Robert Finn

HUNTINGTON BEACH, CALIF. — In a study of 95 morbidly obese patients with hypertension, 46% had complete resolution of their hypertension and another 19% showed some improvement 12 months after laparoscopic Roux-en-Y gastric bypass surgery, Dr. Marcelo W. Hinojosa reported at the Academic Surgical Congress.

It's well known that when obese patients lose weight, their hypertension often improves, and when obese patients have gastric bypass surgery, they usually lose weight. It's therefore reasonable to assume that when obese patients have gastric bypass surgery, their hypertension will probably improve. The study data provided evidence to support these relationships.

The research was a retrospective review. All of the patients in the study were taking at least one antihypertensive medication, and 40% were on two or more. Their mean age was 47 years at the time of surgery, and their mean body mass index was 47 kg/m

As expected, the surgery resulted in significant weight loss. Within 1 month after the surgery, patients had lost an average of 23% of their excess weight, and that increased to 66% at the end of 12 months.

Dr. Hinojosa and his colleagues at the University of California, Irvine, defined complete resolution of hypertension as a systolic blood pressure less than 140 mm Hg and diastolic pressure less than 80 mm Hg without the use of any antihypertensive medication. They defined improvement as maintaining that pressure or less while decreasing the requirement for antihypertensives.

Within 1 month, the average blood pressure declined from 139.8/79.9 to 123.3/75.3, a significant difference. At 12 months, the group showed evidence of further decline, with an average blood pressure of 120.0/71.3.

At 1 month, 25% of the patients had complete resolution of their hypertension, and 36% showed some improvement. The proportion showing complete resolution increased to 41% at 6 months and 46% at 12 months. The proportion showing some improvement was 21% at 6 months and 19% at 12 months.

The patients in the study had experienced hypertension for an average of approximately 6 years. The investigators determined that the patients with a disease duration of less than 4 years were significantly more likely to have complete resolution of their hypertension than were those with a longer duration of disease.

Dr. Hinojosa declared that he had no relevant financial relationships associated with this study.

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HUNTINGTON BEACH, CALIF. — In a study of 95 morbidly obese patients with hypertension, 46% had complete resolution of their hypertension and another 19% showed some improvement 12 months after laparoscopic Roux-en-Y gastric bypass surgery, Dr. Marcelo W. Hinojosa reported at the Academic Surgical Congress.

It's well known that when obese patients lose weight, their hypertension often improves, and when obese patients have gastric bypass surgery, they usually lose weight. It's therefore reasonable to assume that when obese patients have gastric bypass surgery, their hypertension will probably improve. The study data provided evidence to support these relationships.

The research was a retrospective review. All of the patients in the study were taking at least one antihypertensive medication, and 40% were on two or more. Their mean age was 47 years at the time of surgery, and their mean body mass index was 47 kg/m

As expected, the surgery resulted in significant weight loss. Within 1 month after the surgery, patients had lost an average of 23% of their excess weight, and that increased to 66% at the end of 12 months.

Dr. Hinojosa and his colleagues at the University of California, Irvine, defined complete resolution of hypertension as a systolic blood pressure less than 140 mm Hg and diastolic pressure less than 80 mm Hg without the use of any antihypertensive medication. They defined improvement as maintaining that pressure or less while decreasing the requirement for antihypertensives.

Within 1 month, the average blood pressure declined from 139.8/79.9 to 123.3/75.3, a significant difference. At 12 months, the group showed evidence of further decline, with an average blood pressure of 120.0/71.3.

At 1 month, 25% of the patients had complete resolution of their hypertension, and 36% showed some improvement. The proportion showing complete resolution increased to 41% at 6 months and 46% at 12 months. The proportion showing some improvement was 21% at 6 months and 19% at 12 months.

The patients in the study had experienced hypertension for an average of approximately 6 years. The investigators determined that the patients with a disease duration of less than 4 years were significantly more likely to have complete resolution of their hypertension than were those with a longer duration of disease.

Dr. Hinojosa declared that he had no relevant financial relationships associated with this study.

ELSEVIER GLOBAL MEDICAL NEWS

HUNTINGTON BEACH, CALIF. — In a study of 95 morbidly obese patients with hypertension, 46% had complete resolution of their hypertension and another 19% showed some improvement 12 months after laparoscopic Roux-en-Y gastric bypass surgery, Dr. Marcelo W. Hinojosa reported at the Academic Surgical Congress.

It's well known that when obese patients lose weight, their hypertension often improves, and when obese patients have gastric bypass surgery, they usually lose weight. It's therefore reasonable to assume that when obese patients have gastric bypass surgery, their hypertension will probably improve. The study data provided evidence to support these relationships.

The research was a retrospective review. All of the patients in the study were taking at least one antihypertensive medication, and 40% were on two or more. Their mean age was 47 years at the time of surgery, and their mean body mass index was 47 kg/m

As expected, the surgery resulted in significant weight loss. Within 1 month after the surgery, patients had lost an average of 23% of their excess weight, and that increased to 66% at the end of 12 months.

Dr. Hinojosa and his colleagues at the University of California, Irvine, defined complete resolution of hypertension as a systolic blood pressure less than 140 mm Hg and diastolic pressure less than 80 mm Hg without the use of any antihypertensive medication. They defined improvement as maintaining that pressure or less while decreasing the requirement for antihypertensives.

Within 1 month, the average blood pressure declined from 139.8/79.9 to 123.3/75.3, a significant difference. At 12 months, the group showed evidence of further decline, with an average blood pressure of 120.0/71.3.

At 1 month, 25% of the patients had complete resolution of their hypertension, and 36% showed some improvement. The proportion showing complete resolution increased to 41% at 6 months and 46% at 12 months. The proportion showing some improvement was 21% at 6 months and 19% at 12 months.

The patients in the study had experienced hypertension for an average of approximately 6 years. The investigators determined that the patients with a disease duration of less than 4 years were significantly more likely to have complete resolution of their hypertension than were those with a longer duration of disease.

Dr. Hinojosa declared that he had no relevant financial relationships associated with this study.

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Hyperglycemia is common in acute coronary syndrome and is a strong predictor of poor outcome, but many questions remain about how to take these facts into account in clinical practice, according to a scientific statement from the American Heart Association.

Although it's still uncertain whether treating hyperglycemia in acute coronary syndrome (ACS) produces definite benefits, it's reasonable to consider intensive glucose control in patients with plasma glucose levels above 180 mg/dL, and even for some patients with milder degrees of hyperglycemia, according to the members of the writing group, led by Dr. Prakash Deedwania of the University of California, San Francisco (Circulation 2008 Feb. 25 [doi:10.1161/circulationaha.107.188629]).

“Most cardiologists are not aware of the importance of hyperglycemia in the acute coronary syndrome,” Dr. Deedwania said in an interview. “Although some specialty centers are taking care of hyperglycemia, the majority of them are not paying any attention.”

More than 2 million patients are treated in the United States annually for ACS, and as many as 50% of them might have hyperglycemia, Dr. Deedwania said. Numerous analyses and meta-analyses have found increased risks linked to hyperglycemia in ACS. The largest retrospective study, which involved 141,680 patients, found that hyperglycemia increased the risk of 30-day mortality by 13%–77%, and it increased 1-year mortality by 7%–46%, depending on the degree of hyperglycemia.

The risks appear to be greatest in hyperglycemic patients with no previous evidence of diabetes, but it's still unclear whether hyperglycemia is a marker or a mediator of adverse outcomes.

The most pressing unanswered question, according to Dr. Deedwania, is to determine which treatment for hyperglycemia has the best combination of efficacy and safety. One large recent trial showed that hypoglycemia can be more dangerous than hyperglycemia, so it's important to figure out how critical it is to control hyperglycemia and to what extent it should be controlled.

Other areas in need of further investigation include whether persistent hyperglycemia during ACS hospitalization has a greater impact on prognosis than does admission hyperglycemia alone, whether there is a critical period of vulnerability from hyperglycemia in these patients, whether the best target glucose levels differ in patients with and without pre-existing diabetes, and what the optimal timing of therapy might be.

Meanwhile, the writing group determined that there is now excellent (level A) evidence to recommend that glucose levels should be part of the initial laboratory evaluation in all patients with suspected or confirmed ACS. And there is good (level B) evidence that glucose levels should be monitored closely in patients admitted to an ICU with ACS, that it's reasonable to consider treatment in patients with high levels of hyperglycemia, that insulin by intravenous infusion is the most effective measure to control glucose in ICU patients, and that special attention should be paid to ACS patients with hyperglycemia but no history of diabetes.

In addition to informing physicians about the importance of hyperglycemia in ACS, the release of the AHA scientific statement has another goal, Dr. Deedwania said. “This is a call to action for all the different agencies such as the National Institutes of Health to consider doing trials on some of these very specific questions. This should be a priority.”

Hyperglycemia is common in acute coronary syndrome and is a strong predictor of poor outcome, but many questions remain about how to take these facts into account in clinical practice, according to a scientific statement from the American Heart Association.

Although it's still uncertain whether treating hyperglycemia in acute coronary syndrome (ACS) produces definite benefits, it's reasonable to consider intensive glucose control in patients with plasma glucose levels above 180 mg/dL, and even for some patients with milder degrees of hyperglycemia, according to the members of the writing group, led by Dr. Prakash Deedwania of the University of California, San Francisco (Circulation 2008 Feb. 25 [doi:10.1161/circulationaha.107.188629]).

“Most cardiologists are not aware of the importance of hyperglycemia in the acute coronary syndrome,” Dr. Deedwania said in an interview. “Although some specialty centers are taking care of hyperglycemia, the majority of them are not paying any attention.”

