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Adult outpatients with a nonpsychotic major depressive disorder received sustained-release bupropion, sertraline, or extended-release venlafaxine after a lack of response to or an inability to tolerate the selective serotonin-reuptake inhibitor (SSRI) citalopram. Approximately one in four patients had a remission of symptoms after switching to another antidepressant. All these medications provided a reasonable second-step choice for depressed outpatients who did not have a remission with or could not tolerate the SSRI.
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Although clinicians frequently add a second medication to an ineffective antidepressant, randomized trials comparing augmentation medications are lacking. In this study, adult outpatients with nonpsychotic major depressive disorder who had not had a remission during citalopram therapy were assigned to sustained-release bupropion or buspirone and had similar remission rates on the basis of clinician and self-reports. Several important secondary measures favored citalopram plus bupropion over citalopram plus buspirone.
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The enzyme acyl–coenzyme A:cholesterol acyltransferase (ACAT) esterifies cholesterol, and studies in animals suggest that inhibiting ACAT may reduce the progression of atherosclerosis. In this trial, the ACAT inhibitor pactimibe had no beneficial effect on the progression of coronary atherosclerosis and actually worsened some angioscopic measures of atherosclerosis. Contrary to expectations, ACAT inhibition may in fact promote atherogenesis.
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A 25-year-old woman presents with a one-week history of blurred vision in the left eye. One day before the onset of visual loss, she noted a dull ache in the left periorbital region and pain on eye movement. Her symptoms progressed for three days but have not worsened since. She has no history of other visual or neurologic symptoms. Examination reveals visual acuity of 20/40 in the left eye, reduced color perception, and a left afferent pupillary defect. There is no visible swelling of the optic disk or pallor of the optic nerve, and a neurologic examination is normal. How should she be evaluated and treated?
A 35-year-old woman had recurrent abdominal pain in the right upper quadrant. Two similar episodes, one year earlier and one month earlier, had led to imaging studies that detected dilated intrahepatic bile ducts with numerous calculi; removal of stones and sphincterotomy led to the relief of symptoms. She had fever, abdominal tenderness, mildly elevated aminotransferase levels, dilated bile ducts with numerous stones, and possible external compression of the left intrahepatic duct.
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