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, September 17, 2007)
SURGEONS SUCCESSFULLY REMOVE GALLBLADDER WITHOUT OUTER INCISIONS
HOSPITAL COMPARISON WEB SITES MAY OFFER INCONSISTENT RESULTS
ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, September 17, 2007)
PATIENTS WITH HEAD AND NECK CANCER MAY HAVE IMPAIRMENT OF SOME DRIVING SKILLS
CERTAIN TONSIL REMOVAL TECHNIQUE ASSOCIATED WITH REDUCED POSTOPERATIVE PAIN, BLEEDING
ARCHIVES OF FACIAL PLASTIC SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, September 17, 2007)
NASAL SURGERY CREATES FEMININE PROFILES IN MALE-TO-FEMALE TRANSSEXUALS
ARCHIVES OF DERMATOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, September 17, 2007)
SKIN COOLING ASSOCIATED WITH INCREASED RISK OF DISCOLORATION AFTER LASER TREATMENT
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
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Please Note: The FOR THE MEDIA website now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, September 17, 2007
Media Advisory: To contact Jacques Marescaux, M.D., F.R.C.S., e-mail jacques.marescaux{at}ircad.u-strasbg.fr.
SURGEONS SUCCESSFULLY REMOVE GALLBLADDER WITHOUT OUTER INCISIONS
Surgical Technique Leaves No Visible Scar
CHICAGO—French surgeons successfully removed a woman’s gall bladder through her vagina, according to a report in the September issue of Archives of Surgery, one of the JAMA/Archives journals.
The history of surgery has moved toward less invasive procedures, according to background information in the article. "Whenever it was possible, patients would ask for a surgical procedure that left no outer scarring and resulted in no postoperative pain," the authors write. "Patients, both male and female, independent of age and body shape, dislike scars, not only for cosmetic reasons but because scars indicate they have undergone treatment because of illness. This resulted in natural orifice transluminal endoscopic surgery (NOTES), with its general goal of minimizing the trauma of any interventional process by eliminating the incision through the abdominal wall and using natural orifices."
Jacques Marescaux, M.D., F.R.C.S., and colleagues at University Louis Pasteur, Strasbourg, France, performed a cholecystectomy (gall bladder removal) through the vagina in a 30-year-old woman. The surgical team was multidisciplinary and included a gynecologist experienced in transvaginal procedures, who made and closed the small incision in the back of the vagina. The procedure was performed with instruments inserted through this opening and the gallbladder was removed through the vagina. No bleeding or leakage of liver fluids occurred during the three-hour procedure.
"The patient recovered promptly after surgery, with no postoperative pain and no scars," the authors write. "Although she was feeling well on the evening of the surgery, we elected to discharge her on postoperative day two because this was our first case. At the follow-up visit 10 days after surgery, the patient had completely resumed full activity, with no discharge or bleeding and no discomfort at the perineal [bottom of pelvis] access site."
"It is exciting to contemplate the potential for NOTES in improving patient care," they continue. "A surgical intervention that eradicates the need for any incision, avoiding bodily trauma, is attractive to patients and also has an aura that surgeons find hard to resist." However, these benefits must be supported by research and show results comparable to the currently accepted surgical criteria, and surgeons must be trained properly in the new procedures, they note.
(Arch Surg. 2007;142(9):823-827. 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, September 17, 2007
Media Advisory: To contact Michael J. Leonardi, M.D., call Rachel Champeau at 310-794-2270.
HOSPITAL COMPARISON WEB SITES MAY OFFER INCONSISTENT RESULTS
CHICAGO—A review of six publicly available hospital comparison Web sites suggests that they display inconsistent results and use inappropriate or incomplete standards to measure quality, according to a report in the September issue of Archives of Surgery, one of the JAMA/Archives journals.
A total of 113 million Americans searched for health information on the Internet in 2006, according to background information in the article. Of those, 29 percent searched for information on specific hospitals and physicians. At the same time, pressure from insurance companies and the public for transparency and accountability in health care continues to increase. Data on hospital performance is frequently made available through Web sites aimed at patients, but few researchers have examined these sites and their content.
