Acetylcysteine is an antioxidant that has been shown to prevent acute
contrast nephrotoxicity in patients with impaired renal function exposed to
contrast agents during computed tomography. In this randomized placebo-controlled
trial, Kay and colleaguesArticle assessed whether acetylcysteine prevents acute deterioration
in renal function in patients with moderate chronic renal insufficiency undergoing
elective coronary angiography. Significantly more patients experienced greater
than a 25% rise in serum creatinine in the placebo group than in the acetylcysteine
group within 48 hours after contrast administration. Serum creatinine was
lower in the acetylcysteine group than in the placebo group during the first
48 hours after angiography, and creatinine clearance increased significantly
in the acetylcysteine group 2 days after contrast administration, but not
in the placebo group. In an editorial, CurhanArticle discusses clinical measures
for reducing risk of contrast nephropathy in patients undergoing coronary
angiography and when they should be used.
Serious cardiopulmonary compromise and disability from back pain have
been reported in previous long-term studies of idiopathic scoliosis, but these
studies have included patients with scoliosis of other etiologies, including
congenital, neuromuscular, or early-onset scoliosis. In this 50-year follow-up
study, Weinstein and colleaguesArticle found that untreated patients with late-onset
idiopathic scoliosis did not have an increased rate of mortality in general
or of mortality from cardiac or pulmonary conditions possibly related to the
spine curvature compared with control patients. Significantly more patients
with scoliosis complained of back pain than did control patients, but among
those with back pain, most reported little or moderate pain. Overall function
was not significantly different in the 2 groups, but patients with scoliosis
had lower body satisfaction scores. In an editorial, SponsellerArticle discusses
the use of this information for discussing treatment options with patients
with idiopathic scoliosis.
Safety balls and faceguards are widely used in youth baseball. In this
analysis of data from a national database of compensated insurance claims
maintained by Little League Baseball Incorporated, Marshall and colleagues
found that use of reduced-impact balls and faceguards was associated with
reduced risk of injury in youth baseball during the 1997-1999 seasons.
In August 2001, a serious shortage of the heptavalent pneumococcal conjugate
vaccine (PCV7) developed in 34 state immunization programs in the United States.
The vaccine had recently been recommended for universal administration to
all children younger than 2 years. Freed and colleagues interviewed office
staff responsible for ordering vaccine at private practices in 12 states to
determine the nature and extent of the PCV7 shortage at the practice level.
Overall, more than half of practices reported at least 1 episode during the
shortage of being out of stock of PCV7 from both public and private supply
sources, with marked state-to-state variation. Few practices altered their
PCV7 administration policy in accordance with revised recommendations to prioritize
PCV7 to specific groups of children.
The Environmental Protection Agency is considering whether to end a
self-imposed moratorium on using human toxicity studies to help determine
safe levels of pesticide use.
In this meta-analysis of observational studies on alcohol consumption
and stroke risk, heavy alcohol consumption was associated with increased relative
risk of total, ischemic, and hemorrhagic stroke. Light or moderate alcohol
consumption was associated with reduced relative risk of total and ischemic
Scientific Review/Clinical Applications
In part 1Article, evidence on the effectiveness of interventions aimed at preventing
abuse or reabuse of women is reviewed. Hypothetical cases in the primary care
setting presented in part 2Article illustrate clinical approaches to intimate partner
Medical narratives: a collection of creative writing.
For your patients: Information about baseball safety.
This Week in JAMA. JAMA. 2003;289(5):519. doi:10.1001/jama.289.5.519