This Week in the Journal

This Week in the Journal

March 27, 2003

Novel Fusion Protein as a Target of Imatinib in the Hypereosinophilic Syndrome

A fusion between the PDGFRA and FIP1L1 genes was found in somecases of the hypereosinophilic syndrome, a fatal disorder inwhich eosinophils invade and destroy various organs. The fusionprotein is a constitutively active tyrosine kinase, which explainsthe effect of imatinib, an inhibitor of tyrosine kinases, inthe disease. The immortalization of hematopoietic cells by thefusion protein indicates its role in causing the syndrome.

A novel fusion of two genes, a novel mechanism of the fusion,and a novel gene product are at the heart of this report. Althoughthe hypereosinophilic syndrome is rare, these findings haveimplications for finding molecular defects in other cancers.

Related Perspective

Silent Brain Infarcts and the Risk of Cognitive Decline

Silent brain infarcts (i.e., infarcts without associated neurologicsymptoms) are common, and their clinical significance is unclear.In this population-based study, elderly people without dementiaunderwent cognitive testing and magnetic resonance imaging in1995 to 1996 and again in 1999 to 2000. Dementia was more thantwice as likely to develop in participants who had silent braininfarcts at base line.

The incidental finding of an infarct on brain imaging is clinicallyrelevant; silent infarcts are associated with an increased riskof cognitive decline.

Related Editorial

Oral Opioid Therapy for Neuropathic Pain

Pain occurring after central nervous system or peripheral-nerveinjury is known as neuropathic pain and is notoriously difficultto treat. Many physicians have avoided the use of opiates totreat this type of pain for fear of addiction or loss of efficacydue to tolerance. In this eight-week study, patients with neuropathicpain who were treated with high-strength levorphanol tabletshad less intense pain than patients assigned to low-strengthtablets but had more side effects.

High-strength levorphanol was successful in reducing neuropathicpain, but there was substantial residual untreated pain. Betteroverall approaches to neuropathic pain are needed.

Related Editorial

Obstructive Sleep Apnea in Heart Failure

Obstructive sleep apnea may exacerbate the manifestations ofheart failure, because it causes hypoxia and activation of thesympathetic nervous system, leading to increases in the heartrate and blood pressure. In this study, continuous positiveairway pressure was found to reduce systolic blood pressureand increase left ventricular function in patients with heartfailure and obstructive sleep apnea.

Since obstructive sleep apnea may occur in up to one third ofthose with heart failure, continuous positive airway pressuremay be beneficial in a substantial proportion of such patients.

Painful Sensory Neuropathy

A 67-year-old woman who had been in excellent health noticedthe onset of burning pain in the left great toe two years beforeevaluation. The pain subsequently extended to involve both feet,from the toes to the heels, and was associated with numbness,tingling, and burning. The discomfort has become severe, ispresent throughout the day, and disrupts sleep. A physical examinationreveals normal muscle strength, muscle-stretch reflexes, proprioception,and vibratory sensation; only pinprick sensation in the toesand feet is diminished. How should this patient be evaluatedand treated?

Medical Progress: How Contagious Are Common Respiratory Tract Infections?

The answer to this frequently asked question is addressed inthis review article, which focuses on common respiratory tractinfections that are spread from person to person. The authorconcentrates on community-based contagion rather than nosocomialinfections or agents that have received recent attention principallybecause of their actual or potential role in biologic terrorism.

Atrial Fibrillation — Rate versus Rhythm Control
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Caspofungin versus Amphotericin B for Invasive Candidiasis
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Specialty of Ambulatory Care Physicians and Mortality after Myocardial Infarction
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Management of Latent Tuberculosis Infection in Immigrants
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Treatment of Latent Tuberculosis Infection
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Postpartum Depression
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A Clinical-Skills Examination for Medical Students?
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