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October 19, 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, October 19, 2009)
ARCHIVES OF SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, October 19, 2009)
ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY
(Embargoed Until: 3 P.M. (CT), Monday, October 19, 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, October 19, 2009
Aggressive Microdermabrasion Induces Wound-Healing Response in Aging Skin
CHICAGO—Microdermabrasion using a coarse diamond-studded instrument appears to induce molecular changes in the skin of older adults that mimic the way skin is remodeled during the wound healing process, according to a report in the October issue of Archives of Dermatology, one of the JAMA/Archives journals. "Microdermabrasion is a popular procedure for skin rejuvenation," the authors write as background information in the article. "It has been suggested that microdermabrasion can improve the appearance of wrinkles, atrophic acne scars, dyspigmentation and other signs of aging skin." The procedure involves buffing the skin using grains of diamond or another hard substance. In order to objectively change the appearance of wrinkled skin, such a procedure would have to induce the production of collagen, the major structural protein in the skin. Previous studies have shown that microdermabrasion using aluminum oxide may not always stimulate collagen production; whether more aggressive but still nonablative (not involving the destruction of skin tissue) methods could consistently do so is unknown. Darius J. Karimipour, M.D., and colleagues at the University of Michigan, Ann Arbor, conducted a biochemical analysis of skin biopsy specimens before and four hours to 14 days after a microdermabrasion procedure. Forty adults age 50 to 83 years with sun-damaged skin on their arms volunteered to participate in the study. Each underwent microdermabrasion with a diamond-studded handpiece of either a coarse-grit or medium-grit abrasiveness. When performed with the coarse-grit handpiece, microdermabrasion resulted in the increased production of a wide variety of compounds associated with wound healing and skin remodeling. This includes cytokeratin 16, a well-characterized response to injuries to the skin's outer layer; antimicrobial peptides that fight infection; matrix metalloproteinases that break down skin's structural proteins to allow for rebuilding; and both collagen precursors and other substances that form the pathway to its production. These molecular changes were not seen in individuals who received microdermabrasion using the medium-grit handpiece, the authors note. All patients experienced a mild period of redness that typically lasted less than two hours.
"We demonstrate that aggressive nonablative microdermabrasion is an effective procedure to stimulate collagen production in human skin in vivo," they write. "The beneficial molecular responses, with minimal downtime, suggest that aggressive microdermabrasion may be a useful procedure to stimulate remodeling and to improve the appearance of aged human skin."
Editor's Note: This study was supported by a Dermatology Foundation Clinical Career Development Award in Dermatologic Surgery to Dr. Karimipour and by a University of Michigan Human Appearance Research Fund to the Department of Dermatology. 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, October 19, 2009
Resident Physicians Seldom Trained in Skin Cancer Examination
CHICAGO—Many resident physicians are not trained in skin cancer examinations, nor have they ever observed or practiced the procedure, according to a report in the October issue of Archives of Dermatology, one of the JAMA/Archives journals. Melanoma is the only cancer that can be detected early for which U.S. death rates are not decreasing, according to background information in the article. Although melanoma remains the second most common cause of cancer in individuals age 15 to 29, screening rates have not changed in recent years. "In response, a number of recommendations have been made to provide training programs for instruction of the skin cancer examination," the authors write. About one-fourth of all melanomas are detected by physicians as opposed to patients, and a consensus is emerging that cancers detected by a clinician are generally thinner and have a better prognosis. However, most primary care physicians do not regularly perform skin examinations. Emily Wise, M.D., of the Boston University School of Medicine, and colleagues surveyed resident physicians in family medicine, obstetrics and gynecology, pediatrics and internal medicine in November 2003. Residents reported their training and experience with skin cancer examinations, along with their current skill level in performing the exams. Of 454 surveys distributed, 342 residents in four programs completed the survey (a 75.3 percent response rate). "Clinical training for the skin cancer examination during residency was infrequent," the authors write. "During residency, 75.8 percent were never trained in the skin cancer examination, 55.3 percent never observed a skin cancer examination and 57.4 percent never practiced the examination. Only 15.9 percent of residents reported being skilled in the skin cancer examination." Performing four skin cancer examinations—an average of slightly more than one per year of residency—was associated with increases in self-reported skill levels. "Visits to internists and family practitioners make up an estimated 40 percent of physician visits in the United States, and nearly two-thirds of patients with melanoma report a physician visit in the year before diagnosis. Primary care physicians are thus ideally suited to screen and triage high-risk patients and those with suspicious lesions," the authors write.
