NEW YORK (Reuters Health) - Burns around the lips and mouth - primarily from the use of a cauterizing device -- are an underreported complication of tonsillectomy, and can result in long-term problems, according to a study reported in the Archives of Otolaryngology and Head and Neck Surgery.

Removal of the tonsils (along with the nearby adenoid glands) "remains one of the most commonly performed surgical procedures in the United States," Dr. Albert H. Park, of The University of Utah School of Medicine, Salt Lake City, and colleagues write. While most patients do very well, a number of complications can occur, included bleeding, pain, and voice changes.

In the present study, the team conducted a review of children and teens who sustained a mouth burn during a tonsillectomy at Primary Children's Medical Center (PCMC) in Salt Lake City between January 1997 and December 2005. In addition, they conducted an online national survey of pediatric ear, nose, and throat doctors.

Of the 4,327 surgeries performed at PCMC, 7 patients sustained mouth burns, including one that required reconstructive surgery.

Of 298 surveys sent to physicians, 101 were completed. A total of 61 respondents reported having a patient develop a burn around the mouth. Roughly 10 percent of the burns were severe, necessitating additional treatment.

As expected, most of the burns occurred when the tonsils were removed with devices used to cauterize the area. However, a few cases accured even when a scalpel was the main instrument for removal and cautery was simply used to control bleeding.

The most common cause of injury was a defective cautery device tip. The surgeon's experience level, by contrast, had no impact on the risk of a mouth burn.

The authors conclude that "because tonsillectomy remains one of the most frequently performed procedures, measures to avoid this complication exist and should be considered for every case. In addition, consideration should be given to discussing this potential complication during preoperative counseling for informed consent."

SOURCE: Archives of Otolaryngology and Head and Neck Surgery, January 2008.

Copyright © 2008 Reuters Limited.

NEW YORK (Reuters Health) - A combination of genes and neglectful parenting may make some young people more vulnerable to major depression, new research conducted in northern Russia suggests.

In a study of 176 teenage boys recruited from a juvenile detention center, researchers found a higher depression risk among those who had both a neglectful mother and a particular variant of a gene called DAT1, or the dopamine transporter gene. DAT1 helps regulate brain levels of dopamine, a chemical "messenger" that transmits nerve impulses among cells.

While the gene variant and a neglectful mother together affected depression risk, neither one alone did, the study found.

The findings, published in the journal Psychological Science, add to evidence that depression is a product of both nature and nurture.

"This study indicates that people with a particular variant of the DAT1 gene may be at heightened risk for depression when stress occurs -- in this case, maternal rejection," explained lead researcher Dr. Gerald J. Haeffel, of the University of Notre Dame in Indiana.

It's known that stressful life events play a major role in depression, Haeffel told Reuters Health, but not everyone becomes depressed in response to such experiences. So, he said, "it is critical to determine what makes some people susceptible to depression in the face of stress, whereas others are resilient."

Most research on the gene-environment interaction in depression has focused on genes regulating serotonin, a brain chemical involved in mood. But dopamine activity has also been linked to depression.

Dopamine plays a role in a range of vital functions, including movement, emotional responses and the capacity to feel pleasure. For their study, Haeffel and his colleagues focused on three variations in the DAT1 gene.

The researchers tested the boys, all considered to be at high risk of depression, for the three DAT1 variants; assessed them for depression; and questioned them about their mothers' parenting.

Overall, they found, boys who carried one particular DAT1 variant, called rs40184, and who said they were rejected by their mothers were at elevated risk of depression.

If further studies confirm these findings, dopamine could become a good target for depression therapy, according to Haeffel. Treatment would not necessarily mean taking a drug, he said.

Haeffel explained that dopamine is involved in the "approach motivation system," which regulates people's behavior toward goals and rewards. Behavioral therapies that, for example, help people develop new goals might help alter dopamine functioning in the brain.

"Prior work has shown that psychosocial interventions can have a significant impact on brain functioning," Haeffel noted.

Future studies on depression, he and his colleagues recommend, should look at the interaction between environment and the DAT1 gene, as well as other genes related to dopamine.

SOURCE: Psychological Science, January 2008.

Copyright © 2008 Reuters Limited.

NEW YORK (Reuters Health) - A new study questions the notion that for many women, bisexuality is just a phase that comes before settling on a true sexual identity.

A long-debated theory on bisexuality is that it is actually a transitional or denial phase. According to this idea, some women who are actually lesbians take on the label of bisexual when they first come out, while other women who call themselves bisexual are actually heterosexual and simply going through an experimental phase.

But in the new study, Lisa M. Diamond, a psychologist at the University of Utah, Salt Lake City, found that over 10 years, few bisexual women shed that sexual identity for a "lesbian" or "heterosexual" label.

The findings support the belief that bisexuality is a distinct sexual orientation, Diamond reports in the journal Developmental Psychology.

The study included 79 young women who, at the outset, described themselves as lesbian, bisexual or "unlabeled." They were surveyed five times over the next 10 years to see whether their sexuality changed.

