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February 12, 2004 Vol. 350 No. 7
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B-type natriuretic peptide is released from the cardiac ventricles in response to hemodynamic overload, and blood levels are higher in patients with heart failure than in those with other causes of dyspnea. This study showed that the diagnostic use of B-type natriuretic peptide levels in patients with acute dyspnea reduced the rate and duration of hospitalization and the cost of treatment.
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B-type natriuretic peptide and atrial natriuretic peptide are secreted by cardiac cells in response to hemodynamic stress. In the Framingham Heart Study population, natriuretic peptide levels were found to predict the risk of heart failure, first cardiovascular events, atrial fibrillation, and stroke or transient ischemic attack, even after adjustment for traditional cardiovascular risk factors.
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Insulin resistance is the best predictor of the development of diabetes in the children of patients with type 2 diabetes. This study examined insulin sensitivity in liver and muscle in the insulin-resistant offspring of patients with type 2 diabetes and in insulin-sensitive controls. Insulin-stimulated muscle glucose uptake was approximately 60 percent lower in the insulin-resistant offspring and was associated with an increase of approximately 80 percent in intramyocellular lipid content, which was mostly attributable to mitochondrial dysfunction.
A 39-year-old man reports an eight-hour history of colicky pain in the right lower quadrant radiating to the tip of his penis. He had previously had a kidney stone, which passed spontaneously. Examination shows he has tenderness of the right costovertebral angle and right lower quadrant. Urinalysis shows microhematuria. Helical computed tomography shows a 6-mm calculus of the right distal ureter and mild hydroureteronephrosis. How should this patient be treated?
Although pancreas transplantation is increasingly being performed in an effort to provide type 1 diabetic patients with the possibility of an insulin-injection–free existence, islet transplantation is potentially less invasive. This review discusses pancreatic islet-cell transplantation as an evolving procedure.
A 57-year-old right-handed man was admitted to the hospital because of the sudden onset of slurred speech and left hemiparesis. Imaging studies revealed an infarct in the area of the right middle cerebral artery. With thrombolysis, recanalization of the vessels was achieved, but the patient's condition continued to worsen.
The use of spinal-fusion surgery is increasing rapidly in the United States. Most of these expensive, complex procedures are now being done for back pain and degenerative disease. Spinal fusions require long operations and are associated with an increase in the rate of complications, particularly in older patients. The benefits of surgery may be only modest, and pain relief is affected by many factors besides the anatomy. The authors of this article argue for restraint in the use of spinal-fusion surgery and for controlled trials to define more clearly the associated benefits and the indications.
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