The New England journal of medicine
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Randomized Controlled Trial Clinical Trial
Reversal of catabolism by beta-blockade after severe burns.
The catecholamine-mediated hypermetabolic response to severe burns causes increased energy expenditure and muscle-protein catabolism. We hypothesized that blockade of beta-adrenergic stimulation with propranolol would decrease resting energy expenditure and muscle catabolism in patients with severe burns. ⋯ In children with burns, treatment with propranolol during hospitalization attenuates hypermetabolism and reverses muscle-protein catabolism.
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Randomized Controlled Trial Clinical Trial
A clinical trial of estrogen-replacement therapy after ischemic stroke.
Observational studies have suggested that estrogen-replacement therapy may reduce a woman's risk of stroke and death. ⋯ Estradiol does not reduce mortality orthe recurrence of stroke in postmenopausal women with cerebrovascular disease. This therapy should not be prescribed for the secondary prevention of cerebrovascular disease.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Patients at high risk of death after lung-volume-reduction surgery.
Lung-volume-reduction surgery is a proposed treatment for emphysema, but optimal selection criteria have not been defined. The National Emphysema Treatment Trial is a randomized, multicenter clinical trial comparing lung-volume-reduction surgery with medical treatment. ⋯ Caution is warranted in the use of lung-volume-reduction surgery in patients with emphysema who have a low FEV1 and either homogeneous emphysema or a very low carbon monoxide diffusing capacity. These patients are at high risk for death after surgery and also are unlikely to benefit from the surgery.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Prognosis after transient monocular blindness associated with carotid-artery stenosis.
Transient monocular blindness associated with internal-carotid-artery stenosis is a risk factor for stroke. The effect of carotid endarterectomy in patients who present with transient monocular blindness has not been determined. ⋯ Among patients with internal-carotidartery stenosis, the prognosis was better for those presenting with transient monocular blindness than for those presenting with hemispheric transient ischemic attack. Among patients with transient monocular blindness, carotid endarterectomy may be beneficial when other risk factors for stroke are also present.