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November 25, 2004 Vol. 351 No. 22
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Outcomes were compared in adults with leukemia who had received hematopoietic stem-cell transplants from unrelated donors. Patients received HLA-matched bone marrow, bone marrow with one HLA mismatch, or cord blood with one or two mismatches. The outcomes were most favorable in recipients of HLA-matched marrow but similar in those who had received mismatched marrow or cord blood.
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This report compares major outcomes after treatment of acute leukemia in adults with either bone marrow or umbilical-cord blood from an unrelated donor. Except for delayed recovery of neutrophils and a reduced risk of graft-versus-host disease in recipients of cord blood, the results with cord blood and bone marrow were similar.
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In a randomized trial, 238 healthy adults received either the full dose of a candidate influenza vaccine administered intramuscularly or 40 percent of the dose administered intradermally. The antibody responses among those who were 18 to 60 years of age were similar in the intradermal and intramuscular groups, but the responses were somewhat less vigorous in those over the age of 60 years.
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In this trial, 50 healthy adults 18 to 40 years of age received an intradermal injection of one fifth the standard dose of an influenza vaccine. The resulting increases in hemagglutination-inhibition titers were at least similar to those elicited by the standard dose of vaccine administered intramuscularly to 50 control subjects.
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The radial artery was first used as a coronary bypass graft in 1971, but there have been conflicting reports about its patency as compared with that of saphenous-vein grafts. In this study, radial-artery grafts had a higher patency rate at one year than control saphenous-vein grafts. The advantage was particularly evident when the radial artery was grafted to coronary vessels with high-grade lesions. This study supports the use of the radial artery as a coronary bypass conduit in vessels with high-grade stenosis.
This review explains the pathophysiological changes that elevated blood pressure produces in the retinal circulation. Recent studies show that some specific retinal signs are strong predictors of stroke, independent of elevated blood pressure. Identifying the degree of retinopathy can help clinicians to deliver optimal treatment and prevent cardiovascular disease and death.
A male infant was noted to have severe hypospadias and ambiguous genitalia at birth. By one week of age, he began vomiting after even small feedings. An evaluation disclosed no evidence of maternal or fetal infection or prenatal exposure to toxins. On examination, he had slightly dysmorphic facies and axial and appendicular hypotonia. A diagnostic test was performed.
Although the family history is part of the basic workup that has been taught in medical schools for generations, it often does not get the attention it should. In this article, the authors make the case for taking a good family history in the era of genomic medicine and provide a computer tool that can be downloaded and used by patients to help record this history.
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