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This Week in JAMA
JAMA. 1998;280:1465.
Treatment of Patients With a Single Brain Metastasis
In a controlled trial, Patchell and colleagues (SEE ARTICLE) found no significant difference in the overall length of survival of patients with single metastatic brain lesions treated with surgical resection and postoperative whole-brain radiation compared with those treated with surgery alone. Patients treated with postoperative radiation had fewer recurrences of brain metastases, fewer deaths due to neurologic causes, and a longer survival time until death due to neurologic causes, but they had a significantly shorter time until death due to systemic causes. In an editorial, Mintz and Cairncross (SEE ARTICLE) describe the morbidity associated with whole-brain radiation and emphasize the importance of individualized treatment decisions and quality-of-life outcomes.
Improved Short-term Outcomes in Type 2 Diabetes
Patients with type 2 diabetes mellitus treated for 12 weeks with diet and the controlled-release sulfonylurea glipizide had better glycemic control, significant improvement in several quality-of-life and employment productivity outcomes, and less overall health care use compared with patients treated with diet alone. Testa and Simonson observe that these favorable short-term outcomes appeared to be mediated by a decrease in symptoms associated with hyperglycemia and perhaps by smaller fluctuations in blood glucose levels.
(SEE ARTICLE)
Potent Antiretroviral Therapy Slows HIV Progression
To assess the overall effect of changes in antiretroviral therapy on populations of patients infected with HIV, the progression of HIV disease in a cohort of more than 500 men in the Multicenter AIDS Cohort Study who seroconverted after enrollment was compared for 4 calendar periods beginning in 1984. Detels and colleagues found that patients with the same duration of HIV infection had a longer interval to the development of AIDS and to death and a lower rate of decline in CD4 cell counts in the calendar period corresponding to the introduction of potent antiretroviral therapy compared with earlier calendar periods.
(SEE ARTICLE)
Salmonella Outbreak Associated With Orange Juice
Acidic foods have been thought to not transmit infectious microorgansims, but contaminated unpasteurized orange juice (mean pH, 4.3) was the likely source of an outbreak of Salmonella enterica serotype Hartford infections investigated by Cook and colleagues. The investigators recommend that consumers drink only pasteurized juices until juice production routinely includes measures to reduce bacterial contamination.
(SEE ARTICLE)
Accuracy of Endovaginal Ultrasound
In a meta-analysis of data from 35 prospective studies by Smith-Bindman and colleagues (SEE ARTICLE) the diagnostic performance of endovaginal ultrasound compared favorably with office-based endometrial biopsy. In an editorial, Carlson (SEE ARTICLE) discusses the use of endovaginal ultrasound as an alternative to endometrial biopsy in the evaluation of vaginal bleeding in postmenopausal women.
The Cover
"It is the will of the people, not that of the legislature, that is the supreme law." George Caleb Bingham, The County Election, 1852, American.
(SEE ARTICLE)
Medical News & Perspectives
Activist physician Quentin Young prescribes a cure for what ails US health care.
(SEE ARTICLE)
A Piece of My Mind
"I bet I'm the weirdest patient you've ever seen." From "The Intervention."
(SEE ARTICLE)
MSJAMA
Suppose you have a test that indicates a predisposition to a certain disease for which there is currently no treatment. How would you advise the patient?
(SEE ARTICLE)
Policy Perspectives
Ginzberg predicts government funding of essential health care coverage for all Americans early in the 21st century.
(SEE ARTICLE)
JAMA Patient Page
For your patients: A guide to cancer detection and treatment.
(SEE ARTICLE)
Alternative Medicine
Theme issues next week in JAMA and in the November AMA Archives journals.
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