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February 28, 2002 Vol. 346 No. 9
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The t(9;22) translocation that forms the Philadelphia chromosome of chronic myelogenous leukemia (CML) also forms a fusion gene, BCR-ABL. The new gene encodes an abnormal tyrosine kinase, which causes the leukemia. Imatinib mesylate inhibits the function of the BCR-ABL protein and can induce remission of CML. This large trial found that imatinib induced cytogenetic and hematologic responses in most patients in whom standard therapy with interferon alfa had failed.
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Bisphosphonates ameliorate osteoporosis, yet gastrointestinal side effects have limited patients' adherence to oral regimens. Intermittent intravenous therapy is effective, but the optimal interval between doses is unknown. This study examined five intravenous regimens of the potent bisphosphonate zoledronic acid (a total of 1 to 4 mg in one to four doses over the course of one year) and compared them with placebo in postmenopausal women with low bone mineral density.
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In the weeks after a group of 23 young adults returned from a trip to Jamaica, eosinophilic meningitis developed in 12. Symptoms included headache, neck pain, visual disturbances, and hyperesthesias. Nine of the travelers required hospitalization. A case–control study showed that consumption of a Caesar salad at one dinner was strongly associated with the development of aseptic meningitis.
A 60-year-old man is evaluated for a heart murmur. He jogs regularly and has no cardiac symptoms. Examination reveals a delayed carotid upstroke and a grade 3/6 late-peaking systolic ejection murmur. Echocardiography shows normal systolic function and a heavily calcified aortic valve, with a peak Doppler transvalvular gradient of 64 mm Hg and a calculated valve area of 0.7 cm2.
This review discusses the development and uses of imatinib mesylate, a protein tyrosine kinase inhibitor useful in the treatment of chronic myelogenous leukemia and gastrointestinal stromal tumors that was recently approved by the Food and Drug Administration. Imatinib targets platelet-derived growth factor receptor, inhibits the fusion product of the Philadelphia chromosome, and targets c-kit, a protein tyrosine kinase. The drug may also be effective in the treatment of other tumors that express platelet-derived growth factor receptor or c-kit.
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In June 2001, Ellen Roche, a healthy young technician at the Johns Hopkins Asthma and Allergy Center, died during an asthma study. The tragedy prompted several intensive investigations of research oversight at Johns Hopkins and led to the temporary suspension of all federally funded research projects at the institution. In this Health Policy Report, Steinbrook provides a detailed discussion of the outcome of the investigations, the response from Johns Hopkins, and the wider lessons for all involved in clinical investigation.






