Arch Intern Med
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Randomized Controlled Trial Clinical Trial
Effect of postmenopausal estrogen replacement on plasma Lp(a) lipoprotein concentrations.
Women who receive postmenopausal estrogen replacement experience a lower rate of coronary heart disease than women who do not receive these hormones. Evidence suggests that mechanisms in addition to decreases in plasma low-density lipoprotein levels and increases in high-density lipoprotein concentrations are responsible for the apparent beneficial effect of estrogens. Therefore, we studied the effect of estrogen on plasma Lp(a) lipoprotein, newly suggested to be a risk factor for coronary heart disease in postmenopausal women. ⋯ Estrogen decreases the plasma Lp(a) lipoprotein concentration, which could explain some of the protective effect of estrogen replacement therapy on coronary heart disease.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Nicotine replacement therapy for patients with coronary artery disease. Working Group for the Study of Transdermal Nicotine in Patients with Coronary artery disease.
Because nicotine can cause adverse cardiovascular effects, we assessed the safety of transdermal nicotine for smoking cessation in patients with coronary artery disease. ⋯ Transdermal nicotine was well tolerated by patients with stable coronary artery disease in this trial.
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Expert consultation by means of established practice guidelines has been shown to lead to improved accuracy of inpatient anticoagulation therapy, with a reduction in the frequency of hemorrhagic complications. We evaluated a different strategy to improve the accuracy of in-hospital anticoagulation: pharmacy-based, computer-assisted dosing of intravenous heparin therapy. ⋯ Pharmacy-based, computer-assisted dosing of heparin is feasible and results in faster and more accurate anticoagulant dosing.
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The abrupt development of cyanotic and painful toes, "the blue toe syndrome," has been attributed to a number of medical conditions. We describe a patient in which the workup for this condition failed to elucidate a typical cause. Skin biopsy, serologic findings, and response to treatment led to the diagnosis of secondary syphilis. Our experience indicates that secondary syphilis should be included in the differential diagnosis of patients presenting with the blue toe syndrome.