Kate Johnson

SAN FRANCISCO — A new drospirenone-based oral contraceptive awaiting approval by the Food and Drug Administration is effective in relieving premenstrual symptoms because it is given in a low dose and for an extended regimen, according to new research.

Drospirenone is a progestin derived from spironolactone, and thus has a diuretic effect that other progestins do not, Gloria Bachmann, M.D., reported at the annual meeting of the American College of Obstetricians and Gynecologists.

Drospirenone is used in an FDA-approved OC (Yasmin, manufactured by Berlex) in a formulation of 30 mcg of ethinyl estradiol (EE) and 3 mg of drospirenone given in the typical OC regimen of 21 days, followed by 7 hormone-free days.

But the newer low-dose formulation (20 mcg of EE/3 mg drospirenone) given over a 24-day period with only 4 hormone-free days can significantly reduce symptoms of premenstrual dysphoric disorder (PMDD), compared with placebo, said Dr. Bachmann, associate dean for women's health and professor of obstetrics and gynecology at Robert Wood Johnson Medical School, New Brunswick, N.J.

“In the usual OC cycle of 21 hormone days and 7 days off, women begin to get symptomatic even before the pill-free interval because their ovaries are not totally suppressed,” she said in an interview.

“By giving an extended number of days of hormone, you have better ovarian suppression and thus fewer symptoms during the shorter pill-free interval,” she added.

Dr. Bachmann presented a double-blind study, funded by Berlex, in which 83 women with PMDD were randomized to either the low-dose drospirenone-based extended OC regimen (42 women) or placebo (41 women) for three cycles of treatment followed by a washout cycle. The women then crossed over to the other arm of treatment for another three cycles.

PMDD symptoms were assessed using the Daily Record of Severity of Problems (DRSP) scale, which includes 21 symptoms and three functional impairment measures.

Active treatment was significantly more effective than placebo in relieving emotional and physical symptoms of PMDD, and the effects were similar to those seen when PMDD is treated with selective serotonin reuptake inhibitors (SSRIs), Dr. Bachmann said.

“If you're deciding between an SSRI and an OC [to treat women with PMDD], you have the added benefit of birth control. You're actually improving the gynecologic health of women as well, so it's a win-win situation,” according to Dr. Bachmann.

SAN FRANCISCO — A new drospirenone-based oral contraceptive awaiting approval by the Food and Drug Administration is effective in relieving premenstrual symptoms because it is given in a low dose and for an extended regimen, according to new research.

Drospirenone is a progestin derived from spironolactone, and thus has a diuretic effect that other progestins do not, Gloria Bachmann, M.D., reported at the annual meeting of the American College of Obstetricians and Gynecologists.

Drospirenone is used in an FDA-approved OC (Yasmin, manufactured by Berlex) in a formulation of 30 mcg of ethinyl estradiol (EE) and 3 mg of drospirenone given in the typical OC regimen of 21 days, followed by 7 hormone-free days.

But the newer low-dose formulation (20 mcg of EE/3 mg drospirenone) given over a 24-day period with only 4 hormone-free days can significantly reduce symptoms of premenstrual dysphoric disorder (PMDD), compared with placebo, said Dr. Bachmann, associate dean for women's health and professor of obstetrics and gynecology at Robert Wood Johnson Medical School, New Brunswick, N.J.

“In the usual OC cycle of 21 hormone days and 7 days off, women begin to get symptomatic even before the pill-free interval because their ovaries are not totally suppressed,” she said in an interview.

“By giving an extended number of days of hormone, you have better ovarian suppression and thus fewer symptoms during the shorter pill-free interval,” she added.

Dr. Bachmann presented a double-blind study, funded by Berlex, in which 83 women with PMDD were randomized to either the low-dose drospirenone-based extended OC regimen (42 women) or placebo (41 women) for three cycles of treatment followed by a washout cycle. The women then crossed over to the other arm of treatment for another three cycles.

PMDD symptoms were assessed using the Daily Record of Severity of Problems (DRSP) scale, which includes 21 symptoms and three functional impairment measures.

Active treatment was significantly more effective than placebo in relieving emotional and physical symptoms of PMDD, and the effects were similar to those seen when PMDD is treated with selective serotonin reuptake inhibitors (SSRIs), Dr. Bachmann said.

“If you're deciding between an SSRI and an OC [to treat women with PMDD], you have the added benefit of birth control. You're actually improving the gynecologic health of women as well, so it's a win-win situation,” according to Dr. Bachmann.

SAN FRANCISCO — A new drospirenone-based oral contraceptive awaiting approval by the Food and Drug Administration is effective in relieving premenstrual symptoms because it is given in a low dose and for an extended regimen, according to new research.

Drospirenone is a progestin derived from spironolactone, and thus has a diuretic effect that other progestins do not, Gloria Bachmann, M.D., reported at the annual meeting of the American College of Obstetricians and Gynecologists.

Drospirenone is used in an FDA-approved OC (Yasmin, manufactured by Berlex) in a formulation of 30 mcg of ethinyl estradiol (EE) and 3 mg of drospirenone given in the typical OC regimen of 21 days, followed by 7 hormone-free days.

But the newer low-dose formulation (20 mcg of EE/3 mg drospirenone) given over a 24-day period with only 4 hormone-free days can significantly reduce symptoms of premenstrual dysphoric disorder (PMDD), compared with placebo, said Dr. Bachmann, associate dean for women's health and professor of obstetrics and gynecology at Robert Wood Johnson Medical School, New Brunswick, N.J.

“In the usual OC cycle of 21 hormone days and 7 days off, women begin to get symptomatic even before the pill-free interval because their ovaries are not totally suppressed,” she said in an interview.

“By giving an extended number of days of hormone, you have better ovarian suppression and thus fewer symptoms during the shorter pill-free interval,” she added.

Dr. Bachmann presented a double-blind study, funded by Berlex, in which 83 women with PMDD were randomized to either the low-dose drospirenone-based extended OC regimen (42 women) or placebo (41 women) for three cycles of treatment followed by a washout cycle. The women then crossed over to the other arm of treatment for another three cycles.

PMDD symptoms were assessed using the Daily Record of Severity of Problems (DRSP) scale, which includes 21 symptoms and three functional impairment measures.

Active treatment was significantly more effective than placebo in relieving emotional and physical symptoms of PMDD, and the effects were similar to those seen when PMDD is treated with selective serotonin reuptake inhibitors (SSRIs), Dr. Bachmann said.

“If you're deciding between an SSRI and an OC [to treat women with PMDD], you have the added benefit of birth control. You're actually improving the gynecologic health of women as well, so it's a win-win situation,” according to Dr. Bachmann.

MONTREAL — Comorbid eating disorders and substance abuse are intertwined behaviorally and biologically, so the treatment of both problems must be an integrated effort, Cynthia M. Bulik, Ph.D., said at an international conference sponsored by the Academy for Eating Disorders.

And with growing numbers of middle-aged women presenting to eating disorder programs, substance abuse comorbidity is being seen more frequently than in the teenage population, she said.

“We don't have sufficient integrated treatment programs, so often patients will go to substance abuse programs, which either ignore or are ill equipped to deal with their eating disorder, and then they are sent to an eating disorders program without necessarily the proper follow-up for their substance abuse,” said Dr. Bulik, professor of eating disorders and nutrition at the University of North Carolina, Chapel Hill.

Although the abuse of substances, such as laxatives or diet pills, may have superficial connections to the desire for weight loss, the abuse is almost always intertwined with other complex psychiatric issues, noted Dr. Bulik.

“If we try to discourage a patient from abusing laxatives by pointing out that they are ineffective as weight loss agents, we are missing the mark clinically, because there's a real self-harm component to this behavior,” she said in an interview. “When a person takes 50 laxatives a day, it hurts, there's incredible cramping and diarrhea, it keeps them up at night, and it's very painful. If we fail to address this whole self-punishing aspect, we're really not addressing their needs.”

Indeed, she and her associates have found that laxative abuse, most common among patients with purging anorexia (72%) and combined anorexia and bulimia nervosa (59%), is associated with a significantly higher prevalence of borderline personality disorder—characterized particularly by feelings of suicidality, self-harm, emptiness, and anger, she reported.

In another study, Dr. Bulik and her associates found that alcohol abuse is more prevalent in patients with bulimia (46%) and combined bulimia and anorexia (37%), compared with those with anorexia (16%) alone (J. Clin. Psychiatry 2004;65:1000–6). Other studies have suggested anywhere from two to six times the risk of alcohol dependency in the eating disordered population, compared with the general population, she said.

As with laxative abuse, alcohol abuse in patients with eating disorders occurs with other psychiatric comorbidities such as major depressive disorder, obsessive compulsive disorder, posttraumatic stress disorder, social phobia, borderline personality disorder, and perfectionism—all of which need to be evaluated and treated, Dr. Bulik said.

Also, other drugs such as nicotine and caffeine should be considered more problematic in patients with eating disorders than in healthy individuals, she said. In such patients, these drugs can actually be part of the eating disorder.

