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 of 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, November 20, 2006)
MARATHON RUNNERS MAY BE AT INCREASED RISK FOR SKIN CANCER
ARCHIVES OF SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, November 20, 2006)
SINGLE DOSE OF ANTIBIOTICS BEFORE SURGERY SUFFICIENT TO HELP PREVENT INFECTION
ARCHIVES OF FACIAL PLASTIC SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, November 20, 2006)
HIGH-RESOLUTION CT SCAN MODELING FOR CREATING FACIAL IMPLANTS AIDS IN FACIAL RECONSTRUCTION SURGERY
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, November 20, 2006
Media Advisory: To contact Christina M. Ambros-Rudolph, M.D., e-mail: christina.ambros-rudolph{at}meduni-graz.at.
MARATHON RUNNERS MAY BE AT INCREASED RISK FOR SKIN CANCER
CHICAGO—In an Austrian study, marathon runners had more atypical moles and other skin lesions suggestive of a risk for skin cancer than did a comparison group of age- and sex-matched controls, according to a report in the November issue of Archives of Dermatology, one of the JAMA/Archives journals.
Marathon running has become increasingly popular in recent years, according to background information in the article. While regular exercise is associated with improved health, some evidence suggests that endurance exercise—including marathon running—may be linked to skin cancer and other severe illnesses. During training and competition, marathon runners are exposed to high levels of ultraviolet (UV) radiation, the most important environmental risk factor for the skin cancer melanoma. Endurance exercise also may suppress the immune system and increase the risk for malignant melanoma.
Christina M. Ambros-Rudolph, M.D., and colleagues at the Medical University of Graz, Austria, evaluated 210 marathon runners, 166 men and 44 women age 19 to 71 years, for skin cancer risk factors. The runners were recruited at a local marathon and asked questions about their training, including weekly intensity, what type of clothing they typically wore and whether or not they used sunscreen. A group of 210 controls, matched to the runners by age and sex, were recruited at a skin cancer screening campaign. All participants underwent a skin cancer examination and completed a comprehensive questionnaire about personal and family history of skin cancer, changes in skin lesions, sun sensitivity, sunburn frequency and physical characteristics such as skin and eye color.
Controls exhibited higher sun sensitivity than marathon runners, reflected by a larger number of individuals with blue, green or gray eyes and more sensitive skin types. However, the marathon runners had more atypical nevi (moles) and more solar lentigines (small, flat pigmented lesions, sometimes referred to as "liver spots"), higher numbers of which indicate a greater risk for malignant melanoma. These features were more pronounced in those with more intense training regimens. Twenty-four individuals in the marathon running group and 14 in the control group were referred to dermatologists for skin lesions suggestive of non-melanoma skin cancer. Among the marathon group, there was a higher referral rate among those with the highest training intensity.
Seventy-eight (37.1 percent) of the runners ran up to 40 kilometers (about 25 miles) per week, while 101 (48.1 percent) ran 40 to 70 kilometers (25 to 44 miles) per week and 31 (14.8 percent) logged more than 70 kilometers weekly. Most (203, or 96.7 percent) said they wore shorts and short-sleeved (184, or 87.6 percent) or sleeveless (23, or 11 percent) shirts. These clothing items would not or would only partially cover shoulders, upper arms and legs, body parts that are particularly susceptible to UV radiation exposure. Just more than half—118, or 56.2 percent—of runners regularly used sunscreen while training or competing, while 88 (41.9 percent) used it occasionally and four (1.9 percent) did not use it at all.
These sun-exposure risk factors, in addition to possible weakening of the immune system caused by extreme training, may increase athletes' skin cancer risk. "In short, until further sport-physiologic studies elucidate in detail the potential association between exercise-induced immunosuppression and malignant melanoma, runners should be alerted to the crucial role of UV radiation in the development of malignant melanoma and non-melanoma skin cancer," the authors conclude. "In particular, they should be advised to reduce UV exposure during exercising by choosing training and competition schedules with low sun exposure, wearing adequate clothing and regularly using water-resistant sunscreens."
(Arch Dermatol. 2006;142:1471-1474. Available to the media pre-embargo 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.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, November 20, 2006
MMedia Advisory: To contact Silvia Nunes Szente Fonseca, M.D., M.P.H., e-mail: silvia-fonseca{at}saofrancisco.com.br.
SINGLE DOSE OF ANTIBIOTICS BEFORE SURGERY SUFFICIENT TO HELP PREVENT INFECTION
CHICAGO—A single dose of antibiotics prior to surgery appears to prevent infections occurring at the surgical site as effectively as a 24-hour dosing regimen, and with reduced antibiotic costs, according to an article in the November issue of the Archives of Surgery, one of the JAMA/Archives journals.
Infections remain an important complication of surgical procedures despite increased knowledge about prevention and technological advances in modern surgery, according to background information in the article. Prophylactic antibiotics—preventive antibiotics given before surgery—have been shown to decrease the occurrence of infection at the site of the surgery. However, due to rising health care costs and concerns about antimicrobial resistance, hospitals have been under pressure to use fewer antibiotics. Most guidelines for the use of prophylactic antibiotics recommend using only one dose prior to surgery; however, surgeons might not comply with this recommendation, sometimes giving patients more than one dose or using broad-spectrum (targeting many types of bacteria) rather than the recommended narrow-spectrum drugs.
