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 15, 2008)
STUDY IDENTIFIES FACTORS ASSOCIATED WITH POOR WEIGHT LOSS AFTER GASTRIC BYPASS SURGERY
LIMITING RESIDENT SURGEON’S WORK HOURS ASSOCIATED WITH FEWER COMPLICATIONS FOR PATIENTS HAVING GALLBLADDER SURGERY
ARCHIVES OF DERMATOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, September 15, 2008)
TOPICAL USE OF ESTRADIOL MAY STIMULATE COLLAGEN PRODUCTION IN AGING SKIN
ARCHIVES OF FACIAL PLASTIC SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, September 15, 2008)
STUDY EXAMINES FUNCTION OF PROSTHETIC EARS IN IMPROVING HEARING, SPEECH RECOGNITION
ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, September 15, 2008)
MRI REVEALS INNER EAR ANOMALIES IN CHILDREN WITH HEARING LOSS
SELF-REPORTED PHYSICAL HEALTH SCORES AFTER ONE YEAR MAY PREDICT LONG-TERM SURVIVAL IN PATIENTS WITH HEAD AND NECK CANCER
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, September 15, 2008
Media Advisory: To contact Guilherme M. Campos, M.D., call Kirsten Michener at 415-502-4608.
STUDY IDENTIFIES FACTORS ASSOCIATED WITH POOR WEIGHT LOSS AFTER GASTRIC BYPASS SURGERY
CHICAGO—Individuals with diabetes and those whose stomach pouches are larger appear less likely to successfully lose weight after gastric bypass surgery, according to a report in the September issue of Archives of Surgery, one of the JAMA/Archives journals.
Roux-en-Y gastric bypass surgery is the most common bariatric procedure in North America, according to background information in the article. During the procedure, surgeons create a smaller stomach pouch that restricts food intake and bypasses large sections of the digestive system. “When performed in high-volume centers and with a low rate of complications, gastric bypass provides sustained and meaningful weight loss, significant improvement in quality of life, improvement or resolution of obesity-associated comorbidities and extended life span,” the authors write. “However, 5 percent to 15 percent of patients do not lose weight successfully, despite perceived precise surgical technique and regular follow-up.”
Guilherme M. Campos, M.D., and colleagues at the University of California, San Francisco, examined data from 361 patients who underwent gastric bypass at one institution between 2003 and 2006. Poor weight loss was defined as losing 40 percent or less of excess body weight after 12 months and good weight loss as losing more than 40 percent of excess weight.
Twelve-month follow-up data were available for 310 of the patients, who had an average body mass index (BMI) of 52 before surgery. At follow-up, they had an average BMI of 34 and had lost an average of 60 percent of their excess body weight. A total of 38 patients (12.3 percent) had poor weight loss. After adjusting for other related factors, diabetes and having a larger size of the stomach pouch after gastric bypass surgery were independently associated with poor weight loss.
Individuals with diabetes may take insulin or other drugs that stimulate the production of fat and cholesterol, the authors note. “Other factors that may lead to weight gain in patients with diabetes include a ‘protective’ increase in caloric intake to treat episodes of hypoglycemia [low blood sugar], reduction of urinary glucose losses and sodium and water retention that are a direct effect of insulin on the distal tubule in the kidney,” the authors write.
The restriction on dietary intake imposed by a small stomach pouch is one of the most important aspects of gastric bypass surgery, they note. Surveys suggest that many surgeons estimate pouch size using anatomical landmarks rather than using a sizing balloon. “As the use of gastric bypass continues to grow, we believe it is critical to stress the importance of and to teach the creation of the small gastric pouch and to better standardize the technique used for pouch creation,” the authors write.
“We conclude that gastric bypass provides good or excellent weight loss for most patients,” they continue. “However, diabetes mellitus and larger pouch size are independently associated with poor weight loss after gastric bypass. Changes in the use of diabetes medications may reduce the risk of poor weight loss among diabetics undergoing gastric bypass. Detailed attention to the creation of a small gastric pouch is essential for achieving the best results.”
(Arch Surg. 2008;143[9]:877-884. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported in part by a grant from the National Center for Research Resources. 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 15, 2008
Media Advisory: To contact corresponding author Christian de Virgilio, M.D., call Laura Mecoy at 310-546-5860.
