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November 11, 2004 Vol. 351 No. 20
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Angiotensin-converting–enzyme (ACE) inhibitors improve outcomes in patients with left ventricular dysfunction or heart failure. The Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) Trial investigators studied the effect of the ACE inhibitor trandolapril in patients with stable coronary disease and normal or only slightly reduced left ventricular function, and no benefit was found.
The cytokine interleukin-12 has been implicated in the intestinal inflammation of Crohn's disease. In this phase 2 trial, the rates of adverse events were similar among patients who received a monoclonal antibody against interleukin-12 and patients who received placebo, with the exception of local reactions at injection sites, which were more common in the former group. The rates of clinical response and remission were higher among patients treated with antibody but not significantly so in most cases.
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The causation of diseases involving the deficiency of more than one enzyme involved in the process of mitochondrial oxidative phosphorylation is unclear. This study suggests one potential cause. The authors identified mutation of a gene encoding a component of the mitochondrial translation machinery in two siblings with early fatal hepatoencephalopathy.
Intermediate filaments provide scaffolding for the cell and protect it against stress. This comprehensive review points out that there are more than 100 intermediate filament genes and that mutant intermediate filament proteins cause more than 30 diseases. Selective expression of these genes in particular tissues accounts for tissue-specific diseases caused by mutant intermediate filament genes, such as epidermolysis bullosa simplex and certain types of cardiomyopathy.
A 45-year-old man had right flank pain associated with hematuria. Computed tomographic scanning without enhancement disclosed a nonobstructing stone in the right kidney. After a second episode 11 months later, the stone was still present, and there was new dilatation of the right renal pelvis. The physicians discuss how this patient was evaluated and treated.
In 1990, a neonatologist resuscitated a severely premature infant against the wishes of the parents. The child survived with severe disabilities. The parents sued the hospital for battery and negligence. In 2003, the Texas Supreme Court ruled in favor of the physicians and hospitals. According to the ruling, physicians who are faced with split-second, life-or-death decisions do not need parental consent to provide life-sustaining treatment to minors.
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