JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. the Archives of Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENTS
ARCHIVES OF INTERNAL MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, June 13, 2005)
OBESE WOMEN WITH BREAST CANCER MAY BE UNDERTREATED
DIETS RICH IN CALCIUM AND VITAMIN D MAY DECREASE RISK OF PMS
ARCHIVES OF NEUROLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, June 13, 2005)
SPECIAL ONLINE PUBLICATION — STUDY EXAMINES REASONS FOR SUBOPTIMAL OUTCOMES FOLLOWING DEEP BRAIN STIMULATION SURGERY
REPORT DESCRIBES DETAILS OF FOUR TRANSPLANT RECIPIENTS WHO CONTRACTED RABIES FROM DONOR
ARCHIVES OF OPHTHALMOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, June 13, 2005)
CHILDREN BORN PREMATURELY AT RISK FOR POORER VISION
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 13, 2005
Media Advisory: To contact Jennifer J. Griggs, M.D., M.P.H., call Leslie White at 585-273-1119.
OBESE WOMEN WITH BREAST CANCER MAY BE UNDERTREATED
CHICAGO—Overweight and obese women with breast cancer may receive reduced doses of chemotherapy drugs, which may put them at greater risk of cancer recurrence, according to a study in the June 13 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
Women who are 20 to 25 percent over their ideal body weight have a 1.3 times greater risk of a recurrence of breast cancer, according to background information in the article. Differences in body chemistry in overweight and obese women, including differences in estrogen and insulin levels, may account for their poorer prognosis, but, the authors suggest, there is evidence that inadequate doses of adjuvant chemotherapy may also contribute to the differences in outcome. Adjuvant chemotherapy is given to women with no measurable spread of the cancer beyond the primary tumor to improve the likelihood of disease-free and overall survival. Physicians may deliberately reduce dosage levels, which are calculated on the basis of body weight, for heavier women because of fears of toxic effects, the authors write.
Jennifer J. Griggs, M.D., M.P.H., of the University of Rochester, Rochester, N.Y., and colleagues analyzed data on patients with early stage breast cancer treated with adjuvant therapy between 1990 and 2001. They determined the quality of the therapy as measured by the use of reduced doses for the first treatment compared with standard doses, dose proportion over the course of the therapy and the relative dose intensity. There were 9,672 women from 901 practices included in the study. Of the women, 62 percent were above a healthy weight, 31 percent were overweight, 17 percent were obese and 14 percent were severely obese.
Among the severely obese women, 37 percent had a first-cycle dose reduction of at least 10 percent, compared with 20 percent of obese women, 11 percent of overweight women and nine percent of healthy weight women. The practices varied widely in their use of first-cycle dose reductions in their overweight and obese breast cancer patients. Although 60 percent of the practices reduced the doses in more than 10 percent of their overweight and obese patients, 33 percent of practices did not reduce doses for any of their overweight and obese patients.
"However, given the evidence that maintaining dose intensity improves the likelihood of overall and disease-free survival and the lack of data supporting dose reductions in overweight and obese women, it is likely that the practice variations we have observed represent 'unwarranted variation' in the adjuvant treatment of patients with breast cancer," the authors write. "The incidence of obesity, particularly severe obesity, is increasing in the United States. Eliminating unwarranted dose reductions will therefore become increasingly important in defining best practices for the care of overweight and obese women."
(Arch Intern Med. 2005;165:1267-1273. Available post-embargo at archinternmed.com)
Editor's Note: Gary H. Lyman, M.D., M.P.H., one of the co-authors, has served on the speaker's bureau for Amgen and Ortho Biotech and has received research support from Amgen and GlaxoSmithKline.
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, June 13, 2005
Media Advisory: To contact Elizabeth R. Bertone-Johnson, Sc.D., call Ed Blaguszewski at 413-545-2986.
DIETS RICH IN CALCIUM AND VITAMIN D MAY DECREASE RISK OF PMS
CHICAGO—A diet rich in calcium and vitamin D may lower the risk of developing premenstrual syndrome (PMS), according to a study in the June 13 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
While most women may experience mild emotional or physical premenstrual symptoms, as many as eight to 20 percent of women experience symptoms severe enough to meet the definition of premenstrual syndrome, characterized by moderate to severe symptoms that substantially interfere with normal life activities and interpersonal relationships, according to background information in the article. Previous studies have suggested that calcium supplements and vitamin D, a hormone that regulates the absorption of calcium, may reduce premenstrual occurrence and severity.
Elizabeth R. Bertone-Johnson, Sc.D., of the University of Massachusetts, Amherst, and colleagues compared the diets and supplement use of 1,057 women aged 27 to 44 years who reported developing PMS over the course of 10 years to 1,968 women who reported no diagnosis of PMS or no or minimal premenstrual symptoms in the same time period. The women, who participated in the Nurses Health Study (NHS), all reported no PMS in 1991, at the beginning of the study period. Their intake of calcium and vitamin D from diet and/or supplements was calculated from food frequency and standard NHS questionnaires administered in 1991, 1995 and 1999.
