In a randomized comparison of letrozole with tamoxifen for the adjuvant treatment of early-stage, hormone-receptor–positive breast cancer in more than 8000 postmenopausal women, disease-free survival was significantly longer in the letrozole group. The five-year survival rates were 84.0 percent in the letrozole group and 81.4 percent in the tamoxifen group.

In this multicenter trial, patients in whom thrombolytic therapy for acute myocardial infarction failed were randomly assigned to repeated thrombolysis, conservative therapy, or emergency percutaneous coronary intervention (rescue PCI). Event-free survival was better among patients assigned to rescue PCI.

Prophylactic transfusions have been shown to prevent stroke in children with sickle cell disease, but at the risk of iron overload. This trial of transfusion cessation in children with sickle cell disease who were not considered to be at high risk for stroke showed that cessation was associated with either Doppler blood-flow recordings suggesting a high risk of stroke or stroke itself.

As of September 13, 2005, the International Committee of Medical Journal Editors has required that all trials submitted for publication be registered in a public database. This study examines the records registered in ClinicalTrials.gov from May 11 to October 11, 2005. The number of trials in the database approximately doubled, and the information about the trials became more specific.

A 62-year-old man presents with a three-day history of progressive dyspnea, nonproductive cough, and low-grade fever. His blood pressure is 100/60 mm Hg, his heart rate 110 beats per minute, his temperature 37.9°C, and his oxygen saturation while breathing room air 86 percent. Chest auscultation reveals rales and rhonchi bilaterally. A chest radiograph shows bilateral pulmonary infiltrates consistent with pulmonary edema and borderline enlargement of the cardiac silhouette. How should this patient be evaluated to establish the cause of the acute pulmonary edema and to determine appropriate therapy?

An 18-year-old man reported gradual painless swelling of the left mandible that had occurred over one month. An examination showed enlargement of the left mandible, with normal dentition. Imaging studies revealed a large, cystic lesion in the ramus and body of the left mandible. A diagnostic and therapeutic procedure were performed.