In the COURAGE trial, percutaneous coronary intervention (PCI), added to optimal medical therapy, did not reduce the subsequent rate of death or myocardial infarction among patients with chronic coronary disease. A quality-of-life analysis showed that measures of health status improved significantly with either strategy, but patients in the PCI group had greater initial improvements.

Bivalirudin is a new direct thrombin inhibitor. In patients undergoing PCI for stable coronary disease, bivalirudin and unfractionated heparin resulted in similar overall outcomes, but there was less major bleeding with bivalirudin.

In this trial, tibolone, which has estrogenic, progestogenic, and androgenic effects, was compared with placebo in women between 60 and 85 who had osteoporosis or a vertebral fracture. Tibolone was associated with a reduced risk of fracture, breast cancer, and possibly colon cancer. But the drug was associated with an increased risk of stroke and therefore should generally be avoided in elderly women and in women with risk factors for stroke.

This report describes transplantation of hearts from three infant donors (mean age at donation, 3.7 days) who had died from cardiocirculatory causes. The recipients (mean age, 2.2 months) all survived to 6 months with excellent left ventricular function. This approach to transplantation has been controversial but offers the prospect of expanding the donor pool.

A 44-year-old businessman presents with clinical evidence of alcohol dependence and acknowledges excessive drinking. The use of naltrexone is recommended. Naltrexone is an opioid-blocking agent that inhibits reward signaling in the brain and reduces alcohol craving. Hepatotoxicity has been reported with naltrexone. This drug should not be used in patients who are physically dependent on opiates.

This review gives an account of chromosomal aberrations in cancer cells. Such abnormalities have typically been associated with hematologic cancers, but recent work has shown a variety of chromosomal changes in solid tumors, including prostate cancer and non–small-cell lung cancer. The authors point out that some of the chromosomal abnormalities have revealed targets for cancer treatment, and others have clinical application in the diagnosis of certain types of neoplasms and in the formulation of a prognosis.

A 43-year-old man was seen in the rheumatology clinic because of fatigue and lesions in the pituitary and cerebellum. Diabetes insipidus, hypogonadism, and hypothyroidism had developed beginning 9 years earlier, and lesions had been detected in the region of the pituitary stalk and in the cerebellum. He was treated with glucocorticoids for suspected neurosarcoidosis, but fatigue, ataxia, and neurologic symptoms worsened. Computed tomography of the chest and abdomen disclosed abnormal soft tissue surrounding the aorta, renal arteries, and kidneys. A diagnostic procedure was performed.

A recombinant version of the bacterial protein flagellin protects the mouse gut and bone marrow against the effects of irradiation.