sleep-onset delay, sleep anxiety, and sleep parasomnia. Self-reported anxiety was higher in children with parent-related bedtime resistance than in those without this condition.

Sleep problems in school-aged children appear to be associated with depression but not with anxiety, reported Alice M. Gregory, Ph.D., of King's College of London, and her colleagues.

Their study of sleep problems in twins suggests that genetics also may play a role in these disorders. “Symptoms of depression in midchildhood are associated with a range of sleep difficulties, indicating that it may be useful to assess sleep difficulties in children who present with symptoms of depression and vice versa,” they said (Pediatrics 2006;118:1124–32).

The 300 twin pairs who participated in this study came from the Emotions, Cognitions, Hereditary, and Outcome (ECHO) study. The pairs had a mean age of 8 years, and there were more girls than boys (57% vs. 43%). Most families in the study were white (87%), and most parents in the study had completed education to at least age 18 years and were employed at the time of the study.

Children in the ECHO sample were screened for anxiety at age 8 using the Screen for Childhood Anxiety-Related Disorders. They were screened for depression with the Children's Depression Inventory. Parents reported on the sleep habits of their 8-year-olds with a version of the Child Sleep Habits Questionnaire.

Self-reported depression indicators were greater in children with bedtime resistance, sleep-onset delay, sleep anxiety, and sleep parasomnia. Self-reported anxiety was higher in children with parent-related bedtime resistance than in those without this condition.

Men with a history of gouty arthritis have a significantly higher risk of developing an acute myocardial infarction, reported Dr. Eswar Krishnan of the University of Pittsburgh, and his associates.

“This study is the first to show that among men with no previous history of coronary artery disease, gouty arthritis is a significant independent correlate of subsequent acute myocardial infarction,” the researchers reported.

The results revealed a significantly greater number of acute MI events in men with gout (odds ratio, 1.26). The study also found that hyperuricemia is an independent risk factor for acute MI (OR, 1.11).

The finding comes from an evaluation of the Multiple Risk Factor Intervention Trial (MRFIT) data. Researchers of MRFIT, a randomized controlled trial of 12,866 men with a mean age of 46 years, followed the group prospectively for approximately 6.5 years. Initial evaluation included blood pressure and cholesterol measurement (Arthritis Rheum. 2006;54:2688–96). Men with a history of diabetes, acute MI, a high cholesterol level (350 mg/dL or higher), a diastolic blood pressure of greater than 115 mm Hg, and body weight greater than 150% of desirable weight were excluded.

In the original trial, the participants were randomized to a special intervention program that promoted smoking cessation and blood pressure and cholesterol reduction versus usual care, Dr. Krishnan and his associates reported.

To determine the potential relationship between acute MI and gout, the researchers used a two-part definition of gout.

Participants had to answer affirmatively when asked if they had ever been told by a physician that they had gout. They also had to have a uric acid level of greater than 7.0 mg/dL on at least four visits.

Though researchers have not fully elucidated the pathophysiology of the relationship between gouty arthritis and cardiovascular disease, Dr. Krishnan proposed that the increased inflammation associated with gout and hyperuricemia could lead to an increased risk for an acute MI.

Men with a history of gouty arthritis have a significantly higher risk of developing an acute myocardial infarction, reported Dr. Eswar Krishnan of the University of Pittsburgh, and his associates.

“This study is the first to show that among men with no previous history of coronary artery disease, gouty arthritis is a significant independent correlate of subsequent acute myocardial infarction,” the researchers reported.

The results revealed a significantly greater number of acute MI events in men with gout (odds ratio, 1.26). The study also found that hyperuricemia is an independent risk factor for acute MI (OR, 1.11).

The finding comes from an evaluation of the Multiple Risk Factor Intervention Trial (MRFIT) data. Researchers of MRFIT, a randomized controlled trial of 12,866 men with a mean age of 46 years, followed the group prospectively for approximately 6.5 years. Initial evaluation included blood pressure and cholesterol measurement (Arthritis Rheum. 2006;54:2688–96). Men with a history of diabetes, acute MI, a high cholesterol level (350 mg/dL or higher), a diastolic blood pressure of greater than 115 mm Hg, and body weight greater than 150% of desirable weight were excluded.

In the original trial, the participants were randomized to a special intervention program that promoted smoking cessation and blood pressure and cholesterol reduction versus usual care, Dr. Krishnan and his associates reported.

To determine the potential relationship between acute MI and gout, the researchers used a two-part definition of gout.

Participants had to answer affirmatively when asked if they had ever been told by a physician that they had gout. They also had to have a uric acid level of greater than 7.0 mg/dL on at least four visits.

Though researchers have not fully elucidated the pathophysiology of the relationship between gouty arthritis and cardiovascular disease, Dr. Krishnan proposed that the increased inflammation associated with gout and hyperuricemia could lead to an increased risk for an acute MI.