Research suggests that smoking can significantly increase resting energy expenditure, making it counterproductive to treatment because it can interfere with the treatment goal of weight restoration; caffeine is used to overcome some of the fatigue caused by undernourishment. “There's both a cognitive component and a physiologic component to this kind of drug use. Patients know that nicotine increases their metabolism, and they know that caffeine might be giving them false energy when they are not eating,” she said. In addition, cravings for all drugs are enhanced with food deprivation, a neurobiologic factor that could interfere with drug abuse rehabilitation.

“People need reinforcers, and food is the major reinforcer. Just like in laboratory animals, when you take food away, they often turn to other substances,” Dr. Bulik said.

Careful attention to patterns and changes in patients' substance abuse can offer important insight when tracking their eating disorder, and vice versa. It can also help in the prediction or prevention of relapse.

As an example, she described a person who may have gained control of her eating disorder but not her alcohol abuse. Because alcohol disinhibits appetite, it could trigger binge eating that could trigger a relapse of the eating disorder.

Similarly, if a patient is unable to decrease her nicotine consumption, this could be an indication that her eating disorder is not well controlled.

“We need to focus on integrated treatments where we are dealing with both things at the same time, looking at how they interrelate, understanding what some of the overarching integrators might be, and exploring how substances can influence relapse,” Dr. Bulik said.

MONTREAL — Comorbid eating disorders and substance abuse are intertwined behaviorally and biologically, so the treatment of both problems must be an integrated effort, Cynthia M. Bulik, Ph.D., said at an international conference sponsored by the Academy for Eating Disorders.

And with growing numbers of middle-aged women presenting to eating disorder programs, substance abuse comorbidity is being seen more frequently than in the teenage population, she said.

“We don't have sufficient integrated treatment programs, so often patients will go to substance abuse programs, which either ignore or are ill equipped to deal with their eating disorder, and then they are sent to an eating disorders program without necessarily the proper follow-up for their substance abuse,” said Dr. Bulik, professor of eating disorders and nutrition at the University of North Carolina, Chapel Hill.

Although the abuse of substances, such as laxatives or diet pills, may have superficial connections to the desire for weight loss, the abuse is almost always intertwined with other complex psychiatric issues, noted Dr. Bulik.

“If we try to discourage a patient from abusing laxatives by pointing out that they are ineffective as weight loss agents, we are missing the mark clinically, because there's a real self-harm component to this behavior,” she said in an interview. “When a person takes 50 laxatives a day, it hurts, there's incredible cramping and diarrhea, it keeps them up at night, and it's very painful. If we fail to address this whole self-punishing aspect, we're really not addressing their needs.”

Indeed, she and her associates have found that laxative abuse, most common among patients with purging anorexia (72%) and combined anorexia and bulimia nervosa (59%), is associated with a significantly higher prevalence of borderline personality disorder—characterized particularly by feelings of suicidality, self-harm, emptiness, and anger, she reported.

In another study, Dr. Bulik and her associates found that alcohol abuse is more prevalent in patients with bulimia (46%) and combined bulimia and anorexia (37%), compared with those with anorexia (16%) alone (J. Clin. Psychiatry 2004;65:1000–6). Other studies have suggested anywhere from two to six times the risk of alcohol dependency in the eating disordered population, compared with the general population, she said.

As with laxative abuse, alcohol abuse in patients with eating disorders occurs with other psychiatric comorbidities such as major depressive disorder, obsessive compulsive disorder, posttraumatic stress disorder, social phobia, borderline personality disorder, and perfectionism—all of which need to be evaluated and treated, Dr. Bulik said.

Also, other drugs such as nicotine and caffeine should be considered more problematic in patients with eating disorders than in healthy individuals, she said. In such patients, these drugs can actually be part of the eating disorder.

Research suggests that smoking can significantly increase resting energy expenditure, making it counterproductive to treatment because it can interfere with the treatment goal of weight restoration; caffeine is used to overcome some of the fatigue caused by undernourishment. “There's both a cognitive component and a physiologic component to this kind of drug use. Patients know that nicotine increases their metabolism, and they know that caffeine might be giving them false energy when they are not eating,” she said. In addition, cravings for all drugs are enhanced with food deprivation, a neurobiologic factor that could interfere with drug abuse rehabilitation.

“People need reinforcers, and food is the major reinforcer. Just like in laboratory animals, when you take food away, they often turn to other substances,” Dr. Bulik said.

Careful attention to patterns and changes in patients' substance abuse can offer important insight when tracking their eating disorder, and vice versa. It can also help in the prediction or prevention of relapse.

As an example, she described a person who may have gained control of her eating disorder but not her alcohol abuse. Because alcohol disinhibits appetite, it could trigger binge eating that could trigger a relapse of the eating disorder.

Similarly, if a patient is unable to decrease her nicotine consumption, this could be an indication that her eating disorder is not well controlled.

“We need to focus on integrated treatments where we are dealing with both things at the same time, looking at how they interrelate, understanding what some of the overarching integrators might be, and exploring how substances can influence relapse,” Dr. Bulik said.

MONTREAL — Comorbid eating disorders and substance abuse are intertwined behaviorally and biologically, so the treatment of both problems must be an integrated effort, Cynthia M. Bulik, Ph.D., said at an international conference sponsored by the Academy for Eating Disorders.

And with growing numbers of middle-aged women presenting to eating disorder programs, substance abuse comorbidity is being seen more frequently than in the teenage population, she said.

“We don't have sufficient integrated treatment programs, so often patients will go to substance abuse programs, which either ignore or are ill equipped to deal with their eating disorder, and then they are sent to an eating disorders program without necessarily the proper follow-up for their substance abuse,” said Dr. Bulik, professor of eating disorders and nutrition at the University of North Carolina, Chapel Hill.

Although the abuse of substances, such as laxatives or diet pills, may have superficial connections to the desire for weight loss, the abuse is almost always intertwined with other complex psychiatric issues, noted Dr. Bulik.

“If we try to discourage a patient from abusing laxatives by pointing out that they are ineffective as weight loss agents, we are missing the mark clinically, because there's a real self-harm component to this behavior,” she said in an interview. “When a person takes 50 laxatives a day, it hurts, there's incredible cramping and diarrhea, it keeps them up at night, and it's very painful. If we fail to address this whole self-punishing aspect, we're really not addressing their needs.”

Indeed, she and her associates have found that laxative abuse, most common among patients with purging anorexia (72%) and combined anorexia and bulimia nervosa (59%), is associated with a significantly higher prevalence of borderline personality disorder—characterized particularly by feelings of suicidality, self-harm, emptiness, and anger, she reported.

In another study, Dr. Bulik and her associates found that alcohol abuse is more prevalent in patients with bulimia (46%) and combined bulimia and anorexia (37%), compared with those with anorexia (16%) alone (J. Clin. Psychiatry 2004;65:1000–6). Other studies have suggested anywhere from two to six times the risk of alcohol dependency in the eating disordered population, compared with the general population, she said.

As with laxative abuse, alcohol abuse in patients with eating disorders occurs with other psychiatric comorbidities such as major depressive disorder, obsessive compulsive disorder, posttraumatic stress disorder, social phobia, borderline personality disorder, and perfectionism—all of which need to be evaluated and treated, Dr. Bulik said.

Also, other drugs such as nicotine and caffeine should be considered more problematic in patients with eating disorders than in healthy individuals, she said. In such patients, these drugs can actually be part of the eating disorder.

Research suggests that smoking can significantly increase resting energy expenditure, making it counterproductive to treatment because it can interfere with the treatment goal of weight restoration; caffeine is used to overcome some of the fatigue caused by undernourishment. “There's both a cognitive component and a physiologic component to this kind of drug use. Patients know that nicotine increases their metabolism, and they know that caffeine might be giving them false energy when they are not eating,” she said. In addition, cravings for all drugs are enhanced with food deprivation, a neurobiologic factor that could interfere with drug abuse rehabilitation.

“People need reinforcers, and food is the major reinforcer. Just like in laboratory animals, when you take food away, they often turn to other substances,” Dr. Bulik said.

Careful attention to patterns and changes in patients' substance abuse can offer important insight when tracking their eating disorder, and vice versa. It can also help in the prediction or prevention of relapse.

As an example, she described a person who may have gained control of her eating disorder but not her alcohol abuse. Because alcohol disinhibits appetite, it could trigger binge eating that could trigger a relapse of the eating disorder.

Similarly, if a patient is unable to decrease her nicotine consumption, this could be an indication that her eating disorder is not well controlled.

“We need to focus on integrated treatments where we are dealing with both things at the same time, looking at how they interrelate, understanding what some of the overarching integrators might be, and exploring how substances can influence relapse,” Dr. Bulik said.

MONTREAL – Eating disorders occur twice as often in adolescent girls and young women with type 1 diabetes mellitus, compared with their nondiabetic peers, and prepubertal diabetic girls should be screened for these disorders routinely, experts said at an international conference sponsored by the Academy for Eating Disorders.

Studies show that full-syndrome eating disorders are present in 10%, and subthreshold disorders in 14%, of adolescent girls with diabetes, compared with 4% and 8% respectively in healthy age-matched controls, said Patricia Colton, M.D., of the University of Toronto. Her own work in diabetic girls aged 9–14 years found an 8% prevalence of subthreshold eating disorders, compared with 1% in nondiabetic controls (Diabetes Care 2004;27:1654–9).

