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This Week in JAMA
December 22/29, 2004

This Week in JAMA

JAMA. 2004;292(24):2945. doi:10.1001/jama.292.24.2945
Genetics, Arsenic, and Tobacco and Lung Cancer Risk

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.

Menopause and Estrogen Sensitivity

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.

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Eosinophilic Pneumonia in Military Personnel in Iraq

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.

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Infection Associated With Pulsatile Lavage Therapy

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 care room.

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Medical News & Perspectives

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.

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Postponing Death

Death certificate review revealed no evidence that cancer patients are able to postpone death to survive holidays or birthdays.

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CLINICIAN’S CORNER

Diagnosis and treatment of aspirin sensitivity and implications for patients with coronary artery disease are discussed.

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Virtual Reality Skill Training

Training physicians to place carotid stents may be improved with virtual reality technology.

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Violence and Human Rights

Authors are invited to submit manuscripts for the annual JAMA theme issue on violence and human rights.

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JAMA Patient Page

For your patients: Information about aspirin sensitivity.

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