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December 25, 2003 Vol. 349 No. 26
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This investigation of the treatment of multiple myeloma compared one cycle of high-dose chemotherapy plus a single autologous stem-cell transplantation with two cycles of high-dose chemotherapy, each followed by stem-cell transplantation. The double-transplantation regimen had a substantial survival benefit.
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Lack of glycogen phosphorylase in patients with McArdle's disease blocks muscle glycogenolysis, resulting in low exercise tolerance and often in muscle injury, particularly in the first minutes of exercise. As the investigators in this single-blind, randomized, placebo-controlled trial hypothesized, ingesting sucrose before exercise increased the availability of glucose and therefore improved exercise tolerance in patients with the disease.
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This prospective cohort study compared the performance of two clinical decision rules for evaluating cervical-spine injury. As compared with the NEXUS Low-Risk Criteria (which are widely recommended), the Canadian C-Spine Rule was more sensitive and more specific for clinically important injury and would have resulted in fewer orders for cervical-spine radiographs.
The transportation of illicit drugs by concealment within the body is now a common practice, and it has implications for clinical care. Body packers may ingest dozens of packets containing life-threatening doses of heroin, cocaine, or amphetamines. These smugglers may then present to physicians for evaluation while in legal custody or because of drug-induced toxic effects or obstruction or perforation of the gastrointestinal tract. This review provides guidance for the recognition and management of this clinical problem, which often also poses ethical and legal challenges for the clinician.
In acquired pulmonary alveolar proteinosis, lipids and proteins accumulate within the alveoli because alveolar macrophages cannot catabolize surfactants. Surprisingly, alveolar macrophages require granulocyte–macrophage colony-stimulating factor (GM-CSF) to perform this function. Autoantibodies against GM-CSF may cause pulmonary alveolar proteinosis.
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