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November 21, 2002 Vol. 347 No. 21
Human papillomavirus type 16 (HPV-16) is sexually transmitted and is present in 50 percent of cervical cancers. This randomized, double-blind trial assessed the effectiveness of a vaccine that consists of HPV-16 L1 virus-like particles in women who were seronegative for HPV-16. The vaccine was highly effective in preventing HPV-16 infection.
Two double-blind, controlled trials assessed the efficacy of a glycoprotein-D–subunit vaccine to prevent genital herpes disease. The vaccine elicited humoral and cellular responses, but efficacy was found only in women who were seronegative for both herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2) (efficacy in the two studies was 73 and 74 percent). The vaccine was not efficacious in women who were seronegative for HSV-2 if they were seropositive for HSV-1, nor was it efficacious in men.
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This study compared extended transthoracic resection with limited transhiatal resection for adenocarcinoma of the esophagus or gastric cardia. The five-year survival rates in the two groups were not significantly different, but a nonsignificant trend in overall survival favored transthoracic resection in later years.
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In patients with fibrous dysplasia, the optic canals may become encased by abnormal bone. Loss of vision is a complication, but there is controversy about whether prophylactic surgical decompression of the optic nerve can be helpful. Careful analysis of computed tomographic studies in 38 patients with polyostotic fibrous dysplasia or the McCune–Albright syndrome showed that most had complete encasement of the optic canal, but there was no clear relation between the size of the canals and visual function.
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The investigators used Medicare data to assess associations between the type of physician providing ambulatory care and mortality after myocardial infarction among 35,520 patients 65 years of age or older. After adjustment for multiple potential confounders, patients who saw a cardiologist in the three months after discharge from the hospital had lower mortality at two years than similar patients who saw only an internist or a family practitioner (14.6 percent vs. 18.3 percent, P<0.001). Patients who saw both a cardiologist and an internist or a family practitioner had the lowest mortality rates.
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