August 14, 2003
August 14, 2003
Intensity of Warfarin Therapy to Prevent Recurrent Venous Thromboembolism |
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Long-Term Survivors of Childhood Acute Lymphoblastic Leukemia Survivors of acute lymphoblastic leukemia who had been in complete remission for at least 10 years and had not received radiation therapy had a negligible risk of recurrent leukemia and a survival equal to that of the general U.S. population. Survivors who had undergone cranial or craniospinal irradiation had slightly reduced rates of health insurance coverage, employment, and (among women) marriage. A person treated for acute lymphoblastic leukemia who did not receive radiation therapy and who remains healthy for 10 years or more after therapy should be considered cured of the disease.
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Psychiatric Hospitalizations among Survivors of Cancer in Childhood or Adolescence This nationwide Danish study found no evidence that survivors of childhood or adolescent cancer were susceptible to serious psychiatric disorders later in life, except for survivors of brain tumor. The lingering concern about serious psychiatric sequelae among survivors of childhood cancer appears to have been put to rest by this large study.
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Methotrexate versus Cyclosporine for Moderate-to-Severe Chronic Plaque Psoriasis Although methotrexate and cyclosporine are both effective treatments for psoriasis, their comparative efficacy has not been established. This trial compared the two drugs and found them to be similarly effective. Each was associated with specific but limited side effects. Moderate-to-severe psoriasis responds equally well to methotrexate or cyclosporine. The potential side effects of each drug should be considered in individual treatment decisions.
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Estimating the Number of Potential Organ Donors in the United States Waiting lists for organ transplantation are growing. This study examined numbers of potential organ donors and actual organ donations from 1997 through 1999 in areas of the United States that are served by 36 organ-procurement organizations. Hospitals with 150 or more beds had significantly higher proportions of potential donors and actual donors than smaller hospitals; 19 percent of hospitals accounted for 80 percent of all potential donors. Resources invested in improving the consent process in larger hospitals should maximize the rate of organ recovery.
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Management of Long-Term Oral Anticoagulation A 75-year-old man with diabetes mellitus is found to have chronic atrial fibrillation, and warfarin therapy is begun for the prevention of thromboembolic stroke. How should the anticoagulant therapy be initiated and managed?
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Current Concepts: Acute Cardiac Tamponade Acute cardiac tamponade is life threatening and requires prompt pericardial drainage. This review explains the manifestations of tamponade, including a presentation in which the diagnostic finding of pulsus paradoxus is absent, and variant forms, such as low-pressure tamponade and regional tamponade.
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