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This randomized trial of the surgical treatment of curable gastric cancer in Japan compared gastrectomy and extended (D2) lymphadenectomy with gastrectomy and D2 lymphadenectomy plus para-aortic nodal dissection (PAND). There were no significant differences in overall survival between the two groups. Gastrectomy with D2 lymphadenectomy remains the preferred surgical treatment for curable gastric cancer in Japan.
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Women-controlled methods to prevent male-to-female transmission of human immunodeficiency virus (HIV) are needed. In this study of vaginally applied 6% cellulose sulfate gel conducted in India and Africa, 1398 women were randomly assigned to use the gel or placebo before sexual acts. Use of the gel did not prevent the acquisition of HIV or other sexually transmitted infections and may have increased the risk of HIV infection.
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Experimental evidence suggests that cyclosporine may attenuate myocardial reperfusion injury. In a pilot trial, 58 patients with acute ST-elevation myocardial infarction were randomly assigned to receive an intravenous bolus of either cyclosporine or saline immediately before undergoing percutaneous coronary intervention. Creatine kinase release was significantly reduced in the patients who received cyclosporine. These results require confirmation in a larger trial.
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After enactment of a law in Scotland that prohibited smoking in public places, the number of hospital admissions for acute coronary syndrome decreased by 17%. The decrease was greater among persons who had never smoked than among smokers, suggesting that the reduction in passive smoking had a public health benefit.
Malignant gliomas, the most common type of primary brain tumor in adults, are associated with disproportionate cancer-related morbidity and mortality. Recently, there have been important advances in our understanding of the molecular pathogenesis of malignant gliomas and progress in treating them. This review summarizes the diagnosis and management of these tumors in adults, highlighting new advances.
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A 35-year-old woman was admitted to the psychiatry service 5 days after the birth of her first child because of confusion, agitation, and delusions. A diagnosis of bipolar disorder had been made 2 years earlier, which was treated with lithium and citalopram. She discontinued her medications to become pregnant and had stated that if a relapse occurred, she should not be given medications that would prevent her from breast-feeding her infant.
The author discusses the case of Coombes v. Florio, in which the Massachusetts Supreme Judicial Court overturned a trial judge's ruling to dismiss a lawsuit against a physician whose patient was the driver in a car accident that resulted in the death of a child. The trial judge had ruled that physicians' responsibilities were restricted to their patients, whereas the court ruled that the victim of a car accident can sue the driver's physician if the physician has failed to inform the patient about medication side effects that may impair driving.
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