July 24, 2003
July 24, 2003
Bone Loss and Bone Size after Menopause |
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Screening with the PSA Test The failure to perform prostate biopsy in all members of a screened population affects the sensitivity and specificity of the measurement of prostate-specific antigen (PSA). Correction for verification bias with the use of a mathematical method revealed that the usual threshold value of 4.1 ng of PSA per milliliter for a recommendation of biopsy misses 82 percent of prostate cancers in men younger than 60 years and 65 percent in older men. The authors of this provocative study argue that the threshold for prostate biopsy should be lowered, perhaps to 2.6 ng of PSA per milliliter, especially for men under 60 years of age.
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Acquired von Willebrand Syndrome in Aortic Stenosis Some patients with aortic stenosis have a bleeding tendency that may result, as this study shows, from an acquired form of von Willebrand syndrome. High shear forces at the stenotic valve change the shape of the von Willebrand protein, resulting in proteolysis, loss of the largest multimers, and reduction in platelet adhesion to the vascular endothelium. Because the clotting function improved after valve replacement, the authors suggest that a bleeding tendency may be an indication for valve replacement in selected patients with aortic stenosis.
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Epidermal Growth Factor Enemas to Treat Ulcerative Colitis and Proctitis This small, placebo-controlled, randomized trial evaluated the direct application of epidermal growth factor (EGF) and oral 5-aminosalicylic acid (a conventional therapy). After 2 weeks, most patients given EGF enemas were in remission, and they continued to do well at 4 and 12 weeks. These data prove the principle that ulcerative colitis and proctitis respond to locally applied EGF.
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Refusing Food and Drink to Hasten Death In Oregon, 102 hospice nurses reported having cared for a patient who decided to stop eating and drinking, usually because the patient was ready to die. Most of these patients died within 15 days, and most died without excess suffering. Although physician-assisted suicide is legal in Oregon, refusal of food and fluids may be a more common way by which patients choose to end their lives. Most who died this way did so peacefully.
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Mechanisms of Disease: Prostate Cancer |
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