EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 18, 2004
To contact corresponding author C. Daniel Smith, M.D., call Cindy Sanders at 404/686-8538.

PATIENTS UNDERGOING WEIGHT LOSS SURGERY HAVE HIGH RATES OF BACTERIAL INFECTION ASSOCIATED WITH GASTROINTESTINAL DISEASE

CHICAGO—The prevalence of Helicobacter pylori (a type of bacteria associated with gastrointestinal disorders) is high among patients about to undergo weight loss surgery, and treatment to eradicate the bacterial infection before surgery may be beneficial, according to an article in the October issue of Archives of Surgery, one of the JAMA/Archives journals.

The number of obese and morbidly obese Americans is steadily increasing, according to background information in the article. It is estimated that more than 30 percent of the U.S. population has a body mass index (BMI) over 30 (obese), and five percent of the U.S. population has a BMI over 40, resulting in a increased demand for weight loss surgery, including gastric bypass surgery (surgery that results in food bypassing much of the intestinal tract). Twenty to 50 percent of people living in industrialized countries are infected with H pylori, which is believed to be involved in gastroduodenal ulcer disease (a gastrointestinal tract disease characterized by ulcers in the stomach and upper intestinal tract, or foregut), in addition to gastric cancer, according to the article. The role of H pylori after gastric bypass surgery is unknown.

Archana Ramaswamy, M.D., from Emory University, School of Medicine, Atlanta, and colleagues examined 99 patients between September 2001 and September 2002 as part of an evaluation for weight loss surgery. The patients (16 men and 83 women; average age 40 years; average BMI, 48) underwent routine testing before their weight loss surgeries, including testing for the presence of H pylori.

Before surgery, 24 percent of the patients tested positive for the H pylori infection. Of those who tested positive for H pylori, 48 percent showed significant upper gastrointestinal tract symptoms indicative of H pylori infection after surgery, while similar symptoms were present in 19 percent of the H pylori-negative group. Those with prolonged symptoms who tested positive for the infection were given treatment to eliminate the infection.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 18, 2004
To contact Wei-Jei Lee, M.D., Ph.D., e-mail wjlee{at}km.eck.org.tw.

WEIGHT LOSS SURGERY CAN HELP REDUCE METABOLIC SYNDROME IN OBESE PATIENTS

CHICAGO—Obese patients who underwent surgical treatment for weight loss had significant reductions in the components of the metabolic syndrome one year after surgery, according to an article in the October issue of Archives of Surgery, one of the JAMA/Archives journals.

According to the article, obese patients are at risk for numerous health problems, including diabetes, hypertension, hyperlipidemia (high cholesterol), sleep apnea, osteoarthritis and other illnesses. Hypertension, dyslipidemia, glucose intolerance (a hallmark of diabetes) and obesity together represent a disorder called the metabolic syndrome. People with the metabolic syndrome are at an increased risk for developing diabetes mellitus and cardiovascular disease and have higher death rates, the article states.

Wei-Jei Lee, M.D., Ph.D., of En-Chu Kong Hospital, Taipei, Taiwan, and colleagues determined the prevalence and characteristics of patients enrolling in a surgical weight loss program who met the criteria for the metabolic syndrome and examined the efficacy of surgically induced weight loss on the treatment of the metabolic syndrome.

From December 1, 1999 through March 31, 2002, 645 morbidly obese patients enrolled in a surgical weight loss program and were followed up for one year after their surgeries. Of the patients, 337 (52.2 percent) met criteria for the metabolic syndrome. Patients with the metabolic syndrome tended to be older (31.5 years vs. 28.1 years), and were more likely to be male (127 [37.7 percent] of 337 men vs. 81 [26.3 percent] of 308 women). Laparoscopic vertical banded gastroplasty (which limits food intake by creating a small pouch in the upper stomach) was performed in 528 patients (81.9 percent) and laparoscopic gastric bypass (surgery that causes food to bypass much of the intestinal tract, thereby limiting absorption of calories) was performed in 117 patients (18.1 percent).

There was significant weight loss in both groups, but patients who underwent laparoscopic gastric bypass lost significantly more weight (average 38.4 kilograms vs. 35.1 kilograms) and achieved a lower body mass index than patients who underwent laparoscopic vertical banded gastroplasty. In patients with the metabolic syndrome, the average weight loss one year after surgery was 38.2 kilograms, or 31.9 percent of their initial body weight. These patients had a substantial reduction in blood pressure and blood glucose, triglycerides and total cholesterol, resulting in a 95.6 percent resolution of the metabolic syndrome one year after surgery. The researchers also report that the metabolic syndrome was resolved in 95 percent of patients who underwent laparoscopic vertical banded gastroplasty and in 98.4 percent of patients who underwent laparoscopic gastric bypass surgery one year after the surgeries.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 18, 2004
corresponding author Jean Marie Naeyaert, M.D., Ph.D., e-mail jeanmarie.naeyaert{at}UGent.be. To contact Sanjeev V. Mulekar, M.D., e-mail dr_mulekar{at}vsnl.com. To contact editorialist Mats J. Olsson, Ph.D., e-mail mats.olsson{at}medsci.uu.se.

