Archives News Releases - July 20, 2009

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, July 20, 2009)

Most Women Would Choose Surgical Profession Again

Evaluating More Lymph Nodes May Not Improve Identification of Late-Stage Colorectal Cancer

ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY

(Embargoed Until: 3 P.M. (CT), Monday, July 20, 2009)

Babies With Mild Facial Paralysis from Forceps Typically Do Not Need Treatment

Removal of Tonsils and Adenoids Associated With Ongoing Benefits for Children With Breathing Problems During Sleep

ARCHIVES OF DERMATOLOGY NEWS RELEASES

(Embargoed Until: 3 P.M. (CT), Monday, July 20, 2009)

Clotting in Veins Close to Skin May Be Associated With More Dangerous Deep-Vein Blood Clots

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, July 20, 2009
Media Advisory: To contact Kathrin M. Troppmann, M.D., call Karen Finney at 916-734-9064 or e-mail karen.finney{at}ucdmc.ucdavis.edu.

Most Women Would Choose Surgical Profession Again

CHICAGO—Most women surgeons would choose their career again, although many would favor more options for part-time or other alternative work schedules, according to a report in the July issue of Archives of Surgery, one of the JAMA/Archives journals.

Over the past three decades, women have increased their presence in the surgical field, according to background information in the article. "In the medical field, a career in surgery has significant lifestyle implications: the profession is associated with high degrees of patient acuity, significant on-call responsibility and irregular work hours, all requiring a significant commitment of personal time," the authors write. "The extent to which the surgical workplace has evolved to accommodate women and their role in family life is unknown to the public, in general, and to the upcoming generation of women physicians, in particular."

To assess professional and personal situations, perceptions and challenges for both male and female surgeons, Kathrin M. Troppmann, M.D., of the UC Davis Medical Center, Sacramento, Calif., and colleagues mailed a questionnaire to all surgeons board certified in 1988, 1992, 1996, 2000 or 2004. Of 3,507 surgeons, 895 (25.5 percent) responded, of whom 178 (20.3 percent) were women and 698 (79.7 percent) were men.

Among the surgeons who responded:

General surgery was the most common specialty among both sexes (39.3 percent of women and 46.7 percent of men); more women than men specialized in breast surgery (20.2 percent vs. 1.3 percent) and fewer specialized in vascular surgery (2.9 percent vs. 10.3 percent), but essentially there were no other sex differences in subspecialties
Most women (82.5 percent) and men (77.5 percent) would choose surgery as a profession again, and 83.5 percent of women and 61.3 percent of men would recommend surgery as a career choice to women
Men worked a median (midpoint) of 65 hours a week, compared with 60 for women
More women (8.5 percent) than men (3.2 percent) had ever worked part-time as a clinical surgeon, and women were less likely to disagree with the statement that more part-time work opportunities should be available for surgeons (33.3 percent vs. 55.5 percent)
Women were significantly less likely than men to have a spouse who did not work outside the home (9.4 percent vs. 56.3 percent)
Women surgeons were also less likely than men to have children (63.8 percent vs. 91.3 percent), as were surgeons of the younger generation (board certified in 2000 or 2004); more women than men surgeons had children later in life, after entering surgical practice (62.4 percent vs. 32 percent)
More women than men reported that maternity leave was important (67.8 percent vs. 30.8 percent) and that child care should be available at work (86.5 percent vs. 69.7 percent)

"In conclusion, most women surgeons would choose the surgical profession again. This highly positive perception should be pointed out to women considering a surgical career," the authors conclude. "To foster realistic expectations among medical students, the rewarding and challenging aspects of the surgical profession must be pointed out. Finally, our study results suggest that maximizing recruitment and retention of women surgeons will include giving serious consideration to alternative work schedules and optimization of maternity leave and child care opportunities."
(Arch Surg. 2009;144[7]:635-642. Available to the media pre-embargo at www.jamamedia.org).

Editor's Note: This work was supported by the American College of Surgeons and the Association of Women Surgeons. 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, July 20, 2009
Media Advisory: To contact corresponding author Tina J. Hieken, M.D., call Rikki Ragland at 847-570-3144 or e-mail rragland{at}northshore.org.

