This Week in the Journal

This Week in the Journal

September 18, 2003

HHV-8 Expression in Primary Pulmonary Hypertension

Human herpesvirus 8 (HHV-8) is believed to cause Kaposi's sarcoma,and the vascular lesions of Kaposi's sarcoma resemble the plexiformlesions of primary pulmonary hypertension. In this study, molecularevidence of HHV-8 was found in the lung tissue of 10 of 16 patientswith primary pulmonary hypertension, but in none of 14 patientswith secondary pulmonary hypertension.

This vasculotropic virus may have a role in the pathogenesisof primary pulmonary hypertension.

Related Perspective

Withdrawal of Mechanical Ventilation in Anticipation of Death in the ICU

The reasons underlying physicians' decisions to withdraw mechanicalventilation from patients in anticipation of their death wereexamined in this observational study. A daily accounting ofpotential reasons for withdrawal was scored and compared withthe eventual outcome. Patients who required vasoactive medications,patients who physicians predicted either had a slim chance ofsurvival or would have severe cognitive impairment if they survived,and patients perceived by their physicians as not wanting lifesupport were those in whom ventilation was withdrawn in anticipationof death.

This study examines the thinking of physicians as they makesome of the most difficult decisions in medicine.

Related Perspective

Intensity of Warfarin for the Prevention of Recurrent Thrombosis

Warfarin can prevent recurrent thrombosis in patients with theantiphospholipid antibody syndrome, but the intensity of anticoagulationis an unsettled matter. In this randomized trial, patients withthe syndrome were assigned to moderate- or high-intensity warfarin.The high-intensity regimen was no more effective than the moderate-intensityregimen.

This trial is a step forward in settling the controversy overthe management of warfarin thromboprophylaxis for patients withthe antiphospholipid antibody syndrome.

Related Editorial

Brief Report: Growth Hormone Insensitivity and STAT5b Mutations

This report documents that the syndrome of growth hormone insensitivity(severe short stature, increased secretion of growth hormone,but low serum concentrations of insulin-like growth factor I[IGF-I] and IGF–binding protein 3) in a teenage girl wasdue to a homozygous missense mutation in the gene for STAT5b,an essential component of the actions of growth hormone, aswell as many other cytokine-induced functions.

Mutations in STAT5b can be responsible for profound growth failure.

Related Perspective

Current Concepts: Molecular Epidemiology of Tuberculosis

The ability to determine the genotype of Mycobacterium tuberculosisis changing our understanding of the dynamics of tuberculosistransmission. This review summarizes the methods of genotypingand explains how they can assist clinical management. Thesetechniques can be used to evaluate tuberculosis-control programsand provide clues to the pathogenesis of tuberculosis infection.

Drug Therapy: Developmental Pharmacology

For those using drugs to treat infants and children, the integrationof developmental pharmacology is crucial to appropriate clinicalpractice. Changes in metabolic capacity, distribution sites,and organ function all affect the way in which medications arehandled in the very young. This review examines the developmentalchanges that profoundly affect the responses of children tomedications and related therapies.

The advances in pediatric clinical pharmacology during the pastdecade stem from an enhanced understanding of the influenceof growth and development on the disposition and actions ofdrugs.

Use of MRI to Detect Lymph-Node Metastases in Prostate Cancer
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Chemotherapy for Hodgkin's Disease
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Radiotherapy for Advanced Hodgkin's Disease
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Staging of Non–Small-Cell Lung Cancer with Integrated PET and CT
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Preventing Fungal Infections in Chronic Granulomatous Disease
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Preventing Lyme Disease
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HIV Infection Masquerading as Monoclonal Gammopathy of Undetermined Significance
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