More than 2 million patients are treated in the United States annually for ACS, and as many as 50% of them might have hyperglycemia, Dr. Deedwania said. Numerous analyses and meta-analyses have found increased risks linked to hyperglycemia in ACS. The largest retrospective study, which involved 141,680 patients, found that hyperglycemia increased the risk of 30-day mortality by 13%–77%, and it increased 1-year mortality by 7%–46%, depending on the degree of hyperglycemia.

The risks appear to be greatest in hyperglycemic patients with no previous evidence of diabetes, but it's still unclear whether hyperglycemia is a marker or a mediator of adverse outcomes.

The most pressing unanswered question, according to Dr. Deedwania, is to determine which treatment for hyperglycemia has the best combination of efficacy and safety. One large recent trial showed that hypoglycemia can be more dangerous than hyperglycemia, so it's important to figure out how critical it is to control hyperglycemia and to what extent it should be controlled.

Other areas in need of further investigation include whether persistent hyperglycemia during ACS hospitalization has a greater impact on prognosis than does admission hyperglycemia alone, whether there is a critical period of vulnerability from hyperglycemia in these patients, whether the best target glucose levels differ in patients with and without pre-existing diabetes, and what the optimal timing of therapy might be.

Meanwhile, the writing group determined that there is now excellent (level A) evidence to recommend that glucose levels should be part of the initial laboratory evaluation in all patients with suspected or confirmed ACS. And there is good (level B) evidence that glucose levels should be monitored closely in patients admitted to an ICU with ACS, that it's reasonable to consider treatment in patients with high levels of hyperglycemia, that insulin by intravenous infusion is the most effective measure to control glucose in ICU patients, and that special attention should be paid to ACS patients with hyperglycemia but no history of diabetes.

In addition to informing physicians about the importance of hyperglycemia in ACS, the release of the AHA scientific statement has another goal, Dr. Deedwania said. “This is a call to action for all the different agencies such as the National Institutes of Health to consider doing trials on some of these very specific questions. This should be a priority.”

Hyperglycemia is common in acute coronary syndrome and is a strong predictor of poor outcome, but many questions remain about how to take these facts into account in clinical practice, according to a scientific statement from the American Heart Association.

Although it's still uncertain whether treating hyperglycemia in acute coronary syndrome (ACS) produces definite benefits, it's reasonable to consider intensive glucose control in patients with plasma glucose levels above 180 mg/dL, and even for some patients with milder degrees of hyperglycemia, according to the members of the writing group, led by Dr. Prakash Deedwania of the University of California, San Francisco (Circulation 2008 Feb. 25 [doi:10.1161/circulationaha.107.188629]).

“Most cardiologists are not aware of the importance of hyperglycemia in the acute coronary syndrome,” Dr. Deedwania said in an interview. “Although some specialty centers are taking care of hyperglycemia, the majority of them are not paying any attention.”

More than 2 million patients are treated in the United States annually for ACS, and as many as 50% of them might have hyperglycemia, Dr. Deedwania said. Numerous analyses and meta-analyses have found increased risks linked to hyperglycemia in ACS. The largest retrospective study, which involved 141,680 patients, found that hyperglycemia increased the risk of 30-day mortality by 13%–77%, and it increased 1-year mortality by 7%–46%, depending on the degree of hyperglycemia.

The risks appear to be greatest in hyperglycemic patients with no previous evidence of diabetes, but it's still unclear whether hyperglycemia is a marker or a mediator of adverse outcomes.

The most pressing unanswered question, according to Dr. Deedwania, is to determine which treatment for hyperglycemia has the best combination of efficacy and safety. One large recent trial showed that hypoglycemia can be more dangerous than hyperglycemia, so it's important to figure out how critical it is to control hyperglycemia and to what extent it should be controlled.

Other areas in need of further investigation include whether persistent hyperglycemia during ACS hospitalization has a greater impact on prognosis than does admission hyperglycemia alone, whether there is a critical period of vulnerability from hyperglycemia in these patients, whether the best target glucose levels differ in patients with and without pre-existing diabetes, and what the optimal timing of therapy might be.

Meanwhile, the writing group determined that there is now excellent (level A) evidence to recommend that glucose levels should be part of the initial laboratory evaluation in all patients with suspected or confirmed ACS. And there is good (level B) evidence that glucose levels should be monitored closely in patients admitted to an ICU with ACS, that it's reasonable to consider treatment in patients with high levels of hyperglycemia, that insulin by intravenous infusion is the most effective measure to control glucose in ICU patients, and that special attention should be paid to ACS patients with hyperglycemia but no history of diabetes.

In addition to informing physicians about the importance of hyperglycemia in ACS, the release of the AHA scientific statement has another goal, Dr. Deedwania said. “This is a call to action for all the different agencies such as the National Institutes of Health to consider doing trials on some of these very specific questions. This should be a priority.”

HONOLULU — Influenza testing should be considered in children hospitalized for asthma because children with both conditions have almost five times the chance of intubation or death, compared with asthmatic children without a comorbid condition, according to a study of over 600,000 children.

Adolescence, race, male gender, Medicaid status, and lack of insurance were other risk factors that predicted an adverse outcome, Dr. Alan S. Weller and Dr. Kitaw Demissie of the Robert Wood Johnson Medical School, New Brunswick, N.J., wrote in a poster presentation at the annual meeting of the Pediatric Academic Societies.

The study involved a nationally representative sample of 641,354 children, aged 2–17 years, who were included in the National Hospital Discharge Survey for 2001–2005. All were hospitalized primarily for asthma.

Of the 2,505 children with influenza in that group, 2% had an adverse outcome (intubation or death) with an adjusted odds ratio of 4.79 in the multivariate analysis, which corrected for age, race, gender, insurance, region, and comorbid conditions. Other significant predictors of adverse outcomes were age between 12 and 17 years, compared with 2–4 years (OR, 3.37), male gender (OR, 1.47), black race (OR, 1.31), and other race (OR, 1.34).

Children with private insurance had a significantly lower risk of adverse outcomes. Compared with privately insured children, the odds ratio for children with Medicaid was 2.29, the odds ratio for children with HMO/PPO insurance was 1.39, and the odds ratio for uninsured children was 1.42.

Children in the Western region of the United States fared worst (OR, 5.07), compared with those in the South. Compared with those in the South, the odds ratio for children in the Northeast was 1.89, and for those in the Midwest it was 1.22.

Influenza was the only comorbid condition that predicted adverse outcome. Sinusitis and upper respiratory infections predicted significantly better outcomes, compared with children who had no comorbid conditions. Children with sinusitis had a 63% lower chance of an adverse outcome, and those with upper respiratory infections had an 88% lower chance of an adverse outcome.

The investigators concluded that further studies would be required to characterize the role of these predictors and to formulate appropriate interventions for those in high-risk groups.

Dr. Weller disclosed no conflicts of interest related to this study.

HONOLULU — Influenza testing should be considered in children hospitalized for asthma because children with both conditions have almost five times the chance of intubation or death, compared with asthmatic children without a comorbid condition, according to a study of over 600,000 children.

Adolescence, race, male gender, Medicaid status, and lack of insurance were other risk factors that predicted an adverse outcome, Dr. Alan S. Weller and Dr. Kitaw Demissie of the Robert Wood Johnson Medical School, New Brunswick, N.J., wrote in a poster presentation at the annual meeting of the Pediatric Academic Societies.

The study involved a nationally representative sample of 641,354 children, aged 2–17 years, who were included in the National Hospital Discharge Survey for 2001–2005. All were hospitalized primarily for asthma.

Of the 2,505 children with influenza in that group, 2% had an adverse outcome (intubation or death) with an adjusted odds ratio of 4.79 in the multivariate analysis, which corrected for age, race, gender, insurance, region, and comorbid conditions. Other significant predictors of adverse outcomes were age between 12 and 17 years, compared with 2–4 years (OR, 3.37), male gender (OR, 1.47), black race (OR, 1.31), and other race (OR, 1.34).

Children with private insurance had a significantly lower risk of adverse outcomes. Compared with privately insured children, the odds ratio for children with Medicaid was 2.29, the odds ratio for children with HMO/PPO insurance was 1.39, and the odds ratio for uninsured children was 1.42.

Children in the Western region of the United States fared worst (OR, 5.07), compared with those in the South. Compared with those in the South, the odds ratio for children in the Northeast was 1.89, and for those in the Midwest it was 1.22.

Influenza was the only comorbid condition that predicted adverse outcome. Sinusitis and upper respiratory infections predicted significantly better outcomes, compared with children who had no comorbid conditions. Children with sinusitis had a 63% lower chance of an adverse outcome, and those with upper respiratory infections had an 88% lower chance of an adverse outcome.

The investigators concluded that further studies would be required to characterize the role of these predictors and to formulate appropriate interventions for those in high-risk groups.

Dr. Weller disclosed no conflicts of interest related to this study.

HONOLULU — Influenza testing should be considered in children hospitalized for asthma because children with both conditions have almost five times the chance of intubation or death, compared with asthmatic children without a comorbid condition, according to a study of over 600,000 children.

Adolescence, race, male gender, Medicaid status, and lack of insurance were other risk factors that predicted an adverse outcome, Dr. Alan S. Weller and Dr. Kitaw Demissie of the Robert Wood Johnson Medical School, New Brunswick, N.J., wrote in a poster presentation at the annual meeting of the Pediatric Academic Societies.

The study involved a nationally representative sample of 641,354 children, aged 2–17 years, who were included in the National Hospital Discharge Survey for 2001–2005. All were hospitalized primarily for asthma.