Such disturbed eating has been linked with poor metabolic control and increased rates of diabetes-related complications–in particular, a threefold risk of diabetic retinopathy, she said. Thus, early detection and treatment of eating disorders can have long-term benefits.

It has been suggested that a collection of multiple, interacting factors contributes to the development of eating disorders in patients with diabetes, Dr. Colton said.

Before their diagnosis, many diabetic girls tend to lose weight, which can often return to above baseline after treatment begins. Insulin therapy can cause weight gain, particularly during puberty, and episodes of hypoglycemia, so common in diabetes, can trigger binge eating, which has been reported in 45%–80% of women with diabetes.

“Low blood sugar is an incredibly strong biological trigger to eat,” she noted.

All these factors may contribute to feelings of body dissatisfaction and efforts to control weight, including one method unique to diabetes–the omission of insulin therapy, reported by 12%–40% of this population.

But overlying these concerns are such daily management concerns as self-monitoring, dietary restraint, and preoccupation with food, which can give rise to issues of control and rebellion, especially in the adolescent population, she said.

“Dealing with a chronic medical condition can have significant effects on the child and the family. Depression and anxiety disorders are doubled or tripled in individuals with diabetes,” she said, adding that depressive symptoms have also been linked with hyperglycemia.

Established treatments for eating disorders appear effective in patients with diabetes, but tailoring these treatments more closely to diabetes-specific issues may enhance their value for this population, said Marion Olmsted, Ph.D., who is also with the University of Toronto and is director of ambulatory care for eating disorders at the University Health Network, Toronto General Hospital.

Psychoeducational interventions can improve weight and body-shape attitudes in teenaged girls who do not have full-blown eating disorders. Cognitive-behavioral strategies can be used to address issues such as blood sugar monitoring, insulin underdosing or omission, and eating patterns. And psychotherapy can address issues of rebellion, control, anger, and depression. More intensive approaches, such as day hospital treatment, are required in some cases, she said. Just as family dysfunction is recognized as a risk factor for eating disorders in nondiabetic girls, this dynamic can be a powerful factor in the diabetic population, she explained.

Research by Dr. Olmsted and her colleagues at the University of Toronto has shown that diabetic girls with eating disturbances report less support, poorer communication, and less trust in their relationships with their parents than do diabetic girls without eating disturbances (J. Psychosom. Res. 1998;44:479–90).

In one study, mothers who were videotaped interacting with their daughters who had diabetes and eating disturbances showed less empathy, affective engagement, and support for their child's age-appropriate autonomy, compared with mothers of diabetic daughters without eating disturbances (J. Consult Clin. Psychol. 2001;69:950–8).

“Mothers of diabetic girls with eating disturbances appear to be less able to balance their teenage daughters' complementary needs for independence and supportive guidance,” Dr. Olmsted and her associates said in a literature review (J. Psychosom. Res. 2002;53:943–9).

Evidence shows that as adolescence progresses, behaviors such as insulin omission and binge eating become more common in young women, they reported.

“Indeed, [these behaviors] may account for the increased frequency of diabetic ketoacidosis and hospitalization for this complication in teenage girls, compared to teenage boys with diabetes,” they said in the review.

MONTREAL – Eating disorders occur twice as often in adolescent girls and young women with type 1 diabetes mellitus, compared with their nondiabetic peers, and prepubertal diabetic girls should be screened for these disorders routinely, experts said at an international conference sponsored by the Academy for Eating Disorders.

Studies show that full-syndrome eating disorders are present in 10%, and subthreshold disorders in 14%, of adolescent girls with diabetes, compared with 4% and 8% respectively in healthy age-matched controls, said Patricia Colton, M.D., of the University of Toronto. Her own work in diabetic girls aged 9–14 years found an 8% prevalence of subthreshold eating disorders, compared with 1% in nondiabetic controls (Diabetes Care 2004;27:1654–9).

Such disturbed eating has been linked with poor metabolic control and increased rates of diabetes-related complications–in particular, a threefold risk of diabetic retinopathy, she said. Thus, early detection and treatment of eating disorders can have long-term benefits.

It has been suggested that a collection of multiple, interacting factors contributes to the development of eating disorders in patients with diabetes, Dr. Colton said.

Before their diagnosis, many diabetic girls tend to lose weight, which can often return to above baseline after treatment begins. Insulin therapy can cause weight gain, particularly during puberty, and episodes of hypoglycemia, so common in diabetes, can trigger binge eating, which has been reported in 45%–80% of women with diabetes.

“Low blood sugar is an incredibly strong biological trigger to eat,” she noted.

All these factors may contribute to feelings of body dissatisfaction and efforts to control weight, including one method unique to diabetes–the omission of insulin therapy, reported by 12%–40% of this population.

But overlying these concerns are such daily management concerns as self-monitoring, dietary restraint, and preoccupation with food, which can give rise to issues of control and rebellion, especially in the adolescent population, she said.

“Dealing with a chronic medical condition can have significant effects on the child and the family. Depression and anxiety disorders are doubled or tripled in individuals with diabetes,” she said, adding that depressive symptoms have also been linked with hyperglycemia.

Established treatments for eating disorders appear effective in patients with diabetes, but tailoring these treatments more closely to diabetes-specific issues may enhance their value for this population, said Marion Olmsted, Ph.D., who is also with the University of Toronto and is director of ambulatory care for eating disorders at the University Health Network, Toronto General Hospital.

Psychoeducational interventions can improve weight and body-shape attitudes in teenaged girls who do not have full-blown eating disorders. Cognitive-behavioral strategies can be used to address issues such as blood sugar monitoring, insulin underdosing or omission, and eating patterns. And psychotherapy can address issues of rebellion, control, anger, and depression. More intensive approaches, such as day hospital treatment, are required in some cases, she said. Just as family dysfunction is recognized as a risk factor for eating disorders in nondiabetic girls, this dynamic can be a powerful factor in the diabetic population, she explained.

Research by Dr. Olmsted and her colleagues at the University of Toronto has shown that diabetic girls with eating disturbances report less support, poorer communication, and less trust in their relationships with their parents than do diabetic girls without eating disturbances (J. Psychosom. Res. 1998;44:479–90).

In one study, mothers who were videotaped interacting with their daughters who had diabetes and eating disturbances showed less empathy, affective engagement, and support for their child's age-appropriate autonomy, compared with mothers of diabetic daughters without eating disturbances (J. Consult Clin. Psychol. 2001;69:950–8).

“Mothers of diabetic girls with eating disturbances appear to be less able to balance their teenage daughters' complementary needs for independence and supportive guidance,” Dr. Olmsted and her associates said in a literature review (J. Psychosom. Res. 2002;53:943–9).

Evidence shows that as adolescence progresses, behaviors such as insulin omission and binge eating become more common in young women, they reported.

“Indeed, [these behaviors] may account for the increased frequency of diabetic ketoacidosis and hospitalization for this complication in teenage girls, compared to teenage boys with diabetes,” they said in the review.

MONTREAL – Eating disorders occur twice as often in adolescent girls and young women with type 1 diabetes mellitus, compared with their nondiabetic peers, and prepubertal diabetic girls should be screened for these disorders routinely, experts said at an international conference sponsored by the Academy for Eating Disorders.

Studies show that full-syndrome eating disorders are present in 10%, and subthreshold disorders in 14%, of adolescent girls with diabetes, compared with 4% and 8% respectively in healthy age-matched controls, said Patricia Colton, M.D., of the University of Toronto. Her own work in diabetic girls aged 9–14 years found an 8% prevalence of subthreshold eating disorders, compared with 1% in nondiabetic controls (Diabetes Care 2004;27:1654–9).

Such disturbed eating has been linked with poor metabolic control and increased rates of diabetes-related complications–in particular, a threefold risk of diabetic retinopathy, she said. Thus, early detection and treatment of eating disorders can have long-term benefits.

It has been suggested that a collection of multiple, interacting factors contributes to the development of eating disorders in patients with diabetes, Dr. Colton said.

Before their diagnosis, many diabetic girls tend to lose weight, which can often return to above baseline after treatment begins. Insulin therapy can cause weight gain, particularly during puberty, and episodes of hypoglycemia, so common in diabetes, can trigger binge eating, which has been reported in 45%–80% of women with diabetes.

“Low blood sugar is an incredibly strong biological trigger to eat,” she noted.

All these factors may contribute to feelings of body dissatisfaction and efforts to control weight, including one method unique to diabetes–the omission of insulin therapy, reported by 12%–40% of this population.

But overlying these concerns are such daily management concerns as self-monitoring, dietary restraint, and preoccupation with food, which can give rise to issues of control and rebellion, especially in the adolescent population, she said.

“Dealing with a chronic medical condition can have significant effects on the child and the family. Depression and anxiety disorders are doubled or tripled in individuals with diabetes,” she said, adding that depressive symptoms have also been linked with hyperglycemia.

Established treatments for eating disorders appear effective in patients with diabetes, but tailoring these treatments more closely to diabetes-specific issues may enhance their value for this population, said Marion Olmsted, Ph.D., who is also with the University of Toronto and is director of ambulatory care for eating disorders at the University Health Network, Toronto General Hospital.