Evaluating More Lymph Nodes May Not Improve Identification of Late-Stage Colorectal Cancer

CHICAGO—Surgically removing and evaluating an increasing number of lymph nodes does not appear to identify a greater number of patients with stage III colorectal cancer, according to a report in the July issue of Archives of Surgery, one of the JAMA/Archives journals.

Colorectal cancer is the third most common type of cancer and the third leading cause of cancer-related death in the United States, according to background information in the article. More than 80 percent of newly diagnosed colorectal cancer patients will have locoregional disease (limited to a small region) and will be offered surgery that may cure their illness. The status of lymph nodes near the cancer has been recognized as the most powerful prognostic factor for recurrence and survival in these patients.

"Accurate lymph node staging also is important for determining prognosis and the need for adjuvant chemotherapy," the authors write. "In addition, lymphadenectomy [lymph node removal] may be therapeutic; several studies have shown a positive association between the number of lymph nodes removed and survival for patients with negative and positive lymph nodes."

In 1990, the World Congress of Gastroenterology first proposed a minimum threshold of 12 lymph nodes to be removed during surgery for colorectal cancer. This benchmark has since been adopted as a quality measure for surgical practice by multiple organizations. Sachin S. Kukreja, M.D., and colleagues at Rush North Shore Medical Center (now Skokie Hospital, NorthShore University HealthSystem), Skokie, Ill., and Rush University Medical Center and Rush Medical College, Chicago, in late 2004 began a multidisciplinary institutional initiative to increase the number of lymph nodes removed during colorectal cancer surgery. The effort involved discussing unacceptably low lymph node counts and reviewing the rationale for increased lymph node evaluation at multidisciplinary cancer committee meetings, along with a program of institutional awareness of the issue and a change in pathologists' lymph node assessment technique.

The researchers then evaluated 701 consecutive colorectal cancer cases treated with surgery from 1996 through 2007. The initiative appeared successful in increasing the numbers of lymph nodes removed—when patients operated on in January 2005 or after were compared with those who had surgery before the initiative began, both the average number of lymph nodes removed (17.3 vs. 12.8) and the percentage of patients who had at least 12 lymph nodes removed (71.6 percent vs. 53 percent) increased.

However, the proportion of patients diagnosed with stage III colorectal cancer did not change, with 204 of 553 (36.9 percent) of the earlier cases and 48 of 148 (32.4 percent) of the late cases having positive lymph nodes.

"Overall, our improvement in lymph node yield demonstrates the value and impact of communication through a multidisciplinary initiative engaged in adherence to recommended standards and improving quality of care," the authors conclude. However, "our data suggest that mandatory harvest of a minimum of 12 lymph nodes as a quality indicator or performance measure appears unfounded."
(Arch Surg. 2009;144[7]:612-617. Available to the media pre-embargo at www.jamamedia.org)

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, July 20, 2009
Media Advisory: To contact corresponding author Sam J. Daniel, M.D., M.Sc., F.R.C.S.C., call Lisa Dutton at 514-412-4307 or e-mail lisa.dutton{at}muhc.mcgill.ca.

Babies With Mild Facial Paralysis from Forceps Typically Do Not Need Treatment

CHICAGO—Mild facial nerve paralysis caused by the use of forceps during birth generally resolves on its own and does not require treatment, according to a report in the July issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.

Facial nerve palsy (inability to move some facial muscles) occurs in approximately 0.8 to 7.5 of 1,000 births overall and 8.8 of every 1,000 births in which forceps are used, according to background information in the article. "Previous observations indicate that while most cases of facial nerve palsy caused by birth trauma implicate the use of forceps, up to 33 percent occur in spontaneous vaginal delivery without instrumentation," the authors write. The injury is caused when the forceps blade or a bone in the mothers' pelvis puts pressure on the baby's head in the area of the facial nerve.

Melanie Duval, M.D., of McGill University, Montreal, Quebec, Canada, and Sam J. Daniel, M.D., M.Sc., F.R.C.S.C., of McGill University and Montreal Children's Hospital, reviewed the medical records of 28 babies with facial nerve palsy caused by forceps use between 1989 and 2005.

