Parents of children with bone marrow diseases that can be treated with
a stem cell transplant may try to conceive and give birth to a child whose
cord blood might be used to treat the affected sibling. Verlinsky and colleaguesArticledescribe the process and outcomes of preimplantation HLA
testing performed for 9 couples who had a child with acute leukemia or Diamond-Blackfan
anemia and who desired another child. In 13 in vitro fertilization cycles,
DNA was removed from 199 eight-cell embryos, for which HLA typing had been
performed. Forty-five embryos had the same HLA type as the affected sibling,
and 28 embryos were transferred, resulting in 5 clinical pregnancies and the
birth of 5 healthy neonates. In an editorial,ArticleFost discusses
benefits and concerns associated with this application of genetic and reproductive
The BCG tuberculosis (TB) vaccine has been in use for more than 80 years,
but its long-term efficacy is not known. Aronson and colleaguesArticlereviewed medical records and death certificates of participants in a 1935-1938
placebo-controlled, single-dose BCG vaccine trial. Participants had been followed
up through 1998 to determine the duration of vaccine protection. Results of
their analyses suggest the vaccine has an efficacy of 52% over the 60 years
of follow-up. In an editorial,ArticleDye reviews factors that
can contribute to varying efficacy of the BCG vaccine and the challenges for
new TB vaccine development.
An estimated 2% to 3% of patients undergoing major noncardiac surgery
will experience a perioperative myocardial infarction, with mortality rates
that approach 25% to 40%. Through examination of patient data from 329 US
hospitals, Lindenauer and colleagues sought to determine whether the use of
lipid-lowering medication was associated with reduced mortality in these patients.
They found that patients who received lipid-lowering agents in the first 2
days after surgery experienced significantly lower in-hospital mortality than
patients who were not receiving these medications.
Cervical intraepithelial neoplasia (CIN) is often diagnosed and treated
during a woman's reproductive years, but whether treatment can increase the
risk of preterm delivery in a subsequent pregnancy is not known. To address
this question, Sadler and colleagues reviewed the delivery outcomes from a
cohort of women with CIN. They found no effect of CIN treatment on the risk
of spontaneous preterm delivery, but women who were treated with loop electrosurgical
excision procedures or laser conization had a significantly increased risk
of premature rupture of membranes.
Recent studies in adults have documented concurrent increases in body
mass index (BMI) and hypertension, and the increase in hypertension has been
directly attributed to the rise in BMI. Whether similar increases in blood
pressure levels have occurred in children and adolescents and whether such
increases are related to overweight is not known. Muntner and colleagues compared
data from 2 national health surveys conducted in 1988-1994 and 1999-2000.
Among participants aged 8 to 17 years, significant increases in systolic and
diastolic blood pressure levels were documented in the 1999-2000 survey. They
conclude that these increases could be partially attributed to increases in
Researchers say that bypassing a ban on federal funding for human embryonic
stem cell research is all the more urgent in light of findings that adult
stem cells might be less flexible than once thought.
Increases in the prevalence of abuse and dependence disorders may reflect
an increased potency of marijuana.
External fixation for unstable extremity fractures and reconstructive
Evaluating historical and cultural trends in medical education.
For your patients: Information about bone fractures.
This Week in JAMA. JAMA. 2004;291(17):2049. doi:10.1001/jama.291.17.2049