This large randomized trial compared the standard adjuvant treatment for early breast cancer in postmenopausal women, five years of therapy with tamoxifen (an inhibitor of the estrogen receptor), with two to three years of tamoxifen followed by therapy with exemestane, an aromatase inhibitor, for the balance of the five-year period. Disease-free survival was significantly better in the exemestane group than in the tamoxifen group.

This trial indicates that the sequential use of antiestrogen compounds with different mechanisms of action has the potential to obviate the problem of resistance that has been encountered in women treated only with tamoxifen.

Purine-rich foods and protein intake have been proposed as risk factors for gout, and consumption of dairy products has been proposed as a protective factor. This study prospectively examined the relationship between purported dietary risk factors and the incidence of gout over a 12-year period among 47,150 men who did not have gout at base line; 730 new cases of gout were documented.

The results indicate that the consumption of meat or seafood increases the risk of gout, whereas the consumption of dairy products may reduce the risk.

Calcitonin gene–related peptide (CGRP) dilates cerebral and dural vessels and may contribute to migraine, since cranial CGRP levels have been shown to be elevated in patients with migraine. In this randomized, controlled trial, patients with migraine had a higher rate of response to the CGRP-receptor antagonist BIBN 4096 BS than to placebo (66 percent vs. 27 percent).

This proof-of-concept study introduces a CGRP-receptor antagonist as an effective acute treatment for migraine. These data do not have immediate relevance for clinical practice.

A 30-year-old white woman has a 72-hour history of a pruritic rash on her arms and chest. This is the third episode of the rash this summer, and each episode began in the evening after she had spent less than 30 minutes by a swimming pool in the morning. She has no history of sensitivity to sunlight and is taking no medications. Both the rash and the pruritus are improving, but she still has discomfort. How should this woman be evaluated and treated?

This review article examines the structure and replication cycle of hepatitis B virus and discusses the natural history of primary infection, the mechanisms of clearance of the virus, and reasons for persistent infection. It concludes with a discussion of what we know about the virus and how it causes hepatitis and the implications for treatment.

A 28-year-old Moroccan man was admitted to the hospital because of a 10-day history of epigastric pain and a 2-day history of right-upper-quadrant pain and fever. On examination, there was right-upper-quadrant tenderness with guarding and rebound. Imaging studies disclosed a complex, cystic mass in or adjacent to the neck of the pancreas.

Data safety and monitoring boards are part of many clinical trials. This Sounding Board article addresses the ethical issues facing board members when they make a decision to stop a clinical trial early or to continue it in the face of evidence that one treatment is more effective than another.