"Residency programs and medical schools may have neither the time nor the infrastructure to teach an expert, comprehensive examination to all physicians in training," they conclude. "However, the basic ability to recognize potentially suspicious lesions and triage persons with such lesions should be a vital and key component of both training programs. If current physicians in training do not learn this skill set in medical school or residency, there is a low likelihood that they will acquire this knowledge in their day-to-day practice, which could have potentially devastating consequences for melanoma recognition going forward."
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, October 19, 2009
"Superobesity," Chronic Disease Burden Associated With Risk of Death Following Bariatric Surgery
CHICAGO—Veterans classified as superobese and those with a higher chronic disease burden appear more likely to die within a year of having bariatric surgery, according to a report in the October issue of Archives of Surgery, one of the JAMA/Archives journals. Currently, 165,000 veterans who use Veterans Affairs (VA) medical facilities have class III obesity, defined as a body mass index (BMI) of 40 or greater, according to background information in the article. Evidence suggests bariatric surgery is one of the few interventions that can help morbidly obese individuals lose enough weight to significantly improve their health and quality of life. The risk of death associated with bariatric surgery is thought to be low, but most previous studies have involved younger women rather than the older male population that typically uses VA facilities. The number of bariatric procedures performed in approved VA medical facilities more than tripled between 2000 and 2006; however, the surgery is being performed on only approximately 0.1 percent of all veterans who meet BMI criteria. "Whether the volume of the VA bariatric surgery program should be expanded in the coming years largely depends on the impact such operations have on long-term health outcomes," the authors write. David Arterburn, M.D., M.P.H., of Group Health Research Institute, Seattle, and colleagues examined patient factors associated with the risk of death among 856 veterans who underwent bariatric surgery in any of 12 VA bariatric centers from 2000 to 2006. The patients had an average BMI of 48.7 and an average age of 54 years; 73 percent were men. Dr. Arterburn also has a joint appointment at University of Washington, and his coauthors are at the University of Texas, Duke University, the University of Colorado and Veterans Affairs. Overall, a total of 54 patients (6.3 percent) died during the follow-up period; 1.3 percent of the patients died 30 days after surgery, 2.1 percent died 90 days after surgery and 3.4 percent had died after one year. In statistical models performed by the researchers, the patients who were classified as superobese (having a BMI of 50 or higher; 36 percent of the sample) and those with a higher score on a measure of costs related to co-occurring diseases (8 percent of the sample) had an increased risk of death. Superobese patients (who accounted for 30 deaths) had 30-day, 90-day and one-year death rates of 2.0 percent, 3.6 percent and 5.2 percent, whereas those with a higher comorbidity cost score had rates of 1.5 percent, 5.8 percent and 10.1 percent. Several possible explanations exist for the increased risk of death among the superobese, the authors note. Bariatric procedures are technically more difficult in these patients because of their abdominal fat; they may be at greater risk for wound complications and blood clotting; and they are likely to have more obesity-related illnesses.
"The results of this study should inform discussions with patients with regard to the potential risks and benefits of bariatric surgery," the authors conclude. "These findings also suggest that the risks of bariatric surgery in patients with significant comorbidities, such as congestive heart failure, complicated diabetes and chronic obstructive pulmonary disease, should be carefully weighed against potential benefits in older male patients and those with superobesity."
Editor's Note: This work was supported by the Office of Research and Development, Health Services Research and Development Service, Department of Veterans Affairs. 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, October 19, 2009
Blood Clots in Lungs Might Not Always Originate in Deep Veins of Legs and Pelvis in Trauma Patients
CHICAGO—Few trauma patients who develop potentially deadly blood clots in the lungs (pulmonary embolism) also have clots in the deep veins of their pelvis and legs (deep venous thrombosis), challenging commonly held beliefs about the association between the two conditions, according to a report in the October issue of Archives of Surgery, one of the JAMA/Archives journals. "For decades, it has been taught that pulmonary embolism is a sequel of deep venous thrombosis," the authors write as background information in the article. "Forming in the lower extremity or pelvic veins, clots break off and travel to the pulmonary circulation. Therefore, deep venous thrombosis and pulmonary embolism should coexist in most patients, because part of the clot embolizes [lodges] in the lung, and part remains attached to the vein." George C. Velmahos, M.D., Ph.D., and colleagues at Massachusetts General Hospital and Harvard Medical School, Boston, studied 247 trauma patients who underwent imaging scans of the lungs and the veins in the pelvis and legs between 2004 and 2006. Demographic information, as well as data on injury type and severity, imaging findings, hospital length of stay and death rates, was collected. Among the 247 patients, 46 (19 percent) were diagnosed with pulmonary embolism and 18 (7 percent) had deep venous thrombosis. Seven patients with pulmonary embolism (15 percent) also had deep venous thrombosis. There were no differences between patients with pulmonary embolism who did and did not have deep venous thrombosis in any of the demographic or clinical variables assessed. "Based on these data, there is little evidence that pulmonary embolism originates from deep venous thrombosis of peripheral veins," the authors conclude. Among the potential explanations for the lack of association are that clots formed in the legs and pelvis completely dislodge when they travel to the lungs; therefore, no evidence of deep venous thrombosis would remain in patients with pulmonary embolism. However, studies on cadavers have shown that typically only part of the clot breaks off and lodges elsewhere.