Of the 2,505 children with influenza in that group, 2% had an adverse outcome (intubation or death) with an adjusted odds ratio of 4.79 in the multivariate analysis, which corrected for age, race, gender, insurance, region, and comorbid conditions. Other significant predictors of adverse outcomes were age between 12 and 17 years, compared with 2–4 years (OR, 3.37), male gender (OR, 1.47), black race (OR, 1.31), and other race (OR, 1.34).

Children with private insurance had a significantly lower risk of adverse outcomes. Compared with privately insured children, the odds ratio for children with Medicaid was 2.29, the odds ratio for children with HMO/PPO insurance was 1.39, and the odds ratio for uninsured children was 1.42.

Children in the Western region of the United States fared worst (OR, 5.07), compared with those in the South. Compared with those in the South, the odds ratio for children in the Northeast was 1.89, and for those in the Midwest it was 1.22.

Influenza was the only comorbid condition that predicted adverse outcome. Sinusitis and upper respiratory infections predicted significantly better outcomes, compared with children who had no comorbid conditions. Children with sinusitis had a 63% lower chance of an adverse outcome, and those with upper respiratory infections had an 88% lower chance of an adverse outcome.

The investigators concluded that further studies would be required to characterize the role of these predictors and to formulate appropriate interventions for those in high-risk groups.

Dr. Weller disclosed no conflicts of interest related to this study.

HUNTINGTON BEACH, CALIF. — Two proposed staging systems would divide patients who have rectal and colon carcinoid tumors, respectively, into statistically significant prognostic groups based on survival data, Dr. Christine S. Landry reported at the Academic Surgical Congress.

The proposed staging systems show overall survival at 5 years ranging from 100% for stage I rectal carcinoid tumors to 18% for stage IV, and from 96% for stage I colon carcinoid tumors to 20% for stage IV. No system is currently accepted for carcinoid tumors, according to the National Cancer Institute (NCI).

The proposed stages are based on an analysis of the NCI's Surveillance, Epidemiology, and End Results (SEER) database for 1977–2004. The SEER database includes 4,701 patients with rectal carcinoid tumors and 2,459 colon carcinoid tumors during that time period, said Dr. Landry of the University of Louisville (Ky.).

“Although rectal carcinoid tumors are often thought of as very slow-growing tumors, they do have significant malignant potential,” Dr. Landry said. “And the purpose of this study was to identify clinical pathological characteristics that predict overall prognosis as well as develop a staging system to help determine overall survival.” Similar considerations were at play in the study of colon carcinoid tumors.

Size of primary tumor, depth of invasion, lymph node metastasis, distant metastasis, and surgical resection were all significantly associated with prognosis for both rectal and colon carcinoid tumors in univariate analysis. Differences between the two tumors appeared in multivariate analysis.

For patients who have rectal carcinoid tumors, only the size of the primary tumor and the depth of invasion proved statistically significant prognostic indicators after controlling for the other factors. For patients who have colon carcinoid tumors, on the other hand, lymph node metastasis and distant metastasis were the only statistically significant independent prognostic indicators, she said.

Dr. Landry and her colleagues then looked at different combinations of these indicators to see how best to separate patients into different survival groups. For rectal carcinoid tumors, it proved best to divide patients into T stages based on a tumor size greater than or less than 2 cm and whether the depth of invasion went beyond the muscularis propria.

They proposed that tumors would be designated T1 if they had not grown beyond the muscularis propria and were less than 2 cm in diameter. Tumors would be designated T2 if they were beyond the muscularis propria and less than 2 cm in diameter or not beyond the muscularis propria and 2 cm or more in diameter. And tumors would be designated T3 if they were beyond the muscularis propria and 2 cm or more in diameter.

Colon carcinoid tumors, on the other hand, would be designated T1 if they were less than 2 cm in diameter, T2 if they were between the 2 cm and 4 cm in diameter, and T3 if they were 4 cm in diameter or more.

Both rectal and colon carcinoid tumors would be designated N0 if there was no nodal metastasis, N1 if there was nodal metastasis, M0 if there was no distant metastasis, and M1 if there was distant metastasis.

The investigators then analyzed different combinations of T, N, and M to determine how they should best be combined into staging systems. (See boxes.)

“Incorporating the staging systems into clinical practice will help us determine the best treatments for rectal [and colon] carcinoid tumors as well as predict overall survival,” Dr. Landry said.

Dr. Landry disclosed that she did not have any relevant financial relationships associated with her presentation.

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HUNTINGTON BEACH, CALIF. — Two proposed staging systems would divide patients who have rectal and colon carcinoid tumors, respectively, into statistically significant prognostic groups based on survival data, Dr. Christine S. Landry reported at the Academic Surgical Congress.

The proposed staging systems show overall survival at 5 years ranging from 100% for stage I rectal carcinoid tumors to 18% for stage IV, and from 96% for stage I colon carcinoid tumors to 20% for stage IV. No system is currently accepted for carcinoid tumors, according to the National Cancer Institute (NCI).

The proposed stages are based on an analysis of the NCI's Surveillance, Epidemiology, and End Results (SEER) database for 1977–2004. The SEER database includes 4,701 patients with rectal carcinoid tumors and 2,459 colon carcinoid tumors during that time period, said Dr. Landry of the University of Louisville (Ky.).

“Although rectal carcinoid tumors are often thought of as very slow-growing tumors, they do have significant malignant potential,” Dr. Landry said. “And the purpose of this study was to identify clinical pathological characteristics that predict overall prognosis as well as develop a staging system to help determine overall survival.” Similar considerations were at play in the study of colon carcinoid tumors.

Size of primary tumor, depth of invasion, lymph node metastasis, distant metastasis, and surgical resection were all significantly associated with prognosis for both rectal and colon carcinoid tumors in univariate analysis. Differences between the two tumors appeared in multivariate analysis.

For patients who have rectal carcinoid tumors, only the size of the primary tumor and the depth of invasion proved statistically significant prognostic indicators after controlling for the other factors. For patients who have colon carcinoid tumors, on the other hand, lymph node metastasis and distant metastasis were the only statistically significant independent prognostic indicators, she said.

Dr. Landry and her colleagues then looked at different combinations of these indicators to see how best to separate patients into different survival groups. For rectal carcinoid tumors, it proved best to divide patients into T stages based on a tumor size greater than or less than 2 cm and whether the depth of invasion went beyond the muscularis propria.

They proposed that tumors would be designated T1 if they had not grown beyond the muscularis propria and were less than 2 cm in diameter. Tumors would be designated T2 if they were beyond the muscularis propria and less than 2 cm in diameter or not beyond the muscularis propria and 2 cm or more in diameter. And tumors would be designated T3 if they were beyond the muscularis propria and 2 cm or more in diameter.

Colon carcinoid tumors, on the other hand, would be designated T1 if they were less than 2 cm in diameter, T2 if they were between the 2 cm and 4 cm in diameter, and T3 if they were 4 cm in diameter or more.

Both rectal and colon carcinoid tumors would be designated N0 if there was no nodal metastasis, N1 if there was nodal metastasis, M0 if there was no distant metastasis, and M1 if there was distant metastasis.

The investigators then analyzed different combinations of T, N, and M to determine how they should best be combined into staging systems. (See boxes.)

“Incorporating the staging systems into clinical practice will help us determine the best treatments for rectal [and colon] carcinoid tumors as well as predict overall survival,” Dr. Landry said.

Dr. Landry disclosed that she did not have any relevant financial relationships associated with her presentation.

ELSEVIER GLOBAL MEDICAL NEWS

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HUNTINGTON BEACH, CALIF. — Two proposed staging systems would divide patients who have rectal and colon carcinoid tumors, respectively, into statistically significant prognostic groups based on survival data, Dr. Christine S. Landry reported at the Academic Surgical Congress.

The proposed staging systems show overall survival at 5 years ranging from 100% for stage I rectal carcinoid tumors to 18% for stage IV, and from 96% for stage I colon carcinoid tumors to 20% for stage IV. No system is currently accepted for carcinoid tumors, according to the National Cancer Institute (NCI).

The proposed stages are based on an analysis of the NCI's Surveillance, Epidemiology, and End Results (SEER) database for 1977–2004. The SEER database includes 4,701 patients with rectal carcinoid tumors and 2,459 colon carcinoid tumors during that time period, said Dr. Landry of the University of Louisville (Ky.).

“Although rectal carcinoid tumors are often thought of as very slow-growing tumors, they do have significant malignant potential,” Dr. Landry said. “And the purpose of this study was to identify clinical pathological characteristics that predict overall prognosis as well as develop a staging system to help determine overall survival.” Similar considerations were at play in the study of colon carcinoid tumors.

Size of primary tumor, depth of invasion, lymph node metastasis, distant metastasis, and surgical resection were all significantly associated with prognosis for both rectal and colon carcinoid tumors in univariate analysis. Differences between the two tumors appeared in multivariate analysis.

For patients who have rectal carcinoid tumors, only the size of the primary tumor and the depth of invasion proved statistically significant prognostic indicators after controlling for the other factors. For patients who have colon carcinoid tumors, on the other hand, lymph node metastasis and distant metastasis were the only statistically significant independent prognostic indicators, she said.

Dr. Landry and her colleagues then looked at different combinations of these indicators to see how best to separate patients into different survival groups. For rectal carcinoid tumors, it proved best to divide patients into T stages based on a tumor size greater than or less than 2 cm and whether the depth of invasion went beyond the muscularis propria.

They proposed that tumors would be designated T1 if they had not grown beyond the muscularis propria and were less than 2 cm in diameter. Tumors would be designated T2 if they were beyond the muscularis propria and less than 2 cm in diameter or not beyond the muscularis propria and 2 cm or more in diameter. And tumors would be designated T3 if they were beyond the muscularis propria and 2 cm or more in diameter.

