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December 6, 2001 Vol. 345 No. 23
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Invasive fungal infections cause substantial morbidity and mortality in preterm infants. In this single-center, double-blind, placebo-controlled trial, extremely-low-birth-weight preterm infants who were given the antifungal agent fluconazole prophylactically for six weeks had significantly lower rates of fungal colonization and systemic fungal infection than control infants, without development of resistance to fluconazole or adverse effects on liver enzymes.
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Angiotensin II may contribute to the progression of heart failure. In this trial, valsartan, an angiotensin-receptor blocker, reduced the need for hospitalization for heart failure but had no effect on overall mortality. According to a post hoc analysis, patients treated with valsartan who were also receiving both an angiotensin-converting–enzyme (ACE) inhibitor and a beta-blocker had increased mortality; patients receiving one or neither of these types of drugs had reduced mortality.
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A 65-year-old man requires resection of an abdominal aortic aneurysm. He has a remote history of myocardial infarction and rare episodes of angina. Recent coronary angiography revealed more than 70 percent stenosis of the left circumflex artery. What can be done to minimize this patient's risk of perioperative cardiac complications?
Mesenteric venous thrombosis usually involves the superior mesenteric vein, with the danger of bowel infarction. The newer imaging techniques allow earlier diagnosis. A predisposing condition (such as a prothrombotic state, pancreatitis, and recent abdominal surgery) can be identified in most patients. Treatment involves anticoagulation, and surgery may be avoided if the correct diagnosis is made early.
The potent mineralocorticoid aldosterone has a multifaceted role in the pathogenesis of congestive heart failure. In addition to its contribution to salt and water retention, it also promotes organ fibrosis. Although angiotensin-converting–enzyme inhibitors have important therapeutic benefit in heart failure, they do not eliminate the effects of aldosterone. Thus, recent studies have underscored the value of aldosterone-receptor antagonists, such as spironolactone, in the treatment of chronic heart failure. This review article gives an in-depth update on the mechanisms of action of aldosterone and their implications for therapy.
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