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 FACIAL PLASTIC SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, March 17, 2008)
STUDY OUTLINES RISK OF TREATMENT-RESISTANT INFECTION FOLLOWING FACELIFT SURGERY
YOUNGER AGE, INVOLVEMENT ON NECK OR ARMS ASSOCIATED WITH ABNORMAL SCARRING AFTER BURN INJURY
ARCHIVES OF SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, March 17, 2008)
BODY MASS INDEX HIGHER AMONG BARIATRIC SURGERY PATIENTS WITH TWO GENETIC VARIATIONS
TRAUMA PATIENTS LIKELY TO EXPERIENCE MODERATELY SEVERE PAIN ONE YEAR AFTER INJURIES
ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, March 17, 2008)
STUDY EXAMINES CHANGES IN QUALITY OF LIFE AFTER HEAD AND NECK CANCER TREATMENT
ARCHIVES OF DERMATOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, March 17, 2008)
ROMANIAN COMMUNITY PROVIDES INSIGHT INTO GENETIC FACTORS ASSOCIATED WITH VITILIGO
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, March 17, 2008
Media Advisory: To contact Richard A. Zoumalan, M.D., call Pam McDonnell at 212-404-3555.
STUDY OUTLINES RISK OF TREATMENT-RESISTANT INFECTION FOLLOWING FACELIFT SURGERY
CHICAGO—About one-half percent of patients undergoing facelift surgery at one outpatient surgical center between 2001 and 2007 developed methicillin-resistant Staphylococcus aureus (MRSA) infections, according to a report in the March/April issue of Archives of Facial Plastic Surgery.
MRSA is now a leading cause of infections at surgical sites and in skin and soft tissues, according to background information in the article. It is much more virulent than other forms of staph infection, spreads through tissue more rapidly, is more difficult to control and causes infections that are more expensive to treat and are associated with higher death rates.
Richard A. Zoumalan, M.D., of Lennox Hill–Manhattan Eye, Ear, and Throat Hospital and New York University School of Medicine, New York, and David B. Rosenberg, M.D., also of Lennox Hill–Manhattan Eye, Ear, and Throat Hospital, reviewed the charts of 780 patients who underwent facelifts between 2001 and 2007. Of those, five (0.6 percent) developed surgical site infections, and four of those (0.5 percent of the total) tested positive for MRSA. All of the infections occurred in 2006.
“The high proportion of MRSA infections compared with other pathogens is likely attributable to a combination of factors,” the authors write. MRSA is an aggressive pathogen more likely to complicate surgical sites, and the antibiotic typically prescribed following surgery is effective against other types of bacteria. “For surgical site infections, the facial plastic surgeon should have a high suspicion for MRSA as the causative pathogen,” they continue.
Of the four patients with MRSA-positive infections, two were admitted to the hospital for intravenous antibiotic therapy. Both had potential exposure to MRSA before surgery. One had spent time with her spouse in the cardiac intensive care unit four months prior and the other had frequent contact with her brother-in-law, a cardiologist.
“With the rise of MRSA colonization and infections, facial plastic surgeons performing rhytidectomy [facelift] and other soft tissue procedures may want to consider introducing screening protocols to identify patients who are at increased risk for infection,” the authors write. “During preoperative evaluation, a full medical history should include information on possible prior contacts with persons at high risk for carrying MRSA.” Other significant risk factors include recently having taken antibiotics or having been hospitalized, contact with health care workers, previous MRSA infections, older age, diabetes, smoking and obesity.
“Because the medical, psychological and cosmetic sequelae of wound infections can be devastating, every appropriate step should be used to prevent wound infections in facial plastic surgery,” the authors write. This includes proper hand-washing between patients and preventive courses of antibiotics.
(Arch Facial Plast Surg. 2008;10[2]:116-123. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: 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, March 17, 2008
Media Advisory: To contact Ezio Nicola Gangemi, M.D., e-mail: ezio.nicola{at}tele2.it.
YOUNGER AGE, INVOLVEMENT ON NECK OR ARMS ASSOCIATED WITH ABNORMAL SCARRING AFTER BURN INJURY
CHICAGO—Sex, age, burn site, number of surgical procedures and the type of skin graft are associated with abnormal scarring following burns, according to a report in the March/April 2008 issue of Archives of Facial Plastic Surgery.