Silvia Nunes Szente Fonseca, M.D., M.P.H., Hospital São Francisco, Ribeirão Preto, São Paolo, Brazil, and colleagues studied infection rates before and after the implementation of a one-dose prophylactic antibiotic protocol at a local hospital. "We previously described the successful implementation of an antibiotic prophylaxis program in our hospital, discontinuing prophylactic antibiotic usage after 24 hours and correcting the timing of the first dosage," the authors write. "We decided to reduce all antibiotic prophylaxis to one dose because this measure could safely promote savings for our institution." Under the new protocol, for most procedures, patients are given one 1-gram dose of the antibiotic cephazolin at the same time anesthesia is administered. The protocol was approved by surgeons prior to implementation; education was provided to surgical and medical staff. To assess the effectiveness of this approach, the researchers examined infection rates and costs for 6,140 consecutive patients who had surgery between February 2002 and October 2002 and 6,159 consecutive patients who had surgery between December 2002 and August 2003, following the implementation of the one-dose protocol.
The correct protocol was followed in 6,123 (99 percent) of the surgeries performed after the new guidelines were implemented. Surgical site infections occurred in 127 (2 percent) of surgeries performed under the 24-hour protocol and 133 (2.1 percent) performed under the one-dose protocol. The number of vials of cephazolin purchased decreased from 1,259 in the first time period to 467 in the second, a 63 percent decline that represented a monthly cost savings of $1,980 for this drug alone.
The cooperation and encouragement of hospital administration and clinical staff, as well as educational efforts, contributed to the success of the new protocol, the authors write. "We were able to demonstrate that one-dose prophylaxis is feasible," they conclude. "In this era of restricted hospital budgets and increased bacterial resistance, one-dose prophylaxis may provide a way to improve performance by lowering costs."
(Arch Surg. 2006;141:1109-1113. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by the Waldemar Barnsley Pessoa Foundation and Maternidade Sinha Junqueira Foundation. 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.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, November 20, 2006
Media Advisory: To contact corresponding author Raymond S. Douglas, M.D., Ph.D., call Elaine Schmidt at 310-794-2272.
HIGH-RESOLUTION CT SCAN MODELING FOR CREATING FACIAL IMPLANTS AIDS IN FACIAL RECONSTRUCTION SURGERY
CHICAGO—A preliminary study suggests that high-resolution computed tomography (CT) modeling allows surgeons to custom-design acrylic implants prior to reconstructive surgery for patients with severe defects in their faces and eye cavities. Such implants appear to offer excellent aesthetic results and are well tolerated over the long term, according to a report in the November/December issue of Archives of Facial Plastic Surgery, one of the JAMA/Archives journals.
Severe facial and eye cavity abnormalities may be present at birth or can occur following facial trauma or another medical procedure, such as the removal of a tumor, according to background information in the article. Surgery to correct such defects aims to restore anatomical integrity, to increase the function of the eyelids and face and to improve a patient's appearance by inserting an implant made either of the individual's own bone and tissue or synthetic materials. Typically, use of these implants, which are shaped during surgery, has failed to recreate ideal three-dimensional contours in the face. Designing synthetic implants beforehand may improve precision and contours, but concerns have been raised about the long-term implant stability and risk of infection associated with plastics and other non-organic materials.
Michael J. Groth, M.D., Jules Stein Eye Institute, Los Angeles, and colleagues assessed long-term outcomes following the use of acrylic implants in nine patients with complex facial and eye cavity defects caused by facial trauma. The five men and four women were between the ages of 28 and 63 years, with an average age of 48.7. Between one month and 40 years had elapsed since their facial injuries, which included a boating accident, motor vehicle crashes, falls and a snowboarding accident. All patients had previously undergone reconstructive procedures.
For the current investigation, the patients underwent three-dimensional high-resolution CT scanning of the face and head. These data were used to create a stone mold, from which a customized implant made of polymethyl methacrylate (PMMA, commonly known as acrylic) was cast. The implant was surgically placed and fixed using screws.
During an average of 4.3 years of follow-up, none of the patients experienced significant complications, such as infection, extrusion (forcing out) or displacement of the implant. "In all of the patients, wound healing was uneventful, with antibiotics given perioperatively," the authors write. "All of the patients demonstrated long-term sustained improvement of facial deformities," including facial symmetry and eyelid function.
"Many types of implant materials have been used for reconstructive orbitofacial surgery," they continue. "Autogenous [from the patient's body] materials such as bone grafts provide many advantages, including excellent biocompatibility and low infection and extrusion rates. However, these materials have pertinent limitations, such as the potential for a prolonged operative procedure, limited supply, significant resorption, donor site morbidity and minimal malleability and customization." Surgeons have been using materials such as PMMA to make implants for more than 45 years, and designing them beforehand offers even more advantages, including precision and improved function, they conclude.
(Arch Facial Plast Surg. 2006;8:381-389. Available to the media pre-embargo 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.
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