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October 10, 2002 Vol. 347 No. 15
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Sustained activation of the sympathetic nervous system contributes to the development and progression of heart failure. This study examined two polymorphisms in the β1- and α2C-adrenergic receptors, which are associated with an increase in sympathetic activity. In black subjects, these polymorphisms, particularly when both were present, markedly increased the risk of heart failure.
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Thrombolysis is known to be effective in the treatment of patients with massive pulmonary embolism, but its efficacy is less certain in patients with submassive pulmonary embolism. In this large, randomized trial, the combination of heparin and alteplase was found to be superior to heparin and placebo in the treatment of such patients.
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Staphylococcal infections of the skin are more common in patients with atopic dermatitis than they are in normal persons or patients with psoriasis. In this study, the investigators hypothesized that the elevated rate of skin infections in atopic dermatitis could be attributed to reduced levels of the endogenous antimicrobial peptides LL-37 and human β-defensin 2. They found that the levels of these peptides were lower in skin from patients with atopic dermatitis.
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An otherwise healthy 17-month-old boy had a cold accompanied by two days of rhinorrhea, cough, and fever (temperature of up to 38.8°C). On day 5, he became fussy and woke up crying several times during the night. The following day he was afebrile, and a physical examination was normal except for findings of a slightly red left tympanic membrane with no middle-ear fluid and a bulging right tympanic membrane with white fluid behind it, obscuring the umbo. How should he be treated?
H. pylori is one of the most common bacterial infections in human beings, and its discovery 20 years ago altered the diagnosis and treatment of gastroduodenal disease. This review considers current knowledge about the epidemiology and transmission of H. pylori, as well as the role of this infectious agent in the pathogenesis of upper gastrointestinal tract disease. Diagnostic approaches, indications for therapy, and measures of therapeutic efficacy are reviewed.
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