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May 26, 2005 Vol. 352 No. 21
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The proper management of asthma with the use of inhaled corticosteroids requires the adjustment of doses in proportion to the patient's need for treatment. In this study, the investigators compared groups treated according to two regimens, one based on conventional guidelines for the treatment of asthma and one based on measurements of the fraction of nitric oxide in the exhaled air. In the latter group, equivalent control of asthma was maintained with lower doses of inhaled corticosteroids.
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Using data derived from two large New York State registries, this study compared three-year survival rates among patients with multivessel coronary disease who had undergone coronary-artery bypass grafting (CABG) and those who had received a coronary stent. Survival rates were uniformly superior with CABG. Although this study was not randomized, it has important implications for the selection of revascularization procedures in patients with multivessel coronary disease.
In this case–control study of 1953 patients with colorectal cancer and 2015 matched controls, statin treatment was associated with a decrease in the risk of colorectal cancer of almost 50 percent. Results were similar in analyses adjusted for the use or nonuse of nonsteroidal antiinflammatory drugs; the presence or absence of exercise, hypercholesterolemia, and a family history of colorectal cancer; and diet.
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In this randomized trial, sargramostim (a recombinant granulocyte–macrophage colony-stimulating factor) was not significantly more likely than placebo to result in the primary outcome of a clinical response (a decrease from baseline of at least 70 points in the Crohn's Disease Activity Index [CDAI]). However, sargramostim was more likely to induce significant improvements in secondary outcome measures, including rates of remission (defined by a CDAI score of 150 or less). Injection-site reactions and bone pain were common among patients treated with sargramostim, and three patients in this group had serious adverse events.
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This survey of 107 medical schools revealed that clinical-trial contracts with industry vary across institutions. Although 93 percent of institutions do not allow contract provisions permitting sponsors to decide that results should not be published, a substantial percentage allow contracts specifying that sponsors can draft manuscripts (50 percent) or insert their own statistical analyses into manuscripts (24 percent). The authors call on medical schools to develop standards for clinical-trial agreements with industry.
Differences in drug responsiveness are common, often leading to challenges in optimizing the dosage regimen for a particular patient. Recent advances provide a rational framework for understanding many interpatient differences in drug disposition and their clinical consequences. This article focuses on the cytochrome P-450 enzymes, a superfamily of microsomal drug-metabolizing enzymes that play an important role in oxidative drug metabolism.
A nine-year-old girl was admitted to the hospital because of headache, papilledema, visual changes, and vomiting. The headaches had begun 18 months before admission, and enuresis 9 months before admission, followed by decreased visual acuity. A neurologist had found bilateral papilledema. On admission, the blood pressure was 210/130 mm Hg. A pediatric intensivist and a pediatric nephrologist discuss the urgent treatment and diagnostic evaluation of a child with hypertension.
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