Ventricular Assist Device for End-Stage Heart Failure

Mechanical left ventricular assist devices have been used as a bridge to cardiac transplantation, but not as long-term therapy. In this study of patients with severe heart failure who were not candidates for transplantation, left ventricular assist was compared with optimal medical therapy. The one-year survival rate was 52 percent in the device group and 25 percent in the medical-therapy group. The device permitted patients to be ambulatory and improved the quality of life.

There are formidable problems with the long-term use of left ventricular assist devices, including infection, bleeding, and malfunction of the device. Nonetheless, this study demonstrates feasibility and is an important step in the further development of artificial-heart technology.

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Warfarin or Aspirin to Prevent Recurrent Ischemic Stroke?

Patients who have had an ischemic stroke are at risk of having another. Warfarin is the treatment of choice for the prevention of recurrent cardioembolic stroke. In this study, warfarin and aspirin were compared in the prevention of recurrent ischemic stroke due to causes other than cardioembolism. There was no significant difference between the warfarin and aspirin groups in either the rate of recurrence of ischemic stroke or the rate of hemorrhagic complications.

Because warfarin and aspirin had similar efficacy and safety, both should be considered reasonable therapeutic alternatives.

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Treatment of Acute Hepatitis C with Interferon-alfa 2b

Chronic infection often develops in people who are infected with the hepatitis C virus (HCV). Such infection is difficult to eradicate and can eventually lead to end-stage liver disease. In this study, 44 patients with acute hepatitis C received 24 weeks of treatment with interferon alfa-2b in an attempt to prevent chronic infection. At the end of therapy, as well as 24 weeks later, 43 of the patients had undetectable levels of HCV RNA in serum.

Treatment of acute hepatitis C with interferon-alfa 2b may prevent chronic infection. In many people with HCV infection, the disease is not apparent until after it has become chronic. Others, such as those infected through needle-stick injuries or medical procedures, may come to medical attention quickly, and they could benefit from immediate treatment.

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Transmission of T-Cell Lymphoma by Bone Marrow Transplantation

A 19-year-old woman with an aggressive lymphoma received a bone marrow transplant from her sister. Three and a half years later subcutaneous panniculitic T-cell lymphoma was diagnosed in the donor; the same rare tumor appeared in the recipient four and a half years after transplantation. The tumors had identical molecular features.

The development of neoplasms of donor origin in recipients of bone marrow transplants is rare. Some cases are due to the transformation of donor B cells by Epstein-Barr virus in the recipient. In this case, however, immunosuppression of the recipient and the fact that the two sisters were HLA-identical probably allowed the few tumor cells that were transferred with the marrow to take root and proliferate.

Current Concepts: Chronic Thromboembolic Pulmonary Hypertension

One cause of pulmonary hypertension is chronic thromboembolic obstruction of the pulmonary arteries. If this condition is recognized, thromboendarterectomy can lead to improvements in hemodynamics and in survival.

Medical Progress: Sudden Death from Cardiac Arrhythmias

This review article summarizes important changes in our approach to the serious public health problem of sudden death from ventricular arrhythmias.

Special Report: Stress Reactions after the September 11, 2001, Terrorist Attacks

After the September 11 terrorist attacks, Americans experienced symptoms of psychological stress. This survey of U.S. adults performed just five days after the attacks quantifies the extent of the stress reactions.

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