The pulmonary artery catheter (PAC) is widely used in critically ill
patients, but whether it improves outcomes is not clear. Results from 2 studies
reported in this issue of JAMA address this question.
In the first article from the Evaluation Study of Congestive
Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE)
trialArticle, the investigators found that patients who were randomly assigned to
treatment guided by PAC monitoring and clinical assessment vs clinical assessment
alone had similar hospital days and mortality but experienced more in-hospital
adverse events. In the second article, Shah and colleaguesArticle report results of a meta-analysis of data from 13 clinical trials in which patients were randomly assigned to receive PAC or not to receive PAC. They
found that in the patient groups studied—surgical patients, intensive
care unit admissions for sepsis, patients with acute respiratory distress
or advanced heart failure—the PAC had a neutral effect on mortality
and hospital days. In an editorial, HallArticle discusses
the evidence for and against widespread use of PACs in critically ill patients.
Evidence suggests that TGFBRI*6A, a common
polymorphism of the type I transforming growth factor β receptor (TGFBRI), is involved in cancer development, but precisely how is not known. Pasche and colleagues investigated the acquisition of *6A
in tumor tissue from patients with several common cancers and explored molecular
properties of *6A that may influence cancer development. They report that
*6A is likely to be acquired during cancer development. They also determined
that a characteristic molecular change in the signal sequence of *6A may be
responsible for growth stimulation in affected cancer cells.
Patients with a history of a primary melanoma are at increased risk
of a second primary melanoma, but the risk factors are not well defined. Ferrone
and colleagues used information from a prospectively maintained database of
patients with melanoma to assess the incidence of and risk factors associated
with multiple primary melanoma (MPM). In their patient population, the incidence
of MPM was 8.6%. A personal or family history of dysplastic nevi was associated
with an increased risk of MPM.
Live kidney paired donation (KPD) is an emerging transplantation option
for patients with end-stage renal disease and incompatible donors. Montgomery
and colleaguesArticle assessed the feasibility and effectiveness
of KPD in a small series of patients. At a median follow-up of 13 months,
patient survival and graft survival were comparable with those achieved with
directed compatible live donor transplants, and rejection episodes were similar
to those reported for living unrelated transplant recipients. In an editorialArticle, Matas and Sutherland discuss efforts to increase live kidney donations.
Experts warn that the mental health repercussions for thousands of survivors
of Hurricane Katrina mean that ongoing support, intervention, and treatment
will be needed for months and years to come.
An evidence-based review of new therapies for juvenile idiopathic arthritis.
The Rehnquist Court’s profound effect on medicine and health,
1986 to 2005.
Public education and other strategies to reduce obstetricians’
risk of malpractice litigation.
For your patients: Information about juvenile idiopathic arthritis.
This Week in JAMA . JAMA. 2005;294(13):1589. doi:10.1001/jama.294.13.1589