Since Chlamydia pneumoniae is believed to be involved in the pathogenesis of coronary artery disease, this study investigated whether antibiotic therapy with azithromycin to eliminate C. pneumoniae would reduce the risk of coronary events. There was no beneficial effect associated with azithromycin. This study, along with that reported by Cannon et al. in this issue of the Journal, does not support the idea that C. pneumoniae has a significant pathogenic role in coronary artery disease.

Studies have suggested that infection with Chlamydia pneumoniae may have a role in the pathogenesis of coronary artery disease. This study casts doubt on the idea, since two years of treatment with gatifloxacin, an antibiotic with bactericidal activity against C. pneumoniae, had no beneficial effect on clinical outcomes. This study complements the results of the study by Grayston et al. reported in this issue of the Journal, which led to a similar conclusion.

In this randomized trial of children with polyarticular juvenile rheumatoid arthritis, methotrexate achieved slightly better outcomes than leflunomide; at 16 weeks the respective rates of 30 percent improvement were 89 percent and 68 percent. In each group, the clinical improvement observed at 16 weeks was maintained at 48 weeks.

Methotrexate appears to be slightly more effective than leflunomide for juvenile rheumatoid arthritis, but both drugs produced high rates of response.

ARLTS1 is a member of a large family of genes that encode proteins with a variety of functions, such as membrane and vesicular transport. These investigators provide evidence that ARLTS1 is a tumor-suppressor gene and that a polymorphic variant of ARLTS1 is associated with familial cancer.

The ARLTS1 polymorphism may contribute to the development of cancer by interfering with apoptosis and the nucleotide-binding properties of the ARLTS1 protein.

A 66-year-old man was suddenly unable to speak, follow directions, or move his right arm and leg. He received tissue plasminogen activator within 90 minutes. Four days later, his speech was limited to effortful answers of yes or no. He could not walk or use his right arm, and self-care tasks required maximal assistance. What advice would you offer him and his family regarding rehabilitation for his disabilities?

In this review article, Göran Hansson, a pioneer in the study of the role of inflammation in atherosclerosis and coronary artery disease, summarizes new ideas on the pathogenesis of acute coronary syndromes.

A 30-year-old woman had a two-month history of increasing pain in the left side of her chest and in her arm and shoulder, followed by cough, hemoptysis, and pleuritic chest pain. Chest radiographs showed an infiltrate in the lingula of the left lung. Her symptoms improved minimally with antibiotic therapy. Radiographs of the chest disclosed a large anterior mediastinal mass. A diagnostic procedure was performed.

The parents of Terri Schiavo, a Florida woman who was in a persistent vegetative state, objected to her husband's decision to discontinue artificial nutrition, and a protracted legal battle ensued. The Florida courts ordered the removal of Schiavo's feeding tube to provide care consistent with her wishes. The judicial decisions in the Schiavo case were consistent with legal precedent, but the interference in the case by the legislative and executive branches of the Florida and U.S. governments was unprecedented.