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Identification and follow-up of patients at risk of familial colorectal
cancer (CRC) are the subject of 2 articles in this issue of JAMA. First, Lindor and colleaguesArticle examined
cancer incidence in persons with a family pedigree that suggests hereditary
nonpolyposis colorectal cancer (HNPCC) but who lacked the characteristic DNA
mismatch repair gene defect. They found that families without the DNA defect
had a lower CRC risk, were diagnosed at a later age, and had a lower incidence
of other malignancies associated with HNPCC than did families with the defect.
In the second article, Piñol and colleaguesArticle assessed
the accuracy of the revised Bethesda guidelines for identifying individuals
at risk of HNPCC. They found that microsatellite instability testing and immunostaining
are equivalent and effective in selecting patients for further genetic testing.
In an editorial, Vasen and BolandArticle discuss the
utility and application of molecular diagnostic tools for patients with CRC
and their families.
Direct-to-consumer advertising (DTCA) of prescription medications is
controversial, with claims that it may cause overuse of unnecessary medication
or prevent underuse of effective medication. In a randomized trial using standardized
patients exhibiting symptoms of major depression or adjustment disorder, Kravitz
and colleaguesArticle assessed the effects of patients’
DTCA-related requests on primary care physicians’ initial treatment
decisions. For patients exhibiting signs of major depression, antidepressant
prescribing rates were 76% for patients who made a general request for treatment,
53% for those who had asked for a specific brand, and 31% for patients who
made no request. For patients exhibiting signs of adjustment disorder, antidepressant
prescribing rates were 39% for those making a general request, 55% for those
asking for a specific brand, and 10% for those who made no request. In an
editorial, HollonArticle describes the relationship
of DTCA to prescribing decisions and the need for evidence-based and regulated
Current antiretroviral drugs suppress human immunodeficiency virus (HIV)
replication in peripheral blood, but effects on HIV sequestered in the central
nervous system (CNS) are significantly less. With evidence that minocycline
has anti-inflammatory and neuroprotective effects in animal models of disease,
Zink and colleagues investigated whether it could prevent encephalitis and
neurodegeneration in pigtailed macaques infected with simian immunodeficiency
virus (SIV). In addition, they assessed the effect of minocycline on HIV and
SIV replication in cultured lymphocytes and macrophages. They found that SIV-infected
macaques treated with minocycline had less severe encephalitis and less virus
replication in the CNS than did those not treated with minocycline and that
minocycline suppressed HIV and SIV replication in cell cultures.
Computed tomography (CT) is increasingly used to assess patients with suspected pulmonary embolism, but the validity of a negative CT and the safety of withholding anticoagulant therapy are uncertain. Quiroz and colleagues analyzed pooled data from 3500 patients in studies that used CT to rule out the diagnosis of acute pulmonary embolism to calculate a negative likelihood ratio of venous thromboembolism after a negative chest CT. They found the negative predictive value for CT was comparable with pulmonary angiography and found no evidence of adverse clinical outcomes when anticoagulant therapy was withheld.
Studies of the X chromosome reveal an unsuspected degree of genetic
variation between the sexes and among women that may help explain some medically
important differences between men and women.
Mrs H is a married and sexually active 80-year-old woman who reported
recent symptoms of tissue coming out of her vagina. Cundiff discusses the
pathophysiology, epidemiology, and assessment of vaginal prolapse and provides
options for treatment.
For your patients: Information about uterine prolapse.
This Week in JAMA . JAMA. 2005;293(16):1949. doi:10.1001/jama.293.16.1949