Kate Johnson

QUEBEC CITY — The fasting plasma glucose test is inadequate, compared with the oral glucose tolerance test, in screening high-risk pediatric patients for type 2 diabetes and prediabetes, according to results of a new study.

“This is further evidence that impaired fasting glucose and impaired glucose tolerance are two distinct entities,” said Stasia Hadjiyannakis, M.D., a pediatric endocrinologist at Children's Hospital of Eastern Ontario in Ottawa.

The study included 152 children aged 5-18 years (mean age 13 years), who underwent a 2-hour oral glucose tolerance test (2h OGTT) and a fasting plasma glucose (FPG) test.

The children were referred for the tests for evaluation of a number of conditions, including obesity, irregular menses, hirsutism, dyslipidemia, and/or acanthosis nigricans, said Dr. Hadjiyannakis, who reported the findings at the joint annual meeting of the Canadian Diabetes Association (CDA) and the Canadian Society of Endocrinology and Metabolism.

American Diabetes Association guidelines recommend the FPG test alone as the initial screening test for pediatric type 2 diabetes and prediabetes.

But recent studies suggest that even children with normal FPG values can have abnormal 2h OGTT results—indicating impaired glucose tolerance, even though the fasting plasma glucose level is normal.

“If you only screen them with the FPG test, you would miss picking up this abnormality,” Dr. Hadjiyannakis told this newspaper.

Her study found that of the 152 children who underwent the 2h OGTT and the FPG test, 130 (86%) had normal results on both.

Of the 22 with abnormal results, 13 had abnormal FPG levels that would have been picked up by an FPG screening test alone.

But the remaining nine children had normal FPG levels (defined in this Canadian study by CDA criteria of 5.7 mmol/L [103 mg/dL] or greater).

Eight of these children had 2h OGTT levels between 7.8 and 11 mmol/L (140-199 mg/dL), defined as impaired glucose tolerance. One child had a level greater than 11.1 mmol/L (above 200 mg/dL), defined as type 2 diabetes.

If they had been screened with the FPG test alone, 9 of 13 (73%) of those with impaired glucose tolerance and 1 of 2 (50%) of those with type 2 diabetes would have been missed, Dr. Hadjiyannakis said.

She said the study results suggest that in high-risk children, physicians should consider screening with both the FPG test and the OGTT.

QUEBEC CITY — The fasting plasma glucose test is inadequate, compared with the oral glucose tolerance test, in screening high-risk pediatric patients for type 2 diabetes and prediabetes, according to results of a new study.

“This is further evidence that impaired fasting glucose and impaired glucose tolerance are two distinct entities,” said Stasia Hadjiyannakis, M.D., a pediatric endocrinologist at Children's Hospital of Eastern Ontario in Ottawa.

The study included 152 children aged 5-18 years (mean age 13 years), who underwent a 2-hour oral glucose tolerance test (2h OGTT) and a fasting plasma glucose (FPG) test.

The children were referred for the tests for evaluation of a number of conditions, including obesity, irregular menses, hirsutism, dyslipidemia, and/or acanthosis nigricans, said Dr. Hadjiyannakis, who reported the findings at the joint annual meeting of the Canadian Diabetes Association (CDA) and the Canadian Society of Endocrinology and Metabolism.

American Diabetes Association guidelines recommend the FPG test alone as the initial screening test for pediatric type 2 diabetes and prediabetes.

But recent studies suggest that even children with normal FPG values can have abnormal 2h OGTT results—indicating impaired glucose tolerance, even though the fasting plasma glucose level is normal.

“If you only screen them with the FPG test, you would miss picking up this abnormality,” Dr. Hadjiyannakis told this newspaper.

Her study found that of the 152 children who underwent the 2h OGTT and the FPG test, 130 (86%) had normal results on both.

Of the 22 with abnormal results, 13 had abnormal FPG levels that would have been picked up by an FPG screening test alone.

But the remaining nine children had normal FPG levels (defined in this Canadian study by CDA criteria of 5.7 mmol/L [103 mg/dL] or greater).

Eight of these children had 2h OGTT levels between 7.8 and 11 mmol/L (140-199 mg/dL), defined as impaired glucose tolerance. One child had a level greater than 11.1 mmol/L (above 200 mg/dL), defined as type 2 diabetes.

If they had been screened with the FPG test alone, 9 of 13 (73%) of those with impaired glucose tolerance and 1 of 2 (50%) of those with type 2 diabetes would have been missed, Dr. Hadjiyannakis said.

She said the study results suggest that in high-risk children, physicians should consider screening with both the FPG test and the OGTT.

QUEBEC CITY — The fasting plasma glucose test is inadequate, compared with the oral glucose tolerance test, in screening high-risk pediatric patients for type 2 diabetes and prediabetes, according to results of a new study.

“This is further evidence that impaired fasting glucose and impaired glucose tolerance are two distinct entities,” said Stasia Hadjiyannakis, M.D., a pediatric endocrinologist at Children's Hospital of Eastern Ontario in Ottawa.

The study included 152 children aged 5-18 years (mean age 13 years), who underwent a 2-hour oral glucose tolerance test (2h OGTT) and a fasting plasma glucose (FPG) test.

The children were referred for the tests for evaluation of a number of conditions, including obesity, irregular menses, hirsutism, dyslipidemia, and/or acanthosis nigricans, said Dr. Hadjiyannakis, who reported the findings at the joint annual meeting of the Canadian Diabetes Association (CDA) and the Canadian Society of Endocrinology and Metabolism.

American Diabetes Association guidelines recommend the FPG test alone as the initial screening test for pediatric type 2 diabetes and prediabetes.

But recent studies suggest that even children with normal FPG values can have abnormal 2h OGTT results—indicating impaired glucose tolerance, even though the fasting plasma glucose level is normal.

“If you only screen them with the FPG test, you would miss picking up this abnormality,” Dr. Hadjiyannakis told this newspaper.

Her study found that of the 152 children who underwent the 2h OGTT and the FPG test, 130 (86%) had normal results on both.

Of the 22 with abnormal results, 13 had abnormal FPG levels that would have been picked up by an FPG screening test alone.

But the remaining nine children had normal FPG levels (defined in this Canadian study by CDA criteria of 5.7 mmol/L [103 mg/dL] or greater).

Eight of these children had 2h OGTT levels between 7.8 and 11 mmol/L (140-199 mg/dL), defined as impaired glucose tolerance. One child had a level greater than 11.1 mmol/L (above 200 mg/dL), defined as type 2 diabetes.

If they had been screened with the FPG test alone, 9 of 13 (73%) of those with impaired glucose tolerance and 1 of 2 (50%) of those with type 2 diabetes would have been missed, Dr. Hadjiyannakis said.

She said the study results suggest that in high-risk children, physicians should consider screening with both the FPG test and the OGTT.

MIAMI BEACH — Although most colorectal surgeons tend to prefer open surgery to laparoscopy, adding robotics to their repertoire could enhance the appeal of this technically demanding procedure, Emilio Morpurgo, M.D., said at a congress on laparoscopy and minimally invasive surgery.

“Robotics offers all the articulation of the human wrist”—something that is absent in the classic laparoscopic approach, said Dr. Morpurgo, of the Center for Minimally Invasive and Robotic Surgery, Hospital of Camposampiero, in Padova, Italy. “It is particularly useful in dissecting, anastomosis, and suturing.”

While the laparoscopic learning curve is quite steep, “robotics may be a bridge to that—as it was for urologists, many of whom went directly from open prostatectomy to robot-assisted laparoscopy, without passing through traditional laparoscopy,” he told this newspaper.

Dr. Morpurgo presented the results of 90 colorectal procedures (including 46 cancers) performed at his institution using robot-assisted laparoscopy, and compared them with 386 procedures (including 293 cancers) performed using traditional laparoscopy.

Among the procedures were right and left hernicolectomy, resection of transverse and sigmoid colon, low anterior resection, Miles' operation, total/subtotal colectomy, Hartmann's procedure, and rectopexis.

Robot-assisted surgery proved as safe and effective as laparoscopic techniques, he reported at the congress, sponsored by the Society of Laparoendoscopic Surgeons. There were no differences between the groups regarding duration of surgery, recovery of bowel function, length of postoperative stay, or amount of blood loss.

Among those undergoing the robotic procedure, complications required switching eight patients to another procedure: four were converted to hand-assisted surgery because of advanced cancer (three patients) or adhesions (one patient); three to laparoscopy because of technical difficulties, increased CO2, or bowel distension; and one to laparotomy because of injury to the spleen.

Among those in the laparoscopy group, 34 patients were switched to another procedure: 12 to hand-assisted surgery (5 due to advanced cancer, 3 due to difficulties resulting from obesity, 1 because of adhesions, and 3 nonspecified), and 22 to laparotomy (6 because of advanced cancer, 6 because of bowel distension, 2 because of adhesions, 2 because of splenic injuries, and 6 unspecified).

There were 10 major complications in the robot group (8.8%), including one death from electrolyte imbalance after a small bowel injury. A second case of small bowel injury also occurred. “This may be a new complication unique to this approach, in which it is difficult to see this injury,” said Dr. Morpurgo. “If the small bowel has to be manipulated during the procedure, it must be carefully inspected afterward.”

A higher percentage of patients in the laparoscopy group (13.2%) had complications, but there were no mortalities. Most complications were because of symptomatic anastomotic leaks in 19 patients, or 5% of the total, which is comparable with results seen with open surgery, Dr. Morpurgo said.

Other complications in this group included wound/perineal complications (seven patients), bleeding from trocars (six), abdominal bleeding (five), and stoma complications (four).

