Tolvaptan, a vasopressin antagonist, combined with loop diuretics effectively
reduces body weight without resultant hypokalemia or worsening renal function
in patients with mild heart failure, but whether it might have similar effects
in patients hospitalized for heart failure is not clear. Gheorghiade and
colleaguesArticle report results of a randomized trial to assess the short-
and intermediate-term effects of tolvaptan plus standard therapy in hospitalized
patients with decompensated heart failure. They found that patients receiving
tolvaptan experienced a significantly greater decline in body weight compared
with patients receiving placebo, without experiencing hypotension, increased
heart rate, hypokalemia, or worsening renal function. In an editorial, Francis
and TangArticle discuss the role of vasopressin antagonist
drugs in the treatment of heart failure.
The HER-2 oncoprotein is overexpressed in 20% to 30% of invasive breast
tumors, and its presence confers important prognostic information. However,
the optimal screening test for HER-2 has not been determined. Yaziji and colleaguesArticle
report results of a parallel comparison study of fluorescence
in situ hybridization and immunohistochemistry tests to assess HER-2 status.
Results from both tests were highly correlated and support recent recommendations
that immunohistochemistry is the testing method of choice. In an editorial,
Wiley and DiazArticle review the results of previous evaluations
of tests to detect HER-2 and recommend that future studies of biomarkers adhere
to the rigorous standards used in this investigation.
Patients with type 2 diabetes have elevated plasma levels of biomarkers
reflecting endothelial dysfunction, but whether these abnormalities exist
prior to the development of diabetes is not known. Meigs and colleagues report
results of a nested case-control study comparing baseline levels of 3 markers
of endothelial dysfunction of women who had developed diabetes during the
11-year study with those who did not. They found that women with diabetes
had significantly higher baseline levels of the markers than those without
diabetes and that 2 markers, E-selectin and intercellular adhesion molecule
1, predicted incident diabetes in analyses adjusted for known diabetes risk
Prior investigations have documented an association of maternal antepartum
radiation exposure with infants of low birth weight (LBW), but whether low-dose
head and neck radiation might be associated is not known. Hujoel and colleagues
linked dental and birth certificate data to investigate whether maternal dental
radiographs performed during the antepartum period were associated with the
birth of a LBW infant. After controlling for established risk factors for
LBW, they found that dental radiation exposure was more common among women
who gave birth to LBW infants compared with those who gave birth to normal-weight
infants. This association was strongest for term infants and the risk increased
with greater radiation dose.
"It had been a decent face, Rubens thought on the way to the hospital—a
doctor's face." From "The Scar."
National electronic medical records, physician field officers, and other
strategies are needed to streamline health care and help disseminate innovation
to community physicians, says health care systems expert Donald Berwick, MD,
Adult survivors of bioterrorism-related anthrax disease report health
problems, psychological distress and diminished health-related quality of
life 1 year after illness onset.
A meta-analysis of clinical trial data reveals that vitamin D supplementation
reduces the risk of falls in the elderly.
Evidence from 4 new studies of reading disability documents a significantly
higher prevalence in boys.
Risk factors associated with obstructive sleep apnea.
For your patients: Information about reading disorder.
This Week in JAMA. JAMA. 2004;291(16):1931. doi:10.1001/jama.291.16.1931