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October 14, 2004 Vol. 351 No. 16
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Abdominal aortic aneurysms greater than 5 cm in diameter are usually repaired surgically. This study compared open surgical repair with endovascular repair through the femoral artery, a less invasive approach. After 30 days, mortality and rates of major complications were significantly lower with endovascular than with open repair. Although the operative mortality is decreased, longer follow-up is needed to confirm the durability of these results.
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In this study, associations between breast cancer and patterns of growth during childhood were analyzed in the school health records of 117,415 Danish women. High birth weight, a young age at peak growth, and high stature and low body-mass index at 14 years of age were all independent risk factors for breast cancer in adulthood. The mechanisms of these associations are unknown, but the data indicate that growth during childhood influences the risk of breast cancer during adult life.
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In patients with ischemic heart disease, mitral regurgitation may be a dynamic phenomenon, increasing or decreasing on the basis of changes in loading conditions or left ventricular geometry. This study shows that transient increases in the severity of mitral regurgitation may have an important role in the pathogenesis of acute pulmonary edema. Interventions to reduce or prevent mitral regurgitation might be beneficial.
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Nearly 20,000 operations to repair congenital heart lesions are performed each year in the United States, and most are performed with the use of cardiopulmonary bypass. The bypass circuit needs to be primed before use, either with fresh whole blood or with blood that has been reconstituted from packed red cells and fresh-frozen plasma. This study, which compared the two priming methods, found that fresh whole blood offers no advantage over reconstituted blood and that its use may in fact be disadvantageous.
Modern techniques have reduced the frequency of infections that are associated with prosthetic joints, but such infections continue to pose difficult problems in clinical management. Advances in understanding biofilms and the pathogenesis of microbial interactions with the implant have led to more rational approaches to therapy. This review offers guidance in establishing the diagnosis correctly and an algorithm summarizing the appropriate medical and surgical options.
This review of the mechanism of pulmonary hypertension is focused on pulmonary arterial hypertension, a disorder that can be idiopathic or can occur in association with other disorders, such as infection with the human immunodeficiency virus. The authors suggest that an abnormality involving intracellular signaling mediated by transforming growth factor β underlies the various forms of pulmonary arterial hypertension.
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