In a population of almost 184,000 prospectively studied participants, the risk of lung cancer was ascertained according to the level of cigarette smoking and ethnic or racial background. Among those who smoked no more than 30 cigarettes per day, the relative risk of lung cancer was highest among African Americans and native Hawaiians, as compared with whites, Hispanics, and Japanese Americans.

Outcomes among recipients of single or dual kidney transplants from donors older than 60 years of age that were allocated on the basis of preimplantation histologic evaluation (for the presence or absence of parenchymal, vascular, or other abnormalities) were compared with outcomes among matched recipients of single grafts from older or younger donors without histologic evaluation. The survival and function of dual or single kidney grafts from older donors were excellent when transplantation was based on the results of biopsy before implantation.

The antifibrinolytic agent aprotinin is often used to control blood loss in patients undergoing cardiac surgery. This observational study found that the use of aprotinin is associated with an increased risk of serious end-organ damage. In patients undergoing cardiac surgery, aprotinin should be replaced by aminocaproic acid or tranexamic acid.

This 14-state study compared mortality rates at hospitals with a level 1 trauma center and hospitals without a trauma center among patients with moderate-to-severe injuries. After adjustment for baseline differences in patients' characteristics, the one-year mortality rate was significantly lower at trauma centers than at non–trauma centers (10 percent vs. 14 percent).

A 71-year-old man with type 2 diabetes and hypertension is referred for coronary angiography. Medications include metformin and a thiazide. Before the angiogram, his serum creatinine level is 1.8 mg per deciliter (160 µmol per liter), yielding an estimated glomerular filtration rate of 40 ml per minute per 1.73 m² of body-surface area. What can be done to reduce the risk that an angiographic contrast agent will worsen his kidney function?

Rupture of an intracranial aneurysm is the leading cause of subarachnoid hemorrhage not due to trauma. This review summarizes both the approach to establishing the diagnosis and treatment options, including the placement of intravascular coils to arrest the bleeding. Common management problems include vasospasm, hydrocephalus, and rebleeding.

A 63-year-old woman who had recently emigrated from the Dominican Republic sought medical attention because of the recent onset of dark urine, pruritus, and epigastric pain. Imaging studies revealed a complex cystic mass in the head of the pancreas, with stenosis of the common bile duct. Stenting of the obstruction was followed by resolution of jaundice; two months later, the pancreatic mass had resolved, but new intraabdominal lymphadenopathy had appeared. A diagnostic procedure was performed.