<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_442"
                     title="Most Mountaineers Can Enjoy the View (CME/CE)"
                     score="0.015"
                     href="http://www.medpagetoday.com/Ophthalmology/GeneralOphthalmology/tb/18359?impressionId=1265762806162"
                     
      &lt;p&gt;Although the vistas from some of the world&apos;s highest peaks are literally &quot;eye-popping,&quot; most climbers don&apos;t have to worry about their high-altitude vision.&lt;/p&gt;
&lt;p&gt;Corneal thickness did swell significantly among mountaineers at elevations up to 6,300 meters (about 21,000 feet), but they had no loss in visual acuity, Martina Monika Bosch, MD, of University Hospital Zurich in Switzerland, and colleagues reported in the February &lt;em&gt;Archives of Ophthalmology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;It seems that visual acuity in healthy corneas is not adversely affected despite the presence of edema at altitudes up to 6,300 meters,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;Yet they warned that altitudes above 8,000 meters, or 26,000 feet, &quot;may result in profuse edema leading to dangerous visual loss.&quot;&lt;/p&gt;
&lt;p&gt;Mt. Everest is just over 29,000 feet high.&lt;/p&gt;
&lt;p&gt;Research has shown that hypobaric atmospheric conditions are linked to acute mountain sickness, as well as to the more unusual cerebral edema.&lt;/p&gt;
&lt;p&gt;High altitudes have also been associated with decreases in visual acuity, as was the case for Dr. Beck Weathers, a Mount Everest climber who had lasik surgery prior to his climb and experienced severe vision loss before reaching the summit.&lt;/p&gt;
&lt;p&gt;So, to investigate the effects of very high altitudes on corneal thickness, the researchers conducted a study of 28 healthy mountaineers ages 26 to 62, who were on a medical research expedition to Mount Muztagh Ata in China, an elevation of 24,757 feet.&lt;/p&gt;
&lt;p&gt;The climbers were randomly assigned to two groups: one had a shorter time to acclimate to altitude conditions prior to reaching a camp at 21,736 feet.&lt;/p&gt;
&lt;p&gt;The researchers measured corneal thickness via ultrasound pachymetry.&lt;/p&gt;
&lt;p&gt;They found that corneal thickness increased in both groups at higher altitudes, with shorter acclimatization times leading to greater differences (&lt;em&gt;P&lt;/em&gt;=0.048). For this group, mean corneal thickness increased from 537 mcm to 572 mcm.&lt;/p&gt;
&lt;p&gt;Corneal thickness in the group that had more time to acclimate rose from 534 mcm to 563 mcm.&lt;/p&gt;
&lt;p&gt;Visual acuity didn&apos;t significantly decrease during the course of the expedition. However, the researchers warned that higher altitudes induce more endothelial pump function failure and may result in profuse edema, leading to vision loss.&lt;/p&gt;
&lt;p&gt;While the cause of corneal swelling in hypoxic conditions is still controversial, the researchers suggested that a higher concentration of lactate may reduce activity of the eye&apos;s endothelial pump function, resulting in corneal swelling.&lt;/p&gt;
&lt;p&gt;There were no differences in mountain sickness between the groups, but oxygen saturation during the expedition was significantly lower than at baseline in both.&lt;/p&gt;
&lt;p&gt;Changes in oxygen saturation paralleled those of corneal thickness, the researchers said, indicating that slower acclimatization resulted in less corneal edema.&lt;/p&gt;
&lt;p&gt;Also, climbers with more acute mountain sickness had thicker corneas, possibly due to their higher overall susceptibility to hypoxia.&lt;/p&gt;
&lt;p&gt;&quot;These findings further support our hypothesis that blood oxygen saturation becomes more important for the endothelial pump function when environmental oxygen pressure and, thus, tear film oxygen saturation, is reduced to a critical level,&quot; they wrote. &quot;Our results thus highlight the importance of aqueous humor oxygen delivery.&quot;&lt;/p&gt;
&lt;p&gt;The study was limited by the inability to measure corneal thickness daily due to adverse weather conditions.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by grants from the Swiss National Research Science Foundation, the Swiss Society of Mountain Medicine, and Pfizer.&lt;/p&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_454"
