EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, September 20, 2004
To contact Angela L. Neville, M.D., call Jon Weiner at 323/442-2830.

OBESE TRAUMA PATIENTS MORE LIKELY TO DIE OF THEIR INJURIES

CHICAGO—Critically injured obese trauma patients have higher rates of death than nonobese trauma patients, according to an article in the September issue of the Archives of Surgery, one of the JAMA/Archives journals.

According to the article, 18.9 percent of the U.S. population is obese, defined as a body mass index (BMI) of 30 or higher. Obesity can interfere with the body's response to injury - obese patients have reduced lung capacity and a higher incidence of cardiovascular disease. Obesity also makes surgery more difficult and risky, and radiographic images less reliable, the article states.

Angela L. Neville, M.D., of Los Angeles County and University of Southern California Medical Center, Los Angeles, and colleagues investigated the relationship between obesity and outcomes for blunt trauma patients.

The researchers looked at 242 consecutive patients admitted to the intensive care unit following blunt trauma at a Level 1 trauma center between January 2002 and December 2002. Patients were divided into two groups according to BMI. The obese group had a BMI of 30 or higher, and the nonobese group had a BMI lower than 30.

The researchers found that of the 242 patients, 63 (26 percent) were obese. Both groups were similar in age, and degree of injury severity. The researchers write that "The obese group had a higher incidence of multiple organ failure (13 percent vs. 3 percent) and mortality (32 percent vs. 16 percent)." The overall death rate among study participants was 20 percent.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, September 20, 2004
To contact corresponding author Richard Bold, M.D., call Claudia Morain at 916/734-9023.

IMMEDIATE BREAST RECONSTRUCTION AFTER MASTECTOMY INCREASES WOUND COMPLICATIONS, BUT DOES NOT DELAY CHEMOTHERAPY

CHICAGO—Although there is an increased risk of wound complications in patients who underwent breast reconstruction directly after mastectomy, the procedure did not delay the initiation of postsurgical chemotherapy, according to an article in the September issue of the Archives of Surgery, one of the JAMA/Archives journals.

According to the article, "breast cancer is the most common cancer diagnosed in women in the United States today with an expected incidence of more than 200,000 women in 2003." Breast reconstruction has been shown to reduce the negative effects on self-image and psychosocial well being in women after mastectomy (removal of the breast), the article states. However, it is unknown whether wound complications following mastectomy and breast reconstruction have any effect on the initiation of chemotherapy after surgery.

Melinda M. Mortenson, M.D., of the University of California, Davis Medical Center, Sacramento, and colleagues reviewed the medical records of 128 women to determine whether the risk of wound complications was higher in women when breast reconstruction was combined with mastectomy and whether wound complications delayed the initiation of postoperative chemotherapy.

There were 148 mastectomy procedures among the 128 women whose medical records were reviewed. Sixty-two patients underwent immediate breast reconstruction after their mastectomies, and 81 patients received postoperative chemotherapy.

The overall rate of wound complications was 15.5 percent. The researchers found that 22.3 percent of patients who underwent immediate breast reconstruction after their mastectomies developed wound complications vs. 8.3 percent of patients who did not have immediate breast reconstruction. However, these complications did not interfere with chemotherapy after surgery.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, September 20, 2004
To contact Thierry Passeron, M.D., e-mail: t.passeron{at}free.fr.

COMBINATION OF LASER AND TOPICAL SKIN OINTMENT EFFECTIVE IN TREATING THE SKIN DISEASE VITILIGO

CHICAGO—Patients with vitiligo, a skin disorder characterized by patches of white, or de-pigmented skin, had better repigmentation of these patches when they were treated with a combination of laser therapy and tacrolimus ointment than patients treated with laser therapy alone, according to an article in the September issue of the Archives of Dermatology, one of the JAMA/Archives journals.

According to the article, vitiligo is a skin pigmentation disorder that affects one percent to two percent of people worldwide. Patients with vitiligo develop white patches on their skin, referred to as "lesions." Recently, the 308-nm (nanometer) excimer laser has been used to treat lesions associated with vitiligo with good results. Additionally, a new topical ointment called tacrolimus has shown promise in treating vitiligo.

Thierry Passeron, M.D., of Hopital de l'Archet, Nice, France, and colleagues investigated the effects of the 308-nm excimer laser in combination with tacrolimus on 14 patients with vitiligo aged 12 to 63 years.

