Table of Contents

October 15, 2002; 137 (8)

Articles

  • Community-dwelling elderly persons, especially those with impaired left ventricular function, have a substantial risk for death from congestive heart failure. However, more deaths occur from heart failure in persons with normal systolic function because left ventricular function is more often normal than impaired in elderly persons with heart failure.

  • A 2-month regimen of rifampin and pyrazinamide for latent tuberculosis infection was associated with an increased risk for grade 3 or 4 hepatotoxicity compared with a 6-month regimen of isoniazid. Liver enzymes should be measured routinely during treatment to screen for liver injury and prevent progression to severe toxicity.

  • For prophylaxis of venous thromboembolism, fixed-dose ximelagatran started the morning after total knee arthroplasty is well tolerated and at least as effective as warfarin, but it does not require coagulation monitoring or dose adjustment.

Brief Communications

  • Indinavir levels in hair are associated with virologic outcome in HIV-infected patients receiving highly active antiretroviral therapy.

Academia and Clinic

  • Increasing use of complementary and alternative medical (CAM) therapies by patients, health care providers, and institutions has made it imperative that physicians consider their ethical obligations when recommending, tolerating, or proscribing these therapies. The authors present a risk–benefit framework that can be applied to determine the appropriateness of using CAM therapies in various clinical scenarios.

  • Hospital-onset infections, particularly those involving the urinary tract, lung, and bloodstream, are common and costly and cause substantial morbidity. This article, part of the Quality Grand Rounds series, analyzes the case of a 78-year-old man with lung cancer who died after developing hospital-onset pneumonia and urinary catheter–related infection during hospitalization for elective removal of a cerebellar metastatic lesion.

Review

  • Breast cancer is similar in men and women; however, breast cancer in men is more frequently hormone receptor positive and may be more sensitive to hormonal therapy.

Perspectives

  • Recent federal initiatives are designed to enhance the medical treatment of patients with opioid dependence and will expand the role of internists in the care of these patients. These initiatives include a process for federal exemptions to allow for pharmacologic treatment in office settings, waivers for the use of new medications, and new rules governing the oversight and distribution of opioid agonist medications for maintenance treatment.

Editorials

  • Focusing on Jasmer and colleagues' study in this issue, the authors discuss the use of propensity scores to adjust for overt biases in treatment assignment in nonrandomized trials.

  • In this issue, Bernard and colleagues describe the relationship between the level of indinavir in hair, virologic response, and the occurrence of resistant HIV mutations. Their article provides evidence for a promising new option for monitoring exposure to antiretroviral regimens.

Letters

Medical Writings: Book Notes

Book Listings

Medical Notices

Summaries for Patients

Updates from the Annual Session

  • This Update covers mood disorders, anxiety disorders, medical–psychiatric comorbid conditions, and cognitive disorders.