Colon carcinoid tumors, on the other hand, would be designated T1 if they were less than 2 cm in diameter, T2 if they were between the 2 cm and 4 cm in diameter, and T3 if they were 4 cm in diameter or more.

Both rectal and colon carcinoid tumors would be designated N0 if there was no nodal metastasis, N1 if there was nodal metastasis, M0 if there was no distant metastasis, and M1 if there was distant metastasis.

The investigators then analyzed different combinations of T, N, and M to determine how they should best be combined into staging systems. (See boxes.)

“Incorporating the staging systems into clinical practice will help us determine the best treatments for rectal [and colon] carcinoid tumors as well as predict overall survival,” Dr. Landry said.

Dr. Landry disclosed that she did not have any relevant financial relationships associated with her presentation.

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New joint consensus guidelines on screening for colorectal cancer recommend against the use of the most common form of the fecal occult blood test and add stool DNA testing and computed tomographic colonography to a list of the recommended screening options.

The guidelines were a joint project of the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology (CA Cancer J. Clin. 2008 March 5 [doi:10.3322/CA.2007.0018]). The Multi-Society Task Force includes representatives from the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy.

After reviewing the literature and taking into account expert opinion, the panel concluded that any screening test for colorectal cancer should be able to detect the majority of prevalent or incident cancers at the time of testing. Here the panel chose to make a new distinction between “test sensitivity” and “program sensitivity.”

The most commonly used guaiac-based fecal occult blood tests (gFOBTs), such as Hemoccult II, have relatively low test sensitivity, meaning that a single application of the test has somewhat less than a 50% chance of detecting cancer. Greater sensitivity can be achieved by repeating the test annually, and this is referred to as the program sensitivity.

In view of the fact that patients and physicians do not reliably repeat the test annually, however, the task force recommended that only screening methods with test sensitivities above 50% should be used. The guidelines also state that screening for colorectal cancer with a gFOBT in the office following a digital rectal exam or as part of a pelvic examination “is not recommended and should not be done.”

The task force did not rule out fecal occult blood tests entirely. A new form of the test, called Hemoccult Sensa, has a sensitivity of 64% for cancer and 41% for advanced adenomas according to one study, so the use of high-sensitivity fecal occult blood tests would be acceptable. The task force also stated that immunochemical-based stool tests and stool DNA tests both have acceptable levels of sensitivity.

High-sensitivity fecal occult blood tests and immunochemical-based stool tests should be repeated annually, but the task force said that not enough information is available to make a recommendation on the proper interval for stool DNA testing.

In their recommendations on structural screening tests, the task force concluded that colonoscopy, flexible sigmoidoscopy (with insertion to 40 cm or to the splenic flexure), double-contrast barium enema, and computed tomographic colonography (also called virtual colonoscopy) would all be acceptable for individuals at average risk. Beginning at age 50 years, colonoscopy should be repeated every 10 years, and the other structural tests should be repeated every 5 years.

In helping patients decide which structural test to choose, physicians should inform patients about the benefits, limitations, and harms of each test. Some require extensive bowel preparation, and flexible sigmoidoscopy and colonoscopy can result in accidental perforations. Positive findings with flexible sigmoidoscopy, computed tomographic colonography, or double-contrast barium enema will require follow-up colonoscopy.

“It is the strong opinion of this expert panel that colon cancer prevention should be the primary goal of CRC screening,” the guidelines read. “Tests that are designed to detect both early cancer and adenomatous polyps should be encouraged if resources are available and patients are willing to undergo an invasive test.”

The updated guidelines focus on individuals with an average risk of developing colorectal cancer, stating that individuals at increased risk and high risk should continue to follow recommendations previously issued by the American Cancer Society or the U.S. Multi-Society Task Force.

For example, most patients with a history of polyps at prior colonoscopy, those with colorectal cancer, and those with a family history should be screened with colonoscopy. Patients with a genetic diagnosis of familial adenomatous polyposis should be screened annually with flexible sigmoidoscopy beginning at the age of 10–12 years. Those with a genetic or clinical diagnosis of hereditary nonpolyposis colon cancer should receive colonoscopy every 1–2 years beginning at age 20–25 years or 10 years before the youngest case in the immediate family.

Patients with inflammatory bowel disease, chronic ulcerative colitis, and Crohn's colitis should receive colonoscopy with biopsies for dysplasia every 1–2 years beginning about 8 years after the onset of pancolitis or 12–15 years after the onset of left-sided colitis.

The full text of the guidelines is available at http://caonline.amcancersoc.org/cgi/content/full/CA.2007.0018v1

New joint consensus guidelines on screening for colorectal cancer recommend against the use of the most common form of the fecal occult blood test and add stool DNA testing and computed tomographic colonography to a list of the recommended screening options.

The guidelines were a joint project of the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology (CA Cancer J. Clin. 2008 March 5 [doi:10.3322/CA.2007.0018]). The Multi-Society Task Force includes representatives from the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy.

After reviewing the literature and taking into account expert opinion, the panel concluded that any screening test for colorectal cancer should be able to detect the majority of prevalent or incident cancers at the time of testing. Here the panel chose to make a new distinction between “test sensitivity” and “program sensitivity.”

The most commonly used guaiac-based fecal occult blood tests (gFOBTs), such as Hemoccult II, have relatively low test sensitivity, meaning that a single application of the test has somewhat less than a 50% chance of detecting cancer. Greater sensitivity can be achieved by repeating the test annually, and this is referred to as the program sensitivity.

In view of the fact that patients and physicians do not reliably repeat the test annually, however, the task force recommended that only screening methods with test sensitivities above 50% should be used. The guidelines also state that screening for colorectal cancer with a gFOBT in the office following a digital rectal exam or as part of a pelvic examination “is not recommended and should not be done.”

The task force did not rule out fecal occult blood tests entirely. A new form of the test, called Hemoccult Sensa, has a sensitivity of 64% for cancer and 41% for advanced adenomas according to one study, so the use of high-sensitivity fecal occult blood tests would be acceptable. The task force also stated that immunochemical-based stool tests and stool DNA tests both have acceptable levels of sensitivity.

High-sensitivity fecal occult blood tests and immunochemical-based stool tests should be repeated annually, but the task force said that not enough information is available to make a recommendation on the proper interval for stool DNA testing.

In their recommendations on structural screening tests, the task force concluded that colonoscopy, flexible sigmoidoscopy (with insertion to 40 cm or to the splenic flexure), double-contrast barium enema, and computed tomographic colonography (also called virtual colonoscopy) would all be acceptable for individuals at average risk. Beginning at age 50 years, colonoscopy should be repeated every 10 years, and the other structural tests should be repeated every 5 years.

In helping patients decide which structural test to choose, physicians should inform patients about the benefits, limitations, and harms of each test. Some require extensive bowel preparation, and flexible sigmoidoscopy and colonoscopy can result in accidental perforations. Positive findings with flexible sigmoidoscopy, computed tomographic colonography, or double-contrast barium enema will require follow-up colonoscopy.

“It is the strong opinion of this expert panel that colon cancer prevention should be the primary goal of CRC screening,” the guidelines read. “Tests that are designed to detect both early cancer and adenomatous polyps should be encouraged if resources are available and patients are willing to undergo an invasive test.”

The updated guidelines focus on individuals with an average risk of developing colorectal cancer, stating that individuals at increased risk and high risk should continue to follow recommendations previously issued by the American Cancer Society or the U.S. Multi-Society Task Force.

For example, most patients with a history of polyps at prior colonoscopy, those with colorectal cancer, and those with a family history should be screened with colonoscopy. Patients with a genetic diagnosis of familial adenomatous polyposis should be screened annually with flexible sigmoidoscopy beginning at the age of 10–12 years. Those with a genetic or clinical diagnosis of hereditary nonpolyposis colon cancer should receive colonoscopy every 1–2 years beginning at age 20–25 years or 10 years before the youngest case in the immediate family.

Patients with inflammatory bowel disease, chronic ulcerative colitis, and Crohn's colitis should receive colonoscopy with biopsies for dysplasia every 1–2 years beginning about 8 years after the onset of pancolitis or 12–15 years after the onset of left-sided colitis.

The full text of the guidelines is available at http://caonline.amcancersoc.org/cgi/content/full/CA.2007.0018v1

New joint consensus guidelines on screening for colorectal cancer recommend against the use of the most common form of the fecal occult blood test and add stool DNA testing and computed tomographic colonography to a list of the recommended screening options.

The guidelines were a joint project of the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology (CA Cancer J. Clin. 2008 March 5 [doi:10.3322/CA.2007.0018]). The Multi-Society Task Force includes representatives from the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy.

After reviewing the literature and taking into account expert opinion, the panel concluded that any screening test for colorectal cancer should be able to detect the majority of prevalent or incident cancers at the time of testing. Here the panel chose to make a new distinction between “test sensitivity” and “program sensitivity.”

The most commonly used guaiac-based fecal occult blood tests (gFOBTs), such as Hemoccult II, have relatively low test sensitivity, meaning that a single application of the test has somewhat less than a 50% chance of detecting cancer. Greater sensitivity can be achieved by repeating the test annually, and this is referred to as the program sensitivity.

In view of the fact that patients and physicians do not reliably repeat the test annually, however, the task force recommended that only screening methods with test sensitivities above 50% should be used. The guidelines also state that screening for colorectal cancer with a gFOBT in the office following a digital rectal exam or as part of a pelvic examination “is not recommended and should not be done.”

The task force did not rule out fecal occult blood tests entirely. A new form of the test, called Hemoccult Sensa, has a sensitivity of 64% for cancer and 41% for advanced adenomas according to one study, so the use of high-sensitivity fecal occult blood tests would be acceptable. The task force also stated that immunochemical-based stool tests and stool DNA tests both have acceptable levels of sensitivity.

