After exposure to dilute diesel exhaust, men with coronary disease had increased exercise-induced myocardial ischemia, along with depressed fibrinolytic function. The data reported suggest possible mechanisms for the detrimental effect of air pollution from traffic in patients with coronary disease.

Myeloablative doses of melphalan with rescue by autologous hematopoietic stem cells are currently used in the treatment of immunoglobulin-light-chain (AL) amyloidosis, but the efficacy of the therapy is unproven. This randomized trial compared a regimen of high-dose melphalan with standard doses of melphalan plus high doses of dexamethasone. The aggressive treatment had no survival advantage as compared with conventional treatment with standard-dose melphalan.

The long-acting factor X inhibitor idraparinux was compared with a standard antithrombotic regimen in two randomized trials, one for the treatment of deep venous thrombosis (DVT Study) and the other for the treatment of pulmonary embolism (PE Study). In the DVT Study, idraparinux was not inferior to standard therapy. In the PE Study, idraparinux was less efficacious than standard therapy.

The high risk of recurrent venous thromboembolism in patients with idiopathic venous thrombosis or pulmonary embolism is reason for extended thromboprophylaxis in selected patients. Although 6 months of prophylaxis with idraparinux after the initial 6 months of treatment with an anticoagulant was effective in preventing recurrent thromboembolism, its use caused an excess of major, clinically significant hemorrhagic episodes.

A 55-year-old man is hospitalized with severe community-acquired pneumonia, and the acute respiratory distress syndrome (ARDS) develops. The patient requires intubation and mechanical ventilation. An intensive care specialist recommends the use of a low-tidal-volume ventilation strategy, which may reduce the risk of ventilator-induced lung injury and is associated with better survival in patients with ARDS than conventional ventilation.

Lethal reperfusion injury is a paradoxical type of myocardial injury caused by the restoration of coronary blood flow after an ischemic episode. This review focuses on the mechanisms of the injury, on attempts to protect the heart against it, and on promising new approaches to cardioprotection during percutaneous coronary intervention.

A 68-year-old man was admitted to the hospital because of a syncopal episode, followed by hemiparesis and altered mental status. An electrocardiogram revealed ST-segment elevations in the anterolateral leads, and MRI of the brain revealed infarcts involving all vascular distributions. Transthoracic echocardiography showed hypokinesis of the left ventricle and a mobile echodensity in the left atrium. Angiography revealed occlusion of the left anterior descending coronary artery, both renal arteries, and the superior mesenteric artery. A diagnostic procedure was performed.

A recent study showed that the toxic prion protein causing "mad cow disease" inhibits proteasome function.