"We propose that many pulmonary embolisms form primarily in the lungs and that the risk-benefit ratio of vena cava filters [devices designed to trap clots and stop them from traveling to the lungs] should be reconsidered," they write. "As computed tomographic venography [vein imaging] becomes more popular and accurate, this issue will be further explored, and it may be revealed that (not surprisingly) we have been preaching and practicing the wrong dogma for years."
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, October 19, 2009
Study Examines Treatment for Olfactory Loss After Viral Infection
CHICAGO—Treatment with a glucocorticoid medication, either alone or in combination with Ginkgo biloba, appears to significantly improve the sense of smell in individuals with previous olfactory loss due to upper respiratory infections, according to a report in the October issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals. Olfactory loss [loss of the sense of smell] is common and can be caused by head trauma, chronic sinonasal inflammation and viral infections of the nose, according to background information in the article. "In particular, postviral olfactory loss is a complicated disease," the authors write. Upper respiratory tract viral infections are common and can be caused by numerous viruses such as rhinovirus, influenza viruses, parainfluenza viruses and respiratory syncytial viruses. "However, which viruses cause postviral olfactory loss is unknown, as well as who is susceptible to olfactory damage after the common cold." Therefore, olfactory disorder is not clearly understood, making treatment for the condition difficult. Beom Seok Seo, M.D., of Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea, and colleagues studied 71 patients (average age 53) who were diagnosed as having postviral olfactory loss from July 2007 to June 2008. Patients underwent olfactory function tests, including a butanol threshold test (BTT), which examined patients' ability to differentiate N-butanol from mineral oil with concentrations changing over 13 levels through each nostril; and the cross-cultural smell identification test (CCSIT), which examined odor identification through both nostrils for each patient. Follow-up tests were performed four weeks later. "Anosmia [absence of the sense of smell] was defined as concentration levels zero to three, severe hyposmia [reduced sensibility to odors] as levels four to five, moderate hyposmia as levels six to eight, mild hyposmia as levels nine to 10 and normosmia [a normal sense of smell] as levels 11 to 12," the authors note. Additionally, participants were randomly assigned to two treatment groups: 28 patients were treated with the steroid prednisolone for two weeks and 43 were treated with prednisolone for two weeks plus Ginkgo biloba for four weeks. All participants also used mometasone [a steroid used to relieve inflammation] nasal spray twice daily for four weeks. "On the basis of the BTT results, 17 patients (24 percent) had anosmia, 25 patients (35 percent) had severe hyposmia, 23 patients (32 percent) had moderate hyposmia, 5 patients (7 percent) had mild hyposmia and one patient had normosmia," the authors write. "There was no statistically significant difference in the severity of postviral olfactory loss between the two groups." Both treatment groups' BTT and CCSIT scores increased significantly after treatment. For the group taking prednisolone, the average BTT and CCSIT score changes were 1.4 and 0.9, respectively. For the group taking prednisolone with Ginkgo biloba, the average BTT and CCSIT score changes were 2.2 and 1.9, respectively. Treatment response rates on the BTT (defined as a score increase of three or more) were 32 percent in the prednisolone group and 37 percent in the prednisolone with Ginkgo biloba group. Treatment response rates on the CCSIT were 14 percent in the group taking prednisolone and 33 percent in the combination therapy group.
"Many more patients experience postviral olfactory loss and seek recovery of their olfactory function than otolaryngologists have previously thought," the authors conclude. "Postviral olfactory loss is caused by neurodegeneration of cells in the olfactory neural system. More clinical trials are required to evaluate drugs shown to be effective against neurodegeneration for the future treatment of olfactory disorder."
