Leslie Sabbagh

RANCHO MIRAGE, CALIF. – Alternative therapies are not a replacement for prescription drugs in migraine treatment, but they can reduce the severity of the attacks and help ease symptoms, reported Dr. Alexander Mauskop.

In fact, “anyone suffering from migraines can benefit from these treatments,” Dr. Mauskop said. The most important point, he stressed at a meeting sponsored by the Diamond Headache Clinic, is that nonpharmacologic methods can be as effective as drugs, if not more effective. When instituting an alternative approach, the first step is to eliminate food triggers, encourage a proper sleep regimen, regular meal intake, and sufficient hydration.

Actual alternative therapies to control physiologic response to stress include regular aerobic exercise and biofeedback, said Dr. Mauskop, director of the New York Headache Center.

For migraines, the most commonly used supplements are magnesium, feverfew, coenzyme Q 10 (CoQ10), riboflavin, butterbur extract, and alpha lipoic acid.

The most important supplement, according to Dr. Mauskop, is magnesium. “It's known that up to 50% of people with acute migraine have a magnesium deficiency. … It is much more effective to treat them with a product they're deficient in rather than using drugs,” he said. Magnesium is “very effective for 50% of those who are deficient in it, but even prescription drugs work for only 50% of migraineurs” (Headache 2003;43:601–10).

Research has found that, for migraine, CoQ10 at 300 mg/day is effective, and that for Parkinson's disease 1,200 mg/day is effective. “Riboflavin has similar function in the body as CoQ10 and was shown to prevent migraine in one double-blind study. Although the therapeutic amount of riboflavin is very high–400 mg/day; many multivitamins have only 2–3 mg,” he said (Neurology 1996;50:440–66).

Butterbur, 50 mg t.i.d, has also been found to help treat migraine, most likely due to its anti-inflammatory properties, or “maybe something else. Herbal products contain hundreds of chemicals and we can only guess which are the active ones” (Neurology 2004;63:2240–4).

Dr. Mauskop recommends a combination of magnesium, feverfew, and riboflavin: “I find that about half of people are very happy with [this combination]. Sometimes their headaches completely disappear so that they don't need prescription drugs.”

The triple combination, available as MigreLief, costs $18 per month, and “if money is not an issue, I add CoQ10.” Patients take 300 mg/day of MigreLief for 8 weeks. Although one study that showed favorable results in migraine patients used 100 mg t.i.d., “I often recommend 300 mg once daily due to adherence issues.”

Patients have a continuum of responses. “Some say their headaches are more responsive to prescription drugs and some have total disappearance of migraines, with most responses somewhere in the middle,” he said.

Butterbur has only one manufacturer, Dr. Mauskop said, “but feverfew is sold by many companies and the products are not always of good quality. Patients need to buy recognized brands or the triple combination supplements.” Dr. Mauskop is a paid consultant to Quantum, Inc., the manufacturer of MigreLief.

RANCHO MIRAGE, CALIF. – Alternative therapies are not a replacement for prescription drugs in migraine treatment, but they can reduce the severity of the attacks and help ease symptoms, reported Dr. Alexander Mauskop.

In fact, “anyone suffering from migraines can benefit from these treatments,” Dr. Mauskop said. The most important point, he stressed at a meeting sponsored by the Diamond Headache Clinic, is that nonpharmacologic methods can be as effective as drugs, if not more effective. When instituting an alternative approach, the first step is to eliminate food triggers, encourage a proper sleep regimen, regular meal intake, and sufficient hydration.

Actual alternative therapies to control physiologic response to stress include regular aerobic exercise and biofeedback, said Dr. Mauskop, director of the New York Headache Center.

For migraines, the most commonly used supplements are magnesium, feverfew, coenzyme Q 10 (CoQ10), riboflavin, butterbur extract, and alpha lipoic acid.

The most important supplement, according to Dr. Mauskop, is magnesium. “It's known that up to 50% of people with acute migraine have a magnesium deficiency. … It is much more effective to treat them with a product they're deficient in rather than using drugs,” he said. Magnesium is “very effective for 50% of those who are deficient in it, but even prescription drugs work for only 50% of migraineurs” (Headache 2003;43:601–10).

Research has found that, for migraine, CoQ10 at 300 mg/day is effective, and that for Parkinson's disease 1,200 mg/day is effective. “Riboflavin has similar function in the body as CoQ10 and was shown to prevent migraine in one double-blind study. Although the therapeutic amount of riboflavin is very high–400 mg/day; many multivitamins have only 2–3 mg,” he said (Neurology 1996;50:440–66).

Butterbur, 50 mg t.i.d, has also been found to help treat migraine, most likely due to its anti-inflammatory properties, or “maybe something else. Herbal products contain hundreds of chemicals and we can only guess which are the active ones” (Neurology 2004;63:2240–4).

Dr. Mauskop recommends a combination of magnesium, feverfew, and riboflavin: “I find that about half of people are very happy with [this combination]. Sometimes their headaches completely disappear so that they don't need prescription drugs.”

The triple combination, available as MigreLief, costs $18 per month, and “if money is not an issue, I add CoQ10.” Patients take 300 mg/day of MigreLief for 8 weeks. Although one study that showed favorable results in migraine patients used 100 mg t.i.d., “I often recommend 300 mg once daily due to adherence issues.”

Patients have a continuum of responses. “Some say their headaches are more responsive to prescription drugs and some have total disappearance of migraines, with most responses somewhere in the middle,” he said.

Butterbur has only one manufacturer, Dr. Mauskop said, “but feverfew is sold by many companies and the products are not always of good quality. Patients need to buy recognized brands or the triple combination supplements.” Dr. Mauskop is a paid consultant to Quantum, Inc., the manufacturer of MigreLief.

RANCHO MIRAGE, CALIF. – Alternative therapies are not a replacement for prescription drugs in migraine treatment, but they can reduce the severity of the attacks and help ease symptoms, reported Dr. Alexander Mauskop.

In fact, “anyone suffering from migraines can benefit from these treatments,” Dr. Mauskop said. The most important point, he stressed at a meeting sponsored by the Diamond Headache Clinic, is that nonpharmacologic methods can be as effective as drugs, if not more effective. When instituting an alternative approach, the first step is to eliminate food triggers, encourage a proper sleep regimen, regular meal intake, and sufficient hydration.

Actual alternative therapies to control physiologic response to stress include regular aerobic exercise and biofeedback, said Dr. Mauskop, director of the New York Headache Center.

For migraines, the most commonly used supplements are magnesium, feverfew, coenzyme Q 10 (CoQ10), riboflavin, butterbur extract, and alpha lipoic acid.

The most important supplement, according to Dr. Mauskop, is magnesium. “It's known that up to 50% of people with acute migraine have a magnesium deficiency. … It is much more effective to treat them with a product they're deficient in rather than using drugs,” he said. Magnesium is “very effective for 50% of those who are deficient in it, but even prescription drugs work for only 50% of migraineurs” (Headache 2003;43:601–10).

Research has found that, for migraine, CoQ10 at 300 mg/day is effective, and that for Parkinson's disease 1,200 mg/day is effective. “Riboflavin has similar function in the body as CoQ10 and was shown to prevent migraine in one double-blind study. Although the therapeutic amount of riboflavin is very high–400 mg/day; many multivitamins have only 2–3 mg,” he said (Neurology 1996;50:440–66).

Butterbur, 50 mg t.i.d, has also been found to help treat migraine, most likely due to its anti-inflammatory properties, or “maybe something else. Herbal products contain hundreds of chemicals and we can only guess which are the active ones” (Neurology 2004;63:2240–4).