In all 28 cases, the palsy was classified as mild to moderate. "Except in one neonate, no treatment was initiated in any of the patients," the authors write; one child received a 14-day course of oral prednisone, a corticosteroid. "All 21 neonates with adequate long-term follow-up recovered fully after an average period of 24 days."

"There is discrepancy in the literature on the investigations and/or treatment options to be undertaken in facial palsy owing to birth trauma," the authors conclude. Some authors recommend surgery to explore the nerve, whereas most consider observation to be sufficient in uncomplicated cases. The current results add to evidence that the recovery rate is high without treatment. "This confirms that corticosteroid treatment or surgery should be withheld in neonates presenting with uncomplicated facial nerve palsy resulting from forceps trauma."
(Arch Otolaryngol Head Neck Surg. 2009;135[7]:634-636. Available to the media pre-embargo at www.jamamedia.org)

Editor's Note: Dr. Daniel is a speaker for and has a clinical trial contract with Alcon Research Inc. 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, July 20, 2009
Media Advisory: To contact Julie L. Wei, M.D., call Bob Hallinan at 913-588-5246 or e-mail BHALLINA{at}kumc.edu.

Removal of Tonsils and Adenoids Associated With Ongoing Benefits for Children With Breathing Problems During Sleep

CHICAGO—Two and a half years after children with sleep-related breathing disorders had surgery to remove their tonsils and adenoids (glands in the back of the throat), they appear to sleep better than they did before the procedure but not as well as they did six months after, according to a report in the July issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals. Initial improvements in their behavior were maintained except when measured by an index of attention-deficit/hyperactivity disorder (ADHD) symptoms.

"Since the publication of our previous report demonstrating improvements in both sleep and behavior at six months after adenotonsillectomy for children with sleep-disordered breathing, there have been several articles that continue to support the impact of sleep-disordered breathing on neurocognitive development, behavior and quality of life," the authors write as background information in the article. "Specifically, ADHD, hyperactivity and behavior have been shown to improve at six or 12 months after adenotonsillectomy in correlation with improved postoperative polysomnography [sleep monitoring] parameters regardless of which instruments were used to evaluate behavior."

Julie L. Wei, M.D., of the University of Kansas School of Medicine, Kansas City, and colleagues analyzed long-term (2.4 to 3.6 years) follow-up data from 44 of 71 children with sleep-disordered breathing who initially participated in the six-month study. Before surgery, six months afterward and again at least two years afterward, parents completed a questionnaire assessing their child's sleep and a multi-part parent rating scale with sections about ADHD symptoms, cognitive problems or inattention, hyperactivity and oppositional behavior.

"Our longitudinal study demonstrates that improvements in sleep and behavior may not be exactly maintained over time, but at 2.5 years after the surgical intervention, all parameters reported in this study except the ADHD index remained below baseline values," the authors write. "Although speculative and based on extrapolation, this longitudinal model shows that even if the sleep-related breathing disorder subscale scores increase by 7 percent per year for many consecutive years, which is a statistically significant increase compared with baseline values, it would take nine or 10 years before the values could climb back to baseline values, if indeed a return to baseline values were likely."

Because it is not a randomized controlled trial, the results do not prove the relationship between adenotonsillectomy and changes in sleep and behavior. However, the findings do support an association between the intervention and improvements in theses outcomes, the authors note.
(Arch Otolaryngol Head Neck Surg. 2009;135[7]:642-646. 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, July 20, 2009
Media Advisory: To contact Barbara Binder, M.D., e-mail barbara.binder{at}klinikum-graz.at.

Clotting in Veins Close to Skin May Be Associated With More Dangerous Deep-Vein Blood Clots

CHICAGO—About one-fourth of patients with superficial vein thrombosis—clotting in blood vessels close to the skin—also may have the life-threatening condition deep vein thrombosis, according to a report in the July issue of Archives of Dermatology, one of the JAMA/Archives journals.

