Tobacco use is the major cause of lung cancer, but most smokers are
spared. Two articles in this issue of JAMA examine
factors in addition to tobacco use that contribute to lung cancer risk. Jonsson
and colleaguesArticle investigated the contribution of genetic
factors in the Icelandic population. They found a significantly elevated risk
in first-, second-, and third-degree relatives of lung cancer cases that could
not be explained by tobacco smoke exposure. In a second article, Chen and
colleaguesArticle used data from 2 arseniasis-endemic areas
of Taiwan to assess the relationships of ingested arsenic and cigarette smoking
to lung cancer. They found a significant dose-response relationship for arsenic
ingestion and a synergistic effect of arsenic ingestion and cigarette smoking
on the risk of lung cancer. In an editorial, Ahsan and ThomasArticle
discuss genetic, environmental, and behavioral factors related to lung cancer
etiology and its prevention.
Ovarian failure and oocyte depletion are commonly implicated as the
factors causing menopause, but some data suggest central nervous system involvement.
Weiss and colleagues investigated the hypothalamic-pituitary response to estrogen
in perimenopausal women by measuring daily urine levels of estrogen and progesterone
metabolites, luteinizing hormone (LH), and follicle-stimulating hormone. They
found an absence of an LH surge in response to estrogen levels that in younger
ovulating women would be adequate and a failure of follicular-phase estrogen
levels to diminish LH secretion, findings suggestive of hypothalamic-pituitary
insensitivity to estrogen during the perimenopausal period.
Acute eosinophilic pneumonia (AEP) is rare but was diagnosed in 18 US
military personnel among 183 000 deployed to Iraq. Shorr and colleagues
describe the results of an epidemiologic investigation of these cases and
the clinical features observed. They found no common-source exposure or association
with recent vaccination. All cases of AEP occurred in tobacco users, 14 of
whom were new smokers. Twelve of the patients required mechanical ventilation,
for a median duration of 7 days. Two patients died, and the remainder responded
to corticosteroid therapy and/or supportive care, with eventual normal or
nearly normal respiratory function.
Pulsatile lavage, a high-pressure irrigation treatment widely used for
cleansing and debridement of wounds, is often performed without routine infection
control precautions. Maragakis and colleagues report results of an investigation
of an outbreak of multidrug-resistant Acinetobacter baumannii (MDR-Ab), which they hypothesized to be associated with pulsatile lavage wound treatment. They identified 10 patients who became infected with
MDR-Ab in the hospital, 8 of whom had undergone pulsatile lavage treatment.
The identical strain of MDR-Ab was recovered from all 6 patients from whom
isolates were available and from multiple environmental surfaces in the wound
Vision, drive, and imagination fueled the efforts of transplantation
pioneer Joseph E. Murray, MD, and colleagues to achieve the first successful
human organ transplant—a kidney—a half century ago.
Death certificate review revealed no evidence that cancer patients are
able to postpone death to survive holidays or birthdays.
Diagnosis and treatment of aspirin sensitivity and implications for
patients with coronary artery disease are discussed.
Training physicians to place carotid stents may be improved with virtual
Authors are invited to submit manuscripts for the annual JAMA theme issue on violence and human rights.
For your patients: Information about aspirin sensitivity.
This Week in JAMA . JAMA. 2004;292(24):2945. doi:10.1001/jama.292.24.2945