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, July 16, 2007)
DIABETICS EXPERIENCE MORE COMPLICATIONS FOLLOWING TRAUMA
CERTAIN TYPE OF COLITIS APPEARS TO HAVE BECOME MORE COMMON AND MORE SEVERE AMONG HOSPITALIZED PATIENTS
ARCHIVES OF DERMATOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, July 16, 2007)
RATES OF CUTANEOUS T-CELL LYMPHOMA INCREASE OVER 30 YEARS
ARCHIVES OF FACIAL PLASTIC SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, July 16, 2007)
SURGICAL TECHNIQUE HELPS TO REANIMATE PARALYZED FACES
ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, July 16, 2007)
STUDY SHOWS NO CHANGE IN SENSE OF TASTE AFTER TONSIL REMOVAL
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, July 16, 2007
Media Advisory: To contact corresponding author Robert A. Cherry, M.D., call Megan Walde Manlove at 717-531-8604 or Courtney Verdelli at 717-531-3801.
DIABETICS EXPERIENCE MORE COMPLICATIONS FOLLOWING TRAUMA
CHICAGO—Individuals with diabetes appear to spend more days in the intensive care unit, use more ventilator support and have more complications during hospitalization for trauma than non-diabetics, according to a report in the July issue of Archives of Surgery, one of the JAMA/Archives journals.
Approximately 17 million Americans have diabetes, with one-third remaining undiagnosed, according to background information in the article. These patients develop complications more frequently and do worse after an acute illness than individuals without diabetes. Studies show that diabetics do worse after being hospitalized for stroke, heart attack and heart surgery, but little is known about their outcomes after trauma.
Rehan Ahmad, D.O., and colleagues at the Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Penn., used a statewide database to identify 12,489 patients with diabetes who were hospitalized at 27 trauma centers between 1984 and 2002. They then selected an additional 12,489 patients who were the same age and sex and had the same severity of injury but did not have diabetes for comparison.
There was no difference between the two groups in death rates or length of hospital stay. However, compared with patients who did not have diabetes, patients with diabetes:
- were more likely to experience any complication (23 percent vs. 14 percent)
- were more likely to require care in the intensive care unit (ICU) (38.4 percent vs. 35.9 percent)
- stayed in the ICU longer on average (7.6 days vs. 6.1 days)
- required longer duration of ventilator support (10.8 days vs. 8.4 days)
- developed more infections (11.3 percent vs. 6.3 percent)
“Patients with diabetes mellitus were less likely to be discharged to home and were more likely to require skilled nursing care after discharge compared with patients who did not have diabetes mellitus,” the authors write. “This may have accounted for the similarity in overall hospital length of stay between the diabetes mellitus and non–diabetes mellitus groups. In addition, improved diabetes mellitus treatment modalities and advances in critical care and trauma resuscitation likely contributed to comparable mortality rates between the two groups, despite the greater morbidity associated with having diabetes mellitus.”
Previous studies have demonstrated that diabetes reduces the effectiveness of some components of the immune system, the authors continue. “Results from this study confirm that patients with diabetes mellitus are at higher risk for developing an infectious complication, despite matching for sex, age and the severity of injury,” they conclude. “They also require a higher level of care, which adds to the cost of hospitalization. Future studies are needed to evaluate the effect of improved glycemic control on hospitalized patients with diabetes mellitus involved in trauma.”
(Arch Surg. 2007;142(7):613-618. 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, July 16, 2007
Media Advisory: To contact Rocco Ricciardi, M.D., M.P.H., call Rose Lewis at 781-744-5440.
CERTAIN TYPE OF COLITIS APPEARS TO HAVE BECOME MORE COMMON AND MORE SEVERE AMONG HOSPITALIZED PATIENTS
CHICAGO—The rate of cases of colitis (colon inflammation) caused by the bacteria Clostridium difficile more than doubled among patients hospitalized in the United States between 1993 and 2003, and the illness was more severe and associated with an increased mortality rate, according to a report in the July issue of Archives of Surgery, one of the JAMA/Archives journals.
