Few studies have examined the short-term outcomes of reducing
environmental tobacco smoke (ETS) in adults. Eisner and coworkersArticle observed that self-reported ETS exposure and respiratory symptoms
decreased in a cohort of San Francisco bartenders after smoking in bars
and taverns was prohibited in California, and spirometry performance
improved. In a related editorial, DavisArticle calls for increasing efforts to
ban smoking in indoor areas.
To determine whether declines in blood lead levels in childhood would
be associated with improvement in cognitive function, Tong and
colleagues analyzed data from 375 children followed up from birth
through 11 to 13 years of age in Port Pirie, South Australia, the site
of a large lead smelting facility. The researchers found that mean
blood lead levels declined with age, but overall the cognitive scores
of children with the greatest decline in blood lead levels after age 2
years were not improved relative to those of children whose lead levels
Cerebral edema may result from cellular cytotoxic swelling,
extracellular vasogenic swelling, or both. In a case-control study by
Hackett and colleagues, magnetic resonance imaging (MRI) revealed edema
of the white matter acutely in 7 of 9 patients with high-altitude
cerebral edema, but no gray matter abnormalities—findings consistent
with vasogenic cerebral edema. No MRI abnormalities were found in the 6
control patients with comparable altitude exposure.
In an epidemiologic study of Olmsted County Minnesota residents
between 1980 and 1994, Clouse and colleagues found that the overall
incidence of degenerative thoracic aortic aneurysms was more than
3-fold higher than the rate from 1951 to 1980, but the 5-year survival
was significantly better in the more recent period. Women were
significantly older than men at the time of diagnosis and had a greater
probability of aneurysm rupture and a lower rate of surgical
In a meta-analysis of data from more than 55,000 subjects
in 16 controlled trials of preventive aspirin therapy, He and
colleaguesArticle found that aspirin therapy increases the risk of hemorrhagic
stroke. But the observed reduction in the risk of myocardial infarction
and ischemic stroke with aspirin therapy may outweigh the risk of
hemorrhagic stroke in many patients. In a related editorial, BoisselArticle discusses the application of these findings to decisions about aspirin
therapy for individual patients.
A National Institutes of Health Consensus Conference reviewed the
scientific evidence on the treatment of opiate addiction through a
literature review, expert presentations, and discussion. The Conference
panel concluded that persons dependent on opiates should have ready
access to medical treatment with methadone or other opiate agonists.
"Sinuous hills appear surreal. . . ." Georgia O'Keeffe,
Black Place I, 1944, American.
Advances in assisted human reproduction and insights into gynecologic
disorders are the focus of two major meetings.
"The young technician wondered if this old man had ever done anything
in his life that was worthwhile or important." From "Alton
When to accept gifts from patients—and when to refuse them.
Recommendations for updating regulations that protect human research
Testosterone replacement therapy improves HIV-related wasting and may
also be indicated for HIV-infected men with hypogonadism without weight
For your patients: The hazards of secondhand smoke.
This Week in JAMA. JAMA. 1998;280(22):1891. doi:10.1001/jama.280.22.1891