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In this randomized study, children and adolescents with primary diagnoses of separation anxiety or generalized anxiety disorders or social phobia received cognitive behavioral therapy, sertraline, a combination of these treatments, or placebo for 12 weeks. The results indicate that both cognitive behavioral therapy and sertraline reduced the severity of anxiety in children with anxiety disorders, and a combination of the two therapies had superior response rates.
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Type 1 diabetes and celiac disease, both of which are associated with HLA class II genes, cosegregate in populations, suggesting a common genetic origin. In this article, the authors tested whether any non-HLA loci are shared. They report susceptibility alleles shared by both diseases, indicating that common biologic mechanisms underlie these immune-mediated disorders.
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DNA damage in normal cells triggers a newly discovered pathway that raises intracellular pH, which in turn deaminates and impairs the antiapoptotic Bcl-xL protein, thereby causing an increase in apoptosis. This pathway was found to be suppressed in mature myeloid cells and stem cells from patients with chronic myeloid leukemia and polycythemia vera.
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Current standard therapy for Wegener's granulomatosis and microscopic polyangiitis combines corticosteroids and cyclophosphamide to induce remission, followed by a less toxic immunosuppressant. This prospective, open-label, multicenter trial indicated that the safety and efficacy of azathioprine and methotrexate are similar for maintenance therapy after initial remission in these two conditions.
A 62-year-old man presented with a 5-day history of progressively worsening dyspnea and orthopnea after returning from a 3-day business trip to the Far East. On physical examination, the heart rate was 102 beats per minute and the blood pressure 110/60 mm Hg. The lungs were clear, and the extremities appeared normal. A computed tomographic scan showed multiple thrombi in the pulmonary arteries and a dilated right ventricle. How should this case be managed?
Metastases are the principal cause of death in patients with cancer. Recent advances bring hope that it will be possible to identify the molecules and processes involved in metastasis, and this new knowledge could lead to effective methods of preventing and treating metastases. This review describes the properties of cells that enable them to surmount physical boundaries, disseminate, and colonize a distant organ.
Many distal-extremity injuries can initially be managed in an outpatient setting with the use of basic splinting techniques. Splinting immobilizes injured extremities, prevents further injury, decreases pain and bleeding, and allows healing to begin. This video demonstrates splinting techniques for common injuries.
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A 26-year-old man was seen in the Neuro-Ophthalmology Clinic because of blurred vision and discomfort in the right eye. On examination, there was decreased visual acuity, loss of color vision, a relative afferent pupillary defect, a swollen optic nerve, and visual-field abnormalities. Computed tomography of the orbits and sinuses revealed sinusitis with erosion of the optic canals. A diagnostic procedure was performed.
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