                     title="Glaucoma Meds Linked to Lower Mortality Risk (CME/CE)"
                     score="0.011"
                     href="http://www.medpagetoday.com/Ophthalmology/Glaucoma/tb/18371?impressionId=1265762806162"
                     
      For patients diagnosed with glaucoma, taking medications for the condition appears to improve survival, researchers found.&lt;br&gt;
&lt;br&gt;Patients with suspected or confirmed glaucoma were 74% less likely to die during a five-year period if they were prescribed any glaucoma medication (HR 0.26, 95% CI 0.16 to 0.40), according to Joshua Stein, MD, of the University of Michigan Kellogg Eye Center in Ann Arbor, and colleagues.&lt;br&gt;
&lt;br&gt;However, in an analysis of patients with suspected glaucoma only, the association was no longer significant (HR 1.19, 95% CI 0.43 to 3.27), the researchers reported in the February issue of the &lt;em&gt;Archives of Ophthalmology&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;&quot;Additional studies need to be done to try to sort out exactly why the patients who have diagnosed glaucoma tend to have reduced mortality relative to the other patients who are not being treated,&quot; Stein told &lt;em&gt;MedPage Today&lt;/em&gt;, adding that changes in clinical management should not be made until this is sorted out.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Previous studies of glaucoma and mortality have yielded conflicting results. Few have examined the effect of glaucoma medications, which can be absorbed systemically and affect the body in ways that may confound such analyses.&lt;/p&gt;
&lt;p&gt;So Stein and his colleagues looked at data from a large managed care network involving 21,506 patients 40 and older with suspected or confirmed glaucoma.&lt;/p&gt;
&lt;p&gt;About half (50.5%) had suspected glaucoma and the rest had received a definite diagnosis, most commonly open-angle glaucoma (21.5%).&lt;/p&gt;
&lt;p&gt;Comorbidities were common: 52.7% of the patients had hypertension and 41.3% had diabetes.&lt;/p&gt;
&lt;p&gt;From 2003 through 2007, 28.1% of the patients filled a prescription for a glaucoma medication. The most frequently prescribed drugs were prostaglandin analogues (20.8%) and beta-antagonists (12.8%).&lt;/p&gt;
&lt;p&gt;More than a quarter (28%) were also prescribed oral beta-blockers.&lt;/p&gt;
&lt;p&gt;During the study, 1.1% of the patients died.&lt;/p&gt;
&lt;p&gt;The overall reduction in risk of death during the study held for both single agents  --  topical beta-antagonists (HR 0.40, 95% CI 0.18 to 0.86) and prostaglandin analogues (HR 0.27, 95% CI 0.14 to 0.52),&lt;strong&gt; &lt;/strong&gt;as well as for combinations of glaucoma medications.&lt;/p&gt;
&lt;p&gt;The mortality risk declined as the number of prescribed medications increased (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001). The hazard ratios for one, two, and three or more medications were 0.29, 0.19, and 0.12, respectively.&lt;/p&gt;
&lt;p&gt;Among those with the most common diagnosis, open-angle glaucoma, the risk of dying during the study was reduced by a relative 77% for those prescribed at least one medication (HR 0.23, 95% CI 0.14 to 0.37).&lt;/p&gt;
&lt;p&gt;It is unclear why glaucoma medication use is associated with a lower mortality risk, but it is possible that topical medications absorbed systemically could affect blood pressure, heart rate, breathing, and kidney function, Stein said.&lt;/p&gt;
&lt;p&gt;&quot;But the fact that multiple different medication classes are showing this protective effect suggests to me that it may not necessarily be the medications themselves, but perhaps it&apos;s the types of patients who are receiving the medications,&quot; he said.&lt;/p&gt;
&lt;p&gt;The patients taking medication for glaucoma might be healthier than the untreated patients, he said.&lt;/p&gt;
&lt;p&gt;Those with more serious conditions might have to selectively choose which drugs they buy, and might purchase medications for more serious conditions than glaucoma.&lt;/p&gt;
&lt;p&gt;Also, physicians treating patients with more serious conditions might not focus on glaucoma, Stein said.&lt;/p&gt;
&lt;p&gt;A final possibility might be differences in the beneficiaries&apos; access to healthcare.&lt;/p&gt;
