In a controlled trial, Patchell and colleaguesArticle found no significant
difference in the overall length of survival of patients with single metastatic
brain lesions treated with surgical resection and postoperative whole-brain
radiation compared with those treated with surgery alone. Patients treated
with postoperative radiation had fewer recurrences of brain metastases, fewer
deaths due to neurologic causes, and a longer survival time until death due
to neurologic causes, but they had a significantly shorter time until death
due to systemic causes. In an editorial, Mintz and CairncrossArticle describe the
morbidity associated with whole-brain radiation and emphasize the importance
of individualized treatment decisions and quality-of-life outcomes.
Patients with type 2 diabetes mellitus treated for 12 weeks with diet
and the controlled-release sulfonylurea glipizide had better glycemic control,
significant improvement in several quality-of-life and employment productivity
outcomes, and less overall health care use compared with patients treated
with diet alone. Testa and Simonson observe that these favorable short-term
outcomes appeared to be mediated by a decrease in symptoms associated with
hyperglycemia and perhaps by smaller fluctuations in blood glucose levels.
To assess the overall effect of changes in antiretroviral therapy on
populations of patients infected with HIV, the progression of HIV disease
in a cohort of more than 500 men in the Multicenter AIDS Cohort Study who
seroconverted after enrollment was compared for 4 calendar periods beginning
in 1984. Detels and colleagues found that patients with the same duration
of HIV infection had a longer interval to the development of AIDS and to death
and a lower rate of decline in CD4 cell counts in the calendar period corresponding
to the introduction of potent antiretroviral therapy compared with earlier
Acidic foods have been thought to not transmit infectious microorgansims,
but contaminated unpasteurized orange juice (mean pH, 4.3) was the likely
source of an outbreak of Salmonella enterica serotype
Hartford infections investigated by Cook and colleagues. The investigators
recommend that consumers drink only pasteurized juices until juice production
routinely includes measures to reduce bacterial contamination.
In a meta-analysis of data from 35 prospective studies by Smith-Bindman
and colleaguesArticle the diagnostic performance of endovaginal ultrasound compared
favorably with office-based endometrial biopsy. In an editorial, CarlsonArticle discusses
the use of endovaginal ultrasound as an alternative to endometrial biopsy
in the evaluation of vaginal bleeding in postmenopausal women.
"It is the will of the people, not that of the legislature, that is
the supreme law." George Caleb Bingham, The County Election, 1852, American.
Activist physician Quentin Young prescribes a cure for what ails US
"I bet I'm the weirdest patient you've ever seen." From "The Intervention."
Suppose you have a test that indicates a predisposition to a certain
disease for which there is currently no treatment. How would you advise the
Ginzberg predicts government funding of essential health care coverage
for all Americans early in the 21st century.
For your patients: A guide to cancer detection and treatment.
Theme issues next week in JAMA and in the November AMA Archives journals.
This Week in JAMA. JAMA. 1998;280(17):1465. doi:10.1001/jama.280.17.1465