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This multicenter, randomized trial compared the effects of clomiphene citrate plus placebo, metformin plus placebo, and combination therapy in infertile women with the polycystic ovary syndrome. The rate of live birth was significantly higher with clomiphene than with metformin; there was no significant difference between the rates with combination therapy and with clomiphene alone. Multiple birth was a complication associated with clomiphene but was infrequent. These data support the use of clomiphene over metformin for the treatment of infertility in women with the polycystic ovary syndrome.
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Infection, especially with opportunistic microbes, is a prominent feature of pulmonary alveolar proteinosis; extrapulmonary infection suggests a systemic susceptibility. The authors show that neutrophil functions (phagocytosis, adhesion, oxidative burst, and bactericidal activity) are depressed in patients with pulmonary alveolar proteinosis and that the cause is autoantibodies against granulocyte–macrophage colony-stimulating factor (GM-CSF). These findings clearly demonstrate the essential role of GM-CSF in the antimicrobial activities of neutrophils.
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Type 1 cytokines are overexpressed in psoriatic plaques. This trial evaluated a monoclonal antibody against interleukin-12 and interleukin-23 in patients with psoriasis. Response rates at 12 weeks were significantly higher in patients treated with interleukin-12/23 monoclonal antibody than in those treated with placebo. Four percent of patients who received interleukin-12/23 monoclonal antibody and 1% of those who received placebo had serious adverse events. Larger studies of longer duration are needed to assess the effectiveness and safety of interleukin-12/23 monoclonal antibody for psoriasis.
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Results of a survey showed that most practicing physicians believe it is ethically permissible to explain to patients their moral objections to procedures such as terminal sedation, abortion, and the prescription of birth control to adolescents without parental approval. Many physicians do not consider themselves obligated to disclose any information to patients about these procedures.
A 68-year-old woman is incidentally found to have a left adrenal mass, 2.8 cm in diameter, on abdominal computed tomography that was ordered to evaluate right lower abdominal discomfort (which has since resolved). Her medical history is notable only for hypertension that has been well controlled with hydrochlorothiazide, at a dose of 25 mg daily. She reports no sweating, palpitations, headache, weight gain, or proximal muscle weakness. Her physical examination is unremarkable. How should she be evaluated?
A 56-year-old woman had dizziness and nausea, followed by slurred speech and ataxia; 2 months later she was unable to walk. Neurologic examination disclosed severe ataxia. Imaging studies of the brain did not show discrete parenchymal lesions or vascular occlusion; there was cerebellar atrophy. A diagnostic procedure was performed.
Nonprofit hospitals agree to operate for charitable purposes in exchange for exemption from taxes. As financial pressures facing hospitals have intensified, the business decisions of nonprofit hospitals are being challenged by the Internal Revenue Service, state attorneys general, and patients. Uninsured patients have joined class-action lawsuits arguing that nonprofit hospitals are abandoning their charitable missions and accusing them of overcharging uninsured patients and of using aggressive debt-collection measures when uninsured patients cannot pay their bills.
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