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Racial
Disparities in Access to Renal Transplantation
In the United States, blacks are less likely than whites to undergo
renal transplantation. It is uncertain, however, whether these disparities
reflect racial differences in the clinical appropriateness of transplantation
or inappropriate care. In this study of 1518 patients between the
ages of 18 and 54 years, all of whom started to undergo dialysis
in 1996 or 1997, blacks were less likely than whites to be considered
appropriate candidates for transplantation. However, there was also
evidence of underuse of transplantation among blacks and of overuse
among whites. The authors conclude that reducing these disparities
will require interventions focused on their specific causes. Elsewhere
in this issue, Young and Gaston review renal transplantation in
blacks, examining additional aspects of racial disparities in access
to transplantation, as well as disparities in outcome.
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The
pain of postherpetic neuralgia is very difficult to treat. In this randomized
trial, patients received up to four weekly intrathecal injections of methylprednisolone
plus lidocaine (89 patients) or lidocaine alone (91) or received no treatment
(90). The patients in the methylprednisolonelidocaine group had greater
reductions in pain and in the requirement for analgesics than did the
other two groups.
Nonsteroidal
antiinflammatory drugs are widely used, but gastrointestinal toxicity is
a major concern. This study of more than 8000 patients with rheumatoid arthritis
compared rofecoxib, a selective inhibitor of cyclooxygenase-2, with naproxen,
a nonselective inhibitor of cyclooxygenase. The two medications were equally
efficacious. Treatment with rofecoxib was associated with fewer instances
of gastroduodenal perforation or obstruction, upper gastrointestinal bleeding,
and symptomatic gastroduodenal ulcers, but with a higher rate of myocardial
infarction.
