Electroconvulsive therapy (ECT) is an effective treatment for severe
major depression, but relapse rates during the 6 to 12 months after discontinuation
of ECT may exceed 50%. Sackeim and colleaguesArticle studied the effect of continuation
pharmacotherapy (nortriptyline alone or nortriptyline plus lithium vs placebo)
on relapse of major depression among patients with remission of unipolar major
depression after an open ECT treatment phase. Over the 24-week trial, patients
in the placebo group had a higher relapse rate compared with patients in the
nortriptyline or combination nortriptyline plus lithium groups. In an editorial,
GlassArticle describes how ECT is currently practiced and discusses the indications,
efficacy, and possible adverse effects of this
Using data from the national HIV/AIDS surveillance system of the Centers
for Disease Control and Prevention, Lee and colleagues examined trends in
survival time among adults and adolescents diagnosed as having AIDS from 1984
through 1997. Survival time after AIDS diagnosis improved with each subsequent
year of diagnosis. The greatest relative gain in survival time occurred among
persons with AIDS diagnosed in 1996 compared with those diagnosed in 1995.
Mannose-binding lectin (MBL) is a serum protein that is thought to play
a role in the innate immune response by binding to carbohydrates on the surface
of microorganisms where it can activate the complement system or act directly
as an opsonin. In this prospective study of children aged 2 years or younger,
Koch and colleaguesArticle examined the association between variants in structural
and promoter MBL alleles and the risk of acute respiratory tract infections.
Children with genotypes that result in undetectable MBL levels (MBL insufficiency)
had a 2-fold increased risk of acute respiratory tract infections compared
with children with MBL sufficiency. In an editorial, Winkelstein and ChildsArticle
discuss other common genetic variations in the immune system that may be associated
with increased susceptibility to infections.
Women have a higher incidence than men of torsades de pointes ventricular
arrhythmias after administration of drugs that prolong cardiac repolarization.
Although the QT interval does not vary during the menstrual cycle in the absence
of drugs, Rodriguez and colleagues report that mean QT prolongation after
administration of ibutilide, an antiarrhythmic agent, was greater for women
during menses and the ovulatory phase compared with women during the luteal
phase or with men.
Histamine poisoning from fish is caused by ingestion of improperly refrigerated
fish contaminated by bacteria that convert histidine to histamine. Becker
and colleagues investigated an increase in the number of cases of histamine
fish poisoning reported in North Carolina between July 1998 and February 1999.
Twenty of the 22 cases occurred during 5 outbreaks and all case-patients had
eaten tuna. In 19 cases, the tuna had been frozen and thawed more than once
before being prepared as burgers or in salads.
"I soon learned that country doctors—working alone—not only
made house calls, but were to handle any and all "medical" problems." From
"The Condition We Don't Discuss."
Revised recommendations for the management of cardiac arrest.
Experts on treating HIV infection and AIDS reported recently on rising
drug-resistance rates and on novel therapies and insights into human genetics
that may help them continue to combat the HIV/AIDS epidemic.
Two cases—a 74-year-old woman with end-stage chronic obstructive
pulmonary disease and a 65-year-old woman with lung cancer—illustrate
strategies for the treatment of patients with severe dyspnea approaching the
end of life.
Meta-analysis of 34 studies indicates that magnetic resonance angiography
is highly accurate for detection of stenosis greater than 50% or occlusion
within the entire lower extremity arterial tree.
Limited communication about health-related quality-of-life issues occurs
between patients and their oncologists during outpatient palliative treatment
For your patients: Information about electroconvulsive therapy.
This Week in JAMA. JAMA. 2001;285(10):1257. doi:10.1001/jama.285.10.1257