This report describes the clinical details of 10 patients who were shown to have been infected with an H5N1 influenzavirus, which normally does not affect humans. The patients had direct contact with fowl a median of three days before they presented with fever, respiratory symptoms, and an acute influenza syndrome, characterized by lymphopenia and marked pulmonary infiltrates on chest radiography. Eight of the patients died, even though none had preexisting medical conditions.

These patients appear to have acquired severe influenza A (H5N1) infection directly from infected poultry. A major concern is the potential for genetic reassortment with human influenzaviruses to produce a variant that is capable of human-to-human transmission. Containment of influenza A (H5N1) in poultry throughout Asia is therefore an urgent priority for public health.

Osteoporosis in postmenopausal women is chronic and progressive. In a randomized, multicenter trial, extended three times, involving postmenopausal women with osteoporosis, daily alendronate for 10 years produced increases in bone mineral density at the spine, trochanter, and femoral neck. Safety data suggest no loss of benefit in terms of the risk of fracture with prolonged treatment, though the discontinuation of alendronate resulted in the gradual diminution of effects.

Alendronate appears to have sustained and well-tolerated effects over a 10-year period.

This randomized trial of adjuvant therapy after resection of pancreatic cancer found a significant survival benefit for chemotherapy with fluorouracil. Chemoradiotherapy alone or followed by chemotherapy was not beneficial and even appeared to shorten survival.

Even with the improvements in survival reported in this trial, the prognosis for patients with pancreatic cancer remains grim.

Thrombocytosis is usually discovered incidentally, but the differential diagnosis is important. In cases of reactive, or secondary, thrombocytosis, the underlying disease may require treatment. Clonal thrombocytosis, in contrast, is associated with both thrombotic and bleeding complications, and cytoreductive treatment may be necessary. This review also summarizes the current understanding of platelet production.

Lipodystrophies, heterogeneous acquired or inherited disorders characterized by the selective loss of adipose tissue, predispose affected patients to insulin resistance and its attendant complications. This review focuses on the clinical features, underlying pathogenetic mechanisms, and management of various types of acquired and inherited lipodystrophies.

The genetic basis of many inherited lipodystrophy syndromes has been elucidated through the detailed and systematic characterization of phenotypes based on distinct clinical features and unique patterns of adipose-tissue distribution, together with molecular techniques.

Cough, fever, and myalgias developed in an 18-year-old college student; five days later he was admitted to the hospital in shock. Despite intensive fluid resuscitation and pressor administration, his condition deteriorated, and he died the next day. An autopsy was performed.