In this randomized trial involving nulliparous women at term, the rate of cesarean delivery was not higher among women who were given intrathecal analgesia early in labor than among those given systemic analgesia early in labor. Women who received intrathecal analgesia early also had better pain control and a shorter time to delivery.

These data provide reassurance that the initiation of intrathecal anesthesia early in labor does not increase the risk of cesarean delivery.

B-type natriuretic peptide is released by the ventricles in response to hemodynamic stress, and circulating levels have prognostic value in heart failure and unstable coronary disease. In this study, there was a significant independent association between circulating levels of N-terminal pro-BNP (an inactive fragment of the parent molecule) and overall mortality in stable coronary disease. The findings extend the prognostic value of this biomarker to a wider population of patients with cardiac disease.

Patients being treated for gonorrhea or chlamydia were offered medication to give to their sexual partners or standard referral of partners. There was a lower rate of recurrent or persistent gonorrhea among the patients with expedited treatment of partners than among those with standard referral of partners (10 percent vs. 13 percent). This strategy had a smaller effect on recurrent chlamydial infection than on recurrent gonorrhea.

A strategy of expedited treatment of partners can help control sexually transmitted diseases, but its legal status remains uncertain in many states.

In southern Vietnam, a four-year-old boy presented with severe diarrhea, followed by seizures, coma, and death. His nine-year-old sister had died from a similar syndrome two weeks earlier. In both children, the clinical diagnosis was acute encephalitis. Neither had respiratory symptoms at presentation.

The diagnosis of avian influenza A (H5N1) was established by isolating the virus from cerebrospinal fluid, fecal, throat, and serum specimens from the boy. These two cases suggest that the spectrum of influenza H5N1 is wider than previously thought and may have important public health implications.

This practical review for clinicians explains that memory dysfunction is now understood in terms of four systems: episodic memory, semantic memory, procedural memory, and working memory. Separate anatomical areas of the brain are responsible for each memory system. This overview of memory should help nonspecialists in the evaluation and diagnosis of patients with various types of memory dysfunction.

Although much has been published about the pathophysiology and treatment of necrotic spider bites, therapeutic interventions continue without evidence-based justification.

Recent advances in medical arachnology are resulting in a reassessment of how to approach suspected necrotic spider bites. This review considers the epidemiology, pathophysiology, and treatment of bites of brown recluse spiders and suspected necrotic arachnidism.

A 53-year-old man had decreased energy and appetite after losing his job; he came to the emergency department for psychiatric evaluation. A diagnosis of major depressive disorder was made; on the medical-clearance evaluation, a pulmonary infiltrate and a high white-cell count were found. While awaiting admission, he became short of breath; pulmonary edema was observed.

The authors discuss the medical clearance of psychiatric patients and the evaluation and management of "flash" pulmonary edema.

A recent study suggests that a molecule that binds amyloid and recruits an endogenous protein to its surface may pave the way for the development of efficient inhibitors of amyloidogenesis.