In this placebo-controlled trial of patients who had had colonic adenomas removed before study entry, celecoxib reduced the risk of recurrence of adenomas after three years of treatment (risk ratio, 0.67 for 200 mg of celecoxib twice daily and 0.55 for 400 mg of celecoxib twice daily) and increased the risk of serious cardiovascular events (risk ratio, 2.6 and 3.4, respectively).

Subjects who had a history of colonic adenomas were randomly assigned to three years of treatment with 400 mg of celecoxib or placebo once daily. Celecoxib significantly reduced the risk of adenomas (cumulative rate, 34 percent in the celecoxib group and 49 percent in the placebo group) and advanced adenomas (cumulative rate, 5 percent and 10 percent, respectively).

In this randomized trial comparing neurostimulation of the subthalamic nucleus with medical management alone in 156 patients with severe Parkinson's disease, neurostimulation improved the quality of life and motor symptoms. Severe adverse events included a fatal intracerebral hemorrhage resulting from surgical placement of the neurostimulator.

An outbreak of 154 cases of Marburg hemorrhagic fever in the Democratic Republic of the Congo between 1998 and 2000 had a case fatality rate of 83 percent. Multiple insertions of the virus into the population were identified and were associated with independent chains of human transmission.

This study compared the increases in spending on medical care and the gains in life expectancy from 1960 through 2000. The authors estimate that increased spending on health care resulted in a cost of about $20,000 per year of life gained and conclude that the additional spending has been worthwhile.

Saccular intracranial aneurysms cause substantial morbidity and mortality. Recently, major changes have occurred in the way we think about and treat this disease. This review discusses the percutaneous endovascular treatment of intracranial aneurysms as compared with surgical intervention. The technological advances and supporting research contributing to this important change in practice patterns are reviewed.

A 17-year-old boy began to have daily fevers two weeks after moving to the Dominican Republic, which persisted for two months despite antibiotic therapy. Imaging studies disclosed nodules in the liver and spleen. Routine cultures were negative. A diagnostic procedure was performed.

RNA interference has been successfully used to treat several animal models of human disease, giving hope that this approach may have therapeutic potential. A new study shows, however, that the approach interferes with an innate mechanism of gene silencing and that it is associated with toxic effects and death.