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 SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, December 19, 2005)
WOMEN WHO UNDERGO RECONSTRUCTIVE BREAST IMPLANTATION FREQUENTLY DEVELOP SHORT-TERM COMPLICATIONS
DRAMATIC INCREASE IN ANNUAL RATE OF LAPAROSCOPIC BARIATRIC SURGERIES
ARCHIVES OF DERMATOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, December 19, 2005)
SMOKING ASSOCIATED WITH SEVERITY OF PSORIASIS
ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, December 19, 2005)
AGE DOES NOT PREDICT HEARING OUTCOMES FOR ELDERLY RECIPIENTS OF COCHLEAR IMPLANTS
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, December 19, 2005
Media Advisory: To contact corresponding author Joseph K. McLaughlin, Ph.D., call John Howser at 615-322-4747.
WOMEN WHO UNDERGO RECONSTRUCTIVE BREAST IMPLANTATION FREQUENTLY DEVELOP SHORT-TERM COMPLICATIONS
CHICAGO—Almost one-third of women who underwent reconstructive breast implantation after mastectomy had at least one short-term complication in the chest or breast area, with one in five women requiring additional surgery, according to a study in the December issue of Archives of Surgery, one of the JAMA/Archives journals.
Breast cancer is the most common malignancy among women in North American, Europe, Australia, New Zealand and some parts of South America, according to background information in the article. Women with breast cancer and their physicians may face several choices in the course of treatment, including whether to remove the breast (mastectomy) or undergo breast-conserving therapies, when and whether to reconstruct the breast following mastectomy and what materials to use in doing so. Surgeons performing postmastectomy reconstruction can form the new breast from flaps of skin and other tissue from the woman's body (autologous tissue) or insert an implant, and sometimes use both techniques at once. Many women choose implants alone because the procedure is simpler and requires less operation time than those using autologous tissue, and it can preserve the color of the skin of the breast and possibly some of its sensitivity.
Trine F. Henrikson, M.D., of the Danish Registry for Plastic Surgery of the Breast (DPB), Copenhagen, Denmark, and colleagues analyzed data from 574 women in the registry who underwent postmastectomy breast reconstruction between June 1, 1999, and July 24, 2003. The patients' surgeons reported the dates and details of each implantation and filled out follow-up forms when the women returned for subsequent visits. The women, ages 21 to 78 years with a mean (average) age of 51 years, were monitored through Sept. 15, 2003.
Following their first implantation, 31 percent of the women developed at least one adverse event, 16 percent developed two complications and 8 percent experienced three or more during the course of the study. The most common complications were infection, blood clotting, seroma (collection of serum in the tissues) and skin perforation. Forty-nine percent of these complications occurred within three months and 67 percent within six months.
Additional surgery was required for 21 percent of the women, while 3 percent underwent additional nonsurgical treatment. Surgery was most often needed to correct asymmetry of the breasts, displacement of the implant or capsular contracture, when the capsule-like scar tissue that forms around the implant tightened and hardened. "Surgical or medical intervention is commonly required during the reconstructive course, but reconstruction failure (loss of implant) is rare," the authors report.
The researchers also examined data on the 302 women in the study who had reimplantations, usually to exchange or replace the existing implant. These women had similar rates of complications-36 percent of them developed at least one adverse event and 21 percent required additional surgery.
"When evaluating benefits and risks associated with breast reconstruction, the surgeon and patient should consider that the reconstructive process often requires additional surgical interventions to treat local complications or to achieve the desired cosmetic result," the authors conclude. "Detailed information on the likelihood of local complications associated with the given indication (cosmetic vs. reconstructive) should be an essential part of adequate informed consent for women seeking breast implantation."
(Arch Surg. 2005;140:1152-1159. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was funded by the International Epidemiology Institute, which received unrestricted funding for the DPB from the Dow Corning Corporation, Midland, Mich.
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, December 19, 2005
Media Advisory: To contact Ninh T. Nguyen, M.D., call Tom Vasich at 949-824-6455.
DRAMATIC INCREASE IN ANNUAL RATE OF LAPAROSCOPIC BARIATRIC SURGERIES
CHICAGO—The number of bariatric surgeries performed in the U.S. increased by 450 percent between 1998 and 2002, a growth the researchers say could be linked with use of the minimally invasive laparoscopic technique, according to an article in the December issue of Archives of Surgery, one of the JAMA/Archives journals.
Currently, surgery is the only effective sustained weight loss option for patients with morbid obesity, according to background information in the article. "The increased enthusiasm for bariatric surgery coincides with the development and dissemination of the laparoscopic approach to bariatric surgery," the authors write. The American Society for Bariatric Surgery (ASBS) estimated that approximately 140,000 bariatric procedures would be performed in 2004.
