In this randomized, controlled trial, 224 obese adults were assigned to one of four weight-loss treatments for one year: sibutramine alone, lifestyle modification through group therapy alone, combined therapy, or sibutramine plus brief counseling about lifestyle modification delivered by a physician. Combined therapy resulted in more weight loss than either drug therapy alone or lifestyle modification alone, underscoring the importance of prescribing weight-loss medications in combination with, rather than in lieu of, lifestyle modification.

Rimonabant is a selective cannabinoid-1 receptor blocker. In this clinical trial, the drug was found to result in moderate weight loss and improvement in several metabolic variables, including high-density lipoprotein cholesterol and triglyceride levels. Adverse effects included nausea, depression, and anxiety. This drug may find a place in the treatment of obese patients with dyslipidemia and a high risk of cardiovascular disease.

A genomic study of four groups of melanoma arising at sites with different levels of exposure to ultraviolet light reveals distinct genetic alterations among the groups and suggests that the groups will have differential responses to targeted therapies. These findings have implications for our understanding of the susceptibility to melanoma and the design of clinical trials.

In this randomized trial involving patients with pulmonary hypertension, sildenafil (an inhibitor of phosphodiesterase type 5) was found to improve exercise capacity and pulmonary hemodynamics. The study was not powered to assess mortality, but the findings suggest that sildenafil may have a place in the treatment of symptomatic pulmonary hypertension.

This cost-effectiveness analysis of screening strategies for cervical cancer in India, Kenya, Peru, South Africa, and Thailand demonstrates that a one-time screening of women at 35 years of age, with the use of visual inspection or human papillomavirus DNA testing, would reduce the incidence of cervical cancer by more than 25 percent and would cost less than $500 per year of life saved. The authors argue that screening for cervical cancer with strategies that require limited laboratory infrastructure is practical and cost-effective in developing countries.

A healthy, multiparous 23-year-old woman requests advice about contraception. Her last child was conceived while she was using oral contraceptives, which she took irregularly. She wants no more children and desires a highly effective and long-acting method of contraception. She is sexually active in a monogamous relationship and was treated for gonococcal cervicitis at the age of 16 years. She has normal menses. Findings on pelvic examination are normal. What contraceptive methods are appropriate for her?

A 56-year-old woman with a 1-cm invasive ductal carcinoma of the breast came to a multidisciplinary breast clinic for advice on management. A lumpectomy and axillary dissection disclosed a small focus of metastatic tumor in a sentinel lymph node. The staging and management of breast cancer with sentinel lymph-node involvement are discussed.