This controlled trial was conducted in 1484 heterosexual couples in whom one partner had symptomatic genital herpes simplex virus type 2 (HSV-2) infection. Daily treatment of the infected partner with valacyclovir was associated with a lower rate of acquisition of HSV-2 by the uninfected partner (1.9 percent, vs. 3.6 percent in the placebo group).

Valacyclovir treatment reduces shedding of HSV-2 on genital mucosal surfaces and can reduce the rate of transmission of genital herpes among infection-discordant couples. This treatment strategy was studied as an addition to the use of condoms and safer sex practices.

The use of cardiopulmonary bypass in coronary-artery surgery ("on pump") provides a bloodless operative field and a nonbeating heart but may carry a risk of neurocognitive dysfunction. Thus, there has been interest in "off-pump" surgery as an alternative. This single-center study found that the rate of graft patency at three months was lower with off-pump surgery than with on-pump surgery (88 percent vs. 98 percent).

The lower graft-patency rate with off-pump surgery has adverse implications for long-term clinical outcomes associated with this surgical approach.

Inflammation is believed to have a key role in atherosclerosis. Leukotrienes are important inflammatory mediators generated from arachidonic acid by the enzyme 5-lipoxygenase. This study found that variant genotypes of the 5-lipoxygenase gene, which lacked the common allele, were associated with an increase in intima– media thickness of the carotid artery. A diet high in arachidonic acid further increased the effect of the gene on this measurement.

This study has found a gene–diet interaction that appears to be involved in the pathogenesis of atherosclerosis.

An otherwise healthy 23-year-old man presents after the acute onset of watery diarrhea that has persisted for two days. He reports associated nausea and cramping but no emesis and is febrile, with a temperature of 38.7°C (101.7°F). How should he be evaluated and treated?

The risk of blindness from diabetic retinopathy, the most severe ocular complication of diabetes, has greatly diminished, owing to advances in management. This review discusses the spectrum of clinical manifestations of diabetic retinopathy, with particular attention to new aspects of management. Since diabetes is common, diabetic retinopathy remains an important medical problem for affected patients and those caring for them.

A 51-year-old woman was admitted to a community hospital with a six-week history of progressive shortness of breath. She had initially noted dyspnea when climbing stairs at work, and by the time of admission it prevented her from walking approximately 4.6 m (15 ft).

This article reviews the subjective and objective indicators of dissatisfaction with medical practice. Discontent seems to have increased substantially during the past two decades, after a period of unprecedented satisfaction within the medical profession. Some of the sources of dissatisfaction include pressures from managed-care systems, the malpractice crisis, aggravation with bureaucratic red tape, and constant time pressures. However, most physicians still take satisfaction in their work.