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This Week in JAMA
JAMA. 1998;280:1033.
Cerebral Blood Flow and Stroke Risk
Using positron emission tomography, Grubb and colleagues (SEE ARTICLE) 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, Adams (SEE ARTICLE) suggests that patients with carotid artery occlusion and highly compromised cerebral hemodynamics be considered for a new trial of extracranial-intracranial bypass surgery.
Hydrocortisone for Chronic Fatigue Syndrome
McKenzie and coworkers (SEE ARTICLE) 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, Streeten (SEE ARTICLE) considers factors that may mediate fatigue in CFS.
Effects of Dairy Products on Colonic Epithelium
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 colleagues (SEE ARTICLE) 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 Byers (SEE ARTICLE) discuss the limitations of using surrogate end points in research on chemoprevention for colon cancer.
Positive HIV Test Results in Volunteer Blood Donors
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.
(SEE ARTICLE)
A 55-Year-Old Man With ADHD
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.
(SEE ARTICLE)
The Cover
". . . wearing on his head a ‘diadem of eyes.'" Joan Miró, Passage of the Divine Bird, 1941, Spanish.
(SEE ARTICLE)
Medical News & Perspectives
Most physicians finally accept that young children feel pain. Now awareness is growing of sex-based differences in its perception.
(SEE ARTICLE)
President's Address
"Ethics and professionalism give us the solid foundation—the credibility and respect—needed to achieve our goals." From "Packing My Bag for the Road Ahead."
(SEE ARTICLE)
Policy Perspectives
Restoring trust in the patient-physician relationship through shared accountability and mutual learning among patients, physicians, and health care organizations.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Carotid artery disease and stroke.
(SEE ARTICLE)
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