High-sensitivity fecal occult blood tests and immunochemical-based stool tests should be repeated annually, but the task force said that not enough information is available to make a recommendation on the proper interval for stool DNA testing.

In their recommendations on structural screening tests, the task force concluded that colonoscopy, flexible sigmoidoscopy (with insertion to 40 cm or to the splenic flexure), double-contrast barium enema, and computed tomographic colonography (also called virtual colonoscopy) would all be acceptable for individuals at average risk. Beginning at age 50 years, colonoscopy should be repeated every 10 years, and the other structural tests should be repeated every 5 years.

In helping patients decide which structural test to choose, physicians should inform patients about the benefits, limitations, and harms of each test. Some require extensive bowel preparation, and flexible sigmoidoscopy and colonoscopy can result in accidental perforations. Positive findings with flexible sigmoidoscopy, computed tomographic colonography, or double-contrast barium enema will require follow-up colonoscopy.

“It is the strong opinion of this expert panel that colon cancer prevention should be the primary goal of CRC screening,” the guidelines read. “Tests that are designed to detect both early cancer and adenomatous polyps should be encouraged if resources are available and patients are willing to undergo an invasive test.”

The updated guidelines focus on individuals with an average risk of developing colorectal cancer, stating that individuals at increased risk and high risk should continue to follow recommendations previously issued by the American Cancer Society or the U.S. Multi-Society Task Force.

For example, most patients with a history of polyps at prior colonoscopy, those with colorectal cancer, and those with a family history should be screened with colonoscopy. Patients with a genetic diagnosis of familial adenomatous polyposis should be screened annually with flexible sigmoidoscopy beginning at the age of 10–12 years. Those with a genetic or clinical diagnosis of hereditary nonpolyposis colon cancer should receive colonoscopy every 1–2 years beginning at age 20–25 years or 10 years before the youngest case in the immediate family.

Patients with inflammatory bowel disease, chronic ulcerative colitis, and Crohn's colitis should receive colonoscopy with biopsies for dysplasia every 1–2 years beginning about 8 years after the onset of pancolitis or 12–15 years after the onset of left-sided colitis.

The full text of the guidelines is available at http://caonline.amcancersoc.org/cgi/content/full/CA.2007.0018v1

Nearly half of all patients with chronic idiopathic urticaria have Axis I psychiatric diagnoses and 45% have Axis II diagnoses, a new study shows..

Obsessive-compulsive disorder (OCD) and major depression were the most common Axis I diagnoses among 89 consecutive patients with chronic idiopathic urticaria (CIU), and both psychiatric illnesses were significantly more common in the patients than in a control group.

Among the patients, 26% had OCD, compared with 2% of the controls, and 13% had major depression, compared with 3% of the controls, reported Dr. Faruk Uguz and his colleagues at Selcuk University, Konya, Turkey (J. Psychosom. Res. 2008;64:225–9).

Obsessive-compulsive personality disorder and avoidant personality disorder were the most common Axis II diagnoses among the CIU patients, and both were significantly more prevalent in the patients than in the controls. Thirty percent of the patients had obsessive-compulsive personality disorder, compared with 3% of the controls, and 18% of the patients had avoidant personality disorder, compared with 5% of the controls.

Characterized by the rapid appearance of itchy wheals, urticaria is considered chronic when it is recurrent for at least 6 weeks. Few chronic urticaria cases have identifiable physical causes, such as infections, reactions to drugs or foods, or vasculitic diseases. But 75% of all cases have no known cause, and these are referred to as chronic idiopathic urticaria.

The study involved 89 consecutive patients with CIU who were seen at an outpatient clinic in Turkey and a control group of 64 hospital employees and their relatives who were matched to the patients' sociodemographic characteristics. The investigators excluded from both groups individuals who were illiterate, and those who had accompanying severe medical illnesses, or had used corticosteroid or psychotropic medications within the prior 4 weeks.

Psychiatrists made Axis I diagnoses using the Structured Clinical Interview for DSM-IV and the Structured Clinical Interview for DSM, Revised Third Edition, Personality Disorders.

In all, 44 of the CIU patients (49%) and 8 of the individuals in the control group (12%) had an Axis I disorder. Forty of the CIU patients (45%) and nine of the controls (14%) had Axis II disorders. Both differences were statistically significant.

The investigators acknowledged that their study could not establish a causal relationship between psychiatric disorders and CIU because of its cross-sectional design. Psychiatric disorders could either be a cause or a consequence of CIU.

“We think that obsessive-compulsive and avoidant personality disorders may constitute a predisposition for occurrence of both urticarial symptoms and Axis I psychiatric disorders, negatively impacting patients' coping mechanisms with stressful life events or leading to cognitive misinterpretations of various life events, which are actually not stressful,” the authors wrote.

They concluded that all patients with CIU should be screened for Axis I psychiatric disorders, particularly patients with OCD.

ELSEVIER GLOBAL MEDICAL NEWS

Nearly half of all patients with chronic idiopathic urticaria have Axis I psychiatric diagnoses and 45% have Axis II diagnoses, a new study shows..

Obsessive-compulsive disorder (OCD) and major depression were the most common Axis I diagnoses among 89 consecutive patients with chronic idiopathic urticaria (CIU), and both psychiatric illnesses were significantly more common in the patients than in a control group.

Among the patients, 26% had OCD, compared with 2% of the controls, and 13% had major depression, compared with 3% of the controls, reported Dr. Faruk Uguz and his colleagues at Selcuk University, Konya, Turkey (J. Psychosom. Res. 2008;64:225–9).

Obsessive-compulsive personality disorder and avoidant personality disorder were the most common Axis II diagnoses among the CIU patients, and both were significantly more prevalent in the patients than in the controls. Thirty percent of the patients had obsessive-compulsive personality disorder, compared with 3% of the controls, and 18% of the patients had avoidant personality disorder, compared with 5% of the controls.

Characterized by the rapid appearance of itchy wheals, urticaria is considered chronic when it is recurrent for at least 6 weeks. Few chronic urticaria cases have identifiable physical causes, such as infections, reactions to drugs or foods, or vasculitic diseases. But 75% of all cases have no known cause, and these are referred to as chronic idiopathic urticaria.

The study involved 89 consecutive patients with CIU who were seen at an outpatient clinic in Turkey and a control group of 64 hospital employees and their relatives who were matched to the patients' sociodemographic characteristics. The investigators excluded from both groups individuals who were illiterate, and those who had accompanying severe medical illnesses, or had used corticosteroid or psychotropic medications within the prior 4 weeks.

Psychiatrists made Axis I diagnoses using the Structured Clinical Interview for DSM-IV and the Structured Clinical Interview for DSM, Revised Third Edition, Personality Disorders.

In all, 44 of the CIU patients (49%) and 8 of the individuals in the control group (12%) had an Axis I disorder. Forty of the CIU patients (45%) and nine of the controls (14%) had Axis II disorders. Both differences were statistically significant.

The investigators acknowledged that their study could not establish a causal relationship between psychiatric disorders and CIU because of its cross-sectional design. Psychiatric disorders could either be a cause or a consequence of CIU.

“We think that obsessive-compulsive and avoidant personality disorders may constitute a predisposition for occurrence of both urticarial symptoms and Axis I psychiatric disorders, negatively impacting patients' coping mechanisms with stressful life events or leading to cognitive misinterpretations of various life events, which are actually not stressful,” the authors wrote.

They concluded that all patients with CIU should be screened for Axis I psychiatric disorders, particularly patients with OCD.

ELSEVIER GLOBAL MEDICAL NEWS

Nearly half of all patients with chronic idiopathic urticaria have Axis I psychiatric diagnoses and 45% have Axis II diagnoses, a new study shows..

Obsessive-compulsive disorder (OCD) and major depression were the most common Axis I diagnoses among 89 consecutive patients with chronic idiopathic urticaria (CIU), and both psychiatric illnesses were significantly more common in the patients than in a control group.

Among the patients, 26% had OCD, compared with 2% of the controls, and 13% had major depression, compared with 3% of the controls, reported Dr. Faruk Uguz and his colleagues at Selcuk University, Konya, Turkey (J. Psychosom. Res. 2008;64:225–9).

Obsessive-compulsive personality disorder and avoidant personality disorder were the most common Axis II diagnoses among the CIU patients, and both were significantly more prevalent in the patients than in the controls. Thirty percent of the patients had obsessive-compulsive personality disorder, compared with 3% of the controls, and 18% of the patients had avoidant personality disorder, compared with 5% of the controls.

Characterized by the rapid appearance of itchy wheals, urticaria is considered chronic when it is recurrent for at least 6 weeks. Few chronic urticaria cases have identifiable physical causes, such as infections, reactions to drugs or foods, or vasculitic diseases. But 75% of all cases have no known cause, and these are referred to as chronic idiopathic urticaria.

The study involved 89 consecutive patients with CIU who were seen at an outpatient clinic in Turkey and a control group of 64 hospital employees and their relatives who were matched to the patients' sociodemographic characteristics. The investigators excluded from both groups individuals who were illiterate, and those who had accompanying severe medical illnesses, or had used corticosteroid or psychotropic medications within the prior 4 weeks.

Psychiatrists made Axis I diagnoses using the Structured Clinical Interview for DSM-IV and the Structured Clinical Interview for DSM, Revised Third Edition, Personality Disorders.

In all, 44 of the CIU patients (49%) and 8 of the individuals in the control group (12%) had an Axis I disorder. Forty of the CIU patients (45%) and nine of the controls (14%) had Axis II disorders. Both differences were statistically significant.

The investigators acknowledged that their study could not establish a causal relationship between psychiatric disorders and CIU because of its cross-sectional design. Psychiatric disorders could either be a cause or a consequence of CIU.

