Highlights

Deep vein thrombosis in pregnancy

In nonpregnant patients, most deep vein thromboses of the lower extremities start in the calf veins and progress proximally, but is the pattern the same for pregnant women? Based on their review of the literature, Chan and colleagues found that proximal deep vein thrombosis restricted to the femoral or iliac veins is more common among pregnant women. They also found, as with previous studies, that these thromboses usually develop on the left side.

See Research, page 657

We lack good evidence-based studies on techniques for diagnosing deep vein thromboses in pregnant women, says Kaaja. As a consequence, the natural course of proximal or distal deep vein thrombosis in pregnancy is not clear. See Commentary, page 649

The genetics of Crohn disease

More than 30 genetic variants have been linked to Crohn disease in case–control studies. Yazdanyar and colleagues examined the penetrance of three of these variants (on the NOD2/CARD15 gene) in a general population in Denmark. Although more than 11% were carriers of the variants, only 162 of the 43 596 individuals studied developed Crohn disease by the age of 50, a result that was lower than expected from previous studies. See Research, page 661

The findings of the Yazdanyar paper remind us that genomic technology has dramatically outpaced our understanding of human genetics, say Hirschfield and colleagues. Major challenges remain in translating genetic information into a personalized health paradigm. See Commentary, page 651

Predicting survival benefit of renal transplantation

While kidney transplantation is the treatment of choice for end-stage renal disease, accurately predicting survival can be difficult for the various treatment options facing a patient in this situation. Van Walraven and colleagues have developed a prognostic index based on commonly available information for patients and clinicians to use when discussing dialysis and transplantation options. See Research, page 666

Underdiagnosis of COPD in primary care

Detection of chronic obstructive pulmonary disease at an early stage is crucial for implementing targeted interventions, such as smoking cessation and increased exercise. In their study of three primary care sites, Hill and colleagues found that up to one in five patients with known risk factors had spirometric evidence of chronic obstructive pulmonary disease. Of these patients, only one-third were aware of their diagnosis before the study. See Research, page 673

Preventing migraine

Prophylaxis of migraine should be considered in patients whose headaches affect their quality of life despite appropriate symptomatic treatment and in those who are at risk of medication overuse headache. See Review, page E269

Laws for healthy eating

Legal measures can be used to promote healthier eating and more physical activity especially in children, say Ries and Tigerstrom. See Analysis, page 687

Managing breast lumps in office setting

Breast lumps are common, yet breast cancer will develop in only 1 in 10 women. Heisey and McCready present an algorithm for managing patients with palpable breast lumps in the primary care setting and describe several techniques for breast lump aspiration. See Practice, page 693

Five things to know about contrast media

Oral administration of ionic contrast media should be avoided when checking chest drains or the position of nasogastric feeding tubes, Baerlocher and colleagues conclude in this first instalment of the new Five things to know about series. See Practice, page 697