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, July 17, 2006)
STUDY COMPARES GASTRIC BYPASS AND GASTRIC BANDING SURGERIES IN EXTREMELY OBESE PATIENTS
RADIO WAND MAY HELP DETECT SPONGES LEFT IN SURGERY PATIENTS
ARCHIVES OF DERMATOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, July 17, 2006)
STUDY COMPARES TREATMENTS FOR CHRONIC PLAQUE PSORIASIS
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ON-LINE.
Go to www.jamamedia.org for more information and to apply for access.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, July 17, 2006
Media Advisory: To contact corresponding author George S. Ferzli, M.D., call Ellen Watson at 718-270-1176.
STUDY COMPARES GASTRIC BYPASS AND GASTRIC BANDING SURGERIES IN EXTREMELY OBESE PATIENTS
CHICAGO—Extremely obese patients who undergo gastric bypass procedures may have fewer complications, a greater reduction in obesity-related diseases, more weight loss and a higher level of satisfaction than those who have gastric banding procedures, according to a report in the July issue of the Archives of Surgery, one of the JAMA/Archives journals.
Obesity is increasingly prevalent in the United States, with some individuals reaching super morbid obesity, or having a body mass index (BMI) greater than 50, according to background information in the article. The weight of super morbidly obese patients has been described as being equal to or greater than 225 percent of their ideal body weight. Conditions associated with obesity in these patients, including hypertension (high blood pressure), diabetes, sleep apnea and arthritis, raise their risk for complications following bariatric (weight loss) surgery.
Wilbur B. Bowne, M.D., and colleagues at The State University of New York, Health Science Center of Brooklyn, and Lutheran Medical Center, Brooklyn, compared the outcomes among super morbidly obese patients following two commonly performed types of bariatric surgery. Laparoscopic Roux-en-Y gastric bypass involves sectioning off a small portion of the stomach into a pouch that bypasses the first part of the small intestine and connects directly to the lower portions. In laparoscopic adjustable gastric banding, surgeons place a band-like device around the stomach, dividing the stomach into two smaller compartments. The researchers analyzed the records of 106 consecutive patients who had one of the two procedures at a single community teaching hospital between February 2001 and June 2004.
Of the 106 patients, 60 (57 percent, average age 41.9 years) had gastric banding procedures and 46 (43 percent, average age 42.8 years) underwent gastric bypass. Gastric bypass procedures took longer (121 vs. 75 minutes) and required longer hospital stays than gastric banding procedures (3.5 vs. 1.8 days). However, after 30 days, 78 percent of those who had gastric banding experienced complications, including dehydration and vomiting, compared with 28 percent of those who had gastric bypass surgery. Gastric banding patients also had more secondary operations (15 vs. three), less weight loss (a BMI decrease of 9.8 as compared with 26.5) and reported a lower rate of overall satisfaction with the procedure. Nearly 80 percent of gastric bypass patients said they were very satisfied and none were dissatisfied or regretted having had the procedure, while 46 percent of gastric banding patients were very satisfied, 35 percent were satisfied and 10 patients reported dissatisfaction or regret. One death was reported, in a gastric banding patient. All patients reported fewer comorbidities after surgery, but the decrease was more pronounced in gastric bypass patients-for example, rates of diabetes dropped from 17.4 to 0 percent in the gastric bypass group and 18.3 to 11 percent among gastric banding patients.
"Our study represents the first focused attempt to address the effectiveness of laparoscopic adjustable gastric banding compared with laparoscopic Roux-en-Y gastric bypass in super morbidly obese patients, in hopes of better defining potential benefits that may guide future treatment planning," the authors write. "In our experience, laparoscopic Roux-en-Y gastric bypass appears superior to laparoscopic adjustable gastric banding in super morbidly obese patients."
(Arch Surg. 2006;141:683-689. 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.
Go back to the top.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, July 17, 2006
Media Advisory: To contact Alex Macario, M.D., M.B.A., call Michelle Brandt at 650-723-0272.
RADIO WAND MAY HELP DETECT SPONGES LEFT IN SURGERY PATIENTS
CHICAGO—A preliminary study suggests that a handheld wand scanning device that detects surgical sponges tagged with radiofrequency identification chips could help operating room personnel detect sponges that have been inadvertently left inside patients after procedures, according to a report in the July issue of the Archives of Surgery, one of the JAMA/Archives journals.
