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December 13, 2001 Vol. 345 No. 24
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In this prospective study, 235 adults with suspected meningitis underwent computed tomography (CT) of the head before undergoing lumbar puncture. The results were abnormal in 24 percent of patients. The presence of any of 13 clinical and neurologic features at base line was associated with a significant risk of abnormal findings on CT. The scans were normal in 97 percent of the patients who had none of these characteristics at base line.
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Alcoholism is a devastating illness that is difficult to treat. Naltrexone, an opioid-receptor antagonist, has been approved by the Food and Drug Administration for the treatment of alcohol dependence, but its effectiveness is uncertain. This study of veterans (mostly men) found no evidence that naltrexone, combined with attendance at Alcoholics Anonymous meetings and other psychosocial treatment, was more effective than placebo for chronic and severe alcohol dependence.
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Patent foramen ovale and atrial septal aneurysm have been identified as possible risk factors for stroke. This study examined whether these structural abnormalities, alone or in combination, increased the risk of recurrent stroke. Patients with both patent foramen ovale and atrial septal aneurysm, but not either lesion alone, were found to be at substantial risk for recurrent stroke.
Fever of undetermined origin may be familial and have a periodic course. This article discusses three syndromes of hereditary periodic fever: familial Mediterranean fever, the hyper-IgD syndrome, and the tumor necrosis factor receptor–associated periodic syndrome. Each is caused by mutations in different genes and affects different ethnic groups. Important recent advances in our understanding of the pathophysiology of these disorders are presented in this review article.
The mitochondrion of the insulin-secreting pancreatic islet cell is a biochemical beehive in which the products of glucose oxidation influence the secretion of insulin. Work with cultured islets has shown that a mitochondrial ion carrier termed uncoupling protein 2 (UCP2 ) affects glucose-stimulated insulin levels. A recent report demonstrated that in mice with a disabled UCP-2 gene, insulin secretion was enhanced and blood levels of glucose were reduced. When the gene was knocked out in ob/ob mice, which are obese, insulin-resistant, and diabetic, insulin secretion increased and the hyperglycemia was ameliorated.
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