This Week in the Journal

This Week in the Journal

June 19, 2003

Noninvasive Detection of Occult Lymph-Node Metastases in Prostate Cancer

Two methods were compared for the detection of small lymph-nodemetastases in men with prostate cancer: conventional magneticresonance imaging (MRI) and MRI performed 24 hours after theintravenous injection of lymph-node–seeking nanoparticlescontaining an iron oxide core. The latter method proved superiorto conventional MRI in sensitivity and specificity.

The noninvasive MRI method described in this study could changethe initial workup of men with newly diagnosed prostate cancerand ultimately influence their treatment.

Related Perspective

Staging of Non–Small-Cell Lung Cancer with Integrated PET and Computed Tomography

In this prospective study, integrated positron-emission tomography(PET) and computed tomography were more accurate for the radiographicassessment of disease stages in non–small-cell lung cancerthan the use of either technique alone or simultaneous visualinspection of the two types of images.

Preoperative staging is a crucial step in the management ofnon–small-cell carcinoma — not only to determinethe suitability of surgery in a given case but also to guidesurgeons in planning and performing the operation.

Leisure Activities and the Risk of Dementia

In a prospective study of 469 elderly subjects who were freeof dementia at base line, activities such as reading, playingboard games, and playing musical instruments were associatedwith a significant reduction in the risk of dementia. Participationin physical activities was not associated with any reductionin the risk of dementia.

Cognitive activities may reduce the risk of dementia in theelderly.

Related Perspective

Prevalence of Celiac Disease

This study of Finnish schoolchildren found that the presenceof serum autoantibodies can be used to identify celiac diseaseand reported a prevalence of 1 case in 99 children.

The prevalence of celiac disease may be higher than previouslybelieved. Prospective screening for specific autoantibodiesand HLA genotypes can identify persons with asymptomatic disease.

Related Editorial

Improving Safety with Information Technology

Information technology can improve patient safety by preventingerrors and facilitating rapid response to adverse events. Computerizedprescribing by physicians reduces the rate of medication-relatederrors. Systems that automatically page clinicians about seriouslaboratory abnormalities and remote monitoring of patients inintensive care units also appear promising.

Related Editorial

Mechanisms of Disease: Diseases Involving Type IV Collagen

Defects in type IV collagen, a collagenous protein involvedin the formation of basement membranes, have been implicatedin hereditary Alport's syndrome and acquired Goodpasture's syndrome.Mutations in genes corresponding to the building blocks of typeIV collagen cause Alport's syndrome, whereas autoantibodiesagainst structures that are usually hidden in the recesses ofcollagen IV cause Goodpasture's syndrome.

The Solitary Pulmonary Nodule

A 60-year-old man undergoes chest radiography during an evaluationfor pneumonia, and a 1.5-cm nodule is discovered. He is a heavysmoker but has no history of lung disease. The results of aphysical examination are unremarkable. How should he be evaluated?

Celiac Disease

The mechanism by which some types of cereal proteins triggerceliac disease (also known as gluten-sensitive enteropathy)is unknown. A strong candidate has now been put forward: a 33-amino-acidpeptide that resists digestion. The peptide is susceptible todegradation by a bacterial enzyme, raising the possibility ofa new therapeutic approach.

Soluble CD40 Ligand in Acute Coronary Syndromes
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The Outbreak of Conjunctivitis at Dartmouth
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The Death at Duke
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The Chromogranin–Secretogranin Family
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Understanding and Responding to Adverse Events
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Race and Genomics
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Aspiration of Barium
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Interleukin-1–Receptor Antagonist in the Muckle–Wells Syndrome
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