Men with a history of gouty arthritis have a significantly higher risk of developing an acute myocardial infarction, reported Dr. Eswar Krishnan of the University of Pittsburgh, and his associates.

“This study is the first to show that among men with no previous history of coronary artery disease, gouty arthritis is a significant independent correlate of subsequent acute myocardial infarction,” the researchers reported.

The results revealed a significantly greater number of acute MI events in men with gout (odds ratio, 1.26). The study also found that hyperuricemia is an independent risk factor for acute MI (OR, 1.11).

The finding comes from an evaluation of the Multiple Risk Factor Intervention Trial (MRFIT) data. Researchers of MRFIT, a randomized controlled trial of 12,866 men with a mean age of 46 years, followed the group prospectively for approximately 6.5 years. Initial evaluation included blood pressure and cholesterol measurement (Arthritis Rheum. 2006;54:2688–96). Men with a history of diabetes, acute MI, a high cholesterol level (350 mg/dL or higher), a diastolic blood pressure of greater than 115 mm Hg, and body weight greater than 150% of desirable weight were excluded.

In the original trial, the participants were randomized to a special intervention program that promoted smoking cessation and blood pressure and cholesterol reduction versus usual care, Dr. Krishnan and his associates reported.

To determine the potential relationship between acute MI and gout, the researchers used a two-part definition of gout.

Participants had to answer affirmatively when asked if they had ever been told by a physician that they had gout. They also had to have a uric acid level of greater than 7.0 mg/dL on at least four visits.

Though researchers have not fully elucidated the pathophysiology of the relationship between gouty arthritis and cardiovascular disease, Dr. Krishnan proposed that the increased inflammation associated with gout and hyperuricemia could lead to an increased risk for an acute MI.

Men with a history of gouty arthritis have a significantly higher risk of developing an acute myocardial infarction, reported Dr. Eswar Krishnan of the University of Pittsburgh, and his associates.

“This study is the first to show that among men with no previous history of coronary artery disease, gouty arthritis is a significant independent correlate of subsequent acute [MI],” they reported.

The results revealed a significantly greater number of acute MI events in men with gout (odds ratio, 1.26). The study also found that hyperuricemia is an independent risk factor for acute MI (OR, 1.11).

The finding comes from an evaluation of the Multiple Risk Factor Intervention Trial (MRFIT) data. Researchers of MRFIT, a randomized controlled trial of 12,866 men with a mean age of 46 years, followed the group prospectively for approximately 6.5 years. Initial evaluation included BP and cholesterol measurement (Arthritis Rheum. 2006;54:2688-96).

Men with a history of diabetes, acute MI, a high cholesterol level (350 mg/dL or higher), a diastolic blood pressure of greater than 115 mm Hg, and body weight greater than 150% of desirable weight were excluded. In the original trial, the participants were randomized to a special intervention program that promoted smoking cessation and blood pressure and cholesterol reduction versus usual care, Dr. Krishnan and his associates reported.

Men with a history of gouty arthritis have a significantly higher risk of developing an acute myocardial infarction, reported Dr. Eswar Krishnan of the University of Pittsburgh, and his associates.

“This study is the first to show that among men with no previous history of coronary artery disease, gouty arthritis is a significant independent correlate of subsequent acute [MI],” they reported.

The results revealed a significantly greater number of acute MI events in men with gout (odds ratio, 1.26). The study also found that hyperuricemia is an independent risk factor for acute MI (OR, 1.11).

The finding comes from an evaluation of the Multiple Risk Factor Intervention Trial (MRFIT) data. Researchers of MRFIT, a randomized controlled trial of 12,866 men with a mean age of 46 years, followed the group prospectively for approximately 6.5 years. Initial evaluation included BP and cholesterol measurement (Arthritis Rheum. 2006;54:2688-96).

Men with a history of diabetes, acute MI, a high cholesterol level (350 mg/dL or higher), a diastolic blood pressure of greater than 115 mm Hg, and body weight greater than 150% of desirable weight were excluded. In the original trial, the participants were randomized to a special intervention program that promoted smoking cessation and blood pressure and cholesterol reduction versus usual care, Dr. Krishnan and his associates reported.

Men with a history of gouty arthritis have a significantly higher risk of developing an acute myocardial infarction, reported Dr. Eswar Krishnan of the University of Pittsburgh, and his associates.

“This study is the first to show that among men with no previous history of coronary artery disease, gouty arthritis is a significant independent correlate of subsequent acute [MI],” they reported.

The results revealed a significantly greater number of acute MI events in men with gout (odds ratio, 1.26). The study also found that hyperuricemia is an independent risk factor for acute MI (OR, 1.11).

The finding comes from an evaluation of the Multiple Risk Factor Intervention Trial (MRFIT) data. Researchers of MRFIT, a randomized controlled trial of 12,866 men with a mean age of 46 years, followed the group prospectively for approximately 6.5 years. Initial evaluation included BP and cholesterol measurement (Arthritis Rheum. 2006;54:2688-96).