“We think that obsessive-compulsive and avoidant personality disorders may constitute a predisposition for occurrence of both urticarial symptoms and Axis I psychiatric disorders, negatively impacting patients' coping mechanisms with stressful life events or leading to cognitive misinterpretations of various life events, which are actually not stressful,” the authors wrote.

They concluded that all patients with CIU should be screened for Axis I psychiatric disorders, particularly patients with OCD.

ELSEVIER GLOBAL MEDICAL NEWS

HUNTINGTON BEACH, CALIF. — Colorectal cancer patients with evidence of new nerve growth within their tumors do far worse than those with no evidence of neurogenesis, according to a study presented at the Academic Surgical Congress.

In the study of 347 patients with colorectal cancer, Kaplan-Meier curves showed that those with stage III cancer and no evidence of neurogenesis achieved significantly greater cancer-specific overall survival at 5 years than did those with stage II cancer and a high degree of neurogenesis.

Patients with more neurogenesis had a 3.8-fold greater risk of cancer-specific death (P = .0005) in a multivariate analysis controlling for standard prognostic factors such as age and tumor location. The only factor that conferred a higher degree of risk was stage IV disease, with a hazard ratio of 14.7.

Suggesting that neurogenesis may be “the next angiogenesis,” the lead author, Dr. Jonathan A. Wilks, raised the possibility that neurogenesis could be an attractive target for future therapeutic intervention.

Dr. Wilks, a surgery resident at Baylor College of Medicine, Houston, said that as far as he knew, nothing has been published in the literature so far regarding neurogenesis in solid tumors outside the nervous system.

Included in the study was a cohort of patients at Baylor who had their colon cancer resected within a 5-year period. All were Veterans Affairs patients; the investigators obtained all of their clinical and demographic data from their electronic medical records.

Dr. Wilks and his colleagues constructed a tissue microarray from these patients' tissue samples, and stained them with antibodies against protein gene product (PGP) 9.5, a neuron cytoplasmic marker associated with new nerve growth.

For the statistical analysis, at least 5 years of survival data were available for each patient.

The investigators looked at cancer-specific overall survival and cancer-specific disease-free survival, dividing the patients into those with no evidence of neurogenesis, those with a high level of neurogenesis (defined as more than 20 nerves per high-powered field), and those with low levels of neurogenesis (defined as 1–20 nerves per high-powered field).

A total of 20–30 patients ended up in the high-neurogenesis group, Dr. Wilks said.

He described the results as “startling.”

For example, among the patients with R0 tumors (those with negative surgical margins), patients with a high degree of neurogenesis had significantly worse disease-free and cancer-specific overall survival than did those with no neurogenesis or moderate amounts of neurogenesis.

At the 1,800-day mark, the cancer-specific overall survival was approximately 45% for patients with high degrees of neurogenesis, about 70% for patients with low degrees of neurogenesis, and about 90% for patients who had no evidence of neurogenesis in their tissue samples.

Dr. Wilks said the study's unexpected findings could be used for therapy stratification. At his institution, chemotherapy is offered to all patients with stage III disease (those with lymphatic invasion), but is not offered to those with stage II disease.

He suggested that stage II patients who have evidence of neurogenesis might be offered the option of chemotherapy, whereas stage III patients without neurogenesis might not require chemotherapy.

The presentation by Dr. Wilks was followed by a notable pause before any of the physicians in the audience asked questions.

Then one surgeon in the audience commented, “What we witnessed was a stunned silence at the end of your talk. And that's not for any lack of interest or enthusiasm. These are actually incredibly exciting results, and surprising, and I congratulate you and your team on pursuing this work.”

Other attendees were more guarded in their comments. In an interview, Dr. James Neifeld, chairman of the department of surgery at Virginia Commonwealth University, Richmond, said, “This represents a new and previously undescribed finding. It is much too early to get excited about this as either a prognostic factor or a potential target for therapy and will require further validation to determine its usefulness.”

Several other experts in the areas of colorectal and brain cancers declined to comment on the record, citing lack of expertise in neurogenesis as it relates to cancer.

In response to a question from the audience, Dr. Wilks acknowledged that the cause of the neurogenesis remains unclear. Preexisting nerve tissue could be invading the tumor, or the nerve tissue could arise from a stem cell within the tumor, he said.

Dr. Wilks stated that he had no financial relationships related to his presentation.

HUNTINGTON BEACH, CALIF. — Colorectal cancer patients with evidence of new nerve growth within their tumors do far worse than those with no evidence of neurogenesis, according to a study presented at the Academic Surgical Congress.

In the study of 347 patients with colorectal cancer, Kaplan-Meier curves showed that those with stage III cancer and no evidence of neurogenesis achieved significantly greater cancer-specific overall survival at 5 years than did those with stage II cancer and a high degree of neurogenesis.

Patients with more neurogenesis had a 3.8-fold greater risk of cancer-specific death (P = .0005) in a multivariate analysis controlling for standard prognostic factors such as age and tumor location. The only factor that conferred a higher degree of risk was stage IV disease, with a hazard ratio of 14.7.

Suggesting that neurogenesis may be “the next angiogenesis,” the lead author, Dr. Jonathan A. Wilks, raised the possibility that neurogenesis could be an attractive target for future therapeutic intervention.

Dr. Wilks, a surgery resident at Baylor College of Medicine, Houston, said that as far as he knew, nothing has been published in the literature so far regarding neurogenesis in solid tumors outside the nervous system.

Included in the study was a cohort of patients at Baylor who had their colon cancer resected within a 5-year period. All were Veterans Affairs patients; the investigators obtained all of their clinical and demographic data from their electronic medical records.

Dr. Wilks and his colleagues constructed a tissue microarray from these patients' tissue samples, and stained them with antibodies against protein gene product (PGP) 9.5, a neuron cytoplasmic marker associated with new nerve growth.

For the statistical analysis, at least 5 years of survival data were available for each patient.

The investigators looked at cancer-specific overall survival and cancer-specific disease-free survival, dividing the patients into those with no evidence of neurogenesis, those with a high level of neurogenesis (defined as more than 20 nerves per high-powered field), and those with low levels of neurogenesis (defined as 1–20 nerves per high-powered field).

A total of 20–30 patients ended up in the high-neurogenesis group, Dr. Wilks said.

He described the results as “startling.”

For example, among the patients with R0 tumors (those with negative surgical margins), patients with a high degree of neurogenesis had significantly worse disease-free and cancer-specific overall survival than did those with no neurogenesis or moderate amounts of neurogenesis.

At the 1,800-day mark, the cancer-specific overall survival was approximately 45% for patients with high degrees of neurogenesis, about 70% for patients with low degrees of neurogenesis, and about 90% for patients who had no evidence of neurogenesis in their tissue samples.

Dr. Wilks said the study's unexpected findings could be used for therapy stratification. At his institution, chemotherapy is offered to all patients with stage III disease (those with lymphatic invasion), but is not offered to those with stage II disease.

He suggested that stage II patients who have evidence of neurogenesis might be offered the option of chemotherapy, whereas stage III patients without neurogenesis might not require chemotherapy.

The presentation by Dr. Wilks was followed by a notable pause before any of the physicians in the audience asked questions.

Then one surgeon in the audience commented, “What we witnessed was a stunned silence at the end of your talk. And that's not for any lack of interest or enthusiasm. These are actually incredibly exciting results, and surprising, and I congratulate you and your team on pursuing this work.”

Other attendees were more guarded in their comments. In an interview, Dr. James Neifeld, chairman of the department of surgery at Virginia Commonwealth University, Richmond, said, “This represents a new and previously undescribed finding. It is much too early to get excited about this as either a prognostic factor or a potential target for therapy and will require further validation to determine its usefulness.”

Several other experts in the areas of colorectal and brain cancers declined to comment on the record, citing lack of expertise in neurogenesis as it relates to cancer.

In response to a question from the audience, Dr. Wilks acknowledged that the cause of the neurogenesis remains unclear. Preexisting nerve tissue could be invading the tumor, or the nerve tissue could arise from a stem cell within the tumor, he said.

Dr. Wilks stated that he had no financial relationships related to his presentation.

HUNTINGTON BEACH, CALIF. — Colorectal cancer patients with evidence of new nerve growth within their tumors do far worse than those with no evidence of neurogenesis, according to a study presented at the Academic Surgical Congress.

In the study of 347 patients with colorectal cancer, Kaplan-Meier curves showed that those with stage III cancer and no evidence of neurogenesis achieved significantly greater cancer-specific overall survival at 5 years than did those with stage II cancer and a high degree of neurogenesis.

Patients with more neurogenesis had a 3.8-fold greater risk of cancer-specific death (P = .0005) in a multivariate analysis controlling for standard prognostic factors such as age and tumor location. The only factor that conferred a higher degree of risk was stage IV disease, with a hazard ratio of 14.7.

Suggesting that neurogenesis may be “the next angiogenesis,” the lead author, Dr. Jonathan A. Wilks, raised the possibility that neurogenesis could be an attractive target for future therapeutic intervention.

Dr. Wilks, a surgery resident at Baylor College of Medicine, Houston, said that as far as he knew, nothing has been published in the literature so far regarding neurogenesis in solid tumors outside the nervous system.

Included in the study was a cohort of patients at Baylor who had their colon cancer resected within a 5-year period. All were Veterans Affairs patients; the investigators obtained all of their clinical and demographic data from their electronic medical records.

Dr. Wilks and his colleagues constructed a tissue microarray from these patients' tissue samples, and stained them with antibodies against protein gene product (PGP) 9.5, a neuron cytoplasmic marker associated with new nerve growth.

For the statistical analysis, at least 5 years of survival data were available for each patient.

