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August 15, 2002 Vol. 347 No. 7
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This prospective study examined the changes in bacterial isolates from sputum samples obtained monthly from 81 outpatients with chronic obstructive pulmonary disease. There were 374 acute exacerbations of lung disease, which were significantly associated with the acquisition of a new strain of Haemophilus influenzae, Moraxella catarrhalis, or Streptococcus pneumoniae (relative risk for any new strain, 2.15). An exacerbation was diagnosed at 33 percent of the clinic visits that coincided with the appearance of a new bacterial strain in the sputum.
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Unresectable or metastatic gastrointestinal stromal tumors fail to respond to conventional chemotherapy and are usually fatal within 12 to 18 months. Most gastrointestinal stromal tumors have a defect in KIT, a transmembrane tyrosine kinase receptor. The abnormality prevents the death of the cell and forces it to proliferate. The effects of imatinib mesylate, which blocks the abnormal signaling by KIT, was studied in 147 patients with advanced gastrointestinal stromal tumors. There were no complete responses, but about half the patients had a stable partial response.
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Imatinib mesylate blocks the activity of three protein tyrosine kinases: ABL, KIT, and platelet-derived growth factor receptor β (PDGFRB). These kinases have crucial roles in chronic myelogenous leukemia (ABL), gastrointestinal stromal tumors (KIT), and certain myeloproliferative diseases (PDGFRB). The first two types of neoplasms have been shown to respond to imatinib mesylate. This article reports that in four patients, a myeloproliferative disorder involving a rearranged PDGFRB gene also responded to the drug.
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Polyomavirus BK (BKV) nephropathy, an emerging cause of renal-allograft failure, may be linked to immunosuppressive regimens containing tacrolimus or mycophenolate mofetil. This prospective, single-center study examined urine for cells with viral inclusions, measured BKV DNA in plasma, and evaluated renal-biopsy specimens for evidence of nephropathy in 78 renal-transplant recipients who were being treated with such regimens. Four of five patients in whom BKV nephropathy developed were among the 77 percent of patients who had BKV antibodies before transplantation. The probability of BKV nephropathy was 8 percent (95 percent confidence interval, 1 to 15 percent).
A 43-year-old man presents with heavy snoring; his bed partner reports that he sometimes stops breathing while he sleeps. He has hypertension controlled by medication but is otherwise healthy. He admits to feeling sleepy at times when he drives, although he has not had any motor vehicle accidents. His body-mass index is 33, and he has a large neck circumference (46 cm). How should he be evaluated and treated?
After international travel, up to 5 percent of travelers become ill enough to seek medical attention. This review focuses on the most common and most serious illnesses seen in persons from the industrialized world who have traveled to developing countries. The authors provide practical guidance for the diagnosis and management of fever, persistent diarrhea, and skin lesions in patients who present with these conditions after international travel.
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