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 SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, December 18, 2006)
LOW TO MODERATE BLOOD ALCOHOL LEVEL ASSOCIATED WITH REDUCED MORTALITY FOLLOWING TRAUMATIC HEAD INJURY
HIV PATIENTS HAVE INCREASED RISK OF PNEUMONIA, DEATH FOLLOWING SURGERY
ARCHIVES OF DERMATOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, December 18, 2006)
PHOTOTHERAPY FOR NEONATAL JAUNDICE ASSOCIATED WITH INCREASED RISK OF SKIN MOLES IN CHILDHOOD
STUDY IDENTIFIES CHARACTERISTICS OF FAST-GROWING SKIN CANCERS
ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, December 18, 2006)
CLINICAL FACTORS OF TINNITUS INFLUENCE PERCEIVED LOUDNESS AND ANNOYANCE
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, December 18, 2006
Media Advisory: To contact Homer C. N. Tien., M.D., F.R.C.S.C., call Laura Bristow at 416-480-4040.
LOW TO MODERATE BLOOD ALCOHOL LEVEL ASSOCIATED WITH REDUCED MORTALITY FOLLOWING TRAUMATIC HEAD INJURY
CHICAGO—Patients who have low to moderate blood alcohol levels may be less likely to die after arriving at the hospital with a traumatic brain injury than those with no alcohol in their bloodstream, according to a report in the December issue of Archives of Surgery, one of the JAMA/Archives journals. However, those with the highest alcohol levels appear to have an increased risk of dying in the hospital.
Alcohol use is a major risk factor for trauma, according to background information in the article. About one-third to one-half of all patients hospitalized with trauma are intoxicated at the time of injury. However, the effect of alcohol on how patients fare after a traumatic brain injury—a leading cause of disability and death among young people—is unclear. Some human and animal studies suggest that alcohol may be neuroprotective, keeping the injury from worsening once it has occurred.
Homer C. N. Tien, M.D., F.R.C.S.C., Sunnybrook Health Sciences Centre, University of Toronto, and colleagues studied 1,158 consecutive patients who were evaluated at an academic level I trauma center for severe brain injury caused by blunt trauma between 1988 and 2003. Tests done when the patients were admitted determined blood alcohol concentration (BAC). This information, as well as data on demographics, type of injury, severity of the injury, length of hospital stay and whether the patient died or left the hospital, was gathered from the hospital’s trauma registry. The researchers also assessed a group of 528 patients with severe torso injuries, but no or mild head injuries, as a comparison.
Of the 1,158 traumatic brain injury patients, 740 had a BAC of zero, 315 had low to moderate BAC (0 to 230 milligrams per deciliter) and 103 had high BAC (230 milligrams per deciliter or higher); 403 died in the hospital. Those with a low to moderate BAC were less likely to die than those with no BAC (27.9 percent died vs. 36.3 percent). After adjusting for other factors that could influence the risk of death—including injury severity, blood transfusions and whether the trauma occurred in a motor vehicle crash—BAC was still associated with the risk of death. Those with a low to moderate BAC had 24 percent lower odds of dying in the hospital than those with no BAC. In contrast, those with a high BAC had 73 percent higher odds of dying than those with no BAC. Among patients with torso injuries, BAC was not related to the risk of death.
The authors mention that low to moderate doses of alcohol may protect the brain by stopping the mechanisms that contribute to secondary brain injury, which occurs when traumatized brain cells continue to be deprived of oxygen and worsens the damage caused by the initial event.
“There are major sociologic implications from implying that intoxicated patients with severe traumatic brain injury have better outcomes than non-intoxicated patients,” the authors write. “We stress that our study only examined the role of alcohol on outcome in the post-injury phase because we examined only in-hospital deaths.” About half of all individuals who die from trauma do so before they arrive at the hospital, they continue. Because alcohol use increases the likelihood of a severe injury, alcohol-related deaths comprise a large percentage of those who die before they have a chance to get to the hospital.
“Overall, people are still at much greater risk of dying if they drive while intoxicated,” the authors conclude. “What our study implies is that there may be a role for an alcohol-based resuscitation fluid in improving outcomes in adequately resuscitated patients with severe head injury.”
(Arch Surg. 2006;141:1185-1191. 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, December 18, 2006
Media Advisory: To contact Michael A. Horberg, M.D., M.A.S., call Michelle Ponte at 510-267-5354.