Dr. Mauskop recommends a combination of magnesium, feverfew, and riboflavin: “I find that about half of people are very happy with [this combination]. Sometimes their headaches completely disappear so that they don't need prescription drugs.”

The triple combination, available as MigreLief, costs $18 per month, and “if money is not an issue, I add CoQ10.” Patients take 300 mg/day of MigreLief for 8 weeks. Although one study that showed favorable results in migraine patients used 100 mg t.i.d., “I often recommend 300 mg once daily due to adherence issues.”

Patients have a continuum of responses. “Some say their headaches are more responsive to prescription drugs and some have total disappearance of migraines, with most responses somewhere in the middle,” he said.

Butterbur has only one manufacturer, Dr. Mauskop said, “but feverfew is sold by many companies and the products are not always of good quality. Patients need to buy recognized brands or the triple combination supplements.” Dr. Mauskop is a paid consultant to Quantum, Inc., the manufacturer of MigreLief.

Glycemic control, body mass index, and diabetes self-care improved significantly in type 2 diabetics with major depressive disorder who used bupropion for both acute and maintenance therapy, a two-phase open-label study found.

“Our study affirms the importance of depression management in diabetic patients in its potential to improve glycemic control, even though the mechanisms involved are not fully understood,” wrote study authors Patrick J. Lustman, Ph.D., of the Washington University School, St. Louis, and colleagues. “This advantage could lead to better outcomes, measured not only in quality of life but also in reduced or delayed onset of complications.”

The researchers evaluated data from a two-phase (acute and maintenance) open-label depression treatment trial in type 2 diabetics with major depressive disorder to determine whether treatment with bupropion hydrochloride extended release (Wellbutrin XL) affected glycemic control.

They assessed whether hemoglobin A_1c (HbA_1c), described as an “aggregate measure of glycemic control over the 120-day period before testing,” improved with treatment and whether mood, diabetes self-care, and anthropometric changes also affected a change in HbA_1c.

Of the 93 patients enrolled, 75 completed the acute 10-week bupropion treatment (mean dosage 334 mg/day). Of the 18 patients who discontinued treatment during the acute phase, 6 withdrew because of side effects, with increased anxiety being the most common. Those patients who withdrew were more likely to be black and older at depression onset; however, there were no significant between-group demographic differences among those completing the acute phase.

Of the 75 patients who completed the acute phase, 63 (84%) had remittance from their depression and therefore were eligible to continue with maintenance therapy. Of that group, 8 patients (13%) discontinued treatment prematurely. The remaining 55 patients (87%) went on to complete the full 24-week maintenance phase; no one in that group suffered a recurrence.

Compared with their baseline values, patients who had relief from depression also significantly improved their adherence to diet and exercise regimens during the 10-week acute phase and 24-week maintenance phase. Glucose testing adherence was not significantly affected throughout the study (Diabetes Care 2007;30:459–66).

“Depression remitted in 68% of those who started bupropion treatment and in 84% of those who completed the acute phase,” the authors wrote.

For the 55 patients who completed the maintenance phase, “changes from baseline over the maintenance interval were significant for weight and [body mass index]; total body fat mass showed a trend toward significance, and, in this instance, the reduction in percent body fat was also significant,” the authors found.

The overall HbA_1c decrease from baseline during the acute phase was a mean of −0.5, and this effect “was completely attributable to changes in the subset showing remission … as the change in those who did not show a remission was minimal and insignificant,” they continued. These levels “remained significantly lower than baseline (−0.7) during the depression-free interval of maintenance,” the researchers noted.

This two-phase study was funded by the National Institutes of Health and GlaxoSmithKline Inc., the manufacturer of Wellbutrin XL.

Glycemic control, body mass index, and diabetes self-care improved significantly in type 2 diabetics with major depressive disorder who used bupropion for both acute and maintenance therapy, a two-phase open-label study found.

“Our study affirms the importance of depression management in diabetic patients in its potential to improve glycemic control, even though the mechanisms involved are not fully understood,” wrote study authors Patrick J. Lustman, Ph.D., of the Washington University School, St. Louis, and colleagues. “This advantage could lead to better outcomes, measured not only in quality of life but also in reduced or delayed onset of complications.”

The researchers evaluated data from a two-phase (acute and maintenance) open-label depression treatment trial in type 2 diabetics with major depressive disorder to determine whether treatment with bupropion hydrochloride extended release (Wellbutrin XL) affected glycemic control.

They assessed whether hemoglobin A_1c (HbA_1c), described as an “aggregate measure of glycemic control over the 120-day period before testing,” improved with treatment and whether mood, diabetes self-care, and anthropometric changes also affected a change in HbA_1c.

Of the 93 patients enrolled, 75 completed the acute 10-week bupropion treatment (mean dosage 334 mg/day). Of the 18 patients who discontinued treatment during the acute phase, 6 withdrew because of side effects, with increased anxiety being the most common. Those patients who withdrew were more likely to be black and older at depression onset; however, there were no significant between-group demographic differences among those completing the acute phase.

Of the 75 patients who completed the acute phase, 63 (84%) had remittance from their depression and therefore were eligible to continue with maintenance therapy. Of that group, 8 patients (13%) discontinued treatment prematurely. The remaining 55 patients (87%) went on to complete the full 24-week maintenance phase; no one in that group suffered a recurrence.

Compared with their baseline values, patients who had relief from depression also significantly improved their adherence to diet and exercise regimens during the 10-week acute phase and 24-week maintenance phase. Glucose testing adherence was not significantly affected throughout the study (Diabetes Care 2007;30:459–66).

“Depression remitted in 68% of those who started bupropion treatment and in 84% of those who completed the acute phase,” the authors wrote.

For the 55 patients who completed the maintenance phase, “changes from baseline over the maintenance interval were significant for weight and [body mass index]; total body fat mass showed a trend toward significance, and, in this instance, the reduction in percent body fat was also significant,” the authors found.

The overall HbA_1c decrease from baseline during the acute phase was a mean of −0.5, and this effect “was completely attributable to changes in the subset showing remission … as the change in those who did not show a remission was minimal and insignificant,” they continued. These levels “remained significantly lower than baseline (−0.7) during the depression-free interval of maintenance,” the researchers noted.

This two-phase study was funded by the National Institutes of Health and GlaxoSmithKline Inc., the manufacturer of Wellbutrin XL.

Glycemic control, body mass index, and diabetes self-care improved significantly in type 2 diabetics with major depressive disorder who used bupropion for both acute and maintenance therapy, a two-phase open-label study found.

“Our study affirms the importance of depression management in diabetic patients in its potential to improve glycemic control, even though the mechanisms involved are not fully understood,” wrote study authors Patrick J. Lustman, Ph.D., of the Washington University School, St. Louis, and colleagues. “This advantage could lead to better outcomes, measured not only in quality of life but also in reduced or delayed onset of complications.”

The researchers evaluated data from a two-phase (acute and maintenance) open-label depression treatment trial in type 2 diabetics with major depressive disorder to determine whether treatment with bupropion hydrochloride extended release (Wellbutrin XL) affected glycemic control.

They assessed whether hemoglobin A_1c (HbA_1c), described as an “aggregate measure of glycemic control over the 120-day period before testing,” improved with treatment and whether mood, diabetes self-care, and anthropometric changes also affected a change in HbA_1c.

Of the 93 patients enrolled, 75 completed the acute 10-week bupropion treatment (mean dosage 334 mg/day). Of the 18 patients who discontinued treatment during the acute phase, 6 withdrew because of side effects, with increased anxiety being the most common. Those patients who withdrew were more likely to be black and older at depression onset; however, there were no significant between-group demographic differences among those completing the acute phase.

