Results of previous studies assessing the effects of perioperative supplemental
oxygen on surgical wound infection rates have been inconclusive. Belda and
colleaguesArticle conducted a randomized trial in which
patients having colorectal surgery were randomly assigned to either 30% or
80% fraction of inspired oxygen (FIO2) intraoperatively
and for 6 hours after surgery. The wound sites were examined through the 14th
postoperative day for signs of superficial or deep infection. The authors
found that patients administered 80% FIO2 had a
significantly lower risk of wound infections. In an editorial, DellingerArticle discusses the results of this and other investigations
of supplemental oxygen and surgical infections and discusses the importance
of implementing all measures known to reduce surgical site infections.
A pneumococcal conjugate vaccine (PCV-7), which reduces pneumococcal
carriage, was licensed for use in infants and young children in 2000. In a
population-based prospective study of adults 50 years of age and older, Lexau
and colleagues sought to determine whether the incidence of invasive pneumococcal
disease, disease characteristics, or spectrum of patients acquiring these
illnesses has changed since the vaccine licensure. The authors found that
invasive pneumococcal disease incidence declined by 28% in this population
of adults. Cases increased among persons with certain comorbid conditions,
such as human immunodeficiency virus infection, recent immunosuppressive therapy,
diabetes, and chronic obstructive pulmonary disease.
Currently available noninvasive tests for early detection of bladder
cancer lack sufficient sensitivity and specificity for routine use. Sanchini
and colleagues conducted a case-control study to test the utility of an enzyme
assay for urine telomerase activity for identifying patients with early bladder
cancer. Confirming results from a pilot study, the authors found that a urine
telomerase activity of 50 arbitrary enzymatic units accurately detects bladder
tumors in men.
In patients enrolled in an international pheochromocytoma registry,
Schiavi and colleagues conducted genetic screening for mutations in the SDHC, SDHB, and SDHD pheochromocytoma
susceptibility genes to determine the prevalence and clinical characteristics
of SDHC mutation–associated head and neck paragangliomas
(HNPs) vs those with SDHB and SDHD mutations or sporadic cases. They found a 4% prevalence of SDHC carriers in HNP cases and 0% prevalence in pheochromocytoma
index cases. Patients with the SDHC mutation had
no signs of pheochromocytoma and had unique clinical characteristics, including
age of onset, tumor location, and absence of multiple or malignant tumors
compared with patients with other mutations or sporadic cases.
Burn units in US hospitals are increasingly treating a new type of patient—methamphetamine
users who are injured in fires and explosions while producing the drug at
improvised covert laboratories.
Educating physicians to recognize and treat depression and restricting
population access to lethal means have the greatest efficacy to prevent suicide.
Barton and Emanuel discuss problems with the current patents-based drug
development process and potential economic and procedural solutions.
A focus on shared values may help diminish antipathy between physicians
Clinical and legal issues in the marketing, distribution, and administration
of growth hormone for antiaging purposes.
For your patients: Information about wound infections.
This Week in JAMA . JAMA. 2005;294(16):1993. doi:10.1001/jama.294.16.1993