C. difficile inhabits the intestines of approximately 1 percent to 3 percent of healthy adults and about 20 percent of patients receiving antibiotics, according to background information in the article. When the balance of bacteria in the colon is altered, C. difficile can cause a variety of symptoms, including severe or complicated diarrhea that may eventually lead to death. Treatment for life-threatening forms of the disease usually involves colectomy, or removal of all or part of the colon, which is associated with a high rate of complications and high mortality. “Three million new cases of C. difficile colitis occur in the United States each year: as many as 10 percent of patients hospitalized for at least two days are affected,” the authors write. “Anecdotal evidence and some case series suggest that C. difficile colitis has become more common and potentially more pathogenic.”
Rocco Ricciardi, M.D., M.P.H., then of the University of Minnesota Medical School, Minneapolis, and now of Lahey Clinic, Burlington. Mass., and colleagues analyzed discharge data from a database of U.S. hospitals between 1993 and 2003. The database, the Nationwide Inpatient Sample, “includes data from about 7 million hospital stays per year in 1,000 hospitals located in 35 states; thus, it approximates a 20 percent stratified sample of U.S. community hospitals,” the authors write. “It provides information on patient demographics, socioeconomic factors, admission profiles, hospital profiles, state codes, discharge diagnoses, procedure codes, total charges and vital status at hospital discharge.”
In the 78,091,119 discharges that occurred in the 11-year study period, 299,453 patients had a diagnosis of C. difficile colitis, a rate of 383 cases per 100,000 discharged patients. “The rate of C. difficile colitis discharges increased from 261 cases per 100,000 discharged patients in 1993 to 546 cases per 100,000 discharged patients in 2003, a 109 percent increase,” the authors write. Colectomy rate, which was 2.7 per 1,000 patients overall, increased from 1.2 per 1,000 patients in 1993 to 3.4 per 1,000 patients in 2003. The total rate of death among patients with C. difficile colitis was 33.6 deaths per 100,000 discharged patients throughout the study; this rate increased 147 percent in 11 years, from 20.3 deaths per 100,000 discharged patients in 1993 to 50.2 deaths per 100,000 discharged patients in 2003.
“Hospital discharge with a C. difficile diagnosis was significantly more likely with increasing calendar year,” the authors continue. “In addition, the likelihood of death and of treatment with colectomy also significantly increased over time.”
The results document the changing nature of C. difficile colitis but do not offer explanations for the change, the authors note. The shift could be caused by new strains of the bacteria, its increasing resistance to antibiotics or the increasing severity of illness and therefore susceptibility to infection among hospitalized patients in the United States.
“Heightened awareness of the increasing disease burden of C. difficile colitis is an important first step in controlling the public health ramifications of this important and morbid nosocomial [hospital-acquired] infection,” they conclude.
(Arch Surg. 2007;142(7):624-631. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by the University of Minnesota Academic Health Center’s Clinical Scholars Research Grant. 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, July 16, 2007
Media Advisory: To contact Vincent D. Criscione, A.B., call Wendy Lawton at 401-863-1862. To contact editorialist Stuart R. Lessin, M.D., call Karen Mallet at 215-728-2700.
RATES OF CUTANEOUS T-CELL LYMPHOMA INCREASE OVER 30 YEARS
CHICAGO—The cancer known as cutaneous T-cell lymphoma became substantially more common in the United States between 1973 and 2002, according to a report in the July issue of Archives of Dermatology, one of the JAMA/Archives journals. The rates of the disease vary by race, sex and geographic area.
Cutaneous T-cell lymphoma occurs when certain cells of the lymph system (called T lymphocytes) become cancerous and affect the skin. The term covers several types of lymphoma, according to background information in the article. The nationwide rates of the disease were last documented in 1992.
Vincent D. Criscione, A.B., and Martin A. Weinstock, M.D., Ph.D., of the VA Medical Center, Rhode Island Hospital, and Brown University, Providence, R.I., used data from 13 cancer registries of the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute to describe incidence trends in cutaneous T-cell lymphoma from 1973 through 2002.
