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, August 21, 2006)
ACNE MEDICATION ASSOCIATED WITH ABNORMAL BLOOD TESTS RESULTS
FACIAL RESURFACING TREATS PRECANCEROUS SKIN LESIONS, MAY HELP PREVENT SKIN CANCER
POSITIVE PARENTING HELPS ENCOURAGE HEALTHY SUN HABITS IN CHILDREN
ARCHIVES OF SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, August 21, 2006)
COMBINED LIVER-KIDNEY TRANSPLANT BENEFICIAL FOR PATIENTS WITH DUAL ORGAN DISEASE
IMAGING TECHNIQUE HELPS PREDICT BREAST CANCER SPREAD PRIOR TO SURGERY
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, August 21, 2006
Media Advisory: To contact Lee T. Zane, M.D., M.A.S., call Vanessa deGier at 415-514-1592.
ACNE MEDICATION ASSOCIATED WITH ABNORMAL BLOOD TEST RESULTS
CHICAGO—Elevated cholesterol levels and liver enzyme levels appear to be more common than previously thought among patients taking the acne medication isoretinoin, including those who had normal blood test results before beginning therapy, according to a report in the August issue of the Archives of Dermatology, one of the JAMA/Archives journals.
Isoretinoin, commonly marketed as Accutane, is the most effective acne treatment currently available, according to background information in the article. As many as 89 percent of patients taking the medication achieve long-term remission from acne. Side effects include elevations in the levels of triglycerides, blood fats that can have an adverse effect on cardiovascular health; liver enzymes, the presence of which indicates liver disease or inflammation; and total blood cholesterol. According to the article, the Accutane package insert notes that 25 percent of patients develop elevated triglycerides and 15 percent elevated liver enzymes. Other studies have found elevated triglycerides in 5 to 18 percent and elevated total cholesterol in 6 to 32 percent of individuals taking the drug.
Lee T. Zane, M.D., M.A.S., University of California, San Francisco, and colleagues assessed the frequency of abnormal laboratory tests in a population of 13,772 patients (aged 13 to 50 years, 51 percent male and 49 percent female) with acne who underwent isoretinoin therapy between 1995 and 2002. The researchers analyzed medical records for each patient before, during and after they took the medication, using information from laboratory tests of triglycerides; total cholesterol; liver transaminase (enzymes) levels; white blood cell (cells that fight infection) count; hemoglobin (which carries oxygen through the body) level; and platelet (involved in blood clotting) count.
Patients taking isoretinoins had an increased incidence of elevated triglyceride, total cholesterol and liver enzyme levels, but not hemoglobin levels, white blood cell counts or platelet counts. Among patients with normal pretreatment laboratory tests, 44 percent developed high triglycerides, 31 percent high cholesterol and 11 percent high liver enzymes while taking the medication. "Moderate to severe abnormalities in triglyceride, total cholesterol and transaminase levels were generally transient and reversible," the authors write. "Among those subjects with such abnormalities who received posttreatment testing, the proportion returning to normal or grade 1 [slightly elevated] levels by the end of the posttreatment period was 92 percent for transaminase level, 80 percent for triglyceride level and 79 percent for total cholesterol level."
"Our study did not examine adverse clinical outcomes and thus cannot estimate the ability of abnormal laboratory results to predict such outcomes," they conclude. "In clinical practice, laboratory abnormalities should be evaluated in the clinical context of the individual patient. Neither does the presence of a laboratory abnormality necessarily signal the presence of an adverse clinical outcome, nor does the absence of a laboratory abnormality preclude the possibility of an adverse clinical outcome." Still, patients with acne who develop substantially high triglyceride levels are at risk for high cholesterol and the metabolic syndrome, which in turn may increase the risk for coronary artery disease; further study is needed regarding these side effects, the authors write.
(Arch Dermatol. 2006;142:1016-1022. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by the Department of Dermatology, University of California, San Francisco, and a Dermatology Foundation Dermatologist Investigator Research Fellowship (Dr. Zane). This study received no funding from any pharmaceutical company. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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, August 21, 2006
Media Advisory: To contact corresponding author Susan M. Swetter, M.D., call Michelle Brandt at 650-724-2456.
