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March 27, 2003 Vol. 348 No. 13
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A fusion between the PDGFRA and FIP1L1 genes was found in some cases of the hypereosinophilic syndrome, a fatal disorder in which eosinophils invade and destroy various organs. The fusion protein is a constitutively active tyrosine kinase, which explains the effect of imatinib, an inhibitor of tyrosine kinases, in the disease. The immortalization of hematopoietic cells by the fusion protein indicates its role in causing the syndrome.
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Silent brain infarcts (i.e., infarcts without associated neurologic symptoms) are common, and their clinical significance is unclear. In this population-based study, elderly people without dementia underwent cognitive testing and magnetic resonance imaging in 1995 to 1996 and again in 1999 to 2000. Dementia was more than twice as likely to develop in participants who had silent brain infarcts at base line.
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Pain occurring after central nervous system or peripheral-nerve injury is known as neuropathic pain and is notoriously difficult to treat. Many physicians have avoided the use of opiates to treat this type of pain for fear of addiction or loss of efficacy due to tolerance. In this eight-week study, patients with neuropathic pain who were treated with high-strength levorphanol tablets had less intense pain than patients assigned to low-strength tablets but had more side effects.
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Obstructive sleep apnea may exacerbate the manifestations of heart failure, because it causes hypoxia and activation of the sympathetic nervous system, leading to increases in the heart rate and blood pressure. In this study, continuous positive airway pressure was found to reduce systolic blood pressure and increase left ventricular function in patients with heart failure and obstructive sleep apnea.
A 67-year-old woman who had been in excellent health noticed the onset of burning pain in the left great toe two years before evaluation. The pain subsequently extended to involve both feet, from the toes to the heels, and was associated with numbness, tingling, and burning. The discomfort has become severe, is present throughout the day, and disrupts sleep. A physical examination reveals normal muscle strength, muscle-stretch reflexes, proprioception, and vibratory sensation; only pinprick sensation in the toes and feet is diminished. How should this patient be evaluated and treated?
The answer to this frequently asked question is addressed in this review article, which focuses on common respiratory tract infections that are spread from person to person. The author concentrates on community-based contagion rather than nosocomial infections or agents that have received recent attention principally because of their actual or potential role in biologic terrorism.
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