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In this large randomized trial (SYNTAX), patients with three-vessel or left main coronary artery disease were randomly assigned to undergo revascularization by means of either percutaneous coronary intervention (PCI) involving drug-eluting stents or coronary-artery bypass grafting (CABG). The need for repeat revascularization was lower, but the risk of stroke was higher, with CABG than with PCI. This tradeoff needs to be considered in making decisions about the treatment of patients with advanced coronary disease.
Asthma exacerbations are characterized by increased symptoms of cough and chest tightness, diminished expiratory airflow, and increased numbers of inflammatory cells in the sputum. In these two small “proof of concept” trials involving patients with eosinophilic asthma and a history of exacerbations, patients treated with an antibody directed against interleukin-5 had fewer exacerbations than did those given placebo.
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A 40-year-old woman in whom Graves' disease was recently diagnosed comes for a follow-up visit. She has been taking methimazole, at a dose of 10 mg per day, and is now euthyroid, but for the past 3 months, she has had bothersome eye symptoms, including redness, tearing, grittiness, photophobia, diplopia at the extremes of gaze, and ocular pain associated with eye movements. She smokes 10 cigarettes per day. How should Graves' ophthalmopathy be managed?
Current estimates suggest that as many as 300 million people worldwide have asthma and atopy. Yet despite the persistently high prevalence of disease, the most recently available data indicate improved outcomes, with fewer annual hospitalizations for asthmatic attacks and fewer asthma-related deaths. Improved management is a likely reason for this improved outcome. This article discusses recent advances and current practice in the management of asthma.
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Medicare's expenditures on medical imaging have grown dramatically in recent years, with spending on computed tomography, magnetic resonance imaging, and positron-emission tomography increasing from $3.6 billion in 2000 to $7.6 billion in 2006 — more rapid growth than in any other service billed by physicians. John Iglehart discusses recent changes in Medicare policies that have reduced payments for imaging studies and the ongoing debate about new policy proposals to reduce the use of expensive imaging studies.
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