FACIAL RESURFACING TREATS PRECANCEROUS SKIN LESIONS, MAY HELP PREVENT SKIN CANCER
CHICAGO—Facial skin resurfacing with lasers, an acid skin peel or a topical cream may reduce the number of precancerous skin lesions and lower the risk of developing skin cancer, according to a report in the August issue of the Archives of Dermatology, one of the JAMA/Archives journals.
Approximately 3.7 million physician visits occur in the United States every year for actinic keratoses, skin lesions that are sensitive to the effects of ultraviolet light. About 331 per 100,000 such lesions per year will progress into the skin cancer squamous cell carcinoma in patients older than age 40 years, according to background information in the article. As many as one-fourth of patients with multiple actinic keratoses will develop squamous cell carcinoma, and up to 60 percent of such cancers are thought to originate from actinic keratoses. Current treatment generally involves freezing the lesions with liquid nitrogen. "However, despite an overreliance by dermatologists on liquid nitrogen, there are, to our knowledge, no published studies that justify this expensive treatment modality as an efficient means to reduce the financial impact of actinic keratoses and nonmelanoma skin cancer on the health care system," the authors write.
Basil M. Hantash, M.D., Ph.D., and colleagues at Veterans Affairs Palo Alto Health Care System and Stanford University Medical Center, California, evaluated three alternative treatments for actinic keratoses in 24 patients with a history of lesions or of carcinoma. The participants had an average age of 73 years and were randomly assigned to undergo skin resurfacing with either a carbon dioxide laser, a chemical peel using 30 percent trichloroacetic acid or a cream with 5 percent fluorouracil, a medication used in chemotherapy, applied twice daily for three weeks. Dermatologists charted patients' actinic keratoses on a diagram of the head at the beginning of the study and again every three months for a period of at least 24 months. Five patients who were eligible for the study but declined treatment were used as controls.
After three months, the number of actinic keratoses had decreased significantly in all three treatment groups: 83 percent in the fluorouracil group, 89 percent in the acid group and 92 percent in the laser group. None of the participants experience adverse effects from treatment. The risk of cancer was also lower in all three treatment groups than in the control group; patients in the acid group, in particular, had a 40-fold lower rate of nonmelanoma skin cancer than those in the control group. Patients in that group also reported fewer complaints, less discomfort and a faster healing time than those in the other two treatment groups.
"Improved patient compliance in the trichloroacetic acid arm, ease of performance in the outpatient setting and subjective measures of better tolerance for this procedure make it an attractive alternative to repeated courses with topical agents or laser resurfacing," the authors conclude. "A larger study comparing trichloroacetic acid resurfacing for actinic keratosis reduction and nonmelanoma skin cancer prophylaxis [prevention] would help validate the superiority of this resurfacing technique over the carbon dioxide laser and assess its cost-effectiveness" compared with other therapies.
(Arch Dermatol. 2006;142:976-982. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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, August 21, 2006
Media Advisory: To contact Rob Turrisi, Ph.D., call Abby Diehl at 814-863-2207.
POSITIVE PARENTING HELPS ENCOURAGE HEALTHY SUN HABITS IN CHILDREN
CHICAGO—A program that helps parents talk to their children about skin cancer risks may promote sun-safe behaviors, especially when parents and children have a high-quality relationship, according to a report in the August issue of the Archives of Dermatology, one of the JAMA/Archives journals.
Approximately one in six individuals will develop skin cancer during his or her lifetime, according to background information in the article. The recent increase in skin cancer incidence has been attributed to various forms of high-risk sun exposure among young people, including sunbathing, inadequate use of sunscreen and other protective measures and the use of tanning beds or lamps. Recent preventive interventions have targeted children in school or community settings, but widespread rates of dangerous behaviors persist in young people.