The investigators looked at cancer-specific overall survival and cancer-specific disease-free survival, dividing the patients into those with no evidence of neurogenesis, those with a high level of neurogenesis (defined as more than 20 nerves per high-powered field), and those with low levels of neurogenesis (defined as 1–20 nerves per high-powered field).

A total of 20–30 patients ended up in the high-neurogenesis group, Dr. Wilks said.

He described the results as “startling.”

For example, among the patients with R0 tumors (those with negative surgical margins), patients with a high degree of neurogenesis had significantly worse disease-free and cancer-specific overall survival than did those with no neurogenesis or moderate amounts of neurogenesis.

At the 1,800-day mark, the cancer-specific overall survival was approximately 45% for patients with high degrees of neurogenesis, about 70% for patients with low degrees of neurogenesis, and about 90% for patients who had no evidence of neurogenesis in their tissue samples.

Dr. Wilks said the study's unexpected findings could be used for therapy stratification. At his institution, chemotherapy is offered to all patients with stage III disease (those with lymphatic invasion), but is not offered to those with stage II disease.

He suggested that stage II patients who have evidence of neurogenesis might be offered the option of chemotherapy, whereas stage III patients without neurogenesis might not require chemotherapy.

The presentation by Dr. Wilks was followed by a notable pause before any of the physicians in the audience asked questions.

Then one surgeon in the audience commented, “What we witnessed was a stunned silence at the end of your talk. And that's not for any lack of interest or enthusiasm. These are actually incredibly exciting results, and surprising, and I congratulate you and your team on pursuing this work.”

Other attendees were more guarded in their comments. In an interview, Dr. James Neifeld, chairman of the department of surgery at Virginia Commonwealth University, Richmond, said, “This represents a new and previously undescribed finding. It is much too early to get excited about this as either a prognostic factor or a potential target for therapy and will require further validation to determine its usefulness.”

Several other experts in the areas of colorectal and brain cancers declined to comment on the record, citing lack of expertise in neurogenesis as it relates to cancer.

In response to a question from the audience, Dr. Wilks acknowledged that the cause of the neurogenesis remains unclear. Preexisting nerve tissue could be invading the tumor, or the nerve tissue could arise from a stem cell within the tumor, he said.

Dr. Wilks stated that he had no financial relationships related to his presentation.

A meta-analysis has failed to clarify whether one drug is better than another when added to metformin in patients with type 2 diabetes.

Sulfonylureas and α-glucosidase inhibitors—and possibly glinides as well—appear to have about equal efficacy when used as add-ons to failed metformin monotherapy, Dr. Matteo Monami and his colleagues from the University of Florence (Italy) determined in their analysis of 27 clinical trials (Diabetes Res. Clin. Pract. 2008;79:196–203).

On the other hand, thiazolidinediones appear to have a lesser effect on hemoglobin A_1c (HbA_1c) at 6 months, although in the long term they may actually work better than insulin secretagogues.

“Despite the fact that many patients with type 2 diabetes receiving metformin need additional treatments in order to reach an adequate metabolic control, the number of clinical trials assessing the effects of combined therapy with metformin and other agents in type 2 diabetes is surprisingly small,” the investigators wrote. “For this reason the result of the present meta-analysis should be considered with caution, as further evidence, if available, could affect the conclusions.”

The investigators conducted their Medline search in January 2007, looking for randomized clinical trials in which metformin was associated with any one of a large number of add-on therapies. For their meta-analysis, they included only trials in which a hypoglycemic agent was compared either with placebo or with another active drug in combination with metformin for at least 16 weeks. They excluded trials of “triple therapy” that tested two or more drugs in combination with metformin.

The investigators identified 16 placebo-controlled trials and 11 trials in which two active treatments were compared. Among the placebo-controlled trials, five included sulfonylureas, five included α-glucosidase inhibitors, three included thiazolidinediones, two included glinides, and one included GLP-1 agonists. They were unable to identify trials involving pramlintide or DPP-IV inhibitors that met their inclusion criteria.

Combining trials for each class of drugs, sulfonylureas reduced HbA_1c by an average of 0.85%, thiazolidinediones by 0.42%, and α-glucosidase inhibitors by 0.61%. After the researchers corrected for baseline HbA_1c, the reduction obtained with sulfonylurea with respect to placebo was significantly greater than that of thiazolidinediones. On the other hand, there were no significant differences between sulfonylurea and α-glucosidase inhibitors or between α-glucosidase inhibitors and thiazolidinediones.

Among the trials in which two active agents were compared, sulfonylureas were significantly superior to thiazolidinediones, with an overall difference between the two treatments of 0.17% in reducing HbA_1c. There were no significant differences between sulfonylureas and insulin. Insulin regimens that were based on two administrations of biphasic insulin analogues were more effective than insulin glargine once a day.

The investigators disclosed receiving speaking fees, consultancy fees, and/or research grants from Abiogen Pharma, GlaxoSmithKline, Guidotti, Eli Lilly & Co., Menarini, Merck Sharp & Dome, Merck KgA, Novo Nordisk, Sanofi-Aventis, Takeda, and Novartis.

A meta-analysis has failed to clarify whether one drug is better than another when added to metformin in patients with type 2 diabetes.

Sulfonylureas and α-glucosidase inhibitors—and possibly glinides as well—appear to have about equal efficacy when used as add-ons to failed metformin monotherapy, Dr. Matteo Monami and his colleagues from the University of Florence (Italy) determined in their analysis of 27 clinical trials (Diabetes Res. Clin. Pract. 2008;79:196–203).

On the other hand, thiazolidinediones appear to have a lesser effect on hemoglobin A_1c (HbA_1c) at 6 months, although in the long term they may actually work better than insulin secretagogues.

“Despite the fact that many patients with type 2 diabetes receiving metformin need additional treatments in order to reach an adequate metabolic control, the number of clinical trials assessing the effects of combined therapy with metformin and other agents in type 2 diabetes is surprisingly small,” the investigators wrote. “For this reason the result of the present meta-analysis should be considered with caution, as further evidence, if available, could affect the conclusions.”

The investigators conducted their Medline search in January 2007, looking for randomized clinical trials in which metformin was associated with any one of a large number of add-on therapies. For their meta-analysis, they included only trials in which a hypoglycemic agent was compared either with placebo or with another active drug in combination with metformin for at least 16 weeks. They excluded trials of “triple therapy” that tested two or more drugs in combination with metformin.

The investigators identified 16 placebo-controlled trials and 11 trials in which two active treatments were compared. Among the placebo-controlled trials, five included sulfonylureas, five included α-glucosidase inhibitors, three included thiazolidinediones, two included glinides, and one included GLP-1 agonists. They were unable to identify trials involving pramlintide or DPP-IV inhibitors that met their inclusion criteria.

Combining trials for each class of drugs, sulfonylureas reduced HbA_1c by an average of 0.85%, thiazolidinediones by 0.42%, and α-glucosidase inhibitors by 0.61%. After the researchers corrected for baseline HbA_1c, the reduction obtained with sulfonylurea with respect to placebo was significantly greater than that of thiazolidinediones. On the other hand, there were no significant differences between sulfonylurea and α-glucosidase inhibitors or between α-glucosidase inhibitors and thiazolidinediones.

Among the trials in which two active agents were compared, sulfonylureas were significantly superior to thiazolidinediones, with an overall difference between the two treatments of 0.17% in reducing HbA_1c. There were no significant differences between sulfonylureas and insulin. Insulin regimens that were based on two administrations of biphasic insulin analogues were more effective than insulin glargine once a day.

The investigators disclosed receiving speaking fees, consultancy fees, and/or research grants from Abiogen Pharma, GlaxoSmithKline, Guidotti, Eli Lilly & Co., Menarini, Merck Sharp & Dome, Merck KgA, Novo Nordisk, Sanofi-Aventis, Takeda, and Novartis.

A meta-analysis has failed to clarify whether one drug is better than another when added to metformin in patients with type 2 diabetes.

Sulfonylureas and α-glucosidase inhibitors—and possibly glinides as well—appear to have about equal efficacy when used as add-ons to failed metformin monotherapy, Dr. Matteo Monami and his colleagues from the University of Florence (Italy) determined in their analysis of 27 clinical trials (Diabetes Res. Clin. Pract. 2008;79:196–203).

On the other hand, thiazolidinediones appear to have a lesser effect on hemoglobin A_1c (HbA_1c) at 6 months, although in the long term they may actually work better than insulin secretagogues.

“Despite the fact that many patients with type 2 diabetes receiving metformin need additional treatments in order to reach an adequate metabolic control, the number of clinical trials assessing the effects of combined therapy with metformin and other agents in type 2 diabetes is surprisingly small,” the investigators wrote. “For this reason the result of the present meta-analysis should be considered with caution, as further evidence, if available, could affect the conclusions.”

The investigators conducted their Medline search in January 2007, looking for randomized clinical trials in which metformin was associated with any one of a large number of add-on therapies. For their meta-analysis, they included only trials in which a hypoglycemic agent was compared either with placebo or with another active drug in combination with metformin for at least 16 weeks. They excluded trials of “triple therapy” that tested two or more drugs in combination with metformin.

The investigators identified 16 placebo-controlled trials and 11 trials in which two active treatments were compared. Among the placebo-controlled trials, five included sulfonylureas, five included α-glucosidase inhibitors, three included thiazolidinediones, two included glinides, and one included GLP-1 agonists. They were unable to identify trials involving pramlintide or DPP-IV inhibitors that met their inclusion criteria.

