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This Week in JAMA
November 5, 2008

This Week in JAMA

JAMA. 2008;300(17):1969. doi:10.1001/jama.2008.597

Opioid-addicted youth are often treated with short-term pharmacological detoxification and counseling; however, the rate of relapse is high. To assess the efficacy of extended medication-assisted therapy, Woody and colleagues Article randomly assigned opioid-addicted youth to outpatient treatment that involved weekly counseling and either buprenorphine-naloxone up to 24 mg per day for 9 weeks and then tapered to week 12 or buprenorphine-naloxone up to 14 mg per day and tapered to day 14. The authors report that more patients in the 14-day detoxification group had opioid-positive urine test results at weeks 4 and 8 but not at week 12 than did patients in the extended treatment group. In an editorial, Fiellin Article discusses the treatment of adolescent opioid addiction.

Folate, vitamin B6, and vitamin B12 are important for the maintenance of DNA integrity and regulation of gene expression and are thought to have a role in cancer prevention. In an analysis of cancer end points in a randomized trial that tested the effect of daily supplementation of a combination of folic acid, vitamin B6, and vitamin B12 vs placebo on prevention of cardiovascular disease in women at high risk, Zhang and colleagues found that women who received the vitamin supplement had comparable risks of total invasive cancer, breast cancer, and any cancer-related death as women who received placebo.

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In a population-based surveillance study of residents of Olmsted County, Minnesota, who experienced a myocardial infarction between 1979 and 2005, Adabag and colleagues assessed the risk of out-of-hospital sudden cardiac death after myocardial infarction. The authors found that among 30-day survivors of myocardial infarction, the risk of out-of-hospital sudden cardiac death has declined significantly over the past 30 years. Sudden cardiac death was independently associated with heart failure but not with recurrent ischemia in this patient cohort.

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Anaplastic large-cell lymphoma (ALCL) in the fibrous capsule of cosmetic breast implants has been reported. To further assess this association, de Jong and colleagues Article searched the national pathology database of the Netherlands for cases of ALCL and other lymphomas of the breast diagnosed between 1990 and 2006. The authors identified 11 cases of ALCL of the breast diagnosed during these 17 years. In a case-control analysis, the authors found the relative risk of ALCL associated with a breast prosthesis was 18.2 (95% confidence interval, 2.1-156.8), with an estimated absolute risk of 0.1 to 0.3 per 100 000 individuals per year. In an editorial, Evens and Chiu Article discuss the epidemiology of non-Hodgkin lymphoma and the biology of primary breast lymphomas.

Mrs S is an 82-year-old woman with long-standing hypertension and a recent diagnosis of renal artery stenosis. Rosenfield and Jaff discuss the clinical presentation and natural history of renal artery stenosis and present options and indications for treatment.

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“[T]hose etherized afternoons in the lab knocked our inhibitions for a loop and promoted collegiality.” From “Worms.”

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International aid organizations are launching an effort to prevent the long-term effects of malnourishment in young children.

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International health aid beyond PEPFAR

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Insulin levels and macrovascular disease in type 2 diabetes

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Detecting alcoholism: the CAGE questionnaire

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Authors are invited to submit manuscripts for an upcomingJAMA theme issue.

Join Rita F. Redberg, MD, MSc, November 19 from 2 to 3 PM eastern time to discuss stress testing to document ischemia before PCI. To register, go to http://www.ihi.org/AuthorintheRoom.

How would you manage a 24-year-old woman with intractable seizures since age 10 years? Go to www.jama.com, read the case, and submit your response, which may be selected for online publication. Submission deadline is November 26.

For your patients: Information about renal artery stenosis.

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