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In this randomized comparison of stenting and endarterectomy as treatment for carotid-artery stenosis, there was no significant difference in the rate of the composite primary end point of stroke, myocardial infarction, or death (7.2% and 6.8%, respectively; P=0.51). Stroke was more common with carotid-artery stenting than carotid endarterectomy; myocardial infarction was more common with carotid endarterectomy. The 4-year rate of stroke or death was 6.4% for carotid-artery stenting and 4.7% for carotid endarterectomy (P=0.03).
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Human papillomavirus (HPV)–associated oropharyngeal squamous-cell carcinoma differs from oropharyngeal cancers caused by tobacco and other factors. In this study, patients with oropharyngeal cancer were treated with cisplatin plus radiation therapy; the 3-year rate of overall survival was 82.4% among patients with HPV-positive tumors and 57.1% among patients with HPV-negative tumors. HPV status is an independent prognostic factor for survival among patients with oropharyngeal squamous-cell carcinoma.
An entirely subcutaneous implantable cardioverter–defibrillator without transvenous or epicardial leads was evaluated in two short-term trials to identify a suitable device configuration and assess energy requirements. In a 6-patient, long-term pilot study and a 55-patient, single-group trial, the cardioverter–defibrillator consistently detected and converted induced ventricular fibrillation and detected and treated all 12 episodes of spontaneous ventricular tachyarrhythmia.
This article shows that there are substantial variations in diagnostic practices in different regions of the United States. These variations have an important effect on risk adjustment, which, according to the authors, may introduce biases in comparative-effectiveness research, public reporting, and payment reforms.
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The large variation in Medicare spending across geographic areas has raised concern about inappropriate spending in some areas. In this study, the authors assessed how differences in patients' characteristics contribute to variation in spending. In unadjusted analyses, spending was 52% higher in areas in the highest quintile of per-beneficiary spending than in the lowest quintile. After adjustment for demographic and health-status variables, the difference was reduced to 33%.
A 23-year-old woman presents with migraine headaches that are unresponsive to analgesics. Triptan therapy is recommended. Triptans are serotonin agonists that were originally thought to provide migraine relief by causing cranial vasoconstriction; other mechanisms are now also proposed. Chest pain is a common side effect, but cardiac ischemia is rare and usually associated with known cardiovascular disease or risk factors.
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