Oral contraceptive (OC) use has been associated with a slight increase
in breast cancer risk in the general population, but among women with a family
history of breast cancer, evidence on the association of OC use and breast
cancer risk has been inconsistent. Between 1991 and 1996, Grabrick and colleaguesArticle interviewed the relatives of women who had been diagnosed with breast cancer
between 1944 and 1952. Among sisters and daughters of the probands, ever use
of OCs was associated with a significantly increased risk of breast cancer,
but not among granddaughters or nieces or women who had married into the families.
In an editorial, BurkeArticle points out that factors that may influence the apparent
association between OC use and breast cancer risk are still uncertain, complicating
the decision to use OCs, especially for high-risk women considering OCs to
reduce ovarian cancer risk.
Women have been thought to have poorer outcomes than men after conventional
coronary interventions. In this study of patients with symptomatic coronary
artery disease treated with coronary stenting between May 1992 and December
1998, Mehilli and colleaguesArticle found that the risk of death or myocardial infarction
1 year after coronary artery stenting was similar in women and men, but baseline
characteristics, outcomes at 30 days, and baseline prognostic factors were
substantially different. Suwaidi and coauthorsArticle, in a review of studies comparing
coronary artery stenting with balloon angioplasty, note that the use of coronary
stents has improved the outcomes of interventional procedures for many types
of lesions in patients with coronary artery disease. In an editorial, LincoffArticle
qualifies these reports with a discussion of problems associated with coronary
stenting, including restenosis within a stent and failure to use adjunctive
antiplatelet therapy, economic issues, and lack of comparative data on outcomes
of death or myocardial infarction after stenting.
Hearing aids are the principal treatment for persons with sensorineural
hearing loss. In this crossover trial of 3 common hearing aid circuits—the
linear peak clipper, the compression limiter, and the wide dynamic range compressor—Larson
and colleagues found that all 3 circuits improved speech recognition compared
with the unaided condition in patients with bilateral sensorineural hearing
loss, and reduced the frequency of problems in verbal communication. Differences
in speech recognition and sound quality observed in pairwise comparisons of
the 3 circuits were small, but generally favored the compression limiter and
wide dynamic range compressor circuits over the linear peak clipper.
Chronic rhinosinusitis is a common condition in the general population
and also a consistent feature of cystic fibrosis. To investigate the molecular
basis of chronic rhinosinusitis, Wang and colleagues screened patients with
this condition and matched controls for mutations in the cystic fibrosis transmembrane
regulator (CFTR) gene. The proportion of patients
who had the CFTR mutations was significantly higher
in the chronic rhinosinusitis group than in the control group, suggesting
that the CFTR gene may be associated with the development
of chronic rhinosinusitis in the general population.
Rates of immunization of children and adults in the United States have
been increasing, but are still below national goals. Szilagyi and colleagues
systematically reviewed studies on the effectiveness of patient reminder systems
(postcards, letters, and telephone or autodialer calls) to improve immunization
rates. In 33 of the 41 reviewed studies, patient reminder systems improved
immunization rates independent of baseline immunization rates, patient age,
clinical setting, or vaccination type. All types of reminders were effective;
telephone reminders were the most effective, but the most costly.
"To see you was to glimpse the limits of the medical craft, but worse,
it was to realize even the strongest love couldn't stop a disease's course."
From "Hands That Held Other Hands."
Surgical reconstruction of defects of the head and neck using microvascular
free-tissue transfer restores function and appearance after tumor excision
The release of the National Institutes of Health guidelines for research
using pluripotent stem cells holds promise for the discovery of potentially
Establishing a secure Internet Web site for collecting and managing
data for collaborative multisite research studies.
For your patients: A primer on cystic fibrosis.
This Week in JAMA. JAMA. 2000;284(14):1749. doi:10.1001/jama.284.14.1749