EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, March 15, 2004
To contact Irene L. Katzan, M.D., M.S., call Eileen Sheil at 216/444-8927.

FEW STROKE PATIENTS GET TO THE HOSPITAL IN TIME FOR CLOT-DISSOLVING THERAPY

CHICAGO—Only a small proportion of patients who are having a stroke arrive at an emergency department (ED) in time to receive the clot-dissolving therapy, intravenous tissue plasminogen activator (IV tPA), according to an article in the March issue of the Archives of Neurology, one of the JAMA/Archives journals.

Strokes can occur when blood clots block an artery (ischemic stroke) or when blood vessels rupture (hemorrhagic stroke), interrupting blood flow to the brain. For some patients with ischemic stroke, IV tPA can help dissolve blood clots and restore blood flow, but this drug must be given within three hours from the start of symptoms. According to the article, national estimates suggest that IV tPA is used in only 2 percent of eligible patients.

Irene L. Katzan, M.D., M.S., of the Cleveland Clinic Foundation, Ohio and colleagues examined the rate of IV tPA use for stroke patients in Cleveland.

The researchers reviewed the medical charts of patients admitted because of stroke to the nine Cleveland Clinic Health System hospitals from June 15, 1999 to June 15, 2000. There were 1,923 admissions for ischemic stroke within this one-year period, and of these, 288 (15 percent) arrived at an emergency department (ED) within the three-hour time window, and approximately 6.9 percent were considered eligible for IV tPA. The most common reasons patients were ineligible for IV tPA even if they arrived within the three-hour window were mild neurologic impairment or rapidly improving symptoms. Overall, the researchers found that the rate of use of IV tPA among patients who arrived at the hospital within the three-hour time period was 19.4 percent, and the rate of use among eligible patients was 43.4 percent.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, March 15, 2004
To contact corresponding author Eric J. Moore, M.D., call Lisa Copeland at 507/538-0844.

PREVALENCE OF CHRONIC SINUSITIS MAY BE LOWER THAN COMMONLY REPORTED

CHICAGO—The prevalence of chronic sinusitis may be much lower than previously estimated and reported, according to an article in the March issue of the Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.

Chronic sinusitis is inflammation of the sinuses that lasts for more than 90 days, and often longer. According to background information in the article, "Commonly cited estimates from the National Health Interview Survey rank chronic sinusitis as one of the most prevalent chronic diseases in the United States. These data rely on patient self-reporting of the disease. However, chronic sinusitis is difficult to diagnose because its symptoms overlap those of many other disease processes. As such, these prevalence data may be unreliable."

Ron G. Shashy, M.D., of the Mayo Clinic, Rochester, Minn., and colleagues identified all 2,405 residents of Olmstead County, Minnesota, who were assigned a coded diagnosis for chronic sinusitis in the year 2000 using database information. The researchers found that the overall age- and sex-adjusted prevalence of chronic sinusitis was 1,955 per 100,000 of the population, or 1.96 percent.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, March 15, 2004
To contact corresponding author Richard M. Costanzo, Ph.D., call Joe Kuttenkuler at 804/828-6607.

IMPAIRED SENSE OF SMELL INCREASES RISK FOR CERTAIN HAZARDS

CHICAGO—Patients with an impaired or absent sense of smell are at risk for experiencing certain hazards that may have been avoided with an intact sense of smell, according to an article in the March issue of the Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.

Approximately 2.7 million adults in the United States have chronic olfactory dysfunction, according to background information in the article. Olfaction, or sense of smell, helps detect environmental cues that can warn of potentially life-threatening situations, like fires, spoiled food or gas leaks. Sense of smell can be impaired by head trauma, viral infection, nasal obstruction or septal deviation, neurologic disorders, medications, hormonal disturbances, and normal aging.

Daniel V. Santos, M.D., of Virginia Commonwealth University, Richmond, and colleagues assessed the risk of olfactory-related hazardous events in 445 patients who were evaluated in a university-based clinic for smell and taste disorders, and who underwent olfactory testing and were interviewed between 1983 and 2001.

Of these patients, the average age was 50 years, approximately half were men, and 18 percent were regular tobacco users. The researchers found that 76 percent of patients had some degree of olfactory impairment, and 30 percent had no sense of smell. Thirty-seven percent of patients with olfactory impairment, but only 19 percent of patients with a normal sense of smell experienced at least one olfactory-related potentially hazardous event. Cooking-related incidents were the most common, representing 45 percent of olfactory-related hazardous events, and ingestion of spoiled food (25 percent), inability to detect a gas leak (23 percent), and inability to detect a fire (7 percent) were reported less frequently.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, March 15, 2004
To contact Peter Wolf, M.D., e-mail: peter.wolf{at}kfunigraz.ac.at

PRESENCE OF HUMAN PAPILLOMA VIRUS INCREASED IN SKIN OF PSORIASIS PATIENTS TREATED WITH COMBINATION OF MEDICATION AND UV LIGHT THERAPY

CHICAGO—Patients with psoriasis who have been treated with a combination of drug (psoralen) and ultraviolet light therapy have an increased prevalence of human papilloma virus (HPV) in their skin, according to an article in the March issue of the Archives of Dermatology, one of the JAMA/Archives journals.

According to the article, treatment of psoriasis with the drug psorlaen plus ultraviolet A light therapy (PUVA) has been linked with an increased risk for developing skin cancer, but the exact causes of the increased risk are not well understood. HPV has been closely linked to skin cancer, and "It has been suggested that PUVA may increase expression of the tumorigenic [cancer-causing] agent HPV in skin by directly stimulating virus replication, immune suppression or both, thereby leading to skin cancer formation," the article states.

Peter Wolf, M.D., of Karl-Franzens-University, Graz, Austria, and colleagues examined whether the presence of HPV in the skin is increased after long-term PUVA treatment.

The researchers screened for HPV DNA in body hairs plucked from patients with psoriasis (81 patients, average age 52 years), including those with a history of PUVA exposure and a history of skin cancer (group A, n=16 patients, average of 702 PUVA exposures), PUVA exposure and no history of skin cancer (group B, n=35 patients, average of 282 PUVA exposures), and no PUVA exposure and no history of cancer (group C, n=30 patients).

The researchers found HPV DNA in 73 percent of patients (11 of 15) in group A; 69 percent of patients (24 of 35) in group B; and 36 percent of patients (10 of 28) in group C.