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December 16, 2004 Vol. 351 No. 25
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In this multicenter, four-year observational study of women with a history of cesarean section and a singleton gestation, a trial of labor was associated with a higher risk of symptomatic uterine rupture in the mother and hypoxic–ischemic encephalopathy in the infant than was elective cesarean delivery, although the absolute risks of these complications were low. The findings from this study should help inform women about their choices regarding the type of delivery after a prior cesarean section.
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Oral mucositis can be a debilitating and dangerous adverse effect of the chemoradiation used to prepare patients for bone marrow transplantation. Palifermin, a recombinant keratinocyte growth factor, was shown in this study to reduce the incidence and duration of severe oral mucositis after high-dose chemoradiation.
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This study examined the relation between the level of C-reactive protein (CRP) and other inflammatory markers and the risk of coronary heart disease in large cohorts of men and women who were free of cardiovascular disease at baseline. During a follow-up period of six to eight years, men and women with CRP levels of at least 3 mg per liter had a risk of coronary events that was 1.68 times that of those with CRP levels of less than 1 mg per liter.
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In this large study based on data from the United Kingdom General Practice Research Database, rates of myocardial infarction and stroke increased sharply during the first three days after the diagnosis of an acute respiratory syndrome. The rates increased to a lesser degree after acute urinary tract infections. By contrast, there was no increase in risk after influenza, tetanus, or pneumococcal vaccination.
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A 30-year-old man with hypogonadism, delayed puberty, and an absence of circulating luteinizing hormone was found to have a homozygous missense mutation in the gene that encodes the beta subunit of luteinizing hormone (Gly36Asp), which abrogated the heterodimerization and secretion of luteinizing hormone. Treatment with human chorionic gonadotropin increased circulating testosterone levels and promoted virilization and the appearance of normal spermatozoa in low concentrations, illustrating the important physiological role that luteinizing hormone plays in male sexual maturation and fertility.
A six-month-old girl presents for a “well-baby” appointment in New Jersey. The mother is concerned about a dead bat she found in the child's bedroom. A Virginia businessman relaxing on his patio after work pulls a toy from his puppy's mouth. He notices a dead raccoon within his fenced yard, where his puppy has been playing, and telephones you for advice. You receive e-mail from a South American colleague, who has been bitten by a stray dog while jogging. She solicits your medical opinion. How would you manage these situations?
A 40-year-old man noted a lump on the top of his head. Imaging studies showed a dural-based tumor invading bone and soft tissue. The lesion was excised and a diagnosis of plasmacytoma was made. Additional staging studies disclosed multiple lytic bone lesions, with no paraprotein and a negative bone marrow biopsy and aspirate. The discussants review recent advances in the management of multiple myeloma.
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