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April 8, 2004 Vol. 350 No. 15
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Low levels of high-density lipoprotein (HDL) cholesterol increase the risk of coronary heart disease. The authors of this study investigated a novel method of raising HDL cholesterol levels. Torcetrapib is a potent inhibitor of cholesteryl ester transfer protein, a plasma glycoprotein that conveys cholesteryl esters from HDL to low-density lipoprotein (LDL). Over the main four-week study period, this drug markedly increased levels of HDL cholesterol, whether or not the patient was also taking atorvastatin to lower LDL cholesterol.
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Hypercalcemia and hyperphosphatemia often complicate secondary hyperparathyroidism therapy in patients who are receiving dialysis. Unlike vitamin D and calcium, calcimimetic agents target the calcium-sensing receptor. This study reports the safety and effectiveness of the calcimimetic agent cinacalcet in patients receiving dialysis who had uncontrolled hyperparathyroidism. The mean parathyroid hormone values decreased 43 percent with cinacalcet therapy but increased 9 percent with placebo, and the calcium–phosphorus product declined with cinacalcet but not placebo.
A 45-year-old fair-skinned woman has noted increasing sallowness, roughness, fine wrinkles, and mottled hyperpigmentation on her face. She is bothered by these changes and is worried about the development of nonmelanoma skin cancer. What treatments may minimize skin aging and lower the risk of skin cancer?
A 12-year-old boy was admitted to the hospital with a two-day history of a rash and of swelling of the face, hands, and feet. On admission, he was afebrile and hypertensive, with pitting edema of the legs. Laboratory studies disclosed hematuria, proteinuria, urinary casts, and elevated blood urea nitrogen and creatinine levels. The discussant reviews the differential diagnosis of acute renal failure in children.
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