To assess the long-term outcomes of patients with Lyme disease, Seltzer
and colleaguesArticle followed up a community-based sample of 678 patients with suspected
Lyme disease reported to the Connecticut Department of Public Health (median
follow-up, 51 months). Sixty-nine percent of patients reported increased frequency
of symptoms or increased difficulty performing certain daily activities since
being diagnosed with Lyme disease, but only 19% of these problems were attributed
to Lyme disease. The frequency of increased symptoms and increased difficulties
with daily activities and scores on measures of health-related quality of
life and of depression were similar in a subsample of 212 patients with Lyme
disease and in a cohort of age-matched controls without Lyme disease. In an
editorial, GardnerArticle discusses how the absence of a serologic criterion standard
for Lyme disease complicates diagnosis and treatment.
In this decision analysis using a Markov model with a hypothetical cohort
of women with early-stage unilateral breast cancer and a BRCA1 or BRCA2 gene mutation, Schrag and colleagues
estimated the gain in life expectancy from secondary cancer prevention strategies
(tamoxifen, bilateral prophylactic oophorectomy, prophylactic contralateral
mastectomy) singly and as combinations compared with surveillance alone. Potential
life expectancy gains from cancer prevention strategies were higher for women
with high-penetrance mutations, younger age, and node-negative disease.
Using follow-up data from 14,189 infants in the 1970 British Birth Cohort
Study, Strauss found that persons who were full-term infants with fetal growth
retardation (birth weight less than the fifth percentile for age at term)
had small but significant deficits on standardized testing and poorer teacher
ratings at 5, 10, and 16 years of age compared with persons with normal birth
weight. At 26 years of age, adults who were small for gestational age at birth
were less likely to have professional or managerial jobs and reported lower
weekly incomes, but years of education, employment status, hours of work per
week, marital status, and satisfaction with life were similar in the 2 groups.
Hypertension may directly reduce long-term renal allograft function
or it may result from progressive allograft failure. In this study of 277
adults who underwent cadaveric renal transplantation and whose allograft was
functioning 1 year after transplantation, Mange and colleagues found that
blood pressure adjusted for creatinine clearance 1 year posttransplantation
predicted allograft survival during a mean follow-up of 5.7 years. The rate
ratio for allograft failure per 10-mm Hg increase in blood pressure measured
1 year posttransplantation and adjusted for creatinine clearance was 1.15
for systolic blood pressure, 1.27 for diastolic blood pressure, and 1.30 for
mean arterial pressure.
Nucleic acid amplification (NAA) tests for the diagnosis of tuberculosis
(TB) detect nucleic acid sequences unique to Mycobacterium
tuberculosis, distinguishing M tuberculosis
from other mycobacteria detected by acid-fast bacilli smear microscopy and
offering results more rapidly than culture. Catanzaro and colleagues compared
the performance of an NAA test with the physician estimate of probability
that a patient had TB (clinical suspicion of TB [CSTB]). In 338 patients with
symptoms and signs consistent with active pulmonary TB, the sensitivity of
the NAA test was 83% for low level of CSTB, 75% for intermediate level of
CSTB, and 87% for high level of CSTB. Specificity at each level of CSTB was
97%, 100%, and 100%, respectively.
"Can I ever hope to be as brave as my patients? Am I even brave enough
for thoughts of my own demise?" From "Good Fridays."
Phase 1 trials show, for the first time, that patients with a severe
form of inherited immunodeficiency and patients with hemophilia B appear to
have derived clinical benefit from gene therapy.
Women with symptoms of unstable angina may be less likely than men to
undergo diagnostic cardiovascular procedures, but subsequent risk of death
and of cardiac events is greater in men.
See Article and editorial Article
Highly active antiretroviral therapy has allowed discontinuation of
anti-cytomegalovirus (CMV) therapy in some patients with AIDS and CMV retinitis,
but immune recovery has also been associated with intraocular inflammation
with macular edema (arrow), vitritis, and visual
Advances and setbacks for women in medicine.
For your patients: Lyme disease.
This Week in JAMA. JAMA. 2000;283(5):569. doi:10.1001/jama.283.5.569