To determine whether pathological brain overgrowth precedes the initial
clinical signs of autism, Courchesne and colleaguesArticle reviewed
medical record growth data from the first year of life of children aged 2
to 5 years with autism spectrum disorder. Compared with normative data from
healthy infants, head circumference in children with autism spectrum disorder
was significantly smaller at birth and increased from the 25th percentile
to the 84th percentile by 6 to 14 months. In an editorial,Article Lainhart
notes that it is not clear whether increased rate of head growth in infancy,
which may precede clinical recognition of autism, also precedes the actual
onset of the disorder.
Pelvic floor electrical stimulation has been widely used for the treatment
of urinary incontinence. In this randomized controlled trial among women aged
40 to 78 years with stress or mixed urinary incontinence, Goode and colleaguesArticle found that reduction in incontinence episodes in
the group that received clinic-based behavioral training plus pelvic floor
electrical stimulation was not significantly different from that in the group
that received clinic-based behavioral training alone. Reductions in incontinence
episodes in both clinic-based behavioral training groups were significantly
greater than in the group that received self-administered behavioral treatment
using a self-help booklet (control condition). In an editorial, Resnick and
GriffithsArticle discuss the generalizability and clinical
implications of the study results and research questions raised by the study.
Cardiac causes account for 40% to 45% of all deaths among patients with
end-stage renal disease (ESRD). deFilippi and colleagues conducted a prospective
cohort study to investigate the association between 2 prognostic biomarkers
in acute coronary syndromes—cardiac troponin T (cTnT) and C-reactive
protein (CRP)—and long-term risk of all-cause mortality and cardiac
pathology among patients with ESRD who did not have symptoms of myocardial
ischemia. Increasing cTnT and CRP levels at study entry were independently
associated with increased risk of death during a mean follow-up of 827 days.
Elevated levels of cTnT were significantly associated with increased risk
of multivessel coronary artery disease assessed by coronary angiography.
The current system of institutional review board (IRB) assessment of
human subjects protection was developed primarily for clinical trials conducted
at single sites. Multicenter studies involve approval by each local IRB in
the study. In a survey of cystic fibrosis centers participating in a multicenter
genetic epidemiology study, Cutting and colleagues found that local IRB assessment
of risk and type of review required, types and numbers of consent forms, whether
assent was required for children, and time to approval varied considerably.
Consent forms often failed to include items necessary for genetic studies
and information consistent with DNA banking guidelines.
In this issue of THE JOURNAL, case series reported by Fowler and colleaguesArticle and by Lew and colleaguesArticle describe
the clinical features and outcomes of patients with severe acute respiratory
syndrome (SARS) who were critically ill and treated in intensive care units
(ICUs)—38 of 196 hospitalized patients in the Toronto area and 46 of
199 hospitalized patients in Hong Kong. Most of the critically ill patients
in both series met diagnostic criteria for acute respiratory distress syndrome
(ARDS). Mortality at 28 days after ICU admission was 34% in the Toronto series, and mortality at 28 days after symptom onset was 37% in the Hong Kong series. In an editorial, Rubenfeld Articlediscusses current
clinical questions and controversies in the care of patients with ARDS of
all etiologies, including SARS.
"There's only one thing that really and truly scares me." From "A Mutual
An epidemic of Ebola hemorrhagic fever that has continued in a remote
region of Africa since October 2001 raises questions about how health officials
should respond to this kind of outbreak.
Mr C is a 48-year-old man with temporal lobe epilepsy associated with
complex neurologic and psychiatric symptoms. Devinsky discusses the clinical
features (Figure 1), diagnosis,
and treatment of temporal lobe epilepsy.
Levin and Lessell discuss the clinical implications of risk factors for multiple sclerosis after optic neuritis identified in a 10-year follow-up study recently published in the Archives of Ophthalmology.
For your patients: Information about stress incontinence.
This Week in JAMA . JAMA. 2003;290(3):295. doi:10.1001/jama.290.3.295