HIV PATIENTS HAVE INCREASED RISK OF PNEUMONIA, DEATH FOLLOWING SURGERY
CHICAGO—HIV-infected patients undergoing surgical procedures may be more likely to develop pneumonia after surgery and to die within 12 months than those without HIV, according to a report in the December issue of Archives of Surgery, one of the JAMA/Archives journals. In addition, HIV patients with a preoperative viral load (number of copies of the virus in the blood) greater than 30,000 per milliliter appear to have increased risk of surgical complications.
Since the development of medication regimens known as highly active antiretroviral therapy (HAART), HIV has become a chronic, manageable condition, according to background information in the article. “Consequently, many HIV-infected patients elect to undergo surgical procedures to correct physical ailments that would not have been treated previously, and undergo operative interventions in lieu of medical therapies for certain conditions,” the authors write.
Michael A. Horberg, M.D., M.A.S., and colleagues at Kaiser Permanente Medical Care Program–Northern California, Oakland, studied surgical outcomes in 332 HIV-infected patients who underwent a variety of procedures (including abdominal, orthopedic and heart surgeries) between 1997 and 2002. For comparison, the researchers selected a group of 332 patients who did not have HIV but were the same age and sex and had a similar procedure at around the same time and at the same location as one of the HIV-infected patients. The investigators then used health plan databases to obtain clinical information about the HIV patients’ disease and to track whether any of the patients had complications after surgery or died within 12 months.
The surgical procedures analyzed included abdominal or pelvic procedures (80.8 percent), cardiac or breast procedures (8.4 percent) and orthopedic procedures (10.8 percent). Most complications—including infections and delayed wound healing—occurred equally frequently in patients with and without HIV. No difference between the two groups was found in the length of hospital stay, number of complications or need for additional procedures to treat complications. However, more HIV patients developed pneumonia (eight or 2.4 percent vs. one or .3 percent) and more died within 12 months (10 or 3 percent vs. two or .6 percent). “The causes of death varied” in HIV patients, the authors write. “While none of the causes appeared to be a direct consequence of the operation, two deaths were within 30 days of the operation.”
The researchers also examined risk factors for complications and death among HIV patients, including CD4 cell count response, a measure of the state of the immune system. The lower the CD4 count, the more likely a patient with HIV/AIDS is to develop secondary infections or illnesses. Those with a CD4 count of less than 50 cells per cubic millimeter of blood had more complications than those with higher CD4 counts. In addition, viral loads—measured as the number of copies of the virus in a milliliter of blood—of more than 30,000 were associated with a higher complication rate. Whether the patients were taking antiretroviral therapy did not appear to be related to their risk of developing complications. “Our results indicate that a higher HIV viral load seems to be a greater predictor of surgically related complications than either the CD4 cell count or the presence or absence of HAART use,” the authors write.
“Patients with HIV are living longer and regaining a substantial amount of immune function,” they conclude. “Many HIV-infected patients will require surgical attention because of a variety of disorders. In many cases, HIV serostatus [whether a person is infected with HIV or not] should not be a criterion when determining the need for surgery if patients have adequate viral control.”
(Arch Surg. 2006;141:1238-1245. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was funded through the Kaiser Permanente–Northern California Community Benefits Program. 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, December 18, 2006
Media Advisory: To contact corresponding author Vincent Descamps, M.D., Ph.D., e-mail: vincent.descamps{at}bch.aphp.fr.
PHOTOTHERAPY FOR NEONATAL JAUNDICE ASSOCIATED WITH INCREASED RISK OF SKIN MOLES IN CHILDHOOD
CHICAGO—Children who received light therapy (phototherapy) for jaundice as infants appear to have an increased risk of developing skin moles in childhood, according to a report in the December issue of Archives of Dermatology, one of the JAMA/Archives journals. Some types of moles are risk factors for developing the skin cancer melanoma.
Jaundice or hyperbilirubinemia occurs when bilirubin, a yellow pigment created as a byproduct of the normal breakdown of red blood cells, cannot yet be processed by a newborn’s liver and builds up in the blood, turning the skin, whites of the eyes and mucous membranes yellow. The condition affects between 45 percent and 60 percent of healthy babies and as many as 80 percent of infants born prematurely, according to background information in the article. During phototherapy, the treatment of choice for jaundice, babies are placed under blue lights (bili lights) that convert the bilirubin into compounds that can be eliminated from the body. Studies have been performed to assess the safety of this therapy, but many have not focused on its effects on the skin, the authors write.
Emmanuelle Matichard, M.D., Bichat-Claude Bernard Hospital, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, and colleagues assessed the presence of melanocytic nevi (moles) in 58 French children who were 8 or 9 years old at the time of the study. Eighteen children had phototherapy as newborns; 40 who were the same age but did not have phototherapy were recruited from a public school and served as controls. All the children and their parents were interviewed about the use of phototherapy, history of sun exposure and sunscreen use. A dermatologist performed physical examinations on the children and recorded their skin color, eye color, hair color, skin type and the number and size of moles.
