In this multicenter, placebo-controlled, randomized trial of postmenopausal women at high risk for a coronary event, raloxifene had no significant effect on the risk of primary coronary events, reduced the risk of invasive breast cancer and vertebral fractures, and increased the risk of fatal stroke and venous thromboembolism. A decision whether to use raloxifene for the prevention of breast cancer or vertebral fractures should be individualized, weighing benefits against potential risks.

In a cross-sectional analysis of the offspring cohort of the Framingham Heart Study, clinical heart failure in one or both parents correlated with a increased likelihood of echocardiographic evidence of left ventricular dysfunction, increased left ventricular mass, and increased internal left ventricular dimensions in the offspring.

In this double-blind, placebo-controlled study, soldiers at high risk for tick-borne relapsing fever were given doxycycline or placebo for five days after high-risk exposure to soft ticks. Postexposure prophylaxis was found to be highly effective in preventing symptomatic illness.

This multicenter study compared noninvasive Doppler measurement of the peak velocity of systolic blood flow in the middle cerebral artery with amniocentesis to determine bilirubin values according to the change in the optical density of amniotic fluid at a wavelength of 450 nm in the diagnosis of severe fetal anemia in Rh-alloimmunized pregnancies. As compared with invasive testing, Doppler ultrasonography of the middle cerebral artery had significantly better sensitivity and accuracy.

A 20-year-old woman notes having had recurrent painful mouth ulcers for the past 10 years. She is otherwise healthy and reports no genital or anal ulcers, skin lesions, gastrointestinal or joint problems, or fevers. Physical examination reveals several ulcers, 3 mm in diameter, on her buccal mucosae. She has no lesions on the skin or on other mucosal surfaces. How should she be evaluated and treated?

The intensive care of patients with human immunodeficiency virus (HIV) infection is increasingly complex and may involve difficult decisions about the initiation or continuation of antiretroviral therapy. In some critically ill patients, the diagnosis of HIV has not been established, and there are legal implications for many important clinical decisions. Care may also be complicated by HIV-related pulmonary, cardiac, or renal impairment.

A 61-year-old man was seen in the neurosurgery clinic because of facial pain. The pain had begun eight months earlier and was characterized by sharp paroxysms over the left side of the face that were brought on by the patient's eating or touching his moustache; there was a dull, throbbing pain in the same area. The neurologic examination was normal. A diagnostic and therapeutic procedure was performed.

The rising cost of health care has become a serious problem for employers who provide health insurance to their workers. In this second part of a two-part Health Policy Report, Blumenthal discusses an array of strategies that employers and health-insurance companies are adopting to reduce health care costs and improve the efficiency of the nation's health care system.