The benefits and risks of unopposed estrogen therapy for postmenopausal
women with a prior hysterectomy are uncertain. The estrogen-alone component
of the Women's Health Initiative (WHI)Articleassessed whether
conjugated equine estrogen (CEE) therapy would reduce coronary heart disease
incidence and the risk of stroke, fractures, and breast and colorectal cancers
in women who participated in this randomized, placebo-controlled trial. After
an average 6.8 years of follow-up, the trial was terminated when it was determined
that CEE increased the risk of stroke and had no preventive effect on coronary
heart disease events. However, women taking CEE had a reduced risk of fracture
and demonstrated a trend toward a reduction in breast cancer vs women taking
placebo. Yet a summary estimate of overall risks and benefits did not favor
CEE therapy for postmenopausal women with hysterectomy. In an editorial, Hulley
and GradyArticlereview the outcome data from the 3 major trials
of hormone therapy for postmenopausal women and discuss the limited circumstances
for which postmenopausal hormone use might be considered.
The reported sensitivity of computed tomographic colonography (CTC)
to detect clinically significant colonic lesions varies widely. Cotton and
colleaguesArticlepresent results of a multicenter study to
assess the accuracy of CTC among patients with clinical indications for colonoscopy
who agreed to undergo CTC before conventional colonoscopy. The investigators
found that CTC's sensitivity in detecting either clinically significant or
any lesions was significantly less than that of conventional colonoscopy.
In an editorial, RansohoffArticlediscusses the discrepant
results in studies of CTC and the implications for its wide clinical use.
A better understanding of the factors associated with atrial fibrillation
after coronary artery bypass graft (CABG) surgery could improve identification
of patients at greatest risk and enhance the use of preventive strategies.
Mathew and colleagues reviewed data from patients undergoing CABG to assess
the nature and consequences of new-onset atrial fibrillation and to develop
and test a comprehensive risk index to identify patients at greatest risk
of new-onset and recurrent atrial fibrillation. They identified a number of
operative, comorbid, and medication-related factors predictive of new-onset
and recurrent atrial fibrillation and pharmacologic therapies that may offer
Plasma levels of adiponectin, a newly described secretory product of
adipocytes, are inversely associated with several cardiovascular risk factors
and some studies suggest adiponectin may have antiatherogenic and anti-inflammatory
properties. Pischon and colleagues assessed the association of plasma adiponectin
level and risk of nonfatal or fatal myocardial infarction in men. In analyses
that adjusted for traditional cardiovascular risk factors, they found that
men with adiponectin levels in the highest quintile had a significantly decreased
risk of myocardial infarction compared with men in the lowest quintile.
Researchers and clinicians are becoming increasingly aware that as men
age, they have a greater likelihood of passing along defective genes to their
Surgical repair of hip fracture within 24 hours of hospital admission
has no effect on mortality or function but results in shorter length of stay,
less pain, and fewer postoperative complications compared with later surgery.
Surveys of Medicare beneficiaries in fee-for-service (FFS) and managed
care plans revealed that managed care plans scored higher for preventive care
and customer service, but patients in FFS plans were more satisfied with access
and their overall care.
Mechanically ventilated patients with delirium have a higher risk of
mortality, longer hospital stay, and increased cognitive impairment at discharge
compared with ventilated patients without delirium.
Women's susceptibility to carcinogens in cigarette smoke, sex-associated
differences in lung tumor biology, and estrogen effects on tumorigenesis are
discussed in relation to the increasing incidence of lung cancer in women.
For your patients: Information about delirium.
This Week in JAMA. JAMA. 2004;291(14):1673. doi:10.1001/jama.291.14.1673