"Superficial vein thrombosis is a common disease that most often affects the veins of the leg but can also be found in other locations," the authors write as background information in the article. Different risk factors have been reported, many of which are the same as risk factors for deep vein thrombosis—varicose veins, thrombophilia (a disorder in which the blood clots too easily), use of oral contraceptives, trauma, malignancy or a period of immobility. "In the past, not much interest has been focused on superficial vein thrombosis because of its generally benign course. However, recent investigations showed an unsuspected association of superficial vein thrombosis with deep vein thrombosis and thromboembolism [blockage of a blood vessel by a clot that has broken apart]."

Barbara Binder, M.D., of the Medical University of Graz, Austria, and colleagues studied 46 consecutive patients (32 women and 14 men) with superficial vein thrombosis between November 2006 and June 2007. All patients underwent color-coded duplex sonography, an imaging test, to confirm superficial vein thrombosis and exclude or detect deep vein thrombosis. Participants also reported their history of clotting events, use of oral contraceptives and compression stockings, any recent immobilization and active malignant disease. Laboratory tests included D-dimer levels, a measure of protein fragments that tends to be elevated in patients with deep vein thrombosis.

Deep vein thrombosis was detected in 24 percent of patients with superficial vein thrombosis and was usually asymptomatic. Deep vein thrombosis occurred in the same leg as superficial vein thrombosis in 73 percent of the patients, in the other leg in 9 percent and in both legs in 18 percent. "The calf muscle veins were most commonly involved," the authors write. "In all patients with deep vein thrombosis, the superficial vein thrombosis was located on the lower leg and the D-dimer findings were positive."

"Generally, superficial vein thrombosis is regarded as a condition with an uncomplicated course and usually is not considered to be a severe or life-threatening disease. However, the occurrence of concomitant deep vein thrombosis and/or pulmonary embolism [blood clot that travels to the lungs] may lead to severe complications," they continue. "The results of this study indicate that concurrent deep vein thrombosis is more likely when superficial vein thrombosis affects the lower leg. In these cases, the deep veins should be assessed by color-coded duplex sonography (from the inguinal [groin] region to the ankle) to exclude or confirm acute deep vein thrombosis."
(Arch Derm. 2009;145[7]:753-757. 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.


