In hospitals with angioplasty facilities, coronary angioplasty is the preferred approach to revascularization in patients with acute myocardial infarction. In this Danish study, patients initially admitted to hospitals without angioplasty facilities were randomly assigned to receive on-site fibrinolytic therapy or to be transferred to an invasive-treatment center for angioplasty. Despite the time required for transfer, patients assigned to angioplasty had a better outcome than those assigned to fibrinolytic therapy.

Angioplasty should be considered the standard method of revascularization for patients with myocardial infarction.

Related Editorial

This trial of concurrent chemotherapy and granulocyte colony-stimulating factor (G-CSF) for acute myeloid leukemia was based on the ability of G-CSF to heighten the sensitivity of cultured leukemia cells to chemotherapeutic agents. Patients who received the dual treatment ("G-CSF priming") fared better than patients given chemotherapy alone.

G-CSF priming is a novel approach to augmenting the cytotoxicity of chemotherapy without incurring additional myelotoxicity.

Related Perspective

This Brief Report describes recurrent gestational spontaneous ovarian hyperstimulation syndrome in a family with a heterozygous mutation in the transmembrane domain of the receptor for follicle-stimulating hormone (FSH). The mutant receptor responded to human chorionic gonadotropin as well as to follicle-stimulating hormone. A second Brief Report describes another FSH receptor mutation that also leads to gestational ovarian hyperstimulation syndrome.

When the follicle-stimulating hormone receptor responds to more than one ligand, ovarian hyperstimulation syndrome may result.

Related Perspective

The overproduction of endogenous chorionic gonadotropin during pregnancy has been associated with spontaneous ovarian hyperstimulation syndrome. Yet the syndrome has been observed in women with normal levels of chorionic gonadotropin. This Brief Report defines a mutation in the follicle-stimulating hormone (FSH) receptor that is associated with recurrent, spontaneous ovarian hyperstimulation syndrome. In this instance, the mutant receptor responded both to chorionic gonadotropin and to thyrotropin.

Inappropriate stimulation of the follicle-stimulating hormone receptor is a key element in the development of the ovarian hyperstimulation syndrome.

Related Perspective

The authors estimate that the costs of health care administration in the United States are about $1,000 per capita and represent 31 percent of all health care expenditures. Administrative costs in Canada are lower, at roughly $300 per capita and 17 percent of all health care expenditures.

This article updates the estimates of the costs of health care administration made in 1991 by the same authors. Administrative costs in the United States account for almost one third of all health care expenditures and remain substantially higher than those in Canada.

Related Editorial

In this review of recent developments in Canadian health care policy, Detsky and Naylor describe the strains on the system in the 1990s that led to declining satisfaction on the part of the public and providers and to national debate about health care reform. A 2003 agreement between the federal and provincial governments called for a substantial increase in federal funds for health care but no major changes in organization, delivery, or financing.

HOME  |  SUBSCRIBE  |  SEARCH  |  CURRENT ISSUE  |  PAST ISSUES  |  COLLECTIONS  |  PRIVACY  |  HELP  |  beta.nejm.org

Comments and questions? Please contact us.

The New England Journal of Medicine is owned, published, and copyrighted © 2008 Massachusetts Medical Society. All rights reserved.