Of the 75 patients who completed the acute phase, 63 (84%) had remittance from their depression and therefore were eligible to continue with maintenance therapy. Of that group, 8 patients (13%) discontinued treatment prematurely. The remaining 55 patients (87%) went on to complete the full 24-week maintenance phase; no one in that group suffered a recurrence.

Compared with their baseline values, patients who had relief from depression also significantly improved their adherence to diet and exercise regimens during the 10-week acute phase and 24-week maintenance phase. Glucose testing adherence was not significantly affected throughout the study (Diabetes Care 2007;30:459–66).

“Depression remitted in 68% of those who started bupropion treatment and in 84% of those who completed the acute phase,” the authors wrote.

For the 55 patients who completed the maintenance phase, “changes from baseline over the maintenance interval were significant for weight and [body mass index]; total body fat mass showed a trend toward significance, and, in this instance, the reduction in percent body fat was also significant,” the authors found.

The overall HbA_1c decrease from baseline during the acute phase was a mean of −0.5, and this effect “was completely attributable to changes in the subset showing remission … as the change in those who did not show a remission was minimal and insignificant,” they continued. These levels “remained significantly lower than baseline (−0.7) during the depression-free interval of maintenance,” the researchers noted.

This two-phase study was funded by the National Institutes of Health and GlaxoSmithKline Inc., the manufacturer of Wellbutrin XL.

Undertreatment for hypertension and dyslipidemia is highly prevalent among diabetic patients who receive care at community-based centers, with only a small group having all their cardiovascular risk factors managed, according to an observational Italian study.

The authors wrote that there could be several possible explanations for this outcome, “including the complex and challenging nature of diabetes management and the low reimbursement rate for outpatient visits. … In fact, a short encounter with a high-risk and challenging patient does not adequately provide the time necessary for addressing adherence to complex care behaviors and assessment for optimal therapeutic effectiveness.”

Dr. Furio Colivicchi of the S. Filippo Neri Hospital in Rome and colleagues prospectively evaluated 1,078 type 2 diabetes mellitus patients (571 men and 507 women) with a mean age of 67.6 years to assess how hyperglycemia, hypertension, and dyslipidemia are detected, treated, and controlled in urban community-based diabetic care clinics in Italy. The authors cited the lack of treatment and outcome data for these patients as a reason for conducting the study.

The researchers prospectively collected glycosylated hemoglobin, blood pressure, and cholesterol subfractions values and clinical and medication data to assess cardiovascular risk factor control. The mean time from the initial diagnosis to the inclusion visit was 11.6 years (Diabetes Res. Clin. Pract. 2007;75:176–83).

Despite a 66.6% hypertension prevalence in the study cohort, only 29.6% of patients met the treatment goal of systolic blood pressure less than 130 mm Hg. The goal of diastolic blood pressure less than 80 mm Hg was met in 38.6% of patients, and only 25.5% of patients met the treatment guideline for LDL cholesterol values less than 100 mg/dL.

Glycosylated hemoglobin values less than 7% were recorded in 57.8% of cases; the mean value for glycosylated hemoglobin in the study sample was 6.9%. The authors called these findings “far more satisfactory than those reported in other similar previous surveys, possibly expressing the fact that clinical management of diabetic patients in this setting of urban diabetic care clinics is mainly focused on glycemic control.”

Undertreatment for hypertension and dyslipidemia in community-based centers was “highly prevalent in this survey, and only a very small group of diabetic patients had all cardiovascular risk factors comprehensively addressed,” the authors noted. Consequently, “a high proportion of our patients were noncompliant with European guidelines.”

They added that their results “underscore the major difficulties in following complex guidelines in our present health care system, rather than the lack of enthusiasm among health care providers to rigorously implement recommendations.”

The authors advised their study should be “considered as a baseline measurement and an initial step paving the way for further quality improvement initiatives.”

Undertreatment for hypertension and dyslipidemia is highly prevalent among diabetic patients who receive care at community-based centers, with only a small group having all their cardiovascular risk factors managed, according to an observational Italian study.

The authors wrote that there could be several possible explanations for this outcome, “including the complex and challenging nature of diabetes management and the low reimbursement rate for outpatient visits. … In fact, a short encounter with a high-risk and challenging patient does not adequately provide the time necessary for addressing adherence to complex care behaviors and assessment for optimal therapeutic effectiveness.”

Dr. Furio Colivicchi of the S. Filippo Neri Hospital in Rome and colleagues prospectively evaluated 1,078 type 2 diabetes mellitus patients (571 men and 507 women) with a mean age of 67.6 years to assess how hyperglycemia, hypertension, and dyslipidemia are detected, treated, and controlled in urban community-based diabetic care clinics in Italy. The authors cited the lack of treatment and outcome data for these patients as a reason for conducting the study.

The researchers prospectively collected glycosylated hemoglobin, blood pressure, and cholesterol subfractions values and clinical and medication data to assess cardiovascular risk factor control. The mean time from the initial diagnosis to the inclusion visit was 11.6 years (Diabetes Res. Clin. Pract. 2007;75:176–83).

Despite a 66.6% hypertension prevalence in the study cohort, only 29.6% of patients met the treatment goal of systolic blood pressure less than 130 mm Hg. The goal of diastolic blood pressure less than 80 mm Hg was met in 38.6% of patients, and only 25.5% of patients met the treatment guideline for LDL cholesterol values less than 100 mg/dL.

Glycosylated hemoglobin values less than 7% were recorded in 57.8% of cases; the mean value for glycosylated hemoglobin in the study sample was 6.9%. The authors called these findings “far more satisfactory than those reported in other similar previous surveys, possibly expressing the fact that clinical management of diabetic patients in this setting of urban diabetic care clinics is mainly focused on glycemic control.”

Undertreatment for hypertension and dyslipidemia in community-based centers was “highly prevalent in this survey, and only a very small group of diabetic patients had all cardiovascular risk factors comprehensively addressed,” the authors noted. Consequently, “a high proportion of our patients were noncompliant with European guidelines.”

They added that their results “underscore the major difficulties in following complex guidelines in our present health care system, rather than the lack of enthusiasm among health care providers to rigorously implement recommendations.”

The authors advised their study should be “considered as a baseline measurement and an initial step paving the way for further quality improvement initiatives.”

Undertreatment for hypertension and dyslipidemia is highly prevalent among diabetic patients who receive care at community-based centers, with only a small group having all their cardiovascular risk factors managed, according to an observational Italian study.

The authors wrote that there could be several possible explanations for this outcome, “including the complex and challenging nature of diabetes management and the low reimbursement rate for outpatient visits. … In fact, a short encounter with a high-risk and challenging patient does not adequately provide the time necessary for addressing adherence to complex care behaviors and assessment for optimal therapeutic effectiveness.”

Dr. Furio Colivicchi of the S. Filippo Neri Hospital in Rome and colleagues prospectively evaluated 1,078 type 2 diabetes mellitus patients (571 men and 507 women) with a mean age of 67.6 years to assess how hyperglycemia, hypertension, and dyslipidemia are detected, treated, and controlled in urban community-based diabetic care clinics in Italy. The authors cited the lack of treatment and outcome data for these patients as a reason for conducting the study.

The researchers prospectively collected glycosylated hemoglobin, blood pressure, and cholesterol subfractions values and clinical and medication data to assess cardiovascular risk factor control. The mean time from the initial diagnosis to the inclusion visit was 11.6 years (Diabetes Res. Clin. Pract. 2007;75:176–83).

Despite a 66.6% hypertension prevalence in the study cohort, only 29.6% of patients met the treatment goal of systolic blood pressure less than 130 mm Hg. The goal of diastolic blood pressure less than 80 mm Hg was met in 38.6% of patients, and only 25.5% of patients met the treatment guideline for LDL cholesterol values less than 100 mg/dL.

