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April 12, 2001
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Survival after the Onset of Dementia
Although it is known that dementia shortens life expectancy, previous estimates of median survival may have underestimated its effects by excluding people with rapidly progressive illness, who did not live long enough to be enrolled in a study. This is known as length bias. When this bias was taken into account, the estimated median survival with dementia was only 3.3 years.
Dementia is an increasingly common health problem in industrialized nations. These findings highlight the serious nature of the disorder. The median survival of people with dementia is markedly shorter than had previously been estimated and is similar to that found with aggressive forms of cancer.
Related Editorial
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Coronary-Artery Bypass Surgery versus Stenting for Multivessel Coronary Disease
Coronary-artery bypass surgery and angioplasty with stenting are both accepted approaches to the treatment of multivessel coronary disease. In this randomized comparison of the two forms of revascularization, there were no significant differences in the rates of death, stroke, or myocardial infarction at one year. However, a second revascularization procedure was more frequently needed by patients in the stenting group. Costs at one year were approximately $3,000 less per patient in the stenting group.
The rates of the major clinical outcomes were virtually the same at one year. Thus, the trade-offs involve a highly invasive procedure versus a less invasive one; a greater likelihood of needing a second revascularization procedure when stenting is the initial procedure; and higher costs with surgery than with stenting. All of these factors must be taken into consideration in deciding between the two approaches.
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Human Papillomavirus Infection and the Risk of Head and Neck Cancer
Persuasive evidence implicates human papillomaviruses (HPVs), especially HPV-16 and HPV-18, in causing cervical cancer, but the role of HPV in head and neck cancer is uncertain. These investigators searched for anti-HPV antibodies in serum that was collected an average of about nine years before the diagnosis of head and neck cancer. As compared with matched controls, twice as many of the 292 patients who had donated serum had antibodies against HPV-16.
The main strength of this caseÐcontrol study is its prospective design: serum samples that were collected years before the diagnosis of head and neck cancer were tested for anti-HPV antibodies. But such antibodies are only signposts of an infection that might have been eradicated long before the cancer began to evolve. The case for a causative role of HPV-16 in head and neck cancer is not as convincing as it is in cervical cancer.
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The Teratogenicity of Anticonvulsant Drugs
Infants born to women treated with anticonvulsant drugs during pregnancy have an increased risk of major malformations, microcephaly, hypoplasia of the midface and fingers, and growth retardation. In this study, 316 newborn infants of mothers who took anticonvulsant drugs during the pregnancy, 98 infants of mothers with epilepsy who did not take any anticonvulsant drugs during the pregnancy, and 508 infants of mothers without epilepsy were examined systematically for manifestations of embryopathy associated with exposure to anticonvulsant drugs. The frequency of abnormalities in the three groups was 22.8 percent, 6.1 percent, and 8.5 percent, respectively.
This study was undertaken to address the question of whether anticonvulsant-associated embryopathy is indeed caused by anticonvulsant drugs or, rather, by the maternal epilepsy itself. The results indicate that the drugs, not the disease or some factor related to it, are the cause.
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Advances in Immunology: Complement
This is the second part of a two-part review of the complement system. The review centers on diseases associated with abnormalities of the system. The focus is on the role of complement in adoptive immunity, inflammation, tissue necrosis, immune-complexÐmediated disease, and systemic lupus erythematosus.
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Primary Care: Epilepsy
This review article summarizes the initial evaluation of seizures and explains how to select and adjust antiepileptic medications. It also covers the management of common complications in patients with epilepsy and discusses decisions about the discontinuation of antiepileptic medications.
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