“Colorectal surgeons have to start doing more minimally invasive surgery,” said Dr. Morpurgo. “Since laparoscopy is not usually performed by colorectal surgeons, the robot can render an operation more like an open surgery, with all the benefits of laparoscopy.”

William Kelley, M.D., a general surgeon who practices in Richmond, Va., agreed that robotic surgery can make the laparoscopic approach less intimidating for colorectal surgeons. A fair number of U.S. colorectal surgeons have already familiarized themselves adequately with laparoscopic techniques, he said.

“Colon cancer is one of the hottest areas for robotic surgery,” said Dr. Kelley, who also is director of general surgery at the Minimally Invasive Surgery Center in Richmond, Va.

MIAMI BEACH — Although most colorectal surgeons tend to prefer open surgery to laparoscopy, adding robotics to their repertoire could enhance the appeal of this technically demanding procedure, Emilio Morpurgo, M.D., said at a congress on laparoscopy and minimally invasive surgery.

“Robotics offers all the articulation of the human wrist”—something that is absent in the classic laparoscopic approach, said Dr. Morpurgo, of the Center for Minimally Invasive and Robotic Surgery, Hospital of Camposampiero, in Padova, Italy. “It is particularly useful in dissecting, anastomosis, and suturing.”

While the laparoscopic learning curve is quite steep, “robotics may be a bridge to that—as it was for urologists, many of whom went directly from open prostatectomy to robot-assisted laparoscopy, without passing through traditional laparoscopy,” he told this newspaper.

Dr. Morpurgo presented the results of 90 colorectal procedures (including 46 cancers) performed at his institution using robot-assisted laparoscopy, and compared them with 386 procedures (including 293 cancers) performed using traditional laparoscopy.

Among the procedures were right and left hernicolectomy, resection of transverse and sigmoid colon, low anterior resection, Miles' operation, total/subtotal colectomy, Hartmann's procedure, and rectopexis.

Robot-assisted surgery proved as safe and effective as laparoscopic techniques, he reported at the congress, sponsored by the Society of Laparoendoscopic Surgeons. There were no differences between the groups regarding duration of surgery, recovery of bowel function, length of postoperative stay, or amount of blood loss.

Among those undergoing the robotic procedure, complications required switching eight patients to another procedure: four were converted to hand-assisted surgery because of advanced cancer (three patients) or adhesions (one patient); three to laparoscopy because of technical difficulties, increased CO2, or bowel distension; and one to laparotomy because of injury to the spleen.

Among those in the laparoscopy group, 34 patients were switched to another procedure: 12 to hand-assisted surgery (5 due to advanced cancer, 3 due to difficulties resulting from obesity, 1 because of adhesions, and 3 nonspecified), and 22 to laparotomy (6 because of advanced cancer, 6 because of bowel distension, 2 because of adhesions, 2 because of splenic injuries, and 6 unspecified).

There were 10 major complications in the robot group (8.8%), including one death from electrolyte imbalance after a small bowel injury. A second case of small bowel injury also occurred. “This may be a new complication unique to this approach, in which it is difficult to see this injury,” said Dr. Morpurgo. “If the small bowel has to be manipulated during the procedure, it must be carefully inspected afterward.”

A higher percentage of patients in the laparoscopy group (13.2%) had complications, but there were no mortalities. Most complications were because of symptomatic anastomotic leaks in 19 patients, or 5% of the total, which is comparable with results seen with open surgery, Dr. Morpurgo said.

Other complications in this group included wound/perineal complications (seven patients), bleeding from trocars (six), abdominal bleeding (five), and stoma complications (four).

“Colorectal surgeons have to start doing more minimally invasive surgery,” said Dr. Morpurgo. “Since laparoscopy is not usually performed by colorectal surgeons, the robot can render an operation more like an open surgery, with all the benefits of laparoscopy.”

William Kelley, M.D., a general surgeon who practices in Richmond, Va., agreed that robotic surgery can make the laparoscopic approach less intimidating for colorectal surgeons. A fair number of U.S. colorectal surgeons have already familiarized themselves adequately with laparoscopic techniques, he said.

“Colon cancer is one of the hottest areas for robotic surgery,” said Dr. Kelley, who also is director of general surgery at the Minimally Invasive Surgery Center in Richmond, Va.

MIAMI BEACH — Although most colorectal surgeons tend to prefer open surgery to laparoscopy, adding robotics to their repertoire could enhance the appeal of this technically demanding procedure, Emilio Morpurgo, M.D., said at a congress on laparoscopy and minimally invasive surgery.

“Robotics offers all the articulation of the human wrist”—something that is absent in the classic laparoscopic approach, said Dr. Morpurgo, of the Center for Minimally Invasive and Robotic Surgery, Hospital of Camposampiero, in Padova, Italy. “It is particularly useful in dissecting, anastomosis, and suturing.”

While the laparoscopic learning curve is quite steep, “robotics may be a bridge to that—as it was for urologists, many of whom went directly from open prostatectomy to robot-assisted laparoscopy, without passing through traditional laparoscopy,” he told this newspaper.

Dr. Morpurgo presented the results of 90 colorectal procedures (including 46 cancers) performed at his institution using robot-assisted laparoscopy, and compared them with 386 procedures (including 293 cancers) performed using traditional laparoscopy.

Among the procedures were right and left hernicolectomy, resection of transverse and sigmoid colon, low anterior resection, Miles' operation, total/subtotal colectomy, Hartmann's procedure, and rectopexis.

Robot-assisted surgery proved as safe and effective as laparoscopic techniques, he reported at the congress, sponsored by the Society of Laparoendoscopic Surgeons. There were no differences between the groups regarding duration of surgery, recovery of bowel function, length of postoperative stay, or amount of blood loss.

Among those undergoing the robotic procedure, complications required switching eight patients to another procedure: four were converted to hand-assisted surgery because of advanced cancer (three patients) or adhesions (one patient); three to laparoscopy because of technical difficulties, increased CO2, or bowel distension; and one to laparotomy because of injury to the spleen.

Among those in the laparoscopy group, 34 patients were switched to another procedure: 12 to hand-assisted surgery (5 due to advanced cancer, 3 due to difficulties resulting from obesity, 1 because of adhesions, and 3 nonspecified), and 22 to laparotomy (6 because of advanced cancer, 6 because of bowel distension, 2 because of adhesions, 2 because of splenic injuries, and 6 unspecified).

There were 10 major complications in the robot group (8.8%), including one death from electrolyte imbalance after a small bowel injury. A second case of small bowel injury also occurred. “This may be a new complication unique to this approach, in which it is difficult to see this injury,” said Dr. Morpurgo. “If the small bowel has to be manipulated during the procedure, it must be carefully inspected afterward.”

A higher percentage of patients in the laparoscopy group (13.2%) had complications, but there were no mortalities. Most complications were because of symptomatic anastomotic leaks in 19 patients, or 5% of the total, which is comparable with results seen with open surgery, Dr. Morpurgo said.

Other complications in this group included wound/perineal complications (seven patients), bleeding from trocars (six), abdominal bleeding (five), and stoma complications (four).

“Colorectal surgeons have to start doing more minimally invasive surgery,” said Dr. Morpurgo. “Since laparoscopy is not usually performed by colorectal surgeons, the robot can render an operation more like an open surgery, with all the benefits of laparoscopy.”

William Kelley, M.D., a general surgeon who practices in Richmond, Va., agreed that robotic surgery can make the laparoscopic approach less intimidating for colorectal surgeons. A fair number of U.S. colorectal surgeons have already familiarized themselves adequately with laparoscopic techniques, he said.

“Colon cancer is one of the hottest areas for robotic surgery,” said Dr. Kelley, who also is director of general surgery at the Minimally Invasive Surgery Center in Richmond, Va.

MIAMI BEACH — A simple tubal catheterization procedure, done at the time of diagnosis of proximal tubal occlusion during hysterosalpingography, can restore tubal patency and enable natural conception in a large percentage of women, according to one expert.

Transcervical tubal catheterization (TTC) should be offered first to infertile patients with unilateral or bilateral proximal tubal occlusion, but these patients are often sent instead to laparoscopic tubal repair or in vitro fertilization (IVF), said Ilan Tur-Kaspa, M.D., director of the Institute for Human Reproduction, and director of the clinical IVF program at the Reproductive Genetics Institute in Chicago.

“It could be used more often. It depends on the experience and expertise of the physician, as well as the patient's wishes,” he said in an interview.

Speaking at a congress on laparoscopy and minimally invasive surgery, Dr. Tur-Kaspa outlined his experience with TTC in 625 infertile women who together had 1,010 blocked fallopian tubes. Almost half of the women (45%) already had been treated or referred for IVF because of proximal tubal occlusion.

After TTC, 84% of occluded tubes were recanalized, and 87% of these patients were advised to attempt natural conception. A total of 81% of patients followed this advice, and 41% achieved a natural pregnancy.

The pregnancy rate was considerably higher in women who had no other causes of infertility identified (52%), but was still significant in women with other diagnosed causes of infertility (32%). The highest pregnancy rate was 71%, in women under age 30, and the rate in women over age 40 was 19%, he reported at the congress, sponsored by the Society of Laparoendoscopic Surgeons.

“With a diagnosis of proximal tubal occlusion, often the next steps would be either laparoscopy or IVF. But in most of these cases you could either avoid or postpone those procedures [by performing TTC], and for many women this would result in a natural conception,” he said.

Dr. Tur-Kaspa said that when hysterosalpingography (HSG) is performed with a balloon catheter, there is no change in catheter required for tubal catheterization. However, the catheter usually used for HSG is much smaller, and in this case a different catheter is necessary for TTC, he said.

