Celecoxib and rofecoxib are nonsteroidal anti-inflammatory drugs (NSAIDs)
that selectively inhibit cylooxygenase (COX) 2, sparing COX-1, which is expressed
in the gastrointestinal (GI) tract, kidneys, and platelets. In a randomized
trial, Simon and colleaguesArticle found that the reduction in signs and symptoms
of rheumatoid arthritis were comparable among patients randomly assigned to
receive celecoxib or naproxen, but the incidence of asymptomatic endoscopic
ulcers was significantly less in the celecoxib and placebo groups compared
with naproxen. Based on an analysis of data from 8 randomized trials of rofecoxib
for the treatment of osteoarthritis, Langman and colleagues reportArticle that the
combined incidence of upper GI tract perforations, symptomatic gastroduodenal
ulcer, and upper GI bleeding over 12 months was significantly lower among
patients who received rofecoxib compared with placebo. In an editorialArticle, Peterson
and Cryer point out that because the anti-inflammatory effects of the COX-2
inhibitors and nonselective NSAIDs appear to be equivalent, the selective
COX-2 inhibitors are most likely to benefit only those individuals who are
at higher risk for NSAID-induced ulcer complications.
Hysterectomy has been reported to have detrimental effects on sexual
function in some studies and beneficial effects in others. In this prospective
study of 1132 women followed up for 2 years after hysterectomy, Rhodes and
colleagues found that overall, women reported improved sexual function after
hysterectomy. Frequency of sexual relations, orgasm, and sexual desire increased
significantly after hysterectomy, dyspareunia decreased, and vaginal dryness
Assays that detect immune complexes may be more likely to identify active
infection than assays that detect free antibody, which may reflect active
disease, past exposure, or a nonspecific polyclonal response to another stimulus.
Using enzyme-linked immunosorbent assay (ELISA) and Western blot, Schutzer
and colleagues detected Borrelia burgdorferi immune
complexes in serum samples from 25 of 26 patients with early seronegative
Lyme disease and erythema migrans, in 105 of 107 patients with seropositive
Lyme disease and erythema migrans, in 6 of 10 patients with seronegative but
culture-positive erythema migrans, and in all 13 patients with neurologic
Lyme disease without erythema migrans. B burgdorferi
immune complex assays were negative in all 12 patients who had been treated
and recovered from Lyme disease and in 145 of 147 control subjects.
The Nuremberg Code and the Declaration of Helsinki provide the basis
for US federal regulations that protect the rights of human subjects who participate
in biomedical research. Woodward details Articlerecent trends in medical research
and changes in the interpretation of federal requirements that threaten the
ethical treatment of human research subjects. In an editorialArticle, Ellis points
out that ongoing education for researchers and research institutions and sponsors
is essential to maintain ethical research practices and protect human subjects
and delineates responsibilities of institutional review boards.
Mrs T, whose maternal grandmother had breast cancer and whose mother
and sister died of complications related to metastatic breast cancer, has
recently started preventive treatment with tamoxifen in addition to regular
screening mammography and breast self-examination, but she has decided not
to have genetic testing. Garber discusses determinants of breast cancer risk,
indications for and interpretation of genetic testing, and management of women
with strong family histories of breast or ovarian cancer.
"The beginning of each new training year is another book, another series
of stories, that become richer with time, tucked in among the routines of
daily work." From "Ward 55."
Which patients are most likely to benefit from treatment with statins?
How to lower the high rate of violent injury and death among US children
and adolescents is the focus of a recent report and several studies.
Original research, reviews, and commentaries on caring for patients
at the end of life are invited for a JAMA theme issue scheduled for November
Wife abuse was reported by almost half of 6632 men from the north Indian
state of Uttar Pradesh and was associated with sexually transmitted disease
among the men and unplanned pregnancy.
For your patients: A primer on arthritis.
JAMA Theme Issue on Atherosclerosis
This Week in JAMA. JAMA. 1999;282(20):1893. doi:10.1001/jama.282.20.1893