The survival rate of patients with burns has dramatically increased over the past few decades, but healing burns almost always form scars, according to background information in the article. “Burn scars have a dramatic influence on a patient’s quality of life,” the authors write. “They have been associated with anxiety, social avoidance, depression, a disruption in activities of daily living, the onset of sleep disturbances and all of the consequent difficulties in returning to normal life after physical rehabilitation.”
Normal scars are characterized by minor alterations in skin properties, whereas disturbances in the wound healing process produce abnormal or pathologic scars. Ezio Nicola Gangemi, M.D., and colleagues at the University of Turin, Italy, analyzed the records of 703 patients treated at an outpatient burn clinic between 1994 and 2006. In addition to the sex, age, total burn surface, cause of the burn and wound healing time, they noted the prevalence and evolution of several types of pathologic scars: hypertrophic (enlarged) scars; contracted scars, which shorten the length of the tissue; and scars with both characteristics.
Of the 703 patients, 540 (77 percent) had pathologic scars, including 310 (44 percent) with hypertrophic scars, 34 (5 percent) with contractures and 196 (28 percent) with hypertrophic-contracted scars. Patients who were female, young, burned on the neck or arms, had multiple surgical procedures or received meshed skin grafts (sections of skin that have been mechanically cut and expanded, as opposed to sheet or solid grafts) all had a higher risk of pathologic scarring.
Questions remain regarding the clinical course of post-burn scarring, the authors note. “Our data seem to support the role of the immune system for a number of reasons,” they write. Females have a higher risk for both pathologic burn scarring and most immune-related diseases, including rheumatoid arthritis and lupus. In addition, younger patients with more active immune systems are also more likely to develop abnormal scars.
The results could improve physicians’ approach to post-burn scarring, the authors note. “Risk information may be easily integrated into routine clinical practice for early risk stratification, thus facilitating optimal medical prevention and helping physicians adopt follow-up timing and more aggressive or experimental therapies for subjects likely to be at high risk,” they write.
(Arch Facial Plast Surg. 2008;10[2]:93-102. 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, March 17, 2008
Media Advisory: To contact corresponding author Glenn S. Gerhard, M.D., call Patti Urosevich at 570-271-7441.
BODY MASS INDEX HIGHER AMONG BARIATRIC SURGERY PATIENTS WITH TWO GENETIC VARIATIONS
CHICAGO—The combination of two obesity-related genetic variations may be associated with an increased body mass index (BMI) among severely obese patients undergoing bariatric weight loss surgery, according to a report in the March issue of Archives of Surgery, one of the JAMA/Archives journals.
Bariatric surgery is a highly effective treatment for patients with morbid (severe) obesity, or a BMI of 40 or higher, according to background information in the article. “Although the long-term effectiveness of bariatric surgery is not surpassed by any other modality, a subgroup of patients remain resistant to weight loss,” the authors write. “Identification of variables that determine the success of bariatric surgery have shown little consistency, and long-term success may depend on not yet identified factors.”
Xin Chu, Ph.D., and colleagues at the Geisinger Clinic, Danville, Pa., assessed 707 morbidly obese adult patients (average age 45.9, average BMI 51.2) undergoing gastric bypass operations at the facility. Demographic, BMI and laboratory data were obtained from electronic medical records. Blood samples were taken and analyzed for two common single nucleotide polymorphisms (SNPs)—variations that occur when a single building block of DNA is altered—previously found to be associated with obesity.
About 21 percent of the patients had two copies of one obesity-related SNP variant,13 percent had two copies of the other SNP and 3.4 percent had two copies of both. The average BMI among those with two identical copies of either obesity-related SNP were not significantly different from those who did not have two copies. However, those with two copies of both SNPs, or two copies of one and one copy of the other, had significantly higher BMIs than the other groups. These individuals comprised less than 20 percent of the total group.
The mechanism by which these genes may influence obesity is not yet known, the authors note. “Our results indicate that the two genes may interact, suggesting that the physiological pathways in which each is involved may be linked in some way,” they write.
