One-Year Outcomes in Survivors of the Acute Respiratory Distress Syndrome

As respiratory care improves, more patients are surviving the acute respiratory distress syndrome (ARDS). This study followed a cohort of 109 survivors of ARDS for one year. The patients lost about 20 percent of their body weight during their stay in the intensive care unit (ICU) and regained it over the ensuing year. Although the median distance walked in six minutes increased from 281 m at 3 months to 422 m at 12 months, the latter value was still only 66 percent of that predicted on the basis of age and sex. One year after discharge from the ICU, the patients' lung function was essentially normal.

Although this study did not include an equally ill control group without ARDS, the striking finding is that general, rather than pulmonary, disability limits activity in these patients.

Related Editorial

Ifosfamide and Etoposide for Ewing's Sarcoma
Ewing's sarcoma, a highly malignant tumor of children, adolescents, and young adults, often responds to local excision plus a now-standard four-drug regimen of chemotherapy. This study shows that standard chemotherapy alternating with courses of ifosfamide plus etoposide significantly improves survival in patients with nonmetastatic disease at the time of diagnosis, but not in those with metastatic disease.

Improvements in the treatment of Ewing's sarcoma are a major achievement of the pediatric oncologists who have united to investigate new ways of treating childhood cancer. With the six-drug combination described in this report, 70 percent of patients without metastases can expect to live at least five years without a recurrence of this once rapidly fatal disease.

Related Editorial

Antiretroviral Therapy and Cardiovascular Disease
There is concern that, with prolonged survival, patients with human immunodeficiency virus (HIV) infection may be at risk for cardiovascular and cerebrovascular disease due to HIV infection itself and to the effects of antiretroviral drugs. This retrospective study, involving a large population of veterans, dispels this concern.

There was a large reduction in mortality with antiretroviral therapy and no increase in the rate of cardiovascular disease. Still, because the study was short, it cannot rule out the possibility that the long-term risk of cardiovascular disease will increase as HIV-infected patients survive longer.

Related Perspective

Prion Protein in the Olfactory Epithelium

In nine patients who died of sporadic Creutzfeldt–Jakob disease, detailed autopsy studies identified deposition of pathologic prion protein in the olfactory cilia and along the olfactory pathway.

The identification of prion protein in the neuroepithelium of the olfactory mucosa suggests that olfactory biopsy may provide diagnostic information in living patients. Currently, diagnosis requires examination of brain tissue.

Related Perspective

Readability Standards for Informed-Consent Forms and Actual Readability

Investigators found that although many institutional review boards advise researchers to write informed-consent forms at an 8th-grade reading level, the sample forms they provide are often written above the 10th-grade level. Readability was not associated with local rates of literacy.

The reading level for most informed-consent forms is inappropriately high. Informed-consent forms can be written at a 4th-grade to 6th-grade level, providing the same information in simple language.

Current Concepts: Corticosteroid Insufficiency in Acute Illness
Recent studies report benefits from corticosteroid treatment in patients with septic shock. This review summarizes the physiology of the corticosteroid response in acute illness. The authors present an updated, practical approach to the diagnosis and treatment of hypoadrenalism in acutely ill patients. Supplemental corticosteroid treatment may be beneficial in many critical illnesses.

The Right to Health and the South African Nevirapine Case
This article describes the successful legal challenge of the South African government's controversial decision to restrict the availability of nevirapine for use in preventing the transmission of the human immunodeficiency virus (HIV) from mother to infant. With its order requiring the government to provide comprehensive health services to prevent mother-to-child transmission of HIV, the Constitutional Court of South Africa upheld the public's right to health care, as guaranteed in the South African constitution.

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