This randomized study of patients in a medical ICU compared insulin infusion to normalize the blood glucose level with conventional therapy. Overall, insulin infusion was associated with decreased morbidity but not decreased mortality. However, a lower relative risk of both was observed among patients receiving insulin who remained in the ICU for more than three days, although predicting length of stay on admission to the ICU is not possible. Further studies are needed to confirm these data.

In a randomized trial and subsequent open-label study, the orphan drug intravenous human botulism immune globulin (BIG-IV) was safe and effective in treating infant botulism. Its use reduced the mean length of the hospital stay, duration of intensive care, duration of mechanical ventilation, and per patient hospital charges. Efficacy was greater when the drug was given within three days after hospital admission. These data support the prompt use of BIG-IV in infants in whom botulism is suspected.

Patients with schizophrenia are often treated with multiple antipsychotic drugs, but the benefits are not known. In this eight-week randomized, controlled trial in patients with severe schizophrenia and a poor response to clozapine, the combination of clozapine and risperidone did not achieve better control of symptoms than clozapine alone. The findings of this small, short-term study do not support the addition of risperidone to clozapine for patients with severe schizophrenia.

At present, 90 to 95 percent of percutaneous coronary interventions involve the implantation of a stent, often a drug-eluting stent, though most published data originated in the era of bare-metal stents. This article reviews the indications for and biology of coronary-artery stents, focusing on recent advances in drug-eluting stents.

Positron-emission tomography (PET) has become an important tool for evaluating tumors, detecting occult cancer, and staging and restaging tumors. This review includes a Web-only supplement with scans from 10 patients with common cancers, available at www.nejm.org.

A 46-year-old Mexican immigrant presented with epigastric pain and vomiting of coffee-grounds material. He reported fatigue, malaise, jaundice, and a weight loss of 20 lb (9.1 kg) during the previous two months. He had also had dark stools, light-headedness, and mild shortness of breath, but no fever, chills, or night sweats.

Definitive endodermal cells have been generated from human embryonic stem cells — a process that is key to their potential use in the treatment of type 1 diabetes mellitus.