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May 23, 2002 Vol. 346 No. 21
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In this study of 170 women with a BRCA1 or BRCA2 mutation that greatly increases the risk of ovarian and breast cancer, 98 elected to undergo salpingo-oophorectomy and 72 chose to undergo surveillance. During a follow-up of about two years, the risks of both breast and ovarian cancer were considerably lower among the women who underwent the surgical procedure than among those who chose surveillance.
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Among 551 women with a disease-associated mutation in the BRCA1 or BRCA2 gene who were followed for at least eight years, the at least incidence of ovarian cancer was significantly lower in the group that underwent prophylactic bilateral oophorectomy than in the comparison group of women who did not undergo the surgery. In a subgroup of these women, prophylactic oophorectomy also reduced the risk of breast cancer.
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Patients who undergo gastric bypass surgery have dramatic and sustained weight loss. They feel less hungry after eating, although they still perceive foods with high caloric value as enjoyable. Ghrelin is an orexigenic hormone whose levels in normal subjects increase before meals and decrease after meals. In this study of patients who achieved stable weight after gastric bypass surgery, circulating ghrelin levels were low and did not show meal-related periodicity.
High-altitude pulmonary edema occurs in otherwise healthy persons when they are at high elevations. Since β-adrenergic agonists increase clearance of alveolar fluid and attenuate pulmonary edema in animal models, these investigators studied the effect of inhaled salmeterol (a β-adrenergic agonist) or placebo in 37 subjects who were prone to high-altitude pulmonary edema. In addition, nasal transepithelial potential difference, a marker of fluid clearance in distal airways, was studied in 33 mountaineers who were susceptible to this condition and 33 who were resistant to the condition. Prophylactic inhalation of salmeterol halved the incidence of high-altitude edema in susceptible subjects. Nasal transepithelial potential difference was significantly lower in susceptible subjects.
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Physicians in the Netherlands described on a questionnaire the deaths of their patients with amyotrophic lateral sclerosis. Of the 203 patients, 35 (17 percent) had chosen euthanasia and died that way. An additional six patients died as a result of suicides that involved assistance from a physician. The choice of euthanasia or physician-assisted suicide was not associated with the patient's income or educational level.
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