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This Week in JAMA
October 3, 2007

This Week in JAMA

JAMA. 2007;298(13):1481. doi:10.1001/jama.298.13.1481
Sex and Racial Differences in ICD Use

Two articles in this issue report data relating to sex and racial differences in the use of implantable cardioverter-defibrillators (ICDs). Curtis and colleaguesArticle analyzed national Medicare patient data (1991-2005) and found that women were significantly less likely than men to receive ICD therapy for either primary or secondary prevention of sudden cardiac death. In the second article, Hernandez and colleaguesArticle analyzed 2005-2007 data collected in a voluntary heart failure quality improvement initiative and found that fewer than 40% of eligible patients received ICD therapy. Women and black patients were significantly less likely than white men to receive an ICD. In an editorial, RedbergArticle discusses possible reasons for sex and racial disparities in ICD use and implications for clinical decision making and patient outcomes.

Gleason Grade 5 Prostate Biopsy and Prognosis

Prognosis among men with prostate cancer is associated with the Gleason score, which is based on assignment of a grade of 1 to 5 to the predominant and second most prevalent histologic patterns. A higher grade denotes less differentiation. Some pathologists also assign a tertiary pattern grade, but the relationship of the tertiary pattern to prognosis is not clear. In a cohort of men with node-negative, nonmetastatic and definitively treated biopsy Gleason score 7 prostate cancer, Patel and colleagues assessed whether there is an association between time to biochemical recurrence (prostate-specific antigen [PSA] failure) and the presence or absence of tertiary grade 5 disease. The authors found that men with tertiary grade 5 had a median time to PSA failure of 5.0 years, whereas men without tertiary grade 5 had a median time to PSA failure of 6.7 years.

Article
Effect of Perindopril Therapy in Marfan Syndrome

Cardiac complications of Marfan syndrome include progressive aortic stiffening and dilatation, which can culminate in aortic rupture. In light of evidence that the renin-angiotensin system may be involved in these vascular effects and that angiotensin-converting enzyme (ACE) inhibitors reduce large artery stiffness, Ahimastos and colleagues tested the effects of adding the ACE inhibitor perindopril vs placebo to standard β-blocker therapy in 17 adult patients with Marfan syndrome. The authors report that patients who were randomly assigned to receive perindopril had reduced aortic stiffness and aortic root diameters compared with patients who received placebo therapy.

Article
CLINICIAN'S CORNER

Mrs F, a 30-year-old woman with a history of chronic hypertension and possible preeclampsia during her first pregnancy, has concerns about how hypertension may affect a future pregnancy. PowrieArticle discusses the management of chronic hypertension before, during, and after pregnancy and the current understanding of preeclampsia. In an editorial, SibaiArticle discusses additional management considerations and the challenge of identifying women at risk of adverse maternal and perinatal outcomes from hypertensive disease during pregnancy.

A Piece of My Mind

“If a pluralistic society protects individual decisions, we can certainly conquer the loneliness, fear, and anguish brought about by ignorance while those irrevocable decisions are being considered.” From “Knowledge Is Power.”

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Medical News & Perspectives

A growing body of animal studies suggest a chemical in some plastics may pose human health risks.

Article
Natural Orifice Endoscopic Surgery

An article in the Archives of Surgery reports a case of natural orifice transluminal endoscopic surgery—a cholecystectomy via transvaginal access. Buyske discusses the emergence of alternatives to “open” surgery and the benefits of cross-specialty collaboration and standard setting.

Article
Abortion Politics

Implications of Gonzales v Carhart for public trust in the judiciary, clinical freedom, and personal privacy.

Article
LITERATIM

An examination of the 1947 Rodgers and Hammerstein's physician-themed production Allegro.

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Author in the Room Teleconference

Join Romsai T. Boonyasai, MD, MPH, October 17 from 2 to 3 PM eastern time to discuss effective teaching of quality improvement concepts. To register, go to http://www.ihi.org/AuthorintheRoom.

JAMA Patient Page

For your patients: Information about grading of prostate cancer.

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