Psychoeducational interventions can improve weight and body-shape attitudes in teenaged girls who do not have full-blown eating disorders. Cognitive-behavioral strategies can be used to address issues such as blood sugar monitoring, insulin underdosing or omission, and eating patterns. And psychotherapy can address issues of rebellion, control, anger, and depression. More intensive approaches, such as day hospital treatment, are required in some cases, she said. Just as family dysfunction is recognized as a risk factor for eating disorders in nondiabetic girls, this dynamic can be a powerful factor in the diabetic population, she explained.

Research by Dr. Olmsted and her colleagues at the University of Toronto has shown that diabetic girls with eating disturbances report less support, poorer communication, and less trust in their relationships with their parents than do diabetic girls without eating disturbances (J. Psychosom. Res. 1998;44:479–90).

In one study, mothers who were videotaped interacting with their daughters who had diabetes and eating disturbances showed less empathy, affective engagement, and support for their child's age-appropriate autonomy, compared with mothers of diabetic daughters without eating disturbances (J. Consult Clin. Psychol. 2001;69:950–8).

“Mothers of diabetic girls with eating disturbances appear to be less able to balance their teenage daughters' complementary needs for independence and supportive guidance,” Dr. Olmsted and her associates said in a literature review (J. Psychosom. Res. 2002;53:943–9).

Evidence shows that as adolescence progresses, behaviors such as insulin omission and binge eating become more common in young women, they reported.

“Indeed, [these behaviors] may account for the increased frequency of diabetic ketoacidosis and hospitalization for this complication in teenage girls, compared to teenage boys with diabetes,” they said in the review.

MONTREAL – Parents of toddlers who refuse food or are picky eaters should not worry about this behavior affecting their child's health or weight, according to new research.

They should, however, be more concerned about the subconscious cues they give their children about body image and eating habits based on gender stereotypes, said Jill M. Denoma, principal investigator of the study, which was presented as a poster at an international conference sponsored by the Academy for Eating Disorders.

“Parents said their daughters ate enough, should stop eating so quickly, and should eat low-fat foods. But they said their sons didn't eat quite enough and were a little underweight, even though the boys and girls had essentially identical” body mass indexes (BMIs), she said in an interview.

“Parents probably have these ideas deeply ingrained, but they need to be aware of them and do what they can to avoid expressing them to their children,” said Ms. Denoma, a clinical psychologist and Ph.D. candidate at Florida State University in Tallahassee. “Doctors can educate parents and help them become aware of these stereotyped attitudes.”

The study included 93 mothers and their 3-year-olds (55 girls and 38 boys), plus 54 of the fathers. Eight-three percent of the children were white, 8% were Hispanic, 3% were Native American, 2% were African American, and 2% were Asian.

Parents answered questions about their children's appetite, BMI, and dietary habits and completed a battery of psychological assessment tests that included the Children's Eating Behavior Inventory and the Bayley Scales of Infant Development.

A subset of 26 children was retested at age 4 years.

The study identified four main areas of parental concern about children's eating habits: pickiness, food refusal, struggle for control, and concerns about praising the child about food intake.

“Parents come to their [physicians] worried about these things, but we actually didn't find any links between these behaviors and being underweight or not thriving nutritionally, so they can relax,” she said, adding that mothers' and fathers' opinions often differed about which eating habits were problematic. She suggested that both parents be included in such discussions.

In fact, about 20% of the girls and 18% of the boys were overweight based on their BMI, yet none of the parents described their children as fat. Ten percent of the children were described as plump, 76% as average, and 13% as underweight, Ms. Denoma reported.

“Doctors should be candid with parents of overweight children to help them keep their children at healthy weights and decrease the risk of medical problems associated with being overweight, such as diabetes,” she said.

The investigators found that one problematic eating habit–that of struggling for control over food–was linked to more generalized behavioral problems measured on the Child Behavior Checklist.

“Children who struggle for control with their parents during mealtimes are likely to exhibit troublesome behaviors in many areas of their life, such as acting out, aggression, and withdrawal,” Ms. Denoma said, suggesting that children with this eating behavior could be targets for assessment and intervention. Otherwise, she said, parents should be advised to just be patient with pickiness.

MONTREAL – Parents of toddlers who refuse food or are picky eaters should not worry about this behavior affecting their child's health or weight, according to new research.

They should, however, be more concerned about the subconscious cues they give their children about body image and eating habits based on gender stereotypes, said Jill M. Denoma, principal investigator of the study, which was presented as a poster at an international conference sponsored by the Academy for Eating Disorders.

“Parents said their daughters ate enough, should stop eating so quickly, and should eat low-fat foods. But they said their sons didn't eat quite enough and were a little underweight, even though the boys and girls had essentially identical” body mass indexes (BMIs), she said in an interview.

“Parents probably have these ideas deeply ingrained, but they need to be aware of them and do what they can to avoid expressing them to their children,” said Ms. Denoma, a clinical psychologist and Ph.D. candidate at Florida State University in Tallahassee. “Doctors can educate parents and help them become aware of these stereotyped attitudes.”

The study included 93 mothers and their 3-year-olds (55 girls and 38 boys), plus 54 of the fathers. Eight-three percent of the children were white, 8% were Hispanic, 3% were Native American, 2% were African American, and 2% were Asian.

Parents answered questions about their children's appetite, BMI, and dietary habits and completed a battery of psychological assessment tests that included the Children's Eating Behavior Inventory and the Bayley Scales of Infant Development.

A subset of 26 children was retested at age 4 years.

The study identified four main areas of parental concern about children's eating habits: pickiness, food refusal, struggle for control, and concerns about praising the child about food intake.

“Parents come to their [physicians] worried about these things, but we actually didn't find any links between these behaviors and being underweight or not thriving nutritionally, so they can relax,” she said, adding that mothers' and fathers' opinions often differed about which eating habits were problematic. She suggested that both parents be included in such discussions.

In fact, about 20% of the girls and 18% of the boys were overweight based on their BMI, yet none of the parents described their children as fat. Ten percent of the children were described as plump, 76% as average, and 13% as underweight, Ms. Denoma reported.

“Doctors should be candid with parents of overweight children to help them keep their children at healthy weights and decrease the risk of medical problems associated with being overweight, such as diabetes,” she said.

The investigators found that one problematic eating habit–that of struggling for control over food–was linked to more generalized behavioral problems measured on the Child Behavior Checklist.

“Children who struggle for control with their parents during mealtimes are likely to exhibit troublesome behaviors in many areas of their life, such as acting out, aggression, and withdrawal,” Ms. Denoma said, suggesting that children with this eating behavior could be targets for assessment and intervention. Otherwise, she said, parents should be advised to just be patient with pickiness.

MONTREAL – Parents of toddlers who refuse food or are picky eaters should not worry about this behavior affecting their child's health or weight, according to new research.

They should, however, be more concerned about the subconscious cues they give their children about body image and eating habits based on gender stereotypes, said Jill M. Denoma, principal investigator of the study, which was presented as a poster at an international conference sponsored by the Academy for Eating Disorders.

“Parents said their daughters ate enough, should stop eating so quickly, and should eat low-fat foods. But they said their sons didn't eat quite enough and were a little underweight, even though the boys and girls had essentially identical” body mass indexes (BMIs), she said in an interview.

“Parents probably have these ideas deeply ingrained, but they need to be aware of them and do what they can to avoid expressing them to their children,” said Ms. Denoma, a clinical psychologist and Ph.D. candidate at Florida State University in Tallahassee. “Doctors can educate parents and help them become aware of these stereotyped attitudes.”

The study included 93 mothers and their 3-year-olds (55 girls and 38 boys), plus 54 of the fathers. Eight-three percent of the children were white, 8% were Hispanic, 3% were Native American, 2% were African American, and 2% were Asian.

Parents answered questions about their children's appetite, BMI, and dietary habits and completed a battery of psychological assessment tests that included the Children's Eating Behavior Inventory and the Bayley Scales of Infant Development.

A subset of 26 children was retested at age 4 years.

The study identified four main areas of parental concern about children's eating habits: pickiness, food refusal, struggle for control, and concerns about praising the child about food intake.

“Parents come to their [physicians] worried about these things, but we actually didn't find any links between these behaviors and being underweight or not thriving nutritionally, so they can relax,” she said, adding that mothers' and fathers' opinions often differed about which eating habits were problematic. She suggested that both parents be included in such discussions.

In fact, about 20% of the girls and 18% of the boys were overweight based on their BMI, yet none of the parents described their children as fat. Ten percent of the children were described as plump, 76% as average, and 13% as underweight, Ms. Denoma reported.

“Doctors should be candid with parents of overweight children to help them keep their children at healthy weights and decrease the risk of medical problems associated with being overweight, such as diabetes,” she said.

The investigators found that one problematic eating habit–that of struggling for control over food–was linked to more generalized behavioral problems measured on the Child Behavior Checklist.

“Children who struggle for control with their parents during mealtimes are likely to exhibit troublesome behaviors in many areas of their life, such as acting out, aggression, and withdrawal,” Ms. Denoma said, suggesting that children with this eating behavior could be targets for assessment and intervention. Otherwise, she said, parents should be advised to just be patient with pickiness.

