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June 15, 2009JAMA 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 DERMATOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, June 15, 2009)
ARCHIVES OF SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, June 15, 2009)
ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY
(Embargoed Until: 3 P.M. (CT), Monday, June 15, 2009)
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 15, 2009
Psoriasis Associated With Cardiovascular Disease and Increased Mortality
CHICAGO—The skin disease psoriasis is associated with atherosclerosis (a buildup of plaque in the arteries) characterized by an increased prevalence of ischemic heart disease, cerebrovascular disease, peripheral artery disease and an increased risk of death, according to a report in the June issue of Archives of Dermatology, one of the JAMA/Archives journals. Psoriasis affects nearly 2 percent to 3 percent of the world's population, including 7 million Americans, according to background information in the article. In addition to its effects on the skin, psoriasis is associated with arthritis, depression and a lower quality of life. "More recently, psoriasis has also been shown to be a systemic inflammatory condition, with similarities to other inflammatory immune disorders," the authors write. "Since the risk of myocardial infarction is increased in rheumatoid arthritis and systemic lupus erythematosus, which are both inflammatory conditions, attention has been focused on the association between psoriasis, cardiovascular risk factors and myocardial infarction." Srjdan Prodanovich, M.D., of the University of Miami Miller School of Medicine, and colleagues analyzed the computerized records of 3,236 patients with psoriasis and 2,500 individuals without psoriasis who were seen at the same Veterans Administration facility. Patients in the psoriasis group were slightly older than those in the control group without psoriasis (average age 67.9 vs. 65.1) and were more likely to be men (95.5 percent vs. 88.2 percent). "After age, sex and history of hypertension, diabetes, dyslipidemia [abnormal cholesterol levels] and smoking status were controlled for, patients with psoriasis were significantly more likely than controls to carry a diagnosis of atherosclerosis," the authors write. Patients with psoriasis were also more likely to have an additional diagnosis of another blood vessel disease, including ischemic heart disease (affecting vessels leading to the heart), cerebral vascular disease (vessels leading to the brain) or peripheral arterial disease (vessels outside the heart and brain). "This result is not surprising, given the systemic nature of atherosclerosis," the authors write. "It has tremendous and far-reaching clinical implications, as all of these vascular conditions represent a major financial cost to the health care system as well as a major cause of disability and death. The latter finding was corroborated by our analysis, whereby we concluded that psoriasis is an independent risk factor for mortality; i.e., we found a higher percentage of deaths among patients with psoriasis than among patients without psoriasis (19.6 percent vs. 9.9 percent)."
Future studies should investigate whether aggressive treatment of either cardiovascular risk factors or psoriasis will lead to an improvement in atherosclerosis in these patients, the authors conclude. "In the meantime, we recommend that health care providers who are caring for patients with psoriasis be vigilant with respect to traditional risk factor screenings," they write. "It would be prudent for dermatologists to be familiar with suggested screening for cardiovascular risk factors and recommendations for aspirin use. If not, it is imperative that they work in collaboration with a primary care provider or another internal medicine specialist, who also needs to be aware of our findings."
