Periampullary adenocarcinomas, which include carcinomas of the bile duct, the ampulla of Vater, and the periampullary duodenum, are typically treated by surgical resection. Five-year survival rates following surgical resection rarely exceed 50%. To assess whether adjuvant chemotherapy might improve patient survival, Neoptolemos and colleagues randomly assigned 428 patients with surgically resected periampullary carcinomas to receive adjuvant chemotherapy (either fluorouracil plus folinic acid or gemcitabine) or no chemotherapy. The authors report that compared with no chemotherapy, treatment with gemcitabine or fluorouracil was not associated with a significant survival benefit. However, in analyses that adjusted for prognostic variables (patient age, tumor type and grade, and lymph node involvement), a survival benefit of chemotherapy was demonstrated.
Some data have suggested that perioperative and postoperative infusion of acadesine—an adenosine-regulating agent with cardioprotective potential—is associated with reductions in ischemia/reperfusion injury and adverse cardiac outcomes among patients undergoing on-pump coronary artery bypass graft (CABG) surgery. In a randomized trial that enrolled 3080 intermediate- and high-risk patients undergoing nonemergent, on-pump CABG surgery, Newman and colleagues assessed the efficacy and safety of acadesine (vs placebo) administered during the perioperative period. The authors found that compared with placebo, acadesine was not associated with a reduction in a composite outcome of all-cause mortality, nonfatal stroke, or severe left ventricular dysfunction through postoperative day 28.
Risks of adverse outcomes after receipt of the influenza A(H1N1) vaccine are the subject of 2 articles in this issue. In a nationwide cohort study involving 53 432 live-born Danish infants delivered between November 2009 and October 2010, Pasternak and colleagues found that infants exposed in utero to the influenza A(H1N1)pdm09 vaccine did not have a significantly increased risk of major birth defects, preterm birth, or fetal growth restriction compared with infants without influenza vaccine exposure. De Wals and colleagues assessed the risk of Guillain-Barré syndrome following a province-wide (Quebec, Canada) influenza A(H1N1) immunization campaign that resulted in vaccination of an estimated 4.4 million residents of Quebec (57% of the target population). The authors report that vaccine recipients had a small increased risk of Guillain-Barré syndrome during the 4 to 8 weeks after vaccination—an estimated 2 cases per million doses of administered vaccine. In an editorial, Steinhoff and MacDonald discuss influenza vaccine safety, particularly vaccine safety during pregnancy.
A 68-year-old woman who was recently diagnosed with small cell lung cancer presents with a bulging area behind her ear. Nine years earlier she underwent resection and radiation therapy for a recurrent hemangioblastoma, with poor medical follow-up since then. What would you do next?
The Centers for Medicare & Medicaid Services has launched an initiative to reduce inappropriate use of antipsychotic medications for nursing home residents by 15% by the end of 2012.
The moral duty to buy health insurance
Patient satisfaction and patient-centered care
Ending preventable child death
Eliminating partially hydrogenated oils in foods
“The more doctor-speak becomes second nature to us, the more it can distance ourselves from our patients.” From “Learning to Talk.”
Update on JAMA policies
Dr Bauchner summarizes and comments on this week's issue. Go to http://jama.jamanetwork.com/multimedia.aspx#Weekly.
How would you manage a patient with probable nonalcoholic fatty liver disease? Read the case at www.jama.com and submit your response by August 5 for possible online posting.
Join Peter B. Bach, MD, MAPP, and George T. O’Connor, MD, Wednesday, July 18, from 2 to 3 pm eastern time to discuss the benefits and harms of computed tomographic screening for lung cancer. To register, go to http://www.ihi.org/AuthorintheRoom.
For your patients: Information about hospice care.
This Week in JAMA. JAMA. 2012;308(2):109. doi:10.1001/jama.2012.3093