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This Week in JAMA |

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JAMA. 2004;291(16):1931. doi:10.1001/jama.291.16.1931.
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TOLVAPTAN FOR WORSENING HEART FAILURE

Tolvaptan, a vasopressin antagonist, combined with loop diuretics effectively reduces body weight without resultant hypokalemia or worsening renal function in patients with mild heart failure, but whether it might have similar effects in patients hospitalized for heart failure is not clear. Gheorghiade and colleaguesArticle report results of a randomized trial to assess the short- and intermediate-term effects of tolvaptan plus standard therapy in hospitalized patients with decompensated heart failure. They found that patients receiving tolvaptan experienced a significantly greater decline in body weight compared with patients receiving placebo, without experiencing hypotension, increased heart rate, hypokalemia, or worsening renal function. In an editorial, Francis and TangArticle discuss the role of vasopressin antagonist drugs in the treatment of heart failure.

IDENTIFYING HER-2 IN BREAST TUMORS

The HER-2 oncoprotein is overexpressed in 20% to 30% of invasive breast tumors, and its presence confers important prognostic information. However, the optimal screening test for HER-2 has not been determined. Yaziji and colleaguesArticle report results of a parallel comparison study of fluorescence in situ hybridization and immunohistochemistry tests to assess HER-2 status. Results from both tests were highly correlated and support recent recommendations that immunohistochemistry is the testing method of choice. In an editorial, Wiley and DiazArticle review the results of previous evaluations of tests to detect HER-2 and recommend that future studies of biomarkers adhere to the rigorous standards used in this investigation.

ENDOTHELIAL DYSFUNCTION AND RISK OF TYPE 2 DIABETES

Patients with type 2 diabetes have elevated plasma levels of biomarkers reflecting endothelial dysfunction, but whether these abnormalities exist prior to the development of diabetes is not known. Meigs and colleagues report results of a nested case-control study comparing baseline levels of 3 markers of endothelial dysfunction of women who had developed diabetes during the 11-year study with those who did not. They found that women with diabetes had significantly higher baseline levels of the markers than those without diabetes and that 2 markers, E-selectin and intercellular adhesion molecule 1, predicted incident diabetes in analyses adjusted for known diabetes risk factors.

MATERNAL DENTAL RADIOGRAPHY AND INFANT BIRTH WEIGHT

Prior investigations have documented an association of maternal antepartum radiation exposure with infants of low birth weight (LBW), but whether low-dose head and neck radiation might be associated is not known. Hujoel and colleagues linked dental and birth certificate data to investigate whether maternal dental radiographs performed during the antepartum period were associated with the birth of a LBW infant. After controlling for established risk factors for LBW, they found that dental radiation exposure was more common among women who gave birth to LBW infants compared with those who gave birth to normal-weight infants. This association was strongest for term infants and the risk increased with greater radiation dose.

A PIECE OF MY MIND

"It had been a decent face, Rubens thought on the way to the hospital—a doctor's face." From "The Scar."

MEDICAL NEWS & PERSPECTIVES

National electronic medical records, physician field officers, and other strategies are needed to streamline health care and help disseminate innovation to community physicians, says health care systems expert Donald Berwick, MD, MPP.

HEALTH STATUS AFTER ANTHRAX INFECTION

Adult survivors of bioterrorism-related anthrax disease report health problems, psychological distress and diminished health-related quality of life 1 year after illness onset.

VITAMIN D PREVENTS FALLS

A meta-analysis of clinical trial data reveals that vitamin D supplementation reduces the risk of falls in the elderly.

READING DISABILITY

Evidence from 4 new studies of reading disability documents a significantly higher prevalence in boys.

CLINICIAN'S CORNER

Risk factors associated with obstructive sleep apnea.

JAMA PATIENT PAGE

For your patients: Information about reading disorder.

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