&lt;p&gt;The authors noted a number of limitations of the study: &lt;ul&gt; &lt;li&gt;The use of claims data, and not patient records, resulted in missing information on some important clinical variables&lt;strong&gt;,&lt;/strong&gt; such as smoking, body weight, blood pressure.&lt;/li&gt; &lt;li&gt;The results are not necessarily generalizable beyond the insured patients in this single, managed care network.&lt;/li&gt; &lt;li&gt;Death status could not be verified and cause of death could not be determined because of the use of de-identified data.&lt;/li&gt; &lt;li&gt;It is unclear whether patients actually took the prescribed medications.&lt;/li&gt; &lt;li&gt;The relationship between certain drug classes and mortality risk could not be determined because of low patient numbers.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors did not make any financial disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_354"
                     title="AMD Drugs Equally Effective (CME/CE)"
                     score="0.011"
                     href="http://www.medpagetoday.com/Ophthalmology/GeneralOphthalmology/tb/18238?impressionId=1265762806162"
                     
      Visual acuity showed similar improvements with two vascular endothelial growth factor inhibitors used to treat age-related macular degeneration (AMD), data from a retrospective study showed.&lt;br&gt;
&lt;br&gt;About a fourth of patients treated with bevacizumab (Avastin) or ranibizumab (Lucentis) had &amp;#8805;20/40 vision at 12 months.&lt;br&gt;
&lt;br&gt;The frequency of adverse events did not differ between treatment groups, but bevacizumab patients received fewer injections over the course of a year, investigators at Kaiser Permanente Southern California in Pasadena reported in the February issue of &lt;em&gt;Ophthalmology&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;&quot;What this article principally does is that it reassures patients and ophthalmologists that bevacizumab appears to be just as effective as ranibizumab,&quot; said first author Donald Fong, MD. &quot;It provides more reassurance than changing practice.&quot;&lt;br&gt;
&lt;br&gt;The results likely will not end discussion about the relative safety and efficacy of the two drugs for treatment of AMD.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Ranibizumab was developed specifically for treatment of neovascular (wet) AMD, while bevacizumab was developed for oncology but is widely used off-label for treatment of AMD.&lt;/p&gt;
&lt;p&gt;Much of the debate over the drugs involves cost, as ranibizumab costs about $2,000 per injection compared with about $50 for bevacizumab.&lt;/p&gt;
&lt;p&gt;The two drugs are being compared in an NIH-sponsored multicenter clinical trial, but results are not expected before 2011.&lt;/p&gt;
&lt;p&gt;In an indirect comparison of the two drugs, Fong and co-authors retrospectively reviewed records of 452 patients treated for exudative AMD with bevacizumab or ranibizumab, both of which inhibit angiogenesis via vascular endothelial growth factor.&lt;/p&gt;
&lt;p&gt;The study population comprised 324 patients treated with bevacizumab and 128 treated with ranibizumab.&lt;/p&gt;
&lt;p&gt;The bevacizumab patients were younger (78 versus 82 on average), and 83% of the ranibizumab patients were 75 or older compared with 70% of the bevacizumab group.&lt;/p&gt;
&lt;p&gt;A higher proportion of bevacizumab patients had baseline visual acuity &amp;#8804;20/200 (40.1% versus 33.6%), but a similar proportion in each group had visual acuity &amp;lt;20/40 (86.4% versus 88.3%).&lt;/p&gt;
&lt;p&gt;The primary outcome of the analysis was visual acuity at 12 months. The authors reported that 22.9% of bevacizumab patients and 25.0% of ranibizumab patients attained visual acuity &amp;#8805;20/40 after a year of treatment.&lt;/p&gt;
&lt;p&gt;Additionally, 27.3% of bevacizumab patients and 20.2% of the ranibizumab group exhibited some degree of improvement at 12 months. Neither difference was statistically significant.&lt;/p&gt;
&lt;p&gt;Eight (2%) bevacizumab patients and four (3%) ranibizumab patients died before 12 months. Two patients in each group developed endophthalmitis.&lt;/p&gt;
&lt;p&gt;Bevacizumab patients received an average of 4.4 injections during 12 months, compared with 6.2 for the ranibizumab group. The authors speculated that the difference might reflect physicians&apos; belief that bevacizumab is a larger molecule with a longer intraocular half-life.&lt;/p&gt;