Combining trials for each class of drugs, sulfonylureas reduced HbA_1c by an average of 0.85%, thiazolidinediones by 0.42%, and α-glucosidase inhibitors by 0.61%. After the researchers corrected for baseline HbA_1c, the reduction obtained with sulfonylurea with respect to placebo was significantly greater than that of thiazolidinediones. On the other hand, there were no significant differences between sulfonylurea and α-glucosidase inhibitors or between α-glucosidase inhibitors and thiazolidinediones.

Among the trials in which two active agents were compared, sulfonylureas were significantly superior to thiazolidinediones, with an overall difference between the two treatments of 0.17% in reducing HbA_1c. There were no significant differences between sulfonylureas and insulin. Insulin regimens that were based on two administrations of biphasic insulin analogues were more effective than insulin glargine once a day.

The investigators disclosed receiving speaking fees, consultancy fees, and/or research grants from Abiogen Pharma, GlaxoSmithKline, Guidotti, Eli Lilly & Co., Menarini, Merck Sharp & Dome, Merck KgA, Novo Nordisk, Sanofi-Aventis, Takeda, and Novartis.

High serum uric acid level is an independent risk factor for the development of type 2 diabetes, according to findings from a large population-based study.

In a study of 4,536 people free of diabetes at baseline, those with serum uric acid levels in the top quartile were 68% more likely to develop type 2 diabetes than were those in the lowest quartile after adjusting for potential confounders, according to a report in the journal Diabetes Care.

The population-attributable risk of high serum uric acid for diabetes was 0.24, indicating that, “One-quarter of diabetes cases can be attributed to a high serum uric acid level,” reported Dr. Abbas Dehghan and colleagues of Erasmus Medical Center, Rotterdam, the Netherlands (Diabetes Care 2008;31:361–2).

The participants were part of the Rotterdam Study, a population-based, prospective cohort study involving subjects aged 55 years and older who were followed for a mean of 10.1 years. During that time, 462 of the participants developed diabetes, giving an incidence rate of 10.1/1,000 person-years.

After adjustment for age, sex, body mass index, waist circumference, HDL cholesterol level, and systolic and diastolic blood pressure, participants with serum uric acid levels above 370 micromol/L had a hazard ratio of 1.68, compared with those with levels of 267 micromol/L or below. The difference was statistically significant.

The importance of this finding is that “lowering serum uric acid in subjects in the highest quartile may decrease the incidence of diabetes by 24%, if the relationship is causal,” the investigators wrote.

High serum uric acid level is an independent risk factor for the development of type 2 diabetes, according to findings from a large population-based study.

In a study of 4,536 people free of diabetes at baseline, those with serum uric acid levels in the top quartile were 68% more likely to develop type 2 diabetes than were those in the lowest quartile after adjusting for potential confounders, according to a report in the journal Diabetes Care.

The population-attributable risk of high serum uric acid for diabetes was 0.24, indicating that, “One-quarter of diabetes cases can be attributed to a high serum uric acid level,” reported Dr. Abbas Dehghan and colleagues of Erasmus Medical Center, Rotterdam, the Netherlands (Diabetes Care 2008;31:361–2).

The participants were part of the Rotterdam Study, a population-based, prospective cohort study involving subjects aged 55 years and older who were followed for a mean of 10.1 years. During that time, 462 of the participants developed diabetes, giving an incidence rate of 10.1/1,000 person-years.

After adjustment for age, sex, body mass index, waist circumference, HDL cholesterol level, and systolic and diastolic blood pressure, participants with serum uric acid levels above 370 micromol/L had a hazard ratio of 1.68, compared with those with levels of 267 micromol/L or below. The difference was statistically significant.

The importance of this finding is that “lowering serum uric acid in subjects in the highest quartile may decrease the incidence of diabetes by 24%, if the relationship is causal,” the investigators wrote.

High serum uric acid level is an independent risk factor for the development of type 2 diabetes, according to findings from a large population-based study.

In a study of 4,536 people free of diabetes at baseline, those with serum uric acid levels in the top quartile were 68% more likely to develop type 2 diabetes than were those in the lowest quartile after adjusting for potential confounders, according to a report in the journal Diabetes Care.

The population-attributable risk of high serum uric acid for diabetes was 0.24, indicating that, “One-quarter of diabetes cases can be attributed to a high serum uric acid level,” reported Dr. Abbas Dehghan and colleagues of Erasmus Medical Center, Rotterdam, the Netherlands (Diabetes Care 2008;31:361–2).

The participants were part of the Rotterdam Study, a population-based, prospective cohort study involving subjects aged 55 years and older who were followed for a mean of 10.1 years. During that time, 462 of the participants developed diabetes, giving an incidence rate of 10.1/1,000 person-years.

After adjustment for age, sex, body mass index, waist circumference, HDL cholesterol level, and systolic and diastolic blood pressure, participants with serum uric acid levels above 370 micromol/L had a hazard ratio of 1.68, compared with those with levels of 267 micromol/L or below. The difference was statistically significant.

The importance of this finding is that “lowering serum uric acid in subjects in the highest quartile may decrease the incidence of diabetes by 24%, if the relationship is causal,” the investigators wrote.

High serum uric acid level is an independent risk factor for the development of type 2 diabetes, according to data from a large population-based study.

In a study of 4,536 people who were free of diabetes at baseline, those who had serum uric acid levels that were in the top quartile were 68% more likely to develop type 2 diabetes than were those in the lowest quartile after adjusting for potential confounders, according to a report in the journal Diabetes Care.

The population-attributable risk of high serum uric acid for diabetes was 0.24, indicating that, “One-quarter of diabetes cases can be attributed to a high serum uric acid level,” reported Dr. Abbas Dehghan and colleagues of Erasmus Medical Center in Rotterdam, the Netherlands (Diabetes Care 2008; 31:361–2).

The participants were part of the Rotterdam Study, a population-based, prospective cohort study involving subjects aged 55 years and older who were followed for a mean of 10.1 years.

During that time, 462 of the participants developed diabetes, giving an incidence rate of 10.1/1,000 person-years.

After adjustment for age, sex, body mass index, waist circumference, HDL cholesterol level, and systolic and diastolic blood pressure, participants with serum uric acid levels above 370 micromol/L had a hazard ratio of 1.68, compared with those with levels of 267 micromol/L or below. The difference was statistically significant.

Although gout and renal disorders are currently the only confirmed consequences of hyperuricemia, findings from other studies have implicated high serum uric acid as a potential risk factors for hypertension, stroke, and cardiovascular disease, and the current study has now added type 2 diabetes to the list.

The importance of this finding is that “lowering serum uric acid in subjects in the highest quartile may decrease the incidence of diabetes by 24%, if the relationship is causal,” the investigators wrote.

High serum uric acid level is an independent risk factor for the development of type 2 diabetes, according to data from a large population-based study.

In a study of 4,536 people who were free of diabetes at baseline, those who had serum uric acid levels that were in the top quartile were 68% more likely to develop type 2 diabetes than were those in the lowest quartile after adjusting for potential confounders, according to a report in the journal Diabetes Care.

The population-attributable risk of high serum uric acid for diabetes was 0.24, indicating that, “One-quarter of diabetes cases can be attributed to a high serum uric acid level,” reported Dr. Abbas Dehghan and colleagues of Erasmus Medical Center in Rotterdam, the Netherlands (Diabetes Care 2008; 31:361–2).

The participants were part of the Rotterdam Study, a population-based, prospective cohort study involving subjects aged 55 years and older who were followed for a mean of 10.1 years.

During that time, 462 of the participants developed diabetes, giving an incidence rate of 10.1/1,000 person-years.

After adjustment for age, sex, body mass index, waist circumference, HDL cholesterol level, and systolic and diastolic blood pressure, participants with serum uric acid levels above 370 micromol/L had a hazard ratio of 1.68, compared with those with levels of 267 micromol/L or below. The difference was statistically significant.

Although gout and renal disorders are currently the only confirmed consequences of hyperuricemia, findings from other studies have implicated high serum uric acid as a potential risk factors for hypertension, stroke, and cardiovascular disease, and the current study has now added type 2 diabetes to the list.

The importance of this finding is that “lowering serum uric acid in subjects in the highest quartile may decrease the incidence of diabetes by 24%, if the relationship is causal,” the investigators wrote.

High serum uric acid level is an independent risk factor for the development of type 2 diabetes, according to data from a large population-based study.

In a study of 4,536 people who were free of diabetes at baseline, those who had serum uric acid levels that were in the top quartile were 68% more likely to develop type 2 diabetes than were those in the lowest quartile after adjusting for potential confounders, according to a report in the journal Diabetes Care.

The population-attributable risk of high serum uric acid for diabetes was 0.24, indicating that, “One-quarter of diabetes cases can be attributed to a high serum uric acid level,” reported Dr. Abbas Dehghan and colleagues of Erasmus Medical Center in Rotterdam, the Netherlands (Diabetes Care 2008; 31:361–2).

The participants were part of the Rotterdam Study, a population-based, prospective cohort study involving subjects aged 55 years and older who were followed for a mean of 10.1 years.

During that time, 462 of the participants developed diabetes, giving an incidence rate of 10.1/1,000 person-years.

After adjustment for age, sex, body mass index, waist circumference, HDL cholesterol level, and systolic and diastolic blood pressure, participants with serum uric acid levels above 370 micromol/L had a hazard ratio of 1.68, compared with those with levels of 267 micromol/L or below. The difference was statistically significant.

Although gout and renal disorders are currently the only confirmed consequences of hyperuricemia, findings from other studies have implicated high serum uric acid as a potential risk factors for hypertension, stroke, and cardiovascular disease, and the current study has now added type 2 diabetes to the list.

The importance of this finding is that “lowering serum uric acid in subjects in the highest quartile may decrease the incidence of diabetes by 24%, if the relationship is causal,” the investigators wrote.