EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, July 18, 2005
Media Advisory: To contact Wolfgang Gubisch, M.D., e-mail: wolfganggubisch{at}vinzenz.de.

RECONSTRUCTIVE TECHNIQUE PROVIDES OPTION FOR DIFFICULT NASAL PLASTIC SURGERY

CHICAGO—A surgical technique that requires the removal, restructure and re-implantation of the nasal septum (the partition of the nose between the nostrils) appears to be a useful option for repairing the hard-to-treat severely deviated septum, according to an article in the July/August issue of the Archives of Facial Plastic Surgery, one of the JAMA/Archives journals.

Severe nasal septal deviations, usually the result of trauma, previous surgery or congenital malformations such as cleft palate, pose a particular challenge to plastic surgeons, according to background information in the article. The nasal septum affects both the appearance and the airway passages of the nose. Usual plastic surgical techniques often prove insufficient for reliably correcting severe septal deformities, the author suggests, necessitating the complete removal and correction of the septum to achieve good functional and aesthetic results.

Wolfgang Gubisch, M.D., of Marienhospital, Stuttgart, Germany, reviewed the medical charts of patients undergoing septoplasty (surgery of the nasal septum), either performed by him or under his supervision, at a facial plastic surgery center. Of the 2,119 patients from 1981 to 2004 with severe nasal septal deviations undergoing the surgery developed and refined by Dr. Gubisch, the charts of two groups were reviewed: 459 procedures performed by Dr. Gubisch from January 1, 1981 through July 31, 1987 and 108 patients whose procedures were supervised by Dr. Gubisch in 1996.

In the first group of patients, "Based on the subjective opinion of the surgeon and patients and the findings of the clinical examinations, a good to excellent functional result was obtained in 96 percent," the author writes. "Despite the complex deformity and complicated operative procedure, postoperative complications were rare and only 20 patients (four percent) elected to have revision septoplasty. Fifty-seven complications (12 percent) occurred, with the most common complaint being irregular contour of the dorsum [the bridge of the nose] (32 patients, seven percent)." In the supervised procedures, there were 14 postoperative complications (13 percent) and 12 dorsal (bridge of the nose) irregularities (11 percent). Eight patients (7 percent) chose to redo surgery.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, July 18, 2005
Media Advisory: To contact Matthias W. Wichmann, M.D., e-mail: Matthias.Wichmann{at}med.uni-muenchen.de.

LAPAROSCOPIC SURGERY ASSOCIATED WITH REDUCED INFLAMMATORY RESPONSE

CHICAGO—Minimally invasive colorectal surgery may have a less pronounced inflammatory response and less of a suppressing effect on the immune system than conventional surgery, resulting in a possible reduction in post-operative complications, according to a study in the July issue of Archives of Surgery, one of the JAMA/Archives journals.

Minimally invasive (laparoscopic) techniques have become more common for colorectal surgery and may be associated with reduced rates of post-operative bowel obstruction, wound infection and cardio-respiratory complications, according to background information in the article. There have been reports of reduced inflammation and other indications of suppression of the immune system following laparoscopic surgery, which may have implications for the long-term prognosis of patients with cancer, the authors suggest.

Matthias W. Wichmann, M.D., of Ludwig-Maximilians University, Munich, Germany, and colleagues took blood samples from 70 patients with colorectal disease undergoing laparoscopic (35) or conventional (35) surgery, before surgery and on one, three and five days following surgery. The blood was examined to determine the levels of white blood cells involved in the immune response, including B-cells, T-cells and natural killer cells, white blood cells that attack foreign bodies or abnormal cells, as well as levels of two molecules involved in the inflammatory response, interleukin 6 (IL-6) and C-reactive protein (CRP).

The researchers found that although the levels of the inflammatory markers CRP and IL-6 increased after both types of surgery, the levels were significantly higher in patients who had undergone conventional surgery. The levels of natural killer cells were significantly higher in patients undergoing laparoscopic surgery. The levels of other white blood cells, including the B-cells and different types of T-cells were depressed in all patients, with no significant differences.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, July 18, 2005
Media Advisory: To contact Marina Boruk, M.D., call Ron Najman at 718-270-2696.

TIME UNDER GENERAL ANESTHESIA ASSOCIATED WITH POSTOPERATIVE COMPLICATIONS IN HEAD AND NECK SURGERY

CHICAGO—The amount of time a patient is under general anesthesia during major head and neck surgery, not their age, was associated with postoperative complications, according to an article in the July issue of the Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.

The elderly population in the United States is expected to rise from 34.7 million in 2000 to 69.4 million persons older than 65 years in 2030, according to background information in the article. This may result in increased numbers of elderly patients requiring major head and neck surgical procedures. As age has received increased attention as a predictive factor for postoperative complications, so has the question of the appropriateness of candidates for surgery based on age.

Marina Boruk, M.D., from the State University of New York Downstate Medical Center, Brooklyn, and colleagues, conducted a retrospective study of medical records, between January 1999 and January 2004, to determine if age alone is a predictor of outcomes for major head and neck surgery. The review included 157 cases of patients who had undergone a major head and neck surgical procedure, of whom 31 (20 percent) were 70 years or older. The age of patients ranged from nine to 95 years, with an average of 56.1 years. Fifty-nine percent (92) were men and 41 percent (65) were women.

Patient's age alone was not found to be a predictive indicator of outcomes for major head and neck surgery. Time under general anesthesia (TUGA) was the only factor found to be consistently related to surgical complications and length of hospital stay. TUGA ranged from 75 to 1,160 minutes, with a median (middle value) of 240 minutes. The odds of a patient having a complication increased by 0.6 percent with every minute of anesthesia, therefore the odds of having a major complication increased by 36 percent every hour under anesthesia. The odds of having any complication (major or minor) increased by 18 to 36 percent for every hour under anesthesia, depending on the analysis. Being 70 years or older was not associated with complications or length of stay (LOS) in any of the researchers' analyses. The median length of stay for patients was three days in males and two days in females.