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This Week in JAMA
January 28, 2004

This Week in JAMA

JAMA. 2004;291(4):397. doi:10.1001/jama.291.4.397
Subclinical Brain Lesions in Patients With Migraine

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.

Placental Growth Factor as a Predictor in Acute Chest Pain

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 Implants and Accuracy of Mammography

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.

Cholesterol Levels and Mortality in Dialysis Patients

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.

Fragile X–Associated Tremor/Ataxia Syndrome

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 or older.

Medical News & Perspectives

Efforts to standardize computed tomography (CT) quantification of coronary artery calcium are under way; the debate on the procedure's clinical value continues.

Ethical Oversight of Pediatric Research

Assessment of processes used to protect children participating in clinical research through informed consent and institutional review board approval.

Clinician's corner

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.

JAMA Patient Page

For your patients: Information about childhood leukemia.