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The association between the apolipoprotein E (apoE) ε4 allele and Alzheimer disease does not seem to be mediated by vascular factors. The apoE ε4 allele, elevated midlife total cholesterol level, and high midlife systolic blood pressure are independent risk factors for Alzheimer disease. The risk for Alzheimer disease from treatable factors—elevated total cholesterol level and blood pressure—appears to be greater than that from the apoE ε4 allele.
Almost half of the deaths that result from myelodysplastic syndromes are due to cytopenia associated with bone marrow failure. Treatment is mostly supportive care. In this nonrandomized, single-treatment study, 34% of patients with myelodysplastic syndromes who were treated with antithymocyte globulin became transfusion independent. Response was associated with a statistically significant longer survival and an almost significantly decreased time to disease progression.
Successful pregnancy with normal outcome is possible in women with aplastic anemia previously treated with immunosuppression. Complications appear to be more likely in patients with low platelet counts and paroxysmal nocturnal hemoglobinuria–associated aplastic anemia.
This paper provides the clinician with an understanding of the epidemiologic and biological characteristics of West Nile virus in North America, as well as useful information on the diagnosis, reporting, and management of patients with suspected West Nile virus infection and on advising patients about prevention.
This case-based review defines and discusses various aspects of emergency contraception, including available methods, efficacy, safety, side effects, prescribing guidelines, and follow-up.
Although human growth hormone is now readily available and approved for treatment of the growth hormone deficiency syndrome in adults, skepticism exists about its use. The author discusses questions surrounding this therapy and concludes that it should not be routinely used for most patients.
The author addresses common concerns about growth hormone therapy and encourages reluctant practitioners to at least consider it in patients with definite growth hormone deficiency.
The U.S. Preventive Services Task Force concludes that the evidence is insufficient to recommend for or against behavioral counseling in primary care settings to promote physical activity.
This systematic review supports the U.S. Preventive Services Task Force's position on behavioral counseling to promote physical activity.
In this issue, Isley and Cook provide strong arguments for diametrically opposed positions concerning growth hormone treatment for adult growth hormone deficiency. For those searching for a position between the two extremes, this editorial attempts to offer a rationale for a “middle ground.”
Too often housestaff speak of residency training as a “test of survival.” However, faculty physicians know that these years of training are not lived in a vacuum but are inextricably interwoven into the fabric of residents' personal and professional lives. This paper describes the stories written by primary care housestaff during their 3 years of training.
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