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.
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.
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.
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.
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.
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.
Design factors in studies of dying patients may lead to invalid conclusions
about the care provided.
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
For your patients: Information about melanoma.
This Week in JAMA . JAMA. 2004;292(22):2691. doi:10.1001/jama.292.22.2691