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October 25, 2001 Vol. 345 No. 17
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Patients with severe burns have catecholamine-mediated hypermetabolism, including pronounced muscle-protein catabolism, that adversely affects recovery. In a prospective, randomized study, 13 children with severe burns were given oral propranolol for up to four weeks in an attempt to interrupt this process, and 12 served as controls. Beta-blockade decreased resting energy expenditure and increased net muscle-protein balance by 82 percent, as compared with a 27 percent decrease in net muscle-protein balance in the control group.
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Anemia may be detrimental in patients with coronary artery disease. This observational study, in which data on a large number of elderly patients with acute myocardial infarction were analyzed, found that blood transfusion was beneficial when the hematocrit on admission was 30 percent or lower. Transfusion was not beneficial, and may even have been harmful, in patients with hematocrit values higher than 33 percent.
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This study examined the effect on survival of shipping cadaveric renal allografts from one region to another. Shipment was associated with an overall increase in the rate of allograft failure. The risk of failure during the first year after transplantation was 17 percent higher for shipped kidneys, after adjustment for HLA mismatches, than for similar kidneys transplanted locally.
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Some observational studies have suggested that women who are receiving estrogen-replacement therapy have a lower risk of stroke and death than others. The Women's Estrogen for Stroke Trial was a double-blind, placebo-controlled trial of estradiol-17β in 664 women with a recent cerebrovascular event. Estrogen therapy did not reduce the risk of stroke or death in these women and was associated with a borderline increase in the risk of fatal stroke; this therapy was also associated with adverse effects on the endometrium.
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Human polyomaviruses include JC virus, which can cause progressive multifocal leukoencephalopathy, and BK virus, which can cause severe allograft dysfunction in renal-transplant recipients. This report describes a renal-transplant recipient in whom a disseminated BK virus infection with vascular tropism developed, resulting in systemic vasculopathy, the capillary leak syndrome, and death.
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A 26-year-old man with an eight-year history of asthma has shortness of breath and cough about three times a week. He wheezes routinely with exercise, but his asthma does not usually bother him at night. Office spirometry shows that the forced expiratory volume in one second is 85 percent of his predicted value. How should he be treated?
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