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June 24, 2004 Vol. 350 No. 26
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Physiological observations indicate that the small airways are the predominant site of airway obstruction in patients with chronic obstructive pulmonary disease (COPD). In this detailed pathological study of airway specimens obtained during resection from patients with COPD and various levels of airway obstruction, the mass of airway wall tissue was closely linked to the degree of airflow impairment.
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Data from a large Australia–New Zealand registry were analyzed to determine long-term survival among children and adolescents with end-stage renal disease who were younger than 20 years of age when renal-replacement therapy was initiated. Survival was 79 percent 10 years after the initiation of therapy and 66 percent at 20 years. There was a trend toward improved survival over the four decades of the study.
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α-Lactalbumin–oleic acid, a protein–lipid complex derived from human milk, was serendipitously found to kill virus-transformed cells in tissue culture without affecting normal cells. In this in vivo study, the local application of α-lactalbumin–oleic acid induced the regression of skin papillomas, even those that were resistant to conventional treatments.
Some studies have shown that the use of folate supplementation to lower plasma homocysteine levels reduces the rate of restenosis in patients who have undergone angioplasty, but results have been inconsistent. In this study, patients who had received a coronary stent were randomly assigned to receive placebo or a combination of folate, vitamin B6, and vitamin B12. Those receiving active therapy had a higher rate of in-stent restenosis.
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Both acquired and inherited disorders of muscle are common; thus, greater understanding of muscle growth and maintenance is important for future therapies. Myostatin down-regulates muscle growth. These investigators describe a mutation in the gene for myostatin in a child with muscle hypertrophy and unusual strength.
The goals of therapy for chronic obstructive pulmonary disease include relieving symptoms, improving abnormal physiology, and limiting complications, including abnormal gas exchange and exacerbations of the disease. This review summarizes current guidelines and provides recommendations for management, including assessment of lung function, preventive measures, stepwise medical therapy, and pulmonary rehabilitation and surgical therapy. By the time this disease becomes symptomatic, the forced vital capacity of most patients has already declined by about 50 percent.
A woman told her physician that she had pelvic pressure and a vaginal bulge shortly after her second vaginal delivery. Examination showed uterine prolapse, cystocele, and rectocele. Despite conservative management with a pessary and exercises, the prolapse worsened and urinary symptoms developed. Is there a link among pregnancy, vaginal delivery, uterine prolapse, and incontinence? How should this condition be managed?
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