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This Week in JAMA
December 8, 2004

This Week in JAMA

JAMA. 2004;292(22):2691. doi:10.1001/jama.292.22.2691
Drug-Eluting vs Uncoated Stents and Restenosis

Prior studies have demonstrated that sirolimus-eluting stents are effective in reducing restenosis in large coronary arteries treated percutaneously. Whether similar outcomes are possible in small coronary vessels is not clear. Ardissino and colleaguesArticle report results of a randomized trial designed to test whether implantation of a sirolimus-eluting stent vs an uncoated stent in atherosclerotic small coronary arteries would be associated with less angiographic restenosis and fewer major adverse cardiac and cerebrovascular events. These outcomes were assessed at a mean 8-month follow-up, and all were significantly lower in patients with a sirolimus-eluting stent. In an editorial, HolmesArticle discusses the importance of extended patient follow-up to confirm long-term clinical benefit.

Breast MRI for Cancer Detection

Magnetic resonance imaging (MRI) of the breast prior to biopsy in women with mammographically or clinically suspicious lesions has been suggested as a potential way to improve breast cancer diagnosis. However, the accuracy of MRI for detecting breast cancer has not been adequately assessed. Bluemke and colleaguesArticle report data from a multicenter clinical study that assessed the role of MRI as an adjunct to conventional methods of breast cancer detection. The MRI examinations were obtained prior to breast biopsy and the sensitivity and specificity of MRI determined. The authors found that breast MRI had high sensitivity but only moderate specificity for detecting breast cancer. In an editorial, MorrowArticle highlights the need to demonstrate clinical benefit before adding MRI to the routine evaluation of women with suspected breast cancer.

Body Mass Index and Medicare Expenditures

Overweight and obesity have well-established links to adverse health outcomes, but little is known about the relationship of overweight and obesity to long-term expenditures for medical care. To address this question, Daviglus and colleagues examined Medicare charges for participants in a prospective cohort study of cardiovascular disease risk, for whom body mass index was determined at enrollment in 1967-1973 and who were Medicare eligible in 1984-2002. The authors found a significant positive association between overweight or obesity assessed during young adulthood and middle age and increased Medicare charges in later life.

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Lead Exposure and Risk of Cataract

Lead exposure is related to several chronic disorders of aging, and there are some reports of lead in lenses with cataract. To further investigate this association, Schaumberg and colleagues measured bone lead in the tibia and patella in men participating in a longitudinal study of aging and reviewed their medical records for diagnoses of age-related cataract. The authors found a significantly increased risk of age-related cataract in men with tibial lead levels in the highest vs lowest quintile.

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Birth Weight and Cholesterol

A number of studies have reported an inverse association between birth weight and adverse lipid levels in adulthood, leading to suggestions of a possible fetal origin for this cardiac risk factor. Huxley and colleagues report results of a systematic review of studies that recorded birth weight and total blood cholesterol or reported qualitative or quantitative estimates of an association between them to further characterize this potential relationship. The authors found only a weak association between birth weight and total blood cholesterol level in adulthood.

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Medical News & Perspectives

Encouraging phase 2 results from a malaria vaccine trial in Africa offer hope for protecting millions against uncomplicated malaria, infection, and severe forms of the disease.

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Studies of Dying Patients

Design factors in studies of dying patients may lead to invalid conclusions about the care provided.

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CLINICIAN’S CORNER

Adding “E” for “evolving” to the ABCD criteria (Asymmetry, Border irregularity, Color variegation, Diameter >6 mm) used in the assessment of pigmented lesions will improve the early diagnosis of cutaneous melanoma.

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JAMA Patient Page

For your patients: Information about melanoma.

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