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July 29, 2004 Vol. 351 No. 5
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In this randomized trial involving patients with chronic hepatitis C who were also infected with the human immunodeficiency virus (HIV), peginterferon alfa-2a plus ribavirin was more effective than interferon alfa-2a plus ribavirin or peginterferon alfa-2a plus placebo (rates of sustained virologic response, 40 percent, 12 percent, and 20 percent, respectively).
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Chronic hepatitis C infection is common among patients with human immunodeficiency virus (HIV) infection. In this randomized trial, 133 patients were assigned to receive either peginterferon alfa-2a with ribavirin or interferon alfa-2a with ribavirin. The rate of sustained virologic response was higher in the peginterferon group than in the interferon group (27 percent vs. 12 percent).
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Familial cardiac myxomas may occur in conjunction with a variety of other abnormalities, together called the Carney complex. A particular variant is characterized by musculoskeletal manifestations. In this study, a mutation in the perinatal myosin heavy chain was identified as the underlying cause of this Carney complex variant. Although the disorder is rare, the findings are important because they suggest a role of mutated contractile proteins in cardiac tumorigenesis.
A 32-year-old woman with moderate myopia and mild dry eye has worn soft contact lenses for 12 years but now is not tolerating them well. On examination, her refraction is –4.25 + 1.0 × 90 (–3.75 diopters of spherical equivalent and 1 diopter of astigmatism at 90 degrees) in the right eye and –3.5 + 0.5 × 88 in the left eye, yielding a best corrected visual acuity of 20/20 in each eye. She asks about refractive surgery. What would you advise?
Bipolar disorder, one of the most distinct syndromes in psychiatry, has been described in numerous cultures throughout history. The unique hallmark of the illness is mania, which is characterized by elevated mood or euphoria, overactivity with a lack of need for sleep, and overoptimism that impairs judgment. Periods of depression are also a feature of the disorder.
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A 48-year-old man had had a 33-month history of intermittent abdominal pain and black stools containing occult blood. Endoscopic and imaging studies of the upper and lower gastrointestinal tract revealed no abnormalities. Video-capsule endoscopy revealed a mucosal lesion in the distal ileum. A diagnostic procedure was performed.
In recent years, the Food and Drug Administration (FDA) has granted fast-track approval for cancer treatments that are effective in only 10 to 15 percent of patients, without requiring sponsors to identify the patients who are most likely to benefit. In this article, the authors propose that the FDA make rapid approval of new molecularly targeted cancer therapies contingent on sponsors' agreement to invest in research designed to identify subgroups of patients who are likely to have a response to treatment.
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