LIMITING RESIDENT SURGEON’S WORK HOURS ASSOCIATED WITH FEWER COMPLICATIONS FOR PATIENTS HAVING GALLBLADDER SURGERY
CHICAGO—Fewer patients undergoing gallbladder surgery at one major public teaching hospital sustained injuries to their bile ducts or other complications after resident physicians’ work hours were limited to 80 per week, according to a report in the September issue of Archives of Surgery, one of the JAMA/Archives journals.
Concerns about patient safety and resident well-being led to the implementation of the 80-hour workweek in July 2003, according to background information in the article. “However, some surgical educators have expressed misgivings about the restricted hours because of more frequent shift changes, decreased patient exposure for residents, interruption in continuity of care and increased potential for communication breakdown,” the authors write.
Arezou Yaghoubian, M.D., and colleagues at Harbor-UCLA Medical Center, Torrance, Calif., analyzed the medical records of 2,470 patients who underwent laparoscopic cholecystectomy (gallbladder removal)—a procedure commonly performed by surgical residents nationwide—before and after the duty hour limitations. “Previous studies using simulators have indicated that sleep deprivation has substantial adverse effects on laparoscopic skills in residents,” the authors write. “Bile duct injury [a common complication of cholecystectomy, in which the tubes that transport fluids between the liver and gallbladder are damaged] has a potentially devastating long-term adverse effect on the patient.”
Overall, 1,353 procedures were performed before the 80-hour workweek implementation (January 2000 to June 2003) and 1,117 afterward (July 2003 to June 2006). After the restrictions, fewer patients experienced bile duct injury (0.4 percent vs. 1 percent) or any complication (2 percent vs. 5 percent). Analyses revealed that having surgery during the second time period was associated with reduced odds of bile duct injury and of total complications.
“The complication rate in period two decreased despite there being a higher percentage of patients with acute cholecystitis and a greater percentage of male patients, both of which have been shown to be associated with a higher risk of bile duct injury,” the authors write.
“In conclusion, we observed improved outcomes in the era of restricted resident work hours in patients undergoing laparoscopic cholecystectomy,” they continue. “Despite the concerns that work hour restrictions may have deleterious effects on patient care and resident education, these results clearly indicate otherwise. Whether the better-rested resident surgeon leads to better surgical outcomes needs further study.”
(Arch Surg. 2008;143[9]:847-851. 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 15, 2008
Media Advisory: To contact corresponding author Gary J. Fisher, Ph.D., call Katie Vloet at 734-764-2220.
TOPICAL USE OF ESTRADIOL MAY STIMULATE COLLAGEN PRODUCTION IN AGING SKIN
CHICAGO—Applying the hormone estradiol to skin protected from the sun appears to stimulate production of the protein collagen in older men and women, according to a report in the September issue of Archives of Dermatology, one of the JAMA/Archives journals. However, it may not have the same effect on sun-exposed skin, such as the face or arms.
As skin ages, its function is reduced, it becomes more fragile and wound healing is compromised, according to background information in the article. On areas of the body that are typically not covered by clothing, long-term exposure to the sun’s ultraviolet rays causes skin to look prematurely old, a process known as photo-aging. Natural aging and photo-aging share biochemical features, including a reduction in collagen, the major protein that forms the structure of skin’s inner layer.
Laure Rittié, Ph.D., and colleagues at the University of Michigan Medical School, Ann Arbor, recruited 70 healthy volunteers (40 postmenopausal women and 30 men, average age 75 years) with photodamaged skin. For two weeks, volunteers were treated with estradiol three times every other day both on sun-protected areas near the hip and photodamaged skin on the forearm; a 4-millimeter biopsy (tissue sample) was taken from each treatment area 24 hours after the last treatment. Participants also applied estradiol, incorporated into moisturizing cream, to their faces twice per day during the two weeks. A 2-millimeter biopsy was taken from the crow’s-foot area near the eye before and 24 hours after the last treatment.
After the two-week treatment period, applying estradiol to the sun-protected hip skin increased levels of collagen and other compounds that promote its production in the women and, to a lesser extent, in the men. “Surprisingly, no significant changes in production were observed in women or men after two-week estradiol treatment of photo-aged forearm or face skin, despite similar expression of estrogen receptors [protein molecules to which estrogen binds] in aged and photo-aged skin,” the authors write.