“Recent data on the long-term effectiveness of bariatric surgery on BMI suggest that, for most patients, BMI will be maintained substantially below preoperative levels, though some patients regain weigh and relapse toward morbid obesity,” the authors conclude. This subgroup may carry genetic susceptibilities to obesity that overcome the effects of bypass surgery. “The identification of such susceptibility genes may therefore be important in identifying patients at high risk for postoperative weight gain. These studies may also represent some of the first specific examples of ‘surgicogenomics,’ paralleling the well-developed field of pharmacogenomics,” or using genetic information to predict individuals’ responses to medications.
(Arch Surg. 2008;143[3]:235-240. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by the Geisinger Clinical Research Fund. 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, March 17, 2008
Media Advisory: To contact Frederick P. Rivara, M.D., M.P.H., call Mary Guiden at 206-616-3192.
TRAUMA PATIENTS LIKELY TO EXPERIENCE MODERATELY SEVERE PAIN ONE YEAR AFTER INJURIES
CHICAGO—Most patients have moderately severe pain resulting from their injuries one year after sustaining major trauma, according to a report in the March issue of Archives of Surgery, one of the JAMA/Archives journals.
“Pain is a natural accompaniment of acute injury to tissues and is expected in the setting of acute trauma,” according to background information in the article. Recent studies have shown that most patients with pelvic fractures and lower extremity injuries continue to experience chronic pain five to seven years after injury. Pain after injury can lead to disability, post-traumatic stress disorder and depression.
Frederick P. Rivara, M.D., M.P.H., of the University of Washington, Seattle, and colleagues analyzed information from 3,047 patients (age 18 to 84) who were admitted to the hospital and survived to one year after experiencing acute trauma. Pain 12 months after injury was measured on a 10-point scale. Personal, injury and treatment factors that may predict chronic pain in these patients were also noted.
“At 12 months after injury, 62.7 percent of patients reported injury-related pain. Most patients had pain in more than one body region, and the mean [average] severity of pain in the last month was 5.5 on a 10-point scale,” the authors write. The occurrence of pain one year after injury was most common in those age 35 to 44 and least common in those 75 to 84. “The most common painful areas were joints and extremities (44.3 percent), back (26.2 percent), head (11.5 percent), neck (6.9 percent), abdomen (4.4 percent), chest (3.8 percent) and face (2.8 percent).”
Most (59.3 percent) of those with injury-related pain had three or more painful areas one year after injury, while only 37.3 percent had a single painful area. Patients age 75 to 84 had the fewest number of injury-related painful areas, while those 35 to 44 had the most.
“The reported presence of pain varied with age and was more common in women and those who had untreated depression before injury,” the authors write. “Pain at three months was predictive of both the presence and higher severity of pain at 12 months. Lower pain severity was reported by patients with a college education and those with no previous functional limitations.”
“The findings of this study suggest that interventions to decrease chronic pain in trauma patients are needed,” the authors conclude. “The high prevalence of pain, its severity and its effect on functioning warrant such interventions. This may consist of interventions during the acute phase of hospitalization to aggressively treat early pain and better manage neuropathic pain.”
(Arch Surg. 2008;143[3]:282-287. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was funded by a grant from the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, and a grant from the National Institute on Aging, National Institutes of Health. 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, March 17, 2008
Media Advisory: To contact David L. Ronis, Ph.D., call VA Ann Arbor Healthcare System Office of Public Affairs at 734-845-3403.
STUDY EXAMINES CHANGES IN QUALITY OF LIFE AFTER HEAD AND NECK CANCER TREATMENT
CHICAGO—In the year following their first treatment, patients with head and neck cancer report declines in their physical quality of life but improvements in their mental health quality of life, according to a report in the March issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals. Some types of treatment—especially feeding tube placement, chemotherapy and radiation therapy—were associated with changes in quality of life.
More than 40,000 new cases of head and neck cancer are diagnosed in the United States each year, according to background information in the article. “In addition to mortality [death], head and neck cancer and its treatment produce substantial reductions in health-related quality of life,” the authors write. “The treatments tend to produce pain, disfigurement, eating problems and communication problems. Many patients become disabled, and about one-third of patients continue to smoke and half are depressed.”