“I insert a double-balloon catheter for HSG, and after that I introduce a selective salpingography catheter to reconfirm the diagnosis of proximal tubal occlusion. I then feed a guide wire into the fallopian tube to dislodge the occlusion, which is usually a mucous plug. After this I remove the catheter and perform selective salpingography to ensure the tube is patent. Finally, at the end, I repeat the HSG. My goal is to visualize both patent tubes,” he explained.

The procedure was unsuccessful in recanalizing an occluded tube in 7% of cases, and another 7% of cases ended in a diagnosis of distal tubal occlusion, after the proximal occlusion was treated. Distal occlusions can be reached with the guide wire but they cannot be treated as easily because the width of the fallopian tube as it nears the ovary can be as much as 15 mm, but it is less than half a millimeter on the proximal end near the uterus, he explained. Women with distal occlusions should be referred for laparoscopic treatment or IVF, he advised.

Five women in his series were treated later for suspected pelvic inflammatory disease (PID), even though one of them conceived spontaneously the next month. Two of these women had distal occlusions, which could have caused the PID, he said.

There were two tubal perforations during the TTC procedures, but these injuries are insignificant, Dr. Tur-Kaspa said.

“There could be scar tissue or bleeding, but because it is a soft guidewire, it just heals by itself. It's my experience as well as [that of] others that it has no clinical sequelae,” he said.

There were three ectopic pregnancies reported in the group (1.4%), but this was likely related to the patient population, not the procedure, he said.

“These results are definitely comparable with any IVF program. TTC can have a major impact on the counseling and management of infertile women. It should be recommended as first choice for infertile women with unilateral and bilateral proximal occlusions,” Dr. Tur-Kaspa said.

MIAMI BEACH — A simple tubal catheterization procedure, done at the time of diagnosis of proximal tubal occlusion during hysterosalpingography, can restore tubal patency and enable natural conception in a large percentage of women, according to one expert.

Transcervical tubal catheterization (TTC) should be offered first to infertile patients with unilateral or bilateral proximal tubal occlusion, but these patients are often sent instead to laparoscopic tubal repair or in vitro fertilization (IVF), said Ilan Tur-Kaspa, M.D., director of the Institute for Human Reproduction, and director of the clinical IVF program at the Reproductive Genetics Institute in Chicago.

“It could be used more often. It depends on the experience and expertise of the physician, as well as the patient's wishes,” he said in an interview.

Speaking at a congress on laparoscopy and minimally invasive surgery, Dr. Tur-Kaspa outlined his experience with TTC in 625 infertile women who together had 1,010 blocked fallopian tubes. Almost half of the women (45%) already had been treated or referred for IVF because of proximal tubal occlusion.

After TTC, 84% of occluded tubes were recanalized, and 87% of these patients were advised to attempt natural conception. A total of 81% of patients followed this advice, and 41% achieved a natural pregnancy.

The pregnancy rate was considerably higher in women who had no other causes of infertility identified (52%), but was still significant in women with other diagnosed causes of infertility (32%). The highest pregnancy rate was 71%, in women under age 30, and the rate in women over age 40 was 19%, he reported at the congress, sponsored by the Society of Laparoendoscopic Surgeons.

“With a diagnosis of proximal tubal occlusion, often the next steps would be either laparoscopy or IVF. But in most of these cases you could either avoid or postpone those procedures [by performing TTC], and for many women this would result in a natural conception,” he said.

Dr. Tur-Kaspa said that when hysterosalpingography (HSG) is performed with a balloon catheter, there is no change in catheter required for tubal catheterization. However, the catheter usually used for HSG is much smaller, and in this case a different catheter is necessary for TTC, he said.

“I insert a double-balloon catheter for HSG, and after that I introduce a selective salpingography catheter to reconfirm the diagnosis of proximal tubal occlusion. I then feed a guide wire into the fallopian tube to dislodge the occlusion, which is usually a mucous plug. After this I remove the catheter and perform selective salpingography to ensure the tube is patent. Finally, at the end, I repeat the HSG. My goal is to visualize both patent tubes,” he explained.

The procedure was unsuccessful in recanalizing an occluded tube in 7% of cases, and another 7% of cases ended in a diagnosis of distal tubal occlusion, after the proximal occlusion was treated. Distal occlusions can be reached with the guide wire but they cannot be treated as easily because the width of the fallopian tube as it nears the ovary can be as much as 15 mm, but it is less than half a millimeter on the proximal end near the uterus, he explained. Women with distal occlusions should be referred for laparoscopic treatment or IVF, he advised.

Five women in his series were treated later for suspected pelvic inflammatory disease (PID), even though one of them conceived spontaneously the next month. Two of these women had distal occlusions, which could have caused the PID, he said.

There were two tubal perforations during the TTC procedures, but these injuries are insignificant, Dr. Tur-Kaspa said.

“There could be scar tissue or bleeding, but because it is a soft guidewire, it just heals by itself. It's my experience as well as [that of] others that it has no clinical sequelae,” he said.

There were three ectopic pregnancies reported in the group (1.4%), but this was likely related to the patient population, not the procedure, he said.

“These results are definitely comparable with any IVF program. TTC can have a major impact on the counseling and management of infertile women. It should be recommended as first choice for infertile women with unilateral and bilateral proximal occlusions,” Dr. Tur-Kaspa said.

MIAMI BEACH — A simple tubal catheterization procedure, done at the time of diagnosis of proximal tubal occlusion during hysterosalpingography, can restore tubal patency and enable natural conception in a large percentage of women, according to one expert.

Transcervical tubal catheterization (TTC) should be offered first to infertile patients with unilateral or bilateral proximal tubal occlusion, but these patients are often sent instead to laparoscopic tubal repair or in vitro fertilization (IVF), said Ilan Tur-Kaspa, M.D., director of the Institute for Human Reproduction, and director of the clinical IVF program at the Reproductive Genetics Institute in Chicago.

“It could be used more often. It depends on the experience and expertise of the physician, as well as the patient's wishes,” he said in an interview.

Speaking at a congress on laparoscopy and minimally invasive surgery, Dr. Tur-Kaspa outlined his experience with TTC in 625 infertile women who together had 1,010 blocked fallopian tubes. Almost half of the women (45%) already had been treated or referred for IVF because of proximal tubal occlusion.

After TTC, 84% of occluded tubes were recanalized, and 87% of these patients were advised to attempt natural conception. A total of 81% of patients followed this advice, and 41% achieved a natural pregnancy.

The pregnancy rate was considerably higher in women who had no other causes of infertility identified (52%), but was still significant in women with other diagnosed causes of infertility (32%). The highest pregnancy rate was 71%, in women under age 30, and the rate in women over age 40 was 19%, he reported at the congress, sponsored by the Society of Laparoendoscopic Surgeons.

“With a diagnosis of proximal tubal occlusion, often the next steps would be either laparoscopy or IVF. But in most of these cases you could either avoid or postpone those procedures [by performing TTC], and for many women this would result in a natural conception,” he said.

Dr. Tur-Kaspa said that when hysterosalpingography (HSG) is performed with a balloon catheter, there is no change in catheter required for tubal catheterization. However, the catheter usually used for HSG is much smaller, and in this case a different catheter is necessary for TTC, he said.

“I insert a double-balloon catheter for HSG, and after that I introduce a selective salpingography catheter to reconfirm the diagnosis of proximal tubal occlusion. I then feed a guide wire into the fallopian tube to dislodge the occlusion, which is usually a mucous plug. After this I remove the catheter and perform selective salpingography to ensure the tube is patent. Finally, at the end, I repeat the HSG. My goal is to visualize both patent tubes,” he explained.

The procedure was unsuccessful in recanalizing an occluded tube in 7% of cases, and another 7% of cases ended in a diagnosis of distal tubal occlusion, after the proximal occlusion was treated. Distal occlusions can be reached with the guide wire but they cannot be treated as easily because the width of the fallopian tube as it nears the ovary can be as much as 15 mm, but it is less than half a millimeter on the proximal end near the uterus, he explained. Women with distal occlusions should be referred for laparoscopic treatment or IVF, he advised.

Five women in his series were treated later for suspected pelvic inflammatory disease (PID), even though one of them conceived spontaneously the next month. Two of these women had distal occlusions, which could have caused the PID, he said.

There were two tubal perforations during the TTC procedures, but these injuries are insignificant, Dr. Tur-Kaspa said.

“There could be scar tissue or bleeding, but because it is a soft guidewire, it just heals by itself. It's my experience as well as [that of] others that it has no clinical sequelae,” he said.

There were three ectopic pregnancies reported in the group (1.4%), but this was likely related to the patient population, not the procedure, he said.

“These results are definitely comparable with any IVF program. TTC can have a major impact on the counseling and management of infertile women. It should be recommended as first choice for infertile women with unilateral and bilateral proximal occlusions,” Dr. Tur-Kaspa said.

Long-term bisphosphonate therapy can lead to osteonecrosis of the jaw —a previously unrecognized and potentially serious complication that can often be avoided, according to Salvatore Ruggiero, M.D., D.M.D.

Patients on intravenous therapy, whether for cancer or osteoporosis, face the highest risk regardless of whether they are taking the medication for cancer or for osteoporosis, while the risk is lower, although not absent in those taking oral bisphosphonates, said Dr. Ruggiero, who is chief of oral and maxillofacial surgery at Long Island Jewish Medical Center in New Hyde Park, NY.

“The push is to alert physicians that this is a potential problem, so that before they start a patient on bisphosphonates, they send them to a dentist to extract any teeth that are nonrestorable,” he told this newspaper. “Prevention and early detection are important for preserving the jawbone in these individuals.”

