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This Week in JAMA
November 24, 1999

This Week in JAMA

JAMA. 1999;282(20):1893. doi:10.1001/jama.282.20.1893
COX-1–Sparing NSAIDs and Ulcer Complications

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.

Sexual Function After Hysterectomy

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 improved.

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Immune Complex Assay for Lyme Disease Detection

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.

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Protection of Human Subjects in Biomedical Research

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.

A 40-Year-Old Woman With Breast Cancer in Family

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.

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A Piece of My Mind

"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."

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Contempo 1999

Which patients are most likely to benefit from treatment with statins?

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Medical News & Perspectives

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.

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Caring for Patients at the End of Life

Original research, reviews, and commentaries on caring for patients at the end of life are invited for a JAMA theme issue scheduled for November 2000.

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Domestic Violence and Reproductive Health

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.

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JAMA Patient Page

For your patients: A primer on arthritis.

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JAMA Theme Issue on Atherosclerosis