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In This Issue of Archives of Internal Medicine |

In This Issue of Archives of Internal Medicine FREE

Arch Intern Med. 2004;164(22):2403. doi:10.1001/archinte.164.22.2403.
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Despite high cardiovascular risk among adults with diabetes, aspirin use in this group has been low in the past. In 1997, the American Diabetes Association published a position statement recommending that aspirin should be considered for most adults with diabetes to prevent cardiovascular events. Since that time in the United States, aspirin use among adults with diabetes has increased. Still, by 2001, fewer than half of adults with diabetes who were 35 years and older used aspirin regularly. Aspirin use was less common among women, younger adults, and persons without diagnosed cardiovascular disease. Many adults with diabetes at high cardiovascular disease risk do not use this inexpensive effective therapy.

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Increasing evidence suggests that certain patients with bacterial abscesses in general, and spinal epidural abscess in particular, may respond well to appropriate antimicrobial therapy alone without surgical drainage. In a retrospective review of 57 cases of spinal epidural abscess seen over a 14-year period, prolonged parenteral antibiotics alone or combined with percutaneous needle drainage yielded clinical outcomes at least comparable with antibiotics plus surgical intervention, irrespective of patient age, presence of comorbid illness, disease onset, neurologic abnormality at time of presentation, or abscess size. Many patients with spinal epidural abscess can be safely and effectively treated with conservative medical treatment without the need for surgery.

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A number of recent mortality follow-up studies of women who received cosmetic breast implants have reported 2- to 3-fold excess risk for suicide. This nationwide follow-up study by Jacobsen and colleagues of 2761 Danish women with cosmetic breast implants confirms the earlier studies, showing that women with cosmetic breast implants have a suicide mortality risk 3.1 times higher than other Danish women of the same age. Moreover, for the first time the prevalence of psychiatric hospital admissions, prior to any implant or cosmetic surgery, was assessed for women with implants and women who underwent other forms of cosmetic procedures for comparison. When compared with women who underwent other types of cosmetic procedures, women with cosmetic breast implants had a 70% greater likelihood for psychiatric hospital admission at some time prior to cosmetic breast implant surgery. These findings raise the issues of preimplant psychiatric screening and the need for further research to clarify the underlying reasons for the consistently elevated suicide rate among women with cosmetic breast implants.

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Hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch syndrome, is a cancer susceptibility disorder. Its most common manifestation is colorectal cancer (CRC). In this retrospective cohort study, Watson and colleagues evaluated the association between tobacco use and CRC risk in carriers of HNPCC-associated mutations in hMLH1 or hMLH2 and found that tobacco use, hMLH1 mutation carriage (as opposed to hMSH2), and male sex were significantly associated with increased risk of CRC. Alcohol use did not alter CRC risk. The authors concluded that smoking cessation should be an integral part of HNPCC management. Study of other possible environmental risk modifiers may lead to cancer-preventive interventions in hereditary cancer susceptibility disorders.

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Further analyses of the Intervention as a Goal in Hypertension Treatment (INSIGHT) trial show that in hypertensive patients at high risk, renal function is better preserved during long-term treatment with nifedipine gastrointestinal therapeutic system than with hydrochlorothiazide-amiloride. In addition, renal function, whether assessed by serum creatinine level, estimated creatinine clearance, or the presence of proteinuria, predicted cardiovascular outcome. Serum uric acid, while being a determinant of outcome in univariate analysis, did not prove to be an independent risk factor.

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