In Beira, Mozambique, a mass-immunization program was undertaken in 2003 and 2004 with two doses of an orally administered recombinant cholera toxin-B subunit, killed whole-cell vaccine. During an outbreak of cholera in 2004, a study of 43 case subjects with cholera and 172 matched controls showed that vaccination was associated with 78 percent protection against cholera.

This immunization program was conducted in an area where cholera is endemic and where the prevalence of HIV infection approaches 30 percent of the population. The results are encouraging, although the duration of protection remains uncertain.

In this study of serial saliva specimens from 277 children, 40 percent were infected with human herpesvirus 6 (HHV-6) by 12 months of age and 77 percent were infected by 2 years of age. Nearly all primary infections were symptomatic, with almost 40 percent leading to clinic visits for symptoms such as fever, fussiness, and diarrhea.

Unlike prior studies based on visits to emergency rooms, this prospective study of infants showed no association of HHV-6 infection with seizures. Roseola was present in 23 percent of the primary infections.

In this randomized trial, treatment of patients with intracerebral hemorrhage with recombinant activated factor VII (rFVIIa) within four hours after the onset of bleeding reduced the growth of the hematoma and the rates of disability and mortality (90-day mortality was 18 percent with rFVIIa and 29 percent with placebo). Serious thromboembolic adverse events were more common among patients treated with rFVIIa than among those who received placebo.

Despite the higher rates of such complications, early treatment with rFVIIa improved functional outcomes and survival among patients with intracerebral hemorrhage.

A non–small-cell lung cancer that was highly responsive to gefitinib contained a mutation in the epidermal growth factor receptor (EGFR) gene that increases susceptibility of the tumor to gefitinib. After two years of remission, the disease relapsed. A second biopsy of the tumor revealed a new mutation in the gene that negated the effects of gefitinib.

Effective treatment with gefitinib may not prevent repopulation of non–small-cell lung cancer by cells with an activating mutation of EGFR. In this case, the tumor cells were resistant to the drug. The hypothetical repopulating precursors may be better targets of curative treatment than the large population of easily visible tumor cells.

A 47-year-old white woman reports facial redness and flushing. Her eyes are itchy and irritated. She thinks she may have rosacea and is worried that she will have a "whiskey nose." On examination, multiple erythematous papules, pustules, and telangiectasias are observed on a background of erythema of the central portion of her face. How should her case be managed?

Our concept of the pathogenesis of chronic lymphocytic leukemia has undergone remarkable changes during the past decade. This review addresses the latest ideas concerning the origin of this common form of leukemia and discusses how molecular investigations are beginning to change the management of the disease.

A 58-year-old man with esophageal cancer had nausea, spontaneous vomiting, and intractable hiccups. The discussants review the role of palliative care in the management of distressing symptoms in patients with cancer, emphasizing the importance of the differential diagnosis in identifying the cause and selecting appropriate treatment for each symptom.