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This randomized, controlled trial involving more than 10,000 Canadian women investigated Papanicolaou (Pap) cytologic testing and human papillomavirus (HPV) DNA testing in screening for high-grade cervical intraepithelial neoplasia (CIN). All women received both tests. Biopsies, colposcopies, and excisional procedures were performed when indicated. The HPV test was found to be more sensitive than the Pap test.
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This Swedish study demonstrates the value of adding a test for HPV DNA to the Pap test for cervical-cancer screening. High-grade (grade 2 or 3) CIN was found more frequently in the initial screening of women who had both tests, and the incidence of grade 3 CIN lesions was reduced in later screening of women who had both tests.
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In this randomized trial of patients with Bell's palsy, recovery at 9 months was achieved in 94% of patients treated with prednisolone within 72 hours after the onset of symptoms and in 82% of patients not treated with prednisolone (P<0.001); recovery rates were 85% and 91% with and without acyclovir, respectively (P=0.10). Early treatment with prednisolone significantly improved recovery in patients with Bell's palsy; treatment with acyclovir did not.
Identifying the gene that underlies the hyper-IgE immune syndrome — also known as Job's syndrome — has been a challenge. Affected persons typically have extremely high levels of IgE and are susceptible to cold staphylococcal abscesses, pneumonia, and eczema. The cause of this disease is now established: mutations in STAT3.
A 45-year-old white woman presents with a 1-year history of scalp-hair loss. She was hospitalized with appendicitis 14 months ago. She has been a vegetarian for 20 years. She takes no medications. Her father was bald. On physical examination, she has diffuse, nonscarring hair thinning with a widened part over the central portion of the scalp. How should this problem be evaluated and treated?
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Early administration of reperfusion therapy improves survival among patients with ST-elevation myocardial infarction. For primary percutaneous intervention, a goal of 90 minutes or less for door-to-balloon time is incorporated into many measures of quality performance, but delay remains common, with little improvement in this measure over recent years. This review examines the strategies for reducing door-to-balloon time and for selecting the appropriate reperfusion therapy, especially when a delay is unavoidable.
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A 62-year-old woman with a history of breast cancer was found to have a mass in the contralateral breast on magnetic resonance imaging performed for follow-up of the first cancer. Excision of the mass and examination of the biopsy specimen showed infiltrating and in situ ductal carcinoma, grade 3 of 3, positive for human epidermal growth factor receptor 2. Options for management are discussed in a multidisciplinary setting.
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