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November 8, 2001 Vol. 345 No. 19
Hyperglycemia is common in critically ill patients, but it is not known whether normalization of blood glucose levels with insulin therapy improves the prognosis. This trial compared intensive insulin treatment (maintenance of blood glucose levels at 80 to 110 mg per deciliter) with conventional treatment in patients admitted to a surgical intensive care unit. Most of the patients did not have a history of diabetes. Intensive insulin therapy reduced mortality among patients who spent more than five days in the intensive care unit and reduced rates of multiple-organ failure due to sepsis and acute renal failure.
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Severe sepsis is a common clinical problem associated with a high mortality rate. Goal-directed therapy involves algorithmic adjustment of central venous pressure, mean arterial pressure, and central venous oxygen saturation to balance systemic oxygen supply with oxygen demand. In this study, goal-directed therapy, initiated early, reduced in-hospital mortality from 46.5 percent to 30.5 percent.
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Breast-conserving surgery (usually lumpectomy) followed by local radiotherapy is a standard treatment for early breast cancer. This study found that additional radiation (a “booster dose”) aimed at the center of the site of the excised tumor reduced the rate of local recurrences, especially in women younger than 50 years of age.
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Sperm concentration, motility, and morphology were assessed in 765 men in infertile couples and 696 men in fertile couples to identify values that would distinguish fertile from subfertile men. Subfertile ranges were a sperm concentration of less than 13.5 million per milliliter, less than 32 percent motility, and less than 9 percent sperm with normal morphologic features. Fertile ranges were a concentration greater than 48.0 million per milliliter, greater than 63 percent motility, and greater than 12 percent normal morphologic features. However, there was extensive overlap between fertile and infertile men with regard to all measures.
A 39-year-old woman repeatedly sees her physician for symptoms including paresthesias and “swelling” of the hands and feet. The results of physical examination and laboratory studies have been normal, yet this has failed to reassure her. She is now concerned that she has lupus and urgently requests a rheumatology consultation. How should you manage this problem?
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