Schömig and colleaguesArticle report results
of a clinical trial that enrolled patients with acute ST-segment elevation
myocardial infarction (STEMI), diagnosed 12 to 48 hours after symptom onset
and without persistent symptoms, and randomly assigned them to either coronary
stenting with adjunctive use of abciximab or conventional noninvasive treatment.
The investigators found that final left ventricular infarct size was significantly
smaller and risks of death, recurrent myocardial infarction, or stroke at
30 days were similar in patients who received the invasive strategy compared
with patients receiving noninvasive treatment. In an editorial, Gibbons and
GrinesArticle urge prompt treatment of all patients
with STEMI rather than liberal adoption of an urgent invasive strategy.
In a randomized controlled trial to assess the effect of orlistat vs
placebo, combined with diet, exercise, and behavioral therapy, in the treatment
of obese adolescents, Chanoine and colleaguesArticle found
that adolescents who received orlistat had a greater reduction in body mass
index compared with those receiving placebo at the 1-year study’s conclusion.
In an editorial, JoffeArticle discusses the need for
safe, comprehensive, and individualized treatment of adolescent obesity.
A diet high in omega-3 polyunsaturated fatty acids (omega-3 PUFAs) has
been associated with a lower risk of sudden cardiac death, and it has been
hypothesized that omega-3 PUFAs may have antiarrhythmic properties. Raitt
and colleaguesArticle randomly assigned patients receiving
an implantable cardioverter defibrillator (ICD) to either a fish oil supplement
or a placebo and assessed the time to first ICD treatment of ventricular tachycardia
or ventricular fibrillation (VT/VF). They found no evidence that fish oil
supplementation reduced the risk of VT/VF, with some data suggesting fish
oil intake may increase the risk in these patients.
Apolipoprotein E (APOE) allelic variations
are implicated in diabetic nephropathy, but whether these are associated with
other forms of chronic kidney disease is not known. Hsu and colleaguesArticle assessed the risk of chronic kidney disease progression
associated with APOE in a population-based cohort
and found a moderately increased risk with the ε2 allelic variation
and a decreased risk with variant ε4, independent of diabetes, race,
and lipid and nonlipid risk factors.
In a retrospective review of medical records in 5 states, Snyder and
AndersonArticle compared quality of care in hospitals
voluntarily participating with Medicare quality improvement organizations
(QIOs) with quality of care in nonparticipating hospitals. They found that
participating hospitals showed no greater improvement than nonparticipating
hospitals on 14 of 15 quality indicators targeted by the QIOs.
In a meta-analysis of data from trials comparing outcomes following
routine early invasive vs selective (conservative) invasive strategies in
patients with acute coronary syndromes (ACS), Mehta and colleaguesArticle found
that a routine invasive strategy was superior to a conservative approach in
reducing myocardial infarction, severe angina, and rehospitalization but carried
a higher risk of early mortality. In an editorial, BhattArticle discusses
optimal care of patients with ACS.
“I must find something personal, something fully human about this
stranger; something that will make it possible to yield to his plan . . . to
voluntarily place my heart, my life in his hands.”
From “Informed Consent.”
Advances in brain imaging are allowing researchers to visualize “pain
memories,” the changes that occur in the brain due to pain, revealing
how physiological and behavioral therapies may offer patients relief.
A review of susceptibility testing for malignant hyperthermia.
From the Archives Journals
Results of a survey of twins reported in the Archives
of Otolaryngology–Head & Neck Surgery suggest a genetic predisposition
for recurrent tonsillitis.
A statement from the International Committee of Medical Journal Editors.
For your patients: Information about malignant hyperthermia.
This Week in JAMA . JAMA. 2005;293(23):2831. doi:10.1001/jama.293.23.2831