One large study estimated that a foreign object is left in patients after one of 10,000 surgical procedures involving open cavities, with two-thirds of the objects being surgical sponges, according to background information in the article. In some cases, these sponges may cause no symptoms and can remain undiscovered for decades; however, they add an average of four days of hospital stay after surgery and may also lead to sepsis (toxins in the blood or tissues), obstruction of the intestines and death. The currently recommended procedure for preventing foreign bodies being left in patients requires operating room staff to count sponges and surgical instruments three times: once before surgery, once during and again when the incision is closed.
Alex Macario, M.D., M.B.A., Stanford University School of Medicine, Calif., and colleagues tested a 1.5-pound battery-powered handheld scanning device on eight patients undergoing elective abdominal or pelvic surgery. Before each patient's wound was closed, one surgeon placed a tagged or untagged sponge inside the patient while the other surgeon looked away. The edges of the wound were pulled together to cover the inside of the abdominal cavity and the second surgeon used the wand to determine the existence and placement of the tagged sponge. The surgeons and nurses who used the device took a survey about their experience afterward.
The wand detected the tagged sponges 100 percent of the time in an average of less than 3 seconds. There were no false positives-meaning the wand did not indicate there was a tagged sponge in the cavity when there was not-and no false negatives, meaning that the want did not fail to detect sponges that were placed. Surgeons and nurses said the device was easy to use and could improve patient safety, but gave it lower marks for efficiency and requested a smaller version. They also expressed concern that human error could interfere with the system's effectiveness.
If such a device were to be used in the operating room, "the surgical team will remain responsible for inspecting the surgical site and avoiding retained foreign bodies," the authors write. "Technologies to increase safety in the operating room, such as the radiofrequency identification wand device described in this article, deserve further study to assess if they should be added to manual counting (rather than replace it). However, related human and system factors need to be addressed as well because it is likely that technology alone will not be foolproof in solving the retained foreign-body program."
(Arch Surg. 2006;141:659-662. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Dean and Sharon Morris own several patents and have patents pending related to RFID-tagged sponges. Dean Morris is a director and Sharon Morris is a nursing consultant for ClearCount Medical Solutions Inc. This study was supported in part by a grant from the Small Business Innovation Research Program and the National Institutes of Health.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
Go back to the top.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), Monday, July 17, 2006
Media Advisory: To contact Sami S. Yones, M.Sc., e-mail: yones5{at}yahoo.com.
STUDY COMPARES TREATMENTS FOR CHRONIC PLAQUE PSORIASIS
CHICAGO—Oral psoralen - UV-A therapy was found to be more effective than narrowband UV-B therapy in treating patients with chronic plaque psoriasis, according to an article in the July issue of the Archives of Dermatology, one of the JAMA/Archives journals.
It is unclear whether narrowband UV-B (NB-UVB) therapy is as effective as psoralen-UV-A (PUVA) therapy in treating psoriasis, according to background information in the article. PUVA therapy includes the combination of 8-methoxypsoralen medication (taken orally) and exposure to UV-A (long-wave) radiation. NB-UVB involves exposure to UV-B (short-wave) radiation and is thought to be safer than PUVA.
Sami S. Yones, M.Sc., and colleagues from King's College London conducted a randomized, double-blind trial comparing the efficacy of PUVA and NB-UVB therapies in treating chronic plaque psoriasis. Ninety-three patients with moderate-to-severe cases of the disease were recruited to participate in the study. Two hours before receiving UV treatment, patients in the NB-UVB group took a placebo and those in the PUVA group took 10-mg of 8-methoxypsoralen. Patients in both groups attended sessions twice weekly until their skin cleared, up to a maximum of 30 sessions. Patients whose skin cleared were followed up until relapse or for 12 months.
In patients with skin types I through IV (skin more likely to burn), PUVA was more effective than NB-UVB at clearing skin, with respective 84 percent vs. 65 percent clearance. Patients in the PUVA group also achieved skin clearance in a significantly shorter number of treatments, a median of 17 treatments, compared to 28.5 treatments in the NB-UVB group. Nearly half of patients in the PUVA group experienced erythema (redness of the skin) at some point during treatment, compared to less than one-quarter in the NB-UVB group. Six months after skin clearance was achieved, 68 percent of patients in the PUVA group were still clear compared to 35 percent of patients in the NB-UVB group. Overall, patients with skin types V and VI had a lower rate of clearance than those with skin types I through IV (24 percent vs. 75 percent).
The authors write that despite the disadvantages of PUVA treatment (i.e., may cause nausea, has the potential to cause skin cancer, cannot be used during pregnancy), their results "suggest that PUVA compared with NB-UVB tends to clear psoriasis more reliably, with fewer treatments and for longer and should, therefore, still be used in appropriate patients."
(Arch Dermatol. 2006;142:836-842. 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.
Go back to the top.
