In this randomized, placebo-controlled trial involving 435 adolescents and adults with meningitis in Vietnam, the use of adjunctive dexamethasone did not reduce the rate of death or disability at 6 months. In subgroup analyses, a benefit of treatment was seen in patients with confirmed bacterial meningitis, whereas harm was identified in those with probable bacterial meningitis.

Bacterial meningitis is associated with high morbidity and mortality. This randomized, double-blind study in Malawi involving 465 patients with acute meningitis, 90% of whom were HIV-positive, showed no significant difference in morbidity or mortality among patients treated with intravenous versus intramuscular ceftriaxone or among those who did or did not receive corticosteroids.

This report describes the 18-month follow-up of the patient who underwent the first human face allograft after severe facial trauma. The patient has had return of sensation (to light touch and temperature) and motor function, with restoration of facial expression with emotion. She has had two rejection episodes, both of which were successfully reversed. The patient reports satisfaction with the outcome.

Cardiac-resynchronization therapy is beneficial in patients with heart failure and a prolonged QRS interval, but a new clinical trial showed that patients with heart failure and a normal QRS interval did not benefit. The results will direct this therapy, which is invasive and costly, to patients most likely to benefit from it.

A 65-year-old man presents to an outpatient clinic, reporting that he can no longer maintain an erection sufficient for intercourse. His history includes well-controlled hypertension and stable coronary artery disease. He smokes a pack of cigarettes daily. His medications include atenolol and low-dose aspirin. On physical examination, his body-mass index is 31. He has normal external genitalia and no loss of body hair. How should he be evaluated and treated?

This review of the role of platelets in atherothrombosis illuminates the surprisingly numerous activities of these tiny, anucleate cells and stresses their participation in the inflammatory component of atherothrombosis. The information is presented in the context of the prevention of atherothrombosis by antiplatelet agents now in clinical use.

A 44-year-old woman was admitted to this hospital because of generalized, painful, ulcerated skin lesions. Four years before admission, she had generalized hyperkeratotic lesions that responded poorly to treatment. Biopsy specimens had been interpreted as squamous-cell carcinoma. Three months before admission, mycophenolate mofetil was begun; some of the lesions regressed, but 1 month later, new painful nodules and plaques developed, with central necrosis and ulceration.

The authors describe the global shortage of health care workers and the inadequate personnel available to care for patients with HIV infection. They review evidence showing the benefits of delegating tasks to less specialized workers (task shifting) and promote the expanded use of such services in countries with inadequate supplies of doctors and nurses.

The placement of a central venous catheter is indicated for the continuous monitoring of central venous pressure and for the delivery of critical or caustic medications. This video demonstrates one technique for placement of a catheter in the subclavian vein and considers how to avoid potential complications.