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This Week in JAMA
JAMA. 2002;287:1359.
Cognitive Outcomes After On- vs Off-Pump CABG Surgery
Cerebral morbidity, including cognitive decline and stroke, has been associated with coronary artery bypass graft (CABG) surgery using cardiopulmonary bypass (on-pump surgery). In this randomized trial, Van Dijk and colleagues (SEE ARTICLE) found that 3 months after a first CABG surgery, the incidence of cognitive decline was not significantly different between patients who received on-pump CABG surgery and those who received CABG surgery using cardiac stabilizers (off-pump surgery group), but overall improvement in cognitive outcomes was greater in the off-pump group compared with the on-pump group. At 12 months, however, differences in improvements in cognitive outcomes between the 2 groups were not statistically significant. In an editorial, Mark and Newman (SEE ARTICLE) discuss the possible mechanisms of cognitive dysfunction after CABG surgery and emphasize the importance of additional research on neuroprotective strategies.
Risk of Non-Hodgkin Lymphoma in Celiac Disease
To estimate the risk of non-Hodgkin lymphoma associated with celiac disease, Catassi and colleagues evaluated patients with newly diagnosed non-Hodgkin lymphoma (cases) and healthy adults (controls) for celiac disease using measurement of IgA class serum antiendomysial antibody level as a screening test. Celiac disease was associated with a significantly increased risk of non-Hodgkin lymphoma, especially of the T-cell type and with a primary site in the gut, although the magnitude of increased risk was lower than previous estimates.
(SEE ARTICLE)
Nitric Oxide Synthase Inhibitor and Insulin Resistance
Increased levels of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, are associated with endothelial dysfunction, an abnormality that may be part of the link between insulin resistance, a feature of the metabolic syndrome, and coronary heart disease risk. In this cross-sectional study, Stühlinger and colleagues (SEE ARTICLE) found that plasma ADMA concentrations were positively correlated with insulin resistance, as measured by steady-state plasma glucose concentrations, in both normotensive and hypertensive nondiabetic volunteers. In a subset of insulin-resistant hypertensive volunteers, insulin sensitivity improved and ADMA levels decreased after treatment for 12 weeks with rosiglitazone, an insulin-sensitizing agent. In an editorial, Nash (SEE ARTICLE) discusses the complex relationship among insulin resistance, ADMA levels, and cardiovascular disease.
Biochemical Diagnosis of Pheochromocytoma
The diagnosis of pheochromocytoma depends on biochemical evidence of excessive production of catecholamines by the tumor. Lenders and colleagues evaluated the diagnostic performance of several biochemical tests in a cohort of patients tested for pheochromocytoma. Plasma free metanephrines or urinary fractionated metanephrines were more sensitive diagnostic tests than measurements of plasma or urinary catecholamines or of urinary metanephrines or urinary vanillylmandelic acid. Based on receiver operating characteristic curves, measurement of plasma free metanephrines was the best test for confirming or excluding pheochromocytoma.
(SEE ARTICLE)
Medical News & Perspectives
The serendipitous discovery of harmless particles that exactly mimic the Ebola virus promises to speed basic research on that virulent pathogen and, possibly, the development of vaccines and drug therapies.
(SEE ARTICLE)
CLINICIAN'S CORNER
Scientific Review and Clinical Applications
Part 1 (SEE ARTICLE) reviews clinical trials evaluating the efficacy of perioperative  -blocker therapy for reduction of adverse cardiac events and mortality in patients undergoing noncardiac surgery. Hypothetical cases in part 2 (SEE ARTICLE) illustrate clinical decision-making for perioperative -blocker use despite limitations of the current evidence base.
Rotavirus Vaccine in the News Media
An analysis of how the news media portrayed the rotavirus vaccine before and after reports of intussusception in vaccine recipients.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about celiac disease.
(SEE ARTICLE)
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