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In a randomized trial, 2161 patients with peripheral arterial disease were assigned to combination therapy with an antiplatelet agent and an oral anticoagulant or to antiplatelet therapy alone. At a mean follow-up of 35 months, the rate of myocardial infarction, stroke, or death from cardiovascular causes was not significantly different between the two groups. The group receiving combination therapy had a significantly higher rate of life-threatening bleeding.
In this randomized trial involving 662 patients with moderate-to-severe Crohn's disease, 23% of patients who were treated with certolizumab pegol (a pegylated humanized Fab′ fragment that binds tumor necrosis factor) had a response at both 6 and 26 weeks, as compared with 16% of patients treated with placebo (P=0.02). Rates of remission did not differ significantly between the two study groups. Serious infections were reported in 2% of patients in the certolizumab group and in less than 1% in the placebo group.
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Patients who had a response to open-label induction treatment with certolizumab pegol were randomly assigned to receive maintenance treatment with certolizumab pegol or placebo. At 26 weeks, more patients in the certolizumab group than in the placebo group had maintained their response (63% vs. 36%, P<0.001). Serious infection occurred in 3% of patients in the certolizumab group and in less than 1% in the placebo group.
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In vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) is effective for male-factor infertility; its role for other forms of infertility is unclear. ICSI is more costly than IVF alone and may confer more risks. In the United States from 1995 to 2004, the use of ICSI increased dramatically, while diagnoses of male-factor infertility remained stable. These data suggest that guidance regarding the appropriate use of ICSI is warranted.
A 28-year-old woman with recently diagnosed chronic myelogenous leukemia (CML) presents for consideration of appropriate treatment. No siblings are available as candidate donors for stem-cell transplantation. Imatinib, an inhibitor of the BCR-ABL tyrosine kinase present in almost all CML, is recommended. The patient may need to take imatinib indefinitely to maintain suppression of abnormal bone marrow clones.
Once foods in the United States were fortified with vitamin D, rickets appeared to have been conquered, and many considered major health problems from vitamin D deficiency resolved. But vitamin D deficiency is common. This review considers the role of vitamin D in skeletal and nonskeletal health and suggests strategies for the prevention and treatment of vitamin D deficiency.
A 38-year-old woman came to the Gastrointestinal Cancer Genetics Clinic of this hospital because of a family history of breast and gastric cancer. Her mother had died of gastric cancer, and her maternal aunt had bilateral breast cancer and died of gastric cancer. Screening upper gastrointestinal endoscopy had been negative in the patient. A diagnostic procedure was performed.
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