In his experience, the majority of cases have been associated with infections following dental surgeries such as tooth extractions.

However, necrosis has also occurred spontaneously in a significant number of patients, he said.

For this reason Dr. Ruggiero recommends that all patients on long-term bisphosphonates have two or three preventive dental visits per year, and that physicians be alert for any early signs of necrosis.

Patients should be alert to “things like tooth pain, swelling, numbness of the lip and chin, or pain within the jaw.

“This is not a very difficult diagnosis to make. You basically have to look in the mouth and if you see exposed bone it is very clear,” he said.

Dr. Ruggiero's research, published in the Journal of Oral and Maxillofacial Surgery (J. Oral Maxillofac. Surg. 62;2004:527-34), has prompted warnings from the Food and Drug Administration (FDA), as well as from Novartis, which manufactures the intravenous bisphosphonates pamidronate disodium (Aredia) and zoledronic acid (Zometa).

Novartis has also changed its package inserts to reflect this information. However, labeling for oral bisphosphonates has not changed.

His study identified 63 patients with osteonecrosis of the jaw (ONJ), all of whom were on long-term bisphosphonate therapy for a period ranging from 6 to 48 months.

Fifty-six of the patients had used intravenous bisphosphonates for cancer chemotherapy, while the remaining 7 had used oral bisphosphonates for treatment of osteoporosis.

Until these cases were identified, ONJ had been a rare clinical scenario, Dr. Ruggiero noted.

The typical presenting symptoms were pain and nonhealing exposed bone at the site of a previous tooth extraction. However, 9 patients (14%) had no history of a recent dentoalveolar procedure and presented with spontaneous exposure and necrosis of the alveolar bone. Biopsies of the lesions showed no evidence of metastatic disease, Dr. Ruggiero said.

The lesions had been refractory to conservative debridement procedures and antibiotic therapy.

The majority of patients required surgical procedures to remove all of the involved bone. These procedures included 45 sequestrectomies, 4 marginal mandibular resections, 6 segmental mandibular resections, 5 partial maxillectomies, and 1 complete maxillectomy. Despite these surgical procedures, 5 patients had persistent bone necrosis and developed new regions of exposed bone even after they stopped bisphosphonate therapy.

Dr. Ruggiero speculates that the impaired bone wound healing may result from a compromised vascular supply caused by the antiangiogenic effects of bisphosphonates. He suggests that the absence of bone problems elsewhere in the body may be due to the unique environment created by oral microflora.

Source: Dr. McHenry

Spontaneous jaw osteonecrosis can occur in patients treated with long-term bisphosphonates; however, the majority of cases occur after tooth extraction or other dental surgeries. Photos courtesy Salvatore Ruggiero, MD, DMD/Long Island Jewish Medical Center

Long-term bisphosphonate therapy can lead to osteonecrosis of the jaw —a previously unrecognized and potentially serious complication that can often be avoided, according to Salvatore Ruggiero, M.D., D.M.D.

Patients on intravenous therapy, whether for cancer or osteoporosis, face the highest risk regardless of whether they are taking the medication for cancer or for osteoporosis, while the risk is lower, although not absent in those taking oral bisphosphonates, said Dr. Ruggiero, who is chief of oral and maxillofacial surgery at Long Island Jewish Medical Center in New Hyde Park, NY.

“The push is to alert physicians that this is a potential problem, so that before they start a patient on bisphosphonates, they send them to a dentist to extract any teeth that are nonrestorable,” he told this newspaper. “Prevention and early detection are important for preserving the jawbone in these individuals.”

In his experience, the majority of cases have been associated with infections following dental surgeries such as tooth extractions.

However, necrosis has also occurred spontaneously in a significant number of patients, he said.

For this reason Dr. Ruggiero recommends that all patients on long-term bisphosphonates have two or three preventive dental visits per year, and that physicians be alert for any early signs of necrosis.

Patients should be alert to “things like tooth pain, swelling, numbness of the lip and chin, or pain within the jaw.

“This is not a very difficult diagnosis to make. You basically have to look in the mouth and if you see exposed bone it is very clear,” he said.

Dr. Ruggiero's research, published in the Journal of Oral and Maxillofacial Surgery (J. Oral Maxillofac. Surg. 62;2004:527-34), has prompted warnings from the Food and Drug Administration (FDA), as well as from Novartis, which manufactures the intravenous bisphosphonates pamidronate disodium (Aredia) and zoledronic acid (Zometa).

Novartis has also changed its package inserts to reflect this information. However, labeling for oral bisphosphonates has not changed.

His study identified 63 patients with osteonecrosis of the jaw (ONJ), all of whom were on long-term bisphosphonate therapy for a period ranging from 6 to 48 months.

Fifty-six of the patients had used intravenous bisphosphonates for cancer chemotherapy, while the remaining 7 had used oral bisphosphonates for treatment of osteoporosis.

Until these cases were identified, ONJ had been a rare clinical scenario, Dr. Ruggiero noted.

The typical presenting symptoms were pain and nonhealing exposed bone at the site of a previous tooth extraction. However, 9 patients (14%) had no history of a recent dentoalveolar procedure and presented with spontaneous exposure and necrosis of the alveolar bone. Biopsies of the lesions showed no evidence of metastatic disease, Dr. Ruggiero said.

The lesions had been refractory to conservative debridement procedures and antibiotic therapy.

The majority of patients required surgical procedures to remove all of the involved bone. These procedures included 45 sequestrectomies, 4 marginal mandibular resections, 6 segmental mandibular resections, 5 partial maxillectomies, and 1 complete maxillectomy. Despite these surgical procedures, 5 patients had persistent bone necrosis and developed new regions of exposed bone even after they stopped bisphosphonate therapy.

Dr. Ruggiero speculates that the impaired bone wound healing may result from a compromised vascular supply caused by the antiangiogenic effects of bisphosphonates. He suggests that the absence of bone problems elsewhere in the body may be due to the unique environment created by oral microflora.

Source: Dr. McHenry

Spontaneous jaw osteonecrosis can occur in patients treated with long-term bisphosphonates; however, the majority of cases occur after tooth extraction or other dental surgeries. Photos courtesy Salvatore Ruggiero, MD, DMD/Long Island Jewish Medical Center

Long-term bisphosphonate therapy can lead to osteonecrosis of the jaw —a previously unrecognized and potentially serious complication that can often be avoided, according to Salvatore Ruggiero, M.D., D.M.D.

Patients on intravenous therapy, whether for cancer or osteoporosis, face the highest risk regardless of whether they are taking the medication for cancer or for osteoporosis, while the risk is lower, although not absent in those taking oral bisphosphonates, said Dr. Ruggiero, who is chief of oral and maxillofacial surgery at Long Island Jewish Medical Center in New Hyde Park, NY.

“The push is to alert physicians that this is a potential problem, so that before they start a patient on bisphosphonates, they send them to a dentist to extract any teeth that are nonrestorable,” he told this newspaper. “Prevention and early detection are important for preserving the jawbone in these individuals.”

In his experience, the majority of cases have been associated with infections following dental surgeries such as tooth extractions.

However, necrosis has also occurred spontaneously in a significant number of patients, he said.

For this reason Dr. Ruggiero recommends that all patients on long-term bisphosphonates have two or three preventive dental visits per year, and that physicians be alert for any early signs of necrosis.

Patients should be alert to “things like tooth pain, swelling, numbness of the lip and chin, or pain within the jaw.

“This is not a very difficult diagnosis to make. You basically have to look in the mouth and if you see exposed bone it is very clear,” he said.

Dr. Ruggiero's research, published in the Journal of Oral and Maxillofacial Surgery (J. Oral Maxillofac. Surg. 62;2004:527-34), has prompted warnings from the Food and Drug Administration (FDA), as well as from Novartis, which manufactures the intravenous bisphosphonates pamidronate disodium (Aredia) and zoledronic acid (Zometa).

Novartis has also changed its package inserts to reflect this information. However, labeling for oral bisphosphonates has not changed.

His study identified 63 patients with osteonecrosis of the jaw (ONJ), all of whom were on long-term bisphosphonate therapy for a period ranging from 6 to 48 months.

Fifty-six of the patients had used intravenous bisphosphonates for cancer chemotherapy, while the remaining 7 had used oral bisphosphonates for treatment of osteoporosis.

Until these cases were identified, ONJ had been a rare clinical scenario, Dr. Ruggiero noted.

The typical presenting symptoms were pain and nonhealing exposed bone at the site of a previous tooth extraction. However, 9 patients (14%) had no history of a recent dentoalveolar procedure and presented with spontaneous exposure and necrosis of the alveolar bone. Biopsies of the lesions showed no evidence of metastatic disease, Dr. Ruggiero said.

The lesions had been refractory to conservative debridement procedures and antibiotic therapy.

The majority of patients required surgical procedures to remove all of the involved bone. These procedures included 45 sequestrectomies, 4 marginal mandibular resections, 6 segmental mandibular resections, 5 partial maxillectomies, and 1 complete maxillectomy. Despite these surgical procedures, 5 patients had persistent bone necrosis and developed new regions of exposed bone even after they stopped bisphosphonate therapy.

Dr. Ruggiero speculates that the impaired bone wound healing may result from a compromised vascular supply caused by the antiangiogenic effects of bisphosphonates. He suggests that the absence of bone problems elsewhere in the body may be due to the unique environment created by oral microflora.

