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Francine Grodstein, ScD; JoAnn E. Manson, MD; Graham A. Colditz, MD; Walter C. Willett, MD; Frank E. Speizer, MD; and Meir J. Stampfer, MD

Postmenopausal hormone use appears to decrease risk for major coronary events in women without previous heart disease. Furthermore, 0.3 mg of oral conjugated estrogen daily is associated with a reduction similar to that seen with the standard dose of 0.625 mg. However, estrogen at daily doses of 0.625 mg or greater and in combination with progestin may increase risk for stroke.

Topics: hormone replacement therapy, cardiovascular diseases, hormone, endocrine therapy, estrogen, primary prevention of ...
George F. Sawaya, MD; Deborah Grady, MD, MPH; Karla Kerlikowske, MD; June La Valleur, MD; Vanessa M. Barnabei, MD, PhD; Katherine Bass, MD; Thomas E. Snyder, MD; James H. Pickar, MD; Sanjay K. Agarwal, MD; Jeanne Mandelblatt, MD, MPH, Heart and Estrogen/progestin Replacement Study (HERS) Research Group

Because of a poor positive predictive value, cervical smears should not be performed within 2 years of normal cytologic results in postmenopausal women. Therapy with oral estrogen plus progestin does not significantly affect the incidence of cytologic abnormalities.

Topics: glycogen storage disease type vi, postmenopause, heart, women, progestins, estrogen, abnormal pap ...
Shreyasee Amin, MD, FRCP(C), MPH; Yuqing Zhang, DSc; Clark T. Sawin, MD; Stephen R. Evans, MPH; Marian T. Hannan, DSc, MPH; Douglas P. Kiel, MD, MPH; Peter W.F. Wilson, MD; and David T. Felson, MD, MPH

In elderly men, hypogonadism related to aging has little influence on bone mineral density, but serum estradiol levels have a strong and positive association with this measure.

Topics: testosterone, bone mineral density, estradiol, hypogonadism, elderly
John F. Reinus, MD; Seth Persky, MD; Jill S. Burkiewicz, PharmD; David Quan, PharmD; Nathan M. Bass, MD, PhD; and Timothy J. Davern, MD

Patients receiving zafirlukast may develop severe liver injury and should be observed for signs and symptoms of hepatitis.

Topics: liver, injury of, leukotriene antagonists, aftercare, zafirlukast, hepatitis
Steven J. Lester, MD; Matthew Baggott, BA; Susette Welm, MA; Nelson B. Schiller, MD; Reese T. Jones, MD; Elyse Foster, MD; and John Mendelson, MD

Modest oral doses of MDMA (the psychoactive stimulant commonly known as ecstasy) increase heart rate, blood pressure, and myocardial oxygen consumption in a magnitude similar to that seen with dobutamine, 20 to 40 µg/kg per minute. Unlike dobutamine, MDMA has no measurable inotropic effects.

Topics: ecstasy-drug, cardiovascular system, double-blind method

Reducing influenza to a minor medical problem will require approval of the live attenuated vaccine, development of better inactivated vaccines, availability of better rapid diagnostic methods, additions to the current antiviral options, and optimal application of all available methods.

Topics: influenza, vaccines, antiviral agents

Despite strong observational evidence from the Nurses' Health Study (including that reported by Grodstein and colleagues in this issue) and others, the disappointing results of three recent trials indicate that clinicians should not use hormone therapy for prevention of coronary disease until this practice is supported by evidence from randomized trials.

Topics: hormone, women, coronary heart disease
Ronald S. Swerdloff, MD; and Christina Wang, MD

In this issue, Amin and colleagues report a lack of relationship between serum levels of total testosterone and bone mineral density in older men. However, they found a strong positive correlation between serum estradiol level and bone mineral density. These data are of considerable interest and require careful interpretation because they may have implications for management of older men using androgen replacement treatment.

Topics: androgens, estrogen

The techniques of close-magic tricks and a procedure in the catheterization lab have some things in common.

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Santiago Ewig, MD; Michael Niederman, MD; and Antoni Torres, MD
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Jean-Yves Fagon, MD; and Jean Chastre, MD
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Karen C. McCowen, MB, MRCPI; Peter A. Burke, MD; and Bruce R. Bistrian, MD, PhD
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J. Carlos Ayus, MD; and Allen I. Arieff, MD
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Topics: ovarian cancer, cervical cancer, women
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Topics: ischemic stroke, hormone, women, primary prevention of cardiovascular disease
Topics: postmenopause, vaginal smears, hormone, women
Topics: testosterone, estrogen, bone mineral density, elderly
Topics: liver, injury of, asthma, zafirlukast
Topics: ecstasy-drug, cardiovascular system
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Robert Fromm Jr., MD; and Kalpalatha Guntupalli, MD

The studies summarized in this Update illustrate how relatively simple ideas and solutions in the intensive care unit can reduce mortality and complication rates and save costs.

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Ralph Gonzales, MD, MSPH; and Merle A. Sande, MD

The authors describe recent developments in the pathophysiology, evaluation, and treatment of uncomplicated acute bronchitis and discuss the impact of efforts to reduce prescription of antibiotics for this illness.

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