&lt;p&gt;In summarizing the results, the authors acknowledged the observational, nonrandomized nature of the study, as well as the lack of a standardized protocol for injecting the drugs.&lt;/p&gt;
&lt;p&gt;Moreover, some patients initially on bevacizumab switched to ranibizumab when the newer drug became available and that switch &quot;most likely accounted for some of the changes observed in the bevacizumab group.&quot;&lt;/p&gt;
&lt;p&gt;The authors also addressed differences between their findings and those from two Genentech-sponsored clinical trials.&lt;/p&gt;
&lt;p&gt;The trials showed that 94% of patients treated with ranibizumab did not have doubling of their visual angle versus 85% in the Kaiser chart review. The authors attributed the difference to the older age of their patients, the exclusion of patients with visual &amp;lt;20/320 in the Genentech studies, and the fewer ranibizumab injections (6.2 versus &amp;gt;11 in the Genentech studies).&lt;/p&gt;
&lt;p&gt;Despite the differences and limitations, the authors concluded that &quot;both treatments seem to be effective in stabilizing visual acuity loss.&quot;&lt;/p&gt;
&lt;p&gt;In a prepared statement, Genentech officials said they still believe ranibizumab &quot;is the most appropriate medicine for people with wet age-related macular degeneration because it was specifically designed, formally studied, manufactured for intraocular delivery, and is approved by the FDA.&lt;/p&gt;
&lt;p&gt;At the same time, Genentech does not interfere with doctors&apos; prescribing choices and believes that they should be able to prescribe the treatment they believe is most appropriate for their patients.&quot;&lt;/p&gt;
&lt;p&gt;In addition to limitations acknowledged by the authors, the statement also pointed out that the method for measuring visual acuity differed from the method used in most phase III clinical trials and that methods used to collect safety data differed from those typically used in prospective, randomized clinical trials.&lt;/p&gt;
&lt;p&gt;Genentech also questioned the lack of explanation for the higher proportion of patients who switched from bevacizumab to ranibizumab compared with ranibizumab to bevacizumab (23% versus 3%).&lt;/p&gt;
&lt;p&gt;A clinical spokesperson for the American Academy of Ophthalmology told &lt;em&gt;MedPage Today&lt;/em&gt; that the results of the Kaiser study tend to support ophthalmologists&apos; views about use of the two drugs to treat AMD.&lt;/p&gt;
&lt;p&gt;&quot;It looks like all the debate about the superiority or inferiority of one medicine over the other medicine is becoming essentially nullified,&quot; said Abdhish Bhavsar, MD, director of clinical research at the Retina Center of Minnesota in Minneapolis.&lt;/p&gt;
&lt;p&gt;&quot;I think that these medicines both do a good job at treating, and I don&apos;t think that distinction in clinical practice is relevant anymore.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the Southern California Permanente Medical Group.&lt;/p&gt;&lt;p&gt;Co-author Peter Custis disclosed a relationship with Med E Direct.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_467"
                     title="FDA Unveils New Safety Plan for Medical Imaging"
                     score="0.01"
                     href="http://www.medpagetoday.com/Radiology/DiagnosticRadiology/tb/18398?impressionId=1265762806162"
                     
      &lt;p&gt;WASHINGTON  --  The Food and Drug Administration (FDA) says it wants to issue new safety requirements for manufacturers of computed tomography (CT) and fluoroscopic devices to reduce unnecessary radiation from medical imaging.&lt;/p&gt;
&lt;p&gt;The FDA&apos;s plan focuses on three procedures with high radiation doses: CT, nuclear medicine studies, and fluoroscopy. These are the greatest contributors to total radiation exposure within the U.S. population, the FDA said. That&apos;s because they require much higher radiation doses than other radiographic procedures, such as standard X-rays, dental X-rays, and mammography.&lt;/p&gt;
&lt;p&gt;&quot;The amount of radiation Americans are exposed to from medical imaging has dramatically increased over the past 20 years,&quot; Jeffrey Shuren, MD, director of the FDA&apos;s Center for Devices and Radiological Health, said in a prepared statement. &quot;The goal of FDA&apos;s initiative is to support the benefits associated with medical imaging while minimizing the risks.&quot;&lt;/p&gt;
