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 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 DERMATOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, September 19, 2005)
USE OF ANTIBIOTICS FOR ACNE MAY INCREASE RISK OF COMMON INFECTIOUS ILLNESS
ARCHIVES OF SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, September 19, 2005)
SURGEONS LACK TRAINING IN PALLIATIVE SURGICAL OPTIONS
ARCHIVES OF FACIAL PLASTIC SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, September 19, 2005)
SPECIAL THEME ISSUE—EVOLVING TRENDS IN THE TREATMENT OF VASCULAR BIRTHMARKS
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, September 19, 2005
Media Advisory: To contact David J. Margolis, M.D., Ph.D., call Rebecca Harmon at 215-349-5660.
To contact editorial corresponding author James Shaw, M.D., F.R.C.P.C., call Elaine Smith at 416-978-5948.
USE OF ANTIBIOTICS FOR ACNE MAY INCREASE RISK OF COMMON INFECTIOUS ILLNESS
CHICAGO—Individuals treated with antibiotics for acne for more than six weeks were more than twice as likely to develop an upper respiratory tract infection within one year as individuals with acne who were not treated with antibiotics, according to an article in the September issue of the Archives of Dermatology, one of the JAMA/Archives journals.
Although there is considerable concern that the overuse of antibiotics will lead to resistant organisms and an increase in infectious illness, there have been few studies on people who have actually been exposed to antibiotics for long periods, according to background information in the article. Patients with acne, for which long-term antibiotic use is standard and appropriate therapy, represent a unique and natural population in which to study the effects of long-term antibiotic use, the authors suggest.
David J. Margolis, M.D., Ph.D., of the University of Pennsylvania School of Medicine, Philadelphia, and colleagues identified individuals diagnosed with acne between 1987 and 2002 (aged 15 to 35 years) in a medical database in the United Kingdom. Using statistical models and controlling for possible confounding variables including how often individuals were likely to see a physician, the researchers compared the incidence of a common infectious illness, upper respiratory tract infection (URTI), in individuals with acne who were treated with antibiotics to those whose acne was not treated with antibiotics.
Of 118,496 individuals with acne, 84,977 (71.7 percent) received either topical or oral antibiotic for more than six weeks for treatment of their acne and 33,519 (28.3 percent) did not. "Within the first year of observation, 18,281 (15.4 percent) of the patients with acne had at least one URTI, and within that year, the odds of a URTI developing among those receiving antibiotic treatment were 2.15 times greater than among those who were not receiving antibiotic treatment," the authors report.
"In this study, we have shown that the odds of a URTI developing among individuals who use an antibiotic to treat acne is about two times greater compared with those who do not use an antibiotic," the authors conclude. "The true clinical importance of our findings, in which patients and practitioners need to balance the risk of these infections with the benefits that patients with acne receive from this therapy, will require further investigation. However, patients with acne represent an ideal model in which to study the long-term effects of antibiotic therapy, the risks associated with colonization, and the risks of increasing resistance among bacterial pathogens exposed to antibiotics during treatment."
(Arch Dermatol. 2005;141:1132-1136. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by the Centers for Education and Research on Therapeutics, which is administered as a cooperative agreement by the Agency for Healthcare Research and Quality; by a grant from the National Institutes of Health, Bethesda, Md.; and by a summer student research award from the American Academy of Dermatology Association.
EDITORIAL: ACNE, ANTIBIOTICS AND UPPER RESPIRATORY TRACT INFECTIONS
In an accompanying editorial, An-Wen Chan, M.D., D. Phil., and James C. Shaw, M.D., F.R.C.P.C., of the University of Toronto, write that there are several limitations to the study which may affect the interpretation of the results, including the limitations studies that are not randomized controlled trials have with unmeasured confounding variations in the individuals in the study, in this case such as acne severity, socio-economic status and smoking. The editorialists also highlight problems in establishing a causal association between antibiotic use and URTIs and determining what the underlining cause of such a connection might be and the difficulties differentiating between bacterial and viral causes of URTIs.
"Margolis and coworkers should be congratulated on a well-designed study, albeit with stated limitations and the need for further analysis," the authors conclude. "We can all hope that their findings will stimulate further research to strengthen or dispel the observed association between URTIs and antibiotic use in patients with acne. Large prospective clinical studies will be required, ideally as part of a randomized trial. If an association is confirmed, additional research will also be needed to discover the precise mechanism."
(Arch Dermatol. 2005;141:1157-1158. Available pre-embargo to the media at www.jamamedia.org)
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, September 19, 2005
Media Advisory: To contact corresponding author Richard J. Bold, M.D., call Carole Gan at 916-734-9047.
SURGEONS LACK TRAINING IN PALLIATIVE SURGICAL OPTIONS
CHICAGO—A survey of general surgeons suggests that the amount of education and training they receive in palliative care is limited, according to a study in the September issue of Archives of Surgery, one of the JAMA/Archives journals.
Previous studies have indicated that surgeons receive little training in palliative surgical intervention, the objective of which is to relieve symptoms and improve quality of life rather than cure disease or extend survival, according to background information in the article. Because the goals of surgical palliation must be balanced with the associated risks of surgery, the decision to operate can be challenging for even the most experienced surgeon. Deficiencies in training during residencies and insufficient education in the evaluation of surgical options when there is not much hope of cure may contribute to a lack of consensus treatment recommendations for patients with advanced cancer and a variety of common symptoms, the authors suggest.
