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This Week in JAMA
March 14, 2001

This Week in JAMA

JAMA. 2001;285(10):1257. doi:10.1001/jama.285.10.1257
Pharmacotherapy for Major Depression After ECT

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 treatment.

Improved Survival After AIDS Diagnosis

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.

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Mannose-Binding Lectin and Respiratory Infections

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.

Drug-Induced QT Changes During the Menstrual Cycle

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.

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Histamine Poisoning From Tuna Consumption

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.

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A Piece of My Mind

"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."

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Contempo Updates

Revised recommendations for the management of cardiac arrest.

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Medical News & Perspectives

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.

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Severe Dyspnea With End-Stage Lung Disease

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.

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Accuracy of Magnetic Resonance Angiography

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.

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Discussing Quality-of-Life Issues

Limited communication about health-related quality-of-life issues occurs between patients and their oncologists during outpatient palliative treatment visits.

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JAMA Patient Page

For your patients: Information about electroconvulsive therapy.

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