PIGMENT CELL TRANSPLANTATION APPEARS HELPFUL FOR TREATING PATIENTS WITH STABLE VITILIGO

CHICAGO—Patients with stable vitiligo, a skin disorder characterized by patches of lighter colored, or depigmented skin, may achieve good repigmentation of these areas with skin transplants using skin taken from normally-pigmented areas of their own bodies, according to two articles in the October issue of the Archives of Dermatology, one of the JAMA/Archives journals.

According to the articles, vitiligo is one of the most common pigment cell disorders, distinguished by depigmented patches of skin. Approximately one percent of the world population has vitiligo, whose psychosocial impact is often underestimated, the article states. The standard treatment for vitiligo is ultraviolet (UV) light therapy, which may last several months and can cause physical discomfort. Transplantation of pigment cells (called melanocytes) is another treatment option in patients with vitiligo.

Nanny van Geel, M.D., of Ghent University Hospital, Belgium, and colleagues investigated the efficacy of using transplanted pigment cells to treat 28 patients with vitiligo.

Patients were divided into two groups: patients with stable vitiligo (no new depigmented patches in the past 12 months, n=19) and patients whose vitiligo was not stable (n=9). The researchers selected 33 pairs of depigmented skin patches on the patients- one patch was randomly assigned to be treated with grafted pigment cells, the other was given a sham transplant. Pigment cells were taken from each patient from a site where the skin was normally pigmented. Three weeks after surgery, all patches received UV irradiation therapy twice per week for approximately two months.

The researchers found that there was a significant difference between pigment cell graft sites and placebo graft sites after three, six and 12 months. In patients with stable vitiligo, repigmentation of at least 70 percent of the treated area was achieved in 55 percent, 57 percent, and 77 percent of the actively treated lesions at three, six and twelve months after treatment. In group two, repigmentation of at least 70 percent of the treated area was not achieved at any time point. Repigmentation was diffuse on 94 percent of responding patients.

"After a strict preoperative selection for disease stability, transplantation resulted in repigmentation of at least 70 percent of the treated area in most actively treated vitiligo lesions," the authors write.

In another study, Sanjeev V. Mulekar, M.D., of the Noble Clinic, Pune, India investigated the long-term efficacy of skin cell transplantation in 67 patients with vitiligo. Dr. Mulekar used a melanocyte-keratinocyte cell mixture (pigment cells and structural skin cells) taken from normally-pigmented sites on the patients' own bodies. Patients were followed up for five years.

Dr. Mulekar found that 41 patients (84 percent) with segmental vitiligo (located in a few similar locations on each side of the body, such as around the mouth or on the hands) had 95 percent to 100 percent repigmentation in the treated areas. In patients with focal vitiligo, 73 percent had 95 percent to 100 percent repigmentation in treated areas. These results remained throughout the follow-up period.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 18, 2004
To contact Neil Bhattacharyya, M.D., call Amy Dayton at 617/534-1603.

PATIENTS WITH CHRONIC SINUS WITH RECURRENT ATTACKS DO NOT NECESSARILY DEVELOP RESISTANCE TO ANTIBIOTICS

CHICAGO—Patients with chronic rhinosinusitis (CRS, inflammation of the nasal passages and sinuses) do not necessarily develop resistance to antibiotics although they may be treated for long periods of time with these drugs, according to an article in the October issue of the Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.

According to the article, although the cause of CRS is controversial, most investigators agree that at least one of the main culprits is bacterial infection. Guidelines recommend extended courses of antibiotics as a first-line treatment for CRS before surgery is considered, the article states.

Neil Bhattacharyya, M.D., and Lynn J. Kepnes, R.N.P. of Brigham and Women's Hospital, Boston, investigated whether patients with CRS develop an increasing prevalence of antibiotic resistance over time.

Over a seven-year period, the researchers studied data on microbiological sinus culture results (224 culture results, average 2.5 cultures per patient) from 90 adult patients with CRS. The average time between cultures for patients was 157 days, and 429 organisms were isolated from the cultures. Patterns of antimicrobial resistance were identified.

The researchers found, "No statistically significant increase in severity of antimicrobial resistance was demonstrated within patients as serial cultures were drawn," the authors write. "In fact, a general trend toward decreasing antimicrobial resistance was noted overall, with many patients showing reversion to lesser degrees of antimicrobial resistance over time."