In this randomized trial of atypical antipsychotic medications in patients with Alzheimer's disease and psychosis, aggression, or agitation, effectiveness (as measured by the time to drug discontinuation) was similar for olanzapine, risperidone, quetiapine, and placebo. Patients were more likely to stop taking placebo because of lack of efficacy and were likely to stop taking antipsychotic medications because of intolerability.

For culture and antimicrobial-susceptibility testing of Mycobacterium tuberculosis, results are typically available in 1 to 2 months. This report from Peru demonstrates that the microscopic-observation drug-susceptibility assay may be more sensitive for the detection of M. tuberculosis than the current standard techniques and that results are available in significantly less time (median, 7 days).

In a 2-by-2 factorial design, participants without cardiovascular disease but with impaired fasting glucose levels or impaired glucose tolerance received ramipril or placebo (with or without rosiglitazone) for a median of 3 years. The results suggest that ACE inhibitors may modestly improve glucose metabolism, though ramipril failed to change the rate of death or newly diagnosed diabetes.

This maintenance program was based on self-regulation theory that included daily self-weighing. The authors tested the efficacy of delivering the program face to face or over the Internet as compared with the provision of a quarterly newsletter. The interventions improved maintenance of weight loss, particularly when delivered face to face.

The Childhood Cancer Survivor Study found a high rate of illness owing to chronic health conditions among more than 10,000 adult survivors of childhood cancer.

External-beam radiotherapy is recommended for a 69-year-old man with localized prostate cancer. This therapy has evolved rapidly owing to the development of sophisticated techniques for focusing the radiation beam precisely on its target. Important adverse effects include radiation proctitis, cystitis, urethritis, and erectile dysfunction.

A girl had been severely obese since early childhood. She had been adopted in infancy, and her adoptive parents and siblings had normal weights. Numerous programs had failed to produce sustained weight loss. She had problems with snoring, insomnia, somnambulation, daytime sleepiness, and depression. Management options were discussed.

Progression of amyotrophic lateral sclerosis may be influenced by microglia, immune cells of the central nervous system.

Thoracentesis may dramatically reduce respiratory distress in patients presenting with large pleural effusions. In addition, diagnostic thoracentesis is a valuable procedure in a patient with pleural effusion of unknown cause. The fluid can be categorized as a transudate (a product of imbalanced hydrostatic forces) or an exudate (a product of increased capillary permeability or lymphatic obstruction). This procedural video demonstrates how to perform thoracentesis.