In this large case–control study, the first-trimester use of selective serotonin-reuptake inhibitors (SSRIs) overall was not associated with significantly increased risks of craniosynostosis, omphalocele, or heart defects. Analyses of individual SSRIs revealed some significant associations; however, the analyses involved multiple comparisons and small numbers of exposed subjects. These findings do not show significantly increased risks of major birth defects in association with SSRI use overall.

Previous studies have suggested associations between maternal use of SSRIs and congenital heart defects. In this large case–control study, there were no significant associations between maternal SSRI use overall during early pregnancy and most categories or subcategories of birth defects. Associations were found between maternal SSRI use and anencephaly, craniosynostosis, and omphalocele, but they were based on small numbers of exposed infants.

This report of survey data from surgeons at 17 U.S. medical centers indicates that the majority reported at least one needlestick injury during training and that half of the most recent injuries (including many sustained in the care of high-risk patients) were not reported to an employee health service. The observations that needlestick injuries are common among surgeons in training and are often not reported suggest the need for better strategies to improve occupational safety.

A 3-year-old boy with mevalonic aciduria was treated with a bone marrow transplant from his HLA-identical sister. Soon after transplantation, the recurrent febrile attacks, hepatosplenomegaly, and signs of inflammation that characterize the disease subsided.

A 51-year-old woman presents with a generalized tonic–clonic seizure. After a brief postictal period, she recovers and reports no headache or other neurologic symptoms. She takes no medications and her medical history is unremarkable. Computed tomography of the head suggests a right occipital arteriovenous malformation, without evidence of hemorrhage. Imaging studies show a right occipital arteriovenous malformation as well as a feeding-artery aneurysm.

Historically, fear of malpractice litigation made clinicians cautious about informing patients when they made mistakes in their care. This article reviews recent efforts by regulators, hospitals, accreditation organizations, and legislators to encourage and facilitate discussions between health care providers and patients when patients are harmed by medical errors.

An 11-year-old boy was seen because of a calcified mass in the ethmoid sinus and nose. He had a 5-year history of nasal congestion and headaches; 2 months before presentation, physical examination disclosed a mass in the right naris, and imaging studies showed a calcified mass that appeared to arise in the ethmoid sinus.

Research subjects in a clinical trial sued Amgen because they were not provided with experimental treatment after the trial was stopped early because of lack of efficacy and concerns about safety. The informed consent form promised continued treatment after the trial ended, but a U.S. Court of Appeals ruled in favor of Amgen, arguing that the consent form was a contract between the academic investigators and the subjects and was not binding on Amgen.

This video demonstrates how to perform a comprehensive pelvic examination, including an examination of the external genitalia, a Papanicolaou test to screen for cervical dysplasia, a bimanual examination, and a rectovaginal examination.