Source: Dr. McHenry

Spontaneous jaw osteonecrosis can occur in patients treated with long-term bisphosphonates; however, the majority of cases occur after tooth extraction or other dental surgeries. Photos courtesy Salvatore Ruggiero, MD, DMD/Long Island Jewish Medical Center

Children vaccinated for MMR who present with mumps-like illnesses have other identifiable viral etiologies about 14% of the time, according to results of a Finnish study.

“When one is trying to establish the cause of mumps-like symptoms in a patient, it would be worthwhile to test at least for antibodies to EBV [Epstein-Barr virus] and the parainfluenza viruses, if not for antibodies to other viruses as well,” wrote Irja Davidkin, Ph.D., and colleagues from the National Public Health Institute in Helsinki (J. Infect. Dis. 2005;191:719-23).

The study analyzed frozen serum samples from 601 children and adolescents who had reported mumps-like illness but in whom mumps had been ruled out. Their symptoms usually included swelling of the parotid gland and low-grade fever.

A previous study of 848 patients with mumps-like symptoms, which included the 601 nonmumps patients, had confirmed mumps in 2% (17) of cases, while inadequate sample collection or storage accounted for the remaining 230 cases.

Among the 601 nonmumps cases, antibody testing revealed an acute viral infection in 84 (14%) patients; the remaining patients could not be diagnosed.

EBV was the most commonly identified viral infection, occurring in 7% of patients, which was half of the diagnosed group. Parainfluenza types 1, 2, and 3 made up another 4% of the diagnosable cases, adenovirus was seen in 3% of cases, and enterovirus was seen in 2% of cases.

Additionally, 0.5% of patients were diagnosed with parvovirus, and human herpesvirus was seen in 4% of a subgroup of children under 4 years old.

A total of 14 patients were diagnosed with 2 concomitant viral infections, and 2 patients had 3 diagnoses.

The authors noted that although adenovirus infection associated with parotitis has been previously reported only in HIV-positive patients, this study indicates it should be considered in the differential diagnosis for mumps-like symptoms in otherwise healthy children and adolescents.

Children vaccinated for MMR who present with mumps-like illnesses have other identifiable viral etiologies about 14% of the time, according to results of a Finnish study.

“When one is trying to establish the cause of mumps-like symptoms in a patient, it would be worthwhile to test at least for antibodies to EBV [Epstein-Barr virus] and the parainfluenza viruses, if not for antibodies to other viruses as well,” wrote Irja Davidkin, Ph.D., and colleagues from the National Public Health Institute in Helsinki (J. Infect. Dis. 2005;191:719-23).

The study analyzed frozen serum samples from 601 children and adolescents who had reported mumps-like illness but in whom mumps had been ruled out. Their symptoms usually included swelling of the parotid gland and low-grade fever.

A previous study of 848 patients with mumps-like symptoms, which included the 601 nonmumps patients, had confirmed mumps in 2% (17) of cases, while inadequate sample collection or storage accounted for the remaining 230 cases.

Among the 601 nonmumps cases, antibody testing revealed an acute viral infection in 84 (14%) patients; the remaining patients could not be diagnosed.

EBV was the most commonly identified viral infection, occurring in 7% of patients, which was half of the diagnosed group. Parainfluenza types 1, 2, and 3 made up another 4% of the diagnosable cases, adenovirus was seen in 3% of cases, and enterovirus was seen in 2% of cases.

Additionally, 0.5% of patients were diagnosed with parvovirus, and human herpesvirus was seen in 4% of a subgroup of children under 4 years old.

A total of 14 patients were diagnosed with 2 concomitant viral infections, and 2 patients had 3 diagnoses.

The authors noted that although adenovirus infection associated with parotitis has been previously reported only in HIV-positive patients, this study indicates it should be considered in the differential diagnosis for mumps-like symptoms in otherwise healthy children and adolescents.

Children vaccinated for MMR who present with mumps-like illnesses have other identifiable viral etiologies about 14% of the time, according to results of a Finnish study.

“When one is trying to establish the cause of mumps-like symptoms in a patient, it would be worthwhile to test at least for antibodies to EBV [Epstein-Barr virus] and the parainfluenza viruses, if not for antibodies to other viruses as well,” wrote Irja Davidkin, Ph.D., and colleagues from the National Public Health Institute in Helsinki (J. Infect. Dis. 2005;191:719-23).

The study analyzed frozen serum samples from 601 children and adolescents who had reported mumps-like illness but in whom mumps had been ruled out. Their symptoms usually included swelling of the parotid gland and low-grade fever.

A previous study of 848 patients with mumps-like symptoms, which included the 601 nonmumps patients, had confirmed mumps in 2% (17) of cases, while inadequate sample collection or storage accounted for the remaining 230 cases.

Among the 601 nonmumps cases, antibody testing revealed an acute viral infection in 84 (14%) patients; the remaining patients could not be diagnosed.

EBV was the most commonly identified viral infection, occurring in 7% of patients, which was half of the diagnosed group. Parainfluenza types 1, 2, and 3 made up another 4% of the diagnosable cases, adenovirus was seen in 3% of cases, and enterovirus was seen in 2% of cases.

Additionally, 0.5% of patients were diagnosed with parvovirus, and human herpesvirus was seen in 4% of a subgroup of children under 4 years old.

A total of 14 patients were diagnosed with 2 concomitant viral infections, and 2 patients had 3 diagnoses.

The authors noted that although adenovirus infection associated with parotitis has been previously reported only in HIV-positive patients, this study indicates it should be considered in the differential diagnosis for mumps-like symptoms in otherwise healthy children and adolescents.

SAN ANTONIO — Adults with dust-mite allergy respond better to sublingual immunotherapy compared with standard allergy medications, according to Italian researchers.

“The clinical efficacy of sublingual immunotherapy has been previously established in pollen, but not dust-mite allergy,” said lead author Carlo Lombardi, M.D., who presented his research at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

While the effect of sublingual immunotherapy is relatively easy to assess in pollen allergy, its effect on year-round dust-mite allergy has been more difficult to assess, added Giovanni Passalacqua, M.D., a coauthor of the study.

But, over a 3-year study period, the investigators observed a significant reduction in nasal obstruction, itching and cough, and a decreased need for symptom-relief medications in patients treated with sublingual immunotherapy compared with those treated with standard medications for allergic rhinitis and asthma.

The study randomized 68 patients with mild dust-mite rhinitis and/or asthma to standard medication plus sublingual immunotherapy or standard medication plus placebo for 1 year. Drug consumption and allergy symptom scores were tracked through diary cards, and the Short Form-36 Quality of Life Questionnaire.

Compared with patients receiving placebo, patients treated with sublingual immunotherapy experienced a significant reduction in symptoms. The treated group was also significantly less likely to report at least 1 missed day of work due to asthma (25% vs. 43%), said Dr. Lombardi.

There was no change in the quality of life in both groups, he said, adding that at baseline, all patients displayed a normal QOL profile. But sublingual therapy patients reported an overall improvement in their 'change in health status,'” he said.

The study results are “revealing and important to the practice of allergy medicine worldwide,” commented Clifford W. Bassett, M.D., medical director of Allergy & Asthma Care of New York.

Although sublingual immunotherapy has been a part of clinical practice in many parts of Europe for the past decade, and in Italy is used more commonly than the subcutaneous route of administration (70% vs 30%), according to Dr. Passalacqua, it remains unapproved by the Food and Drug Administration.

“This and other research is fairly convincing that sublingual immunotherapy is effective when given correctly, at the proper dosage, and the right time. And its safety seems to be quite good from what we've seen so far,” said Dr. Bassett.

SAN ANTONIO — Adults with dust-mite allergy respond better to sublingual immunotherapy compared with standard allergy medications, according to Italian researchers.

“The clinical efficacy of sublingual immunotherapy has been previously established in pollen, but not dust-mite allergy,” said lead author Carlo Lombardi, M.D., who presented his research at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

While the effect of sublingual immunotherapy is relatively easy to assess in pollen allergy, its effect on year-round dust-mite allergy has been more difficult to assess, added Giovanni Passalacqua, M.D., a coauthor of the study.

But, over a 3-year study period, the investigators observed a significant reduction in nasal obstruction, itching and cough, and a decreased need for symptom-relief medications in patients treated with sublingual immunotherapy compared with those treated with standard medications for allergic rhinitis and asthma.

The study randomized 68 patients with mild dust-mite rhinitis and/or asthma to standard medication plus sublingual immunotherapy or standard medication plus placebo for 1 year. Drug consumption and allergy symptom scores were tracked through diary cards, and the Short Form-36 Quality of Life Questionnaire.

Compared with patients receiving placebo, patients treated with sublingual immunotherapy experienced a significant reduction in symptoms. The treated group was also significantly less likely to report at least 1 missed day of work due to asthma (25% vs. 43%), said Dr. Lombardi.

There was no change in the quality of life in both groups, he said, adding that at baseline, all patients displayed a normal QOL profile. But sublingual therapy patients reported an overall improvement in their 'change in health status,'” he said.

The study results are “revealing and important to the practice of allergy medicine worldwide,” commented Clifford W. Bassett, M.D., medical director of Allergy & Asthma Care of New York.

Although sublingual immunotherapy has been a part of clinical practice in many parts of Europe for the past decade, and in Italy is used more commonly than the subcutaneous route of administration (70% vs 30%), according to Dr. Passalacqua, it remains unapproved by the Food and Drug Administration.

“This and other research is fairly convincing that sublingual immunotherapy is effective when given correctly, at the proper dosage, and the right time. And its safety seems to be quite good from what we've seen so far,” said Dr. Bassett.

SAN ANTONIO — Adults with dust-mite allergy respond better to sublingual immunotherapy compared with standard allergy medications, according to Italian researchers.