Editor's Note: This study was reported in part by a grant from the Seoul National University Bundang Hospital. 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, October 19, 2009
Three-Day Course of Antibiotics May Be Sufficient Following Tonsillectomy
CHICAGO—Children who receive a three-day course of antibiotics following tonsillectomy rather than a seven-day course appear to have no differences in pain or how quickly they return to a normal diet and activity level, according to a report in the October issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals. About 45.6 of every 10,000 children younger than 15 undergo tonsillectomies, most often as a treatment for sleep-related breathing disorders and recurrent tonsillitis, according to background information in the article. Tonsillectomy is a relatively safe procedure with a low death rate, but complications such as pain, bleeding, lethargy and bad breath often occur, particularly in the week following surgery. "Pain can lead to decreased oral intake and ultimately dehydration," the authors write. "The use of postoperative antibiotics to relieve pain following pediatric tonsillectomy was first reported more than 50 years ago. It is thought that the normal oral bacterial flora colonize the denuded tonsilar fossae [cavity] and release inflammatory mediators that cause pain. Antibiotic use after tonsillectomy may quantitatively lessen the bacterial content and thus reduce pain." Paul E. Johnson, M.D., of New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, and colleagues studied 49 patients scheduled to undergo tonsillectomy with or without adenoidectomy (removal of glands in the back of the throat). Twenty-six of the patients were randomly assigned to receive seven days of postoperative antibiotics, and 23 received three days of antibiotics followed by four days of placebo. Parents were asked to record how much pain medication the child took for the first seven days after surgery, as well as when the child resumed a normal diet and activity level and whether he or she required treatment for bleeding or dehydration. A total of 47 patients (96 percent) completed the study. No statistically significant difference was observed between the two groups in postoperative pain or in the amount of time it took children to resume their normal diet and activity level. One adverse effect from the antibiotics—diarrhea—was reported in one patient in each study group. "A potential disadvantage [of a shorter course of antibiotics], outside of the study measures, would be increased postoperative fever and infection," the authors write. Both patients with this problem, and one patient with postoperative bleeding, were in the seven-day antibiotic group.
"Based on our results, a three-day course of antibiotics is as effective as a seven-day course," the authors write. "A shorter course of antibiotics carries other potential advantages, including decreased cost, increased patient compliance with medications and a decrease in antibiotic-associated complications and bacterial resistance."
Editor's Note: Funding for this study was provided by an institutional grant from Weill Cornell Medical College. 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, October 19, 2009
Study Examines Complications of Thyroid Surgery in Older Patients
CHICAGO—In a study of patients undergoing thyroid surgery performed by a single surgeon, older adults did not appear to have more complications than younger patients, according to a report in October issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals. The segment of the U.S. population older than 65 has increased by 90 percent during the past 30 years, according to background information in the article. "As the population ages, surgery is being performed on geriatric patients more frequently on an elective basis than in decades past, for both malignant and benign diseases," the authors write. "Thyroid disorders, particularly those requiring surgical intervention, represent many of the conditions that must be managed, although little has been written about the geriatric patient population and the special challenges they may pose." Surgery is usually considered more hazardous in older patients, but the increased risk may be due to co-occurring illnesses rather than age alone, the authors note. Melanie W. Seybt, M.D., and colleagues at Medical College of Georgia, Augusta, analyzed data from 86 younger (age 21 to 35, average age 29.5) and 44 older (older than age 65, average age 71.3) patients who underwent thyroidectomy (surgery to remove all or part of the thyroid) performed by a single surgeon between 2003 and 2007. They assessed pathology reports, complications and the need for admission or readmission to the hospital. No patients in either group died or experienced permanent vocal cord paralysis, and rates of complications were similar. For instance, 12.5 percent of older patients and 11.1 percent of younger patients experienced temporarily low blood calcium levels, and rates of temporary vocal cord paralysis were 2.9 percent among older and 3.9 percent among younger patients. Older patients did have higher rates of readmission to the hospital (4.5 percent vs. 1.2 percent), but the difference was not statistically significant. None of the readmissions were attributable to an age-related cause; rather, all were due to hypocalcemia (low calcium levels).
"Thyroid surgeons will be faced more often with the prospect of elective thyroid surgery in patients of advanced age as an increasingly aged population emerges and the prevalence of thyroid nodules and thyroid cancer increases. Thyroid surgery in elderly patients is safe and no more dangerous than surgery in youthful patients," the authors conclude. "Careful preoperative management of comorbid [co-occurring] conditions is essential to performing safe thyroidectomy in patients of all ages."
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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