Sunitinib is one of several new antiangiogenic agents undergoing tests of efficacy in the treatment of various types of cancer. Renal-cell carcinoma of the clear-cell type is particularly important in this regard because of the evidence that mutations in the VHL gene result in stimulation of cellular receptors that promote angiogenesis and tumor growth. This trial found promising results with sunitinib in the treatment of metastatic renal-cell cancer.

The prognosis in metastatic renal-cell cancer, especially of the dominant clear-cell type, is dismal. This trial compared sorafenib, an orally active inhibitor of the proliferation of cancer cells and tumor angiogenesis, with placebo in patients with metastatic clear-cell renal cancer. The results with sorafenib were modest but encouraging enough to test the drug as an initial adjuvant treatment.

This study analyzed the response to nevirapine-based antiretroviral treatment among 218 HIV-infected women in Botswana who had previously received either a single dose of nevirapine or placebo at the time of labor. After the single dose of nevirapine, 18.4% of recipients had treatment failure, as compared with only 5.0% who received placebo. However, the risk of virologic failure did not seem to be increased when antiretroviral treatment was initiated 6 months or more, as compared with less than 6 months, after the peripartum dose of nevirapine.

Homozygous familial hypercholesterolemia is a serious disorder resulting in early-onset vascular disease. This preliminary study explored a new therapy, an inhibitor of microsomal triglyceride transfer protein, which was very effective in lowering low-density lipoprotein cholesterol levels. Practical application of this therapy may be limited, however, by substantial accumulation of hepatic fat and elevation of liver aminotransferase levels.

This study showed that inmates released from prison in Washington State between 1999 and 2003 were at high risk for death, especially during the first 2 weeks after release. Most of the deaths among the recently released inmates were due to drug overdose. Inmates were 129 times more likely to die from drug overdose during the first 2 weeks after release than were other residents of Washington State.

A 64-year-old woman slipped on an icy walk, falling forward and striking her forehead. She had a brief convulsion immediately after the fall, was unresponsive for less than 1 minute, and awakened with a severe generalized headache and nausea but no vomiting. In addition to being perplexed about the circumstances of the fall, she could not recall the previous few hours. She was awake and oriented and had no abnormalities on neurologic examination. Tenderness and a scalp contusion were apparent at the site of the impact, and there were abrasions on her right cheek. What is the expected course, and how should her case be managed?

A 40-year-old woman was admitted to this hospital with epistaxis, hematemesis, and altered mental status. The patient had had heavy menstrual bleeding for 6 months, but bleeding developed at other sites 2 weeks before admission. She had no personal or family history of a bleeding disorder. On admission to this hospital, she had evidence of both bleeding and thrombosis; the laboratory evaluation showed markedly abnormal coagulation studies and a low-normal platelet count. On the 10th hospital day, the results of a diagnostic test were reported.