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.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 15, 2009
Topical Application of Chemotherapy Drug May Improve Appearance of Aging Skin Through Wound-Healing Response
CHICAGO—Topical application of the chemotherapy medication fluorouracil appears to reduce potentially precancerous skin patches and improve the appearance of sun-damaged skin, according to a report in the June issue of Archives of Dermatology, one of the JAMA/Archives journals. Fluorouracil stops the body from synthesizing thymine, a building block of DNA, according to background information in the article. This drug is used to treat cancers of the colon, head and neck, pancreas and other organs. In early studies of patients with cancer undergoing treatment with systemic fluorouracil, clinicians noticed changes in skin appearance, which led to the development of a topical therapy for the treatment of actinic keratoses (skin lesions that may develop into skin cancer). Dana L. Sachs, M.D., of the University of Michigan Medical School, Ann Arbor, and colleagues evaluated molecular and clinical changes in the skin of 21 healthy volunteers with actinic keratoses and sun-damaged skin. Participants applied 5 percent fluorouracil cream to the face twice daily for two weeks; skin biopsies and clinical evaluations were performed at the beginning of the study and periodically throughout treatment. Photographs were also taken at the beginning of the study and after one, two, four, six, 10 and 24 weeks, and were evaluated by three dermatologists who were not involved in examining the patients during the study. Nineteen patients completed all aspects of the study, and 20 responded to a questionnaire at week 10. The number of actinic keratoses was significantly reduced following treatment, from an average of 11.6 lesions to an average of 1.5. Clinical evaluations also identified overall improvements in aging-related damage, including decreases in fine (small) and course (large) wrinkling, lentigines (dark skin spots), hyperpigmentation (skin that has become darker) and sallowness (a yellow skin tone). One day after the final fluorouracil treatment, testing of the skin biopsies revealed an increase in the levels of compounds related to skin injury, inflammation and degradation of the extracellular matrix (the non-living tissue that supports skin), in addition to the precursor of collagen, which rebuilds damaged skin. "Topical fluorouracil causes epidermal [outer skin layer] injury, which stimulates wound healing and dermal remodeling resulting in improved appearance," the authors write. "The mechanism of topical fluorouracil in photo-aged skin follows a predictable wound healing pattern of events reminiscent of that seen with laser treatment of photo-aging." The treatment was generally well tolerated. On the 10-week questionnaire, most patients rated their skin as improved (19, or 95 percent) and were willing to undergo the therapy again (17, or 89 percent).
"For patients in whom a course of topical fluorouracil is indicated for the treatment of actinic keratoses, there will likely be the additional benefit of a restorative effect from sun damage; this may provide further motivation for these patients to undergo the rigorous treatment," the authors conclude. "It is possible that for some patients topical fluorouracil may have an important role against photo-aging. For others, however, it may not be cosmetically acceptable given that a standard course of therapy may last two to three weeks and the ensuing reaction can persist for several more weeks. Undoubtedly, there will be patients who desire a therapy such as topical fluorouracil for cosmetic purposes given the relatively low cost of this therapy compared with ablative laser resurfacing."
Editor's Note: This study was supported by Valeant Pharmaceuticals International. 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.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 15, 2009
Perforated Surgical Gloves Associated With Surgical Site Infection Risk
CHICAGO—Surgical gloves that develop holes or leaks during a procedure appear to increase the risk of infection at the surgical site among patients who are not given antibiotics beforehand, according to a report in the June issue of Archives of Surgery, one of the JAMA/Archives journals. Despite substantial efforts to maintain sterile conditions during surgery, pathogens can still be transmitted through contact with skin or blood, according to background information in the article. To prevent skin-borne pathogens on the hands from being transferred to patients, surgical staff wear sterile gloves as a protective barrier. When gloves are perforated by needle puncture, spiked bone fragments, sharp surfaces on surgical instruments or another cause, the barrier breaks down and bacteria can be transferred. The frequency of glove perforation increases in surgical procedures lasting more than two hours and has been found to range from 8 percent to 50 percent. Heidi Misteli, M.D., of University Hospital Basel, Basel, Switzerland, and colleagues studied a series of 4,417 surgical procedures performed at the facility between 2000 and 2001. Of these, 677 involved glove perforations, whereas surgical gloves remained intact during 3,470 procedures. Antimicrobial prophylaxis, (antibiotic therapy given before surgery to prevent infection) was used in 3,233 of the surgeries, including 605 in which perforated gloves were detected. A total of 188 instances of surgical site infection (4.5 percent) were identified, including 51 (7.5 percent) in procedures performed with perforated gloves and 137 (3.9 percent) in procedures where gloves remained intact. In procedures involving antimicrobial prophylaxis, glove perforation was not associated with surgical site infection after other, related factors were considered. "In the absence of surgical antimicrobial prophylaxis, glove leakage was associated with a surgical site infection rate of 12.7 percent, as opposed to 2.9 percent when asepsis was not breached," the authors write. "This difference proved to be statistically significant when assessed with both univariate and multivariate analyses." Measures to decrease the risk of glove perforation—including double gloving and replacing gloves after a specified period of time—are effective and safe and should be encouraged, although implementing them in clinical practice is sometimes difficult, the authors note.
