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This Week in JAMA
March 5, 2008

This Week in JAMA

JAMA. 2008;299(9):989. doi:10.1001/jama.299.9.989

Among patients with resected adenocarcinoma of the pancreas, postoperative adjuvant chemoradiation with fluorouracil is associated with improved survival. In light of evidence that patients with advanced pancreatic cancer who receive first-line therapy with gemcitabine have better outcomes than patients who are treated with fluorouracil, Regine and colleagues investigated whether the addition of gemcitabine to adjuvant fluorouracil chemoradiation is associated with improved survival in patients with resected pancreatic adenocarcinoma and no prior radiation or chemotherapy. The authors found no survival benefit among patients who were randomly assigned to receive gemcitabine vs fluorouracil before and after adjuvant fluorouracil chemoradiation. In an editorial, Abbruzzese discusses opportunities to improve outcomes for patients with pancreatic adenocarcinoma.

Detection and removal of polypoid colonic neoplasms is essential to prevent progression to colorectal cancer. Several studies have suggested that colorectal cancer can arise in nonpolypoid (flat and depressed) colorectal neoplasms (NP-CRNs), but data on their importance in US patients are limited. To evaluate this, Soetikno and colleagues determined the prevalence of NP-CRNs in patients who were undergoing elective colonoscopy at 1 Veterans Affairs hospital and characterized the association of NP-CRNs with colorectal cancer. The authors report the overall prevalence of NP-CRNs was 9.35% and that NP-CRNs were more likely to contain carcinoma than polypoid lesions, irrespective of lesion size. In an editorial, Lieberman discusses the implications of these findings for colorectal cancer screening, optimal colonoscopy technique, and patient follow-up.

The Women's Health Initiative trial comparing the effects of estrogen plus progestin (CEE plus MPA) vs placebo on risks of heart disease, breast cancer, and fractures was stopped early after a mean 5.6 years when it was found that the therapy was associated with an increased risk of invasive breast cancer and no overall health benefit. To assess changes in hormone-relevant health conditions when CEE plus MPA is stopped, Heiss and colleagues analyzed data from 15 730 trial participants (95%) who agreed to postintervention follow-up through the planned study duration of 8.5 years. The authors report that compared with women who were randomly assigned to placebo, women in the CEE plus MPA group had comparable cardiovascular disease and fracture risks, a significantly increased risk of malignancies, and a higher global risk index during the mean 2.4-year postintervention follow-up period.


Mr E is a 74-year-old retired attorney who has a more than a 10-year history of progressive sensorimotor polyneuropathy of unclear etiology, many years of daily alcohol use (3-4 drinks/d), and concerns about memory loss. Brust discusses the effects of alcohol on the nervous system, dementing illnesses in the elderly, and diagnostic and management options for a patient with neuropathy, cognitive impairment, and heavy alcohol use.


“As I have cared for chronically ill patients these many years, I have come to appreciate that people do not live in a vacuum and almost never make autonomous decisions.” From “Lessons From the Santa Fe Trail.”


Experts are calling for improvements in continuing medical education, including technological innovations that help clinicians learn in more effective ways and financing that does not involve potential conflicts of interest.


Who really pays for health care?


CME funding: problems and solutions


Serendipity in psychopharmacology


Join Stephen Shortell, PhD, on March 19, 2008, from 2 to 3 PM eastern time to discuss improving patient safety. To register, go to http://www.ihi.org/AuthorintheRoom.

How would you manage a 21-year-old man with chronic idiopathic pancreatitis? Go to www.jama.com to read the case and submit your response. Your response may be selected for online publication. Submission deadline is March 26.

For your patients: Information about neuropathy.