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August 21, 2003 Vol. 349 No. 8
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In hospitals with angioplasty facilities, coronary angioplasty is the preferred approach to revascularization in patients with acute myocardial infarction. In this Danish study, patients initially admitted to hospitals without angioplasty facilities were randomly assigned to receive on-site fibrinolytic therapy or to be transferred to an invasive-treatment center for angioplasty. Despite the time required for transfer, patients assigned to angioplasty had a better outcome than those assigned to fibrinolytic therapy.
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This trial of concurrent chemotherapy and granulocyte colony-stimulating factor (G-CSF) for acute myeloid leukemia was based on the ability of G-CSF to heighten the sensitivity of cultured leukemia cells to chemotherapeutic agents. Patients who received the dual treatment (“G-CSF priming”) fared better than patients given chemotherapy alone.
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This Brief Report describes recurrent gestational spontaneous ovarian hyperstimulation syndrome in a family with a heterozygous mutation in the transmembrane domain of the receptor for follicle-stimulating hormone (FSH). The mutant receptor responded to human chorionic gonadotropin as well as to follicle-stimulating hormone. A second Brief Report describes another FSH receptor mutation that also leads to gestational ovarian hyperstimulation syndrome.
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The overproduction of endogenous chorionic gonadotropin during pregnancy has been associated with spontaneous ovarian hyperstimulation syndrome. Yet the syndrome has been observed in women with normal levels of chorionic gonadotropin. This Brief Report defines a mutation in the follicle-stimulating hormone (FSH) receptor that is associated with recurrent, spontaneous ovarian hyperstimulation syndrome. In this instance, the mutant receptor responded both to chorionic gonadotropin and to thyrotropin.
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Congenital adrenal hyperplasia is a group of autosomal recessive disorders resulting from the deficiency of one of the enzymes required for cortisol synthesis in the adrenal cortex. The most frequent is steroid 21-hydroxylase deficiency, accounting for more than 90 percent of cases. This article discusses the molecular mechanisms, diagnosis, and management of this disease and highlights new developments, including genotype–phenotype correlations, gene-specific prenatal diagnosis, and prenatal therapy.
In this review of recent developments in Canadian health care policy, Detsky and Naylor describe the strains on the system in the 1990s that led to declining satisfaction on the part of the public and providers and to national debate about health care reform. A 2003 agreement between the federal and provincial governments called for a substantial increase in federal funds for health care but no major changes in organization, delivery, or financing.
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