Glycosylated hemoglobin values less than 7% were recorded in 57.8% of cases; the mean value for glycosylated hemoglobin in the study sample was 6.9%. The authors called these findings “far more satisfactory than those reported in other similar previous surveys, possibly expressing the fact that clinical management of diabetic patients in this setting of urban diabetic care clinics is mainly focused on glycemic control.”

Undertreatment for hypertension and dyslipidemia in community-based centers was “highly prevalent in this survey, and only a very small group of diabetic patients had all cardiovascular risk factors comprehensively addressed,” the authors noted. Consequently, “a high proportion of our patients were noncompliant with European guidelines.”

They added that their results “underscore the major difficulties in following complex guidelines in our present health care system, rather than the lack of enthusiasm among health care providers to rigorously implement recommendations.”

The authors advised their study should be “considered as a baseline measurement and an initial step paving the way for further quality improvement initiatives.”

Hamstring strains that involve the proximal free tendon and are more cranial to the ischial tuberosity have a longer recovery time to preinjury levels.

Carl M. Askling, P.T., of the Karolinska Institutet and Swedish School of Sport and Health Sciences, Stockholm, along with his colleagues evaluated acute first-time hamstring strains in 18 sprint runners.

The researchers measured the progression of clinical and MRI injury signs during the first 6 weeks after the injury. They then correlated those findings with the time it took the athletes to return to preinjury status (Am. J. Sports Med. 2007;35:197–206).

The sprinters, whose injuries occurred at maximal or close to maximal speed, stopped running immediately when the injury occurred, and 11 of the 18 (61%) fell. At the initial examination, 15 sprinters (83%) used crutches.

None of the sprinters reported any preinjury symptoms.

On palpation, all of the patients reported experiencing the most pain in the lateral rear thigh.

The mean distances from the point with the highest pain to the ischial tuberosity were measured at 2–4 days (12 cm), 10 days (11 cm), 21 days (12 cm), and 42 days (11 cm).

The corresponding mean lengths of the painful area were 11 cm, 7 cm, 6 cm, and 5 cm.

At the initial clinical examination, which occurred 2 days after injury, the sprinters estimated that they would return to preinjury levels after a median of 4 weeks.

The actual return was significantly longer: a median of 16 weeks (range, 6–50 weeks).

All of the sprinters could jog without pain at 6 weeks after injury, but only two (11%) could train or compete at their preinjury level.

During the 2-year follow-up period, three of the sprinters (17%) reinjured their hamstrings.

A significant correlation was seen between the location of highest pain during palpation at the first clinical examination and return to preinjury status, and there was a tendency toward a correlation at the second examination.

The more cranial the location, the longer was the return to preinjury level.

The investigators also discovered that free proximal tendon involvement was associated with longer recovery times.

There was no correlation between the palpated length of the painful area and the return to preinjury level.

Recovery prediction was equally as good when the point of highest pain on palpation—established within 3 weeks of injury—was used, as it was when the distance from the most cranial pole of the injury, as determined by MRI, was used.

“Repeated, carefully performed clinical examinations during the first 3 weeks after injury can give important information about the prognosis of a hamstring strain,” the authors wrote.

They added that MRIs are also useful for up to 6 weeks after injury in estimating recovery time.

Repeated, carefully performed examinations during the first 3 weeks after an injury will give key information about the prognosis of hamstring strain. ©Joshua Bickel/FOTOLIA

Hamstring strains that involve the proximal free tendon and are more cranial to the ischial tuberosity have a longer recovery time to preinjury levels.

Carl M. Askling, P.T., of the Karolinska Institutet and Swedish School of Sport and Health Sciences, Stockholm, along with his colleagues evaluated acute first-time hamstring strains in 18 sprint runners.

The researchers measured the progression of clinical and MRI injury signs during the first 6 weeks after the injury. They then correlated those findings with the time it took the athletes to return to preinjury status (Am. J. Sports Med. 2007;35:197–206).

The sprinters, whose injuries occurred at maximal or close to maximal speed, stopped running immediately when the injury occurred, and 11 of the 18 (61%) fell. At the initial examination, 15 sprinters (83%) used crutches.

None of the sprinters reported any preinjury symptoms.

On palpation, all of the patients reported experiencing the most pain in the lateral rear thigh.

The mean distances from the point with the highest pain to the ischial tuberosity were measured at 2–4 days (12 cm), 10 days (11 cm), 21 days (12 cm), and 42 days (11 cm).

The corresponding mean lengths of the painful area were 11 cm, 7 cm, 6 cm, and 5 cm.

At the initial clinical examination, which occurred 2 days after injury, the sprinters estimated that they would return to preinjury levels after a median of 4 weeks.

The actual return was significantly longer: a median of 16 weeks (range, 6–50 weeks).

All of the sprinters could jog without pain at 6 weeks after injury, but only two (11%) could train or compete at their preinjury level.

During the 2-year follow-up period, three of the sprinters (17%) reinjured their hamstrings.

A significant correlation was seen between the location of highest pain during palpation at the first clinical examination and return to preinjury status, and there was a tendency toward a correlation at the second examination.

The more cranial the location, the longer was the return to preinjury level.

The investigators also discovered that free proximal tendon involvement was associated with longer recovery times.

There was no correlation between the palpated length of the painful area and the return to preinjury level.

Recovery prediction was equally as good when the point of highest pain on palpation—established within 3 weeks of injury—was used, as it was when the distance from the most cranial pole of the injury, as determined by MRI, was used.

“Repeated, carefully performed clinical examinations during the first 3 weeks after injury can give important information about the prognosis of a hamstring strain,” the authors wrote.

They added that MRIs are also useful for up to 6 weeks after injury in estimating recovery time.

Repeated, carefully performed examinations during the first 3 weeks after an injury will give key information about the prognosis of hamstring strain. ©Joshua Bickel/FOTOLIA

Hamstring strains that involve the proximal free tendon and are more cranial to the ischial tuberosity have a longer recovery time to preinjury levels.

Carl M. Askling, P.T., of the Karolinska Institutet and Swedish School of Sport and Health Sciences, Stockholm, along with his colleagues evaluated acute first-time hamstring strains in 18 sprint runners.

The researchers measured the progression of clinical and MRI injury signs during the first 6 weeks after the injury. They then correlated those findings with the time it took the athletes to return to preinjury status (Am. J. Sports Med. 2007;35:197–206).

The sprinters, whose injuries occurred at maximal or close to maximal speed, stopped running immediately when the injury occurred, and 11 of the 18 (61%) fell. At the initial examination, 15 sprinters (83%) used crutches.

None of the sprinters reported any preinjury symptoms.

On palpation, all of the patients reported experiencing the most pain in the lateral rear thigh.

The mean distances from the point with the highest pain to the ischial tuberosity were measured at 2–4 days (12 cm), 10 days (11 cm), 21 days (12 cm), and 42 days (11 cm).

The corresponding mean lengths of the painful area were 11 cm, 7 cm, 6 cm, and 5 cm.

At the initial clinical examination, which occurred 2 days after injury, the sprinters estimated that they would return to preinjury levels after a median of 4 weeks.

The actual return was significantly longer: a median of 16 weeks (range, 6–50 weeks).

All of the sprinters could jog without pain at 6 weeks after injury, but only two (11%) could train or compete at their preinjury level.

During the 2-year follow-up period, three of the sprinters (17%) reinjured their hamstrings.

A significant correlation was seen between the location of highest pain during palpation at the first clinical examination and return to preinjury status, and there was a tendency toward a correlation at the second examination.

The more cranial the location, the longer was the return to preinjury level.

