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This Week in JAMA
JAMA. 2003;289:1599.
Intraoperative Cholangiography During Cholecystectomy
Routine use of intraoperative cholangiography to identify the common bile duct during cholecystectomy and prevent common bile duct injury is controversial. In this nationwide cohort analysis of data from Medicare patients undergoing cholecystectomy, Flum and colleagues (SEE ARTICLE) found that the rate of common bile duct injury was significantly higher when intraoperative cholangiography was not performed. In an editorial, Talamini (SEE ARTICLE) describes the ongoing debate about routine vs selective use of intraoperative cholangiography during cholecystectomy.
Hydroxyurea and Mortality in Adult Sickle Cell Anemia
In the Multicenter Study of Hydroxyurea in Sickle Cell Anemia (MSH), a placebo-controlled trial among adults with moderate to severe sickle cell anemia, the rate of vaso-occlusive events over 2.5 years was significantly reduced among patients who received hydroxyurea. In this follow-up study of up to 9 years of observation, in which MSH participants could continue, start, or stop treatment with hydroxyurea, Steinberg and colleagues (SEE ARTICLE) found that mortality was reduced 40% during 3-month intervals when patients were taking hydroxyurea. In an editorial, Weiner and Brugnara (SEE ARTICLE) encourage expanded use of hydroxyurea for patients with sickle cell disease.
Drug Interactions Among Elderly With Drug Toxicity
Drug-drug interactions are a potentially preventable cause of adverse drug events. In this series of 3 population-based case-control studies, Juurlink and colleagues found that elderly patients treated with glyburide, digoxin, or an angiotensin-converting enzyme inhibitor who were admitted to the hospital for drug-related toxicity were significantly more likely to have used an interacting drug in the week prior to admission than were matched control patients.
(SEE ARTICLE)
Dietary Fiber Intake and CVD Risk in Elderly
Dietary fiber consumption has been associated with reduced risk of cardiovascular disease (CVD) in predominantly middle-aged populations. Mozaffarian and colleagues analyzed data from adults aged 65 years or older enrolled in the Cardiovascular Health Study to determine whether consumption of fiber from fruit, vegetables, and cereals is associated with CVD risk in elderly persons, a population in which atherosclerosis is more advanced. Higher cereal fiber intake was associated with a lower risk of incident CVD, but not fruit or vegetable fiber intake.
(SEE ARTICLE)
Mercury Levels in Children, Women of Childbearing Age
Exposure to the neurotoxin methylmercury, which is especially toxic to the developing human fetus, occurs primarily through consumption of fish and shellfish. Schober and colleagues analyzed 1999-2000 data from the National Health and Nutrition Examination Survey, a cross-sectional survey of the noninstitutionalized US population, to describe the distribution of blood mercury levels in young children and women of childbearing age and evaluate the association between blood mercury levels and fish consumption. Blood mercury levels in women aged 16 to 49 years and children aged 1 to 5 years were generally below the recommended reference dose and were 3 times higher in women than in young children. Blood mercury levels were strongly associated with self-reported fish consumption in the past 30 days in both children and women, and among women, increased with the number of fish meals consumed.
(SEE ARTICLE)
Contempo Updates
Lactation mastitis: diagnosis, epidemiology, and treatment.
(SEE ARTICLE)
Medical News & Perspectives
What are the possible health effects of weapons containing "depleted" uranium? More than a decade after the battlefield debut of such weapons, consensus on this issue remains elusive.
(SEE ARTICLE)
Nitrotyrosine Levels and CAD Risk
Results of this preliminary study suggest that levels of nitrotyrosine—a marker specific for protein modification by nitric oxide–derived oxidants—are associated with coronary artery disease (CAD) and are modulated by statin therapy.
(SEE ARTICLE)
CLINICIAN'S CORNER
Statin-Associated Myopathy
A review of muscle complaints associated with statin use and discussion of possible mechanisms of statin-induced muscle injury.
(SEE ARTICLE)
MSJAMA
Legal, psychological, and visual dimensions of the maternal-fetal relationship.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about mastitis.
(SEE ARTICLE)
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