Thirty-seven children (63 percent) had moles that were 2 millimeters or larger, and there was an average of 2.09 moles per child. Those who were exposed to phototherapy had significantly more moles of this size than those who did not—an average of 3.5 vs. 1.45 per child. When the analysis was limited to moles between 2 millimeters and 5 millimeters, the association was stronger. “Lentigo simplex [moles smaller than 2 millimeters in diameter] may represent more recent nevi, whereas those nevi due to early events should be larger,” the authors write. “Nevi larger than 5 millimeters probably are congenital nevi and are most probably associated with genetic predisposition.” These associations did not change when other risk factors for the frequency of moles, including skin type and light hair, were considered. Sun exposure, particularly during vacations, was also associated with the number of moles of all sizes, and light hair color was correlated with the number of moles smaller than 2 millimeters.
The study did not examine whether phototherapy increases the risk for melanoma in adults, and it is possible that the small difference in the number of moles between the two groups would not change their risk of developing cancer. However, further study could help illuminate the association. “Higher numbers of acquired benign nevi are associated with increased risk of melanoma,” they conclude. “A detailed evaluation of the factors responsible for the development of nevi in children would be useful to identify high-risk groups to be targeted for prevention. The link between melanoma and phototherapy should be the focus of such a study.”
(Arch Dermatol. 2006;142:1599-1604. 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, December 18, 2006
Media Advisory: To contact Wendy Liu, M.B.Ch.B., Ph.D., e-mail: wendy.liu{at}petermac.org. To contact editorialist Dan Lipsker, M.D., Ph.D., e-mail: dlipsker{at}noos.fr.
STUDY IDENTIFIES CHARACTERISTICS OF FAST-GROWING SKIN CANCERS
CHICAGO—Melanomas (skin cancers) are more likely to grow rapidly if they are thicker, symmetrical, elevated, have regular borders or have symptoms, according to a report in the December issue of Archives of Dermatology, one of the JAMA/Archives journals. In addition, rapidly progressing melanoma is more likely to occur in elderly men and individuals with fewer moles and freckles, and its cells tend to divide more quickly and have fewer pigments than those of slower-growing cancers.
“Anecdotal experience suggests that there is a form of rapidly growing melanoma, but little is known about its frequency, rate of growth, or associations,” the authors write as background information in the article. One previous study suggested that how quickly a melanoma grew predicted how likely the patient was to relapse at one year or to survive without relapsing. Other research indicates that different types of melanoma grow at different rates; for instance, an aggressive type known as nodular melanoma grows more quickly than any other kind.
Wendy Liu, M.B.Ch.B., Ph.D., Peter MacCallum Cancer Center, East Melbourne, Australia, and colleagues investigated melanoma growth rate in 404 consecutive patients (222 male, 182 female, average age 54.2) with invasive melanoma. Participants’ skin was examined by a dermatologist and information about such characteristics as the number of typical and atypical moles was recorded. In addition, the patients were interviewed as soon as possible after diagnosis and preferably with a friend or family present. The researchers gathered information about demographics, skin cancer risk factors, the characteristics of the tumor and who first detected the cancer—the patient, a family member or friend, or a physician.
In addition, all patients and their families were asked to recall the date at which they first noticed a spot on their skin from which the melanoma later developed and then the date at which they noticed the marking had changed or become suspicious. The researchers used these two dates, the date that the melanoma was removed as obtained from medical records, and the thickness of the tumor at the time of removal to estimate the approximate rate of growth. This method was doubled-checked by comparing the rate of growth with the tumor mitotic rate, or the rate at which the cancer cells multiply. Those tumors with a faster mitotic rate also had a faster rate of growth as determined by the researchers’ formula.
Approximately one-third of all the melanomas (141) grew less than .1 millimeters per month, another one-third (136) grew between .1 millimeters and .49 millimeters per month, and one-third grew by .5 millimeters or more per month. A high rate of growth was associated with tumor thickness, ulceration (formation of a break or sore on the skin), amelanosis (lack of pigment in the tumor), regular borders, elevation and symptoms. Faster-growing melanomas were more likely to occur in individuals 70 years or older, in men and in those with fewer moles and freckles. Factors that were not associated with the rate of growth were the number of atypical moles or solar lentigines (age spots or liver spots), history of sun damage or blistering sunburns, skin type, eye color, family or personal history of melanoma, and current or childhood sun exposure.