The investigators also discovered that free proximal tendon involvement was associated with longer recovery times.

There was no correlation between the palpated length of the painful area and the return to preinjury level.

Recovery prediction was equally as good when the point of highest pain on palpation—established within 3 weeks of injury—was used, as it was when the distance from the most cranial pole of the injury, as determined by MRI, was used.

“Repeated, carefully performed clinical examinations during the first 3 weeks after injury can give important information about the prognosis of a hamstring strain,” the authors wrote.

They added that MRIs are also useful for up to 6 weeks after injury in estimating recovery time.

Repeated, carefully performed examinations during the first 3 weeks after an injury will give key information about the prognosis of hamstring strain. ©Joshua Bickel/FOTOLIA

Dalteparin-treated patients have increased foot skin microcirculation and oxygenation, resulting in better foot ulcer outcomes, compared with controls, a Swedish study has found. Dr. Majid Kalani, of the Karolinska Institutet and Danderyd Hospital, both in Stockholm, and colleagues conducted a prospective, double-blind, placebo-controlled, multicenter study to evaluate dalteparin on peripheral macro- and microcirculation and hemostatic function in 85 diabetic patients with peripheral arterial obliterative disease and chronic foot ulcers.

Inclusion criteria were toe/arm blood pressure index equal to or less than 0.6, foot ulcer duration longer than 2 months, ulcers of Wagner classification stages I and II, and aspirin 75 mg/day. Forty-three patients were randomized to subcutaneous injections of dalteparin 0.2 mL once a day, and 42 were randomized to physiological saline 0.2 mL injections once daily. Treatment continued for 6 months or until the ulcer healed, whichever came first. Ulcer outcomes were defined as healed with intact skin; improved; unchanged; impaired; or amputation above or below the ankle (Thromb. Res. 2007 Feb. 2 [Epub doi:10.1016/j.thromres.2006.12.006]).

Plasma fibrinogen, fibrin gel structure, prothrombin fragment 1+2 antigen, plasminogen activator inhibitor-1 (PAI-1) activity, and tissue plasminogen activator (TPA) antigen were analyzed at baseline and at the end of treatment. Foot skin microcirculation was measured with transcutaneous oxygen tension and laser Doppler fluxmetry (LDF).

The combined ulcer outcome results showed that the dalteparin-treated group had significantly better outcomes than did controls. Dalteparin treatment inhibited thrombin generation and increased fibrin gel porosity, thereby encouraging fibrinolysis. Dalteparin also improved fibrinolytic function by increasing TPA antigen and by blunting increases in plasma PAI-1 activity. Plasma PAI-1 activity increased significantly in the 20 controls who improved and the 13 who deteriorated, but did not significantly change in the dalteparin group.

The seven patients in the dalteparin group with impaired ulcer outcomes (two amputations; five increased ulcer area) had worse baseline peripheral macro- and microcirculation and longer time-to-peak LDF compared with baseline values in the 13 patients with improved outcomes. Two amputations were performed in the dalteparin group compared with eight in the placebo group.

The increase in local skin oxygenation in the dalteparin group “suggests improved blood distribution to nutritive capillaries due to decreased shunting of blood through arteriovenous channels,” which might explain the trend toward improved ulcer outcome in these patients, they said.

Dalteparin-treated patients have increased foot skin microcirculation and oxygenation, resulting in better foot ulcer outcomes, compared with controls, a Swedish study has found. Dr. Majid Kalani, of the Karolinska Institutet and Danderyd Hospital, both in Stockholm, and colleagues conducted a prospective, double-blind, placebo-controlled, multicenter study to evaluate dalteparin on peripheral macro- and microcirculation and hemostatic function in 85 diabetic patients with peripheral arterial obliterative disease and chronic foot ulcers.

Inclusion criteria were toe/arm blood pressure index equal to or less than 0.6, foot ulcer duration longer than 2 months, ulcers of Wagner classification stages I and II, and aspirin 75 mg/day. Forty-three patients were randomized to subcutaneous injections of dalteparin 0.2 mL once a day, and 42 were randomized to physiological saline 0.2 mL injections once daily. Treatment continued for 6 months or until the ulcer healed, whichever came first. Ulcer outcomes were defined as healed with intact skin; improved; unchanged; impaired; or amputation above or below the ankle (Thromb. Res. 2007 Feb. 2 [Epub doi:10.1016/j.thromres.2006.12.006]).

Plasma fibrinogen, fibrin gel structure, prothrombin fragment 1+2 antigen, plasminogen activator inhibitor-1 (PAI-1) activity, and tissue plasminogen activator (TPA) antigen were analyzed at baseline and at the end of treatment. Foot skin microcirculation was measured with transcutaneous oxygen tension and laser Doppler fluxmetry (LDF).

The combined ulcer outcome results showed that the dalteparin-treated group had significantly better outcomes than did controls. Dalteparin treatment inhibited thrombin generation and increased fibrin gel porosity, thereby encouraging fibrinolysis. Dalteparin also improved fibrinolytic function by increasing TPA antigen and by blunting increases in plasma PAI-1 activity. Plasma PAI-1 activity increased significantly in the 20 controls who improved and the 13 who deteriorated, but did not significantly change in the dalteparin group.

The seven patients in the dalteparin group with impaired ulcer outcomes (two amputations; five increased ulcer area) had worse baseline peripheral macro- and microcirculation and longer time-to-peak LDF compared with baseline values in the 13 patients with improved outcomes. Two amputations were performed in the dalteparin group compared with eight in the placebo group.

The increase in local skin oxygenation in the dalteparin group “suggests improved blood distribution to nutritive capillaries due to decreased shunting of blood through arteriovenous channels,” which might explain the trend toward improved ulcer outcome in these patients, they said.

Dalteparin-treated patients have increased foot skin microcirculation and oxygenation, resulting in better foot ulcer outcomes, compared with controls, a Swedish study has found. Dr. Majid Kalani, of the Karolinska Institutet and Danderyd Hospital, both in Stockholm, and colleagues conducted a prospective, double-blind, placebo-controlled, multicenter study to evaluate dalteparin on peripheral macro- and microcirculation and hemostatic function in 85 diabetic patients with peripheral arterial obliterative disease and chronic foot ulcers.

Inclusion criteria were toe/arm blood pressure index equal to or less than 0.6, foot ulcer duration longer than 2 months, ulcers of Wagner classification stages I and II, and aspirin 75 mg/day. Forty-three patients were randomized to subcutaneous injections of dalteparin 0.2 mL once a day, and 42 were randomized to physiological saline 0.2 mL injections once daily. Treatment continued for 6 months or until the ulcer healed, whichever came first. Ulcer outcomes were defined as healed with intact skin; improved; unchanged; impaired; or amputation above or below the ankle (Thromb. Res. 2007 Feb. 2 [Epub doi:10.1016/j.thromres.2006.12.006]).

Plasma fibrinogen, fibrin gel structure, prothrombin fragment 1+2 antigen, plasminogen activator inhibitor-1 (PAI-1) activity, and tissue plasminogen activator (TPA) antigen were analyzed at baseline and at the end of treatment. Foot skin microcirculation was measured with transcutaneous oxygen tension and laser Doppler fluxmetry (LDF).

The combined ulcer outcome results showed that the dalteparin-treated group had significantly better outcomes than did controls. Dalteparin treatment inhibited thrombin generation and increased fibrin gel porosity, thereby encouraging fibrinolysis. Dalteparin also improved fibrinolytic function by increasing TPA antigen and by blunting increases in plasma PAI-1 activity. Plasma PAI-1 activity increased significantly in the 20 controls who improved and the 13 who deteriorated, but did not significantly change in the dalteparin group.

