Annals of internal medicine
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Although many observers believe that cancer chemotherapy is overused at the end of life, there are no published data on this. ⋯ Among patients who died of cancer, chemotherapy was used frequently in the last 3 months of life. The cancer's responsiveness to chemotherapy does not seem to influence whether dying patients receive chemotherapy at the end of life.
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This Update reviews developments in the pathophysiology and treatment of Parkinson disease during the past several years. In the area of pathophysiology, studies have addressed the contribution of environmental factors such as caffeine and pesticides. ⋯ These studies have led to the development of a pathophysiologic model of Parkinson disease that emphasizes abnormal protein aggregation. Studies of treatment have clarified the relative roles of l-dopa and dopamine agonists in early Parkinson disease and shown the potential for surgical interventions, particularly deep-brain stimulation, to relieve the symptoms of advanced, medically refractory disease.
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Multicenter Study
Survival benefit of initiating antiretroviral therapy in HIV-infected persons in different CD4+ cell strata.
Optimal timing of antiretroviral therapy (ART) initiation for HIV-infected persons remains unclear. ⋯ Among HIV-infected persons with CD4+ cell counts of 0.201 to 0.350 x 10(9) cells/L, initiating ART is associated with reduced mortality compared with delaying such therapy. Survival benefits of earlier ART initiation (at CD4+ cell counts of 0.351 to 0.500 x 10(9) cells/L) are possible.
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Pulmonary vein isolation is a new, effective curative procedure for selected patients with atrial fibrillation. Pulmonary vein stenosis is a potential complication and may lead to symptoms that are often underrecognized. ⋯ Severe pulmonary vein stenosis after catheter ablation of atrial fibrillation is associated with respiratory symptoms that frequently mimic more common diseases, often leading to erroneous diagnostic and therapeutic procedures. Awareness of this syndrome is important for proper and prompt management.