July 4, 2002
Widespread Coronary Inflammation in Unstable Angina
Inflammation within a vulnerable coronary plaque may cause unstable angina by producing erosion or rupture. This study used measurements of neutrophil myeloperoxidase to assess neutrophil activation in blood from the aorta, femoral vein, and great cardiac vein. The data support the concept that in unstable angina there is widespread inflammation in the coronary bed, not just in a single vulnerable plaque. These findings add to a growing body of evidence that unstable coronary disease is associated with an inflammatory reaction throughout the coronary tree. There may be important therapeutic implications, since treatment of a single unstable plaque may not address the problem of widespread coronary inflammation.
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Comparative Efficacy of Insect Repellents against Mosquito Bites
Insect-borne diseases are a major cause of illness and death worldwide. Insect repellents can reduce the risk of being bitten. In this study, volunteers inserted their arms into standardized mosquito-containing cages, and investigators calculated the elapsed time until the first bite in order to evaluate which repellent products available to consumers in the United States offered the most complete, reliable protection. Products containing high concentrations of N,N-diethyl-3-methylbenzamide (DEET) were most effective, with other products containing IR3535 or botanicals offering far less protection. Only DEET-based repellents provide adequate, long-lasting protection. Non–DEET-based repellents are unreliable in environments in which mosquito-borne diseases pose a substantial threat.
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Polymorphisms Associated with Thrombophilia
It is uncertain whether thrombophilia polymorphisms in women are associated with an increased risk of intrauterine growth restriction in their offspring. In this large case–control study, the presence in the mother or newborn of polymorphisms for methylenetetrahydrofolate reductase (MTHFR) C677T or A1298C, factor V Leiden G1691A, or prothrombin G20210A was not associated with an increased risk of intrauterine growth restriction (defined as birth weight below the 10th percentile). In contrast to a previous report in the Journal involving a smaller sample, the present findings do not indicate that there are associations between several polymorphisms associated with thrombophilia in the mother and a risk of intrauterine growth restriction; such polymorphisms in the newborn also do not appear to confer an increased risk of intrauterine growth restriction.
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Inactivated Varicella Vaccine in Hematopoietic-Cell Recipients
The efficacy of a heat-inactivated varicella vaccine in recipients of hematopoietic-cell transplants was evaluated in a randomized trial in which vaccination was compared with no vaccination. Patients who received the vaccine had a significantly lower incidence of zoster than patients in the control group and recovered clinically significant T-cell immunity against varicella–zoster virus earlier than did the patients who received no vaccine. This trial differs from previous attempts to prevent zoster in recipients of hematopoietic-cell transplants in that the first dose of vaccine was given before, rather than after, transplantation. The results indicate that protective memory T cells evoked by the vaccine can persist despite a myeloablative preparatory regimen.
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Images in Clinical Medicine (Web only): Malaria and Sickle Cell Disease
Although hemoglobin S is considered to be protective against P. falciparum, this is not always the case.
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Clinical Practice: Long-Term Care after Hematopoietic-Cell Transplantation
A 35-year-old man who underwent allogeneic hematopoietic-cell transplantation two years earlier for acute myeloid leukemia has recently moved to a new town. He comes in for a general checkup because he tires easily and has frequent bouts of sinusitis. Physical examination reveals small central cataracts, some patches of vitiligo, and a dry mouth. What are the major issues in the long-term follow-up of patients after successful hematopoietic-cell transplantation? Currently, more than 20,000 patients are alive more than five years after hematopoietic-cell transplantation, and many such patients are followed by primary care providers. This article reviews medical problems specific to this population and approaches to management.
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Hypocapnia, defined as low partial pressure of arterial blood carbon dioxide, is usually well tolerated and often has no apparent effects. Although transient induction of hypocapnia can be lifesaving in patients with severe intracranial hypertension or neonatal pulmonary-artery hypertension, prolonged hypocapnia may adversely influence outcome. In this article, Laffey and Kavanagh review the prevalence and pathogenesis of hypocapnia, as well as the role of hypocapnia in clinical medicine. The authors present a strong case for reconsidering previous recommendations for the induction of profound or prolonged hypocapnia.
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