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August 7, 2003 Vol. 349 No. 6
This report provides the final results of the Women's Health Initiative trial comparing estrogen plus progestin and placebo in postmenopausal women. For the primary end point of coronary heart disease, there was no protective effect of hormone therapy over a five-year period, and there was the possibility of an adverse effect, especially during the first year of the trial. Combined hormone therapy cannot be recommended for the purpose of preventing coronary heart disease.
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Recent clinical trials have shown that hormone therapy does not prevent, and may actually increase the risk of, coronary events in postmenopausal women. The present study used quantitative coronary angiography to assess the progression of coronary atherosclerosis in women with known coronary disease during therapy with 17β-estradiol alone or 17β-estradiol with medroxyprogesterone acetate. Neither form of hormone therapy had any effect on the progression of coronary atherosclerosis over a period of three years.
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The diagnostic value of sentinel-lymph-node biopsy in women with breast cancer was evaluated in a randomized trial. The accuracy, sensitivity, and specificity of the procedure were high. If a sentinel lymph node is negative for metastases on biopsy, dissection of the axillary nodes can be avoided. This study provides useful data that support the clinical value of sentinel-node biopsy.
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One pathway of complement activation involves mannan-binding lectin and its associated serine protease 2 (MASP-2). MASP-2 deficiency was identified in an adult with a history of ulcerative colitis, erythema multiforme bullosum, and possible systemic lupus erythematosus. He had had recurrent episodes of severe pneumococcal pneumonia. Studies documented that his mannan-binding lectin pathway of complement activation was not functional.
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It is commonly believed that the use of an individual patient's genetic information should be held to a slightly different legal standard than the use of general medical information. This article in the Genomic Medicine series provides examples of appropriate and inappropriate uses of genetic information. For physicians, the biggest dilemma is whether to inform the relatives of patients who have received a diagnosis of a heritable condition for which there is treatment and who are reluctant to share this information with their families.
Adult human stem cells that are intrinsic to various tissues have been described and characterized, some only recently. Analysis of recent data suggests that adult stem cells can generate differentiated cells beyond their own tissue boundaries, a process termed “developmental stem-cell plasticity.” This review focuses on in vivo models of adult stem cells derived from bone marrow and peripheral blood and their potentially novel therapeutic applications.
Amyloidosis affects millions of people, as a cause of Alzheimer's disease or a complication of dialysis, and also causes rare conditions. The many forms of the disorder have one underlying principle: misfolded proteins. Prompt, correct diagnosis is essential, especially in the inherited forms of amyloidosis. This article reviews the molecular basis of various types of amyloidosis and proposes new ways of treating these disorders.
An 86-year-old man presented with abdominal discomfort and fever. His medical history was notable for long-standing hypertension, mild chronic renal insufficiency, coronary-artery bypass surgery, repair of an abdominal aortic aneurysm seven years earlier, gout, diverticulitis, and prostatitis.
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