Embargoed Until: 3 P.M. (CT), Monday, September 15, 2003
Embargoed Until: 3 P.M. (CT), Monday, September 15, 2003
Embargoed Until: 3 P.M. (CT), Monday, September 15, 2003
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, SEPTEMBER 15, 2003
To contact Christoph Hock, M.D., e-mail chock{at}bli.unizh.ch.
To contact editorialist Douglas Galasko, M.D., call Sue Pondrom at 619/543-6163.
BIOCHEMICALS IN SPINAL FLUID MAY AID IN DIAGNOSING ALZHEIMER DISEASE
CHICAGO—Measuring the ratio of two biochemicals in spinal fluid may help in evaluating patients with dementia and aid in diagnosing Alzheimer disease (AD), according to an article in the September 15 issue of The Archives of Neurology, one of the JAMA/Archives journals.
Diagnosing AD and distinguishing it from other dementias relies heavily on the judgment of the examining physician, according to the article. Diagnosing AD is time consuming and costly, and diagnostic accuracy is less than 80 percent to 90 percent particularly in the early stages of the disease. Identifying biochemical markers that could improve the accuracy of diagnosis of AD is highly desirable.
Christoph Hock, M.D., of the University of Zurich, Switzerland, and colleagues evaluated cerebrospinal fluid (CSF) levels of phosphorylated tau protein and beta-amyloid peptide42 (two biochemicals found in higher concentrations in the spinal fluid of individuals with AD or dementias) as potential markers for AD.
The researchers combined CSF measurements of phospho-tau and beta-amyloid42 in 100 consecutive patients who had a diagnostic evaluation for dementia, and in 31 healthy patients who served as controls.
The researchers found that the ratio of phospho-tau to beta-amyloid42 was significantly higher in patients with AD and was accurate in distinguishing patients with AD from healthy patients without AD, patients with non-AD dementias and other neurological disorders.
"In summary, measurement of the CSF ratio of phospho-tau to beta-amyloid42 may provide a promising tool for the biochemical antemortem [before death] diagnosis of AD, and its practical usefulness may be further evaluated in clinical settings," the authors write.
(Arch Neurol. 2003;60:1202-1206. Available post-embargo at archneurol.com)
Editor's Note: This study was supported by the National Center of Competence in Research (NCCR), Neural Plasticity and Repair, Zurich; the European Union DIADEM program on Diagnosis of Dementia, Zurich; and the University of Zurich.
EDITORIAL: CEREBROSPINAL FLUID BIOMARKERS IN ALZHEIMER DISEASE
In an accompanying editorial, Douglas Galasko, M.D., of the University of California, San Diego, writes, "The clinical evaluation used to diagnose Alzheimer disease (AD) and other forms of dementia is often perceived as cumbersome because it places high demands on expertise and time. This perception has spurred research into biomarkers for AD, with 2 main areas of focus: (1) imaging of brain structure, metabolism, and activation and (2) measurement of proteins in cerebrospinal fluid (CSF)."
He writes that dementia specialists can diagnose AD with an accuracy of 90 percent, but non-specialists have a lower accuracy in diagnosing dementia and AD.
"It will be important to validate the diagnostic cutoffs in another series of patients and controls, ideally representative of patients seen in routine clinical practice. In view of the increasing emphasis on early detection, patients with MCI [mild cognitive impairment] should also be evaluated," writes Dr. Galasko. "A further question concerns the additive or incremental value provided by the biomarker after initial clinical assessment and diagnosis. If clinical diagnoses and those based on the marker have similar accuracy, the relative cost and convenience of the biomarker and clinical assessment should be compared."
(Arch Neurol. 2003;60:1195-1196. Available post-embargo at archneurol.com)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, SEPTEMBER 15, 2003
To contact Jean Kanitakis, M.D., e-mail kanitakis{at}lyon.inserm.fr
SKIN CANCERS THAT DEVELOP IN ORGAN TRANSPLANT RECIPIENTS DIFFER FROM SKIN CANCERS IN NON-TRANSPLANT PATIENTS
CHICAGO—Skin cancers differ among patients who have received organ transplants compared with non-transplant patients, according to an article in the September issue of The Archives of Dermatology, one of the JAMA/Archives journals.
