High-dose chemotherapy followed by autologous hematopoietic stem cell
transplantation is often used for the treatment of women with advanced breast
cancer despite controversy regarding its indications and benefits. In a multivariate
analysis of Autologous Blood and Marrow Transplant Registry data from 1188
women with advanced breast cancer who received this treatment, Rowlings and
colleagues found Article that factors associated with disease progression or death
included poor response to pretransplantation chemotherapy, central nervous
system metastases, 3 or more metastatic sites, and prior adjuvant chemotherapy.
In an editorialArticle, Gradishar points out that many of the factors associated
with treatment failure identified in this study are similar to those associated
with poor outcomes using standard-dose chemotherapy and recommends that autotransplantation
be used only in the context of clinical trials until more definitive data
In this randomized trial of the bisphosphonate risedronate for the treatment
of postmenopausal osteoporosis, Harris and coworkers found that among 2458
women with osteoporosis and at least 1 preexisting vertebral fracture, those
who received risedronate had a significantly lower incidence of new vertebral
fractures within 1 year of initiating treatment (Figure 1) and a significantly lower incidence of nonvertebral fractures
within 3 years of treatment compared with women who received placebo. The
incidence of adverse events was similar in the treatment and placebo
Using data from the 1996 state-based Behavioral Risk Factor Surveillance
System telephone survey, Serdula and colleagues found that 28.8% of 46,220
men and 43.6% of 61,584 women reported attempting to lose weight and 35.1%
of the men and 34.4% of the women respondents reported attempting to maintain
weight. Only about a fifth of individuals trying to lose weight reported both
eating fewer calories and exercising at least 150 minutes per week, the weight
loss strategy recommended by US dietary guidelines.
In an analysis of data from the Adverse Childhood Experiences Study
mail survey, Dietz and colleagues found that more than 45% of the 1193 adult
women who responded reported that their first pregnancy was unintended and
65.8% reported exposure to at least 2 types of childhood abuse or household
dysfunction. Compared with women who reported no childhood abuse, women who
reported frequent exposure had a modest but statistically significant increased
risk of unintended first pregnancy and the risk of unintended first pregnancy
increased as the number of types of abuse experienced increased.
Although patients with advanced dementia and eating difficulties are
often fed using enteral feeding tubes, Finucane and colleaguesArticle, in a MEDLINE
search from 1966 through 1999, found no clinical trials comparing tube feeding
with oral feeding in this group of patients, no data supporting that tube
feeding benefits patients with advanced dementia, and some evidence that tube
feeding may be harmful. In an editorialArticle, McCann discusses alternatives to
tube feeding for patients with severe dementia and eating difficulties.
Current concepts in the understanding and treatment of drug addiction.
High hopes that HAART (highly active antiretroviral therapy) might totally
eradicate HIV in infected people have proved illusory. A new report demonstrates
that when therapy is discontinued, the virus rebounds.
How to determine whether a drug is better than others in the same class.
For your patients: Osteoporosis and prevention of hip fractures.
Introductory free and unrestricted access to the complete contents of JAMA
and 10 Archives journals is now available on the JAMA
Additional Web-only reports on gay and lesbian issues in medicine, an
interview with physician-poet Rafael Campo, and selections from his new collection
of poems, Diva.
This Week in JAMA. JAMA. 1999;282(14):1309. doi:10.1001/jama.282.14.1309