In general, Diamond found, bisexual women were more likely than lesbians to change their sexual identity, most of these changes were to the "unlabeled" identity.

However, Diamond observed "no evidence for large-scale shifts toward either lesbianism or heterosexuality," Diamond writes. Only two women who initially described themselves as bisexual eventually "settled" on a lesbian or heterosexual identity, she notes.

The study also found that, contrary to another theory on bisexuality, bisexual women did not seem to shun commitment.

"Not only did bisexual women tend to pursue exclusive, monogamous relationships over time, but they were more likely to do so than either unlabeled or lesbian women," Diamond writes.

By the end of the 10-year study, about 60 percent of bisexual women had been in relationships lasting more than 5 years, while 30 percent were married or had a commitment ceremony.

The study is limited by the fact that it was small and involved only women, most of whom were white and middle-class, Diamond points out.

Future studies, she notes, should include a more diverse group of non-heterosexual women, as well as men.

SOURCE: Developmental Psychology, January 2008.

Copyright © 2008 Reuters Limited.

NEW YORK (Reuters Health) - Surgeon characteristics, such as gender or country of training, appear to influence whether a women with breast cancer receives radiotherapy after surgery to remove the cancer, also referred to as adjuvant radiotherapy, according to a report in the Journal of the National Cancer Institute.

Because adjuvant radiotherapy lowers the risk of cancer recurrence, the U.S. Agency for Healthcare Research and Quality considers radiotherapy after breast conservation surgery a quality of care indicator; yet many do not receive this treatment, Dr. Dawn L. Hershman and colleagues, from Columbia University in New York, point out.

The goal of their study was to determine whether surgeon-related factors play a role in whether or not a woman with breast cancer undergoes radiotherapy after breast conservation surgery.

The researchers analyzed data from 29,760 women, age 65 years or older, who underwent breast conservation surgery for early-stage (I/II) breast cancer between 1991 and 2002. The patients' information was entered in the Surveillance, Epidemiology, and End-Results-Medicare linked database. The surgeons' characteristics were assessed using information in the American Medical Association Masterfile.

Overall, 75 percent of the women received adjuvant radiotherapy, the report indicates. Women who had radiotherapy tended to be younger, have fewer other illnesses and more likely to be white, married and from an urban area. They were also more likely to be diagnosed with breast cancer later in the time period analyzed than women who were not treated with radiotherapy.

The surgeons of patients who underwent radiotherapy were more likely to be women than men, (79 percent vs. 73 percent), to have an MD rather than DO degree (75 percent vs. 68 percent), and to have trained in the U.S. rather than elsewhere (75 percent vs. 70 percent). Women who had surgeons who treated more patients also were more likely to receive radiotherapy.

"Our study is one of the first to demonstrate associations between certain surgeon characteristics and quality of breast cancer care," Hershman and colleagues conclude.

If these findings are confirmed, research will be needed on whether these patterns reflect the surgeons' behavior, the patients' response, or physician-patient interactions.

SOURCE: Journal of the National Cancer Institute, February 6, 2008.

Copyright © 2008 Reuters Limited.

NEW YORK (Reuters Health) - Middle-aged women who followed a high-protein diet compared with those who followed a low-protein diet lost more weight over a 1-year study period, according to researchers from Australia.

"Whether this was actually due to the protein per se or the fact that those women best able to restrict calories chose high protein foods, is not known," lead investigator Dr. Peter M. Clifton of Adelaide University told Reuters Health.

Regardless of protein levels, Clifton added, "even small amounts of weight loss at 12 months were associated with considerable benefits in terms of lipids."

Overall, the women who lost weight had a 20-percent increase in high-density lipoprotein (HDL), the "good" cholesterol, report Clifton and colleagues at CSIRO Human Nutrition.

The researchers assessed the long-term impact of a high-protein diet on weight loss and weight maintenance in 72 obese but otherwise healthy women, an average of 49 years old. They began with an intensive 12-week weight loss diet, and continued on a similar diet for an additional 52 weeks.

The two diets were high-protein -- 34 percent of calories from protein - or high carbohydrate diet -- 64 percent from carbohydrates. Fat provided 20 percent of the calories in both diets, the investigators report in the American Journal of Clinical Nutrition.

After calculating protein levels from the diet records the participants kept over the entire 64-week study period, the researchers found those consuming the highest amount of protein per day averaged 6.5 kilograms (14.3 pounds) of weight loss. By contrast, women consuming the lowest amounts of protein averaged 3.4 kilograms (7.5 pounds) of weight loss.

However, compliance with the diets was poor over time. So, the researchers further examined dietary protein levels, weight and lipid levels in the group as a whole. They found that protein was still directly related to weight loss, but not with improved blood lipid values.

A higher protein diet appears to confer some weight loss benefit, the researchers conclude, while sustained weight loss provides health benefits, whether the diet is high-protein or high-carbohydrate.

SOURCE: The American Journal of Clinical Nutrition, January 2008.

Copyright © 2008 Reuters Limited.