Organ transplant recipients (OTRs) are at an increased risk for developing cancers including skin cancers, according to the article. Basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs), two forms of skin cancer, are among the most common cancers that develop in transplant recipients as a result of immunosuppression from drugs that need to be taken over long periods of time to prevent organ rejection, and light exposure. These skin cancers affect up to 40 percent of OTRs within 20 years of transplantation and account for a mortality rate of 5 percent to 8 percent.
Jean Kanitakis, M.D., of Edouard Herriot Hospital, Lyon, France, and colleagues described the clinical features of BCCs in organ transplant recipients.
Of 2,029 OTRs follwed at the authors' center over 20 years, 146 patients developed 176 clinically diagnosed BCCs. The authors compared these cancers to 153 BCCs from 141 non-immunosuppressed patients (patients who never received an organ transplant) as controls.
The researchers found that BCCs developed an average of 6.9 years after transplantation, sooner after heart transplants than kidney transplants, and were especially common in patients who received heart tissue transplants. The average age of transplant recipients with BCCs was lower than that of control patients (54.6 vs. 69.8 years), especially for patients with kidney transplants.
In both OTRs and non-transplant patients, the BCCs were found mostly on the head and neck. However, BCCs occurred more frequently in other body areas in OTRs (37.5 percent) than in controls (24.5 percent), and superficial BCCs were more common in transplant recipients than controls (33.6 percent vs. 14.4 percent).
"Basal cell carcinomas in transplant recipients show some clinicopathologic differences from their 'ordinary' counterparts, namely, a younger age at development, male preponderance, more frequent distribution in extracephalic sites [areas other than the head and neck], and higher frequency of superficial subtypes," the authors write.
(Arch Dermatol. 2003;139:1133-1137. Available post-embargo at archdermatol.com)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, SEPTEMBER 15, 2003
To contact R. James Koch, M.D., call Michelle Brandt 650/723-0272.
MOST PATIENTS SATISFIED WITH OUTCOMES OF FACIAL LASER RESURFACING
CHICAGO—Most patients are likely to be satisfied with the outcomes of facial laser resurfacing, according to an article in the September/October issue of The Archives of Facial Plastic Surgery, one of the JAMA/Archives journals.
Laser skin resurfacing using pulsed wave carbon dioxide (CO2) lasers improves the appearance and elasticity of skin, according to the article. Many patients undergo this procedure, which is performed by facial plastic surgeons, and have high expectations of outcomes. In demanding, or psychologically disturbed patients, these expectations may be distorted or unrealistic.
R. James Koch, M.D., of Stanford University Medical Center, Stanford, Calif., and colleagues evaluated patient satisfaction with the results of pulsed CO2 laser skin resurfacing, and identified potential psychological factors that may indicate that a patient will be more likely to be dissatisfied with the results.
The researchers evaluated 212 patients (169 women, 43 men) undergoing pulsed CO2 laser facial resurfacing on the face. The average age of the patients was 46 years old (range, 31-69 years). Patients completed a questionnaire prior to their procedures that asked about cosmetic expectations, prior satisfaction with medical care in general, education, informed consent, self-worth, life-changing expectations and psychiatric history. Patients completed a follow-up questionnaire six months after their procedures. The questionnaires were completed by 178 of the 212 patients (84 percent).
"Overall, there was an 89 percent patient satisfaction rate (i.e., patients reported that they 'would undergo the procedure again'). Ninety-two percent of patients listed a complication, the most common being 'scarring,' and this may reflect an adequate consent process," the authors write.
The researchers found that patients who were satisfied with their results were more likely to list improvement in appearance and healthiness of skin as their expected outcomes before the procedure. Patients who expected a change in self esteem were more likely to be dissatisfied with their procedures. Additionally, 12 percent of the patients believed they had a preexisting facial disfigurement, and this also correlated with dissatisfaction in outcomes.
"Based upon… this study, the ideal laser patient expects minimal to moderate improvement in appearance or healthiness of the skin; does not believe that the procedure will affect his or her self-esteem; and does not believe that he or she has an actual facial disfigurement," write the researchers.
(Arch Facial. 2003;5:445-446. Available post-embargo at archfacial.com)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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