The seven patients in the dalteparin group with impaired ulcer outcomes (two amputations; five increased ulcer area) had worse baseline peripheral macro- and microcirculation and longer time-to-peak LDF compared with baseline values in the 13 patients with improved outcomes. Two amputations were performed in the dalteparin group compared with eight in the placebo group.

The increase in local skin oxygenation in the dalteparin group “suggests improved blood distribution to nutritive capillaries due to decreased shunting of blood through arteriovenous channels,” which might explain the trend toward improved ulcer outcome in these patients, they said.

Induction therapy with an intravenous pulse of methylprednisolone shortens patients' response time to oral glucocorticoids for giant cell arteritis, enabling the use of lower total dose, earlier tapering of the drug, and longer remission, Dr. Mehrdad Mazlumzadeh of the Mayo Clinic, Scottsdale, Ariz., and his associates reported.

The investigators conducted a double-blind, placebo-controlled study in which 27 patients (19 women; mean age of 74 years) all had biopsy-confirmed, newly diagnosed giant cell arteritis.

They were randomized to intravenous pulse of either methylprednisolone or saline once daily for the first 3 days of treatment, and then switched to a regimen of 40 mg/day of oral prednisone.

The dose was tapered over the course of 9 months in patients with controlled disease. Specifically, the dosage regimen was lowered every 2 weeks to 30 mg/day, 25 mg/day, 20 mg/day, 17.5 mg/day, 15 mg/day, 12.5 mg/day, and 10 mg/day. At the 10-mg/day dosing period, the dosage was lowered 1 mg per day every 2 weeks.

Although both groups responded well to daily oral prednisone, patients who received the initial intravenous pulse methylprednisolone had faster tapering.

Compared with controls, patients treated with pulsed methylprednisolone used lower doses of oral prednisone (5 mg or less daily) without disease recurrence—a difference that persisted at 52− and 78-week follow-up visits (Arthritis Rheum. 2006;54:3310–8).

Of the 27 patients, 14 were randomized to 3-day pulsed intravenous methylprednisolone followed by oral prednisone and 13 randomized controls had saline infusions and oral prednisone.

Only 12 patients (6 in each group) had 10 mg/day or more of prednisone for 10 days before enrollment.

At 36 weeks, 10 of 14 patients who had intravenous glucocorticoids were on 5 mg/day or less of prednisone, compared with only 2 of the 13 controls.

“Possibly more importantly, this difference was maintained at the 52-week and 78-week follow-up visits, thereby documenting the long-term benefits of the initial pulse in controlling the vascular inflammation,” the researchers wrote.

Those who had intravenous pulse glucocorticoids took lower median doses than did the controls at all follow-up exams, and their total cumulative glucocorticoid dose (5,636 mg) was significantly lower than that of the controls (7,860 mg). Compared with controls, intravenous pulse patients also had fewer relapses.

Induction therapy with an intravenous pulse of methylprednisolone shortens patients' response time to oral glucocorticoids for giant cell arteritis, enabling the use of lower total dose, earlier tapering of the drug, and longer remission, Dr. Mehrdad Mazlumzadeh of the Mayo Clinic, Scottsdale, Ariz., and his associates reported.

The investigators conducted a double-blind, placebo-controlled study in which 27 patients (19 women; mean age of 74 years) all had biopsy-confirmed, newly diagnosed giant cell arteritis.

They were randomized to intravenous pulse of either methylprednisolone or saline once daily for the first 3 days of treatment, and then switched to a regimen of 40 mg/day of oral prednisone.

The dose was tapered over the course of 9 months in patients with controlled disease. Specifically, the dosage regimen was lowered every 2 weeks to 30 mg/day, 25 mg/day, 20 mg/day, 17.5 mg/day, 15 mg/day, 12.5 mg/day, and 10 mg/day. At the 10-mg/day dosing period, the dosage was lowered 1 mg per day every 2 weeks.

Although both groups responded well to daily oral prednisone, patients who received the initial intravenous pulse methylprednisolone had faster tapering.

Compared with controls, patients treated with pulsed methylprednisolone used lower doses of oral prednisone (5 mg or less daily) without disease recurrence—a difference that persisted at 52− and 78-week follow-up visits (Arthritis Rheum. 2006;54:3310–8).

Of the 27 patients, 14 were randomized to 3-day pulsed intravenous methylprednisolone followed by oral prednisone and 13 randomized controls had saline infusions and oral prednisone.

Only 12 patients (6 in each group) had 10 mg/day or more of prednisone for 10 days before enrollment.

At 36 weeks, 10 of 14 patients who had intravenous glucocorticoids were on 5 mg/day or less of prednisone, compared with only 2 of the 13 controls.

“Possibly more importantly, this difference was maintained at the 52-week and 78-week follow-up visits, thereby documenting the long-term benefits of the initial pulse in controlling the vascular inflammation,” the researchers wrote.

Those who had intravenous pulse glucocorticoids took lower median doses than did the controls at all follow-up exams, and their total cumulative glucocorticoid dose (5,636 mg) was significantly lower than that of the controls (7,860 mg). Compared with controls, intravenous pulse patients also had fewer relapses.

Induction therapy with an intravenous pulse of methylprednisolone shortens patients' response time to oral glucocorticoids for giant cell arteritis, enabling the use of lower total dose, earlier tapering of the drug, and longer remission, Dr. Mehrdad Mazlumzadeh of the Mayo Clinic, Scottsdale, Ariz., and his associates reported.

The investigators conducted a double-blind, placebo-controlled study in which 27 patients (19 women; mean age of 74 years) all had biopsy-confirmed, newly diagnosed giant cell arteritis.

They were randomized to intravenous pulse of either methylprednisolone or saline once daily for the first 3 days of treatment, and then switched to a regimen of 40 mg/day of oral prednisone.

The dose was tapered over the course of 9 months in patients with controlled disease. Specifically, the dosage regimen was lowered every 2 weeks to 30 mg/day, 25 mg/day, 20 mg/day, 17.5 mg/day, 15 mg/day, 12.5 mg/day, and 10 mg/day. At the 10-mg/day dosing period, the dosage was lowered 1 mg per day every 2 weeks.

Although both groups responded well to daily oral prednisone, patients who received the initial intravenous pulse methylprednisolone had faster tapering.

Compared with controls, patients treated with pulsed methylprednisolone used lower doses of oral prednisone (5 mg or less daily) without disease recurrence—a difference that persisted at 52− and 78-week follow-up visits (Arthritis Rheum. 2006;54:3310–8).

Of the 27 patients, 14 were randomized to 3-day pulsed intravenous methylprednisolone followed by oral prednisone and 13 randomized controls had saline infusions and oral prednisone.

Only 12 patients (6 in each group) had 10 mg/day or more of prednisone for 10 days before enrollment.

At 36 weeks, 10 of 14 patients who had intravenous glucocorticoids were on 5 mg/day or less of prednisone, compared with only 2 of the 13 controls.

“Possibly more importantly, this difference was maintained at the 52-week and 78-week follow-up visits, thereby documenting the long-term benefits of the initial pulse in controlling the vascular inflammation,” the researchers wrote.

Those who had intravenous pulse glucocorticoids took lower median doses than did the controls at all follow-up exams, and their total cumulative glucocorticoid dose (5,636 mg) was significantly lower than that of the controls (7,860 mg). Compared with controls, intravenous pulse patients also had fewer relapses.

Low-dose aspirin appears to be a safe and effective adjunctive therapy in patients whose giant cell arteritis puts them at increased risk for ischemic vision loss and cerebrovascular accidents, judging from data from a retrospective study.

