Men with a local recurrence of prostate cancer after a radical prostatectomy
may benefit from radiotherapy, but the factors associated with a positive
response are not well defined. Stephenson and colleaguesArticlereport the results of a retrospective analysis of patient outcomes after salvage
radiotherapy. Predictors of progression-free survival at 4 years included
a low preradiotherapy prostate-specific antigen (PSA) level and a PSA doubling
time of longer than 10 months, early initiation of radiotherapy, lower Gleason
score, positive surgical margins, and no seminal vesicle invasion. In an editorial,ArticleAnscher emphasizes the benefits of early salvage treatment
for all prostate cancer recurrences and the advantages of adjuvant therapy
for some patients.
Transdermal, patient-controlled analgesia (PCA) is convenient and eliminates
the need for venous access required for intravenous PCA; however, its efficacy
for postoperative pain is not established. Viscusi and colleagues report the
results of a randomized trial comparing the safety and efficacy of an iontophoretic
transdermal system using fentanyl hydrochloride with standard PCA using morphine
and an electronic pump in adult patients who underwent major surgical procedures
and who were randomized in the recovery room. Assessments of pain control
and pain intensity 24 hours after randomization were similar in the 2 groups,
implying therapeutic equivalence.
The precision and reproducibility of office-based blood pressure measurements
have been challenged because of significant intraobserver and interobserver
variability, leading to the recommendation of home monitoring. Bobrie and
colleagues report results of a prospective observational study of elderly
patients with hypertension whose blood pressure control was assessed at office
visits and at home. They found an increase in cardiovascular events for each
10-mm Hg systolic and 5-mm Hg diastolic increase above predefined thresholds
for blood pressure control recorded at home. However, patients in the normotensive
group with similarly increased elevations during clinical assessments compared
with home measurement experienced no increase in events, suggesting superior
prognostic accuracy for home-based blood pressure monitoring.
Studies document increased survival in patients with hypotension and
severe traumatic brain injury who are treated with hypertonic saline (HTS)
in the acute resuscitation phase, but whether HTS improves outcomes is unknown.
Cooper and colleaguesArticlecompared HTS plus standard intravenous
fluids with standard resuscitation fluids alone in the prehospital setting
by assessing neurological outcomes at 3 and 6 months after injury. They found
equivalent survival rates and long-term neurological status in both groups
of patients. In an editorial,ArticleLewis discusses the importance
of systematic evaluations of prehospital interventions and recommends that
future studies continue to explore potential benefits of HTS resuscitation
Congestive heart failure is the leading reason for hospital readmission
of elderly patients in the United States. Readmissions have been blamed on
poor discharge planning and postdischarge care. Phillips and colleagues report
results of a systematic review examining the efficacy of comprehensive discharge
planning with postdischarge support vs usual care to reduce readmissions and
to improve health outcomes. Their review showed fewer readmissions and higher
scores on measures of health and quality of life in patients assigned to the
comprehensive care interventions vs those receiving usual care.
Researchers hope that targeting molecules that promote the growth of
abnormal blood vessels will prove useful in treating degenerative eye disorders,
such as diabetic retinopathy and age-related macular degeneration.
Vaginal complaints are common, but the symptoms, signs, and microscopy
findings may not identify their cause.
For your patients: Information about vaginal symptoms.
This Week in JAMA. JAMA. 2004;291(11):1293. doi:10.1001/jama.291.11.1293