In a randomized trial, 1059 patients with an acute myocardial infarction with ST-segment elevation presented to hospitals that did not have the capability of performing percutaneous coronary intervention (PCI) and received fibrinolysis. They were then assigned to either immediate transfer to a PCI center for catheterization or transfer only if fibrinolysis failed. The immediate-transfer strategy was associated with significantly fewer ischemic complications at 30 days.

Somatically acquired mutations, which contribute to tumorigenesis, are usually specific to tumor tissue. Sequencing of the whole transcriptome — the entire set of messenger RNAs — in ovarian granulosa-cell tumors implicated a somatic mutation in FOXL2 in a large majority of the tumors that were analyzed.

This large trial of acute lymphoblastic leukemia in children aimed to determine whether intensive systemic and intrathecal chemotherapy could obviate the need for prophylactic central nervous system irradiation, which is associated with distressing late complications. The results show that, with meticulous monitoring of responses and toxic effects, it is possible not only to avoid cranial irradiation but also to improve the overall outcome.

The authors investigated whether mutations in the gene encoding gonadotropin-releasing hormone 1 (GNRH1) might cause idiopathic hypogonadotropic hypogonadism (IHH). They identified a homozygous GNRH1 frameshift mutation in a teenage brother and sister, both of whom had normosmic IHH. This isolated autosomal recessive GnRH deficiency, reversed by pulsatile GnRH administration, shows the pivotal role of GnRH in human reproduction.

A 60-year-old white man presents for evaluation of progressive dyspnea. He is a former smoker with a 20-pack-year smoking history and a 10-year history of chronic obstructive pulmonary disease (COPD). There is no family history of COPD. Severe airflow obstruction is seen on spirometry, with a forced expiratory volume in 1 second that is 40% of the predicted value. Should he be evaluated for alpha₁-antitrypsin (AAT) deficiency? If AAT deficiency is documented, how should his case be managed?

The association between alcohol intake and alcoholic liver disease has been well documented, although cirrhosis of the liver develops in only a small proportion of heavy drinkers. This review focuses on alcoholic hepatitis, a treatable form of alcoholic liver disease. Since up to 40% of patients with severe alcoholic hepatitis die within 6 months after the onset of the clinical syndrome, appropriate diagnosis and treatment are essential.

A 79-year-old woman was admitted to the burn unit of this hospital because of a blistering cutaneous eruption. Five days before admission, itching on her head and back and skin lesions on her abdomen developed. Hydroxychloroquine, which she had begun taking 2 weeks earlier, was discontinued, but the rash spread to her back, arms, and legs and became painful; fever, headache, and sore throat with dysphagia developed. A diagnostic procedure was performed.