Dr. Michael S. Lee of the University of Minnesota, Minneapolis, and his colleagues from the Cleveland Clinic Foundation reviewed the charts of 143 patients (76% women; 95% white; mean age 71.8 years) who met the American College of Rheumatology's criteria for giant cell arteritis (GCA). The patients had presented between January 1989 and November 2004 and 73% had a biopsy-proven diagnosis.

All of the patients were treated with corticosteroids after their diagnosis.

But not all the patients remained on steroids for the duration of follow-up, which was several years in some cases, Dr. Lee said in an interview.

Aspirin, clopidogrel, or warfarin was given to 86 patients at some point since their diagnosis.

Of these 86, 18 started this therapy only after experiencing an ischemic event and 68 took one of these agents without a prior ischemic event. The remaining 57 patients never received antiplatelet or anticoagulant therapy.

The mean follow-up was 53.8 months for the antiplatelet-anticoagulant treated group and 46.7 months for the untreated group.

Fewer ischemic events occurred among patients who were on antiplatelet or anticoagulant therapy.

An ischemic event occurred in 11 (16%) of the 68 patients taking antiplatelet or anticoagulant therapy and in 36 (48%) of 75 patients—the 57 patients who were untreated and the 18 patients who had experienced an ischemic event prior to starting therapy, said Dr. Lee.

One or more cerebrovascular risk factors were present in 99 patients (69%).

For those with risk factors, 53 (54%) were on antiplatelet or anticoagulant therapy and 46 (47%) were not.

Of the patients on antiplatelet or anticoagulant drugs, 77% had at least one cerebrovascular risk factor, compared with 61% of the patients not taking these medications.

Nonfatal bleeding occurred in 2 (3%) of 66 patients on aspirin and in 1 (5%) of 20 on warfarin. In contrast, bleeding occurred in 5 (9%) of 57 patients on prednisone (Arthritis Rheum. 2006;54:3306–9).

Antiplatelet or anticoagulant therapy “may reduce the risk of vision loss or hemispheric stroke in patients with GCA. An increased risk of bleeding complications was not observed in this group,” the investigators wrote.

“Low-dose aspirin is relatively well tolerated and safe” and, when there are no contraindications, adjunctive low-dose aspirin should be considered in the treatment of patients with GCA, they added. “We also believe that our results provide a rationale for a prospective, randomized, placebo-controlled trial to further determine the role of adjunctive antiplatelet therapy in GCA.”

Low-dose aspirin appears to be a safe and effective adjunctive therapy in patients whose giant cell arteritis puts them at increased risk for ischemic vision loss and cerebrovascular accidents, judging from data from a retrospective study.

Dr. Michael S. Lee of the University of Minnesota, Minneapolis, and his colleagues from the Cleveland Clinic Foundation reviewed the charts of 143 patients (76% women; 95% white; mean age 71.8 years) who met the American College of Rheumatology's criteria for giant cell arteritis (GCA). The patients had presented between January 1989 and November 2004 and 73% had a biopsy-proven diagnosis.

All of the patients were treated with corticosteroids after their diagnosis.

But not all the patients remained on steroids for the duration of follow-up, which was several years in some cases, Dr. Lee said in an interview.

Aspirin, clopidogrel, or warfarin was given to 86 patients at some point since their diagnosis.

Of these 86, 18 started this therapy only after experiencing an ischemic event and 68 took one of these agents without a prior ischemic event. The remaining 57 patients never received antiplatelet or anticoagulant therapy.

The mean follow-up was 53.8 months for the antiplatelet-anticoagulant treated group and 46.7 months for the untreated group.

Fewer ischemic events occurred among patients who were on antiplatelet or anticoagulant therapy.

An ischemic event occurred in 11 (16%) of the 68 patients taking antiplatelet or anticoagulant therapy and in 36 (48%) of 75 patients—the 57 patients who were untreated and the 18 patients who had experienced an ischemic event prior to starting therapy, said Dr. Lee.

One or more cerebrovascular risk factors were present in 99 patients (69%).

For those with risk factors, 53 (54%) were on antiplatelet or anticoagulant therapy and 46 (47%) were not.

Of the patients on antiplatelet or anticoagulant drugs, 77% had at least one cerebrovascular risk factor, compared with 61% of the patients not taking these medications.

Nonfatal bleeding occurred in 2 (3%) of 66 patients on aspirin and in 1 (5%) of 20 on warfarin. In contrast, bleeding occurred in 5 (9%) of 57 patients on prednisone (Arthritis Rheum. 2006;54:3306–9).

Antiplatelet or anticoagulant therapy “may reduce the risk of vision loss or hemispheric stroke in patients with GCA. An increased risk of bleeding complications was not observed in this group,” the investigators wrote.

“Low-dose aspirin is relatively well tolerated and safe” and, when there are no contraindications, adjunctive low-dose aspirin should be considered in the treatment of patients with GCA, they added. “We also believe that our results provide a rationale for a prospective, randomized, placebo-controlled trial to further determine the role of adjunctive antiplatelet therapy in GCA.”

Low-dose aspirin appears to be a safe and effective adjunctive therapy in patients whose giant cell arteritis puts them at increased risk for ischemic vision loss and cerebrovascular accidents, judging from data from a retrospective study.

Dr. Michael S. Lee of the University of Minnesota, Minneapolis, and his colleagues from the Cleveland Clinic Foundation reviewed the charts of 143 patients (76% women; 95% white; mean age 71.8 years) who met the American College of Rheumatology's criteria for giant cell arteritis (GCA). The patients had presented between January 1989 and November 2004 and 73% had a biopsy-proven diagnosis.

All of the patients were treated with corticosteroids after their diagnosis.

But not all the patients remained on steroids for the duration of follow-up, which was several years in some cases, Dr. Lee said in an interview.

Aspirin, clopidogrel, or warfarin was given to 86 patients at some point since their diagnosis.

Of these 86, 18 started this therapy only after experiencing an ischemic event and 68 took one of these agents without a prior ischemic event. The remaining 57 patients never received antiplatelet or anticoagulant therapy.

The mean follow-up was 53.8 months for the antiplatelet-anticoagulant treated group and 46.7 months for the untreated group.

Fewer ischemic events occurred among patients who were on antiplatelet or anticoagulant therapy.

An ischemic event occurred in 11 (16%) of the 68 patients taking antiplatelet or anticoagulant therapy and in 36 (48%) of 75 patients—the 57 patients who were untreated and the 18 patients who had experienced an ischemic event prior to starting therapy, said Dr. Lee.

One or more cerebrovascular risk factors were present in 99 patients (69%).

For those with risk factors, 53 (54%) were on antiplatelet or anticoagulant therapy and 46 (47%) were not.

Of the patients on antiplatelet or anticoagulant drugs, 77% had at least one cerebrovascular risk factor, compared with 61% of the patients not taking these medications.

Nonfatal bleeding occurred in 2 (3%) of 66 patients on aspirin and in 1 (5%) of 20 on warfarin. In contrast, bleeding occurred in 5 (9%) of 57 patients on prednisone (Arthritis Rheum. 2006;54:3306–9).

Antiplatelet or anticoagulant therapy “may reduce the risk of vision loss or hemispheric stroke in patients with GCA. An increased risk of bleeding complications was not observed in this group,” the investigators wrote.

“Low-dose aspirin is relatively well tolerated and safe” and, when there are no contraindications, adjunctive low-dose aspirin should be considered in the treatment of patients with GCA, they added. “We also believe that our results provide a rationale for a prospective, randomized, placebo-controlled trial to further determine the role of adjunctive antiplatelet therapy in GCA.”

Knee joint osteoarthritis was significantly more common at 5 years after anterior cruciate ligament reconstruction in patients with patellar tendon autografts than in those with hamstring tendon autografts.