LONDON — An adhesion-prevention solution made from 4% icodextrin significantly reduced the incidence of adhesions after gynecologic laparoscopic adhesiolysis, compared with Ringer's lactate solution, according to results of a multicenter, double-blind clinical trial.

The product, called Adept, is made by ML Laboratories PLC of Leicestershire, England. It has been licensed for use in Europe since 1999; in the United States, it is licensed only as an investigational medical device, said Elizabeth Peers, Ph.D., head of research and development for the company.

The study of postsurgical adhesions after gynecological laparoscopic adhesiolysis—known as the PAMELA study—will form the basis of the company's submission for Food and Drug Administration approval, she told this newspaper. The company plans to apply for approval this year.

Data from the PAMELA study were presented at the annual congress of the International Society for Gynecologic Endoscopy. The study randomized 449 laparoscopic adhesiolysis patients to intraoperative irrigation and instillation of Adept or Ringer's lactate solution (RLS) during a first surgical procedure. The fluids were irrigated at 100 mL/30 min intraoperatively, and a postoperative instillate of 1 L was left in the pelvic cavity.

Because of its high molecular weight, Adept is absorbed slowly via the lymphatic system and remains in the pelvic cavity, providing hydroflotation for 3–5 days post surgery, the critical time for adhesion formation, said Dr. Peers.

During the initial surgical procedure, the presence of adhesions, their extent (localized, moderate, or extensive) and severity (mild or severe) were assessed at 23 anatomical sites. A reassessment made on second-look laparoscopy 4–8 weeks later analyzed the change in number of sites with adhesions, as well as the number of new adhesions.

Adept performed significantly better than RLS on both measures, with 53% of Adept-treated patients free of new adhesions, compared with 43% of RLS patients.

Additionally, Adept-treated patients had a greater reduction in the mean number of sites with adhesions—from 10.3 to 7.9—compared with a reduction from 10.3 to 8.3 for RLS-treated patients.

Subgroups of 192 and 199 patients contributed to a separate analysis assessing American Fertility Society (AFS) scores for adnexal adhesions. Mean initial AFS scores were 7.4 for the Adept group and 7.3 for the RLS group. At second look, the score dropped to 4.9 for the Adept group and 6.2 for the RLS group—significantly favoring the Adept treatment.

Additionally, among patients whose primary diagnosis was infertility, the AFS score was reduced in significantly more Adept than RLS patients (51% vs. 30%).

The fact that any improvements were noted in patients treated with RLS was unexpected, since RLS is not known to reduce adhesions. This finding may be associated with the large volumes of both fluids as postsurgical instillates. “One liter is considerably more than is generally left in the pelvic cavity,” she said.

LONDON — An adhesion-prevention solution made from 4% icodextrin significantly reduced the incidence of adhesions after gynecologic laparoscopic adhesiolysis, compared with Ringer's lactate solution, according to results of a multicenter, double-blind clinical trial.

The product, called Adept, is made by ML Laboratories PLC of Leicestershire, England. It has been licensed for use in Europe since 1999; in the United States, it is licensed only as an investigational medical device, said Elizabeth Peers, Ph.D., head of research and development for the company.

The study of postsurgical adhesions after gynecological laparoscopic adhesiolysis—known as the PAMELA study—will form the basis of the company's submission for Food and Drug Administration approval, she told this newspaper. The company plans to apply for approval this year.

Data from the PAMELA study were presented at the annual congress of the International Society for Gynecologic Endoscopy. The study randomized 449 laparoscopic adhesiolysis patients to intraoperative irrigation and instillation of Adept or Ringer's lactate solution (RLS) during a first surgical procedure. The fluids were irrigated at 100 mL/30 min intraoperatively, and a postoperative instillate of 1 L was left in the pelvic cavity.

Because of its high molecular weight, Adept is absorbed slowly via the lymphatic system and remains in the pelvic cavity, providing hydroflotation for 3–5 days post surgery, the critical time for adhesion formation, said Dr. Peers.

During the initial surgical procedure, the presence of adhesions, their extent (localized, moderate, or extensive) and severity (mild or severe) were assessed at 23 anatomical sites. A reassessment made on second-look laparoscopy 4–8 weeks later analyzed the change in number of sites with adhesions, as well as the number of new adhesions.

Adept performed significantly better than RLS on both measures, with 53% of Adept-treated patients free of new adhesions, compared with 43% of RLS patients.

Additionally, Adept-treated patients had a greater reduction in the mean number of sites with adhesions—from 10.3 to 7.9—compared with a reduction from 10.3 to 8.3 for RLS-treated patients.

Subgroups of 192 and 199 patients contributed to a separate analysis assessing American Fertility Society (AFS) scores for adnexal adhesions. Mean initial AFS scores were 7.4 for the Adept group and 7.3 for the RLS group. At second look, the score dropped to 4.9 for the Adept group and 6.2 for the RLS group—significantly favoring the Adept treatment.

Additionally, among patients whose primary diagnosis was infertility, the AFS score was reduced in significantly more Adept than RLS patients (51% vs. 30%).

The fact that any improvements were noted in patients treated with RLS was unexpected, since RLS is not known to reduce adhesions. This finding may be associated with the large volumes of both fluids as postsurgical instillates. “One liter is considerably more than is generally left in the pelvic cavity,” she said.

LONDON — An adhesion-prevention solution made from 4% icodextrin significantly reduced the incidence of adhesions after gynecologic laparoscopic adhesiolysis, compared with Ringer's lactate solution, according to results of a multicenter, double-blind clinical trial.

The product, called Adept, is made by ML Laboratories PLC of Leicestershire, England. It has been licensed for use in Europe since 1999; in the United States, it is licensed only as an investigational medical device, said Elizabeth Peers, Ph.D., head of research and development for the company.

The study of postsurgical adhesions after gynecological laparoscopic adhesiolysis—known as the PAMELA study—will form the basis of the company's submission for Food and Drug Administration approval, she told this newspaper. The company plans to apply for approval this year.

Data from the PAMELA study were presented at the annual congress of the International Society for Gynecologic Endoscopy. The study randomized 449 laparoscopic adhesiolysis patients to intraoperative irrigation and instillation of Adept or Ringer's lactate solution (RLS) during a first surgical procedure. The fluids were irrigated at 100 mL/30 min intraoperatively, and a postoperative instillate of 1 L was left in the pelvic cavity.

Because of its high molecular weight, Adept is absorbed slowly via the lymphatic system and remains in the pelvic cavity, providing hydroflotation for 3–5 days post surgery, the critical time for adhesion formation, said Dr. Peers.

During the initial surgical procedure, the presence of adhesions, their extent (localized, moderate, or extensive) and severity (mild or severe) were assessed at 23 anatomical sites. A reassessment made on second-look laparoscopy 4–8 weeks later analyzed the change in number of sites with adhesions, as well as the number of new adhesions.

Adept performed significantly better than RLS on both measures, with 53% of Adept-treated patients free of new adhesions, compared with 43% of RLS patients.

Additionally, Adept-treated patients had a greater reduction in the mean number of sites with adhesions—from 10.3 to 7.9—compared with a reduction from 10.3 to 8.3 for RLS-treated patients.

Subgroups of 192 and 199 patients contributed to a separate analysis assessing American Fertility Society (AFS) scores for adnexal adhesions. Mean initial AFS scores were 7.4 for the Adept group and 7.3 for the RLS group. At second look, the score dropped to 4.9 for the Adept group and 6.2 for the RLS group—significantly favoring the Adept treatment.

Additionally, among patients whose primary diagnosis was infertility, the AFS score was reduced in significantly more Adept than RLS patients (51% vs. 30%).

The fact that any improvements were noted in patients treated with RLS was unexpected, since RLS is not known to reduce adhesions. This finding may be associated with the large volumes of both fluids as postsurgical instillates. “One liter is considerably more than is generally left in the pelvic cavity,” she said.

SAN FRANCISCO — Newborns with a 5-minute Apgar score of 7 or less have a high risk of developing respiratory distress syndrome, according to Linda R. Chambliss, M.D., associate director of maternal fetal medicine at the Maricopa Integrated Health System in Phoenix, Ariz.

The recent findings should help alert physicians to high-risk infants who should be monitored more intensively or given therapies to reduce the incidence or severity of respiratory distress syndrome (RDS), she reported at the annual meeting of the American College of Obstetricians and Gynecologists.

“What is surprising is that many people, including myself, have felt that as long as the 5-minute Apgar hits 7, the baby will be fine, but this is not necessarily the case,” she told this newspaper. “Clinicians who deliver an infant with such a score should counsel the families and the nursery that RDS is very likely. These infants have to be watched very closely.”

Her study analyzed more than 26,000 births from a statewide registry and identified 657 admissions to neonatal intensive care with a diagnosis of RDS.

Of these admissions, 540 infants had an Apgar score of 7 or less, compared with 3,803 infants who had the same Apgar score but no RDS.

