In This Issue of Archives of Internal Medicine

As an extension of their study demonstrating that topiramate treats alcohol dependence, Johnson et al reveal in this subgroup analysis that topiramate also shows potential as a safe and promising medication for the promotion of smoking abstinence in alcohol-dependent individuals who smoke. Smoking cessation rates for topiramate recipients were almost 3 times greater than for those who received placebo in this double-blind, randomized, controlled, 12-week study of 94 alcohol-dependent smokers.

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The impact of high insulin levels on cognition, in the absence of diabetes mellitus, has not been well studied. In this investigation, Okereke et al evaluated the relation between mid-life plasma C peptide level (representing insulin secretion) and later-life cognition among 718 nondiabetic women. Higher levels of insulin secretion were consistently associated with worse performance on tests of global cognition and verbal memory. Compared with those in the lowest quartile, women in the highest quartile of C peptide level were 3 times as likely to have impaired performance on both of these measures. The authors estimated that the impact of high C peptide level was cognitively equivalent to aging by 5 to 6 years.

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Angioedema is a rare but potentially serious adverse event of angiotensin-converting enzyme inhibition. However, there are no prospective, controlled studies on its incidence and clinical characteristics. Kostis et al studied the occurrence of angioedema in a randomized, double-blind, controlled trial of 12 557 persons with hypertension treated with enalapril maleate, 5 to 40 mg daily, using a prospective ascertainment and adjudication of angioedema by an expert committee. Although it was more likely to occur early after initiation of therapy, angioedema could also occur at any time. It was more likely to occur in blacks, patients older than 65 years, and those with a history of drug rash or seasonal allergies. Fatal angioedema or angioedema requiring airway protection did not occur in this study.

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This 24-week randomized, double-blind, placebo-controlled, parallel-group, multicenter trial evaluated the efficacy and safety of transdermal testosterone in healthy women (age, 24-70 years) who developed low sexual desire with resulting personal distress following bilateral salpingo-oophorectomy and hysterectomy and were receiving oral estrogen therapy. Treatment with a 300-μg/d testosterone patch increased sexual desire and the frequency of satisfying sexual activity and was well tolerated.

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Breast biopsy to determine the nature of a clinical or radiographic breast abnormality was presumed to have increased in frequency with the widespread use of screening mammography, but data regarding the utilization of breast biopsies in the community population are scant. Using the resources of the Rochester Epidemiology Project, the medical records of women 18 years and older, who had a breast biopsy from 1988 through 1999 were reviewed, encompassing the introduction of image-guided, core-needle breast biopsy in 1992. The overall annual utilization rate of breast biopsies was 62.2 per 10 000 women per year and remained stable throughout the study duration, with an increasing trend of core-needle biopsies and decreasing trend of excisional breast biopsies. The benign-malignant ratio remained constant despite changes in the biopsy technique. This population-based study provides much needed data regarding the frequency of breast biopsies in a community population. A multidisciplinary breast practice along with established guidelines for breast biopsy can ensure appropriate use of new technology and thereby improve patient care.

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