January 24, 2002
Voriconazole as Empirical Antifungal Therapy in Patients with Neutropenia and Persistent Fever
This large, randomized, multicenter trial compared voriconazole, a second-generation triazole, with liposomal amphotericin B as empirical antifungal therapy for 837 patients with persistent fever and neutropenia. The success rates in terms of composite outcome were similar: 26.0 percent with voriconazole and 30.6 percent with amphotericin B. There were fewer breakthrough fungal infections among those treated with voriconazole (1.9 percent vs. 5.0 percent). Voriconazole may be an acceptable alternative to amphotericin B preparations. There were fewer infusion-related reactions and less evidence of nephrotoxicity with voriconazole. However, many patients taking voriconazole reported transient visual changes or hallucinations.
|
|||||
Rituximab in Combination with CHOP Chemotherapy for Diffuse Large-B-Cell Lymphoma in Elderly Patients
This trial compared a combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) with CHOP plus rituximab, a monoclonal antibody against a surface protein (CD20) on lymphoma cells, in elderly patients with diffuse large-B-cell lymphoma. As compared with CHOP alone, CHOP plus rituximab had superior results without an increase in toxicity. The standard treatment for diffuse large-B-cell lymphoma is CHOP. Results in patients over 60 years old, however, have been unsatisfactory. In this rigorously conducted study, the benefit of adding rituximab was clear-cut. The results are likely to change the management of diffuse large-B-cell lymphoma, the most common form of non-Hodgkin's lymphoma.
|
|||||
A Deletion Involving the Connexin 30 Gene in Nonsyndromic Prelingual Hearing Impairment
Up to half of patients with congenital autosomal recessive nonsyndromic deafness have mutations in the gene encoding the gap-junction protein connexin 26 (GJB2); the rest have had no identifiable mutations. In this study, patients with this form of deafness who had one mutant GJB2 allele were found to have a novel 342-kb deletion that truncates the gene encoding another gap-junction protein, connexin 30 (GJB6). Twenty-two of the 33 subjects studied were heterozygous for both mutations and 2 were homozygous for the GJB6 mutation. These data extend our understanding of heritable causes of deafness. Homozygous mutations in either GJB2 or GJB6 or heterozygous mutations in both genes can result in prelingual deafness.
|
|||||
Frequency of Uterine Contractions and the Risk of Preterm Delivery
Although randomized clinical trials have failed to show that ambulatory monitoring of contractions is effective in reducing the risk of preterm delivery, such monitoring continues to be used in clinical practice. In this prospective study, 306 women (most of whom were considered to be at high risk for preterm delivery) used a home contraction monitor from 22 to 24 weeks of gestation until delivery or 37 weeks. No threshold frequency of contractions or other clinical measure effectively identified women who delivered before 35 weeks. Measurement of the frequency of uterine contractions is not useful in clinical practice to predict preterm delivery.
|
|||||
Migraine is a common and sometimes debilitating disorder. This review describes the epidemiology, pathophysiology, and preventive and symptomatic treatment of migraine, with special attention to drug therapy with the triptans.
|
|||||
Case Records of the Massachusetts General Hospital: Case 3-2002
A 17-year-old boy was admitted to the hospital with abdominal pain exacerbated by eating and accompanied by nausea. The serum aspartate aminotransferase level was 119 U per liter.
|
|||||
Sounding Board: Maintaining the Public Trust in Clinical Research
Financial conflicts of interest are present in many types of medical research. Until recently there has been no unified effort to address the many problems that arise because of such conflicts. The Association of American Medical Colleges recently approved guidelines for dealing with individual, as opposed to institutional, conflicts of interest. In this Sounding Board article, Kelch outlines the many features of the guidelines and urges their widespread adoption.
|
|||||
HOME | SUBSCRIBE | SEARCH | CURRENT ISSUE | PAST ISSUES | COLLECTIONS | PRIVACY | TERMS OF USE | HELP | beta.nejm.org Comments and questions? Please contact us. The New England Journal of Medicine is owned, published, and copyrighted © 2009 Massachusetts Medical Society. All rights reserved. |