“The clinical efficacy of sublingual immunotherapy has been previously established in pollen, but not dust-mite allergy,” said lead author Carlo Lombardi, M.D., who presented his research at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

While the effect of sublingual immunotherapy is relatively easy to assess in pollen allergy, its effect on year-round dust-mite allergy has been more difficult to assess, added Giovanni Passalacqua, M.D., a coauthor of the study.

But, over a 3-year study period, the investigators observed a significant reduction in nasal obstruction, itching and cough, and a decreased need for symptom-relief medications in patients treated with sublingual immunotherapy compared with those treated with standard medications for allergic rhinitis and asthma.

The study randomized 68 patients with mild dust-mite rhinitis and/or asthma to standard medication plus sublingual immunotherapy or standard medication plus placebo for 1 year. Drug consumption and allergy symptom scores were tracked through diary cards, and the Short Form-36 Quality of Life Questionnaire.

Compared with patients receiving placebo, patients treated with sublingual immunotherapy experienced a significant reduction in symptoms. The treated group was also significantly less likely to report at least 1 missed day of work due to asthma (25% vs. 43%), said Dr. Lombardi.

There was no change in the quality of life in both groups, he said, adding that at baseline, all patients displayed a normal QOL profile. But sublingual therapy patients reported an overall improvement in their 'change in health status,'” he said.

The study results are “revealing and important to the practice of allergy medicine worldwide,” commented Clifford W. Bassett, M.D., medical director of Allergy & Asthma Care of New York.

Although sublingual immunotherapy has been a part of clinical practice in many parts of Europe for the past decade, and in Italy is used more commonly than the subcutaneous route of administration (70% vs 30%), according to Dr. Passalacqua, it remains unapproved by the Food and Drug Administration.

“This and other research is fairly convincing that sublingual immunotherapy is effective when given correctly, at the proper dosage, and the right time. And its safety seems to be quite good from what we've seen so far,” said Dr. Bassett.

SNOWMASS, COLO. — Skin tumors and their precursors possess potentially attractive targets for chemoprevention, and many are being actively investigated, according to David R. Bickers, M.D.

Exposure to UV light causes mutations in several tumor suppressor genes and increases the risk of skin cancer. That relationship makes methods of augmenting these genes a “tantalizing” prospect for skin cancer chemoprevention, he said at a clinical dermatology seminar sponsored by Medicis.

Topical cyclopamine, topical tazarotene, and topical antioxidants all hold promise, said Dr. Bickers, professor and chair of the department of dermatology at Columbia University, New York.

In addition, cyclooxygenase overexpression is a feature in some human neoplasms, which could point to COX-2 inhibitors as possibly chemoprotective, he added.

Dr. Bickers is also planning a trial of the retinoid tazarotene, which is another potentially chemopreventive agent.

Tazarotene upregulates a tumor suppressor known as tazarotene-induced gene 3 (TIG3) in human keratinocytes. That gene is diminished in patients with basal cell carcinoma (BCC), he explained.

One recent study found that topical treatment of BCCs with tazarotene increased TIG3 expression, resulting in both clinical and histological improvement (J. Invest. Dermatol. 2003;121:902-9).

Cyclopamine, a veratrum alkaloid, also has similar potential to inhibit BCCs, he said.

His work with mice showed that treatment with oral cyclopamine diminished tumor development, he explained. In addition, one human study of topical cyclopamine showed rapid regression of skin tumors and histologic evidence of tumor cell inhibition and apoptosis.

Finally, a very recent study of oral antioxidants has shown that sun exposure results in less DNA damage in patients who have taken a 3-month course of oral ascorbic acid (vitamin C) and alpha tocopherol (vitamin E), said Dr. Bickers (J. Invest. Dermatol. 2005; 124:304-7).

Similarly, another study found that oral antioxidant treatment with Polypodium leucotomos extract reduced sun-induced skin erythema (J. Am. Acad. Dermatol. 2004;51:910-8).

“While these results are modest, this strategy may prove more feasible as more potent compounds are developed,” he said.

SNOWMASS, COLO. — Skin tumors and their precursors possess potentially attractive targets for chemoprevention, and many are being actively investigated, according to David R. Bickers, M.D.

Exposure to UV light causes mutations in several tumor suppressor genes and increases the risk of skin cancer. That relationship makes methods of augmenting these genes a “tantalizing” prospect for skin cancer chemoprevention, he said at a clinical dermatology seminar sponsored by Medicis.

Topical cyclopamine, topical tazarotene, and topical antioxidants all hold promise, said Dr. Bickers, professor and chair of the department of dermatology at Columbia University, New York.

In addition, cyclooxygenase overexpression is a feature in some human neoplasms, which could point to COX-2 inhibitors as possibly chemoprotective, he added.

Dr. Bickers is also planning a trial of the retinoid tazarotene, which is another potentially chemopreventive agent.

Tazarotene upregulates a tumor suppressor known as tazarotene-induced gene 3 (TIG3) in human keratinocytes. That gene is diminished in patients with basal cell carcinoma (BCC), he explained.

One recent study found that topical treatment of BCCs with tazarotene increased TIG3 expression, resulting in both clinical and histological improvement (J. Invest. Dermatol. 2003;121:902-9).

Cyclopamine, a veratrum alkaloid, also has similar potential to inhibit BCCs, he said.

His work with mice showed that treatment with oral cyclopamine diminished tumor development, he explained. In addition, one human study of topical cyclopamine showed rapid regression of skin tumors and histologic evidence of tumor cell inhibition and apoptosis.

Finally, a very recent study of oral antioxidants has shown that sun exposure results in less DNA damage in patients who have taken a 3-month course of oral ascorbic acid (vitamin C) and alpha tocopherol (vitamin E), said Dr. Bickers (J. Invest. Dermatol. 2005; 124:304-7).

Similarly, another study found that oral antioxidant treatment with Polypodium leucotomos extract reduced sun-induced skin erythema (J. Am. Acad. Dermatol. 2004;51:910-8).

“While these results are modest, this strategy may prove more feasible as more potent compounds are developed,” he said.

SNOWMASS, COLO. — Skin tumors and their precursors possess potentially attractive targets for chemoprevention, and many are being actively investigated, according to David R. Bickers, M.D.

Exposure to UV light causes mutations in several tumor suppressor genes and increases the risk of skin cancer. That relationship makes methods of augmenting these genes a “tantalizing” prospect for skin cancer chemoprevention, he said at a clinical dermatology seminar sponsored by Medicis.

Topical cyclopamine, topical tazarotene, and topical antioxidants all hold promise, said Dr. Bickers, professor and chair of the department of dermatology at Columbia University, New York.

In addition, cyclooxygenase overexpression is a feature in some human neoplasms, which could point to COX-2 inhibitors as possibly chemoprotective, he added.

Dr. Bickers is also planning a trial of the retinoid tazarotene, which is another potentially chemopreventive agent.

Tazarotene upregulates a tumor suppressor known as tazarotene-induced gene 3 (TIG3) in human keratinocytes. That gene is diminished in patients with basal cell carcinoma (BCC), he explained.

One recent study found that topical treatment of BCCs with tazarotene increased TIG3 expression, resulting in both clinical and histological improvement (J. Invest. Dermatol. 2003;121:902-9).

Cyclopamine, a veratrum alkaloid, also has similar potential to inhibit BCCs, he said.

His work with mice showed that treatment with oral cyclopamine diminished tumor development, he explained. In addition, one human study of topical cyclopamine showed rapid regression of skin tumors and histologic evidence of tumor cell inhibition and apoptosis.

Finally, a very recent study of oral antioxidants has shown that sun exposure results in less DNA damage in patients who have taken a 3-month course of oral ascorbic acid (vitamin C) and alpha tocopherol (vitamin E), said Dr. Bickers (J. Invest. Dermatol. 2005; 124:304-7).

Similarly, another study found that oral antioxidant treatment with Polypodium leucotomos extract reduced sun-induced skin erythema (J. Am. Acad. Dermatol. 2004;51:910-8).

“While these results are modest, this strategy may prove more feasible as more potent compounds are developed,” he said.

About two-thirds of Americans support the use of genetic testing of embryos during in vitro fertilization to avoid the birth of a child with a fatal disease, but fewer than 30% support its hypothetical use for selecting intelligence or strength, according to a report from the Genetics and Public Policy Center in Washington.

A “majority of Americans think that testing for health-related purposes is an appropriate use of reproductive genetic testing, but only a minority support its use for trait selection,” noted the report entitled “Reproductive Genetic Testing: What America Thinks.”

The report touches on the more textured differences and similarities in opinion concerning these issues among the American public. It describes the political debate over reproductive genetic testing as framed by two polarized views, whereas the views of most Americans “are more nuanced and elastic, reflecting the tensions among hopes, values, and personal experience.”

“Public debate and media coverage of reproductive genetic technologies hide a surprising level of concordance among Americans for using genetic testing to identify risks of disease,” observed Kathy Hudson, director of the center, in a written statement.

The research included 21 focus groups, 62 in-depth interviews, surveys of more than 6,000 people, and both in-person and online town hall meetings.

The study authors noted that respondents' awareness about preimplantation genetic diagnosis (PGD) was very low.

“While most participants had heard of genetic testing at some level, the pace of technology in this field rapidly has outstripped public awareness,” the report noted. When asked whether they had heard of various technologies before that day, only 40% of participants had heard of PGD. A total of 83% said they were aware of prenatal testing, 90% had heard of in vitro fertilization (IVF), and 97% had heard of cloning.

