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September 9, 2004 Vol. 351 No. 11
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Between the ages of 10 and 18 years, the lung undergoes major growth. There has been reason to believe that exposure to air pollution during this period of lung growth leads to a restriction of lung growth, but strong supporting data have been lacking. In this study, conducted in southern California, children from communities with greater air pollution had significantly poorer lung function than children from communities with cleaner air.
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Erythromycin is known to prolong cardiac repolarization and has been associated with case reports of torsades de pointes. In this study, the use of oral erythromycin was found to increase the risk of sudden death from cardiac causes by a factor of two. The concurrent use of erythromycin and cytochrome P-450 inhibitors, such as verapamil or diltiazem, increased the risk by a factor of five. Thus, erythromycin should not be prescribed for patients receiving these drugs.
A 78-year-old woman with a history of hypertension is admitted to the hospital with congestive heart failure. Physical examination reveals a blood pressure of 180/90 mm Hg, increased jugular venous pressure, peripheral edema, and pulmonary rales. A chest radiograph shows pulmonary edema and mild cardiomegaly. An echocardiogram shows a left ventricular ejection fraction of 70 percent. The left ventricular Doppler filling pattern is abnormal and consistent with an elevated pulmonary-capillary wedge pressure. How should this patient be treated?
Despite a large need for new hypoglycemic therapies, given the epidemic of type 2 diabetes, very few agents have been introduced during the past 20 years. The thiazolidinediones represent a potentially important new group of drugs with a mechanism of action differing from and perhaps complementary to that of existing therapies. This article discusses present data on mechanisms, indications, and limitations of thiazolidinedione therapy.
Newborn identical twin boys had thrombocytopenia, leukopenia, and hepatosplenomegaly. Platelet transfusions were ineffective. Screening for infections was negative. Bone marrow aspiration showed a single hemophagocytic histiocyte. Despite medical management, the patients' condition continued to worsen. A diagnostic procedure was performed.
In this article, the authors argue that although racial and ethnic disparities in health have attracted appropriate attention, the association between health and class (i.e., income, education, and occupation) is not widely appreciated. Pointing to strong correlations between higher income and educational levels and better health, they suggest that the nation's health would be greatly enhanced by investment in social and economic policies that address class differences.
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