Using data from a clinical trial of celecoxib to prevent colorectal adenomas, these investigators analyzed cardiovascular events over a three-year follow-up period. There was a dose-related increase in the risk of a composite outcome of death from cardiovascular causes, myocardial infarction, stroke, or heart failure. The hazard ratio was 2.3 with a 200-mg dose and 3.4 with a 400-mg dose. These results raise concern that the use of celecoxib is associated with a serious risk of cardiovascular events.

When administered to patients for pain control after coronary-artery bypass surgery, valdecoxib and its intravenous prodrug, parecoxib, were found to be associated with an increased risk of cardiovascular thromboembolic events. These findings add to the growing concern that the use of COX-2 inhibitors increases the risk of cardiovascular events, particularly in persons who are at risk for such events.

In a clinical trial of chemoprevention for colorectal adenomas, the use of rofecoxib was found to be associated with a significantly increased risk of cardiovascular events, primarily myocardial infarctions and ischemic cerebrovascular events. Although rofecoxib has been removed from the market by the manufacturer, these data need to be carefully considered in making decisions about any future use of rofecoxib.

Neurologic deterioration followed by fatal encephalitis occurred in four patients who had received kidneys, liver, and an artery segment from the same donor. Multiple studies showed evidence of rabies virus in both central nervous system tissues from the four recipients and nerve tissue in the transplanted organs. The donor was thought to have been well before a subarachnoid hemorrhage. It was later learned that he had told friends of being bitten by a bat.

The serotonin syndrome is a potentially life-threatening drug reaction that may result from therapeutic medication use, self-poisoning, or interactions between drugs.

This review explains the clinical presentations that should lead to the diagnosis, the mechanisms of toxicity, and the drugs and interactions most often implicated. Clinical management includes measures to control agitation, autonomic instability, and hyperthermia.

A 10-year-old boy had pain in the right thigh that interfered with activities, awoke him at night, and was only slightly relieved by acetaminophen. Magnetic resonance imaging and radionuclide bone scans showed a large area of abnormality within the femur. Computed tomography–guided (CT) biopsy was not completed because of the patient's agitation, but CT images showed a small lytic lesion in the cortex surrounded by dense bone. A diagnostic and therapeutic procedure was performed.

For the past 100 years or so, there has been a general trend toward increasing life expectancy in developed countries. In this Special Report, the authors argue that obesity, and perhaps infectious diseases, will lead to a decrease in life expectancy in the 21st century.

Achieving appropriate levels of gene expression at the right time and the right place is an important goal of gene therapy. A new study shows one way to meet this goal.