Bile-acid sequestrants have been used to treat children with
heterozygous familial hypercholesterolemia (HeFH), but these agents are
only somewhat effective and poorly tolerated. Stein and colleaguesArticle
report that lovastatin, a 3-hydroxy-3-methylglutaryl coenzyme A
reductase inhibitor, significantly decreased low-density cholesterol
levels in adolescent boys with HeFH treated for 1 year compared with
placebo and did not appear to adversely affect growth or sexual
maturation. In an editorial, Rifkind and coauthorsArticle stress that further
study is needed to identify the optimal time to begin treatment of HeFH.
In this 6-month study of an oral anticoagulation therapy
self-management program, Sawicki and coworkersArticle found that patients in
the program had better anticoagulation control and improved
treatment-related quality of life than patients managed with
conventional care. In an editorial, AnsellArticle suggests that physicians may
be more likely to prescribe oral anticoagulants if therapy is
simplified by patient self-management, but research is needed on
long-term outcomes and costs of self-management.
Antiretroviral treatment is recommended for all HIV-infected
individuals, including pregnant women, but the long-term effects of in
utero and neonatal exposure to antiretroviral agents on children are
not known. In this study of more than 200 uninfected children who had
participated in a trial of perinatal zidovudine for HIV prevention,
Culnane and colleagues found no significant differences in growth,
cognitive development, or immunologic function at 3 to 5 years of age
in children exposed to zidovudine in utero and during the first 6 weeks
of life compared with those who had received placebo.
In this epidemiologic investigation, Van Beneden and coworkers
identified alfalfa sprouts grown from contaminated seed distributed by
a European wholesaler as the common source of 2 North American
outbreaks of Salmonella enterica serotype Newport infections
in late 1995 to early 1996 as well as of an outbreak in Denmark in June
1995. The authors point out that there are no effective methods to
decontaminate alfalfa seed and caution consumers about the risk of
foodborne illness from eating sprouts.
To identify what patients consider to be elements of quality
end-of-life care, Singer and colleagues conducted a content analysis of
in-depth, open-ended interviews with patients undergoing hemodialysis,
patients infected with HIV, and elderly patients with chronic
illnesses. Differences between patient-identified elements of quality
end-of-life care and those in expert-derived models suggest that
end-of-life care based solely on expert models is likely to miss
important areas of concern to patients and their families.
Cannom and Prystowsky review advances in
the detection and treatment of ventricular arrhythmias.
Figure 1 shows ventricular fibrillation detected by an implantable cardioverter
defibrillator that delivers a 24-J shock and the return to sinus
"I had never seen my patients smile before." From "Too Sad."
Advances in the treatment of hypertension.
A report from Sweden showing a decrease in the rate of ectopic
pregnancy as the rate of genital chlamydia infections declined
highlights the promise of chlamydia prevention programs for improving
A new technique for rewriting tiny errors in mutant genes may someday
offer a strategy for treating some human diseases.
Delays in cultivation of redistributed land and in access to water in
postwar El Salvador associated with stunted linear growth in Salvadoran
For your patients: Understanding cholesterol.
This Week in JAMA. JAMA. 1999;281(2):109. doi:10.1001/jama.281.2.109