For each patient, four to ten lesions were chosen and treated twice a week with the 308-nm excimer laser for a total of 24 sessions. Topical 0.1 percent tacrolimus ointment was applied twice daily to target lesions for patients in group A (excimer laser plus tacrolimus). Patients in group B received only the laser treatments. Treated lesions were compared with control lesions (that received no treatment) on the opposite side of the body. Forty-three lesions were treated (23 in group A and 20 in group B).

The researchers observed repigmentation in all group A lesions (100 percent) and in 17 (85 percent) of the 20 group B lesions. Repigmentation was not observed in the control lesions.

"A repigmentation rate of 75 percent or more was obtained in 16 (70 percent) of the 23 group A lesions and in 4 (20 percent) of the 20 group B lesions," the authors write.

The average number of sessions needed to see an improvement in repigmentation was 10 for group A and 12 for group B.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, September 20, 2004
To contact Michael S. Haupert, D.O., call Jennifer Day at 313/577-1058.

PLACING AN INTRAVENOUS LINE FOR MINOR EAR SURGERY IN CHILDREN APPEARS TO OFFER NO ADDED BENEFIT

CHICAGO—Children who had intravenous (IV) access for ear tube placement surgery spent more time in the operating room and in the hospital and required more pain medication than children who underwent the same procedure without IV access, according to an article in the September issue of the Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.

According to the article, IV access (the placement of an IV line in a vein in the arm for the administration of medicines) allows for the administration of fluids (to prevent dehydration) and drugs or medications, but can result in discomfort, and parental dissatisfaction if many attempts are made to puncture the vein. Hospitals and medical institutions vary greatly as to requiring IV access for straightforward, short operations such as bilateral myringotomy with placement of pressure-equalizing tubes (BMT, placement of tubes through the eardrum to drain excess fluids).

Michael S. Haupert, D.O., of Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, and colleagues investigated whether IV access affects the incidence of postoperative vomiting (POV), postoperative pain, and length of hospital stay in children undergoing BMT placement.

The researchers enrolled 100 healthy children between the ages of two and 12 who were having BMT placement at a single hospital. The children were divided into two groups: one received IV access, and the other group did not. Anesthesia was administered through a face mask and all children received an injection of pain medicine into a muscle.

The researchers found that the two groups were similar in age, weight, and incidence of vomiting. Children with IV access spent more time than those without IV access in the operating room (21 minutes vs. 17 minutes), in phase 2 recovery (75 minutes vs. 51 minutes) and in the hospital (119 minutes vs. 88 minutes). Children with IV access also required more pain medication (31 percent vs. 2 percent) and parents of children in the IV access group were less satisfied with the procedure than parents whose children did not receive IV access (28 percent vs. 95 percent).

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, September 20, 2004
To contact Grant S. Hamilton III, M.D., call Sharon Butler at 312/355-2522.

THE TERMS "PLASTIC SURGERY" AND "COSMETIC SURGERY" ARE PERCEIVED DIFFERENTLY

CHICAGO—Cosmetic surgery is perceived as less risky with a shorter recovery time and less pain than plastic or reconstructive surgery, according to an article in the September issue of the Archives of Facial Plastic Surgery, one of the JAMA/Archives journals.

"Historically, a thorough preoperative evaluation for cosmetic surgery included routine psychiatric consultation. A sea change has occurred over the last 40 years regarding the concept of deformity and suitability for surgery, and now most patients seeking cosmetic procedures are considered to be good candidates," according to background information in the article. "This shift in attitude, coupled with the popularity of reality makeover shows, has increased public exposure and demand for cosmetic surgical procedures."

Grant S. Hamilton III, M.D., of the University of Iowa Hospitals and Clinics, Iowa City (now at the University of Illinois at Chicago), and colleagues explored public perception of the terms "cosmetic," "plastic," and "reconstructive," as they relate to surgery. In April and May of 2003, the researchers surveyed 216 people in person and via the internet, aged 18 years or older, assessing their opinions of surgical variables such as permanence, risk, expense, recovery, reversibility, pain, technical difficulty, and surgeon training. Of those surveyed, approximately 66 percent were women and 82 percent were from the midwestern United States.

The authors state: "Cosmetic surgery is perceived to be more temporary and less technically difficult than plastic or reconstructive surgery. In addition, cosmetic surgery is believed to be associated with less risk, shorter recovery time, and less pain. Subjects also thought that cosmetic surgeons required significantly less training than plastic or reconstructive surgeons."

Survey respondents found little difference in perception between 'plastic surgery' and 'cosmetic surgery' when asked about cost. They also seemed less likely to underestimate the dangers and discomfort of plastic surgery.