Inflammation is associated with perioperative myocardial infarction
(MI) and mortality following coronary artery bypass graft (CABG) surgery,
but it is not known whether pharmacologic intervention to block proinflammatory
physiologic responses might improve CABG surgery outcomes. Verrier and colleagues
report results of a randomized, placebo-controlled trial of pexelizumab, an
inhibitor of complement activation, in patients undergoing CABG surgery. For
their primary end point of death or MI within 30 days of CABG surgery (without
concomitant valve surgery), the authors found a nonstatistically significant
benefit of pexelizumab compared with placebo. In analyses examining reductions
in risk for all CABG surgery patients and for the risk of perioperative MI
alone, pexelizumab was superior to placebo.
Cases of acute renal failure from ischemia and from radiographic contrast
are believed to have similar origins, and in animal models of ischemic renal
failure, pretreatment with sodium bicarbonate appears to be protective. However,
whether sodium bicarbonate might prevent contrast-induced nephropathy has
not been determined. Merten and colleaguesArticleconducted
a randomized trial in which patients with renal insufficiency received either
sodium chloride or sodium bicarbonate infusions before and after procedures
involving radiocontrast. The investigators found a significantly reduced risk
of contrast-induced nephropathy in patients receiving sodium bicarbonate hydration.
In an editorial,ArticleChertow reviews prior strategies to
prevent contrast-induced nephropathy and the demonstrated benefits of sodium
Hematopoietic cell transplantation (HCT) can be curative for some patients
with leukemia and lymphoma, but factors predicting the time course of physical
and emotional recovery after HCT have not been well defined. Syrjala and colleagues
assessed physical limitations, mental health, and return to work in a 5-year,
longitudinal follow-up of patients undergoing HCT. They found that only 19%
of patients had recovered within the first year, and most patients required
3 to 5 years to recover. Greater social support and experience with cancer
treatment before HCT were associated with a more rapid recovery. Those who
were depressed before HCT had a longer recovery time.
Increasing pharmacy co-payments is one way health plans have responded
to the increase in expenditures for drugs, but it is not known how changes
in cost-sharing affect the use of commonly prescribed drugs. Goldman and colleagues
analyzed pharmacy claims data and health plan benefits to examine the relationship
of rising co-payments with drug use. They found that a doubling of the copayment
resulted in significant reductions in the use of drugs in 8 common therapeutic
drug classes. The greatest reductions were seen for possibly "nonessential"
nonsteroidal anti-inflammatory drugs and antihistamines and drugs with an
For a 2-month period in 1999, it was recommended that the usual birth
dose of hepatitis B vaccine be delayed until 2 to 6 months of age. Using data
from the National Immunization Survey for children born before, during, and
after the birth-dose vaccination suspension, Luman and colleagues assessed
the effect of this change in vaccine administration on hepatitis—and
overall pediatric—vaccination coverage. They found a significant decline
in the proportion of infants who received the hepatitis B vaccine at birth
and who completed the 3-dose series by age 19 months, beginning during the
suspension period and persisting after the suspension was lifted but no declines
in other recommended vaccinations.
Some chemical modifications to an individual's DNA can silence genes
that normally safeguard against cancer. Scientists are exploring how to shut
down cancer cells by awakening these silenced genes.
Intravenous immunoglobulin (IVIG) is effective in treating many autoimmune
The Patient-Physician Relationship
Methods for communicating clinical evidence to enhance patient participation
in care decisions are discussed.
From the Archives Journals
Improvements in speech and language development in children undergoing
early cochlear implant placement are reported on in the Archives of Otolaryngology–Head & Neck Surgery.
For your patients: Information about cochlear implants.
This Week in JAMA. JAMA. 2004;291(19):2285. doi:10.1001/jama.291.19.2285