"Although surgical antimicrobial prophylaxis has been demonstrated to prevent surgical site infection after clean surgery in several randomized controlled trials, there is no current consensus regarding its use in this area," they conclude. "The present results support an extended indication of surgical antimicrobial prophylaxis to all clean procedures in the absence of strict precautions taken to prevent glove perforation. The advantages of this surgical site infection prevention strategy, however, must be balanced against the costs and adverse effects of the prophylactic antimicrobials, such as drug reactions or increased bacterial resistance."
Editor's Note: This research was funded by the Department of General Surgery, University Hospital Basel, and the Freiwillige Akademische Gesellschaft Basel. 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. EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 15, 2009
U.S. Counties With More African American Patients May Have Fewer Colorectal Cancer Specialists
CHICAGO—Each percentage point increase in the African American population in a county appears to be associated with a decrease in the number of specialists within that county who diagnose and treat colorectal cancer, according to a report in the June issue of Archives of Surgery, one of the JAMA/Archives journals. In contrast, counties with a higher percentage of Asian Americans appear to have more colorectal cancer specialists. Despite overall declines in incidence of and death from colorectal cancer in the general U.S. population, African Americans are more likely than other patients to die of the disease, according to background information in the article. "Minority groups have poor access to quality health care services," the authors write. "This is true of colorectal cancer care and may be related to both geographical proximity and use of surgical, gastroenterology and radiation oncology services. Without suitable access, many minority patients may present with advanced colorectal cancer and be less likely to receive appropriate adjuvant therapies [used after primary treatment to prevent cancer recurrence]." Awori J. Hayanga, M.D., M.P.H., of the University of Michigan Medical Center, Ann Arbor, and colleagues analyzed data from the 2004 version of the Area Resource File, a nationwide database of health care, economic and demographic information. It is derived from a variety of sources and comprises data from all 3,219 counties in the United States. "Multivariate analysis revealed a statistically significant decrease in the number of gastroenterologists and radiation oncologists with each 1 percent increase in African American population and a trend toward a decrease in colorectal surgeons in a given county," the authors write. "Each percentage point increase in the Asian American population, however, was associated with a significant increase in the number of gastroenterologists and radiation oncologists that persisted on adjusting for socioeconomic status and demographic differences within the county with a trend toward an increase in the number of colorectal surgeons." Previous research indicates that African Americans are about 20 percent less likely to undergo colonoscopy compared with other races, and even those who have first-degree relatives with colorectal cancer have a decreased likelihood of undergoing recommended screenings. Disparities have also been reported in the receipt of adjuvant therapies, including radiotherapy and chemotherapy, the authors note. "Perhaps the non-use of diagnostic and adjuvant therapies is related to the great distances that African Americans must travel to seek these services, plausibly outside their own residential counties. This may serve as an impediment to seeking these services despite the best intentions of referring physicians and surgeons," they write.
"Access to diagnostic and adjuvant therapies is central to timely screening, diagnosis, follow-up therapy and surveillance, without which longer-term survival may never be improved and disparities never equalized," they conclude.
