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Women with breast cancer in which the HER2 gene was amplified had a better response to adjuvant treatment with an anthracycline-containing regimen than to a chemotherapy combination that did not contain an anthracycline. Among women with tumors without HER2 amplification, there was no benefit from an anthracycline-containing regimen.
In infants with very low birth weight who have apnea of prematurity, caffeine therapy reduced the risk of bronchopulmonary dysplasia assessed at 36 weeks of postmenstrual age. Caffeine temporarily reduced weight gain; it did not affect the rates of death, ultrasonographic signs of brain injury, or necrotizing enterocolitis. These short-term data demonstrate an important benefit of caffeine therapy in this population, but a definitive assessment of its benefits and risks awaits results of long-term follow-up of this cohort.
Autosomal dominant polycystic kidney disease (ADPKD) is characterized by progressive enlargement of cyst-filled kidneys. A magnetic-resonance–based method was used to determine the rates of change in total kidney volume and cyst volume and iothalamate clearance over a three-year period in patients with ADPKD without azotemia. Higher rates of kidney enlargement were associated with more rapid decreases in renal function.
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The authors evaluated outcomes of children with bilateral permanent childhood hearing impairment according to the age at detection and confirmation. Children who had undergone universal newborn screening or whose hearing impairment was confirmed by nine months of age performed significantly better on tests of language ability than children who were not exposed to the screening or whose hearing impairment was confirmed after nine months of age, although speech scores were not significantly different. These data support the benefits of early detection and intervention for bilateral permanent childhood hearing impairment.
A 56-year-old woman presents with severe epigastric abdominal pain and vomiting of 14 hours' duration, symptoms that developed shortly after dinner the previous evening. She has no history of alcohol use, takes no medications, and has no family history of pancreatitis. On physical examination, she has a heart rate of 110 beats per minute and moderate epigastric abdominal tenderness without peritoneal signs. The white-cell count is 16,500 per cubic millimeter, and the hematocrit is 49 percent. Amylase, lipase, alanine aminotransferase, and lactate dehydrogenase levels are elevated. Calcium, albumin, triglyceride, and electrolyte values are normal. How should this patient be further evaluated and treated?
The implementation of universal screening programs to detect hearing defects in newborns has dramatically increased the identification of hearing loss in infants. Recent advances in understanding the nature and causes of prelingual hearing loss, combined with advances in technology, suggest that further improvement in these programs can readily be achieved.
A 46-year-old woman had rapid onset of ascites, right upper abdominal discomfort, nausea, and vomiting. The serum–ascites albumin gradient was 1.2 g per deciliter. Venography demonstrated narrowing of the intrahepatic portion of the inferior vena cava; hepatic veins could not be visualized. Additional diagnostic procedures were performed.
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