“These findings suggest that menopause-associated estrogen decline is involved in reduced collagen production in sun-protected skin,” the authors write. “Because photo-aging is superimposed on natural aging in sun-exposed areas of the skin, our results suggest that alterations induced by long-term sun exposure hinder the ability of topical estradiol to stimulate collagen production in aged human skin in vivo.”
(Arch Dermatol. 2008;144[9]:1129-1140. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported in part by a grant from Pfizer Inc. (Dr. Fisher). Co-author Dr. Voorhees was a consultant for Pfizer Inc. and received consulting payments. 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 15, 2008
Media Advisory: To contact corresponding author Claus-Peter Richter, M.D., Ph.D., call Marla Paul at 312-503-8928.
STUDY EXAMINES FUNCTION OF PROSTHETIC EARS IN IMPROVING HEARING, SPEECH RECOGNITION
CHICAGO—Prosthetic ears appear to improve hearing and speech recognition in noisy environments, according to a report in the September/October issue of Archives of Facial Plastic Surgery, one of the JAMA/Archives journals.
Some patients require prosthetic ears because their pinna (outer ear) was removed during surgery for cancer or damaged by trauma, according to background information in the article. “Their external auditory canal is usually intact, and the remainder of their auditory system should function normally,” the authors write. “In these patients, the physician must strive not only to correct the aesthetic defect caused by the missing pinna but also to correct the hearing loss caused by its absence.”
William E. Walsh, M.D., C.M.I., of Northwestern University Feinberg School of Medicine, Chicago, and colleagues analyzed eight different silicone rubber prostheses in a two-part study. In the first part, the researchers used a life-sized plastic foam head with a 12-millimeter hole drilled through at the location of the external auditory canal. A microphone was placed at the entrance of the ear canal to measure sound pressure levels both with and without the prosthesis while the head was rotated 360 degrees in 30-degree increments.
On average, the prostheses improved the sound pickup by 8.1 decibels (normal conversation is about 60 decibels) when the frequency of the sound was 4.6 kilohertz, and 9.7 decibels when the frequency was 11.5 kilohertz.
To see if this improvement would benefit patients, 11 English-speaking young adults with normal hearing took two versions of a speech test. The first was unmodified but in the second, the acoustic effects caused by the absence of a pinna were simulated based on the results from the first part of the study. The participants plugged their left ears and sat in front of two speakers, one playing normal speech and one playing white noise. Researchers increased the sound level of the speech by one decibel at a time until all of the sentences were understood. The trial was then repeated with the prosthesis over the right ear.
In this test, the prosthesis significantly improved the average ratio of speech to noise at which all sentences were understood. This part of the study “answers the question whether the gain measured in a model system actually improves a patient’s hearing,” the authors write.
“Auricular prostheses provide an acoustic gain at certain head positions and frequencies, and this acoustic gain is clinically relevant because it benefits speech recognition in noise,” they continue. “In some individuals, auricular prostheses not only effectively restore aesthetics but also may improve hearing. To verify the results of the present experiments, the main outcome measures described in this study will be used to obtain future measurements from individuals who wear auricular prostheses.”
(Arch Facial Plast Surg. 2008;10[5]:321-328. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by an American Academy of Facial Plastic and Reconstructive Surgery Foundation Leslie Bernstein Resident Research Grant (Dr. Walsh). 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 15, 2008
Media Advisory: To contact John E. McClay, M.D., call Russell Rian at 214-648-3404.
MRI REVEALS INNER EAR ANOMALIES IN CHILDREN WITH HEARING LOSS
CHICAGO—Using magnetic resonance imaging (MRI), physicians can identify soft-tissue defects that contribute to hearing loss in children, according to a report in the September issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
Sensorineural (related to sensory nerves) hearing loss affects thousands of children per year, according to background information in the article. About half of all cases are thought to be genetic, 25 percent acquired and 25 percent of unknown cause. Radiography, including plain film X-rays and computed tomography (CT), is often used to evaluate inner ear abnormalities in children with hearing loss. These methods evaluate the bones that contain the working components of inner-ear hearing. However, defects in the soft tissue within these bones also may be responsible for hearing loss.
