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October 30, 2003 Vol. 349 No. 18
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Fondaparinux is a pentasaccharide that selectively inhibits coagulation factor Xa. It is administered by subcutaneous injection and does not require laboratory monitoring. This large study compared fondaparinux and unfractionated heparin in the initial treatment of symptomatic pulmonary embolism. Fondaparinux was as effective and safe as heparin.
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The efficacy of ximelagatran, an orally administered thrombin inhibitor, was compared with that of warfarin for thromboprophylaxis after total knee replacement. Both drugs were given for 7 to 12 days postoperatively, ximelagatran at a dose of 24 or 36 mg twice daily and warfarin with a target international normalized ratio of 2.5. The higher dose of ximelagatran was superior to warfarin in the prevention of venous thrombosis.
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Ximelagatran, a direct inhibitor of thrombin, is administered orally, and its use does not necessitate monitoring of coagulation. In this study, patients treated for venous thromboembolism with warfarin for six months were randomly assigned to receive ximelagatran or placebo. During the subsequent 18 months, the patients in the ximelagatran group had many fewer episodes of recurrent thromboembolism than those in the placebo group, without an increase in the frequency of bleeding.
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Because mutations in the parafibromin gene (HRPT2) occur in a familial syndrome characterized by susceptibility to parathyroid carcinoma, such mutations were sought and found in patients with sporadic cases of parathyroid carcinoma. Moreover, germ-line mutations of HRPT2 were found in some patients with apparently sporadic parathyroid carcinoma.
Mercury poisoning still occurs as a result of accidental and occupational exposure. For the general population, however, the main concern is the possible adverse effect of exposure to mercury through fish consumption and the receipt of dental amalgams and thimerosal, a preservative used in vaccines. This review summarizes both the facts and the controversies surrounding exposure to methyl mercury, mercury vapor, and the ethyl mercury in thimerosal.
Schizophrenia has varied and ominous symptoms that generally begin in late adolescence or early adulthood and usually continue throughout life. This Drug Therapy article discusses the new generation of antipsychotic medications, as well as recent developments in brain imaging and in knowledge of the pathophysiology and molecular genetics of this devastating disease.
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