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This Week in JAMA
January 2, 2008

This Week in JAMA

JAMA. 2008;299(1):9. doi:10.1001/jama.2007.1
Testosterone Supplementation in Older Men

Many signs and symptoms of male aging have been attributed to an age-related decline in testosterone levels. To assess the effect of testosterone supplementation (80 mg of testosterone undecenoate twice daily) in older men, Emmelot-Vonk and colleagues enrolled 237 healthy men who were between the ages of 60 and 80 years and had low-normal serum testosterone levels in a 6-month randomized controlled trial. The authors found that compared with placebo, testosterone supplementation was associated with an increase in lean body mass and decrease in fat mass but no improvement from baseline in functional mobility, muscle strength, cognition, or bone mineral density. Supplementation was associated with adverse metabolic effects.

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Gene Polymorphism and Hepatocellular Cancer

In animal models, overexpression of epidermal growth factor (EGF) in the liver induces transformation to hepatocellular carcinoma. Tanabe and colleagues investigated the relationship of a human EGF gene single-nucleotide polymorphism involving A to G transition at position 61 (61*G) to serum and liver EGF levels and hepatocellular carcinoma risk in patients with cirrhosis. The authors found that this single-nucleotide polymorphism was associated with higher levels of serum and liver EGF. In 2 case-control studies, patients with cirrhosis who had 1 or 2 copies of the G allele had an increased risk of hepatocellular carcinoma compared with patients without the G allele.

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Morphological Abnormalities in Childhood Cancer

Several studies have suggested that developmental genes involved in body plan formation during embryogenesis are also associated with an increased risk of cancer. In a study of 1073 pediatric cancer patients and 1007 healthy control children who had detailed clinical body surface examinations, Merks and colleagues assessed the patterns and prevalence of morphological abnormalities. The authors found a significantly higher prevalence of morphological abnormalities in the cancer patients than in controls and identified several patterns of co-occurring abnormalities indicative of previously unrecognized tumor predisposition syndromes.

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Opioid Prescribing in US Emergency Departments

Opioid prescribing in the United States increased after implementation of several national quality improvement initiatives in the late 1990s. However, it is not known whether opioid prescribing in emergency departments has increased or whether previously documented differential prescribing of opioids by race/ethnicity has decreased. Pletcher and colleagues addressed these questions in an analysis of 1993-2005 national survey data on emergency department visits. The authors found that opioid prescribing for pain increased significantly from 23% in 1993 to 37% in 2005, but racial/ethnic differences did not diminish.

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CLINICIAN'S CORNER

Moellering discusses common pathogens causing skin infections in otherwise healthy adults, risk factors for infection, and the treatment of simple uncomplicated cellulitis while commenting on the case of Mr M, a 39-year-old man who experienced increasing erythema and swelling of his finger.

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Medical News & Perspectives

As increasing numbers of troops with posttraumatic stress disorder return home from the war in Iraq, scientists are ramping up efforts to understand the disorder and develop more effective treatments.

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Commentaries

Effective pain treatment

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Market justice and health care

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Clinical Trials

Information for authors interested in submitting clinical trials to JAMA.

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Author in the Room Teleconference

Join Ian George Williamson, MD, from 2 to 3 PM eastern time on January 16, 2008, to discuss antibiotics and nasal steroids for acute sinusitis. To register, go to http://www.ihi.org/AuthorintheRoom.

Readers Respond

How would you manage a 32-year-old woman with a 1-year history of chronic abdominal pain? Go to www.jama.com to read the case and submit your response. Your response may be selected for online publication. Submission deadline is January 30.

Audio Commentary

Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl

JAMA Patient Page

For your patients: Information about acute pain treatment.

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