Because the waiting list is long, critically ill patients in need of a cardiac transplant may require a "bridge" to transplantation. This is usually accomplished with the use of a left ventricular assist device, but not all patients are candidates for it. In this study, 81 patients received a total artificial heart as a bridge to transplantation. Seventy-nine percent survived to transplantation, and 70 percent were alive at one year.

The use of a total artificial heart as a bridge to transplantation is an effective strategy that helps save lives.

This study was designed to determine the effects of long-term therapy with glucocorticoids on bone mineral content during growth in children and adolescents with glucocorticoid-sensitive nephrotic syndrome, a disorder with minimal known independent effects on bone.

Dual-energy x-ray absorptiometry of the whole body and spine revealed that intermittent use of high-dose glucocorticoids during growth does not appear to be associated with deficits in the bone mineral content.

This double-blind trial involving 387 women with recurrent candidiasis evaluated the effectiveness of a regimen of 150 mg of oral fluconazole once per week. Six months after the completion of therapy, 90.8 percent of the women in the fluconazole group remained free of candidiasis, as compared with 35.9 percent in the placebo group.

Although maintainence therapy with fluconazole appears to be effective, a long-term cure of vulvovaginal candidiasis is difficult to achieve.

The acute respiratory distress syndrome (ARDS) results from a deficiency of functional surfactant in the airways. These investigators carried out a multicenter study in which patients with ARDS were treated with a recombinant human surfactant protein C–based surfactant. No clinical benefits were noted.

If surfactant-replacement therapy is to be successful, we will need to improve patient selection or find more effective surfactants or dosing schedules.

Variations in the clinical course of chronic lymphocytic leukemia (CLL) make decisions about treatment difficult. In more than 300 patients with the disease, the level of ZAP-70, an intracellular tyrosine kinase, in the leukemic cells correlated best with the median time from diagnosis to treatment.

Measurement of ZAP-70 is likely to become a standard prognostic indicator in patients with CLL.

A 43-year-old man has a two-week history of nasal congestion, postnasal drip, and fatigue. He has used an over-the-counter nasal decongestant and acetaminophen, without relief. During the past few days, facial pain and pressure have developed and have not responded to decongestants. In addition, his nasal discharge has turned from clear to yellow. How should he be treated?

A 79-year-old woman had an 18-month history of repeated falls and memory loss. She had truncal ataxia, a wide-based gait, Romberg's sign, increased muscle tone and cogwheeling, and reduced perception of vibration and proprioception. During the next two years hypophonia, dysarthria, and difficulty swallowing developed, with urinary urge incontinence and constipation. The patient died five years after the onset of the illness.

In this Health Policy Report, the author examines the economics of the pharmaceutical industry. Research-and-development costs, patent laws, and health insurance coverage all influence drug pricing. The author discusses the policy dilemmas resulting from the complex economics of pharmaceutical research and development and reviews potential strategies to control prices.