&lt;p&gt;While the three procedures have led to early diagnosis of disease, they expose patients to ionizing radiation that may increase lifetime cancer risk  --  although there is debate within the medical community about the extent of the danger.&lt;/p&gt;
&lt;p&gt;Radiologist Joseph Schoepf, MD, director of Cardiovascular Imaging at the Medical University of South Carolina, lauded the FDA&apos;s initiative and said it would restore the public&apos;s trust in imaging.&lt;/p&gt;
&lt;p&gt;&quot;It is important to note, however, that an increase in cancer mortality [from radiation] has not been observed,&quot; he added. &quot;On the contrary, cancer mortality has dramatically decreased over the past decades, in step with increased utilization of medical imaging.&quot;&lt;/p&gt;
&lt;p&gt;The &lt;em&gt;Archives of Internal Medicine &lt;/em&gt;recently published results from two studies indicating that &lt;a href=&quot;http://www.medpagetoday.com/Radiology/DiagnosticRadiology/17530&quot; mce_href=&quot;http://www.medpagetoday.com/Radiology/DiagnosticRadiology/17530&quot; target=&quot;_blank&quot; title=&quot;CT&amp;#8200;Scans&amp;#8200;May&amp;#8200;Deliver&amp;#8200;Higher-than-Expected&amp;#8200;Radiation&amp;#8200;Doses&quot;&gt;CT scans deliver much higher doses of radiation &lt;/a&gt;than previously thought. The FDA has noted that a patient would have to get 400 standard chest X-rays to be exposed to the same level of radiation as just one CT abdomen scan.&lt;/p&gt;
&lt;p&gt;In an accompanying editorial, the journal&apos;s editor, Rita Redberg, MD, wrote that the studies &quot;make us question if we have gotten carried away in our enthusiasm&quot; for CT.&lt;/p&gt;
&lt;p&gt;It&apos;s becoming clear, she said, that the large doses of radiation from CT scans will lead to additional cancers, which must be taken into account when physicians consider CT for their patients.&lt;/p&gt;
&lt;p&gt;By working with healthcare providers and other federal agencies, the FDA says it hopes to promote safer use of medical imaging and increase patient awareness of their radiation exposure. Part of that involves pushing providers to justify their radiation procedures and optimize the radiation dose in each one.&lt;/p&gt;
&lt;p&gt;&lt;span&gt;Schoepf, who serves on several American College of Radiology committees that discuss the proper used of various imaging procedures, approved of the FDA&apos;s goal but cautioned against restrictions that would hinder clinicians.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&quot;There is indeed a need for enhanced transparency, better patient education, more dialogue between patients and their healthcare providers, and increased involvement of the patient in the decision process leading up to an imaging study,&quot; Schoepf said.&lt;/p&gt;
&lt;p&gt;&lt;span&gt;&quot;What is often forgotten in this discussion is that serious injury or death, resulting from missing a potentially life-threatening diagnosis if no imaging is performed, is a much greater, more imminent, and very real risk.&quot;&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;In its statement, the FDA said it wants to boost efforts to develop at least one national registry of radiation doses that will capture information from a variety of imaging studies that can be used to establish benchmarks for healthcare facilities to use with patients.&lt;/p&gt;


 &lt;p&gt;Donald Frush, MD, a radiologist at Duke Medical Center and expert in CT radiation doses in children, said that radiation doses for CT examination vary widely, depending on the size of the patient and the body area scanned, among other things.&lt;/p&gt;
    &lt;p&gt;&quot;However, sometimes this variation is not necessary, and the dose may be excessive,&quot; Frush said.&lt;/p&gt;

&lt;p&gt;The ACR launched a similar registry about a year ago, according to spokesman Shawn Farley. The database is intended as a guide so a radiologist can quickly see how levels of radiation delivered in other practices and hospitals compare to what he or she is delivering.&lt;/p&gt;