Rob Turrisi, Ph.D., The Pennsylvania State University, University Park, and colleagues evaluated a parent-based intervention and assessed family characteristics that may contribute to the effectiveness of such a program in 469 parent-child pairs. Of those, 340 were assigned to the intervention group, in which parents received a handbook that encouraged them to communicate skin cancer risks, promote safe behaviors and discourage tanning, sunbathing and other high-risk activities. The other 129 were assigned to the control group. The children were all 9 to 12 years old, in fourth through sixth grade and from southern Idaho or eastern Tennessee. Forty-five days after parents in the intervention group received the handbook, children in both groups underwent an assessment in which they were asked questions about their sun-related habits and their family dynamics.
Among children who were in the intervention group, several family variables increased the effectiveness of the program. Children in the intervention who exhibited average levels of compliance-measured by how often they reported obeying their parents or following their parents' rules-had less frequent sunburns than those in the control group, but those with above-average compliance developed even fewer sunburns. Among children who reported that their parents had a low level of monitoring-for instance, that parents do not typically know where a child is or is going-the intervention had a larger effect on sunburn severity than among those who reported that their parents monitored them closely. The quality of the parent-child relationship, the child's level of compliance and the frequency of negative communication all affected sunbathing tendencies among those in the intervention group-the program was most effective in families with a high-quality parent-child relationship, a high level of compliance and a low level of negative communication.
The findings are consistent with current theories regarding effective parenting, the authors write. "Since the intervention was parent based, it follows that if the child feels that the parent encompasses many general positive qualities (e.g., the parent is warm, loving, trusting and a good listener and shows respect for the child), the child will be more likely to listen to his or her parents about issues such as skin cancer risks," they continue. "Furthermore, if the child is willing to comply with parental demands, the parent will have more influence in encouraging sun-safe behaviors and discouraging unsafe sun-related behaviors. Also, it is important that the parent does not exhibit negative communication patterns that can negate the effectiveness of positive communication.
"Finally, when parents are already aware of their child's activities, they are more capable of making sure that their child is adequately protected from the sun, which can prevent severe burns," they conclude. "Parents can be viable change agents for child behavior and the quality of the family relationship is critical to the success of such interventions."
(Arch Dermatol. 2006;142:1009-1014. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by a grant from the American Cancer Society to Drs. Turrisi, Hillhouse and Robinson. Dr. Robinson has served as a consultant to 3M Pharmaceuticals. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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, August 21, 2006
Media Advisory: To contact corresponding author Ronald W. Busuttil, M.D., Ph.D., call Elaine Schmidt at 310-794-2272.
COMBINED LIVER-KIDNEY TRANSPLANT BENEFICIAL FOR PATIENTS WITH DUAL ORGAN DISEASE
CHICAGO—Combined liver and kidney transplant appears to benefit patients with diseases in both organs, including those with a condition known as hepatorenal syndrome who have been receiving dialysis for more than two months, according to an article in the August issue of the Archives of Surgery, one of the JAMA/Archives journals.
A combined liver and kidney transplant is the procedure of choice for patients with both end-stage liver disease and end-stage renal (kidney) disease, according to background information in the article. However, the decision is more complicated in cases when kidney dysfunction may be temporary. Currently, hepatorenal syndrome-potentially reversible kidney failure combined with cirrhosis or another liver disease-is often treated with liver transplant alone and not a combined procedure. As waiting times for organs increase, more patients with hepatorenal syndrome will likely develop a chronic, irreversible condition that may require a combination transplant.
Richard Ruiz, M.D., and colleagues at the University of California, Los Angeles, reviewed data from 98 patients who underwent 99 combined liver and kidney transplants at one academic medical facility during a 16-year period, from 1988 to 2004. The patients had an average age of 46 years; 76 had primary kidney diseases and 22 had hepatorenal syndrome. For comparison, the researchers also reviewed data from 148 patients with hepatorenal syndrome who underwent a liver transplant alone between 1998 and 2002 and 743 patients who received kidney transplants alone.