After controlling for education level, marital status, race, parity, smoking, prenatal care, diabetes, hypertension, preeclampsia, induction/augmentation of labor, intrapartum fever, prolonged rupture of membranes, abruption, nonreassuring fetal heart rate, delivery by cesarean, infant's gender and gestational age, the 5-minute Apgar score of 7 or less was an independent risk factor for RDS, with an adjusted odds ratio of 25, Dr. Chambliss said.

When the infant's birth weight was substituted for gestational age, the risk remained similar (odds ratio 22).

Low birth weight and prematurity are well-recognized risk factors for the development of RDS, even when Apgar scores are normal, Dr. Chambliss said.

But her findings suggest that regardless of birth weight or prematurity, or any of the other variables that the researcher measured, the 5-minute Apgar score of 7 or less remains a high risk factor for RDS.

“People may not have realized how strongly this predicts future problems with RDS. While the Apgar score may not be the best way to predict some complications, such as neurological injury, we feel it has a great deal of utility to predict the risk RDS even when controlled for a number of other variables,” she said.

SAN FRANCISCO — Newborns with a 5-minute Apgar score of 7 or less have a high risk of developing respiratory distress syndrome, according to Linda R. Chambliss, M.D., associate director of maternal fetal medicine at the Maricopa Integrated Health System in Phoenix, Ariz.

The recent findings should help alert physicians to high-risk infants who should be monitored more intensively or given therapies to reduce the incidence or severity of respiratory distress syndrome (RDS), she reported at the annual meeting of the American College of Obstetricians and Gynecologists.

“What is surprising is that many people, including myself, have felt that as long as the 5-minute Apgar hits 7, the baby will be fine, but this is not necessarily the case,” she told this newspaper. “Clinicians who deliver an infant with such a score should counsel the families and the nursery that RDS is very likely. These infants have to be watched very closely.”

Her study analyzed more than 26,000 births from a statewide registry and identified 657 admissions to neonatal intensive care with a diagnosis of RDS.

Of these admissions, 540 infants had an Apgar score of 7 or less, compared with 3,803 infants who had the same Apgar score but no RDS.

After controlling for education level, marital status, race, parity, smoking, prenatal care, diabetes, hypertension, preeclampsia, induction/augmentation of labor, intrapartum fever, prolonged rupture of membranes, abruption, nonreassuring fetal heart rate, delivery by cesarean, infant's gender and gestational age, the 5-minute Apgar score of 7 or less was an independent risk factor for RDS, with an adjusted odds ratio of 25, Dr. Chambliss said.

When the infant's birth weight was substituted for gestational age, the risk remained similar (odds ratio 22).

Low birth weight and prematurity are well-recognized risk factors for the development of RDS, even when Apgar scores are normal, Dr. Chambliss said.

But her findings suggest that regardless of birth weight or prematurity, or any of the other variables that the researcher measured, the 5-minute Apgar score of 7 or less remains a high risk factor for RDS.

“People may not have realized how strongly this predicts future problems with RDS. While the Apgar score may not be the best way to predict some complications, such as neurological injury, we feel it has a great deal of utility to predict the risk RDS even when controlled for a number of other variables,” she said.

SAN FRANCISCO — Newborns with a 5-minute Apgar score of 7 or less have a high risk of developing respiratory distress syndrome, according to Linda R. Chambliss, M.D., associate director of maternal fetal medicine at the Maricopa Integrated Health System in Phoenix, Ariz.

The recent findings should help alert physicians to high-risk infants who should be monitored more intensively or given therapies to reduce the incidence or severity of respiratory distress syndrome (RDS), she reported at the annual meeting of the American College of Obstetricians and Gynecologists.

“What is surprising is that many people, including myself, have felt that as long as the 5-minute Apgar hits 7, the baby will be fine, but this is not necessarily the case,” she told this newspaper. “Clinicians who deliver an infant with such a score should counsel the families and the nursery that RDS is very likely. These infants have to be watched very closely.”

Her study analyzed more than 26,000 births from a statewide registry and identified 657 admissions to neonatal intensive care with a diagnosis of RDS.

Of these admissions, 540 infants had an Apgar score of 7 or less, compared with 3,803 infants who had the same Apgar score but no RDS.

After controlling for education level, marital status, race, parity, smoking, prenatal care, diabetes, hypertension, preeclampsia, induction/augmentation of labor, intrapartum fever, prolonged rupture of membranes, abruption, nonreassuring fetal heart rate, delivery by cesarean, infant's gender and gestational age, the 5-minute Apgar score of 7 or less was an independent risk factor for RDS, with an adjusted odds ratio of 25, Dr. Chambliss said.

When the infant's birth weight was substituted for gestational age, the risk remained similar (odds ratio 22).

Low birth weight and prematurity are well-recognized risk factors for the development of RDS, even when Apgar scores are normal, Dr. Chambliss said.

But her findings suggest that regardless of birth weight or prematurity, or any of the other variables that the researcher measured, the 5-minute Apgar score of 7 or less remains a high risk factor for RDS.

“People may not have realized how strongly this predicts future problems with RDS. While the Apgar score may not be the best way to predict some complications, such as neurological injury, we feel it has a great deal of utility to predict the risk RDS even when controlled for a number of other variables,” she said.

SAN ANTONIO — Consider routine allergy testing for patients with asthma and/or allergic rhinitis, Helen Smith, M.B., advised at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

“There's no doubt that rhinitis is one of those things that goes unnoticed and unattended to, and one could argue that identifying the allergic causes of it could reduce repeat consultations about poorly managed chronic asthma,” she told this newspaper.

Her study of 127 such patients found an 83% allergy rate after skin prick testing—information which resulted in significant changes in patient habits and medications, said Dr. Smith, professor of primary care at Brighton and Sussex Medical School (England).

“We have some follow-up data a few months after the allergy diagnosis, and there have been changes in lifestyle in 35% of patients and changes in medication in 15%,” she said.

The study tested patients for the five most common aeroallergens in England. It identified grass allergy in 55% of patients, pollen allergies in 55%, tree pollen allergy in 41%, cat allergy in 38%, and dog allergy in 15%.

The lifestyle changes that patients adopted after diagnosis were largely avoidance measures such as no longer cutting the grass, she said. And medication changes were mostly additions of medications, such as antihistamines, to the existing asthma/rhinitis regimens.

“These are very much proxy markers, suggesting that there was this unmet ability to improve patient care,” she said. A more accurate assessment of the value of allergy testing is currently being evaluated in another ongoing randomized, controlled trial of skin prick test and allergy assessment, which is following patients for 12 months to track changes in quality of life and symptom control.

SAN ANTONIO — Consider routine allergy testing for patients with asthma and/or allergic rhinitis, Helen Smith, M.B., advised at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

“There's no doubt that rhinitis is one of those things that goes unnoticed and unattended to, and one could argue that identifying the allergic causes of it could reduce repeat consultations about poorly managed chronic asthma,” she told this newspaper.

Her study of 127 such patients found an 83% allergy rate after skin prick testing—information which resulted in significant changes in patient habits and medications, said Dr. Smith, professor of primary care at Brighton and Sussex Medical School (England).

“We have some follow-up data a few months after the allergy diagnosis, and there have been changes in lifestyle in 35% of patients and changes in medication in 15%,” she said.

The study tested patients for the five most common aeroallergens in England. It identified grass allergy in 55% of patients, pollen allergies in 55%, tree pollen allergy in 41%, cat allergy in 38%, and dog allergy in 15%.

The lifestyle changes that patients adopted after diagnosis were largely avoidance measures such as no longer cutting the grass, she said. And medication changes were mostly additions of medications, such as antihistamines, to the existing asthma/rhinitis regimens.

“These are very much proxy markers, suggesting that there was this unmet ability to improve patient care,” she said. A more accurate assessment of the value of allergy testing is currently being evaluated in another ongoing randomized, controlled trial of skin prick test and allergy assessment, which is following patients for 12 months to track changes in quality of life and symptom control.

SAN ANTONIO — Consider routine allergy testing for patients with asthma and/or allergic rhinitis, Helen Smith, M.B., advised at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

“There's no doubt that rhinitis is one of those things that goes unnoticed and unattended to, and one could argue that identifying the allergic causes of it could reduce repeat consultations about poorly managed chronic asthma,” she told this newspaper.

Her study of 127 such patients found an 83% allergy rate after skin prick testing—information which resulted in significant changes in patient habits and medications, said Dr. Smith, professor of primary care at Brighton and Sussex Medical School (England).

“We have some follow-up data a few months after the allergy diagnosis, and there have been changes in lifestyle in 35% of patients and changes in medication in 15%,” she said.

The study tested patients for the five most common aeroallergens in England. It identified grass allergy in 55% of patients, pollen allergies in 55%, tree pollen allergy in 41%, cat allergy in 38%, and dog allergy in 15%.

The lifestyle changes that patients adopted after diagnosis were largely avoidance measures such as no longer cutting the grass, she said. And medication changes were mostly additions of medications, such as antihistamines, to the existing asthma/rhinitis regimens.

“These are very much proxy markers, suggesting that there was this unmet ability to improve patient care,” she said. A more accurate assessment of the value of allergy testing is currently being evaluated in another ongoing randomized, controlled trial of skin prick test and allergy assessment, which is following patients for 12 months to track changes in quality of life and symptom control.

