A 62-year-old man receives a diagnosis of diffuse large B-cell lymphoma; treatment with a regimen including the anti-CD20 antibody rituximab is recommended. Rituximab has been shown to improve progression-free survival when added to standard chemotherapy regimens for lymphoma.

A 39-year-old man with type 1 diabetes mellitus is referred for consideration of insulin-pump therapy because of poor glycemic control and episodes of severe hypoglycemia. Insulin-pump therapy can improve blood glucose control but requires a willing and motivated patient.

A 7-year-old girl with persistent, moderately severe vesicoureteral reflux has recurrent urinary tract infections while receiving prophylactic antibiotic therapy. Endoscopic correction of vesicoureteral reflux is recommended. The technique is described.

A 37-year-old man with multiple sclerosis has recurrent disease activity despite several previous therapies. Treatment with fingolimod is recommended. Fingolimod blocks the egress of lymphocytes from lymph nodes, preventing them from reaching the central nervous system.

A 59-year-old man presents with a recurrent episode of symptomatic atrial fibrillation despite attempts to maintain sinus rhythm with antiarrhythmic drugs. Catheter ablation can be effective in such patients, but more than one procedure may be necessary.

A 41-year-old woman presents with severe pneumonia, and the acute respiratory distress syndrome (ARDS) develops. Despite mechanical ventilation, her oxygenation deteriorates. The use of extracorporeal membrane oxygenation (ECMO) is recommended.

Proliferative retinopathy develops in a 55-year-old man with type 2 diabetes. Panretinal photocoagulation, which causes reduced production of VEGF by destroying hypoxic retinal cells, is recommended. Diminished peripheral vision and night vision can occur.

A young woman with immune thrombocytopenia (ITP) who has been treated with a thrombopoietin-receptor agonist presents for advice regarding long-term treatment. The agents in this therapeutic class, romiplostim and eltrombopag, are effective in increasing platelet counts.

A 42-year-old woman presents after donating blood and receiving a report that she is positive for Chagas' disease. Chagas' disease is caused by a parasite and is endemic in many parts of Latin America.

An 81-year-old man presents to the ER with an acute ischemic stroke; IV thrombolytic therapy is recommended. Administered as a therapeutic agent within 4.5 hours after stroke, tissue plasminogen activator has been shown to improve neurologic outcomes.

In a patient with cutaneous melanoma, a sentinel-lymph-node biopsy is performed with the aid of a handheld gamma scanner and the use of isosulfan blue dye. The nodes are dissected as a group and then separated in preparation for histologic analysis.

A 64-year-old woman receives the diagnosis of metastatic non–small-cell lung cancer (NSCLC), which has progressed during treatment with carboplatin, paclitaxel, and bevacizumab. Erlotinib therapy is recommended.

A 37-year-old woman receives a diagnosis of Graves' disease and is treated with methimazole for 1 year. After completing this treatment, she presents with recurrent symptoms of hyperthyroidism. Radioiodine ablation is recommended.

A 16-year-old boy with sickle cell anemia requires long-term red-cell transfusion. Prophylactic iron-chelating therapy is recommended. Iron chelators bind to plasma and intracellular iron and cause its excretion into urine or bile.

A 67-year-old woman is referred by her primary care physician for treatment of osteoporosis and progressive bone loss. Oral bisphosphonate therapy is recommended. Bisphosphonates suppress bone resorption by interfering with osteoclast activity. Several of these agents have been shown to prevent fractures and increase bone mineral density in patients with osteoporosis. Long-term bisphosphonate therapy has been associated with osteonecrosis of the jaw and atypical femur fractures.

A 66-year-old man presents with a 2-week history of blurred and distorted vision in his right eye. A retinal specialist diagnoses neovascular age-related macular degeneration (AMD) and recommends treatment with ranibizumab.

A 62-year-old man collapses on the street and is found to be in cardiac arrest. He is resuscitated at the scene by emergency medical personnel, but he is comatose. Targeted temperature management, which involves cooling the patient to a core body temperature of 32 to 34°C for 24 hours, is recommended.

A 45-year-old man with a 7-year history of low back pain asks his physician for a referral to a licensed acupuncturist. Acupuncture involves the insertion of fine metallic needles into the body at specific sites. Clinical trials of acupuncture for chronic low back pain have shown higher rates of symptom improvement with either acupuncture or sham acupuncture than with usual care.

A 23-year-old woman presents with migraine headaches that are unresponsive to analgesics. Triptan therapy is recommended. Triptans are serotonin agonists that were originally thought to provide migraine relief by causing cranial vasoconstriction; other mechanisms are now also proposed. Chest pain is a common side effect, but cardiac ischemia is rare and usually associated with known cardiovascular disease or risk factors.

A 57-year-old woman is seen in an outpatient clinic, where her blood pressure reading is 155/95 mm Hg. Dietary therapy is recommended. Dietary changes that have been shown to reduce blood pressure include reduced sodium intake, reduced caloric intake (for weight loss), and diets high in fruits, vegetables, low-fat dairy products, whole grains, poultry, fish, nuts, and unsaturated vegetable oils.