Dr. Matjaz Sajovic, along with researchers from the General Hospital Celje and the University of Ljubljana (Slovenia), conducted a prospective controlled study in which 64 patients with anterior cruciate ligament (ACL) rupture were randomized to reconstruction with hamstring tendon autografts (32) or patellar tendon autografts (32).

The comparative success of the two procedures and their associated incidence of early knee joint osteoarthritis were compared 5 years after surgery.

Among the 54 patients (85%) available for clinical and radiographic follow-up, there were no significant differences in graft rupture or contralateral ACL rupture in the 28 with hamstring tendon grafts and the 26 with patellar tendon grafts. Returns to preinjury activity levels were similar in the hamstring tendon group, 23 of 28, and in the patellar tendon group, 23 of 26. Among those with hamstring tendon autografts, grafts ruptured in two patients and contralateral ACLs ruptured in two. In those with patellar tendon autografts, grafts ruptured in two and contralateral ACLs ruptured in three (Am. J. Sports Med. 2006;34:1933–40).

Clinical and subjective test results were similar for the two groups; however, osteoarthritic changes significantly differed. Radiographic grade B knee joint osteoarthritis was present at the 5-year follow-up in 13 of the 26 patients (50%) with patellar tendon autografts and in 5 of the 28 patients (17%) with hamstring tendon autografts.

In other studies, osteoarthritis rates have been higher after meniscal resection. The authors attribute the lower rate in their study to significantly more (P = 0.027) subtotal meniscal resections performed in the hamstring tendon group, 12 of 28 patients, compared with the patellar tendon group, 4 of 26.

Further, medial meniscal injury was noted at reconstruction in 12 of 28 with hamstring tendon autografts and in 12 of 26 with patellar tendon autografts. Lateral meniscal injury was noted in six patients in each group. “It is difficult to obtain patients with solitary ACL tears without any other intra-articular lesions,” the investigators said.

At 5-year follow-up, radiographic evidence of knee joint osteoarthritis was significantly elevated in patients from the patellar tendon group (P = 0.012). This finding “emphasizes the hypothesis that the choice of the graft is crucial in the development of degenerative knee joint disease at 5 years after ACL reconstruction.”

Only one previous prospective, long-term study has compared the two autografts, but the findings excluded all patients with more than one-third meniscectomy and atraumatic graft failure. After 7 years, patellar tendon grafts were associated (P = 0.002) with more osteoarthritis (Am. J. Sports Med. 2005;33:1337–45).

Knee joint osteoarthritis was significantly more common at 5 years after anterior cruciate ligament reconstruction in patients with patellar tendon autografts than in those with hamstring tendon autografts.

Dr. Matjaz Sajovic, along with researchers from the General Hospital Celje and the University of Ljubljana (Slovenia), conducted a prospective controlled study in which 64 patients with anterior cruciate ligament (ACL) rupture were randomized to reconstruction with hamstring tendon autografts (32) or patellar tendon autografts (32).

The comparative success of the two procedures and their associated incidence of early knee joint osteoarthritis were compared 5 years after surgery.

Among the 54 patients (85%) available for clinical and radiographic follow-up, there were no significant differences in graft rupture or contralateral ACL rupture in the 28 with hamstring tendon grafts and the 26 with patellar tendon grafts. Returns to preinjury activity levels were similar in the hamstring tendon group, 23 of 28, and in the patellar tendon group, 23 of 26. Among those with hamstring tendon autografts, grafts ruptured in two patients and contralateral ACLs ruptured in two. In those with patellar tendon autografts, grafts ruptured in two and contralateral ACLs ruptured in three (Am. J. Sports Med. 2006;34:1933–40).

Clinical and subjective test results were similar for the two groups; however, osteoarthritic changes significantly differed. Radiographic grade B knee joint osteoarthritis was present at the 5-year follow-up in 13 of the 26 patients (50%) with patellar tendon autografts and in 5 of the 28 patients (17%) with hamstring tendon autografts.

In other studies, osteoarthritis rates have been higher after meniscal resection. The authors attribute the lower rate in their study to significantly more (P = 0.027) subtotal meniscal resections performed in the hamstring tendon group, 12 of 28 patients, compared with the patellar tendon group, 4 of 26.

Further, medial meniscal injury was noted at reconstruction in 12 of 28 with hamstring tendon autografts and in 12 of 26 with patellar tendon autografts. Lateral meniscal injury was noted in six patients in each group. “It is difficult to obtain patients with solitary ACL tears without any other intra-articular lesions,” the investigators said.

At 5-year follow-up, radiographic evidence of knee joint osteoarthritis was significantly elevated in patients from the patellar tendon group (P = 0.012). This finding “emphasizes the hypothesis that the choice of the graft is crucial in the development of degenerative knee joint disease at 5 years after ACL reconstruction.”

Only one previous prospective, long-term study has compared the two autografts, but the findings excluded all patients with more than one-third meniscectomy and atraumatic graft failure. After 7 years, patellar tendon grafts were associated (P = 0.002) with more osteoarthritis (Am. J. Sports Med. 2005;33:1337–45).

Knee joint osteoarthritis was significantly more common at 5 years after anterior cruciate ligament reconstruction in patients with patellar tendon autografts than in those with hamstring tendon autografts.

Dr. Matjaz Sajovic, along with researchers from the General Hospital Celje and the University of Ljubljana (Slovenia), conducted a prospective controlled study in which 64 patients with anterior cruciate ligament (ACL) rupture were randomized to reconstruction with hamstring tendon autografts (32) or patellar tendon autografts (32).

The comparative success of the two procedures and their associated incidence of early knee joint osteoarthritis were compared 5 years after surgery.

Among the 54 patients (85%) available for clinical and radiographic follow-up, there were no significant differences in graft rupture or contralateral ACL rupture in the 28 with hamstring tendon grafts and the 26 with patellar tendon grafts. Returns to preinjury activity levels were similar in the hamstring tendon group, 23 of 28, and in the patellar tendon group, 23 of 26. Among those with hamstring tendon autografts, grafts ruptured in two patients and contralateral ACLs ruptured in two. In those with patellar tendon autografts, grafts ruptured in two and contralateral ACLs ruptured in three (Am. J. Sports Med. 2006;34:1933–40).

Clinical and subjective test results were similar for the two groups; however, osteoarthritic changes significantly differed. Radiographic grade B knee joint osteoarthritis was present at the 5-year follow-up in 13 of the 26 patients (50%) with patellar tendon autografts and in 5 of the 28 patients (17%) with hamstring tendon autografts.

In other studies, osteoarthritis rates have been higher after meniscal resection. The authors attribute the lower rate in their study to significantly more (P = 0.027) subtotal meniscal resections performed in the hamstring tendon group, 12 of 28 patients, compared with the patellar tendon group, 4 of 26.

Further, medial meniscal injury was noted at reconstruction in 12 of 28 with hamstring tendon autografts and in 12 of 26 with patellar tendon autografts. Lateral meniscal injury was noted in six patients in each group. “It is difficult to obtain patients with solitary ACL tears without any other intra-articular lesions,” the investigators said.

At 5-year follow-up, radiographic evidence of knee joint osteoarthritis was significantly elevated in patients from the patellar tendon group (P = 0.012). This finding “emphasizes the hypothesis that the choice of the graft is crucial in the development of degenerative knee joint disease at 5 years after ACL reconstruction.”

Only one previous prospective, long-term study has compared the two autografts, but the findings excluded all patients with more than one-third meniscectomy and atraumatic graft failure. After 7 years, patellar tendon grafts were associated (P = 0.002) with more osteoarthritis (Am. J. Sports Med. 2005;33:1337–45).