"We observed a significantly lower risk of developing PMS in women with high intakes of vitamin D and calcium from food sources, equivalent to about four servings per day of skim or low-fat milk, fortified orange juice or low-fat dairy foods such as yogurt," the authors write. "These dietary intakes correspond to approximately 1,200 mg. of calcium and 400 IU of vitamin D from food sources. While previous studies have observed the benefits of calcium supplements for treating PMS, this is the first, to our knowledge, to suggest that calcium and vitamin D may help prevent the initial development of PMS."
"Our findings, together with those from several small randomized trials that found calcium supplements to be effective in treating PMS, suggest that a high intake of calcium and vitamin D may reduce the risk of PMS," the authors conclude. "Clinical trials of this issue are warranted. In the interim, given that calcium and vitamin D may also reduce risk of osteoporosis and some cancers, clinicians may consider recommending these nutrients even for younger women."
(Arch Intern Med. 2005;165:1246-1252. Available post-embargo at archinternmed.com)
Editor's Note: This study was supported by a grant from GlaxoSmithKline Consumer Healthcare, Parsippany, N.J. and a grant from the National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Md. Adrianne Bendich, Ph.D., a co-author, is an employee of GlaxoSmithKline, the manufacturer of Tums and Oc-Cal calcium supplements.
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, June 13, 2005
Media Advisory: To contact Michael S. Okun, M.D., call John Pastor at 352-392-3845.
STUDY EXAMINES REASONS FOR SUBOPTIMAL OUTCOMES FOLLOWING DEEP BRAIN STIMULATION SURGERY
CHICAGO—A study of follow-up care for patients with unsatisfactory outcomes from deep brain stimulation (DBS) surgery for movement disorders offers insights into reasons for problems and proposes strategies for improved outcomes. The study is posted online today and will appear in the August print issue of the Archives of Neurology, one of the JAMA/Archives journals.
According to background information in the article, since the Food and Drug Administration approved deep brain stimulation for the treatment of Parkinson's disease, essential tremor and dystonia (uncontrolled muscle movement), there has been a surge in the number of centers offering this surgical procedure, which involves implanting a device to deliver mild electrical stimulation to block the brain signals that cause tremor. There is currently no consensus regarding appropriate screening procedures, necessary training of individuals providing the therapy, the need for an interdisciplinary team, or guidelines for the management of complications, the authors report.
Michael S. Okun, M.D., of the University of Florida Movement Disorders Center, Gainesville, Fla., and colleagues evaluated 41 consecutive patients who came to one of two specialty movement disorder centers over a two year period complaining of unsatisfactory results from deep brain stimulation surgery performed elsewhere. Each patient was evaluated by a movement disorders neurologist; the patient's medical record was reviewed; the DBS device was examined and properly programmed; and postoperative imaging studies were evaluated whenever possible.
The researchers found problems with screening for surgery and determination of diagnosis, five patients (12 percent) had disorders that would not be expected to respond to deep brain stimulation therapy. The researchers found that 19 patients (46 percent) had suboptimal placements of electrodes and three patients' devices had failed due to end of battery life (although these findings may be due to selection bias, the authors suggest). There were also problems noted with programming the DBS device and with medication adjustment. "Patients with movement disorders, with or without DBS, require frequent medication adjustments. Thirty (73 percent) of 41 patients in our series required medication changes. Three patients in our series improved markedly from medications alone, one from DBS programming alone, and 17 after a combination of DBS programming and medication changes. As evidenced by the numbers in this series, surgery does not replace appropriate medical management," the authors write.
"Ultimately, with diligent reprogramming, medication adjustments, and in some cases electrode replacement, 21 (51 percent) of the 41 DBS failures in our study were successfully salvaged," the authors conclude. "Many patients, however, had persistently poor outcomes despite our interventions. This case series provides important insight into the common reasons for 'DBS failures' and proposes some effective strategies for their management. ...As the prevalence of DBS therapy increases, implanting centers are becoming more experienced. We are hopeful that this experience, along with ongoing efforts to educate DBS practitioners regarding effective practices, will result in global improvement in the outcomes of DBS surgery."
(Arch Neurol. 2005;62:1-6. 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, June 13, 2005
Media Advisory: To contact Elizabeth C. Burton, M.D., Wendy Walker at 214-820-4581.
To contact editorial author Karen L. Roos, M.D., call Mary Hardin at 317-274-7722.
REPORT DESCRIBES DETAILS OF FOUR TRANSPLANT RECIPIENTS WHO CONTRACTED RABIES FROM DONOR
CHICAGO—A new report describes details of the clinical, radiological and pathological findings of four patients who received organs or tissue from a single donor, contracted rabies from the transplant and subsequently died, according to a study in the June issue of the Archives of Neurology, one of the JAMA/Archives journals. Previous articles have already described summaries of these cases, which occurred in May 2004.
