This randomized trial compared local radiotherapy plus tamoxifen with tamoxifen alone in women 50 years of age or older who had undergone breast-conserving surgery for breast cancer. As compared with tamoxifen alone, radiotherapy plus tamoxifen substantially lowered the rate of local relapse. Overall survival at five years did not differ significantly between the two groups.

The results of this trial support the use of tamoxifen with radiotherapy for women 50 years of age or older who have undergone lumpectomy for invasive breast cancer and call into question the trend toward the use of adjuvant treatment with tamoxifen alone.

In this study, women 70 years of age or older who had early, estrogen-receptor–positive breast cancer underwent lumpectomy and were then randomly assigned to receive tamoxifen alone or with local irradiation. The only significant difference in outcome was in the probability of local recurrence at five years (4 percent in the tamoxifen group and 1 percent in the combined-treatment group).

For women 70 years of age or older who have early, estrogen-receptor–positive breast cancer, lumpectomy plus adjuvant treatment with tamoxifen (without local irradiation) is a reasonable choice.

This study, based on analyses of large, linked databases of maternal, perinatal, and birth and death records in Scotland, found a significant association between second-trimester maternal serum alpha-fetoprotein levels and the subsequent risk of the sudden infant death syndrome (SIDS) in singleton infants. This relationship was attenuated but remained significant after adjustment for infants' birth weight and gestational age at delivery.

These findings suggest that intrauterine conditions may influence the vulnerability of an infant to SIDS.

Hypothalamic amenorrhea may be accompanied by low leptin levels. These investigators administered recombinant human leptin to eight women with hypothalamic amenorrhea. Six additional untreated subjects served as historical controls. Treatment with recombinant leptin increased mean luteinizing hormone levels and pulse frequency, improved ovarian variables, and resulted in ovulation in three women and in withdrawal bleeding in two.

Leptin administration may improve reproductive, thyroid, and growth hormone function in women with hypothalamic amenorrhea.

Cutaneous melanoma remains a management challenge. This year an estimated 55,000 Americans will receive a diagnosis of cutaneous melanoma, and 7900 will die from the disease. The authors of this review discuss the pathogenesis and management of cutaneous melanoma and provide perspective on treatment options.

Efforts to reduce the incidence of cutaneous melanoma focus on identifying and screening persons at high risk and on promoting sun protection. Detecting the disease in its early stages can improve outcome.

A 67-year-old obese man was seen by his physician because of a two-month history of shortness of breath, a nonproductive cough, and bilateral swelling of the lower extremities. He also reported the sensation of neck fullness, occasional wheezing, and an increase in dyspnea after meals.

The provenance of the insulin-producing beta cell of the islet of Langerhans has been a long-standing source of debate. A recent study suggests that the beta cell itself, rather than a putative stem cell, gives rise to new beta cells.