	Welcome \| My Account \| Access Rights \| Sign In July 20, 2009 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, July 20, 2009) Most Women Would Choose Surgical Profession Again Evaluating More Lymph Nodes May Not Improve Identification of Late-Stage Colorectal Cancer ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY (Embargoed Until: 3 P.M. (CT), Monday, July 20, 2009) Babies With Mild Facial Paralysis from Forceps Typically Do Not Need Treatment Removal of Tonsils and Adenoids Associated With Ongoing Benefits for Children With Breathing Problems During Sleep ARCHIVES OF DERMATOLOGY NEWS RELEASES (Embargoed Until: 3 P.M. (CT), Monday, July 20, 2009) Clotting in Veins Close to Skin May Be Associated With More Dangerous Deep-Vein Blood Clots 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, July 20, 2009 Media Advisory: To contact Kathrin M. Troppmann, M.D., call Karen Finney at 916-734-9064 or e-mail karen.finney{at}ucdmc.ucdavis.edu. Most Women Would Choose Surgical Profession Again CHICAGO—Most women surgeons would choose their career again, although many would favor more options for part-time or other alternative work schedules, according to a report in the July issue of Archives of Surgery, one of the JAMA/Archives journals. Over the past three decades, women have increased their presence in the surgical field, according to background information in the article. "In the medical field, a career in surgery has significant lifestyle implications: the profession is associated with high degrees of patient acuity, significant on-call responsibility and irregular work hours, all requiring a significant commitment of personal time," the authors write. "The extent to which the surgical workplace has evolved to accommodate women and their role in family life is unknown to the public, in general, and to the upcoming generation of women physicians, in particular." To assess professional and personal situations, perceptions and challenges for both male and female surgeons, Kathrin M. Troppmann, M.D., of the UC Davis Medical Center, Sacramento, Calif., and colleagues mailed a questionnaire to all surgeons board certified in 1988, 1992, 1996, 2000 or 2004. Of 3,507 surgeons, 895 (25.5 percent) responded, of whom 178 (20.3 percent) were women and 698 (79.7 percent) were men. Among the surgeons who responded: General surgery was the most common specialty among both sexes (39.3 percent of women and 46.7 percent of men); more women than men specialized in breast surgery (20.2 percent vs. 1.3 percent) and fewer specialized in vascular surgery (2.9 percent vs. 10.3 percent), but essentially there were no other sex differences in subspecialties Most women (82.5 percent) and men (77.5 percent) would choose surgery as a profession again, and 83.5 percent of women and 61.3 percent of men would recommend surgery as a career choice to women Men worked a median (midpoint) of 65 hours a week, compared with 60 for women More women (8.5 percent) than men (3.2 percent) had ever worked part-time as a clinical surgeon, and women were less likely to disagree with the statement that more part-time work opportunities should be available for surgeons (33.3 percent vs. 55.5 percent) Women were significantly less likely than men to have a spouse who did not work outside the home (9.4 percent vs. 56.3 percent) Women surgeons were also less likely than men to have children (63.8 percent vs. 91.3 percent), as were surgeons of the younger generation (board certified in 2000 or 2004); more women than men surgeons had children later in life, after entering surgical practice (62.4 percent vs. 32 percent) More women than men reported that maternity leave was important (67.8 percent vs. 30.8 percent) and that child care should be available at work (86.5 percent vs. 69.7 percent) "In conclusion, most women surgeons would choose the surgical profession again. This highly positive perception should be pointed out to women considering a surgical career," the authors conclude. "To foster realistic expectations among medical students, the rewarding and challenging aspects of the surgical profession must be pointed out. Finally, our study results suggest that maximizing recruitment and retention of women surgeons will include giving serious consideration to alternative work schedules and optimization of maternity leave and child care opportunities." (Arch Surg. 2009;144[7]:635-642. Available to the media pre-embargo at www.jamamedia.org). Editor's Note: This work was supported by the American College of Surgeons and the Association of Women Surgeons. 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, July 20, 2009 Media Advisory: To contact corresponding author Tina J. Hieken, M.D., call Rikki Ragland at 847-570-3144 or e-mail rragland{at}northshore.org. Evaluating More Lymph Nodes May Not Improve Identification of Late-Stage Colorectal Cancer CHICAGO—Surgically removing and evaluating an increasing number of lymph nodes does not appear to identify a greater number of patients with stage III colorectal cancer, according to a report in the July issue of Archives of Surgery, one of the JAMA/Archives journals. Colorectal cancer is the third most common type of cancer and the third leading cause of cancer-related death in the United States, according to background information in the article. More than 80 percent of newly diagnosed colorectal cancer patients will have locoregional disease (limited to a small region) and will be offered surgery that may cure their illness. The status of lymph nodes near the cancer has been recognized as the most powerful prognostic factor for recurrence and survival in