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May 13, 2004 Vol. 350 No. 20
Patients with homocystinuria, a rare autosomal recessive disease characterized by very high plasma homocysteine levels, frequently have osteoporosis and fractures — an observation that led the authors to examine the association between homocysteine levels and osteoporotic fracture in the context of normal aging. The multivariable-adjusted relative risk of incident osteoporotic fracture was 1.4 (95 percent confidence interval, 1.2 to 1.7) for each increase of 1 SD in the natural-log–transformed homocysteine level.
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This article examines the association between the total homocysteine concentration and the risk of hip fracture in Framingham Study participants during a median follow-up period of 12.3 years for men and 15.0 years for women. Age-adjusted incidence rates for hip fracture increased progressively from the lowest to the highest quartile of homocysteine. For men in the highest quartile, the risk increased by a factor of almost four, and for women, by 1.9.
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Concern about the possibility of inadequate resection and recurrent cancer with the use of laparoscopically assisted colectomy prompted this randomized trial comparing laparoscopically assisted with open surgery for colon cancer. The trial involved 863 patients and 66 surgeons at 48 hospitals. Rates of cancer recurrence, operative complications, and survival were similar in the two groups.
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In this study, the lifetime risk of reactivation tuberculosis among persons in the United States who have had a positive tuberculin skin test was estimated from published data. The lifetime risk is 20 percent or higher among persons with skin-test induration of 10 mm or greater and either human immunodeficiency virus infection or evidence of old, healed tuberculosis.
A 31-year-old man noted fluctuating, painless testicular enlargement over a period of two months. There was no evidence of feminization, and the levels of the β subunit of human chorionic gonadotropin and alpha-fetoprotein were normal. The discussants review the differential diagnosis of testicular enlargement in a young adult, the diagnostic testing needed to establish a diagnosis, and the treatment of the unusual lesion that was ultimately diagnosed.
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