Michael J. Leonardi, M.D., and colleagues at the David Geffen School of Medicine at UCLA, Los Angeles, performed a systematic Internet search in September 2006 to identify publicly available hospital quality comparison sites. Six sites were identified and rated on accessibility, transparency of the data and statistical calculations, appropriateness, consistency and timeliness.
Of the six sites identified, one was government-run (Hospital Compare from the Centers for Medicare and Medicaid Services), two were non-profit (Quality Check from the Joint Commission on Accreditation of Healthcare Organizations and the Leapfrog Group’s Hospital Quality and Safety Survey Results), and three were private and proprietary.
"For accessibility and data transparency, the government and non-profit Web sites were best," the authors write. "For appropriateness, the proprietary Web sites were best, comparing multiple surgical procedures using a combination of process, structure and outcome measures. However, none of these sites explicitly defined terms such as complications." All data on the sites were at least one year old, and most were two or more years old.
To determine consistency, sample searches were conducted on the three proprietary Web sites comparing four Los Angeles–area hospitals on three common procedures (laparoscopic gall bladder removal, hernia repair and colon removal). The searches demonstrated significant inconsistencies—for example, for colon removal, one hospital was ranked best by two sites but worst by the other site, and the hospital ranked best on that site was ranked worst on another.
"Further work is needed to improve these issues, particularly the accessibility by patients, the quality and type of data reporting, the statistical method and the criteria by which hospitals and specific operations are compared. It is probably important that surgeons be involved with the development of such reporting Web sites so that the comparisons accurately and appropriately reflect the quality of surgical care."
(Arch Surg. 2007;142(9):863-869. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by the Robert Wood Johnson Clinical Scholars 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, September 17, 2007
Media Advisory: To contact Hon K. Yuen, Ph.D., O.T.R./L., call Vicky Agnew at 843-792-0376.
PATIENTS WITH HEAD AND NECK CANCER MAY HAVE IMPAIRMENT OF SOME DRIVING SKILLS
CHICAGO—A preliminary study suggests that patients with cancer in the head and neck region may have inferior performance in some driving skills compared with individuals without the disease, according to a report in the September issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
"Driving is a complex task that requires adequate cognitive, psychomotor and visuoperceptualmotor functions that work together. These functions can be compromised to a greater or lesser extent in patients with cancer in the head and neck region who have received cancer treatment," the authors write. Side effects from cancer treatment may reduce head and neck mobility and may cause cognitive impairment, pain and psychological distress predisposing patients to greater driving risks.
Hon K. Yuen, Ph.D., O.T.R./L., of the Medical University of South Carolina, Charleston, and colleagues used a virtual reality driving simulator to evaluate the driving skills of 10 patients with head and neck cancer (average age 56) and 50 members of the community (average age 48). Researchers recorded average speed, average brake reaction time, steering variability (vehicle offset from the center of driving lane in inches), the total number of collisions and the score of the Simulator Driving Performance Scale, which assesses participants’ driving behavior and skills including braking properly at intersections, driving within the speed limit, using mirrors properly and staying a safe distance from other vehicles.
The median (midpoint) time between surgery and participation in the study was 26.6 months and the average time between cancer therapy and study participation was 20 months.
The average brake reaction time and steering variability in the patients with cancer group were significantly longer (3,134.92 milliseconds vs. 2,299.8 milliseconds) and larger (271.26 inches vs. 46.45 inches), respectively, than those in the control group. There was not a significant difference between the two groups in average speed (21.8 miles per hour vs. 25.18 miles per hour), total number of collisions (1.1 vs. 1.4) or Simulator Driving Performance Scale scores.
"This pilot study provides preliminary evidence indicating inferior driving performance in a group of patients with cancer in the head and neck region when compared with a community control group," the authors conclude. Further study is needed to investigate specific causes that may contribute to poor driving performance and the consequences this may have on driving in the real world for patients with cancer.