Rabies has been described as an unpredictable disease whose only consistent feature is its uncharacteristic symptoms, according to background information in the article. Although rabies cases in the United States are rare, the incidence of rabies may be underreported because of the absence of a known animal exposure, lack of clinical suspicion, difficulty in making a diagnosis before death and the decreasing frequency of autopsies. There have been eight documented cases of rabies transmission through corneal transplants, including one in the U.S., but there have been no previously reported cases of rabies transmission through solid organ transplant.
Elizabeth C. Burton, M.D., of Baylor University Medical Center, Dallas, and colleagues, describe detailed features of four cases of transplant recipients who received organs or vascular tissue from a common donor who developed a rapid neurological deterioration and died with clinically unsuspected rabies infection. The two kidneys, the liver and blood vessel tissue were successfully transplanted into four recipients. All four transplant recipients also developed rapidly progressive neurological disease and died within 48 days following transplant.
"Although antemortem [before death] diagnosis of rabies is possible ... the possibility of rabies is often not considered, particularly in the absence of a known exposure," the authors write. "In the cases discussed here, a definitive diagnosis of rabies was not made until after death, similar to previous reports in which more than one third of cases were not diagnosed antemortem primarily because of lack of clinical suspicion. ...This series of cases along with a subsequent case bring the number of reported human rabies cases since 1980 in the United States to 55. Even if the number of U.S. rabies cases increased by 100-fold, given the population and known organ donation rate, a conservative estimated risk of rabies infection through solid organ transplantation is less than 1:1,000,000,000,000."
"However, these cases demonstrate that the risk for transmission of rabies infection through solid organ transplantation exists, and the diagnosis should be considered in any rapidly progressing neurological disease," the authors conclude.
(Arch Neurol. 2005;62:873-882. Available post-embargo at archneurol.com)
EDITORIAL: TRANSMITTING RABIES THROUGH ORGAN TRANSPLATATION
In an accompanying editorial, Karen L. Roos, M.D., of Indiana University School of Medicine, Indianapolis, writes "It is probably unrealistic to suggest that patients who die of atypical or unknown acute neurological illnesses have histopathological examinations of brain tissue prior to their organs being transplanted. It is reasonable, however, to suggest that this be done as soon as possible with the plan to treat the organ recipients if a treatable infectious disease is detected."
Dr. Roos warns that serological testing must be interpreted with caution, but points out that it can be "performed to detect antibodies to rabies virus, St. Louis encephalitis virus, West Nile encephalitis virus, eastern equine encephalitis virus, Rocky Mountain spotted fever, Lyme disease, and ehrlichiosis."
"Transplantation surgeons will transplant organs from any patients but those with Creutzfeldt-Jacob disease or metastatic cancer," Dr. Roos concludes. "They argue that without the organs, their patients will die. But the organ recipients in the Burton et al case report died of rabies virus infection, and if they hadn't received these organs, healthy organs may have been available subsequently. Neurologists should play a role in the decision to transplant organs from patients with acute progressive, and potentially infectious, neurological diseases."
(Arch Neurol. 2005;62:855-856. 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, June 13, 2005
Media Advisory: To contact corresponding author, Gerd Holmstrom, M.D., Ph.D., e-mail: gerd.holmstrom{at}ogon.uu.se.
CHILDREN BORN PREMATURELY AT RISK FOR POORER VISION
CHICAGO—Children who were born prematurely are more likely to have visual problems at 10 years of age than children who were born at full term, according to a study in the June issue of the Archives of Ophthalmology, one of the JAMA/Archives journals.
Eye and neurological problems are common in premature infants, according to background information in the article, but little is known about the effects of prematurity on visual acuity, the sharpness or clarity of vision. The current study evaluated both prematurely born and full-term children at the age of 10 years to determine the effects on visual acuity of prematurity alone, of retinopathy of prematurity (ROP, a disorder of the blood vessels of the retina that is common in premature babies) and of cryotherapy (the standard treatment for ROP).
Eva K. Larsson, M.D., of the Uppsala University Hospital, Uppsala, Sweden, and colleagues compared the visual acuity for distance and near vision of 10-year-old children born either prematurely or full term in Stockholm County, Sweden between 1988 and 1990. Of the 216 prematurely born children, 131 had no retinopathy of prematurity at birth. Of the remaining preterm children with mild to severe retinopathy of prematurity, 25 were treated with cryotherapy.
Prematurely born children had reduced distance and near visual acuities compared with full-term children, even when children who had retinopathy and neurological disorders were excluded, the researchers report. Children who had been treated with cryotherapy had the highest risk of reduced visual acuity. Two percent of the preterm children were visually impaired by the World Health Organization criteria and 5.3 percent had a visual acuity below 20/60 in either eye.
"Although we found an overall good visual outcome in the prematurely born cohort, the risk of reduced visual acuity was greater than in full-term children," the authors conclude. "Children who had been treated with cryotherapy had the highest risk, but prematurity per se was also associated with reduced visual acuity."
(Arch Ophthalmol. 2005;123:825-832. Available post-embargo at archophthalmol.com)
Editor's Note: See article for full funding information.
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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