David L. Ronis, Ph.D., of the Veterans Affairs Ann Arbor Healthcare System and the University of Michigan School of Nursing, Ann Arbor, and colleagues studied 316 patients newly diagnosed with head and neck cancer at three otolaryngology clinics. Participants completed surveys with information about demographics, smoking status, alcohol problems, clinical and treatment variables and depression. Their quality of life was assessed using established scales that measured physical and social functioning, eating and swallowing, communication, head and neck pain and emotional well-being. Patients were reassessed one year later to identify any changes in quality of life.
Smoking, symptoms of depression and co-occurring illnesses were associated with low quality of life scores at the beginning of the study. At the one-year follow-up, quality of life decreased for physical functioning measures and eating but improved for mental health. Treatment factors, especially feeding tube placement, chemotherapy and radiation therapy, were associated with decreases in quality of life from the beginning of the study through one year. “Baseline smoking and depressive symptoms also remained significant predictors of several quality of life scales at one year,” the authors write.
Physicians may be able to improve quality of life in patients with head and neck cancer by treating depression and by emphasizing the negative effects smoking can have on everyday life, the authors note. In addition, “physicians should alert patients to the relative effects on quality of life one may experience with different treatments,” the authors conclude.
(Arch Otolaryngol Head Neck Surg. 2008;134[3]:241-248. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by a grant made available by the U.S. National Institutes of Health through the University of Michigan Head and Neck Specialized Program of Research Excellence. 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, March 17, 2008
Media Advisory: To contact corresponding author Richard A. Spritz, M.D., F.A.C.M.G., call Tonya Ewers at 303-724-1524.
ROMANIAN COMMUNITY PROVIDES INSIGHT INTO GENETIC FACTORS ASSOCIATED WITH VITILIGO
CHICAGO—An isolated, inbred Romanian community has a higher than average frequency of the skin disease vitiligo and other autoimmune diseases, suggesting a genetic variation that may indicate susceptibility to the condition in a broader population, according to a report in the March issue of Archives of Dermatology, one of the JAMA/Archives journals.
Vitiligo is a disorder in which progressive patches of skin, hair and mucous membranes lose color due to a decrease in the number of pigment-producing cells known as melanocytes, according to background information in the article. Vitiligo affects about 0.38 percent of whites and occurs with similar frequency in populations worldwide. Researchers are attempting to identify the genes responsible for susceptibility to vitiligo, in part to identify pathways through which effective treatments might be developed.
Stanca A. Birlea, M.D., Ph.D., and colleagues at the University of Colorado Denver, Aurora, Colo., studied 1,673 residents of a geographically isolated community in the mountains of northern Romania between 2001 and 2006. The researchers identified patients with vitiligo and obtained information on demographic data, genealogies, occurrence of other diseases and family structure. The skin of patients with vitiligo and their relatives was examined.
During the study, researchers identified and examined 51 patients with vitiligo. “The 2.9 percent frequency of vitiligo in the study community is 19.3 times its 0.15 percent frequency in the five surrounding villages, 7.5 times that among whites on the island of Bornholm, 5.7 times that among individuals in Calcutta, India and 22.5 times that among Han Chinese in Shaanxi Province, China, the only other populations for which empirically determined prevalence estimates have been published,” the authors write. Rates of other autoimmune diseases, including thyroid disease, adult-onset type 1 diabetes and rheumatoid arthritis, were also elevated in the community.
However, the average age at which symptoms of vitiligo first developed was 36.5 years, significantly older than the average age of onset among white individuals (24.2 years). Analyses indicated that this unusual factor most likely was not genetic. “Whereas disease susceptibility seems to involve a major genetic component, actual onset of vitiligo in genetically susceptible individuals seems to require exposure to environmental triggers,” the authors write.
The community’s isolation may make it easier for researchers to identify mutated genes that increase risk for vitiligo in this population, they conclude. “While this gene variant is of particular importance in this isolated special population, it likely is also involved in disease susceptibility in the broader white population and, thus, is of broader importance,” they write.
(Arch Dermatol. 2008;144[3]:310-316. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by grants from the National Institutes of Health and a grant from the American Skin Association. 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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