MIAMI BEACH — Laparoscopic management of acute appendicitis decreases recovery time and wound infection rates while showing the same efficacy as the open technique, reported Dalibor Panuska, M.D., at a congress on laparoscopy and minimally invasive surgery.

Although an increasing number of studies have shown the benefits of laparoscopic appendectomy in general, the advantages of the technique specifically for acute appendicitis are not yet been clearly established, reported Dr. Panuska from District Hospital Zvolen, in Slovakia.

In a retrospective study of 553 patients with acute appendicitis who were operated on using either laparoscopy (315) or open surgery (238), the laparoscopic technique resulted in shorter hospital stays (4.4 vs. 5.2 days), fewer doses of postoperative opioids (1.36 vs. 2. 56), and earlier resumption of peristalsis (19 vs. 28 hours), he said at the congress, which was sponsored by the Society of Laparoendoscopic Surgeons.

There was a 6% conversion rate from laparoscopy to open technique. The reasons for conversion were technical failure, perforated appendix, general peritonitis, cavum Douglasi abscesses, and gangrenous or phlegmonous appendix, Dr. Panuska reported.

Wound infections were considerably fewer in the laparoscopy group (1.6% vs. 7.5%). Late abdominal obstruction, a recognized complication of the open technique, was completely absent in the laparoscopic group but occurred in 0.3% of the open-surgery group.

Dr. Panuska said the most important reason for performing the procedure laparoscopically is the opportunity that it affords to pick up other pelvic—particularly gynecologic—pathologies.

“Laparoscopic appendectomy is safe and feasible even in severe, advanced, or destructive forms of acute appendicitis,” he concluded.

MIAMI BEACH — Laparoscopic management of acute appendicitis decreases recovery time and wound infection rates while showing the same efficacy as the open technique, reported Dalibor Panuska, M.D., at a congress on laparoscopy and minimally invasive surgery.

Although an increasing number of studies have shown the benefits of laparoscopic appendectomy in general, the advantages of the technique specifically for acute appendicitis are not yet been clearly established, reported Dr. Panuska from District Hospital Zvolen, in Slovakia.

In a retrospective study of 553 patients with acute appendicitis who were operated on using either laparoscopy (315) or open surgery (238), the laparoscopic technique resulted in shorter hospital stays (4.4 vs. 5.2 days), fewer doses of postoperative opioids (1.36 vs. 2. 56), and earlier resumption of peristalsis (19 vs. 28 hours), he said at the congress, which was sponsored by the Society of Laparoendoscopic Surgeons.

There was a 6% conversion rate from laparoscopy to open technique. The reasons for conversion were technical failure, perforated appendix, general peritonitis, cavum Douglasi abscesses, and gangrenous or phlegmonous appendix, Dr. Panuska reported.

Wound infections were considerably fewer in the laparoscopy group (1.6% vs. 7.5%). Late abdominal obstruction, a recognized complication of the open technique, was completely absent in the laparoscopic group but occurred in 0.3% of the open-surgery group.

Dr. Panuska said the most important reason for performing the procedure laparoscopically is the opportunity that it affords to pick up other pelvic—particularly gynecologic—pathologies.

“Laparoscopic appendectomy is safe and feasible even in severe, advanced, or destructive forms of acute appendicitis,” he concluded.

MIAMI BEACH — Laparoscopic management of acute appendicitis decreases recovery time and wound infection rates while showing the same efficacy as the open technique, reported Dalibor Panuska, M.D., at a congress on laparoscopy and minimally invasive surgery.

Although an increasing number of studies have shown the benefits of laparoscopic appendectomy in general, the advantages of the technique specifically for acute appendicitis are not yet been clearly established, reported Dr. Panuska from District Hospital Zvolen, in Slovakia.

In a retrospective study of 553 patients with acute appendicitis who were operated on using either laparoscopy (315) or open surgery (238), the laparoscopic technique resulted in shorter hospital stays (4.4 vs. 5.2 days), fewer doses of postoperative opioids (1.36 vs. 2. 56), and earlier resumption of peristalsis (19 vs. 28 hours), he said at the congress, which was sponsored by the Society of Laparoendoscopic Surgeons.

There was a 6% conversion rate from laparoscopy to open technique. The reasons for conversion were technical failure, perforated appendix, general peritonitis, cavum Douglasi abscesses, and gangrenous or phlegmonous appendix, Dr. Panuska reported.

Wound infections were considerably fewer in the laparoscopy group (1.6% vs. 7.5%). Late abdominal obstruction, a recognized complication of the open technique, was completely absent in the laparoscopic group but occurred in 0.3% of the open-surgery group.

Dr. Panuska said the most important reason for performing the procedure laparoscopically is the opportunity that it affords to pick up other pelvic—particularly gynecologic—pathologies.

“Laparoscopic appendectomy is safe and feasible even in severe, advanced, or destructive forms of acute appendicitis,” he concluded.

SAN FRANCISCO — Birth trauma occurs at the same rate in vaginal and cesarean deliveries, but the nature of the trauma is different, according to data presented at the annual meeting of the American College of Obstetricians and Gynecologists.

Study investigators were not able to distinguish between planned cesarean deliveries and cesarean deliveries that resulted from a failed trial of labor, however.

“The group we have to pay particular attention to is women who had a failed attempt at delivery and then had a C-section. That's probably the highest risk group and may actually be contributing to the trauma in the C-section group. But we couldn't look at this, so we can't tell the whole story with this research,” said Susan Meikle, M.D., who is lead investigator of the study and works at the Agency for Healthcare Research and Quality (AHRQ), located in Rockville, Md.

The AHRQ is mandated by Congress to produce an annual National Healthcare Quality Report that compiles health care data on patient safety. The report also defines adverse events that could be preventable. This portion of the report focuses on the risks for birth trauma.

Birth trauma data were identified using discharge data from 995 nonfederal hospitals located in 35 states and were then compared with data on infants without birth trauma. The data were analyzed by mode of delivery, clinical characteristics, demographics, and hospital characteristics.

The rate of birth trauma among more than 4,000,000 neonates was about 7 per 1,000 live singleton births, Dr. Meikle said.

When analyzed according to mode of delivery, the unadjusted rate of birth trauma was the same for both vaginal and cesarean deliveries. In addition, male infants and preterm infants were were found to be at higher risk for birth trauma regardless of the mode of delivery.

After adjustment for delivery mode, vaginal delivery of infants that were large for gestational age had a higher risk of skeletal, spinal, clavicular, and brachial plexus injuries, with an odds ratio (OR) of 1.5.

Cesarean delivery was associated with a higher risk of subdural or cerebral hemorrhage (OR 1.6) and other peripheral or cranial nerve or unspecified trauma (OR 2.1).

“Birth trauma is a heterogeneous group of injuries, and it was not possible to determine whether mode of delivery was a precipitating factor,” Dr. Meikle concluded.

“Trauma occurs with both types of delivery. There's a certain element we can't predict, and you need to be careful in deciding whether you do a C-section or a vaginal delivery,” she said in an interview. “It's hard for us to predict how big babies [will be], and if we had some tools to give us better predictive ability, that would help.”

Dr. Meikle said she also recommended that neonatal birth trauma data specify the type of injury, as well as include the attempts at vaginal delivery before a cesarean section should be accounted for in an effort to facilitate research in this field.

SAN FRANCISCO — Birth trauma occurs at the same rate in vaginal and cesarean deliveries, but the nature of the trauma is different, according to data presented at the annual meeting of the American College of Obstetricians and Gynecologists.

Study investigators were not able to distinguish between planned cesarean deliveries and cesarean deliveries that resulted from a failed trial of labor, however.

“The group we have to pay particular attention to is women who had a failed attempt at delivery and then had a C-section. That's probably the highest risk group and may actually be contributing to the trauma in the C-section group. But we couldn't look at this, so we can't tell the whole story with this research,” said Susan Meikle, M.D., who is lead investigator of the study and works at the Agency for Healthcare Research and Quality (AHRQ), located in Rockville, Md.

The AHRQ is mandated by Congress to produce an annual National Healthcare Quality Report that compiles health care data on patient safety. The report also defines adverse events that could be preventable. This portion of the report focuses on the risks for birth trauma.

Birth trauma data were identified using discharge data from 995 nonfederal hospitals located in 35 states and were then compared with data on infants without birth trauma. The data were analyzed by mode of delivery, clinical characteristics, demographics, and hospital characteristics.

The rate of birth trauma among more than 4,000,000 neonates was about 7 per 1,000 live singleton births, Dr. Meikle said.

When analyzed according to mode of delivery, the unadjusted rate of birth trauma was the same for both vaginal and cesarean deliveries. In addition, male infants and preterm infants were were found to be at higher risk for birth trauma regardless of the mode of delivery.

After adjustment for delivery mode, vaginal delivery of infants that were large for gestational age had a higher risk of skeletal, spinal, clavicular, and brachial plexus injuries, with an odds ratio (OR) of 1.5.

Cesarean delivery was associated with a higher risk of subdural or cerebral hemorrhage (OR 1.6) and other peripheral or cranial nerve or unspecified trauma (OR 2.1).

