Most patients who undergo percutaneous coronary intervention (PCI) experience
short-term improvement in ischemic symptoms, but three fifths of patients
at 5 years and only a third of patients at 10 years remain free of major adverse
cardiac events. Serruys and colleaguesArticle conducted a randomized controlled trial
to determine whether lipid-lowering therapy with fluvastatin initiated within
days after successful completion of a first PCI would improve cardiac disease–free
survival among patients with average cholesterol levels. After a median follow-up
of 3.9 years, survival time free of major adverse cardiac events was significantly
longer among patients who received fluvastatin than among patients who received
placebo. In an editorial, SopkoArticle reviews the biological mechanisms underlying
restenosis following PCI, and discusses mechanisms by which statin therapy
might help to prevent this complication.
Evidence suggests that oxidative stress may be important in the pathogenesis
of Alzheimer disease (AD). Two prospective studies in this issue of THE JOURNAL
investigated whether dietary intake of antioxidants is associated with risk
of AD. In the Rotterdam Study, a population-based study of individuals aged
55 years or older at baseline, Engelhart and colleaguesArticle found that high intake
of vitamin C and vitamin E from food was associated with lower risk of incident
AD after a mean follow-up of 6 years, although statistical significance of
the association was borderline. Morris and colleaguesArticle, in the Chicago Health
and Aging Project study of individuals aged 65 years or older, found that
high intake of vitamin E from food was associated with reduced risk of AD
after a mean follow-up of 3.9 years, but only among individuals without the APOE ∊4 allele. Intake of vitamin E, vitamin C, and
beta carotene from supplements, however, was not significantly associated
with risk of AD. In an editorial, Foley and WhiteArticle discuss several methological
issues that must be considered in observational studies evaluating whether
antioxidant vitamin intake reduces the risk of AD.
Noninvasive positive-pressure ventilation (NPPV) has been shown to prevent
the need for endotracheal intubation in patients with acute respiratory failure.
In this randomized controlled trial, Keenan and colleagues evaluated whether
NPPV would reduce the rate of endotracheal reintubation in high-risk patients
who develop respiratory distress during the first 48 hours after extubation
compared with standard medical therapy. The rate of reintubation in the NPPV
group was not significantly different from that in the standard medical therapy
group. Hospital mortality, duration of mechanical ventilation, or length of
hospital or ICU stay were also not significantly different.
Wolfe and colleagues used an Internet metasearch program to identify
Web sites that oppose childhood vaccinations and evaluated the content of
these sites using a standardized instrument to assess antivaccination claims
and other attributes. Twelve antivaccination Web sites were identified. All
of these sites claimed that vaccines cause idiopathic illness and provided
links to other antivaccination sites. More than 90% of the sites claimed that
adverse vaccine reactions are underreported, that vaccines erode immunity,
and that vaccination policy is motivated by profit. More than half provided
information for legally avoiding immunizations.
"I have been forced to confront my own feelings about crime and punishment
and working with men who have committed barbaric, heinous crimes but who are
also human." From "Dead Man Talking."
Pathogenesis and management of preeclampsia.
An eagerly awaited report on macroeconomics and health, presented at
this year's World Health Assembly in Geneva, clearly defines the urgent need
for rich countries to help poor ones improve their prevention and treatment
Mr X is a 23-year-old man who began treatment for paranoid schizophrenia
with clozapine at age 18 years early in the course of his illness. His second
hospitalization for an episode of acute paranoid schizophrenia occurred 2
months ago after he began using ecstasy, cocaine, and alcohol and discontinued
his medication. Goff discusses diagnostic criteria for schizophrenia and the
epidemiology, course, pathophysiology, and treatment of this condition.
For your patients: Information about intensive care units.
This Week in JAMA. JAMA. 2002;287(24):3173. doi:10.1001/jama.287.24.3173