This study compared the effectiveness of four second-generation antipsychotic agents (olanzapine, risperidone, quetiapine, and ziprasidone) with that of an older agent, perphenazine, in patients with chronic schizophrenia. Olanzapine was the most effective agent but was associated with greater weight gain and more adverse metabolic changes. Perphenazine was as effective as risperidone, quetiapine, and ziprasidone.

This article describes a new method of detecting autoantibodies against prostate cancer antigens in the serum of patients with prostate cancer. The method could add information to the standard test for prostate-specific antigen.

This randomized trial involving patients with early syphilis in Tanzania found that treatment with 2 g of azithromycin led to cure rates that were similar to those for penicillin G benzathine at both nine months (97.7 percent and 95.0 percent, respectively) and six months (85.5 percent and 81.5 percent, respectively). This single-dose, oral regimen may be particularly useful in settings in which there are shortages of sterile equipment and trained personnel.

This report describes three young children who died with severe staphylococcal sepsis after a rapidly progressive course, with necrotizing pneumonitis, coagulopathy, and cardiovascular collapse. At autopsy, all three were found to have bilateral adrenal hemorrhage with infarction, known as the Waterhouse–Friderichsen syndrome. The findings in these three children are similar to those usually seen with fulminant meningococcemia.

A 41-year-old man with dyslipidemia, hypertension, and a history of myocardial infarction four years previously comes to establish care. The total cholesterol level is 155 mg per deciliter (4.01 mmol per liter), the low-density lipoprotein cholesterol level 72 mg per deciliter (1.86 mmol per liter), the high-density lipoprotein (HDL) cholesterol level 28 mg per deciliter (0.72 mmol per liter), and the triglyceride level 277 mg per deciliter (3.13 mmol per liter). What strategies can increase his HDL cholesterol level?

Primary biliary cirrhosis, a slowly progressive autoimmune liver disease characterized by portal inflammation and an immune-mediated destruction of the intrahepatic bile ducts, leads to decreased bile secretion and the retention of toxic substances within the liver. This review considers new data concerning both the autoimmune responses involved and the treatment of primary biliary cirrhosis.

A 68-year-old man noted a rash followed by periorbital swelling and muscular weakness. Several months before his hospital admission, he had had involuntary weight loss, and his physician had noted anemia. The results of an evaluation for gastrointestinal cancer were negative. Abdominal computed tomography disclosed a mass involving the spleen and retroperitoneum. A diagnostic procedure was performed.