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, June 16, 2008)
TYPE AND SEVERITY OF COMBAT WOUNDS IN IRAQ WAR HAS CHANGED OVER TIME
ULTRASONIC INSTRUMENTS ASSOCIATED WITH IMPROVED OUTCOMES FOR SOME SURGICAL PROCEDURES
AVAILABILITY OF TWO OPTIONS FOR REPAIR OF RUPTURED ANEURYSM ASSOCIATED WITH REDUCED MORTALITY
ARCHIVES OF DERMATOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, June 16, 2008)
STUDY EXAMINES NORMAL HAIR LOSS IN MEN WITHOUT EVIDENCE OF BALDNESS
ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, June 16, 2008)
OLFACTORY BULB SIZE MAY CHANGE AS SENSE OF SMELL CHANGES
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ON-LINE. Go to www.jamamedia.org for more information and to apply for access.
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, June 16, 2008
Media Advisory: To contact Stacy A. Brethauer, M.D., call Raquel Santiago at 216-444-4235.
TYPE AND SEVERITY OF COMBAT WOUNDS IN IRAQ WAR HAVE CHANGED OVER TIME
CHICAGO—The transition in Iraq from maneuver warfare to insurgency warfare is associated with changes in the type and severity of injuries treated by surgical units of the U.S. Marine Corps, according to a report in the June issue of Archives of Surgery, one of the JAMA/Archives journals. In the second, insurgent phase of the war, injuries have been more severe, transport times longer, more injuries have occurred per individual and more soldiers have been killed in action or died of their wounds.
“Operation Iraqi Freedom is an ongoing conflict that has changed dramatically since the initial invasion,” the authors write as background information in the article. “Following the maneuver warfare that resulted in the capture of Baghdad, Iraq, in April 2003, firm U.S. military bases have been established throughout the country to support the Iraqi government and to fight insurgencies.” During the first phase of warfare (March and April 2003), the Forward Resuscitative Surgery System—a small mobile surgery team of eight personnel that treated soldiers’ injuries —moved 11 times as the battlefield changed. In the second phase of the war, from March 2004 to February 2005, medical support for U.S. forces has remained stationary.
Stacy A. Brethauer, M.D., of Cleveland Clinic, and colleagues analyzed records from combat trauma databases for 338 casualties treated during the first phase of the war (maneuver) and 895 treated in the second phase (insurgency). When comparing those injured in phase II with those injured in phase I, the authors found that:
- More major injuries occurred per patient (2.4 vs. 1.6)
- More individuals sustained fragment wounds (61 percent vs. 48 percent) but fewer were injured by gunshots (33 percent vs. 43 percent)
- Critically injured U.S. casualties took longer to reach the surgical unit (a median or midpoint time of 59 minutes vs. 30 minutes)
- The percentage of individuals killed in action before reaching the surgical unit increased (20.2 percent from 13.5 percent)
- The percentage of patients who died of their wounds after evaluation by a physician also increased, from 0.88 percent to 5.5 percent
In the second phase of the war, the use of improvised explosive devices by insurgents has resulted in more fragment wounds and a higher percentage of critically injured patients arriving to the surgical unit. “A higher percentage of patients arriving at the Forward Resuscitative Surgery System are undergoing surgery, and these patients have more injuries and undergo more procedures than casualties during Operation Iraqi Freedom I,” the authors write. The higher percentage of surgeries is due to an increase in the number of wounds per patient, the severity of these wounds and the stationary nature of the surgical unit, they note.
“The nature of the current conflict in Iraq should influence the way that casualties are managed and entered into the medical system,” the authors conclude. “Only with continued data collection and careful attention to the many variables involved will we be able to make definitive statements regarding optimal trauma care in Iraq.”
(Arch Surg. 2008;143[6]:564-569. 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.
Go back to the top.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 16, 2008
Media Advisory: To contact corresponding author Jaime Landman, M.D., call Karin Eskenazi at 212-305-6535.
ULTRASONIC INSTRUMENTS ASSOCIATED WITH IMPROVED OUTCOMES FOR SOME SURGICAL PROCEDURES
CHICAGO—Using ultrasonic surgical instruments is associated with more favorable outcomes when compared with conventional instruments for some procedures, according to a meta-analysis of 51 previously published studies in the June issue of Archives of Surgery, one of the JAMA/Archives journals.
Ultrasonic surgical equipment uses vibrations at a frequency of 55,500 hertz to help make incisions into skin and other tissues and seal blood vessels, according to background information in the article. Ultrasonic instruments were introduced into the clinical practice of surgery approximately a decade ago to minimize the risks associated with conventional surgical technologies.
