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, February 20, 2006)
CORTICOSTEROIDS ASSOCIATED WITH POOR OUTCOMES, DEATH IN THE TRAUMA INTENSIVE CARE UNIT
GUM-CHEWING MAY SPEED RECOVERY AFTER COLON SURGERY
KOREAN BREAST CANCER PATTERNS REFLECT THOSE OF WESTERN COUNTRIES
ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, February 20, 2006)
NO DIFFERENCE BETWEEN OVER-THE-COUNTER DECONGESTANT AND PRESCRIPTION DRUG IN RELIEVING SYMPTOMS OF SEASONAL ALLERGIC RHINITIS
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, February 20, 2006
Media Advisory: To contact Rebecca C. Britt, M.D., call Doug Gardner or Greg Raver-Lampman at 757-446-6070.
CORTICOSTEROIDS ASSOCIATED WITH POOR OUTCOMES, DEATH IN THE TRAUMA INTENSIVE CARE UNIT
CHICAGO—Patients in the trauma intensive care unit who receive corticosteroids may have more infections, longer stays in intensive care or on a ventilator and a higher death rate than those who do not, according to a study in the February issue of Archives of Surgery, one of the JAMA/Archives journals.
Physicians use corticosteroids in the intensive care unit (ICU) to treat a variety of conditions, including sepsis (systemic blood infection), swelling of the airway and spinal cord injury, according to background information in the article. The medications were first used to treat sepsis in the 1950s and 1960s and evidence has suggested they are effective for this purpose. However, their use suppresses the immune system, leaving patients prone to infections and other complications, the authors write.
Rebecca C. Britt, M.D., of Eastern Virginia Medical School, Norfolk, and colleagues analyzed the records of 100 patients who had received corticosteroids in the trauma-burn ICU at Sentara Norfolk General Hospital between 2002 and 2003. They matched these patients with 100 control patients who were the same age and had injuries of the same severity, but did not receive corticosteroids.
More patients in the corticosteroid group than those in the control group developed pneumonia (26 percent vs. 12 percent), bloodstream infection (19 percent vs. 7 percent) or urinary tract infection (17 percent vs. 8 percent). The rates of these infections did not appear to be related to the type of corticosteroids patients were given or the length of time for which they received them. Patients receiving corticosteroids also stayed in the ICU seven days longer (17.6 vs. 10.2 days) and on a ventilator five additional days (9.9 vs. 4.9 days), and were more likely to die than those who did not.
Many patients in the study had conditions for which use of corticosteroids has not been widely studied. "Thirty-nine of the 100 patients in our study received corticosteroids for an indication supported by the literature," the authors write. "The remaining 61 should not have received corticosteroids based on a strict interpretation of the current literature. Certainly the risk of infection outweighs the potential benefit in these cases." Considering their extra time in the ICU and on a ventilator, those 61 patients also accumulated an additional $717,535.68 in cost because of the corticosteroids, the authors report.
"Caution must be taken to carefully consider the indications, risks and benefits of corticosteroids when deciding on their use," they conclude.
(Arch Surg. 2006;141:145-149. Available pre-embargo to the media at www.jamamedia.org)
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, February 20, 2006
Media Advisory: To contact corresponding author Kenneth Waxman, M.D., call Janet O'Neill or Joan Galvan, Cottage Health System Public Affairs, at 805-879-8980.
GUM-CHEWING MAY SPEED RECOVERY AFTER COLON SURGERY
CHICAGO—A small study suggests that chewing gum after colon surgery may speed the return of normal bowel function and shorten patients' hospital stays, according to a report in the February issue of Archives of Surgery, one of the JAMA/Archives journals.
Any type of abdominal surgery can cause ileus, a marked decrease or stoppage of intestinal function, according to background information in the article. Pain, vomiting and abdominal distension are the immediate consequences. Ileus also can lead to longer hospital stays, an increased risk of infection and problems breathing, the authors report.
Rob Schuster, M.D., and colleagues at Santa Barbara Cottage Hospital, California, studied 34 patients who underwent sigmoid colon resection, in which surgeons remove a portion of the large intestine, for cancer or recurrent diverticular diseases. Seventeen of the patients chewed sugarless gum three times a day beginning the morning after their surgeries and lasting until their first bowel movement. The other 17 patients, who did not differ in age, gender, reason for surgery or number of previous surgeries, served as controls.
The gum-chewing group left the hospital after an average of 4.3 days, compared with 6.8 days for the control group. Patients who chewed gum also passed gas sooner (65.4 hours vs. 80.2 hours post-surgery) and had their first bowel movement earlier (after 63.2 hours compared with 89.4 hours) than those who did not. There were no major complications in either group and the gum-chewers had no problems tolerating the gum. All of them continued to chew gum until their bowels began to function again.
Chewing gum may stimulate the same nerves in the body as eating, promoting the release of hormones that activate the gastrointestinal tract, the researchers write. "Early postoperative feeding may stimulate bowel motility, however, many patients fed early after colectomies do not tolerate this," they write. "In a study where patients were given water four hours postoperatively, 20 percent of these patients did not tolerate the intervention."
Gum-chewing may serve as a feasible alternative, an "inexpensive and helpful adjunct to postoperative care after colectomy," they conclude.
(Arch Surg. 2006;141:174-176. 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, February 20, 2006
Media Advisory: To contact corresponding author Sei Hyun Ahn, M.D., e-mail ahnsh{at}amc.seoul.kr.
