This Week in the Journal

January 10, 2002

Dietary Approaches to Prevention of Recurrent Kidney Stones

This randomized trial, involving men with recurrent calciumoxalate stones and hypercalciuria, compared the effectivenessof a low-calcium diet with one containing a normal amount ofcalcium but restricted amounts of animal protein and salt. Afterfive years, only 12 of the 60 men on the diet with normal calcium,low animal protein, and low salt had recurrent stones, as comparedwith 23 of the 60 men on the low-calcium diet (relative riskof a recurrence among those on the normal-calcium, low-protein,low-salt diet, 0.49; 95 percent confidence interval, 0.24 to0.98; P=0.04).

Restriction of both animal-protein and salt intake, coupledwith normal calcium intake, is more effective than restrictionof calcium intake in preventing recurrent nephrolithiasis.

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Irinotecan plus Cisplatin for Metastatic Small-Cell Lung Cancer

In this randomized trial, irinotecan plus cisplatin was comparedwith etoposide plus cisplatin for the treatment of metastaticsmall-cell lung cancer. The trial was stopped early becauseof a significant difference in survival, in favor of irinotecanplus cisplatin.

With the best current treatment, only 10 percent of patientswith metastatic small-cell lung cancer survive for two yearsafter receiving the diagnosis. In this study from Japan, thetwo-year survival among such patients who were treated withirinotecan plus cisplatin was approximately 20 percent. Thissmall but important improvement could change the managementof metastatic small-cell lung cancer.

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Four Chemotherapy Regimens for Advanced Non–Small-Cell Lung Cancer

Four combinations of chemotherapy were compared in patientswith advanced non–small-cell lung cancer. No one regimenappeared to be superior to the others. The overall survivalrate at one year was 33 percent. The regimen of carboplatinplus paclitaxel was less toxic than the other regimens.

Non–small-cell lung cancer causes about one third of alldeaths due to cancer. Patients with the advanced stage of thedisease have a very poor prognosis; they often receive no chemotherapyand die in less than six months. Treatment that allows one thirdof patients to live for a year is therefore worth considering.

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Inactivating GNAS1 Mutations in Progressive Osseous Heteroplasia

The rare disease progressive osseous heteroplasia (POH) is characterizedby disabling skeletal-muscle and connective-tissue ossificationthat begins in childhood. It has been proposed that POH mighthave a common basis with another rare disease associated withextensive heterotopic ossification, Albright's hereditary osteodystrophy(AHO). Since heterozygous inactivating mutations in the GNAS1gene are known to cause AHO, GNAS1 mutations were sought insubjects with POH. Heterozygous inactivating GNAS1 mutationswere found in 13 of 18 probands with POH, all of whom inheritedthe defective allele exclusively from their fathers —a finding consistent with paternal imprinting.

The same mutation caused either POH or AHO within a single family,with the phenotype correlating with the parental origin of themutant allele.

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Images in Clinical Medicine: Bronchoalveolar-Cell Carcinoma

Chest radiography and high-resolution CT led to transbronchialbiopsy and the diagnosis of cancer.

Current Concepts: Post-Traumatic Stress Disorder

In the wake of the terrorist attacks on September 11, 2001,physicians have been confronted with patients who have sufferedpsychological trauma. This Review Article examines an extremereaction, the post-traumatic stress disorder, which may followa variety of traumatic events. The author defines the syndrome,its clinical features, and research findings on its biologicaspects. For patients who require therapy, she discusses bothcounseling and pharmacologic approaches.

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