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A Randomized, Controlled Trial of Surgery for Temporal-Lobe Epilepsy
Whether and when surgical therapy is indicated for temporal-lobe epilepsy is controversial. In this randomized, controlled trial comparing surgery with prolonged medical therapy for temporal-lobe epilepsy, the results support the superiority of surgical therapy. One year after surgery, 58 percent of the patients who were treated surgically, as compared with 8 percent of those who were treated medically, were free of complex partial and generalized seizures, and the quality of life was significantly better in the surgical group.
Temporal-lobe epilepsy is challenging to treat, and surgical therapy has been controversial. This study suggests that carefully chosen patients with uncontrolled temporal-lobe seizures should be evaluated for surgery in order to avert unnecessary disability.
Related Editorial, page 365
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Mutations in the Gene for Bone Morphogenetic Protein Receptor II as a Cause of Primary Pulmonary Hypertension
Familial primary pulmonary hypertension is thought to be uncommon. This study uncovered a large kindred, pieced together from five subfamilies initially thought to be unrelated. A total of 18 members of the kindred had pulmonary hypertension. The genotypes of six affected members and six members believed to be carriers were determined, and all were found to have the same missense mutation in the gene for bone morphogenetic protein receptor II.
Pulmonary hypertension may be familial more often than has previously been recognized, and mutations in the gene encoding bone morphogenetic protein receptor II may be an important cause. Bone morphogenetic protein may have antiproliferative effects in pulmonary vessels, and changes in its receptor caused by mutations may attenuate these effects.
Related Editorial, page 367
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Pulmonary Hypertension in Patients with Hereditary Hemorrhagic Telangiectasia
Patients with hereditary hemorrhagic telangiectasia may have lung disease that is indistinguishable from primary pulmonary hypertension. This study found that the lung disease could involve mutations in the gene encoding activin-receptor-like kinase 1, which are also associated with hereditary hemorrhagic telangiectasia.
These findings provide additional insights into the molecular basis of pulmonary hypertension. Mutations in the gene encoding activin-receptor-like kinase 1 appear to lead to diverse effects, including the vascular dilatation characteristic of hereditary hemorrhagic telangiectasia and the small pulmonary arterial occlusion characteristic of primary pulmonary hypertension.
Related Editorials, pages 367 and 371
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The Pseudomonas Hot-Foot Syndrome
Forty children in Alberta, Canada, presented with painful erythematous nodules on the soles of their feet. All the children had used the same community wading pool within two days before the development of the skin lesions. The plantar lesions resolved with symptomatic treatment in nearly all patients. The strain of Pseudomonas aeruginosa obtained from one patient's plantar pustules was identical to the strain found in water from the wading pool.
P. aeruginosa has been associated with outbreaks of folliculitis after the use of hot tubs and swimming pools, but the warm, tender nodules on the feet of these children appear to be distinct skin lesions. Contaminated water plus trauma from the grit on the floor of the wading pool led to this outbreak.
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Advances in Immunology: Autoimmune Diseases
In Western countries, autoimmune diseases affect almost 5 percent of the population, and some, like rheumatoid arthritis, are important causes of chronic disability and economic loss. This article, part of the Journal 's Immunology series, is a comprehensive review of the classification of autoimmune diseases, the mechanisms that provoke them, and recent advances in treatment.
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Medical Progress: Cardiovascular Complications of Cocaine Use
Cocaine is abused throughout the world. Because it blocks the reuptake of norepinephrine and dopamine in presynaptic neurons, it is a powerful sympathomimetic agent. By this mechanism it can cause constriction of the coronary arteries, along with an increase in myocardial oxygen demand, which together may result in myocardial ischemia or infarction. The use of cocaine is also associated with dilated cardiomyopathy, potentially fatal cardiac arrhythmias, infective endocarditis, and aortic dissection.
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Clinical Problem-Solving: Of Nicks and Time
A 32-year-old man with no history of cardiac disease presented to the emergency department after a syncopal episode. He had smoked "crack" cocaine earlier that evening, and shortly thereafter chest pain developed, followed by a brief loss of consciousness.
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