KOREAN BREAST CANCER PATTERNS REFLECT THOSE OF WESTERN COUNTRIES
CHICAGO—In trends that echo those of Western countries, more Korean women are developing breast cancer; there is a larger proportion of young patients, asymptomatic cancers, breast-conserving surgery and immediate reconstruction after mastectomy in Korea; and more individuals there have risk factors for the disease, according to a study in the February issue of Archives of Surgery, one of the JAMA/Archives journals.
More than 1 million women worldwide develop breast cancer every year and almost 600,000 die, according to background information in the article. Although rates of the disease in Korea remain lower than those in Western countries, the incidence of breast cancer is increasing at a more rapid rate than the world average. This is likely because of continued westernization of the Korean lifestyle, lower birth rates, lower breastfeeding rates and an increase in the number of check-ups for breast cancer, the authors write.
Byung Ho Son, M.D., and colleagues at the University of Ulsan and Asan Medical Center, Seoul, Korea, analyzed data from a group of 5,001 women who underwent surgery for breast cancer at the hospital between July 1989 and March 2004. They examined a number of factors, including age distribution, surgical treatments, staging, survival rate and risk factors.
Compared with data from 1991, the median (mid-point) age of Korean patients with breast cancer increased from age 44 years to 46 years. About 64.9 percent of cases occurred in premenopausal women younger than age 50. The proportion of asymptomatic patients whose cancer was detected by mammography increased from 3.8 percent in 1991 to 21 percent in 2003. The proportion of early cancers (stages 0 and 1) also increased between 1991 and 2003, from 34.2 percent to 48.8 percent. Although it is increasing, this proportion "is still considerably lower compared with that of Western countries, so we believe that more efforts for early detection of breast cancer through screening are necessary."
An increasing number of women (39.1 percent from 5.1 percent) opted for breast-conserving therapies rather than a radical mastectomy (breast removal) between 1991 and 2003. Of the 67.1 percent of women who received a radical mastectomy, 12 percent underwent immediate breast reconstruction. The five-year survival rate among women in the study was 84.1 percent.
The proportion of patients with some risk factors, including early menarche (first menstrual period) and delivering a first child after age 30, was significantly higher among women in the study than 1991 rates. "We believe that the younger generations of Korean women have been directly affected by the progressive westernization of the Korean lifestyle," the authors write. "According to the biennial report of the Korean Breast Cancer Society, the proportion of risk factors, such as early menarche, late menopause, high-fat diet and obesity, was significantly increased among the patients between 1996 and 2000."
"The present results suggest that the rate of breast cancer in Korea will continue to increase owing to westernized lifestyles, and the clinical characteristics of Korean breast cancer are now reflecting the patterns of Western countries," they conclude.
(Arch Surg. 2006;141:155-160. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This work was supported by a grant from the Asan Life Science Institute, Seoul.
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, February 20, 2006
Media Advisory: To contact corresponding author Fuad M. Baroody, M.D., call John Easton at 773-702-6241.
NO DIFFERENCE BETWEEN OVER-THE-COUNTER DECONGESTANT AND PRESCRIPTION DRUG IN RELIEVING SYMPTOMS OF SEASONAL ALLERGIC RHINITIS
CHICAGO—A small study indicates that there was no difference between an over-the-counter decongestant (pseudoephedrine) and a prescription medication (montelukast) in relieving symptoms associated with allergic rhinitis and improving quality of life, according to a study in the February issue of the Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
Allergic rhinitis, inflammation and congestion of the nasal passages associated with seasonal allergies, such as hay fever, affects about 40 million people in the United States. Symptoms include sneezing, runny nose, itchy nose and throat and nasal congestion, according to background information in the article. The condition also may cause more serious consequences, such as problems sleeping, daytime sleepiness and reduced productivity. Several medications, including pseudoephedrine hydrochloride (an over-the-counter preparation) and montelukast sodium (a prescription drug), are available to treat symptoms, the authors report.
Samatha M. Mucha, M.D., and colleagues at the University of Chicago compared these two treatments in a group of 58 adults with ragweed allergic rhinitis, as documented by the results of skin testing. Participants recorded their symptoms and quality of life at the beginning of the study and took one of the medications each morning for two weeks. Thirty patients received montelukast and 28 took pseudoephedrine.
Both treatments reduced all the symptoms of allergic rhinitis, including congestion, runny nose and sneezing, and improved quality of life. Pseudoephedrine was more effective than montelukast at alleviating the symptom of nasal congestion. Both medications improved nasal peak inspiratory flow, which objectively gauges nasal congestion by measuring the amount of air flowing into the nose.
Although nervousness, anxiety, insomnia, dry mouth and palpitations have been associated with pseudoephedrine in previous studies, neither medication caused any significant side effects in this investigation. "Both medications were well tolerated, and pseudoephedrine did not lead to any of its well-known stimulant adverse effects, likely owing to its once-daily administration in the morning and lower blood levels in the later hours of the day closer to bedtime," the authors write.
(Arch Otolaryngol Head Neck Surg. 2006;132:164-172. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Drs. Naclerio and Baroody belong to the Speakers Bureaus of Merck & Co. Inc. and Dr. Baroody has received honoraria from Merck. This study was supported in part by a medical school grant from Merck & Co. Inc. (Dr. Baroody) and Merck contributed editorial suggestions during the preparation of this article.
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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