When asked about the statement “Reproductive genetic technology will inevitably lead to genetic enhancement and designer babies,” 75% of participants said they agreed.

Yet participants were clear that it is not the technologies themselves that they fear, but rather that “unrestrained human selfishness and vanity will drive people to use reproductive genetic testing inappropriately,” noted the authors. “They believed that the technology is being developed for good purposes, but human vices will result in consumer demand for capricious uses.”

The study reports that 84% of participants were concerned about reproductive technologies being unregulated; however, 70% also were concerned “about government regulators invading private reproductive decisions.”

A companion report entitled “Reproductive Genetic Testing: Issues and Options for Policymakers” explores various options for overseeing the use, cost, access, and safety of reproductive genetic testing.

Both of the reports are available at www.dnapolicy.org

About two-thirds of Americans support the use of genetic testing of embryos during in vitro fertilization to avoid the birth of a child with a fatal disease, but fewer than 30% support its hypothetical use for selecting intelligence or strength, according to a report from the Genetics and Public Policy Center in Washington.

A “majority of Americans think that testing for health-related purposes is an appropriate use of reproductive genetic testing, but only a minority support its use for trait selection,” noted the report entitled “Reproductive Genetic Testing: What America Thinks.”

The report touches on the more textured differences and similarities in opinion concerning these issues among the American public. It describes the political debate over reproductive genetic testing as framed by two polarized views, whereas the views of most Americans “are more nuanced and elastic, reflecting the tensions among hopes, values, and personal experience.”

“Public debate and media coverage of reproductive genetic technologies hide a surprising level of concordance among Americans for using genetic testing to identify risks of disease,” observed Kathy Hudson, director of the center, in a written statement.

The research included 21 focus groups, 62 in-depth interviews, surveys of more than 6,000 people, and both in-person and online town hall meetings.

The study authors noted that respondents' awareness about preimplantation genetic diagnosis (PGD) was very low.

“While most participants had heard of genetic testing at some level, the pace of technology in this field rapidly has outstripped public awareness,” the report noted. When asked whether they had heard of various technologies before that day, only 40% of participants had heard of PGD. A total of 83% said they were aware of prenatal testing, 90% had heard of in vitro fertilization (IVF), and 97% had heard of cloning.

When asked about the statement “Reproductive genetic technology will inevitably lead to genetic enhancement and designer babies,” 75% of participants said they agreed.

Yet participants were clear that it is not the technologies themselves that they fear, but rather that “unrestrained human selfishness and vanity will drive people to use reproductive genetic testing inappropriately,” noted the authors. “They believed that the technology is being developed for good purposes, but human vices will result in consumer demand for capricious uses.”

The study reports that 84% of participants were concerned about reproductive technologies being unregulated; however, 70% also were concerned “about government regulators invading private reproductive decisions.”

A companion report entitled “Reproductive Genetic Testing: Issues and Options for Policymakers” explores various options for overseeing the use, cost, access, and safety of reproductive genetic testing.

Both of the reports are available at www.dnapolicy.org

About two-thirds of Americans support the use of genetic testing of embryos during in vitro fertilization to avoid the birth of a child with a fatal disease, but fewer than 30% support its hypothetical use for selecting intelligence or strength, according to a report from the Genetics and Public Policy Center in Washington.

A “majority of Americans think that testing for health-related purposes is an appropriate use of reproductive genetic testing, but only a minority support its use for trait selection,” noted the report entitled “Reproductive Genetic Testing: What America Thinks.”

The report touches on the more textured differences and similarities in opinion concerning these issues among the American public. It describes the political debate over reproductive genetic testing as framed by two polarized views, whereas the views of most Americans “are more nuanced and elastic, reflecting the tensions among hopes, values, and personal experience.”

“Public debate and media coverage of reproductive genetic technologies hide a surprising level of concordance among Americans for using genetic testing to identify risks of disease,” observed Kathy Hudson, director of the center, in a written statement.

The research included 21 focus groups, 62 in-depth interviews, surveys of more than 6,000 people, and both in-person and online town hall meetings.

The study authors noted that respondents' awareness about preimplantation genetic diagnosis (PGD) was very low.

“While most participants had heard of genetic testing at some level, the pace of technology in this field rapidly has outstripped public awareness,” the report noted. When asked whether they had heard of various technologies before that day, only 40% of participants had heard of PGD. A total of 83% said they were aware of prenatal testing, 90% had heard of in vitro fertilization (IVF), and 97% had heard of cloning.

When asked about the statement “Reproductive genetic technology will inevitably lead to genetic enhancement and designer babies,” 75% of participants said they agreed.

Yet participants were clear that it is not the technologies themselves that they fear, but rather that “unrestrained human selfishness and vanity will drive people to use reproductive genetic testing inappropriately,” noted the authors. “They believed that the technology is being developed for good purposes, but human vices will result in consumer demand for capricious uses.”

The study reports that 84% of participants were concerned about reproductive technologies being unregulated; however, 70% also were concerned “about government regulators invading private reproductive decisions.”

A companion report entitled “Reproductive Genetic Testing: Issues and Options for Policymakers” explores various options for overseeing the use, cost, access, and safety of reproductive genetic testing.

Both of the reports are available at www.dnapolicy.org

The provision of chlamydia or gonorrhea treatment directly to patients' sexual partners, without requiring the partners to visit a physician, significantly improved infection control in patients, researchers at the University of Washington in Seattle reported.

“We believe that the inadequacies of current approaches to partner notification and the persistence of unacceptably high levels of morbidity from sexually transmitted infections in the United States should motivate both clinicians and public health authorities to incorporate patient-delivered partner therapy and other approaches to expedited care of partners into clinical and public health policies,” wrote Matthew R. Golden, M.D., the lead investigator (N. Engl. J. Med. 2005;352:676-85).

The study randomized 2,751 patients recently treated for chlamydia and/or gonorrhea infections to either expedited treatment or standard referral for their partners.

The 1,376 patients in the expedited treatment group were offered medication to give to as many as three partners. An additional 1,375 patients in the standard referral group were advised to tell their partners to seek care, available at no cost at the public health department's sexually transmitted diseases (STD) clinic.

The medication for partners in the expedited treatment group was distributed to patients at the STD clinic, by direct mail, or through participating pharmacies. It consisted of either a single 400-mg dose of cefixime and a 1-g sachet of azithromycin for partners of patients with gonorrhea or azithromycin only for partners of patients with chlamydia. Warnings and information about the medication, condoms, and STD prevention also were included in the packets.

A total of 1,860 patients completed the study and were interviewed and retested 10-18 weeks after their initial diagnosis and treatment.

More patients in the expedited treatment group reported that their partners were likely to have been treated, or to have tested negative for STDs—making persistent or recurrent infection with either gonorrhea or chlamydia significantly less common in this group (10%), compared with the standard referral group (13%), for a relative risk of 0.76.

Expedited treatment was more effective in reducing gonorrhea (73%) than chlamydia (15%)—a finding that might be partially explained by chlamydia treatment failure, the authors suggested.

The findings represent “a major advance for the control and prevention of STDs,” reported Emily J. Erbelding, M.D., and Jonathan M. Zenilman, M.D., of Johns Hopkins University, Baltimore, in an accompanying editorial (N. Engl. J. Med. 2005;352:720-1).

“We can conclude that the use of expedited approaches designed to circumvent traditional evaluation by a clinician increases the chance of an exposed partner's receiving proper therapy and, most important, reduces the original patient's risk of reinfection,” they wrote.

The study authors noted several weaknesses in their model of patient-delivered partner therapy, including legal barriers in many states, the uncertain availability of cefixime, and the potential adverse effects of treating partners without a clinical evaluation.

The provision of chlamydia or gonorrhea treatment directly to patients' sexual partners, without requiring the partners to visit a physician, significantly improved infection control in patients, researchers at the University of Washington in Seattle reported.

“We believe that the inadequacies of current approaches to partner notification and the persistence of unacceptably high levels of morbidity from sexually transmitted infections in the United States should motivate both clinicians and public health authorities to incorporate patient-delivered partner therapy and other approaches to expedited care of partners into clinical and public health policies,” wrote Matthew R. Golden, M.D., the lead investigator (N. Engl. J. Med. 2005;352:676-85).

The study randomized 2,751 patients recently treated for chlamydia and/or gonorrhea infections to either expedited treatment or standard referral for their partners.

The 1,376 patients in the expedited treatment group were offered medication to give to as many as three partners. An additional 1,375 patients in the standard referral group were advised to tell their partners to seek care, available at no cost at the public health department's sexually transmitted diseases (STD) clinic.

The medication for partners in the expedited treatment group was distributed to patients at the STD clinic, by direct mail, or through participating pharmacies. It consisted of either a single 400-mg dose of cefixime and a 1-g sachet of azithromycin for partners of patients with gonorrhea or azithromycin only for partners of patients with chlamydia. Warnings and information about the medication, condoms, and STD prevention also were included in the packets.

A total of 1,860 patients completed the study and were interviewed and retested 10-18 weeks after their initial diagnosis and treatment.

More patients in the expedited treatment group reported that their partners were likely to have been treated, or to have tested negative for STDs—making persistent or recurrent infection with either gonorrhea or chlamydia significantly less common in this group (10%), compared with the standard referral group (13%), for a relative risk of 0.76.

Expedited treatment was more effective in reducing gonorrhea (73%) than chlamydia (15%)—a finding that might be partially explained by chlamydia treatment failure, the authors suggested.

The findings represent “a major advance for the control and prevention of STDs,” reported Emily J. Erbelding, M.D., and Jonathan M. Zenilman, M.D., of Johns Hopkins University, Baltimore, in an accompanying editorial (N. Engl. J. Med. 2005;352:720-1).

