Indications for cervical spine (C-spine) radiography in stable and alert
patients who have sustained blunt trauma to the head or neck are controversial,
and current clinical practice regarding the use of C-spine radiography is
highly variable. Based on the assessment of 8924 trauma patients, Stiell and
colleaguesArticle derived a highly sensitive 3-question clinical decision rule for
the use of C-spine radiography in alert and stable trauma patients at risk
for neck injury. In an editorial, DaffnerArticle notes that this clinical decision
rule should help improve identification of trauma patients who can be managed
Newer and more expensive second-line antibiotics are often prescribed
for the treatment of acute sinusitis. In this retrospective study using a
pharmaceutical database, Piccirillo and colleagues report that patients with
acute uncomplicated sinusitis treated with an older, less expensive (first-line)
antibiotic did not have significantly different treatment success rates compared
with patients treated with a second-line antibiotic. The cost of care was
significantly higher for patients treated with a second-line antibiotic.
Macrolide antibiotics are recommended for initial treatment of community-acquired
pneumonia in adults. Hyde and colleagues report that macrolide prescription
rates increased 13% between 1993 and 1999, and resistance to macrolide antibiotics
among invasive isolates of Streptococcus pneumoniae,
the most common cause of community-acquired pneumonia, increased from 10.6%
in 1995 to 20.4% in 1999.
Fetal deaths related to maternal injury are not routinely included in
state and national injury surveillance reports, and few studies have reported
data on trauma as a cause of fetal deaths. Weiss and colleagues analyzed fetal
death certificates from 1995 through 1997 obtained from 16 states and found
that the rate of traumatic fetal deaths during this period was 3.7 per 100 000
live births per year. Motor vehicle crashes accounted for most traumatic fetal
injury deaths, followed by firearm injuries.
In patients with severe sepsis and septic shock, the coagulation system
is activated and endogenous anticoagulants are often depleted, predisposing
to diffuse microthrombus formation that may result in organ failure and death.
Warren and colleagues reportArticle, however, that high-dose administration of antithrombin
III, a natural inhibitor of the coagulation cascade, failed to reduce 28-day
all-cause mortality in patients with severe sepsis and septic shock compared
with placebo. In an editorial, Crowther and MarshallArticle consider why trials of
mediator-targeted therapies for sepsis might fail to show significant benefits
and discuss the implications for future research.
Lymphangioleiomyomatosis (LAM), a multisystem disorder that occurs predominantly
in women of child-bearing age, is characterized by cystic lung disease, abdominal
tumors, and other mass lesions in the thorax and brain. This condition is
commonly treated with progesterone and other hormonal agents. Moss and colleagues
report that on magnetic resonance imaging and/or computed tomography, 8 of
250 women with LAM had evidence of meningiomas, tumors believed to be progesterone
Addressing the psychological aftermath of the terrorist attacks on the
World Trade Center and the Pentagon poses a formidable challenge to primary
care physicians and mental health care professionals.
A survey of pharmaceutical companies indicates that most antiretroviral
drugs are not patented in most countries in Africa.
In this analysis of data from participants with vascular disease in
the Heart Outcomes Prevention Evaluation trial, the rate of new diagnosis
of diabetes was lower in the ramipril group than in the placebo group.
How narrative competence enriches medical practice.
For your patients: Information about neck injuries.
This Week in JAMA. JAMA. 2001;286(15):1803. doi:10.1001/jama.286.15.1803