Brent Matthews, M.D., of the Washington University School of Medicine, St. Louis, and colleagues analyzed studies published between 1990 and 2005 comparing ultrasonic to conventional surgical instruments. Their analysis included 51 studies—24 randomized controlled trials and 27 non-randomized studies— involving 4,902 patients who underwent a variety of procedures, including colorectal, gynecological, solid organ and head and neck surgery.
Overall, ultrasonic equipment appeared at least as effective and safe as conventional equipment. Average blood loss was less for ultrasonic procedures, with the exception of colorectal procedures and Nissen fundoplication, a stomach procedure used to treat acid reflux. Average surgery time was shorter when ultrasonic instruments were used, except in the case of mastectomy. No significant difference was observed in length of hospital stay.
Other complications that occurred less frequently in patients undergoing surgery with ultrasonic instruments included blood clots, bowel leaks, fistulas (unintentional connections between adjacent tissues or structures), blocked blood vessels and injuries to nerves, organs and tissues. “Overall, ultrasonic surgical instrumentation use seems to be associated with fewer complications across all studies that report these outcomes; however, data are sparse,” the authors write.
“The expanded use of ultrasonic instrumentation in general or minimally invasive surgery, colorectal surgery, gynecologic surgery, plastic and reconstructive surgery and otolaryngology is supported by the outcomes from this systematic review,” they conclude. “A decrease in operative blood loss combined with less local thermal damage than traditional electrosurgical instrumentation may prove to be of particular benefit in selected surgical procedures.”
(Arch Surg. 2008;143[6]:592-600. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by Ethicon Endo-Surgery. 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.
Go back to the top.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 16, 2008
Media Advisory: To contact corresponding author Harald Teufelsbauer, M.D., e-mail: harald.teufelsbauer{at}meduniwien.ac.at.
AVAILABILITY OF TWO OPTIONS FOR REPAIR OF RUPTURED ANEURYSM ASSOCIATED WITH REDUCED MORTALITY
CHICAGO—Having two options available for the repair of ruptured abdominal aortic aneurysms, including an open surgery and a less invasive procedure, is associated with improvement in overall survival after surgery, according to a report in the June issue of Archives of Surgery, one of the JAMA/Archives journals.
Most patients with ruptured abdominal aortic aneurysms—which occur when a segment of the aorta, the large blood vessel that supplies the pelvis, legs and abdomen, enlarges and bursts—do not survive long enough to reach the hospital, according to background information in the article. Among those who do, most patients undergo a procedure known as open graft replacement, in which the aorta is repaired through an open incision and the damaged segment of the aorta is replaced with a synthetic graft. Rates of death following this procedure are approximately 40 percent to 50 percent and have not changed over the past four decades, the authors note.
In 1994, endovascular abdominal aortic aneurysm repair—a minimally invasive procedure in which a mesh stent is inserted through an artery and positioned within the aorta—was introduced as a treatment alternative. Andreas Wibmer, M.D., of the Medical University of Vienna, Austria, and colleagues conducted an analysis of 89 consecutive patients treated for abdominal aortic aneurysms at one center between 1999 and 2006. From 1999 through 2003, 42 patients were treated with open graft replacement. In 2003, the university established a protocol during which some selected patients (16 patients or 34 percent) were instead treated with endovascular abdominal aortic aneurysm repair.
The researchers found that the overall death rates in the 90 days after surgery decreased following the introduction of the endovascular procedure, from 54.8 percent in the first period to 27.7 percent in the second period. Improved survival was most apparent in patients older than 75.5 years. However, the 90-day death rate also decreased for patients undergoing open graft reduction following the introduction of endovascular repair, from 54.8 percent to 29 percent.
“Our findings strongly indicate that the implementation of endovascular abdominal aortic aneurysm repair is able to reduce the overall mortality in patients with ruptured abdominal aortic aneurysm,” the authors write. “By offering both treatment options, it was possible to improve the immediate and mid-term overall results by shifting high-risk patients from the open graft reduction to the endovascular abdominal aortic aneurysm repair group, thereby improving the results of open surgery.”
“The issue of which subgroup of patients might benefit the most from this less-invasive technique still remains,” they continue. In the study, older patients and those who were more hemodynamically stable—those whose blood pressure remained relatively constant—appeared to experience the largest improvements in survival with this treatment option.
(Arch Surg. 2008;143[6]:544-549. 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.