“In summary, this study provides descriptive data on the spectrum of melanoma rates of growth and insights into subgroups of patients with melanoma that are associated with rapid growth,” the authors conclude. “We propose that this information on melanoma rate of growth be incorporated into education programs for patients and health professionals.” Awareness of the clinical features of faster-growing melanomas could help ensure that aggressive cancers are diagnosed and treated quickly.
(Arch Dermatol. 2006;142:1551-1558. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by the Melbourne Research Scholarship from The University of Melbourne and by the Fred Bauer research grant from the Australasian College of Dermatologists. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: EDUCATE THE PUBLIC ABOUT FAST-GROWING MELANOMAS
The study by Dr. Liu and colleagues provides physicians with important information about detecting fast-growing melanomas, writes Dan Lipsker, M.D., Ph.D., of Clinique Dermatologique, France, in an accompanying editorial.
Public education efforts surrounding slow-growing melanomas helped improve detection and treatment; in the 1960s, 60 percent of patients diagnosed with melanoma died of the disease, whereas only 11 percent die today. “Thus, the dermatologic community managed to recognize the slow-growing form of melanoma, identify its clinical features, generate public awareness of those clinical features using the ABCD rule and identify its risk factors to allow primary prevention,” Dr. Lipsker concludes. “The challenge in the coming years will be to do the same work for fast-growing tumors, and the work by Dr. Liu et al is a first step in that direction.”
(Arch Dermatol. 2006;142:1638-1640. Available to the media pre-embargo 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, December 18, 2006
Media Advisory: To contact Wolfgang Hiller, Ph.D., e-mail: hiller{at}mail.uni-mainz.de.
CLINICAL FACTORS OF TINNITUS INFLUENCE PERCEIVED LOUDNESS AND ANNOYANCE
CHICAGO—Clinical characteristics of tinnitus such as duration, consistency and other factors influence the way individuals perceive loudness and annoyance associated with the condition, according to a report in the December issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
Tinnitus, a ringing, buzzing or whistling sound in one or both ears occurring without outside stimulus, can be acute or chronic, constant or intermittent. Tinnitus can be due to a medical disease or of unknown origin. According to background information in the article, some patients describe their tinnitus to be louder than most or all environmental sounds and 1 percent to 5 percent report that tinnitus is so troublesome that it interferes with sleep or has led to disability and reduced quality of life.
Wolfgang Hiller, Ph.D., University of Mainz, Germany, and Gerhard Goebel, M.D., from Roseneck Center of Behavioral Medicine, Prien, Germany, analyzed data from a mail survey composed of two parts: a questionnaire to assess perceived annoyance and a comprehensive screening questionnaire that grades loudness. The total of 4,995 individuals who responded had an average age of 56 years and was 42 percent female and 58 percent male.
A total of 4,971 individuals accurately completed the loudness survey. Of these, 407 (8.2 percent) rated their condition as grade I (weak degree of tinnitus loudness), 2,964 (59.6 percent) as grade II (medium degree of tinnitus loudness) and 1,600 (32.2 percent) as grade III (strong degree of tinnitus loudness). Annoyance scores were available for 4,982 people of whom 1,957 (39.2 percent) were categorized as mildly distressed, 1,189 (23.9 percent) as severely distressed and 637 (12.8 percent) as most severely distressed. Most of those with grade I conditions reported mild tinnitus distress, those with grade II conditions were split and approximately two-thirds of those in grade III reported having severe or very severe distress, indicating a moderate correlation between loudness and annoyance.
“In particular, higher levels of severity were found in men, older adults, binaural [in both ears] and centrally perceived tinnitus, increase in tinnitus intensity since onset, sensitivity to loud external noise, continuous tinnitus (as opposed to intermittent tinnitus) and the coexistence of hearing loss, vertigo and hyperacusis [abnormal sensitivity to sounds],” the authors note. However, other factors had an inconsistent influence on loudness and annoyance. The share of individuals who experienced an increase in tinnitus loudness since onset was 35 percent whereas there was no clear increase in tinnitus annoyance in years since onset. The authors believe it is possible that habituation and acceptance of tinnitus increase over time, which is likely to lead to reduced annoyance.
“Although it has been shown that personal distress due to tinnitus is to some degree dependent on primarily psychological factors such as cognitive appraisal or differences in coping behavior, the role of physical, audiologic and medical properties of tinnitus should not be underestimated,” the authors conclude. “We need studies that investigate the determinants of tinnitus loudness and annoyance to understand more deeply how patients react to their tinnitus and which factors contribute to the long-term maintenance of distress.”
(Arch Otolaryngol Head Neck Surg. 2006;132:1323-1330. 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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