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November 13, 2003 Vol. 349 No. 20
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It is known that the angiotensin-converting–enzyme inhibitor captopril is beneficial in patients with myocardial infarction complicated by left ventricular dysfunction or heart failure. This study compared captopril with valsartan, an angiotensin-receptor blocker, and the combination of the two drugs in such patients. Mortality was the same in the three groups, but there were more side effects with the combination therapy.
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This randomized trial assessed the efficacy of CTLA4Ig, a novel agent that prevents T-cell activation, in patients with rheumatoid arthritis. After six months of treatment, 60 percent of patients treated with 10 mg of CTLA4Ig per kilogram of body weight had an improvement in the symptoms and signs of rheumatoid arthritis of at least 20 percent, as compared with 35 percent of patients in the placebo group.
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In this five-year follow-up study, patients with advanced Parkinson's disease who were treated with bilateral stimulation of the subthalamic nucleus sustained marked improvements in motor function and in their ability to perform activities of daily living when tested 8 to 12 hours after the last dose of dopaminergic medication (off medication), and in dyskinesia while receiving maximal benefit from medication (on medication). However, akinesia, speech, postural stability, freezing episodes, and cognitive function worsened between the first year and the fifth year of follow-up, as is consistent with the natural history of Parkinson's disease.
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The authors describe the experience of family caregivers who provided end-of-life care to patients with dementia. During the year before the patient's death, many caregivers reported feeling that they were “on duty” 24 hours a day and had symptoms of depression. These symptoms often resolved after the death of the patient, and 72 percent of caregivers reported that the death was a relief for them. These findings highlight the demanding and stressful nature of end-of-life care provided by family members to patients with dementia.
A difficult decision for physicians who treat patients with chronic pain not associated with terminal disease is whether and how to prescribe opioid therapy, which can relieve pain and improve mood and level of functioning in many such patients. This review considers current guidelines for opioid therapy in patients with chronic pain unrelated to malignant conditions and outlines caveats, areas of uncertainty, and management strategies.
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