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In This Issue of JAMA
May 14, 2014


JAMA. 2014;311(18):1829-1831. doi:10.1001/jama.2013.279486

To determine the effect of preoperative positron emission tomography combined with computed tomography (PET-CT) on the surgical management of potentially resectable liver metastases in patients with colorectal cancer, Moulton and colleagues randomly assigned 263 patients to undergo PET-CT or to a control condition that included baseline (prerandomization) CT of the abdomen-pelvis area but no PET-CT. The authors found that compared with CT alone, use of PET-CT rarely resulted in a change in surgical management—defined as canceled hepatic surgery, more extensive hepatic surgery, or additional organ surgery.

In a 12-week randomized trial that enrolled 2067 patients with primary hypercholesterolemia and mixed dyslipidemia, Robinson and colleagues assessed the efficacy and tolerability of evolocumab—an inhibitor of proprotein convertase subtilisin/kexin type 9, which has a role in cholesterol homeostasis—used in combination with moderate- or high-intensity atorvastatin, rosuvastatin, or simvastatin therapy. The authors report that compared with placebo or ezetimibe (atorvastatin patients only), the addition of evolocumab to moderate- or high-intensity statin therapy resulted in further reductions in low-density lipoprotein cholesterol (LDL-C) levels.

Little is known about long-term neuroanatomic and cognitive consequences of concussion in athletes. To address this question, Singh and colleagues assessed cognitive function and brain volume in collegiate football players with (n=25) and without (n=25) a history of clinician-diagnosed concussion, and in 25 non–football-playing, age-, sex-, and education-matched healthy controls. The authors found that collegiate football players—with and without a history of concussion—had smaller hippocampal volumes compared with healthy controls, and years of football experience correlated with slower reaction time.

In a systematic review and meta-analysis of data from 122 randomized trials and 1 prospective cohort study (22 803 participants total) that assessed benefits and harms of pharmacotherapy for alcohol use disorders, Jonas and colleagues found that both acamprosate and oral naltrexone were associated with reduction in return to drinking. When directly compared, there were no differences between the 2 medications for controlling alcohol consumption. In an Editorial, Bradley and Kivlahan discuss patient-centered care for alcohol use disorder.


Continuing Medical Education

Clinical Review & Education

Glaucoma is the leading cause of irreversible blindness worldwide. Weinreb and colleagues report results of a systematic review of current evidence regarding the pathophysiology and treatment of glaucoma with relevance to primary care physicians. The authors summarize patient risk factors and findings on direct ophthalmoscopy that should prompt specialist referral, and they highlight the primary care physician’s role in reinforcing medication adherence and in recognizing adverse reactions from glaucoma medications and surgeries.

Author Video Interview

An article in JAMA Ophthalmology reported incidence and prevalence of uveitis in Hawaii. In this From The JAMA Network article, Yeh and colleagues compare findings from the Hawaiian cohort with those from other demographic groups, and they highlight the need for further investigation of genetic, environmental, and other factors that may contribute to uveitis risk.

A 60-year-old Nigerian man presents with a 7-month history of an enlarging left eye mass. He underwent surface ocular surgery a year ago; however, he does not know why or what was done. Best-corrected visual acuity in the affected eye was 20/25; extraocular movements, anterior segment, and dilated fundus examinations of both eyes are unremarkable. What would you do next?