Herpes zoster and postherpetic neuralgia occur more often with increasing age. In this controlled trial among 38,546 adults 60 years of age or older, vaccination with a live attenuated varicella–zoster vaccine reduced the incidence of postherpetic neuralgia by 66.5 percent (as compared with placebo) and the incidence of herpes zoster by 51.3 percent.

Vaccination with the highly immunogenic varicella–zoster vaccine was associated with frequent local symptoms but not severe adverse reactions. Boosting immunity to varicella can reduce the incidence and severity of herpes zoster.

The gene encoding vitamin K epoxide reductase complex 1 (VKORC1) is the target of warfarin, and a variant of the gene may be associated with variations in dose requirements. This study reveals a strong association between VKORC1 haplotype and the warfarin dose among European Americans. It also suggests that VKORC1 variants may explain the variations in dose requirements among persons of different ancestries.

The gene encoding type II collagen, COL2A1, was found to be mutated in affected members of three families with an inherited form of avascular osteonecrosis of the femoral head. This finding will spur studies of this gene in persons with the idiopathic form of the disease.

This randomized trial included almost 1500 women with breast cancer and positive axillary nodes and compared treatment with doxorubicin and cyclophosphamide combined with either fluorouracil or docetaxel. The rates of disease-free and overall survival were significantly higher among women in the docetaxel group.

The management of breast cancer has improved step by step, beginning with the abandonment of routine radical mastectomy and continuing to large trials, such as this one, that involve new combinations of drugs and new agents that bring incremental improvements to women with breast cancer.

A 10-year-old girl with atopic dermatitis reports itching that has recently become relentless, resulting in sleep loss. Her mother has been reluctant to treat the girl with topical corticosteroids because she was told that they damage the skin, but she is exhausted and wants relief for her child. How should the problem be managed?

Brucellosis has been present for millennia and has managed to elude eradication, even in most developed countries. Brucellosis causes much clinical morbidity as well as an important loss of agricultural productivity in the developing world. In this era of international tourism, brucellosis has become a common imported disease in the developed world. This review article discusses the pathogenesis and treatment of the disease.

A 20-year-old man who had immigrated to the United States from Mexico three months earlier presented to the emergency department reporting weight loss and pain in his hip and the right side of his lower back. He had noted decreased appetite for several weeks and had unintentionally lost 16 kg.