these patients. "Accurate lymph node staging also is important for determining prognosis and the need for adjuvant chemotherapy," the authors write. "In addition, lymphadenectomy [lymph node removal] may be therapeutic; several studies have shown a positive association between the number of lymph nodes removed and survival for patients with negative and positive lymph nodes." In 1990, the World Congress of Gastroenterology first proposed a minimum threshold of 12 lymph nodes to be removed during surgery for colorectal cancer. This benchmark has since been adopted as a quality measure for surgical practice by multiple organizations. Sachin S. Kukreja, M.D., and colleagues at Rush North Shore Medical Center (now Skokie Hospital, NorthShore University HealthSystem), Skokie, Ill., and Rush University Medical Center and Rush Medical College, Chicago, in late 2004 began a multidisciplinary institutional initiative to increase the number of lymph nodes removed during colorectal cancer surgery. The effort involved discussing unacceptably low lymph node counts and reviewing the rationale for increased lymph node evaluation at multidisciplinary cancer committee meetings, along with a program of institutional awareness of the issue and a change in pathologists' lymph node assessment technique. The researchers then evaluated 701 consecutive colorectal cancer cases treated with surgery from 1996 through 2007. The initiative appeared successful in increasing the numbers of lymph nodes removed—when patients operated on in January 2005 or after were compared with those who had surgery before the initiative began, both the average number of lymph nodes removed (17.3 vs. 12.8) and the percentage of patients who had at least 12 lymph nodes removed (71.6 percent vs. 53 percent) increased. However, the proportion of patients diagnosed with stage III colorectal cancer did not change, with 204 of 553 (36.9 percent) of the earlier cases and 48 of 148 (32.4 percent) of the late cases having positive lymph nodes. "Overall, our improvement in lymph node yield demonstrates the value and impact of communication through a multidisciplinary initiative engaged in adherence to recommended standards and improving quality of care," the authors conclude. However, "our data suggest that mandatory harvest of a minimum of 12 lymph nodes as a quality indicator or performance measure appears unfounded." (Arch Surg. 2009;144[7]:612-617. Available to the media pre-embargo at www.jamamedia.org) 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, July 20, 2009 Media Advisory: To contact corresponding author Sam J. Daniel, M.D., M.Sc., F.R.C.S.C., call Lisa Dutton at 514-412-4307 or e-mail lisa.dutton{at}muhc.mcgill.ca. Babies With Mild Facial Paralysis from Forceps Typically Do Not Need Treatment CHICAGO—Mild facial nerve paralysis caused by the use of forceps during birth generally resolves on its own and does not require treatment, according to a report in the July issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals. Facial nerve palsy (inability to move some facial muscles) occurs in approximately 0.8 to 7.5 of 1,000 births overall and 8.8 of every 1,000 births in which forceps are used, according to background information in the article. "Previous observations indicate that while most cases of facial nerve palsy caused by birth trauma implicate the use of forceps, up to 33 percent occur in spontaneous vaginal delivery without instrumentation," the authors write. The injury is caused when the forceps blade or a bone in the mothers' pelvis puts pressure on the baby's head in the area of the facial nerve. Melanie Duval, M.D., of McGill University, Montreal, Quebec, Canada, and Sam J. Daniel, M.D., M.Sc., F.R.C.S.C., of McGill University and Montreal Children's Hospital, reviewed the medical records of 28 babies with facial nerve palsy caused by forceps use between 1989 and 2005. In all 28 cases, the palsy was classified as mild to moderate. "Except in one neonate, no treatment was initiated in any of the patients," the authors write; one child received a 14-day course of oral prednisone, a corticosteroid. "All 21 neonates with adequate long-term follow-up recovered fully after an average period of 24 days." "There is discrepancy in the literature on the investigations and/or treatment options to be undertaken in facial palsy owing to birth trauma," the authors conclude. Some authors recommend surgery to explore the nerve, whereas most consider observation to be sufficient in uncomplicated cases. The current results add to evidence that the recovery rate is high without treatment. "This confirms that corticosteroid treatment or surgery should be withheld in neonates presenting with uncomplicated facial nerve palsy resulting from forceps trauma." (Arch Otolaryngol Head Neck Surg. 2009;135[7]:634-636. Available to the media pre-embargo at www.jamamedia.org) Editor's Note: Dr. Daniel is a speaker for and has a clinical trial contract with Alcon Research Inc. 