Table of Contents

April 4, 2000; 132 (7)

Articles

  • In this cohort study of patients with chronic hepatitis C, regression of fibrosis was associated with sustained virologic response to interferon therapy.

  • The prevalence of complicated liver disease related to home parenteral nutrition increased with longer duration of parenteral nutrition. This condition was one of the main causes of death in patients with permanent intestinal failure.

  • In this convenience sample, lipoprotein(a) was an additional risk factor for late-onset Alzheimer disease in carriers of the apolipoprotein E ε4 allele. However, lipoprotein(a) may protect against late-onset Alzheimer disease in noncarriers.

  • Previous studies have reported that walnuts decrease serum cholesterol levels in young men. In this study of men and women with polygenic hypercholesterolemia, substituting walnuts for part of the monounsaturated fat in a cholesterol-lowering Mediterranean diet further reduced total fat and low-density lipoprotein cholesterol levels.

Brief Communications

  • According to this survey study, urinary incontinence is common among male veterans and affects all age groups. Despite the unfavorable effects of incontinence on quality of life, the men surveyed seldom discussed the problem with medical providers.

  • Abnormal heart rate recovery after symptom-limited exercise is an important prognostic factor. This study found that even after submaximal exercise in patients in good cardiovascular health, abnormal heart rate recovery predicts death.

Updates

  • This review of the literature on identifying and managing patients in whom thrombolysis had failed after myocardial infarction pays particular attention to the noninvasive identification of reperfusion and the use of rescue percutaneous transluminal coronary angioplasty.

Review

  • In men with advanced prostate cancer, survival after therapy with a luteinizing hormone–releasing hormone (LHRH) agonist was found to be equivalent to survival after orchiectomy. Although patients prefer to avoid orchiectomy, it is unknown whether this procedure decreases quality of life. No evidence shows a difference in effectiveness or adverse effects among the LHRH agonists.

Perspectives

  • The ethical aspects of physicians' attention to the spiritual and religious dimensions of their patients' experiences of illness require review and discussion. Should physicians discuss spiritual issues with their patients? What are the boundaries between physicians and patients regarding these issues? What are the boundaries between physicians and chaplains?

Editorial

  • After years of clinical investigation and experience, questions about the optimal hormonal therapy in men with advanced prostate cancer still remain. In this issue, Seidenfeld and colleagues present results of their meta-analysis on various forms of hormonal monotherapy. What other options are available for these patients?

On Being a Doctor

  • The author's 12-year relationship with an elderly man with emphysema reaffirms his belief in house calls and the benefit of home care.

On Being a Patient

  • The author recounts his long journey through bone marrow transplantation and recovery and the new insights he has gained about the doctor–patient relationship.

Letters

Medical Writings

  • The Mütter Museum of the College of Physicians of Philadelphia is typical of the medical museums that were once found in almost all medical schools. Contemporary visitors to this and other medical museums can easily appreciate the museum's role in preserving artifacts for study, but the other two original functions of the museums—education and commemoration—may not be as apparent.

Medical Writings: Book Notes

Book Listings

Medical Notices

Summaries for Patients