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Using positron emission tomography, Grubb and colleaguesArticle evaluated the
cerebral hemodynamics of patients with internal carotid artery occlusion and
a history of transient ischemic neurologic symptoms or ischemic stroke. A
significantly higher incidence of subsequent stroke was observed in patients
with increased cerebral oxygen extraction distal to the occlusion than in
patients with normal cerebral oxygen extraction. In an editorial, AdamsArticle suggests
that patients with carotid artery occlusion and highly compromised cerebral
hemodynamics be considered for a new trial of extracranial-intracranial bypass
McKenzie and coworkersArticle conducted a 12-week trial of daily low-dose hydrocortisone
vs placebo in 70 patients with chronic fatigue syndrome (CFS). The treatment
group had slight improvements in symptoms measured by one of several self-rating
scales compared with the placebo group, but hydrocortisone treatment was significantly
associated with biochemical evidence of adrenal suppression. In an editorial,
StreetenArticle considers factors that may mediate fatigue in CFS.
In a 1-year trial of increased vs usual intake of dietary calcium via
low-fat dairy products in 70 patients with a history of polypectomy for adenomatous
colonic polyps, Holt and colleaguesArticle found that increased low-fat dairy intake
was associated with a decrease in the proliferative activity of colonic epithelial
cells and an increased number of colonic epithelial cells with biochemical
evidence of normal differentiation and maturation. In an editorial, Ahnen
and ByersArticle discuss the limitations of using surrogate end points in research
on chemoprevention for colon cancer.
In a large retrospective study, 39 of 421 blood donors with positive
human immunodeficiency virus 1 (HIV-1) Western blot test results were suspected
of having false-positive results based on the absence of reactivity to p31
and were followed up with HIV-1 RNA polymerase chain reaction (PCR) testing
and HIV-1 serology. Twenty of the 39 blood donors were proven not to be infected
with HIV-1. Kleinman and coworkers propose that blood donors with positive
Western blot test results lacking the p31 band have confirmatory testing with
RNA PCR and HIV-1 serology.
Mr L relates that his difficulties in concentrating and completing tasks
resulted in poor school performance, frequent job changes, and marital stress.
After a comprehensive evaluation, he began treatment with methylphenidate
and immediately noted improvement in his ability to focus and complete tasks.
Emphasizing the validity of attention-deficit/hyperactivity disorder (ADHD)
as a psychiatric disorder in adults, Biederman discusses the epidemiology,
pathogenesis, and treatment of this condition.
". . . wearing on his head a ‘diadem of eyes.'" Joan Miró, Passage of the Divine Bird, 1941, Spanish.
Most physicians finally accept that young children feel pain. Now awareness
is growing of sex-based differences in its perception.
"Ethics and professionalism give us the solid foundation—the credibility
and respect—needed to achieve our goals." From "Packing My Bag for the
Restoring trust in the patient-physician relationship through shared
accountability and mutual learning among patients, physicians, and health
For your patients: Carotid artery disease and stroke.
This Week in JAMA. JAMA. 1998;280(12):1033. doi:10.1001/jama.280.12.1033