Men with a history of diabetes, acute MI, a high cholesterol level (350 mg/dL or higher), a diastolic blood pressure of greater than 115 mm Hg, and body weight greater than 150% of desirable weight were excluded. In the original trial, the participants were randomized to a special intervention program that promoted smoking cessation and blood pressure and cholesterol reduction versus usual care, Dr. Krishnan and his associates reported.

Men with a history of gouty arthritis have a significantly higher risk of developing an acute myocardial infarction, reported Dr. Eswar Krishnan of the University of Pittsburgh, and his associates.

“This study is the first to show that in men with no previous history of coronary artery disease, gouty arthritis is a significant independent correlate of subsequent acute myocardial infarction,” they said.

The results revealed a significantly greater number of acute MI events in men with gout (odds ratio, 1.26). The study also showed that hyperuricemia is an independent risk factor for acute MI (OR, 1.11).

The finding comes from an evaluation of the Multiple Risk Factor Intervention Trial (MRFIT) data. Researchers of MRFIT, a randomized controlled trial of 12,866 men with a mean age of 46 years, followed the group prospectively for approximately 6.5 years. Initial evaluation included blood pressure and cholesterol measurements (Arthritis Rheum. 2006;54:2688–96).

Men with a history of diabetes, acute MI, a high cholesterol level (350 mg/dL or higher), a diastolic blood pressure of greater than 115 mm Hg, and body weight greater than 150% of desirable weight were excluded. In the original trial, the participants were randomized to a special intervention program that promoted smoking cessation and blood pressure and cholesterol reduction versus usual care, Dr. Krishnan and his associates reported.

The researchers used a two-part definition of gout. Participants had to answer affirmatively when asked if they had ever been told by a physician that they had gout. They also had to have a uric acid level of greater than 7.0 mg/dL on at least four visits. This definition was used because obtaining joint fluid samples on all participants was not within the trial's scope.

Men with a history of gouty arthritis have a significantly higher risk of developing an acute myocardial infarction, reported Dr. Eswar Krishnan of the University of Pittsburgh, and his associates.

“This study is the first to show that in men with no previous history of coronary artery disease, gouty arthritis is a significant independent correlate of subsequent acute myocardial infarction,” they said.

The results revealed a significantly greater number of acute MI events in men with gout (odds ratio, 1.26). The study also showed that hyperuricemia is an independent risk factor for acute MI (OR, 1.11).

The finding comes from an evaluation of the Multiple Risk Factor Intervention Trial (MRFIT) data. Researchers of MRFIT, a randomized controlled trial of 12,866 men with a mean age of 46 years, followed the group prospectively for approximately 6.5 years. Initial evaluation included blood pressure and cholesterol measurements (Arthritis Rheum. 2006;54:2688–96).

Men with a history of diabetes, acute MI, a high cholesterol level (350 mg/dL or higher), a diastolic blood pressure of greater than 115 mm Hg, and body weight greater than 150% of desirable weight were excluded. In the original trial, the participants were randomized to a special intervention program that promoted smoking cessation and blood pressure and cholesterol reduction versus usual care, Dr. Krishnan and his associates reported.

The researchers used a two-part definition of gout. Participants had to answer affirmatively when asked if they had ever been told by a physician that they had gout. They also had to have a uric acid level of greater than 7.0 mg/dL on at least four visits. This definition was used because obtaining joint fluid samples on all participants was not within the trial's scope.

Men with a history of gouty arthritis have a significantly higher risk of developing an acute myocardial infarction, reported Dr. Eswar Krishnan of the University of Pittsburgh, and his associates.

“This study is the first to show that in men with no previous history of coronary artery disease, gouty arthritis is a significant independent correlate of subsequent acute myocardial infarction,” they said.

The results revealed a significantly greater number of acute MI events in men with gout (odds ratio, 1.26). The study also showed that hyperuricemia is an independent risk factor for acute MI (OR, 1.11).

The finding comes from an evaluation of the Multiple Risk Factor Intervention Trial (MRFIT) data. Researchers of MRFIT, a randomized controlled trial of 12,866 men with a mean age of 46 years, followed the group prospectively for approximately 6.5 years. Initial evaluation included blood pressure and cholesterol measurements (Arthritis Rheum. 2006;54:2688–96).

Men with a history of diabetes, acute MI, a high cholesterol level (350 mg/dL or higher), a diastolic blood pressure of greater than 115 mm Hg, and body weight greater than 150% of desirable weight were excluded. In the original trial, the participants were randomized to a special intervention program that promoted smoking cessation and blood pressure and cholesterol reduction versus usual care, Dr. Krishnan and his associates reported.

The researchers used a two-part definition of gout. Participants had to answer affirmatively when asked if they had ever been told by a physician that they had gout. They also had to have a uric acid level of greater than 7.0 mg/dL on at least four visits. This definition was used because obtaining joint fluid samples on all participants was not within the trial's scope.