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September 16, 2004 Vol. 351 No. 12
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More than 400 Swedish parents who had lost a child to cancer were asked whether they had talked with that child about death. None of the parents who had done so regretted it. In contrast, more than one quarter of the parents who did not talk with their child about death regretted not having done so, especially if they had sensed that their child was aware of his or her imminent death.
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Four patients with severe corneal opacification and resultant visual loss had bilateral total corneal stem-cell deficiency and underwent transplantation of autologous oral mucosal epithelial cells in carrier-free cell sheets to reconstruct their corneal surfaces. All four patients (four eyes) had restoration of corneal transparency and improvement in visual acuity. Corneal reconstruction with tissue-engineered cell sheets composed of autologous oral mucosal epithelium has the potential to restore vision in patients with severe bilateral ocular-surface disorders.
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Some children with asymptomatic Wolff–Parkinson–White syndrome are at high risk for tachyarrhythmias and sudden death. These children can be identified because they have inducible tachyarrhythmias on electrophysiological testing. This randomized clinical trial found that such children benefit from radiofrequency catheter ablation of accessory conduction pathways.
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Among patients with hepatitis B e antigen (HBeAg)–negative chronic hepatitis B, the rates of suppression of hepatitis B virus DNA to below 20,000 copies per milliliter were 43 percent with peginterferon alfa-2a alone, 44 percent with peginterferon alfa-2a plus lamivudine, and 29 percent with lamivudine alone after 48 weeks of treatment and 24 weeks of follow-up; the rates of suppression to below 400 copies per milliliter were 19 percent, 20 percent, and 7 percent, respectively.
Owing to improvements in imaging techniques, cystic lesions of the pancreas are being identified more often, even in patients who are asymptomatic. These lesions range from benign to premalignant to highly malignant. This review offers guidance on the strategies for establishing the diagnosis, assessing risk, and making difficult decisions about when surgical resection is indicated.
Although most children with Turner's syndrome are under the care of specialists, the authors of this article suggest that most affected women can best be served by their primary care practitioners, with the use of informed judgment about the need for referral to specialists. This article reviews current concepts in the genetics, diagnosis, and management of Turner's syndrome.
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A 75-year-old woman with a history of aortic-valve stenosis and coronary artery disease awoke in the night with chest pain. The electrocardiogram showed ST-segment depression, and the troponin T levels were elevated. The chest pain resolved, but fever developed. Blood cultures were positive for the Streptococcus milleri group; fever persisted despite antibiotic therapy. A cardiologist, an infectious-disease specialist, and a cardiac surgeon discuss the diagnosis and management of this case.
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Several congenital forms of muscular dystrophy are caused by mutations of glycosyltransferase genes. A recent study shows that overexpression of a specific glycosyltransferase compensates for the deficits produced by other mutant glycosyltransferases, raising the hope that a single therapy could be used to treat different forms of the disorder.
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