Either placebo or a preparation of chemically defined extracts from Echinacea angustifolia root was administered to 399 volunteers before or after inoculation with rhinovirus. These rigorously controlled studies found no evidence that echinacea is effective in treating or preventing the common cold.

In this large, retrospective cohort study of patients who underwent major noncardiac surgery, perioperative beta-blockade was associated with a significantly reduced risk of death in the hospital among those who were at high risk but not among those at low risk. These data support recommendations for wider use of perioperative beta-blockade in high-risk patients and need to be confirmed in a large randomized trial.

In a man with Crohn's disease who was treated with natalizumab and subsequently died, reexamination showed that the fatal lesion was progressive multifocal leukoencephalopathy and not an astrocytoma. Analysis of serial serum specimens showed that JC virus first appeared about three months after the initiation of natalizumab therapy.

A 46-year-old woman with multiple sclerosis died from progressive multifocal leukoencephalopathy after receiving 37 doses of natalizumab plus interferon beta-1a as part of a clinical trial. At autopsy, there were diffuse macroscopic and microscopic PML lesions. JC virus was identified in cerebrospinal fluid before death and in brain tissue at autopsy. There was extensive necrosis and cavitation, with no inflammatory response.

Progressive multifocal leukoencephalopathy developed in a man with multiple sclerosis while he was receiving interferon beta-1a and natalizumab. Quadriparesis, global aphasia, and minimal responsiveness ensued. Three months after natalizumab was stopped and after receiving cytarabine, he became alert and communicative, though he had continued neurologic disabilities.

With data from the 2000 and 2001 National Health Interview Surveys, the authors estimate that 6.6 percent of children in the United States had been uninsured for the previous 12 months and an additional 7.7 percent had had insurance for only part of the year. Children who had been uninsured for all or part of the year were much more likely to go without needed medical care than were children who had continuous coverage.

A 37-year-old woman presents with a two-week history of severe neck pain radiating to her left shoulder girdle and extending to the arm, forearm, and dorsum of the hand. Physical examination reveals weakness of her left triceps, finger extensors, and wrist flexors, as well as hypoesthesia of the third digit and a diminished triceps reflex. How should her case be managed?

A 57-year-old man with chronic active HBV infection was found to have a mass in the liver on routine screening. The results of a fine-needle aspiration biopsy suggested hepatocellular carcinoma. A multidisciplinary group discusses pathophysiology and management.