&lt;p&gt;&quot;Now that the FDA has come out in favor of doing that, we&apos;re hoping that will put a little more weight behind the process and make more facilities want to take part in this,&quot; Farley told &lt;em&gt;MedPage Today. &lt;/em&gt;&lt;/p&gt;


 &lt;p&gt;Schoepf noted that European governments already require a permanent record of radiation exposure for each patient.&lt;/p&gt;
    &lt;p&gt;As a result, manufacturers of radiation equipment, most of whom sell their products in Europe, already have that capability, he said. So it shouldn&apos;t be difficult to implement the same standard in the U.S.&lt;/p&gt;
    &lt;p&gt;&quot;Radiation exposure should be no secret,&quot; Schoepf said.&lt;/p&gt;


&lt;p&gt;The FDA will hold a public meeting March 30 and 31 to hear comments on what types of safety requirements to establish for manufacturers of CT and fluoroscopic devices. Requirements might include: &lt;ul&gt; &lt;li&gt;That the radiation device display, record, and report equipment settings and radiation dose&lt;/li&gt; &lt;li&gt;Alerting users when the dose exceeds the optimal dose for most patients&lt;/li&gt; &lt;li&gt;Increased training for users&lt;/li&gt; &lt;li&gt;Ability to capture and transmit radiation dose information to a patient&apos;s electronic medical record in addition to national dose registries &lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News. &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; alt=&quot;&quot;&gt;&lt;/p&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_466"
                     title="Surgery Trumps Lifestyle Change for Teen Weight Loss (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/Pediatrics/Obesity/tb/18397?impressionId=1265762806162"
                     
      &lt;p&gt;Gastric banding resulted in significantly greater weight loss in obese teens than an intensive lifestyle modification program, a randomized trial showed.&lt;/p&gt;
&lt;p&gt;In the two-year study, 84% of patients in the surgery group lost at least half of their excess weight, compared with 12% who underwent the lifestyle intervention (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001), according to Paul O&apos;Brien, MD, of Monash University in Melbourne, Australia, and colleagues.&lt;/p&gt;
&lt;p&gt;None of the teens who had surgery had metabolic syndrome at the end of follow-up, compared with 22% in the control group (&lt;em&gt;P&lt;/em&gt;=0.025), the researchers reported in the Feb. 10 issue of the &lt;em&gt;Journal of the American Medical Association&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Although the improvements were substantial, O&apos;Brien and his colleagues stressed that &quot;the gastric banding approach to weight loss is not a quick fix.&quot;&lt;/p&gt;
&lt;p&gt;&quot;For optimal effectiveness,&quot; they wrote, &quot;it requires long-term supportive follow-up by trained health professionals.&quot;&lt;/p&gt;
&lt;p&gt;They also noted that the study demonstrates that lifestyle interventions can be effective for some teens and should remain the first option.&lt;/p&gt;
&lt;p&gt;Surgeons contacted for comment on the study unanimously touted the results as evidence that bariatric surgery can be a safe and effective means of weight loss for obese adolescents, a topic that remains controversial.&lt;/p&gt;
&lt;p&gt;J. Christopher Eagon, MD, a bariatric surgeon at Washington University in St. Louis, noted in an e-mail that the significance of the study lies in the fact that participants were randomized between surgery and medical management of weight.&lt;/p&gt;
&lt;p&gt;&quot;This helps to eliminate biases that may have been present in other studies of the effectiveness of bariatric surgery and should make the case for the benefits of surgery more compelling,&quot; Eagon wrote.&lt;/p&gt;
&lt;p&gt;There are more than five million obese adolescents in the U.S., according to O&apos;Brien and his colleagues, and obesity-related complications, once rare in pediatric populations, are becoming more common.&lt;/p&gt;
&lt;p&gt;Because of the generally disappointing results of lifestyle programs aimed at improving diet, increasing exercise, and modifying unhealthy behaviors, bariatric surgery, widely used in adults, has been explored as a strategy for reducing weight in these patients.&lt;/p&gt;
&lt;p&gt;But no randomized trials of bariatric surgery had been conducted in adolescents.&lt;/p&gt;