“Birth trauma is a heterogeneous group of injuries, and it was not possible to determine whether mode of delivery was a precipitating factor,” Dr. Meikle concluded.

“Trauma occurs with both types of delivery. There's a certain element we can't predict, and you need to be careful in deciding whether you do a C-section or a vaginal delivery,” she said in an interview. “It's hard for us to predict how big babies [will be], and if we had some tools to give us better predictive ability, that would help.”

Dr. Meikle said she also recommended that neonatal birth trauma data specify the type of injury, as well as include the attempts at vaginal delivery before a cesarean section should be accounted for in an effort to facilitate research in this field.

SAN FRANCISCO — Birth trauma occurs at the same rate in vaginal and cesarean deliveries, but the nature of the trauma is different, according to data presented at the annual meeting of the American College of Obstetricians and Gynecologists.

Study investigators were not able to distinguish between planned cesarean deliveries and cesarean deliveries that resulted from a failed trial of labor, however.

“The group we have to pay particular attention to is women who had a failed attempt at delivery and then had a C-section. That's probably the highest risk group and may actually be contributing to the trauma in the C-section group. But we couldn't look at this, so we can't tell the whole story with this research,” said Susan Meikle, M.D., who is lead investigator of the study and works at the Agency for Healthcare Research and Quality (AHRQ), located in Rockville, Md.

The AHRQ is mandated by Congress to produce an annual National Healthcare Quality Report that compiles health care data on patient safety. The report also defines adverse events that could be preventable. This portion of the report focuses on the risks for birth trauma.

Birth trauma data were identified using discharge data from 995 nonfederal hospitals located in 35 states and were then compared with data on infants without birth trauma. The data were analyzed by mode of delivery, clinical characteristics, demographics, and hospital characteristics.

The rate of birth trauma among more than 4,000,000 neonates was about 7 per 1,000 live singleton births, Dr. Meikle said.

When analyzed according to mode of delivery, the unadjusted rate of birth trauma was the same for both vaginal and cesarean deliveries. In addition, male infants and preterm infants were were found to be at higher risk for birth trauma regardless of the mode of delivery.

After adjustment for delivery mode, vaginal delivery of infants that were large for gestational age had a higher risk of skeletal, spinal, clavicular, and brachial plexus injuries, with an odds ratio (OR) of 1.5.

Cesarean delivery was associated with a higher risk of subdural or cerebral hemorrhage (OR 1.6) and other peripheral or cranial nerve or unspecified trauma (OR 2.1).

“Birth trauma is a heterogeneous group of injuries, and it was not possible to determine whether mode of delivery was a precipitating factor,” Dr. Meikle concluded.

“Trauma occurs with both types of delivery. There's a certain element we can't predict, and you need to be careful in deciding whether you do a C-section or a vaginal delivery,” she said in an interview. “It's hard for us to predict how big babies [will be], and if we had some tools to give us better predictive ability, that would help.”

Dr. Meikle said she also recommended that neonatal birth trauma data specify the type of injury, as well as include the attempts at vaginal delivery before a cesarean section should be accounted for in an effort to facilitate research in this field.

LONDON — Radical, fertility-sparing excision of severe endometriosis in adolescent girls can eliminate or greatly improve pain, reported Andreas I. Stavroulis, M.D., at the annual congress of the International Society for Gynecologic Endoscopy.

“This is the first study reporting the outcome of radical excision treatment for severe endometriosis in this age-group, and early results are encouraging,” reported Dr. Stavroulis of the endometriosis unit, University College London Hospitals.

Dr. Stavroulis and his colleagues reviewed the cases of 31 girls under age 20 years who underwent laparoscopy to investigate chronic pelvic pain, which had failed to respond to medical treatment.

No pelvic abnormalities were found in 11 patients, and endometriosis was detected in 11. Other diagnoses included four nonfunctional nonendometriotic ovarian cysts, one functional ovarian cyst, one bilateral and one unilateral hydrosalpinx, and two obstructed uterine horns.

Of the 11 patients with endometriosis, 6 had severe disease that was treated with radical excision, and there were no complications. Five were rendered pain free, while one had improved symptoms, he said.

“Our follow-up is only short to medium term—up to 112 weeks—but we are going to follow them further to see if they have any future problems,” he said.

Endometriosis and laparoscopy are not commonly considered in adolescent girls with chronic pelvic pain, partly because of a misconception among many generalists that the disease is rare in this age-group, Dr. Stavroulis said.

In fact, it is the most common reason for chronic pelvic pain that is nonresponsive to medical therapy, and there is evidence in the literature that endometriosis can occur as early as premenarche in some girls, he said.

However, even when the disease is recognized, many physicians hesitate to treat it surgically. “It's not an easy decision. You obviously have to make sure that the girl and her parents appreciate that these operations do have risks. But if you have tried all the other alternatives, like medical therapy, and if you see severe endometriosis on laparoscopy—then why not?”

Dr. Stavroulis said parents must be informed that while endometriosis itself may cause problems with infertility, radical excision may cause adhesions that could also interfere with fertility.

This image shows a teen with severe endometriosis. Courtesy Dr. Andreas I. Stavroulis

LONDON — Radical, fertility-sparing excision of severe endometriosis in adolescent girls can eliminate or greatly improve pain, reported Andreas I. Stavroulis, M.D., at the annual congress of the International Society for Gynecologic Endoscopy.

“This is the first study reporting the outcome of radical excision treatment for severe endometriosis in this age-group, and early results are encouraging,” reported Dr. Stavroulis of the endometriosis unit, University College London Hospitals.

Dr. Stavroulis and his colleagues reviewed the cases of 31 girls under age 20 years who underwent laparoscopy to investigate chronic pelvic pain, which had failed to respond to medical treatment.

No pelvic abnormalities were found in 11 patients, and endometriosis was detected in 11. Other diagnoses included four nonfunctional nonendometriotic ovarian cysts, one functional ovarian cyst, one bilateral and one unilateral hydrosalpinx, and two obstructed uterine horns.

Of the 11 patients with endometriosis, 6 had severe disease that was treated with radical excision, and there were no complications. Five were rendered pain free, while one had improved symptoms, he said.

“Our follow-up is only short to medium term—up to 112 weeks—but we are going to follow them further to see if they have any future problems,” he said.

Endometriosis and laparoscopy are not commonly considered in adolescent girls with chronic pelvic pain, partly because of a misconception among many generalists that the disease is rare in this age-group, Dr. Stavroulis said.

In fact, it is the most common reason for chronic pelvic pain that is nonresponsive to medical therapy, and there is evidence in the literature that endometriosis can occur as early as premenarche in some girls, he said.

However, even when the disease is recognized, many physicians hesitate to treat it surgically. “It's not an easy decision. You obviously have to make sure that the girl and her parents appreciate that these operations do have risks. But if you have tried all the other alternatives, like medical therapy, and if you see severe endometriosis on laparoscopy—then why not?”

Dr. Stavroulis said parents must be informed that while endometriosis itself may cause problems with infertility, radical excision may cause adhesions that could also interfere with fertility.

This image shows a teen with severe endometriosis. Courtesy Dr. Andreas I. Stavroulis

LONDON — Radical, fertility-sparing excision of severe endometriosis in adolescent girls can eliminate or greatly improve pain, reported Andreas I. Stavroulis, M.D., at the annual congress of the International Society for Gynecologic Endoscopy.

“This is the first study reporting the outcome of radical excision treatment for severe endometriosis in this age-group, and early results are encouraging,” reported Dr. Stavroulis of the endometriosis unit, University College London Hospitals.

Dr. Stavroulis and his colleagues reviewed the cases of 31 girls under age 20 years who underwent laparoscopy to investigate chronic pelvic pain, which had failed to respond to medical treatment.

No pelvic abnormalities were found in 11 patients, and endometriosis was detected in 11. Other diagnoses included four nonfunctional nonendometriotic ovarian cysts, one functional ovarian cyst, one bilateral and one unilateral hydrosalpinx, and two obstructed uterine horns.

Of the 11 patients with endometriosis, 6 had severe disease that was treated with radical excision, and there were no complications. Five were rendered pain free, while one had improved symptoms, he said.

“Our follow-up is only short to medium term—up to 112 weeks—but we are going to follow them further to see if they have any future problems,” he said.

Endometriosis and laparoscopy are not commonly considered in adolescent girls with chronic pelvic pain, partly because of a misconception among many generalists that the disease is rare in this age-group, Dr. Stavroulis said.

In fact, it is the most common reason for chronic pelvic pain that is nonresponsive to medical therapy, and there is evidence in the literature that endometriosis can occur as early as premenarche in some girls, he said.

However, even when the disease is recognized, many physicians hesitate to treat it surgically. “It's not an easy decision. You obviously have to make sure that the girl and her parents appreciate that these operations do have risks. But if you have tried all the other alternatives, like medical therapy, and if you see severe endometriosis on laparoscopy—then why not?”

Dr. Stavroulis said parents must be informed that while endometriosis itself may cause problems with infertility, radical excision may cause adhesions that could also interfere with fertility.

This image shows a teen with severe endometriosis. Courtesy Dr. Andreas I. Stavroulis