Ninh T. Nguyen, M.D., and colleagues from the University of California, Irvine Medical Center, Orange, evaluated Nationwide Inpatient Sample (NIS) data for patients who underwent bariatric surgery for the treatment of morbid obesity from 1998 through 2002 to see if the recent growth in bariatric operations correlated with the widespread use of laparoscopic bariatric surgery.
Between 1998 and 2002, the number of bariatric operations performed in the U.S. increased by 450 percent, from 12,775 to 70,256 cases. Most of the bariatric operations consisted of Roux-en-Y gastric bypass, which increased from 78 percent of bariatric surgeries in 1998 to 92 percent in 2002. Laparoscopic bariatric surgery also increased, from 2.1 percent to 17.9 percent of bariatric surgeries from 1998 to 2002. The number of institutions that perform bariatric surgery increased from 131 to 323. The researchers also saw an increase in the number of bariatric surgeons with membership in the American Society for Bariatric Surgery, from 258 to 631 members.
"Although most patients currently seeking bariatric surgery are requesting the laparoscopic approach, not all patients qualify for the laparoscopic technique and not all surgeons are comfortable with performing laparoscopic bariatric surgery," the authors note. "Other factors probably contribute to the growth of bariatric surgery," the authors add. "The medical community now recognizes that morbid obesity is a chronic illness and that surgery can substantially reduce obesity-related illnesses and improve one's quality of life."
In conclusion the authors write: "The observed increase in bariatric surgery rates is related in part to an increase in utilization of the laparoscopic technique by surgeons and greater acceptance by patients of the minimally invasive option," the authors write. "Without a long-term, effective non-surgical treatment for morbid obesity on the horizon, the rate of bariatric surgery will continue to increase and the procedure will become on of the most commonly performed gastrointestinal operations."
(Arch Surg. 2005;140:1198-1202. 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 Cristina Fortes, Ph.D., e-mail c.fortes{at}idi.it.
To contact corresponding author Gerald G. Krueger, M.D., call Phil Sahm at 801-581-7387.
To contact editorialist Mark G. Lebwohl, M.D., call Leslie Schwartz at 212-241-9100.
SMOKING ASSOCIATED WITH SEVERITY OF PSORIASIS
CHICAGO—Cigarette smoking is associated with the clinical severity of the skin disease psoriasis, and both smoking and obesity are more prevalent among psoriasis patients, according to two studies in the December issue of theArchives of Dermatology, one of the JAMA/Archives journals.
Psoriasis is a chronic, persistent, lifelong disease characterized by scaly red plaques on the surface of the skin. Although psoriasis is not a life-threatening disease, the disability experienced by patients with psoriasis is comparable with that of patients with other chronic illnesses, such as heart disease, diabetes, cancer, and depression, according to background information in the article. Cigarette smoking is a risk factor for many chronic diseases, including psoriasis, but little is known about the effect of smoking on psoriasis severity.
Cristina Fortes, Ph.D., of Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy, and colleagues conducted a cross-sectional study to evaluate the association between different components of smoking history and the clinical severity of psoriasis. They analyzed data on 818 adults with psoriasis in inpatient wards of a hospital for skin diseases.
"Specifically, patients who smoked more than a pack of cigarettes (more than 20 cigarettes) daily had twice the risk of more severe psoriasis compared with those who smoked ten cigarettes or less per day," the authors report.
Cigarette-years, measured as the product of the intensity and duration of smoking, significantly increased the risk of clinically more severe psoriasis. "Separate analyses for men and women showed that the effect of cigarette-years on psoriasis severity was stronger for women than for men," the authors write.
"Smoking is associated with the clinical severity of psoriasis and highlights the importance of smoking cessation in patients with psoriasis," they conclude.
(Arch Dermatol. 2005;141:1580-1584. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by the Istituto Dermopatico dell'Immacolata, Istituto di Ricovero e Cura a Carattere Scientifíco, and by the Progetto Ricerca Corrente 2003, Italian Ministry of Health, Rome.
SMOKING AND OBESITY MORE PREVALENT AMONG PSORIASIS PATIENTS
In another article, researchers report that the prevalence of both smoking and obesity is higher among patients with psoriasis than in the general population.
Mark D. Herron, M.D., now in private practice in Montgomery, Ala., and colleagues from the University of Utah School of Medicine, Salt Lake City, studied the impact of obesity and smoking on psoriasis. A case series of patients with psoriasis enrolled in the prospective Utah Psoriasis Initiative (UPI) was compared with three population databases: the Behavioral Risk Factor Surveillance System of the Utah population, the 1998 patient-member survey from the National Psoriasis Foundation, and 500 adult patients who attend the University of Utah Department of Dermatology clinics and do not have psoriasis.
"The prevalence of obesity in patients within the UPI population was higher than that in the general Utah population (34 percent vs. 18 percent) and higher than that in the non-psoriatic population attending our clinics," the authors write. "The prevalence of smoking in the UPI population was higher than in the general Utah population (37 percent vs. 13 percent) and higher than in the non-psoriatic population."
