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May 1, 2003 Vol. 348 No. 18
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In 2000, a protein–polysaccharide pneumococcal conjugate vaccine was recommended for use in infants and young children. Surveillance data show that from 1998 to 2001 the rate of invasive disease declined by 69 percent among children less than two years of age. There were also smaller but significant reductions in pneumococcal disease in adults.
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This population-based, retrospective study of more than 47,000 older persons assessed the effectiveness of pneumococcal vaccination. Vaccination was associated with a significant reduction in the risk of pneumococcal bacteremia, but over three years of follow-up there was no reduction in the risk of community-acquired pneumonia (hazard ratio, 1.07).
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In critically ill patients with aortic stenosis and left ventricular dysfunction, vasodilator therapy has been considered to be contraindicated because of concern that it could cause hypotension. In this study, nitroprusside was administered to 25 such patients under carefully monitored conditions and, contrary to traditional teaching, was found to cause substantial improvement in the cardiac index and other hemodynamic variables.
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Mutations of immunoglobulin genes in chronic-lymphocytic-leukemia (CLL) cells augur a good outcome, whereas the absence of mutations indicates a poor prognosis. The presence of ZAP-70 on CLL cells correlated with unmutated immunoglobulin genes and a poor prognosis, whereas its absence indicated the presence of mutated genes and a good outcome.
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Hematologic cancers — that is, leukemias and lymphomas — usually result from somatic mutations in hematopoietic cells rather than heritable mutations. Many of these cancers have been classified on the basis of their morphology and the presence of tumor marker antigens. This review explains complementary DNA expression profiling, a genomic approach to the diagnosis of such tumors, with certain leukemias and lymphomas used as examples.
This review summarizes the current approaches to the management of withdrawal in patients addicted to sedatives such as alcohol or benzodiazepines, opioids, or stimulants such as amphetamines or cocaine. Included are details of detoxification regimens and guidelines for recognizing and managing the most common complications.
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