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February 20, 2003 Vol. 348 No. 8
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As respiratory care improves, more patients are surviving the acute respiratory distress syndrome (ARDS). This study followed a cohort of 109 survivors of ARDS for one year. The patients lost about 20 percent of their body weight during their stay in the intensive care unit (ICU) and regained it over the ensuing year. Although the median distance walked in six minutes increased from 281 m at 3 months to 422 m at 12 months, the latter value was still only 66 percent of that predicted on the basis of age and sex. One year after discharge from the ICU, the patients' lung function was essentially normal.
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Ewing's sarcoma, a highly malignant tumor of children, adolescents, and young adults, often responds to local excision plus a now-standard four-drug regimen of chemotherapy. This study shows that standard chemotherapy alternating with courses of ifosfamide plus etoposide significantly improves survival in patients with nonmetastatic disease at the time of diagnosis, but not in those with metastatic disease.
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There is concern that, with prolonged survival, patients with human immunodeficiency virus (HIV) infection may be at risk for cardiovascular and cerebrovascular disease due to HIV infection itself and to the effects of antiretroviral drugs. This retrospective study, involving a large population of veterans, dispels this concern.
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Recent studies report benefits from corticosteroid treatment in patients with septic shock. This review summarizes the physiology of the corticosteroid response in acute illness. The authors present an updated, practical approach to the diagnosis and treatment of hypoadrenalism in acutely ill patients. Supplemental corticosteroid treatment may be beneficial in many critical illnesses.
This article describes the successful legal challenge of the South African government's controversial decision to restrict the availability of nevirapine for use in preventing the transmission of the human immunodeficiency virus (HIV) from mother to infant. With its order requiring the government to provide comprehensive health services to prevent mother-to-child transmission of HIV, the Constitutional Court of South Africa upheld the public's right to health care, as guaranteed in the South African constitution.
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