Children with Kawasaki disease are at risk for the development of coronary-artery aneurysms. Standard therapy for this disorder includes intravenous immune globulin and aspirin. This study shows that, as compared with placebo, the addition of a single pulsed dose of intravenous methylprednisolone has no further beneficial effect over that of standard therapy and therefore cannot be recommended for routine treatment.

In this randomized trial of 39 patients with chronic pancreatitis and a distal obstruction of the pancreatic duct, surgical drainage was more effective at reducing pain than was endoscopic drainage. Complete or partial relief of pain was achieved in 32% of patients assigned to endoscopic treatment and 75% of those assigned to surgery.

An intranasally administered influenza vaccine may be useful in efforts toward universal vaccination of children less than 5 years of age. In this trial involving 8352 young children, the attack rate for symptomatic influenza was 5% with the live attenuated vaccine, as compared with 10% with the inactivated influenza vaccine administered intramuscularly. However, with the live vaccine, as compared with the inactivated influenza vaccine, there was a higher rate of hospitalization for any cause among children younger than 12 months of age.

Epigenetic silencing of the MLH1 gene, which repairs errors in DNA, is a feature of hereditary nonpolyposis colorectal cancer and usually occurs only in tumor cells. This study identified two women with this syndrome who had germ-line epigenetic silencing of MLH1. One of these women transmitted her silenced MLH1 allele to one of her sons, but the epigenetic change was erased in his spermatozoa. Germ-line transmission of an epigenetic modification of a gene is a novel form of inheritance of a cancer-susceptibility gene.

Stroke is one of the most feared complications of surgery. This article reviews the pathophysiology of perioperative stroke, explains risk-factor stratification, and provides guidance on risk reduction — for example, in patients with carotid stenosis. The review also summarizes the management of stroke in the perioperative period.

A 53-year-old man was admitted to the hospital with a 4-month history of worsening fatigue, dyspnea, weight loss, and sweats. Four years earlier, aortic-valve replacement surgery had been performed for severe aortic insufficiency, which recurred 3 months later, requiring replacement of the prosthetic valve. Evaluation during the current admission showed splenomegaly and an abnormal echocardiogram. A procedure was performed.

The author describes new Medicaid policies signed into law on February 8, 2006, as part of the Deficit Reduction Act of 2005. This act permits states to impose more cost-sharing on beneficiaries, reduce benefits, and deny nursing home benefits to persons with substantial equity in their homes.

The normal B cells that have the t(14;18) translocation in healthy persons may be primed to proliferate by surface immune receptors.