A total of 4,783 cases were identified in the 30-year period, a rate of 6.4 per million persons and a total of 0.14 percent of all cancers and 3.9 percent of non-Hodgkins lymphomas. The overall incidence increased each decade, was higher among blacks than whites and among men than women, increased substantially with age, and varied geographically. The San Francisco registry had the highest rates—9.7 per million white individuals and 10.8 per million black individuals—while the Iowa registry had the lowest, with 3.7 per million white individuals and 5.8 per million among blacks.
“The geographic differences in incidence are substantial even after controlling for race. Incidence is correlated with high physician density and several indexes of socioeconomic status such as median family income, percentage of the population with a bachelor’s degree or higher and median home value,” the authors write. “These geographic differences in incidence may be related, to some degree, by differences in access to medical care.”
Changes and ambiguities in classifications and coding may be partially responsible for the increase in incidence over time, the authors note, as may improved detection and advances in medical technology. “An epidemiological investigation using population-based data is important to better understand this disorder,” they conclude. However, “these data may be useful in planning public health strategies, identifying risk factors and understanding the etiology of this cancer so that it may some day be prevented.”
(Arch Dermatol. 2007;143(7):854-859. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This project was funded by a grant from the Cutaneous Lymphoma Foundation. Dr. Weinstock was supported by grants from the Department of Veterans Affairs, Office of Research and Development, Washington, D.C., and from the National Cancer Institute, Bethesda, Md. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: PATIENTS HELPING TO SOLVE DISEASE’S MYSTERY
Scientists have been attempting for 200 years to uncover the underlying causes of cutaneous T-cell lymphoma, and while the disease remains mysterious, dermatologists and patients have begun working together to understand it, writes Stuart R. Lessin, M.D., of the Fox Chase Cancer Center, Philadelphia, in an accompanying editorial.
“Many etiologic factors have been advanced and studied, but none have been conclusive,” Dr. Lessin writes. “These have included occupational exposures, viruses (Epstein-Barr virus, human T-lymphotropic virus 1 and human herpesvirus 6) and bacteria (staphylococcal superantigens).”
“While the increased incidence of cutaneous T-cell lymphoma remains unexplained, it demonstrates the increasing importance of the role of the dermatologist to remain at the forefront of diagnosis and treatment” of the disease, Dr. Lessin continues.
(Arch Dermatol. 2007;143(7):916-918. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Dr. Lessin serves as chairman of the Medical Advisory Board and as a member of the Board of Directors of the Cutaneous Lymphoma Foundation, the organization that funded the project that is the subject of this editorial. Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, July 16, 2007
Media Advisory: To contact Patrick J. Byrne, M.D., call David March at 410-955-1534.
SURGICAL TECHNIQUE HELPS TO REANIMATE PARALYZED FACES
CHICAGO—A surgical technique known as temporalis tendon transfer, in conjunction with intense physical therapy before and after surgery, may help reanimate the features of those with facial paralysis, according to a report in the July/August issue of Archives of Facial Plastic Surgery, one of the JAMA/Archives journals.
“The rehabilitation of facial paralysis is one of the greatest challenges faced by reconstructive surgeons today,” the authors write as background information in the article. “It is an unfortunate fact that there is no ideal procedure that leads to the return of fully normal facial function. Furthermore, every case of facial paralysis is different in the cause of the paralysis, the degree and location of the paralysis and the resulting condition of the facial musculature and surrounding soft tissue envelope.” Many patients have excessive movement in some areas of the face and no movement in others; as a result, surgeons treating this condition must be able to perform multiple types of procedures and understand the underlying neurologic dysfunction.
Patrick J. Byrne, M.D., and colleagues at The Johns Hopkins University School of Medicine, Baltimore, report the results of seven facial paralysis patients treated with temporalis tendon transfer. This technique typically involves an incision beginning at the ear and ending 3 to 4 centimeters into the hairline at the temple. The temporalis muscle, a fan-shaped muscle on the side of the head, is cut at the point that it connects to the jawbone and released from the tissue surrounding it. Then, it is stretched to the point where the muscles of the mouth join together. The tendon that previously connected the temporalis muscle to the jawbone is cut free and then stretched horizontally for 3 to 4 centimeters; it is sutured to the surrounding muscles and deep skin tissue. Physical therapy to retrain facial muscles begins before the surgery and continues beginning seven days after the procedure.