Joseph M. Galante, M.D., of the University of California, Davis, Medical Center, Sacramento, Calif., and colleagues surveyed 124 surgeons in Sacramento and the surrounding area about the type and extent of their postgraduate education in palliative surgery. The surgeons were also asked to select the single best treatment option from a preset list for four clinical scenarios and to identify the goals of the intervention and the three most important factors influencing their decision.
"Significant deficiencies in education were identified; 59 (84 percent) of the [70] respondents did not receive any education in palliative surgical care during residency and 28 (44 percent) lacked continuing medical education," the authors report. "A consensus treatment recommendation was not selected in three of the four clinical vignettes, but the respondents used similar clinical factors and goals of treatment for selection of the specific recommendation.
"Part of the lack of a standard approach to palliative surgical care in patients we identified may be based on the fact that physicians receive their training and experience in palliative care from diverse sources at various stage in their careers," the authors write.
"In conclusion, although most surgeons have similar goals in providing palliative care, treatments recommended may vary significantly," the authors write. "Furthermore, prior education clearly affects the recommended treatment option to achieve palliation of disease-related symptoms in patients with advanced malignancies. Thus, we advocate a continued effort to train surgeons in palliation and recommend that the training be part of a nationwide program to standardize palliative surgical care."
(Arch Surg. 2005;140:873-880. Available pre-embargo to the media at www.jamamedia.org)
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, September 19, 2005
Media Advisory: To contact Marcelo Hochman, M.D.,
e-mail hochman{at}facialsurgerycenter.com
To contact Kristen M. Kelly, M.D., Tom Vasich at 949-824-6455.
To contact Rami K. Batniji, M.D., call Beth Engeler at 518-262-3421.
To contact John P. Deveikis, M.D., call Ellen Bank at 843-792-2626.
To contact Alfons Krol, M.D., F.R.C.P.C., call Tamara Hargens at 503-494-8231.
To contact Juan Carlos Lopez-Guiterrez, M.D.,
e-mail queminfantil.hulp{at}salud.madrid.org.
EVOLVING TRENDS IN THE TREATMENT OF VASCULAR BIRTHMARKS
The September/October issue of Archives of Facial Plastic Surgery, one of the JAMA/Archives journals, contains several articles on the current state of knowledge and experience with vascular birthmarks, which are caused by blood vessels that do not form correctly. Vascular birthmarks can be internal, or form an external birthmark and can be disfiguring, especially if formed on the face. In an editorial accompanying the articles, Marcelo Hochman, M.D., of The Facial Surgery Center, Charleston, S.C., writes that more than 400,000 infants in the United States are born with a vascular lesion, including hemangiomas (which include "strawberry" or "raspberry" marks and port wine stains) and various malformations.
"The gap between the perpetuated beliefs about these lesions ('Leave it alone; it will go away') and the current state of our knowledge and experience is very wide," Dr. Hochman writes. "By disseminating the various viewpoints in this issue we hope to slowly help bridge that gap. Our patients will continue to benefit from the advances in management espoused by the authors until a consensus about treatment is eventually reached."
In Description and Analysis of Treatments for Port-wine Stain Birthmarks, Kristen M. Kelly, M.D., of the University of California at Irvine, and colleagues present the current treatment approaches for port-wine stains using pulse-dye laser therapy, which currently offers the most effective treatment, the authors suggest, with its ability to selectively target blood vessels.
Rami K. Batniji, M.D., of the Albany Medical College, Albany, N.Y., and colleagues present an algorithmic approach to the management of facial hemangiomas in An Aesthetic Approach to Facial Hemangiomas. They review the natural course, classification and history of treatment of these lesions throughout the past 100 years. Observation may be all that is necessary for stable lesions, the authors suggest, but superficial lesions that are growing rapidly, ulcerating or functionally limiting may require intervention with pulsed laser therapy; deep lesions may require treatment with corticosteroids; and involuting (rolling inward) hemangiomas may require surgery.
Vascular malformation of the head and neck may cause not only significant cosmetic defects but also functional impairment of structures such as the eye, tongue or throat, John P. Deveikis, M.D., of the Medical University of South Carolina, Charleston, reports in Percutaneous Ethanol Sclerotherapy for Vascular Malformations in the Head and Neck. Although surgical treatment is traditionally recommended, Dr. Deveikis suggests that the benefits of surgery may be limited when healthy structures are intimately involved with the lesion. In the article, he presents a study on the evaluation and treatment of patients with vascular malformations of the head and neck using an alternative, minimally invasive treatment.
In Management of Nasal Hemangiomas, Marcelo Hochman, M.D., of The Facial Surgery Center, Charleston, S.C., and Alfredo Mascareno, M.D., an International Visiting Fellow, Guadalajara, Mexico, report their extensive experience treating infantile hemangiomas involving the nose. They present a comprehensive review of the management of these lesions.
Two short articles, Current Knowledge of the Pathogenesis of Infantile Hemangiomas and Hemangiomas of Infancy present the current understanding of the natural course of infantile hemangiomas, the most common benign tumor of infancy, review the common characteristics of ulcerated infantile hemangiomas and discuss treatment options.
Finally, in Congenital Hemangiomas, Alfons Krol, M.D., F.R.C.P.C., and Carol J. MacArthur, M.D., of the Oregon Health and Science University, Portland, describe congenital hemangiomas, much more rare and only recently described hemangiomas, as they differ from infantile hemangiomas in their presentation, natural history and treatment. Juan Carlos Lopez-Guiterrez, M.D., and colleagues from the University of Madrid, Spain, provide a case study of in Giant Rapidly Involuting Congenital Hemangioma of the Face of a rare congenital hemangioma with a 15-year follow-up.
(Arch Facial Plast Surg. 2005;7. Available pre-embargo to the media at www.jamamedia.org)
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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