&lt;p&gt;So O&apos;Brien&apos;s group randomized 50 obese teens ages 14 to 18 (mean 16.5) to laparoscopic adjustable gastric banding or an intensive, supervised lifestyle modification program.&lt;/p&gt;
&lt;p&gt;The participants all had a body mass index of at least 35 kg/m&lt;sup&gt;2&lt;/sup&gt; and had obesity-related complications, such as hypertension, metabolic syndrome, asthma, back pain, physical limitations, and psychosocial difficulties.&lt;/p&gt;
&lt;p&gt;All had previously failed to lose weight through lifestyle changes.&lt;/p&gt;
&lt;p&gt;Before the study began, prospective participants attended a two-month program teaching them about healthy eating and the importance of physical activity.&lt;/p&gt;
&lt;p&gt;Those randomized to the lifestyle intervention were on a diet of 800 to 2,000 calories a day, and were instructed to increase activity and decrease sedentary behavior at regular visits with a physician, dietitian, exercise coordinator, nurse, and sports medicine physician. The program included six weeks with a personal trainer.&lt;/p&gt;
&lt;p&gt;Teens in the surgery group were given instructions on correct eating and exercising at regular visits.&lt;/p&gt;
&lt;p&gt;Through two years, all but one of the teens in the surgery group completed the study; 18 of 25 in the lifestyle group completed.&lt;/p&gt;
&lt;p&gt;The mean weight loss was significantly greater in the surgery group (76.3 pounds versus 6.6), which equated to a significantly greater percentage of excess weight lost (78.8% versus 13.2%).&lt;/p&gt;
&lt;p&gt;The mean decrease in BMI was 12.7 kg/m&lt;sup&gt;2&lt;/sup&gt; in the surgery group and 1.3 kg/m&lt;sup&gt;2&lt;/sup&gt; in the lifestyle modification group.&lt;/p&gt;
&lt;p&gt;All differences were significant at &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001.&lt;/p&gt;
&lt;p&gt;Insulin sensitivity improved in both groups, but to a larger extent in the surgery group (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Quality of life was also improved in the surgery group.&lt;/p&gt;
&lt;p&gt;Overall, adverse events occurred at similar rates in the surgery (48%) and lifestyle modification (44%) groups.&lt;/p&gt;
&lt;p&gt;There were no perioperative adverse events in the surgery group, but seven patients required revisional procedures during follow-up, for proximal pouch dilatation or tubing injury.&lt;/p&gt;
&lt;p&gt;The researchers said eating small meals slowly is an important way to avoid these problems.&lt;/p&gt;
&lt;p&gt;In an accompanying editorial, Edward Livingston, MD, a surgeon at the University of Texas Southwestern Medical Center in Dallas, said the high rate of revisional procedures is significant because the study authors &quot;are among the most experienced group in the world with these operations, suggesting that these complication rates will probably be higher in actual community practice.&quot;&lt;/p&gt;
&lt;p&gt;Added Jonathan Schoen, MD, a bariatric surgeon at the University of Colorado Hospital in Denver, in an e-mail: &quot;One thing to keep in mind is that the results they get in Australia with the band are the best in the world and are not uniformly reproducible.&quot;&lt;/p&gt;
&lt;p&gt;In addition to the uncertain generalizability to other settings, the researchers said the study may be limited by its length, which may not be long enough to assess outcomes from the surgery over time.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by a grant from the National Health and Medical Research Council. The laparoscopic adjustable gastric bands used in the study were provided by the manufacturer, Allergan. The Center for Obesity Research and Education receives an unrestricted research support grant from Allergan.&lt;/p&gt;&lt;p&gt;O&apos;Brien did not make any financial disclosures. One of his co-authors reported having relationships with Allergan, Bariatric Advantage, Scientific Intake, SP Health Co., Optifast, Abbott Australasia, Eli Lilly Australia, Merck Sharp &amp;amp; Dohme Australia, Nestle Australia, and Roche Products Australia.&lt;/p&gt;&lt;p&gt;Livingston did not make any financial disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;&lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News. &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; alt=&quot;&quot;&gt;&lt;/p&gt;
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