Psychosocial Support and Survival in Metastatic Breast Cancer

In this randomized trial, the addition of a form of group therapy called supportive–expressive group therapy to standard medical care did not prolong the survival of women with metastatic breast cancer. The therapy did, however, alleviate psychological symptoms.

A previous report indicated that supportive–expressive group therapy prolonged survival considerably in women with metastatic breast cancer. The present rigorously controlled study did not confirm that report.

Related Editorial

CT and Lumbar Puncture for Suspected Meningitis

In this prospective study, 235 adults with suspected meningitis underwent computed tomography (CT) of the head before undergoing lumbar puncture. The results were abnormal in 24 percent of patients. The presence of any of 13 clinical and neurologic features at base line was associated with a significant risk of abnormal findings on CT. The scans were normal in 97 percent of the patients who had none of these characteristics at base line.

The absence of clinical characteristics such as an age of at least 60 years and neurologic abnormalities on physical examination can identify patients with suspected meningitis who are unlikely to have abnormalities on CT of the head. In this cohort, 41 percent of the CT scans could have been avoided by the use of this approach, thereby reducing delay before lumbar puncture.

Related Editorial

Naltrexone for Alcohol Dependence

Alcoholism is a devastating illness that is difficult to treat. Naltrexone, an opioid-receptor antagonist, has been approved by the Food and Drug Administration for the treatment of alcohol dependence, but its effectiveness is uncertain. This study of veterans (mostly men) found no evidence that naltrexone, combined with attendance at Alcoholics Anonymous meetings and other psychosocial treatment, was more effective than placebo for chronic and severe alcohol dependence.

These findings raise questions about the use of naltrexone as a treatment for patients with chronic, severe alcohol dependence and underscore the need for better therapies.

Related Editorial

Patent Foramen Ovale and Atrial Septal Aneurysm as Risk Factors for Recurrent Stroke

Patent foramen ovale and atrial septal aneurysm have been identified as possible risk factors for stroke. This study examined whether these structural abnormalities, alone or in combination, increased the risk of recurrent stroke. Patients with both patent foramen ovale and atrial septal aneurysm, but not either lesion alone, were found to be at substantial risk for recurrent stroke.

Since all patients were receiving aspirin prophylaxis, other preventive strategies must be considered in patients with a previous stroke who have both a patent foramen ovale and an atrial septal aneurysm.

Medical Progress: Hereditary Periodic Fever

Fever of undetermined origin may be familial and have a periodic course. This article discusses three syndromes of hereditary periodic fever: familial Mediterranean fever, the hyper-IgD syndrome, and the tumor necrosis factor receptor–associated periodic syndrome. Each is caused by mutations in different genes and affects different ethnic groups. Important recent advances in our understanding of the pathophysiology of these disorders are presented in this review article.

Diabetes, Insulin, and the Pancreatic Beta-Cell Mitochondrion

The mitochondrion of the insulin-secreting pancreatic islet cell is a biochemical beehive in which the products of glucose oxidation influence the secretion of insulin. Work with cultured islets has shown that a mitochondrial ion carrier termed uncoupling protein 2 (UCP2 ) affects glucose-stimulated insulin levels. A recent report demonstrated that in mice with a disabled UCP2 gene, insulin secretion was enhanced and blood levels of glucose were reduced. When the gene was knocked out in ob/ob mice, which are obese, insulin-resistant, and diabetic, insulin secretion increased and the hyperglycemia was ameliorated.

In ob/ob mice, overproduction of UCP2 appears to contribute to the development of type 2 diabetes. This protein may have a crucial role at the intersection between diabetes and obesity.

HOME  |  SUBSCRIBE  |  SEARCH  |  CURRENT ISSUE  |  PAST ISSUES  |  COLLECTIONS  |  PRIVACY  |  TERMS OF USE  |  HELP  |  beta.nejm.org

Comments and questions? Please contact us.

The New England Journal of Medicine is owned, published, and copyrighted © 2009 Massachusetts Medical Society. All rights reserved.