Kruit and colleaguesArticle used brain magnetic resonance
imaging in a population-based study of patients with migraine with and without
aura and matched controls to determine the prevalence of cerebral infarcts
and white matter lesions in the general migraine population. The overall prevalence
of brain infarcts in patients with migraine was not significantly different
from that of controls, but the prevalence of infarcts in the cerebellar region
of the posterior circulation territory was significantly higher. Patients
with migraine with aura and a high frequency of migraine attacks had the greatest
risk of posterior circulation territory infarcts. Risk of high load of deep
white matter lesions was significantly increased among women with migraine
with and without aura compared with controls, but not among men. In an editorial,
Lipton and PanArticle suggest that prevention of accumulation
of brain lesions may be added to current goals of migraine treatment.
Evidence suggests that placental growth factor, a type of vascular endothelial
growth factor, acts as a primary inflammatory instigator of atherosclerotic
plaque instability. To determine whether placental growth factor is predictive
of adverse outcomes in patients with unstable coronary heart disease, Heeschen
and colleagues measured placental growth factor levels in a cohort of patients
with angiographically confirmed acute coronary syndromes and in a cohort of
patients presenting to an emergency department with acute chest pain. Elevated
levels of placental growth factor were significantly associated with increased
risk for death or nonfatal myocardial infarction at 30 days in both cohorts
independent of evidence of myocardial necrosis or platelet activation.
Breast augmentation is not associated with increased risk of breast
cancer, but it is uncertain whether breast implants interfere with detection
of breast cancer and delay cancer diagnosis. In this analysis of data from
7 US mammography registries, Miglioretti and colleagues found that among asymptomatic
women, the sensitivity of screening mammography was lower in women with breast
implants than in those without implants. Prognostic characteristics of tumors
in women with breast cancer, however, were not significantly different in
women with breast augmentation compared with those without augmentation.
Contrary to findings in the general population, higher cholesterol levels
are associated with lower mortality in patients with renal disease undergoing
dialysis. In this prospective study of patients who recently initiated dialysis,
Liu and colleagues found that total serum cholesterol level was inversely
associated with risk of all-cause mortality during a median follow-up of 2.4
years overall and in the presence of inflammation or malnutrition, but in
the absence of inflammation or malnutrition, hypercholesterolemia was an independent
risk factor for both all-cause and cardiovascular disease mortality.
Jacquemont and colleagues conducted a community-based survey and neurological
evaluation of members of families affected by the fragile X syndrome in California
to determine the penetrance of the fragile X–associated tremor/ataxia
syndrome—a late-onset neurological disorder characterized by progressive
intention tremor, cerebellar ataxia, and other neurological symptoms, in carriers
of premutation expansions of the fragile X mental retardation 1 (FMR1) gene. Penetrance of this disorder increased with increasing age
from 17% in male carriers aged 50 to 59 years to 75% for those aged 80 years
Efforts to standardize computed tomography (CT) quantification of coronary
artery calcium are under way; the debate on the procedure's clinical value
Assessment of processes used to protect children participating in clinical
research through informed consent and institutional review board approval.
Excerpts of interviews with the wife, daughter, and home care nurse
of a man who died of pancreatic cancer illustrate the burdens of family caregiving
and ways physicians can be of service to family members caring for patients
at the end of life.
For your patients: Information about childhood leukemia.
This Week in JAMA. JAMA. 2004;291(4):397. doi:10.1001/jama.291.4.397