The authors found that obesity appears to be the consequence of psoriasis, and not a risk factor for onset of the disease. "Smoking appears to have a role in the onset of psoriasis, but obesity does not," they write.
"It seems certain that the cost of providing care for psoriasis - when coupled with the increased frequency of obesity and smoking in patients attending clinics such as ours - will continue to increase," the authors conclude. "An effort to control obesity and smoking in psoriasis patients and an increased appreciation of the effects of these comorbidities are clearly needed."
(Arch Dermatol. 2005;141:1527-1534. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by a grant from the Dermatology Foundation, Evanston, Ill., and by financial support from LineaGen Inc., Salt Lake City, Utah.
EDITORIAL: ADVANCES IN PSORIASIS
In an accompanying editorial, Mark G. Lebwohl, M.D., of Mount Sinai Medical Center, New York, examines recent advances in psoriasis treatment, and suggests that the impact of those treatments on all dermatologic disease has been profound.
Summarizing the findings of Fortes and colleagues and Herron and colleagues, Dr. Lebwohl writes, "These studies do not answer the question, however, of whether psoriasis leads to smoking or smoking exacerbates psoriasis."
"The current issue of the Archives demonstrates that psoriasis remains a therapeutically and intellectually challenging disease," he concludes. "As research and development continue, we undoubtedly will have better treatments. We can only hope that they will be treatments that patients can afford."
(Arch Dermatol. 2005;141:1589-1590. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: In the past year, members of Dr. Lebwohl's department have served as investigators for and received grants and honoraria from Abbott Laboratories, Allergan, Amgen, Astellas, Biogen Idec, Centocor, Connetics, Genentech, Novartis, and Warner Chilcott. Dr. Lebwohl is also a consultant (or has pending consulting agreements) for Abbott Laboratories, Amgen, Astellas, Biogen Idec, Centocor, Connetics, Genentech, Novartis, Pfizer, Warner Chilcott, and 3M. In addition, members of Mount Sinai's Department of Dermatology hold patents for short-contact tazarotene therapy, excimer laser treatment of vitiligo, and topical genistein. Finally, in the past year, Dr. Lebwohl has served as a speaker for Abbott Laboratories, Amgen, Astellas, Biogen Idec, Centocor, Connetics, Genentech, Novartis, Warner Chilcott, and 3M.
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, December 19, 2005
Media Advisory: To contact corresponding author John K. Niparko, M.D., call Gary Stephenson at 410-955-5384.
AGE DOES NOT PREDICT HEARING OUTCOMES FOR ELDERLY RECIPIENTS OF COCHLEAR IMPLANTS
CHICAGO—Among elderly patients with profound hearing loss, age at time of receipt of an electronic hearing device known as a cochlear implant does not predict subsequent hearing ability, according to a study in the December issue of the Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
Among the 35 million people in the United States aged 65 and older, between 250,000 and 400,000 have severe to profound hearing loss. Psychological disturbances, social and emotional handicaps, and significant reductions in mental and physical functioning are known to be associated with advanced levels of hearing loss in elderly people, according to background information in the article. A question of growing importance is whether cochlear implantation can address these concerns for elderly patients. A cochlear implant is a small, complex electronic device that includes a microphone, a speech processor, a transmitter and receiver/stimulator, and electrodes. It is implanted and connected to the inner ear to help people with certain types of hearing loss to hear.
Janice Leung, A.B., and colleagues at The Johns Hopkins Hospital, Baltimore, Md., examined the performance of multichannel cochlear implant recipients in a large database of adult subjects. The researchers analyzed data on 749 adolescents and adults with profound hearing loss who underwent implantation at The Johns Hopkins Hospital and in two clinical trials at the Cochlear Corporation, Englewood, Colo., and Advanced Bionics, Sylmar, Calif. The authors used statistical modeling techniques to identify factors that predict outcomes after cochlear implantation. They examined the difference between baseline performance on monosyllabic word recognition, and performance within the first year of implantation.
The authors found that "age at implantation carried relatively little predictive value for postoperative performance in subjects 65 years and older," and that postoperative word scores were widely variable across all age groups.
"This study illustrated that age has little predictive value in determining postoperative performance with a cochlear implant, as increasing age seems to have a negligible effect on postoperative word scores," the authors write. "In fact, duration of profound deafness, along with the percentage of life lived deaf, hold greater predictive power than age, demonstrating that residual hearing capacity and language abilities may hold the key to postoperative success in the elderly cochlear implant recipient."
"Elderly patients should therefore not be discriminated against in assessments for cochlear implant candidacy," they conclude.
(Arch Otolaryngol Head Neck Surg. 2005;131:1049-1054. 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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