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August 22, 2002 Vol. 347 No. 8
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An outbreak of Escherichia coli O157:H7 infections was traced to a dairy and petting farm. The 51 patients (median age, four years) included 8 in whom the hemolytic–uremic syndrome developed. Contact with calves was associated with an increased risk of infection. Thirteen percent of the farm's 216 cattle were colonized with the same strain of E. coli that was isolated from the patients.
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Minimally invasive bypass surgery and coronary stenting are both alternatives to standard bypass surgery for the management of stenosis of the proximal left anterior descending artery. In this randomized trial, stenting provided excellent short-term results with fewer periprocedural events, but minimally invasive surgery proved better at six months in terms of freedom from angina and the need for repeated procedures.
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A trial to compare the efficacy of radical mastectomy with that of total mastectomy began in 1971 and enrolled 1665 women with breast cancer. After 10 years of follow-up, radical mastectomy was not superior to total mastectomy. Now, after 25 years of follow-up, 293 of the women are alive and free of breast cancer; radical mastectomy did not show an advantage over total mastectomy.
This report describes a 28-year-old man with lifelong exercise intolerance. Evaluation revealed a mitochondrial myopathy due to a novel 2-bp mitochondrial DNA deletion in the ND2 gene, which codes for a subunit of enzyme complex I of the mitochondrial respiratory chain. Studies of the patient and his immediate family members revealed that the abnormal mitochondrial DNA was paternal in origin and accounted for 90 percent of the mitochondrial DNA in the patient's muscle.
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Physician-assisted suicide was legalized in Oregon with the passage of the Death with Dignity Act in 1997. Seventy-one of the 91 patients who have died by assisted suicide received hospice care. This study reports the results of a survey of hospice nurses and social workers about patients who received prescriptions for lethal medications. Like physicians who responded to a similar survey, hospice nurses and social workers reported that patients chose assisted suicide because they wished to control the circumstances of death, not because they were depressed, lacked social support, or were concerned about being a financial burden. As compared with other hospice patients and their families, patients who received prescriptions for lethal medications appeared to have less pain, depression, and anxiety, and their family caregivers appeared to be less burdened.
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