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April 29, 2004 Vol. 350 No. 18
In this large, multicenter, randomized trial comparing laparoscopic mesh and open mesh repair of inguinal hernias, men randomly assigned to laparoscopic repair had a higher rate of recurrence at two years and a higher rate of complications than those assigned to open repair. Subgroup analyses revealed a significantly higher recurrence rate after laparoscopic repair than after open repair of primary hernias (the majority of the hernias studied), but not of recurrent hernias.
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The expression of 36 genes that have been linked to the outcomes in diffuse large-B-cell lymphoma was studied with the use of real-time polymerase chain reaction in biopsy specimens of the lymphoma. The pattern of expression of a group of 6 of the 36 genes correlated significantly with survival.
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This study shows that some patients with permanent neonatal diabetes have an activating mutation in the gene encoding Kir6.2, a subunit of the ATP-sensitive potassium (KATP) channel. Such mutations are predicted to reduce membrane depolarization in response to ATP and thereby insulin secretion from pancreatic beta cells. Three patients with mutant Kir6.2 secreted insulin in response to a sulfonylurea, which stimulates insulin secretion independently of ATP, suggesting a strategy for treatment.
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Protease-sparing regimens are often used in the initial treatment of HIV-1 infection. This double-blind trial was stopped after an interim analysis showed poorer virologic responses with the triple-nucleoside-analogue regimen of zidovudine, lamivudine, and abacavir than with regimens containing efavirenz, a nonnucleoside reverse-transcriptase inhibitor, plus two or three nucleoside analogues.
Fibromuscular dysplasia is a noninflammatory process that may be difficult to distinguish from vasculitis. It develops in the middle and distal arterial segments, and especially in younger patients, it may cause renovascular hypertension, stroke, and cranial-nerve palsies. Treatment increasingly involves the use of percutaneous angioplasty.
This survey of the cellular and anatomical sites of infection by human immunodeficiency virus (HIV) discusses the mechanisms of attachment of the virus to cells, the cellular receptors through which the virus enters cells, and the all-important reservoir of HIV, which persists despite antiretroviral therapy.
A 66-year-old man developed progressive left-sided weakness over a two-month period. He was a renal-transplant recipient and had alcoholic cirrhosis, diabetes, and coronary artery disease. Magnetic resonance imaging studies showed, on T2-weighted images, a hyperintense lesion in the left frontal white matter, which gradually enlarged. New lesions developed in the right frontal area and brain stem. A diagnostic procedure was performed.
Foodborne disease leads to about 325,000 hospitalizations and 5000 deaths each year in the United States. The irradiation of food could sharply reduce the incidence of foodborne disease, but currently it is rarely performed. This article examines the reasons for the slow growth in the use of food irradiation. Like pasteurization, irradiation is an effective strategy to improve food safety.
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