Table of Contents

April 6, 2004; 140 (7)

Articles

  • In community-dwelling elderly persons with Alzheimer disease, survival was shorter than predicted from U.S. population data. Features significantly associated with reduced survival at diagnosis included earlier age at onset, worse cognitive impairment, decreased function, falls, frontal release signs, and abnormal gait.

  • Maturity-onset diabetes of the young type 5 encompasses a wide clinical spectrum of defects in organogenesis, which are related to specific mutations in hepatocyte nuclear factor-1β. Nonobese patients with diabetes and slowly progressive nondiabetic nephropathy should be tested for mutations of hepatocyte nuclear factor-1β.

  • Successful short-term treatment with a proton-pump inhibitor in patients suspected of having gastroesophageal reflux disease (GERD) does not change the probability of GERD enough to establish the diagnosis. When treatment is not successful, the probability of GERD decreases only slightly.

  • No-show rates for physician appointments predicted attendance at colorectal endoscopic studies. High no-show rates for appointments with physicians may signify patients who need special reminders about appointments for endoscopy.

Brief Communications

  • The plasma concentration of vitamin C is regulated within narrow limits, and oral vitamin C has little effect on plasma levels. Intravenous administration of vitamin C results in high plasma and urine concentrations. This finding may explain discrepancies between past studies of the antitumor effects of vitamin C. Future studies of the role of vitamin C in cancer treatment should examine the intravenous route of administration.

NIH Conferences

  • With more than 9000 cases and 200 deaths in the United States in 2003, West Nile virus has become the most common cause of viral encephalitis in several states. This paper discusses the pathogenesis of West Nile virus, available diagnostic tests, and potential treatment.

Clinical Guidelines

  • The U.S. Preventive Services Task Force (USPSTF) recommends screening and behavioral counseling interventions to reduce alcohol misuse by adults, including pregnant women, in primary care settings. The USPSTF concludes that the evidence is insufficient to recommend for or against interventions to prevent or reduce alcohol misuse by adolescents in primary care settings.

  • Behavioral counseling interventions are effective and could be part of a public health approach to reducing harmful use of alcohol by adult primary care patients. Future research should test strategies to facilitate adoption of these practices into routine health care.

  • Among other recommendations, the U.S. Preventive Services Task Force recommends against routine screening with resting electrocardiography, exercise treadmill test, or electron-beam computerized tomography for coronary calcium for either the presence of severe coronary artery stenosis or predicting coronary heart disease events in adults at low risk for coronary heart disease events.

Editorial

  • According to a study in this issue, Alzheimer disease halves life expectancy at the time of diagnosis. This study can help patients, caregivers, and clinicians to set priorities within their respective roles. Thinking of dementia as a progressive, chronic disease may help clinicians to focus on palliative care planning and to assess their patients' preferences for care at the end of life.

On Being a Doctor

  • Mr. B. most likely saw me not as a physician caring for him but as a shade of white, a voice of institutional racism—the enemy.

Letters

Medical Writings: Book Notes

Ad Libitum

Book Listings

Medical Notices

Summaries for Patients

Updates from the Annual Session

  • For internists, women's health generally encompasses nonobstetric reproductive health, sex and gender differences in diseases that occur in both men and women, and conditions that occur predominantly or uniquely in women. This Update discusses reports on genitourinary conditions, hormone therapy, cardiovascular disease, and breast cancer.