The FDA has cleared a new device for treatment of major depressive disorder (MDD) resistant to antidepressant medication. The NeuroStar TMS System (Neuronetics) produces pulsed magnetic fields that can induce electrical currents in the brain. Unlike electroconvulsive therapy (ECT), it does not require anesthesia or induction of seizures. Other similar devices are under development.

The incidence of oral cancer appears to be increasing, especially in younger patients. Risk factors include use of tobacco and alcohol, and exposure to human papillomavirus. ViziLite Plus (Zila Pharmaceuticals) is a combination device that uses fluorescent light and toluidine blue tissue staining to help dentists identify abnormal changes in the mucous membranes of the oral cavity. Originally developed for detecting abnormal growths on the uterine cervix, in 2001 it received FDA clearance for "identification, evaluation, and monitoring of oral mucosal abnormalities in a patient population at...

Consensus recommendations for dosing and therapeutic monitoring of intravenous (IV) vancomycin (Vancocin, and others) were recently published. IV vancomycin has been used for decades as an alternative to penicillins for treatment of serious infections due to gram-positive cocci. In recent years, the widest use of the drug has been for treatment of serious methicillin-resistant Staphylococcus aureus (MRSA) infections.

The FDA has approved a delayed-release capsule formulation of valproic acid (VPA; Stavzor - Noven Therapeutics) for all of the indications for which divalproex sodium (Depakote, and others; Depakote ER) is approved: monotherapy and adjunctive therapy of complex partial seizures and simple and complex absence seizures, and adjunctive therapy in patients with multiple seizure types that include absence seizures; acute treatment of manic episodes associated with bipolar disorder; and prophylaxis of migraine headaches. In addition, valproate (valproic acid or divalproex sodium) is considered a...

Fludarabine phosphate (Fludara - Berlex), an analog of vidarabine (Vira-A), was recently approved by the U.S. Food and Drug Administration for treatment of patients with refractory chronic lymphocytic leukemia (CLL). The drug has not yet been marketed but is still available, as it has been for two years, through the National Cancer Institute.

Spinal manipulation has been used to treat not only back and neck pain, but also many other conditions. A recent commentary questioned its safety.

The results of a large randomized controlled trial of estrogen plus a progestin to prevent heart disease in postmenopausal women were recently reported (Writing Group for the Women's Health Initiative Investigators, JAMA 2002; 288:321).

Isotretinoin (Accutane - Roche), an effective oral drug for treatment of acne, will soon be available generically. Concerns about its adverse effects, particularly psychiatric symptoms in adolescents, have been widely reported in the media.

A "Dear Colleague" letter from the UK's Committee on Safety of Medicines advised physicians, on the basis of unpublished data, not to use paroxetine (Paxil in the US; Seroxat in the UK) to treat children and adolescents with depression because of possible increased risk of suicidal behavior. This review describes the efficacy and safety of SSRIs in children.

An unpublished 2-year randomized study (ENHANCE) on the effect of adding ezetimibe 10 mg to simvastatin 80 mg in 720 patients with heterozygous familial hypercholesterolemia has been in the news recently. About 80% of these patients had previously been treated with statins. The primary endpoint was the change in the intima-media thickness (IMT) of the carotid artery (baseline 0.68 and 0.69 mm); the IMT increased by 0.0111 mm with ezetimibe plus simvastatin and 0.0058 mm with simvastatin 80 mg alone (p=0.29). The ezetimibe- simvastatin combination lowered LDL-C by 58% compared to 41% lowering...