The last full accounting of trauma centers in the United States identified
471 trauma centers in 1991 and 21 states with formal trauma systems. In this
national inventory of US trauma centers as of April 2002,
MacKenzie and colleaguesArticle identified 1154 trauma centers and 35 states with formal trauma systems. The
number of level I and II centers increased from 374 to 453, but the geographic
distribution and configuration of centers by level varied widely. In an editorial,
TrunkeyArticle discusses implications of these findings for health care
Higher lead levels in bone and blood have been associated with increased
risk of hypertension in older men. Nash and colleagues analyzed data from
women aged 40 to 59 years who participated in the Third National Health and
Nutrition Examination Survey to examine the relationship between blood lead
levels and blood pressure and hypertension during perimenopause and postmenopause
when increased bone demineralization may mobilize skeletal lead stores. Blood
lead levels were positively associated with both systolic and diastolic blood
pressure. Risk of systolic and diastolic hypertension was greatest in the
highest blood lead level quartile, especially among postmenopausal women.
Anti–Epstein-Barr virus (EBV) antibodies are elevated in individuals
with multiple sclerosis. To determine whether antibodies to EBV are elevated
before the onset of multiple sclerosis, Levin and colleagues conducted a case-control
study among US military personnel with blood samples collected between 1988
and 2000. Baseline geometric mean serum antibody titers to EBV were consistently
higher among individuals who later developed multiple sclerosis than among
matched controls. All cases were seropositive at the time of collection of
the first blood sample, a mean of 4 years before onset of multiple sclerosis.
Serious adverse effects have been associated with products containing
ephedrine and ephedra. Shekelle and colleaguesArticle conducted a meta-analysis of
data from controlled trials and reviewed case reports of adverse events to
assess the efficacy and safety of ephedra and ephedrine use for weight loss
and enhanced athletic performance. Ephedrine and ephedra use was associated
with modest short-term weight loss, but no data were available regarding long-term
weight loss. Data regarding enhancement of athletic performance were insufficient
for analysis. Use of ephedrine or ephedra was associated with a 2- to 3-fold
increase in psychiatric symptoms, autonomic symptoms, upper gastrointestinal
symptoms, and heart palpitations. In an editorial, Fontanarosa and coauthorsArticle
propose major revisions to the current system used for regulation of dietary
"The pain has disappeared from his face now, and as a father I can only
pray, Keep him in remission. Let him live his dream." From "Fragile Corners."
Cutaneous lesions in a 34-year-old man with Gorham-Stout disease.
In a large phase 3 trial, an experimental HIV vaccine appears to be
largely ineffective, and the interpretation of some of the findings has ignited
How changes in the legal framework for medicine have influenced medical practice.
Mr H, a 73-year-old man, continues to experience limitations related
to hearing loss despite use of digital hearing aids. Jackler discusses the
epidemiology, pathophysiology, evaluation, and treatment of hearing loss.
For your patients: Information about ephedra and ephedrine in dietary
This Week in JAMA. JAMA. 2003;289(12):1469. doi:10.1001/jama.289.12.1469