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April 19, 2001
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Developmental Outcomes after Placement of Tympanostomy Tubes for Persistent Otitis Media
Children with persistent otitis media and effusion often receive tympanostomy tubes, because of concern that hearing, speech, and cognitive development may be impaired. In this study, 429 young children who had persistent effusion were randomly assigned to have tympanostomy tubes inserted either as soon as possible or up to nine months later if the effusion persisted. There were no significant differences between the two study groups in scores on tests of speech, language, cognition, parent-child stress, and behavior.
The treatment of otitis media with effusion often consists of the insertion of tympanostomy tubes. The results of this study indicate that the procedure has little long-term benefit with respect to hearing, behavior, or cognitive development.
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Role of Adjuvant Adenoidectomy and Tonsillectomy in the Outcome of the Insertion of Tympanostomy Tubes
The usual surgical treatment for children with otitis media is myringotomy with insertion of tympanostomy tubes. In this study of 37,316 children who received tympanostomy tubes, adjuvant adenoidectomy reduced the likelihood of the reinsertion of tympanostomy tubes and rehospitalization for conditions related to otitis media by half. Adjuvant adenotonsillectomy was even more beneficial.
Adjuvant adenoidectomy and adenotonsillectomy reduce the need for rehospitalization for additional procedures related to otitis media. The extent to which they reduce the likelihood of recurrence of otitis media that does not require further invasive procedures is uncertain but is probably substantial.
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Molecular Predictors of Survival after Chemotherapy for Colon Cancer
In this study, more than 450 tumor specimens from patients with stage III and high-risk stage II colon cancer were evaluated for a variety of molecular abnormalities, and the results were analyzed in relation to survival after adjuvant chemotherapy. Loss of genetic material from the long arm of chromosome 18 correlated with short survival, whereas a combination of high levels of microsatellite instability and a mutation in the gene for the type II receptor for transforming growth factor (beta)1 was associated with a good prognosis.
Postoperative chemotherapy remains the mainstay of treatment for most patients with moderately advanced colon cancer, but the decision to administer it is not always easy. This study points the way to individualized treatment based on the molecular profile of the patient's tumor.
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Cognitive Function in Postmenopausal Women Treated with Raloxifene
There is conflicting evidence about whether the administration of estrogen to postmenopausal women slows the age-related decline in cognitive function or even improves cognitive function. This study evaluated the effects of raloxifene, a selective estrogen-receptor modulator, on scores on six tests of cognitive function in more than 7000 postmenopausal women. The study was designed primarily to evaluate the effect of raloxifene on osteoporosis, for which it proved effective, but tests of cognitive function were included. As compared with placebo, raloxifene had no effect on cognitive function, but more of the women who took raloxifene had hot flashes.
Drugs such as raloxifene act as estrogen agonists in bone but as estrogen antagonists in breast and endometrial tissue, as well as in hypothalamic tissue, and they therefore cause an increase in hot flashes. The absence of an effect of raloxifene on cognitive function does not detract from its beneficial action on bone but also does not increase its value. From a physiological perspective, the absence of an effect of raloxifene on cognition helps little in determining whether estrogen itself affects cognition in postmenopausal women.
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Current Concepts: The Diagnosis of Brain Death
The clinical neurologic examination remains the standard for the determination of brain death. This review details the procedures that should be followed in such an examination and explains the role of confirmatory tests such as cerebral angiography, electroencephalography, and technetium nuclear scanning.
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Medical Progress: Genetic Susceptibility to Venous Thrombosis
This article is a comprehensive review of the mechanisms, diagnosis, and management of genetic disorders that increase susceptibility to venous thrombosis. Examples include mutations in the genes encoding factor V (factor V Leiden) and prothrombin.
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