This Week in JAMA FREE

Axillary lymph node dissection (ALND) is the standard of care for patients with breast cancer whose sentinel lymph nodes contain metastases. However, no study has conclusively demonstrated a survival benefit from ALND when metastatic disease is identified in the sentinel node. Giuliano and colleagues Article report results of a multicenter trial that assessed survival among patients with early-stage breast cancer and sentinel node metastasis who were randomly assigned to receive complete ALND or no further treatment of the axilla. All patients underwent lumpectomy and tangential whole-breast irradiation, and systemic therapy was prescribed at the discretion of the treating physician. At a median follow-up of 6.3 years, the investigators found that ALND did not significantly affect overall or disease-free survival. In an editorial, Carlson and Wood Article discuss management of sentinel lymph node metastasis in breast cancer.

Higher than expected rates of lower respiratory tract infections and meningitis and higher mortality in the first year of life have been observed in some studies of infants and children with in utero HIV exposure who are not themselves HIV infected. Whether the increased morbidity and mortality are a consequence of an altered immune response is not known. In a cohort study that involved 109 HIV-infected and uninfected South African mothers and their uninfected infants, Jones and colleagues examined the association between maternal HIV infection and maternal and infant antibody levels to Haemophilus influenzae type b, pneumococcus, Bordetella pertussis antigens, tetanus toxin, and Hepatitis B surface antigen. The authors report that antenatal HIV exposure was associated with lower specific antibody responses in exposed uninfected infants compared with unexposed infants at birth, but with robust antibody responses following routine vaccination.

The prognostic implications of small cardiac enzyme elevations in the 24 hours following coronary artery bypass grafting (CABG) are not clear. In an analysis of data from 18 908 patients who had cardiac enzyme levels determined within 24 hours post-CABG and for whom mortality data were collected, Domanski and colleagues found that elevation of creatine kinase (CK-MB) or troponin levels within the first 24 hours was independently associated with an increased risk of intermediate and long-term mortality.

Ms D is a healthy 36-year-old woman who wishes to donate a kidney to her mother who has diabetes and end stage renal disease. Ms D is overweight and has smoked a pack of cigarettes daily for 22 years. Pavlakis discusses the epidemiology of kidney donation and the medical and psychosocial evaluation of potential live kidney donors, and summarizes what is known about the risks associated with live kidney donation.

“As a bioethicist . . . I was in some ways better prepared than many other health care proxies. I was also a bewildered daughter, more like than unlike any other.” From “Life Imitates Work.”

Electrochemotherapy, which uses electric pulses, may help some cancer drugs penetrate cells and increase potency.

The “high” risk of energy drinks

Provider monopolies and accountable care organizations

Designing clinical research to meet clinical needs

Appreciation for JAMA's authors and peer reviewers

How would you manage a 27-year-old woman who is in her second trimester of pregnancy, is addicted to heroin, and receives a 1-year jail sentence? Go to www.jama.com to read the case, and submit your response, which may be selected for online publication. Submission deadline is February 27.

Join Steven J. Jacobsen, MD, PhD, Wednesday, February 16, 2011, from 2 to 3 PM to discuss herpes zoster in older adults and their risk of future disease. To register, go to http://ihi.org/AuthorintheRoom.

For your patients: Information about kidney transplantation.