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November 29, 2001 Vol. 345 No. 22
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Patients with coronary disease and low high-density lipoprotein (HDL) cholesterol levels are at risk for coronary events. This study found that a combination of niacin and simvastatin was very effective over a period of three years in reducing the frequency of coronary events and causing a slight regression of coronary lesions, as measured by angiography. By contrast, antioxidant vitamins had no benefit, and the addition of antioxidant vitamins to niacin and simvastatin attenuated their beneficial effect.
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In this double-blind study, a combination of folate, vitamin B12, and pyridoxine was found to reduce the rate of restenosis in patients who had undergone coronary angioplasty. There was less benefit in patients who had received stents than in those who had not. Vitamin therapy also resulted in lower plasma homocysteine levels, a potential mechanism of the clinical effect.
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In the summer of 2000, there was an outbreak of tularemia on the island of Martha's Vineyard in Massachusetts. This case–control study identified 15 patients with Francisella tularensis infection, including 11 with primary pneumonic tularemia. One patient died. The patients were more likely than controls to have used a lawn mower or brush cutter in the two weeks before the illness.
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This case report provides a description of the first case of fatal inhalational anthrax in the United States in 25 years. This 63-year-old newspaper photo editor had a rapidly progressive febrile illness, and lumbar puncture showed cloudy cerebrospinal fluid with numerous polymorphonuclear leukocytes and many large gram-positive bacilli, singly and in chains. A diagnosis of inhalational anthrax was made, and despite aggressive treatment the patient died soon thereafter. The infection appeared to have been transmitted through mail contaminated with anthrax spores as a result of biologic terrorism.
The Shattuck Lecture is delivered at the Annual Meeting of the Massachusetts Medical Society. In the 111th lecture, Dr. Barbara McNeil discusses a core problem in health policy, the barriers to improvement in the quality of medical care. She focuses on two key impediments: uncertainty about which therapeutic and diagnostic interventions are actually effective, and cost pressures, which may result in the underuse of potentially valuable medical treatments and techniques.
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