Of the 99 combined transplant patients, 31 had died at the end of the analysis. One-, three-, and five-year survival rates were 76, 72 and 70 percent. None of the risk factors analyzed by the researchers, including characteristics of the donor, age of the recipient or previous transplants affected whether or not the patients would die after surgery. In dual transplant patients, 70 percent of the transplanted livers and 76 percent of the transplanted kidneys survived after one year; after three years, 65 percent of the livers and 72 percent of the kidneys; and after five years, 65 percent of the livers and 70 percent of the kidneys. Among those who underwent kidney transplants only, 23 percent of the kidneys were rejected by the recipient's body after one year, compared with 14 percent of those who had liver-kidney transplants.
When compared with hepatorenal syndrome patients who received only liver transplants, those who were undergoing dialysis-use of a machine to perform the blood filtration normally handled by the kidneys-for longer than eight weeks before surgery did better after the combined transplant. "Before this analysis, we recommended combined liver and kidney transplantation when patients receive hemodialysis for longer than one month before transplantation," the authors write. "However, on the basis of current findings, we find that the acuteness of renal failure subsides after two months of hemodialysis and that combined liver and kidney transplantation after this time will not only offer improvement in patient survival but also reduce hospital expenditures for patient care."
"Combined kidney and liver transplantation offers the best option for patients with simultaneous chronic liver and kidney failure when it is performed at a high-volume academic transplant center," they conclude.
(Arch Surg. 2006;141:735-742. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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, August 21, 2006
Media Advisory: To contact corresponding author Edward H. Phillips, M.D., call Sandy Van at 800-880-2397.
IMAGING TECHNIQUE HELPS PREDICT BREAST CANCER SPREAD BEFORE SURGERY
CHICAGO—Whole-body positron emission tomography (PET) scans could help physicians determine whether breast cancer has spread to the lymph nodes in the armpit prior to surgery, according to a report in the August issue of the Archives of Surgery, one of the JAMA/Archives journals.
Breast cancer is the most common type of malignant cancer in U.S. women, according to background information in the article. The most reliable way for physicians to determine the prognosis of women with the disease is to determine whether cancer has spread to the axillary lymph nodes, small oval structures in or near the armpits. In procedures known as dissection or biopsy, physicians remove all or part of the lymph nodes nearest the breast to determine whether the cancer has metastasized (spread). "A technique to identify positive lymph nodes before surgery would have several advantages," the authors write.
Alice Chung, M.D., and colleagues at the Cedars-Sinai Medical Center, Los Angeles, evaluated such a technique in 51 women (average age 54 years) who had 54 cases of invasive breast cancer as determined by biopsies. Before their surgeries or chemotherapy, the women had all had PET scans, in which a material similar to glucose (fludeoxyglucose F 18, or FDG) was injected into the body along with a chemical tracer. Because cancer cells use more glucose, they absorb more of the FDG. The researchers analyzed the scans to determine the standardized uptake value for each patient, a number that indicated how much of the FDG was absorbed in reference to how much was injected.
The PET scans indicated activity in the axillary area for 32 (59 percent) of the breast cancer cases. The standard uptake value ranged from .7 to 11; 20 tumors had a value of 2.3 or greater, while 34 had a value of less than 2.3. For further analysis, the researchers set the standard uptake value threshold at 2.3, meaning that cancers with a higher value were considered to have spread to the lymph nodes. Using this threshold, the scans were 72 percent accurate; had a sensitivity of 60 percent, meaning that 60 percent of those with axillary metastases were identified; a specificity of 100 percent, meaning that no one without metastases was identified as having metastases; and a positive predictive value-or proportion of patients with a positive result who are accurately diagnosed-of 100 percent.
Physicians should not necessarily replace other methods with PET scans, but if the scans are already performed before surgery, calculating a standard update value for axillary activity will help them determine if the lymph nodes are involved, the authors write. Technical and calibration factors cause variations in readings, therefore, "each PET center needs to develop its reference values," they continue. "However, if a PET standardized uptake value is validated and can predict node positivity with 100 percent specificity, chemotherapy can be initiated or a surgeon can proceed directly to axillary lymph node dissection for locoregional control."
(Arch Surg. 2006;141:783-789. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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.
