During percutaneous coronary intervention (PCI) in acute myocardial
infarction, embolization of atheromatous and thrombotic debris is common and
is thought to compromise patient outcomes. Stone and colleaguesArticle report results of a clinical trial in which patients with ST-segment elevation
myocardial infarction and eligible for PCI were randomly assigned to receive
either PCI with a distal balloon occlusion and aspiration device to remove
embolic debris or PCI without the aspiration device. The authors found the
distal protection aspiration system effectively removed embolic debris but
did not improve postprocedure coronary flow, time to ST-segment resolution,
infarct size, or event-free survival. In an editorial,Article Schömig and Kastrati discuss possible reasons use of the distal protection device failed to yield clinical benefit.
Adjuvant chemotherapy has improved survival in women 50 to 69 years
of age with lymph node–positive breast cancer. However, whether women
aged 70 years or older may experience similar benefit is not clear. Muss and
colleaguesArticle analyzed data from 4 treatment trials of
adjuvant chemotherapy for node-positive disease and compared disease-free
and overall survival and treatment-related mortality among women of different
ages. They found chemotherapy reduced breast cancer mortality and recurrence
for all women and found no association between age and disease-free survival.
Non–breast cancer–related causes resulted in lower overall survival
for women older than 65 years. Treatment-related deaths were few (0.5%) but
increased with advancing age. In an editorial,Article Gradishar
and Kaklamani discuss factors to consider when treating elderly women with
Patients with a history of stroke are at increased risk of hip fracture
and some studies have suggested an association of elevated homocysteine level
and increased fracture risk. Sato and colleaguesArticle investigated
whether treatment with folate and vitamin B12 would reduce the
incidence of hip fractures in elderly Japanese patients with hemiplegia after
ischemic stroke. Through 2 years of follow-up, they found a significant reduction
in hip fractures in patients receiving folate and vitamin B12 compared
with those receiving placebo. In an editorial,Article van Meurs
and Uitterlinden discuss potential physiologic mechanisms for the treatment
Randomized clinical trial enrollment may be hampered when patient or
physician preference for treatment leads to refusal of randomization. King
and colleagues reviewed data from 32 randomized clinical trials to assess
whether patient or physician preference affects trial recruitment or outcomes.
They found that patient treatment preferences did lead to refusals of randomization,
but there was scant evidence that treatment preference significantly affects
the validity of trial outcomes.
Evidence supports empathy as an important component of effective medical
care, but empathic patient-physician relationships are not universal. In a
discussion of empathy in clinical medicine, Larson and Yao equate empathy
to “emotional labor” and propose the use of acting methods to
help physicians learn and practice empathy.
A new recipe for growing motor neurons from human embryonic stem cells
is expected to help provide insights into such motor neuronal disorders as
amyotrophic lateral sclerosis and clues to human stem cell development.
Clinical Crossroads Ms P is a 44-year-old
woman with morbid obesity who was recently diagnosed with kidney stones. Curhan
discusses the pathophysiology, diagnosis, treatment, and prevention of kidney
stones, including particular considerations in obese patients.
Sincere appreciation is extended to the peer reviewers for JAMA in 2004.
See Article and Article
For your patients: Information about kidney stones.
This Week in JAMA . JAMA. 2005;293(9):1033. doi:10.1001/jama.293.9.1033