July 3, 2003
July 3, 2003
High-Dose Chemotherapy with Hematopoietic Stem-Cell Rescue for High-Risk Breast Cancer The efficacy of high-dose chemotherapy plus hematopoietic stem-cell rescue for breast cancer with axillary-lymph-node metastases was tested in a multicenter randomized trial. The advantage of the aggressive treatment over conventional therapy was marginal and was confined to women whose tumors expressed little or no HER2/neu. This well-conducted and carefully analyzed study does not support the routine use of high-dose chemotherapy for high- and intermediate-risk breast cancer.
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High-Dose Chemotherapy and Stem-Cell Transplantation in High-Risk Breast Cancer Women with breast cancer and at least 10 involved ipsilateral axillary lymph nodes were randomly assigned to receive postoperative (adjuvant) chemotherapy either alone or followed by high-dose chemotherapy plus hematopoietic stem-cell rescue. After six years, the outcome was the same in the two groups. The concordant results of this trial and another similar study reported in this issue support the use of conventional chemotherapy in women with breast cancer and a high risk of recurrence.
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Nebulized Epinephrine in Acute Bronchiolitis Pediatricians often treat infants who have acute bronchiolitis with inhaled epinephrine, but the efficacy of this treatment has not been established. In this randomized, double-blind, controlled trial involving 194 infants, treatment with nebulized epinephrine did not influence the length of the hospital stay or the respiratory rate. These data suggest that nebulized epinephrine provides no benefit in the treatment of bronchiolitis.
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Treatment of ANCA-Associated Vasculitis This randomized trial involved 144 patients who had generalized vasculitis associated with circulating autoantibodies to neutrophil cytoplasmic antigens (ANCA) that was in remission after initial treatment with cyclophosphamide. The rate of relapse was similar among patients receiving maintenance immunosuppressive treatment with azathioprine and among those receiving maintenance treatment with cyclophosphamide. Early substitution of azathioprine for cyclophosphamide can reduce the rate of toxic effects associated with long-term cyclophosphamide treatment of ANCA-associated vasculitis.
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Brief Report: Nitrous Oxide and MTHFR Deficiency |
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Genomic Medicine: Cardiovascular Disease |
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Valvular Heart Disease in Pregnancy A 29-year-old woman with a history of mitral stenosis who has a St. Jude Medical mitral-valve prosthesis presents for evaluation before attempting to conceive. She is concerned about the risks that pregnancy will confer on her and her child. How should she be evaluated and followed?
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A Gut Feeling A 79-year-old man reports an 18-kg weight loss over the previous six months. Seven months before admission, his house burned down and insomnia and anorexia developed. One month before admission, he began having diffuse abdominal pain that a proton-pump inhibitor did not improve.
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