(Arch Otolaryngol Head Neck Surg. 2007;133(9):904-909. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by a grant from the American Cancer Society. 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, September 17, 2007
Media Advisory: To contact Richard Schmidt, M.D., call James Lardear at 302-651-6092.
CERTAIN TONSIL REMOVAL TECHNIQUE ASSOCIATED WITH REDUCED POSTOPERATIVE PAIN, BLEEDING
CHICAGO—Patients who have a tonsillectomy using an "intracapsular" technique—which removes at least 90 percent of tonsil tissue, but spares the tonsil capsule—appear to have less postoperative heavy bleeding and pain compared with those who undergo traditional tonsil removal surgery, according to a report in the September issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
Tonsillectomy (removal of the tonsils) with or without removal of the adenoids (tissue at the back of the throat) is one of the most commonly performed surgeries in the United States, according to background information in the article. "The technique for performing tonsillectomy, dissection of all tonsillar tissue free of the underlying pharyngeal constrictor muscle, has not changed significantly in more than 60 years," the authors write. "The most common serious complication of tonsillectomy is delayed hemorrhage [severe bleeding], which occurs in 2 percent to 4 percent of all patients. In addition, an expected sequela [consequence] of the procedure is pain, which typically lasts from seven to 10 days and can be moderate to severe in intensity."
Richard Schmidt, M.D., and colleagues at the Alfred I. duPont Hospital for Children, Wilmington, Del., analyzed the medical records of 2,944 patients who underwent tonsillectomy with or without adenoidectomy between 2002 and 2005. For 1,731 patients, surgeons used a newer technique known as intracapsular tonsillectomy, which involves using an instrument known as a microdebrider to remove 90 percent of the tonsil tissue and preserving a layer of tonsil (the capsule) over the throat muscles. A total of 1,212 underwent traditional tonsillectomy, in which all tonsil tissue is cut and removed.
Among those in the traditional tonsillectomy group, 3.4 percent had delayed (more than 24 hours after surgery) hemorrhage and 2.1 percent required treatment in the operating room for bleeding, compared with 1.1 percent and 0.5 percent among those in the intracapsular tonsillectomy group. Three percent of those undergoing intracapsular tonsillectomy and 5.4 percent of those undergoing traditional tonsillectomy required emergency room treatment for pain or dehydration, which often occurs after tonsil surgery when pain restricts fluid intake. Eleven patients (0.64 percent) who had intracapsular tonsillectomies and none of those who had traditional tonsillectomies needed revision tonsillectomies.
"The ideal tonsillectomy would have minimal or no risks and be completely effective," the authors write. "Although the risks for intracapsular tonsillectomy are lower than those for traditional tonsillectomy, the procedure is not always effective. Eleven patients required revision tonsillectomy in the intracapsular tonsillectomy group compared with none in the traditional tonsillectomy group. However, an additional surgical procedure (including control of hemorrhage in the operating room) may be more likely with traditional tonsillectomy than with intracapsular tonsillectomy."
(Arch Otolaryngol Head Neck Surg. 2007;133(9):925-928. 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, September 17, 2007
Media Advisory: To contact corresponding author Hesham A. Saleh, F.R.C.S., e-mail hsaleh{at}hhnt.org.
NASAL SURGERY CREATES FEMININE PROFILES IN MALE-TO-FEMALE TRANSSEXUALS
CHICAGO—Nasal surgery appears to effectively create feminine facial profiles in patients undergoing male-to-female gender reassignment, according to a report in the September/October issue of Archives of Facial Plastic Surgery, one of the JAMA/Archives journals.
"Transsexualism is a recognized medical condition, with an estimated incidence of one in 37,000, in which the affected individuals strongly believe themselves to have been born into the body of the wrong sex," the authors write as background information in the article. "Increasing acceptance of this condition as a medical disorder has led to the development of a number of medical and surgical approaches aimed at aligning the patient’s physical appearance with his or her perceived sex."