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.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 15, 2009
Sinus Infections May Be a Factor in Toxic Shock Syndrome in Children
CHICAGO—Rhinosinusitis (infection and inflammation in the sinus passages surrounding the nose) appears to be a primary factor in about one-fifth of toxic shock syndrome cases in children, according to a report in the June issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals. The hallmark signs of toxic shock syndrome are fever, rash and low blood pressure, according to background information in the article. The condition is usually caused by infection with the bacteria Staphylococcus aureus, although streptococcal bacteria have also been implicated. Toxic shock syndrome is widely recognized as a disease associated with tampon use and menstruation, the authors note. "Although not as publicized, numerous other risk factors have been established for toxic shock syndrome in association with focal infections, such as surgical wound infections (notably after rhinologic surgery and nasal packing), postpartum and postabortion infections and a wide variety of connective tissue lesions," they write. Kenny H. Chan, M.D., of the University of Colorado School of Medicine and The Children's Hospital of Denver, and colleagues analyzed the medical records of 76 children (average age 10) who were identified as having toxic shock syndrome between 1983 and 2000. Of these, 23 were also diagnosed as having either acute or chronic rhinosinusitis. No other source of infection was identified in 17 cases. "Correlation of the data revealed four patients who met the criteria for proven toxic shock syndrome and proven rhinosinusitis, two patients who met the criteria for probable toxic shock syndrome and proven rhinosinusitis, seven patients who met the criteria for proven toxic shock syndrome and possible rhinosinusitis and three patients who met the criteria for probable toxic shock syndrome and possible rhinosinusitis," the authors write. Of the 23 patients with toxic shock syndrome and rhinosinusitis, 10 were admitted to the intensive care unit (ICU), four required pressors (medications to increase blood pressure) and six received surgical interventions. There was little difference in the average number of hospital days following toxic shock syndrome between children with rhinosinusitis and those without, although those with rhinosinusitis had a higher incidence of ICU admission, pressor administration and intubation. "This study illustrates several salient points concerning toxic shock syndrome and rhinosinusitis in children," the authors write. "First, rhinosinusitis as the primary culprit in the pathogenesis of toxic shock syndrome is not a sporadic phenomenon. In fact, the frequency of this combination for this 18-year series is an impressive 21 percent."
"It is imperative that physicians, particularly those who are providing intensive care to children, recognize that rhinosinusitis can be the sole cause of toxic shock syndrome in children," they conclude. "Prompt imaging studies of the sinuses is mandatory when no apparent cause of toxic shock syndrome is found. Once rhinosinusitis is diagnosed, timely otolaryngology referral should be obtained, and sinus culture and lavage should be considered if the clinical condition warrants it."
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.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 15, 2009
Adding Antiviral Agents to Steroids for Treatment of Facial Paralysis Is Not Associated With Improved Recovery
CHICAGO—Adding an antiviral agent to corticosteroids for treatment of Bell's palsy (a condition characterized by partial facial paralysis) is not associated with improved recovery of facial movement function, according to a meta-analysis of previously published studies in the June issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals. Bell's palsy is the most common cause of sudden facial paralysis, affecting an estimated 20 to 45 per 100,000 individuals per year, according to background information in the article. "The main clinical symptom of Bell's palsy is facial motor dysfunction, the degree of which varies from minor weakness to complete paralysis depending on the amount of neural injury," the authors write. "Genetic factors, vascular ischemia [blocked blood flow] and inflammation owing to viral infection or autoimmune disorders have been proposed as the possible underlying cause, but the etiology remains unknown." Current treatment choices for Bell's palsy include corticosteroids, antiviral therapy or a combination of the two. John K. Goudakos, M.D., M.Sc., and Konstantinos D. Markou, M.D., Ph.D., of the University of Thessaloniki, Greece, identified randomized controlled trials comparing corticosteroids to combination therapy in patients with this condition published between 1996 and 2007. A total of five eligible studies involving 738 patients were identified, four of which (involving 709 patients, including 358 taking corticosteroids and 351 taking combination therapy) were included in the meta-analysis. "The complete recovery rate of facial motor function at three months after the initiation of therapy was not significantly different between the corticosteroids group and the combined therapy group," the authors write. Adverse effects also were not significantly different between the two treatment groups. "Treatment decisions regarding patients with Bell's palsy are doubtful and remain a common problem in medical practice. Corticosteroids have been established as the therapy of choice, despite the fact that the available evidence from randomized controlled trials does not exhibit a clear benefit. However, the largest available randomized controlled trial published recently suggested a benefit from the use of corticosteroids in patients with idiopathic [of unknown cause] acute facial paralysis," the authors conclude.
"Additional well-designed randomized controlled trials are needed to assess the potential value of antiviral addition to the recovery of facial palsy with more confidence. However, based on the currently available evidence, the addition of an antiviral agent to corticosteroids for the treatment of patients with Bell's palsy is not justified."
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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