Coronary Magnetic Resonance Angiography for the Detection of Coronary Stenoses

This study compared a noninvasive approach to the diagnosis of coronary disease, coronary magnetic resonance angiography, with standard invasive x-ray coronary angiography. Magnetic resonance angiography accurately detected proximal and mid-coronary stenoses, especially three-vessel and left main coronary artery disease. It was particularly effective in ruling out coronary disease.

An accurate, noninvasive approach to the diagnosis of coronary disease would represent a substantial advance. In its current state of development, magnetic resonance angiography is useful in diagnosing advanced coronary disease and in ruling out coronary disease.

Related Editorial

High-Dose Intravenous Immune Globulin for Stiff-Person Syndrome

Patients with stiff-person syndrome, a disabling central nervous system disease with no effective therapy, are plagued by muscle rigidity and episodes of muscle spasm. Patients have high titers of antibodies against glutamic acid decarboxylase (anti-GAD65), suggesting an autoimmune pathogenesis. In this study, 16 patients were randomly assigned to receive either placebo or intravenous immune globulin for three months, followed by a washout period and then three months of therapy with the other agent. Eleven of the 14 patients who completed the study had a marked improvement in their condition with active therapy.

Intravenous immune globulin is a safe and effective, though costly, therapy for patients with stiff-person syndrome and anti-GAD65 antibodies.

Serologic Markers of Epstein–Barr Virus Infection and Nasopharyngeal Carcinoma

Almost 9700 men were tested for IgA antibodies against Epstein–Barr virus (EBV) capsid antigen and neutralizing antibodies against EBV DNase (both antibodies that are strongly associated with nasopharyngeal carcinoma). The men were then followed for up to 16 years. Subjects with either or both types of antibody had a much higher risk of nasopharyngeal carcinoma than seronegative subjects.

This large-scale, prospective, epidemiologic study provides convincing evidence that EBV infection not only occurs long before the development of nasopharyngeal carcinoma but also is an important risk factor for the disease. Screening of high-risk populations for the antibodies used in this study could help in the early diagnosis of nasopharyngeal carcinoma.

Octreotide for Tumor-Induced Osteomalacia

This Brief Report describes a patient with the rare syndrome of tumor-induced osteomalacia, which is accompanied by phosphaturia and hypophosphatemia. Renal phosphate wasting, presumably caused by phosphatonins, was abolished by octreotide, a synthetic somatostatin analogue, before successful surgical removal of a benign hemangiopericytoma.

The patient's response to octreotide therapy suggests that phosphate metabolism involves secretory mechanisms that may be modulated by somatostatin receptors. Whether this holds true only under pathologic conditions or is relevant to normal states remains to be seen.

Medical Progress: Head and Neck Cancer

Head and neck cancers include neoplasms of the oral cavity, pharynx, and larynx. The risk of these cancers is strongly associated with smoking and alcohol ingestion. There have been important advances in understanding of the molecular pathogenesis and progression of head and neck cancer and also in approaches to therapy, which include innovations in surgery, radiation therapy, and cytotoxic-drug therapy.

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