S. A. Reza Noureai, M.B.B.Chir., and colleagues at Charing Cross Hospital, London, studied 12 patients who underwent rhinoplasty (plastic surgery on the nose) as part of male-to-female gender reassignment between 1998 and 2004. The surgery involves reducing the overall size of the nose and also changing nasal angles to more closely match those of female noses. Two independent observers assessed the participants’ facial profile before and after surgery and also measured specific facial angles. Patients’ nasal function was tested before and after surgery, and they were asked to rate their satisfaction on a five-point scale after the operation and again one year later.
"The surgical procedure resulted in a more feminine nasal profile in all patients," the authors write. "One patient was subjectively unhappy with the results of surgery and underwent revision surgery, and the remaining patients were very satisfied with the results of surgical treatment, both in the early postoperative period and at the one-year follow-up visit. Five patients stated at the one-year visit that their nasal procedure had had one of the greatest impacts on their overall perception of themselves as female." No patients had difficulty with nasal valve functioning.
"Rhinoplasty is effective in achieving feminine facial profiles in patients undergoing male-to-female gender reassignment," they conclude. "This requires reducing the overall nasal size and changing nasal angles to those more reminiscent of the female form. Because of the extensive resections often required to modify the nasal form, it is important to pay particular attention to preserving function, which may require concomitant nasal valve reconstruction."
(Arch Facial Plast Surg. 2007;9(5):318-320. 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, September 17, 2007
Media Advisory: To contact Woraphong Manuskiatti, M.D., e-mail siwmn{at}mahidol.ac.th.
SKIN COOLING ASSOCIATED WITH INCREASED RISK OF DISCOLORATION AFTER LASER TREATMENT
CHICAGO—A cooling technique intended to protect the skin may actually increase the risk of discoloration in dark-skinned patients undergoing laser treatments for mole-like skin lesions, according to a report in the September issue of Archives of Dermatology, one of the JAMA/Archives journals.
Hyperpigmentation, when the skin’s cells increase their production of the brown or black pigment melanin, is the most common adverse effect of laser treatments in dark-skinned individuals, according to background information in the article. "It is not life-threatening, but postinflammatory hyperpigmentation may cause substantial psychological problems," the authors write. "The treatment of postinflammatory hyperpigmentation is difficult and time-consuming, often lasting many months to achieve the desired results, which causes frustration in patients and physicians." Some clinicians have hypothesized that skin cooling, which decreases pain and allows the use of higher laser frequencies, could also reduce hyperpigmentation after laser treatment.
Woraphong Manuskiatti, M.D., and colleagues at Mahidol University, Bangkok, Thailand, used laser irradiation (from a 1,064-nanometer Q-switched Nd:YAG laser) to treat 23 Thai women (average age 43) with Hori nevus, blue-brown pigmented spots on the skin that develop later in life. "One randomly selected face side of each patient was cooled using a cold air cooling device during and 30 seconds before and after laser irradiation, and the other side was irradiated without cooling," the authors write. Two dermatologists not involved in treatment examined digital photographs to measure the occurrence of hyperpigmentation before treatment and one, two, three, four and 12 weeks after treatment.
Of the 21 patients who completed the study, 13 (62 percent) developed hyperpigmentation on the cooled side, five (24 percent) developed it on the uncooled side, one patient (5 percent) developed it on both sides and two (10 percent) did not experience any hyperpigmentation. The cooled sides were three times more likely to become hyperpigmented after laser treatment than the uncooled sides. Most (62 percent) of the cases of hyperpigmentation developed two weeks after treatment, and all but one case completely resolved 12 weeks after treatment.
All patients showed less than 25 percent lightening of their Hori nevi at 12 weeks post-treatment. "No difference in clinical improvement was observed regarding the cooling used on one side during treatment," the authors write.
It is unclear why cold air cooling would increase the risk of hyperpigmentation following laser treatment, but skin cells may have reacted to the combination of laser treatment and cold air, the authors note. "Future studies should address the question of whether the other methods of epidermal cooling are associated with an increased risk of postinflammatory hyperpigmentation," they conclude.
(Arch Dermatol. 2007;143(9):1139-1143. 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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