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September 18, 2003 Vol. 349 No. 12
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Human herpesvirus 8 (HHV-8) is believed to cause Kaposi's sarcoma, and the vascular lesions of Kaposi's sarcoma resemble the plexiform lesions of primary pulmonary hypertension. In this study, molecular evidence of HHV-8 was found in the lung tissue of 10 of 16 patients with primary pulmonary hypertension, but in none of 14 patients with secondary pulmonary hypertension.
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The reasons underlying physicians' decisions to withdraw mechanical ventilation from patients in anticipation of their death were examined in this observational study. A daily accounting of potential reasons for withdrawal was scored and compared with the eventual outcome. Patients who required vasoactive medications, patients who physicians predicted either had a slim chance of survival or would have severe cognitive impairment if they survived, and patients perceived by their physicians as not wanting life support were those in whom ventilation was withdrawn in anticipation of death.
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Warfarin can prevent recurrent thrombosis in patients with the antiphospholipid antibody syndrome, but the intensity of anticoagulation is an unsettled matter. In this randomized trial, patients with the syndrome were assigned to moderate- or high-intensity warfarin. The high-intensity regimen was no more effective than the moderate-intensity regimen.
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This report documents that the syndrome of growth hormone insensitivity (severe short stature, increased secretion of growth hormone, but low serum concentrations of insulin-like growth factor I [IGF-I] and IGF–binding protein 3) in a teenage girl was due to a homozygous missense mutation in the gene for STAT5b, an essential component of the actions of growth hormone, as well as many other cytokine-induced functions.
The ability to determine the genotype of Mycobacterium tuberculosis is changing our understanding of the dynamics of tuberculosis transmission. This review summarizes the methods of genotyping and explains how they can assist clinical management. These techniques can be used to evaluate tuberculosis-control programs and provide clues to the pathogenesis of tuberculosis infection.
For those using drugs to treat infants and children, the integration of developmental pharmacology is crucial to appropriate clinical practice. Changes in metabolic capacity, distribution sites, and organ function all affect the way in which medications are handled in the very young. This review examines the developmental changes that profoundly affect the responses of children to medications and related therapies.
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