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November 18, 2004 Vol. 351 No. 21
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Patients with follicular lymphoma may survive for periods ranging from less than a year to several decades. In this study, DNA-microarray analysis of gene expression in specimens of follicular lymphoma showed that two genetic signatures predicted the length of survival with a high degree of accuracy. Surprisingly, one signature consisted of genes that are typically expressed in normal T cells, and the other consisted of genes expressed in monocytes and dendritic cells.
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Thrombolytic therapy is not consistently effective in patients with acute ischemic stroke. In this phase 2 study, transcranial Doppler ultrasonography that was aimed at residual obstruction in the middle cerebral artery during thrombolytic therapy with tissue plasminogen activator resulted in improved recanalization of the artery. Ultrasonic enhancement of thrombolysis may be due to improved transport of the drug to the thrombus. A larger trial will be needed to investigate the effects of this approach on neurologic recovery.
Term infants who are small for gestational age are prone to the development of insulin resistance later in life. This study measured insulin sensitivity at the age of 4 to 10 years in children who had been born prematurely. An isolated reduction in insulin sensitivity was observed in both children who had been born prematurely but were appropriate for gestational age at birth and those who had been born prematurely but were small for gestational age, suggesting that premature infants may be at high risk for the metabolic syndrome and type 2 diabetes mellitus.
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To control costs, some state Medicaid programs have implemented policies requiring prior approval before a selective cyclooxygenase-2 inhibitor (coxib) can be prescribed. This study found that the implementation of such programs resulted in a 15 percent decrease in the use of coxibs as a proportion of all prescriptions for nonsteroidal antiinflammatory agents and substantial reductions in drug spending.
A 35-year-old woman who is otherwise healthy has had constant retrosternal chest pain for two days. The pain worsens when she lies down and improves when she sits up and leans forward. On physical examination, the patient is afebrile and has a friction rub. The 12-lead electrocardiogram shows widespread ST-segment elevation and concomitant PR-segment depression. How should this patient be evaluated and treated?
Histamine has an important role as a chemical messenger in physiologic responses, neurotransmission, allergic inflammation, and immunomodulation by way of the H1-receptor. Most H1-antihistamines, which are useful in treating these effects, possess similar efficacy in allergic rhinoconjunctivitis and chronic urticaria. However, there are clinically relevant differences among them in their pharmacology and safety profiles.
Thickening of the skin of the arms and legs, with flexion contractures of the knees, elbows, fingers, and toes, developed in a 68-year-old man with long-standing diabetes mellitus complicated by retinopathy, neuropathy, and renal failure. He was unable to walk and had nonhealing ulcers on both heels. Examination disclosed brown-pigmented, indurated plaques on the arms and legs. A diagnostic procedure was performed.
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