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December 4, 2003 Vol. 349 No. 23
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In this large study involving asymptomatic adults, computed tomographic (CT) virtual colonoscopy and optical colonoscopy were performed on the same day. The sensitivity and specificity of virtual colonoscopy for the detection of adenomatous polyps 8 mm or larger were both more than 92 percent. Patients reported more discomfort with virtual colonoscopy than with optical colonoscopy but rated it as more convenient and indicated that they would choose virtual colonoscopy for their next screening test.
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Interleukin-10, an antiinflammatory and immunosuppressive cytokine, is thought to modulate graft-versus-host disease (GVHD), a major complication of allogeneic bone marrow transplantation. In this study, the presence of a particular variant in the recipient's interleukin-10 gene was associated with a substantial decrease in the risk of acute GVHD.
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Two children with intrauterine growth retardation and short stature who had mutations in the gene for the insulin-like growth factor I receptor (IGF-IR) were identified among 51 children with short stature (most with intrauterine growth retardation) who were screened for these mutations. One child was a compound heterozygote for point mutations in exon 2, resulting in marked reductions in IGF-I–receptor binding. The other child had a nonsense mutation that reduced the number of cell-surface IGF-I receptors. No IGF-IR mutations were found in 43 controls with normal birth weights.
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Incentive-based formularies, in which the prices paid by patients for drugs are the lowest for generic drugs and the highest for nonpreferred brand-name drugs, are being used to encourage the use of cost-effective drugs. This study showed that the use of a three-tier incentive-based formulary along with an increase in copayments resulted in a shift from the use of more expensive drugs to the use of less expensive drugs. It also resulted in the patients' bearing a greater share of the overall cost of drugs and, among some patients, in the discontinuation of use of certain types of drugs altogether.
A 26-year-old man comes to establish primary care. Physical examination reveals multiple moles on his body, which he describes as “funny-looking.” There is no family history of melanoma. He thinks that one of his two brothers (15 years of age) and his father have the same kind of moles. How should this case be managed?
Cancers arising from the esophagus, including the gastroesophageal junction, are relatively uncommon in the United States — the lifetime risk of this cancer is 0.8 percent for men and 0.3 percent for women, and it increases with age. The presentation is insidious; at diagnosis, more than 50 percent of patients have either unresectable cancer or radiographically visible metastases, rendering management problematic. This review discusses the pathogenesis of esophageal cancer, as well as the clinical presentation, treatment, and prognosis.
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