In this randomized trial involving 454 patients with pleural infections that required antibiotic therapy and chest-tube drainage, there was no benefit from the use of intrapleural streptokinase in terms of survival, the need for surgery, the length of the hospital stay, or the resolution of radiographic abnormalities.

Fibrinolytic agents may be used to improve drainage of pleural infections. The results of this study call into question the presumed therapeutic benefit of the intrapleural administration of streptokinase.

Most patients with mitral regurgitation are asymptomatic at diagnosis, and the optimal timing of or need for mitral-valve surgery is uncertain. This study shows that the use of Doppler echocardiography to quantify mitral regurgitation accurately predicts the clinical outcome. Patients with an effective regurgitant orifice of 40 mm² or more have an increased risk of death and should promptly be considered for surgery even if they have no symptoms. These findings could have a substantial effect on clinical practice.

Four genes have been implicated in Alzheimer's disease, yet collectively they are estimated to account for less than half the attributable risk. The results of this study implicate variants in the ubiquilin 1 gene on chromosome 9 as risk factors for late-onset Alzheimer's disease. Additional studies to confirm the association and to determine the magnitude and mechanism of the risk effect are warranted.

An analysis of 460 phase 1 oncology trials in adults sponsored by the Cancer Therapy Evaluation Program at the National Cancer Institute between 1991 and 2002, including 11,935 participants, found an overall response rate of 10.6 percent and a toxicity-related death rate of 0.5 percent. Response rates and death rates varied among the different types of trials.

The overall response rate in this analysis exceeds the 4 to 6 percent rate in older trials, with no increase in the risk of death from toxic events. The decision of a patient with advanced, treatment-refractory cancer to participate in a phase 1 trial requires a careful weighing of the risks and benefits.

A 48-year-old airline mechanic from Belize presented to the emergency department with fever and altered mental status. Two weeks earlier, fever, myalgias, and dry cough had developed. Maximal daily temperatures reached 41.1°C, and one week later he awakened unable to speak.

A new compound counters infection with Mycobacterium tuberculosis in a mouse model.

Antithyroid drugs, which have been available for more than half a century, are important in the management of hyperthyroidism, particularly in patients with Graves' disease, who have a high response rate. Since the responses of patients vary and these agents have potentially serious side effects, a working knowledge of their complex pharmacology is required. This review article considers recent pharmacologic and clinical data related to the use of these compounds.