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, July 20, 2009 Media Advisory: To contact Julie L. Wei, M.D., call Bob Hallinan at 913-588-5246 or e-mail BHALLINA{at}kumc.edu. Removal of Tonsils and Adenoids Associated With Ongoing Benefits for Children With Breathing Problems During Sleep CHICAGO—Two and a half years after children with sleep-related breathing disorders had surgery to remove their tonsils and adenoids (glands in the back of the throat), they appear to sleep better than they did before the procedure but not as well as they did six months after, according to a report in the July issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals. Initial improvements in their behavior were maintained except when measured by an index of attention-deficit/hyperactivity disorder (ADHD) symptoms. "Since the publication of our previous report demonstrating improvements in both sleep and behavior at six months after adenotonsillectomy for children with sleep-disordered breathing, there have been several articles that continue to support the impact of sleep-disordered breathing on neurocognitive development, behavior and quality of life," the authors write as background information in the article. "Specifically, ADHD, hyperactivity and behavior have been shown to improve at six or 12 months after adenotonsillectomy in correlation with improved postoperative polysomnography [sleep monitoring] parameters regardless of which instruments were used to evaluate behavior." Julie L. Wei, M.D., of the University of Kansas School of Medicine, Kansas City, and colleagues analyzed long-term (2.4 to 3.6 years) follow-up data from 44 of 71 children with sleep-disordered breathing who initially participated in the six-month study. Before surgery, six months afterward and again at least two years afterward, parents completed a questionnaire assessing their child's sleep and a multi-part parent rating scale with sections about ADHD symptoms, cognitive problems or inattention, hyperactivity and oppositional behavior. "Our longitudinal study demonstrates that improvements in sleep and behavior may not be exactly maintained over time, but at 2.5 years after the surgical intervention, all parameters reported in this study except the ADHD index remained below baseline values," the authors write. "Although speculative and based on extrapolation, this longitudinal model shows that even if the sleep-related breathing disorder subscale scores increase by 7 percent per year for many consecutive years, which is a statistically significant increase compared with baseline values, it would take nine or 10 years before the values could climb back to baseline values, if indeed a return to baseline values were likely." Because it is not a randomized controlled trial, the results do not prove the relationship between adenotonsillectomy and changes in sleep and behavior. However, the findings do support an association between the intervention and improvements in theses outcomes, the authors note. (Arch Otolaryngol Head Neck Surg. 2009;135[7]:642-646. 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, July 20, 2009 Media Advisory: To contact Barbara Binder, M.D., e-mail barbara.binder{at}klinikum-graz.at. Clotting in Veins Close to Skin May Be Associated With More Dangerous Deep-Vein Blood Clots CHICAGO—About one-fourth of patients with superficial vein thrombosis—clotting in blood vessels close to the skin—also may have the life-threatening condition deep vein thrombosis, according to a report in the July issue of Archives of Dermatology, one of the JAMA/Archives journals. "Superficial vein thrombosis is a common disease that most often affects the veins of the leg but can also be found in other locations," the authors write as background information in the article. Different risk factors have been reported, many of which are the same as risk factors for deep vein thrombosis—varicose veins, thrombophilia (a disorder in which the blood clots too easily), use of oral contraceptives, trauma, malignancy or a period of immobility. "In the past, not much interest has been focused on superficial vein thrombosis because of its generally benign course. However, recent investigations showed an unsuspected association of superficial vein thrombosis with deep vein thrombosis and thromboembolism [blockage of a blood vessel by a clot that has broken apart]." Barbara Binder, M.D., of the Medical University of Graz, Austria, and colleagues studied 46 consecutive patients (32 women and 14 men) with superficial vein thrombosis between November 2006 and June 2007. All patients underwent color-coded duplex sonography, an imaging test, to confirm superficial vein thrombosis and exclude or detect deep vein thrombosis. Participants also reported their history of clotting events, use of oral contraceptives and compression stockings, any recent immobilization and active malignant disease. Laboratory tests included D-dimer levels, a measure of protein fragments that tends to be elevated in patients with deep vein thrombosis. Deep vein thrombosis was detected in 24 percent of patients with superficial vein thrombosis and was usually asymptomatic. Deep vein thrombosis occurred in the same leg as superficial vein thrombosis in 73 percent of the patients, in the other leg in 9 percent and in both legs in 18 percent. "The calf muscle veins were most commonly involved," the authors write. "In all patients with deep vein thrombosis, the superficial vein thrombosis was located on the lower leg and the D-dimer findings were positive." "Generally, superficial vein thrombosis is regarded as a condition with an uncomplicated course and usually is not considered to be a severe or life-threatening disease. However, the occurrence of concomitant deep vein thrombosis and/or pulmonary embolism [blood clot that travels to the lungs] may lead to severe complications," they continue. "The results of this study indicate that concurrent deep vein thrombosis is more likely when superficial vein thrombosis affects the lower leg. In these cases, the deep veins should be assessed by color-coded duplex sonography (from the inguinal [groin] region to the ankle) to exclude or confirm acute deep vein thrombosis." (Arch Derm. 2009;145[7]:753-757. 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.