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December 9, 2004 Vol. 351 No. 24
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In patients at high risk for ventricular arrhythmias after a recent myocardial infarction, does prophylactic use of an implantable cardioverter–defibrillator (ICD) improve survival? This randomized trial found that it does not. Patients in the ICD group did have a lower rate of death due to cardiac arrhythmia, but it was offset by an increased rate of death from nonarrhythmic causes.
In women with advanced ovarian cancer who have undergone aggressive primary surgery, the role of secondary debulking surgery after potent chemotherapy with paclitaxel plus cisplatin is unclear. This randomized trial found that the addition of secondary surgery to chemotherapy after maximal primary debulking surgery afforded no survival benefit.
This randomized trial examined the effect of levodopa on the progression of Parkinson's disease. After 40 weeks of treatment followed by another 2 weeks for washout, the clinical severity of Parkinson's disease was greater in patients receiving placebo than in those treated with levodopa. However, neuroimaging data suggested a greater loss of dopamine nerve terminals in the patients treated with levodopa.
In this 24-week randomized study of patients with dementia associated with Parkinson's disease, outcomes were better among patients treated with rivastigmine than among those who received placebo. Clinicians observed clinical improvement in 19.8 percent of patients in the rivastigmine group and 14.5 percent of patients in the placebo group and clinical worsening in 13.0 percent and 23.1 percent, respectively.
Patients with ovarian cancer usually present with advanced disease, and the disease is generally managed with surgical resection followed by platinum-based chemotherapy. Recent chemotherapeutic advances have led to improved survival, and a better understanding of genetic risk factors has permitted a tailored approach to preventive strategies, such as bilateral salpingo-oophorectomy in selected women. This review describes the clinical features of ovarian cancer and recent advances in postoperative management.
A 52-year-old woman with postmenopausal bleeding was found to have a 12-cm cystic ovarian mass on imaging studies. The cyst was resected and contained a papillary serous cystadenocarcinoma, grade 2 to 3 of 3, arising as a polypoid intracystic mass in a serous tumor containing benign and borderline areas. The discussants review the diagnosis, grading, and treatment of early-stage ovarian cancer.
A recent study suggests that the hemagglutinin protein of the 1918–1919 influenza (Spanish influenza) pandemic led to the hemorrhagic pneumonia and hence a high level of mortality associated with Spanish influenza. This finding, together with the epidemiology of Spanish flu, has implications for response to future pandemics.
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