“We can conclude that the use of expedited approaches designed to circumvent traditional evaluation by a clinician increases the chance of an exposed partner's receiving proper therapy and, most important, reduces the original patient's risk of reinfection,” they wrote.

The study authors noted several weaknesses in their model of patient-delivered partner therapy, including legal barriers in many states, the uncertain availability of cefixime, and the potential adverse effects of treating partners without a clinical evaluation.

The provision of chlamydia or gonorrhea treatment directly to patients' sexual partners, without requiring the partners to visit a physician, significantly improved infection control in patients, researchers at the University of Washington in Seattle reported.

“We believe that the inadequacies of current approaches to partner notification and the persistence of unacceptably high levels of morbidity from sexually transmitted infections in the United States should motivate both clinicians and public health authorities to incorporate patient-delivered partner therapy and other approaches to expedited care of partners into clinical and public health policies,” wrote Matthew R. Golden, M.D., the lead investigator (N. Engl. J. Med. 2005;352:676-85).

The study randomized 2,751 patients recently treated for chlamydia and/or gonorrhea infections to either expedited treatment or standard referral for their partners.

The 1,376 patients in the expedited treatment group were offered medication to give to as many as three partners. An additional 1,375 patients in the standard referral group were advised to tell their partners to seek care, available at no cost at the public health department's sexually transmitted diseases (STD) clinic.

The medication for partners in the expedited treatment group was distributed to patients at the STD clinic, by direct mail, or through participating pharmacies. It consisted of either a single 400-mg dose of cefixime and a 1-g sachet of azithromycin for partners of patients with gonorrhea or azithromycin only for partners of patients with chlamydia. Warnings and information about the medication, condoms, and STD prevention also were included in the packets.

A total of 1,860 patients completed the study and were interviewed and retested 10-18 weeks after their initial diagnosis and treatment.

More patients in the expedited treatment group reported that their partners were likely to have been treated, or to have tested negative for STDs—making persistent or recurrent infection with either gonorrhea or chlamydia significantly less common in this group (10%), compared with the standard referral group (13%), for a relative risk of 0.76.

Expedited treatment was more effective in reducing gonorrhea (73%) than chlamydia (15%)—a finding that might be partially explained by chlamydia treatment failure, the authors suggested.

The findings represent “a major advance for the control and prevention of STDs,” reported Emily J. Erbelding, M.D., and Jonathan M. Zenilman, M.D., of Johns Hopkins University, Baltimore, in an accompanying editorial (N. Engl. J. Med. 2005;352:720-1).

“We can conclude that the use of expedited approaches designed to circumvent traditional evaluation by a clinician increases the chance of an exposed partner's receiving proper therapy and, most important, reduces the original patient's risk of reinfection,” they wrote.

The study authors noted several weaknesses in their model of patient-delivered partner therapy, including legal barriers in many states, the uncertain availability of cefixime, and the potential adverse effects of treating partners without a clinical evaluation.

About two-thirds of Americans support the use of genetic testing of embryos during in vitro fertilization to avoid the birth of a child with a fatal disease, but fewer than 30% support its hypothetical use for selecting intelligence or strength, according to a report from the Genetics and Public Policy Center in Washington.

A “majority of Americans think that testing for health-related purposes is an appropriate use of reproductive genetic testing, but only a minority support its use for trait selection,” noted the report entitled “Reproductive Genetic Testing: What America Thinks.”

The report touches on the more textured differences and similarities in opinion concerning these issues among the American public. It describes the political debate over reproductive genetic testing as framed by two polarized views, whereas the views of most Americans “are more nuanced and elastic, reflecting the tensions among hopes, values, and personal experience.”

“Public debate and media coverage of reproductive genetic technologies hide a surprising level of concordance among Americans for using genetic testing to identify risks of disease,” observed Kathy Hudson, director of the center, in a written statement.

The research included 21 focus groups, 62 in-depth interviews, surveys of more than 6,000 people, and both in-person and online town hall meetings.

The study authors noted that respondents' awareness about preimplantation genetic diagnosis (PGD) was very low.

“While most participants had heard of genetic testing at some level, the pace of technology in this field rapidly has outstripped public awareness,” the report noted. When asked whether they had heard of various technologies before that day, only 40% of participants had heard of PGD. A total of 83% said they were aware of prenatal testing, 90% had heard of in vitro fertilization (IVF), and 97% had heard of cloning.

When asked about the statement “Reproductive genetic technology will inevitably lead to genetic enhancement and designer babies,” 75% of participants said they agreed. Yet participants were clear that it is not the technologies themselves that they fear, but rather that “unrestrained human selfishness and vanity will drive people to use reproductive genetic testing inappropriately,” noted the authors. “They believed that the technology is being developed for good purposes, but human vices will result in consumer demand for capricious uses.”

The study reports that 84% of participants were concerned about reproductive technologies being unregulated; however, 70% also were concerned “about government regulators invading private reproductive decisions.”

A companion report entitled “Reproductive Genetic Testing: Issues and Options for Policymakers” explores various options for overseeing the use, cost, access, and safety of reproductive genetic testing.

Both reports are available at www.dnapolicy.org

Source: Dr. Silver

About two-thirds of Americans support the use of genetic testing of embryos during in vitro fertilization to avoid the birth of a child with a fatal disease, but fewer than 30% support its hypothetical use for selecting intelligence or strength, according to a report from the Genetics and Public Policy Center in Washington.

A “majority of Americans think that testing for health-related purposes is an appropriate use of reproductive genetic testing, but only a minority support its use for trait selection,” noted the report entitled “Reproductive Genetic Testing: What America Thinks.”

The report touches on the more textured differences and similarities in opinion concerning these issues among the American public. It describes the political debate over reproductive genetic testing as framed by two polarized views, whereas the views of most Americans “are more nuanced and elastic, reflecting the tensions among hopes, values, and personal experience.”

“Public debate and media coverage of reproductive genetic technologies hide a surprising level of concordance among Americans for using genetic testing to identify risks of disease,” observed Kathy Hudson, director of the center, in a written statement.

The research included 21 focus groups, 62 in-depth interviews, surveys of more than 6,000 people, and both in-person and online town hall meetings.

The study authors noted that respondents' awareness about preimplantation genetic diagnosis (PGD) was very low.

“While most participants had heard of genetic testing at some level, the pace of technology in this field rapidly has outstripped public awareness,” the report noted. When asked whether they had heard of various technologies before that day, only 40% of participants had heard of PGD. A total of 83% said they were aware of prenatal testing, 90% had heard of in vitro fertilization (IVF), and 97% had heard of cloning.

When asked about the statement “Reproductive genetic technology will inevitably lead to genetic enhancement and designer babies,” 75% of participants said they agreed. Yet participants were clear that it is not the technologies themselves that they fear, but rather that “unrestrained human selfishness and vanity will drive people to use reproductive genetic testing inappropriately,” noted the authors. “They believed that the technology is being developed for good purposes, but human vices will result in consumer demand for capricious uses.”

The study reports that 84% of participants were concerned about reproductive technologies being unregulated; however, 70% also were concerned “about government regulators invading private reproductive decisions.”

A companion report entitled “Reproductive Genetic Testing: Issues and Options for Policymakers” explores various options for overseeing the use, cost, access, and safety of reproductive genetic testing.

Both reports are available at www.dnapolicy.org

Source: Dr. Silver

About two-thirds of Americans support the use of genetic testing of embryos during in vitro fertilization to avoid the birth of a child with a fatal disease, but fewer than 30% support its hypothetical use for selecting intelligence or strength, according to a report from the Genetics and Public Policy Center in Washington.

A “majority of Americans think that testing for health-related purposes is an appropriate use of reproductive genetic testing, but only a minority support its use for trait selection,” noted the report entitled “Reproductive Genetic Testing: What America Thinks.”

The report touches on the more textured differences and similarities in opinion concerning these issues among the American public. It describes the political debate over reproductive genetic testing as framed by two polarized views, whereas the views of most Americans “are more nuanced and elastic, reflecting the tensions among hopes, values, and personal experience.”

“Public debate and media coverage of reproductive genetic technologies hide a surprising level of concordance among Americans for using genetic testing to identify risks of disease,” observed Kathy Hudson, director of the center, in a written statement.

The research included 21 focus groups, 62 in-depth interviews, surveys of more than 6,000 people, and both in-person and online town hall meetings.

The study authors noted that respondents' awareness about preimplantation genetic diagnosis (PGD) was very low.

“While most participants had heard of genetic testing at some level, the pace of technology in this field rapidly has outstripped public awareness,” the report noted. When asked whether they had heard of various technologies before that day, only 40% of participants had heard of PGD. A total of 83% said they were aware of prenatal testing, 90% had heard of in vitro fertilization (IVF), and 97% had heard of cloning.

When asked about the statement “Reproductive genetic technology will inevitably lead to genetic enhancement and designer babies,” 75% of participants said they agreed. Yet participants were clear that it is not the technologies themselves that they fear, but rather that “unrestrained human selfishness and vanity will drive people to use reproductive genetic testing inappropriately,” noted the authors. “They believed that the technology is being developed for good purposes, but human vices will result in consumer demand for capricious uses.”

The study reports that 84% of participants were concerned about reproductive technologies being unregulated; however, 70% also were concerned “about government regulators invading private reproductive decisions.”

A companion report entitled “Reproductive Genetic Testing: Issues and Options for Policymakers” explores various options for overseeing the use, cost, access, and safety of reproductive genetic testing.

Both reports are available at www.dnapolicy.org

Source: Dr. Silver