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This Week in JAMA
December 24/31, 2003

This Week in JAMA

JAMA. 2003;290(24):3167. doi:10.1001/jama.290.24.3167

Accuracy of Whole-Body Imaging for Tumor Staging

Two new imaging strategies—whole-body magnetic resonance imaging (MRI) and whole-body dual-modality positron emission tomography and computed tomography (PET/CT)—offer the possibility of whole-body coverage for tumor staging in a single diagnostic session. Antoch and colleaguesArticle evaluated the accuracy of these imaging modalities in a prospective study of patients with different histologically proven malignancies using histology and clinical-radiological follow-up as standards of reference. Overall TNM staging was correctly determined by PET/CT in 77% of patients and by whole-body MRI in 54% of patients. In an editorial, Blomqvist and TorkzadArticle discuss issues that are important to consider when assessing the use of whole-body imaging for tumor staging.

Valve Surgery for Complicated Infective Endocarditis

Uncontrolled observational studies have indicated that valve surgery is associated with improved outcomes in patients with complicated native valve infective endocarditis. Vikram and colleaguesArticle evaluated 6-month all-cause mortality in a cohort of patients with complicated, left-sided native valve endocarditis using multivariable modeling to adjust for prognostic imbalances at baseline and propensity analyses to control for confounding factors that affect treatment selection. Mortality at 6 months after baseline was significantly lower among patients who underwent valve surgery than among patients who received medical therapy alone in unadjusted analyses, in analyses that adjusted for baseline variables associated with mortality, and in a subset of patients matched by propensity to undergo valve surgery. In an editorial, DurackArticle suggests that surgery may offer the best opportunity to reduce the persistently high mortality rate in individuals with infective endocarditis.

Severe Acute Respiratory Syndrome

The first cases in the global outbreak of severe acute respiratory syndrome (SARS) were reported in February 2003. From November 1, 2002 through August 7, 2003, a cumulative total of 8422 probable SARS cases and 916 SARS-related deaths were reported from 29 countries to the World Health Organization. Three articles in this issue of THE JOURNAL focus on this new infectious disease. Pang and colleaguesArticle describe and evaluate measures undertaken to control the largest local SARS outbreak, which occurred in Beijing, China, in March 2003. Loutfy and colleaguesArticle report the results of a preliminary study among patients with SARS comparing treatment with interferon alfacon-1 plus corticosteroids with corticosteroids alone. Gostin and colleaguesArticle discuss legal and ethical implications of public health strategies used by countries to control the SARS outbreak and recommendations for responding to future severe infectious disease threats. In an editorial, HughesArticle urges preparedness planning, heightened vigilance, timely reporting of disease, and interdisciplinary partnerships to contain the spread of newly recognized pathogens.

Clinician's corner

Mr G, a 50-year-old man who has hepatitis C and cirrhosis, failed to respond to antiviral therapy and is currently awaiting liver transplantation. Hanto discusses indications for liver transplantation, pretransplant evaluation, complications after liver transplantation, and posttransplant prognosis.


Medical News & Perspectives

Researchers are seeking better methods and techniques for improving the survival of individuals who experience cardiac arrest.Article

Therapy with bacteriophage, bacteria-killing viruses, was largely abandoned with the development of antibiotics. But the emerging threat of antibiotic-resistant pathogens has sparked renewed interest in the approach.Article

JAMA Patient Page

For your patients: Information about severe acute respiratory syndrome (SARS).