This randomized trial in 383 children in Vietnam who had moderately severe dengue shock syndrome compared the use of Ringer's lactate, 6 percent dextran 70, and 6 percent hydroxyethyl starch after initial resuscitation with colloid. The primary clinical outcomes were similar with the three solutions. The trial provides strong evidence that in moderately severe dengue shock syndrome the outcomes are as good with the use of Ringer's lactate as with either of the more expensive colloid solutions.

An outbreak of hepatitis A involved 601 patrons and workers at a single restaurant in Pennsylvania. At least 124 persons were hospitalized, and 3 died. Investigation implicated raw green onions imported from Mexico and included in a salsa that was served to all customers.

This study compared a single intravenous infusion of zoledronic acid with daily oral risedronate in patients with Paget's disease. At six months, 96 percent of patients receiving zoledronic acid had a therapeutic response, as compared with 74 percent of patients given risedronate. Single-infusion zoledronate produces more rapid, complete, and sustained responses than does daily risedronate and may increase adherence to bisphosphonate therapy.

This large randomized trial showed that, among women in labor who have thick meconium staining of the amniotic fluid, amnioinfusion (infusion of saline into the amniotic cavity) did not reduce the risk of moderate or severe meconium aspiration syndrome, perinatal death, or other major maternal or neonatal morbidity. These data suggest no benefit to amnioinfusion, at least in settings with resources for fetal heart-rate monitoring and resuscitation, as in this trial.

Juvenile Paget's disease, a genetic bone disease characterized by accelerated bone turnover, results from inactivating mutations in the gene encoding osteoprotegerin, a key regulator of osteoclastogenesis. The authors investigated the effects of recombinant osteoprotegerin in two adult siblings with juvenile Paget's disease. After 15 months, radial bone mass had increased, skeletal bisphosphonate retention had decreased, and there was radiographic improvement. Osteoprotegerin may be therapeutic in juvenile Paget's disease.

Dengue infection may be the most common infection other than malaria among travelers to tropical areas. This flavivirus infection is transmitted by mosquitoes. Although it often is asymptomatic, dengue infection can lead to leukopenia, thrombocytopenia, and even hemorrhagic complications and shock. This review summarizes the current approaches to establishing the diagnosis, managing the complications, and preventing this potentially dangerous infection.

A 24-year-old sailor presented to the emergency department with a seven-day history of shortness of breath, occasional substernal chest pain, increasing abdominal girth, and nausea and vomiting. He reported leg swelling and a weight gain of 14 kg during the preceding three weeks.

Most targeted therapies for cancer are designed to bind a specific protein expressed by cancer cells. Two recent studies indicate that a new approach may work: attacking a tumor at its weak spot.