Go back to the top.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 16, 2008
Media Advisory: To contact corresponding author Jeffrey J. Miller, M.D., call Megan Walde Manlove at 717-531-8604.
STUDY EXAMINES NORMAL HAIR LOSS IN MEN WITHOUT EVIDENCE OF BALDNESS
CHICAGO—Performing a standardized 60-second hair count appears to be a reliable method for the assessment of hair shedding, according to a report in the June issue of Archives of Dermatology, one of the JAMA/Archives journals.
“Currently, there is no widely accepted or standard method for assessing the number of hairs shed daily,” according to background information in the article. The widely held belief that it is normal to shed 100 hairs per day is based on the assumption that the average scalp contains 100,000 hairs, 10 percent of which are in the telogen (resting) phase. Although this idea is prevalent, it has not been scientifically validated and does not indicate whether shedding remains constant with age or if it is similar between men and women.
Carina A. Wasko, M.D., of Baylor College of Medicine, Houston, and colleagues studied hair loss in 60 healthy men (half age 20 to 40 and half age 41 to 60) without evidence of alopecia (baldness). All participants were given identical combs and instructions to wash hair with the same brand of shampoo for three consecutive mornings. On the fourth day, they were asked to comb hair forward for 60 seconds over a towel or pillowcase of contrasting color before shampooing. The men combed their hair this way and then counted hairs shed for three consecutive days. This procedure was repeated in eligible participants six months later.
Participants age 20 through 40 shed 0 to 78 hairs, with an average loss of 10.2 hairs per 60-second test. Men age 41 to 60 shed 0 to 43 hairs, with an average loss of 10.3 hairs per 60-second test. Results were consistent on consecutive days for all participants. “When repeated six months later in both age groups, the hair counts did not change much. The hair counts were repeated and verified by a trained investigator, with results similar to those of subject hair counts,” the authors write.
“In summary, the 60-second hair count is a simple, practical and objective tool for monitoring conditions associated with hair shedding,” the authors conclude. “Low intrapatient variability demonstrates that dependable results over an extended period of time are obtainable. The similarity between investigator and subject hair counts indicates that patients can reliably count hairs.
“Studies of the 60-second hair count in normal women and in the setting of hair disease still need to be performed.”
(Arch Dermatol. 2008;144[6]:759-762. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Co-author Dr. Miller is a consultant for and has received honoraria from Pfizer Inc. This study was supported by a study grant from Merck. 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.
Go back to the top.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 16, 2008
Media Advisory: To contact corresponding author Thomas Hummel, M.D., e-mail: thummel{at}rcs.urz.tu-dresden.de.
OLFACTORY BULB SIZE MAY CHANGE AS SENSE OF SMELL CHANGES
CHICAGO—The olfactory bulb in the brain appears to change in size in a way that corresponds to individual alterations in sense of smell, according to a report in the June issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
The size of the olfactory bulb has been studied in patients who have lost their sense of smell due to injury, infection, congenital conditions or neurodegenerative diseases, as well as in those with a normal sense of smell, according to background information in the article. Research indicates that the size of the olfactory bulb changes throughout adult life.
Antje Haehner, M.D., and colleagues at University of Dresden Medical School, Germany, studied 20 patients with loss of sense of smell, or “olfactory loss.” Once between 2003 and 2004 and again 13 to 19 months later, patients underwent an assessment that included magnetic resonance imaging (MRI) of the brain and nasal endoscopy, an examination of the nose with a lighted, flexible instrument known as an endoscope. Their olfactory function was tested using a kit that measures individuals’ threshold of detecting odors, ability to discriminate between odors and identification of particular odors.
At the first assessment, seven of the 20 patients had no sense of smell (anosmia) and 13 had a reduced sense of smell (hyposmia), while at the second assessment six had anosmia and 14 had hyposmia. In patients who initially had hyposmia, the volume of the olfactory bulb increased as olfactory function increased. However, no correlation was found between the volume of the olfactory bulb and the ability to distinguish between or identify specific odors.
“The correlation between olfactory bulb volume and olfactory function may potentially be used in combination with other factors influencing olfaction such as remaining olfactory function, age and duration of olfactory loss as a means to provide patients with individual information on the prognosis of their disease,” the authors write. “Hypothetically, a multifactorial approach could be applied to eventually come up with a formula that would allow a more precise prognosis of olfactory function. Especially since therapeutic options in patients with olfactory loss are limited, at present, this type of information is of high clinical significance.”
(Arch Otolaryngol Head Neck Surg. 2008;134[6]:621-624. 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.
Go back to the top.