At a minimum of four months after the surgery, “patient satisfaction was very high,” the authors write. “Of a possible 10 points, patients reported mean [average] satisfaction with appearance of 8.4, with feeding of 8.1, with speech of 8.7 and with smile function of 7.1.” Photographs taken of the patients were graded by 21 physicians in the Johns Hopkins Department of Otolaryngology–Head and Neck Surgery. “Four patients were physician-graded as excellent to superb. The other three patients were rated as having good postoperative results.”
Movement in each patient’s mouth muscles was assessed by measuring the position of the muscles at rest and again when the patient contracted just the temporalis muscle. Movement was identified in all patients following the procedure, with measurements ranging from 1.6 millimeters to 8.5 millimeters and an average of 4.2 millimeters.
“Temporalis tendon transfer is a relatively easy procedure to perform that has distinct advantages compared with other forms of facial reanimation and provides very good results,” the authors conclude. These advantages include its immediate effect, the ease with which the tendon is harvested and transferred and the predictability of the outcomes. “This procedure results in improved form and function, may often be performed in a minimally invasive manner and eliminates the facial asymmetry typically produced by temporalis transfer,” a similar procedure in which only the temporalis muscle is moved.
(Arch Facial Plast Surg. 2007;9(4):234-241. 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.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, July 16, 2007
Media Advisory: To contact Christian A. Mueller, M.D., e-mail: chr.mue{at}gmx.at.
STUDY SHOWS NO CHANGE IN SENSE OF TASTE AFTER TONSIL REMOVAL
CHICAGO—In a small study of patients undergoing tonsillectomy, or removal of the tonsils, none reported an ongoing dysfunction in their sense of taste following the procedure, according to a report in the July issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
Together with the sense of smell and nerve impulses in the mouth, “the sense of taste contributes considerably to flavor perception during eating and drinking and thus plays a major role in the enjoyment of foods and beverages,” according to background information in the article. The sense of taste shows little deterioration during aging but can be weakened by disease or medications. Accidental nerve damage during some medical procedures, including radiation treatment, middle ear surgery, dental or oral surgery or tonsillectomy, also can cause taste dysfunction.
Christian A. Mueller, M.D., of the University of Vienna, Austria, and colleagues asked 65 tonsillectomy patients (42 females, 23 males; average age 28) to rate their own sense of smell and taste before surgery on a scale of zero to 100, where zero is no sense of taste or smell and 100 is an excellent sense of taste and smell. Taste function and sensitivity also was assessed one day before surgery with gustatory testing, during which taste strips for four concentrations of sweet, sour, salty and bitter were applied to both sides of the front and back areas of the tongue. Between 64 and 173 days after surgery, patients were asked to report any changes to their sense of taste or smell and again asked to rate them from zero to 100. Gustatory testing was performed again on 32 patients.
On average, patients’ ratings of their sense of taste and smell decreased following surgery—the average score was 62.3 before surgery and 51.1 after surgery. However, there were no significant changes in gustatory test scores following surgery. In addition, none of the patients reported ongoing dysfunction in their sense of taste or smell at the follow-up questioning.
“This raises the question of whether taste ratings also depend on attentional factors,” the authors write. “Thus, it may be hypothesized that the patients’ ratings of taste function were influenced by the presence of postoperative pain, oral discomfort or wound healing during the first days and weeks after tonsillectomy.”
“A number of case reports and a few systematic investigations of patients experiencing taste disorders after tonsillectomy have been published,” they conclude. “However, based on the present results, taste loss after tonsillectomy seems to be a rare complication.”
(Arch Otolaryngol Head Neck Surg. 2007;133(7):668-671. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by a grant from the Medizinisch-Wissenschaftlicher Fonds des Bürgermeisters der Bundeshauptstadt Wien. 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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