John E. McClay, M.D., and colleagues at UT Southwestern Medical Center and Children’s Medical Center Dallas analyzed the medical records of 227 children age 1 month to 17 years (average age 5.3 years) with a diagnosis of sensorineural hearing loss. The children underwent MRI between June 1996 and June 2002. A total of 170 children had clinical information available and were included in the study. Of these, 101 (59 percent) had hearing loss in both ears and 69 (41 percent) had hearing loss in one ear, adding up to a total of 271 ears with sensorineural hearing loss.
On the MRIs:
- 108 ears (40 percent) had inner ear abnormalities
- 87 (32 percent) had abnormalities of the cochlea, a spiral structure containing hair cells integral to hearing, including 63 (23 percent) with mild abnormalities and 24 (9 percent) with abnormalities considered moderate to severe
- 49 ears (18 percent) had either missing (26 of 49, or 53 percent) or deficient (23 of 49, or 47 percent) cochlear nerves
- Ears with severe and profound hearing loss had more abnormalities than those with mild and moderate hearing loss (48 percent vs. 29 percent)
- Children with moderate, severe or profound hearing loss in one ear had more inner ear abnormalities than children with hearing loss of the same severity in two ears (62 percent vs. 38 percent)
“Although the specific origin of sensorineural hearing loss may remain undiagnosed in many patients, a thorough workup to identify the cause of sensorineural hearing loss should be considered in each patient,” the authors write. “Historically, high-resolution CT has been the imaging modality of choice in the initial workup of these patients. However, the soft tissue structures of the inner ear responsible for the electrochemical transfer of sound to the brain, such as the membranous labyrinth and the cochlear nerve, are not evaluated well with high-resolution CT.”
“With MRI, these soft tissue components of hearing from the cochlea to the auditory cortex can be elucidated, which should improve our ability to appropriately diagnose the location of the defect in these children with sensorineural hearing loss,” they conclude.
(Arch Otolaryngol Head Neck Surg. 2008;134[9]:945-952. 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 15, 2008
Media Advisory: To contact corresponding author Gerry F. Funk, M.D., call Tom Moore at 319-356-3945.
SELF-REPORTED PHYSICAL HEALTH SCORES AFTER ONE YEAR MAY PREDICT LONG-TERM SURVIVAL IN PATIENTS WITH HEAD AND NECK CANCER
CHICAGO—Changes in patients’ physical health status during the year after being diagnosed with head and neck cancer appear to predict survival at five years, according to a report in the September issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
The TNM staging system for cancer (based on the tumor, involvement of lymph nodes and any distant spread) is effective in predicting whether cancer patients will die of their disease, according to background information in the article. However, it considers only factors directly related to cancer and not information about other medical conditions or the patient’s overall health status. “These factors may have a meaningful effect on the management of patients with head and neck cancer from the initial assessment through treatment selection and management of complications,” the authors write.
Mark J. Jameson, M.D., Ph.D., then of the University of Iowa College of Medicine, Iowa City, and now of the University of Virginia Health System, Charlottesville, and colleagues studied 403 patients (64 percent men, average age 58.7) who were diagnosed with head and neck cancer between 1995 and 2005. Participants completed general physical health assessments when they were diagnosed and again three, six, nine and 12 months later and then were followed up for five years.
Among all patients, scores on the health assessments decreased between diagnosis and the three-month point. Those who died during the second or third year exhibited no recovery in their scores, while those who died within the fourth or fifth year exhibited some recovery and those who survived five years or longer approached beginning scores again at the 12-month mark.
The findings suggest that a self-reported measure of general health “captures prognostic information related to cancer state,” the authors write. “It seems intuitive that a patient’s perception of well-being would fluctuate (e.g., during intensive cancer therapy vs. after recovery from successful treatment), and it seems possible that this fluctuation may be predictive of long-term outcome. This study demonstrates that the change in self-reported health status during the first year is predictive of long-term outcome (i.e., five-year survival).”
In light of the findings, a measure of general health and well-being may be a useful addition to the care of patients with head and neck cancer, especially in the first year, they conclude. “It has the benefits of refining prognosis and identifying patient needs that may not be clinically obvious in a brief encounter but may have substantial effect on quality of life,” the authors write. “Further study is warranted to determine how to best integrate data from patient-reported health assessment into patient care.”
(Arch Otolaryngol Head Neck Surg. 2008;134[9]:958-964. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported in part by a grant from the National Cancer Institute, Office of Cancer Survivorship. 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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