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This Week in JAMA
November 7, 2001

This Week in JAMA

JAMA. 2001;286(17):2061. doi:10.1001/jama.286.17.2061
Purified Poloxamer 188 for Sickle Cell Pain Episodes

Purified poloxamer 188 (PP188) is a nonionic surfactant that improves microvascular blood flow by reducing blood viscosity and adhesive frictional forces. In this randomized controlled trial, Orringer and colleaguesArticle found that the duration of acute vaso-occlusive crises among patients with sickle cell disease who received PP188 was decreased compared with the placebo group, especially among children, and the proportion of patients able to achieve crisis resolution was increased. In an editorial, NagelArticle discusses current research on innovative strategies to inhibit vaso-occlusion in sickle cell disease and stresses the importance of providing prompt, effective pain management for patients with acute sickle cell crisis.

Inflammation and Coronary Artery Disease

Recent evidence suggests that atherosclerosis is a chronic inflammatory condition involving the vessel wall and circulating inflammatory cells. Two studies in this issue of THE JOURNAL investigate the association between markers of inflammation and coronary artery disease (CAD). In an analysis of data from a prospective clinical trial that compared invasive and noninvasive therapies for patients with unstable CAD, Lindmark and colleaguesArticle found that interleukin 6 level was an independent predictor of mortality over 6 to 12 months. Zhang and colleaguesArticle, in a case-control study, found that elevated levels of myeloperoxidase, an enzyme that promotes oxidation of lipoproteins in atheroma, was associated with the presence of CAD. In an editorial, Vorchheimer and FusterArticle note that it is premature to incorporate measurement of inflammatory markers into the routine assessment of patients with CAD and emphasize the importance of treating these patients with medications that have documented efficacy.

Hormone Replacement Therapy and Dry Eye Syndrome

To determine whether dry eye syndrome is associated with postmenopausal hormone replacement therapy, Schaumberg and colleagues analyzed data from postmenopausal women enrolled in the Women's Health Study. At the 4-year follow-up visit, the prevalence of dry eye syndrome was significantly higher among women who used hormone replacement therapy, especially estrogen alone, compared with never-users.

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PET Evaluation of Dementia

Previous studies have found that early stages of neurodegenerative diseases, including Alzheimer disease, can produce alterations in brain metabolism that are detectable with positron emission tomography (PET). Silverman and colleagues followed up patients for an average of 3 years who underwent PET evaluation for symptoms of dementia. Overall, the initial PET pattern of cerebral metabolism was significantly associated with the subsequent course of dementia, and the likelihood of progressive dementia after a single initial negative PET scan was low.

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Small-Area Variation in Rates of Middle-Ear Surgery

Small-area variations in surgical rates have been documented for many surgical procedures. In the 49 counties of Ontario, Coyte and colleagues found almost a 10-fold difference between areas with the highest and lowest rates of myringotomy with insertion of tympanostomy tubes. The dominant modifiable determinant of area variation was the propensity of primary care physicians to refer for this surgical procedure.

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A Piece of My Mind

"I soon realized she was saying that I had the power in my hands to determine when she would die." From "You Have the Power."

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Medical News & Perspectives

From the Centers for Disease Control and Prevention: Guidelines for recognizing and responding to anthrax threats and other illnesses such as plague and smallpox that might result from a bioterrorist attack.

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Alcohol and Breast Cancer

A review of recent epidemiologic studies indicate that alcohol consumption is associated with increased risk of breast cancer; experimental studies suggest several mechanisms by which alcohol may affect breast carcinogenesis.

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Cosmetic and reconstructive surgery, body image, and health: how medicine defines beauty.

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JAMA Patient Page

For your patients: Information about Alzheimer disease.

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