2012 Aug 23 - Hyperosmolar Therapy for Raised Intracranial Pressure

Allan H. Ropper, M.D. N Engl J Med 2012; 367:746-752August 23, 2012
A 49-year-old female passenger was thrown against the doorframe during an automobile accident. After being pulled from the car, she opened her eyes intermittently, moaned, and had flexion withdrawal of her limbs (Glasgow Coma Scale score, 8).

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2012 July 12 - Management of Opioid Analgesic Overdose

Edward W. Boyer, M.D., Ph.D. N Engl J Med 2012; 367:146-155July 12, 2012
Opioid analgesic overdose is a preventable and potentially lethal condition that results from prescribing practices, inadequate understanding on the patient's part of the risks of medication misuse, errors in drug administration, and pharmaceutical abuse.

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2012 June 28 - Hydroxyethyl Starch 130/0.4 versus Ringer's Acetate in Severe Sepsis

Anders Perner, M.D., Ph.D., Nicolai Haase, M.D., Anne B. Guttormsen, M.D., Ph.D., Jyrki Tenhunen, M.D., Ph.D., Gudmundur Klemenzson, M.D., Anders Åneman, M.D., Ph.D., Kristian R. Madsen, M.D., Morten H. Møller, M.D., Ph.D., Jeanie M. Elkjær, M.D., Lone M. Poulsen, M.D., Asger Bendtsen, M.D., M.P.H., Robert Winding, M.D., Morten Steensen, M.D., Pawel Berezowicz, M.D., Ph.D., Peter Søe-Jensen, M.D., Morten Bestle, M.D., Ph.D., Kristian Strand, M.D., Ph.D., Jørgen Wiis, M.D., Jonathan O. White, M.D., Klaus J. Thornberg, M.D., Lars Quist, M.D., Jonas Nielsen, M.D., Ph.D., Lasse H. Andersen, M.D., Lars B. Holst, M.D., Katrin Thormar, M.D., Anne-Lene Kjældgaard, M.D., Maria L. Fabritius, M.D., Frederik Mondrup, M.D., Frank C. Pott, M.D., D.M.Sci., Thea P. Møller, M.D., Per Winkel, M.D., D.M.Sci., and Jørn Wetterslev, M.D., Ph.D. for the 6S Trial Group and the Scandinavian Critical Care Trials Group
June 27, 2012 (10.1056/NEJMoa1204242)

Background
Hydroxyethyl starch (HES) 130/0.4 is widely used for fluid resuscitation in intensive care units (ICUs), but its safety and efficacy have not been established in patients with severe sepsis.

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2012 June 7 - Clinical Practice Acute Limb Ischemia

Mark A. Creager, M.D., John A. Kaufman, M.D., and Michael S. Conte, M.D. N Engl J Med 2012; 366:2198-2206June 7, 2012
Stage
A 57-year-old man presents with an acute onset of left foot pain, numbness, and partial loss of motor function. Four months ago, he underwent endovascular treatment for disabling claudication, which included placement of overlapping polytetrafluoroethylene-coated stents in the left superficial femoral and popliteal arteries. His popliteal and pedal pulses are absent, and the foot is cool and mottled. Angiography reveals complete occlusion of the stent, with thrombosis extending distally into the popliteal and tibial arteries below the knee. How should his case be managed?

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2012 May 31 - Drowning

David Szpilman, M.D., Joost J.L.M. Bierens, M.D., Ph.D., Anthony J. Handley, M.D., and James P. Orlowski, M.D. N Engl J Med 2012; 366:2102-2110May 31, 2012
According to the World Health Organization (WHO), 0.7% of all deaths worldwide — or more than 500,000 deaths each year — are due to unintentional drowning. Since some cases of fatal drowning are not classified as such according to the codes of the International Classification of Disease, this number underestimates the real figures, even for high-income countries, and does not include drownings that occur as a result of floods, tsunamis, and boating accidents.

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2012 May 31 - Nighttime Intensivist Staffing and Mortality among Critically Ill Patients

David J. Wallace, M.D., M.P.H., Derek C. Angus, M.D., M.P.H., Amber E. Barnato, M.D., M.P.H., Andrew A. Kramer, Ph.D., and Jeremy M. Kahn, M.D. N Engl J Med 2012; 366:2093-2101May 31, 2012
Background
Hospitals are increasingly adopting 24-hour intensivist physician staffing as a strategy to improve intensive care unit (ICU) outcomes. However, the degree to which nighttime intensivists are associated with improvements in the quality of ICU care is unknown.

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2012 May 17 - Azithromycin and the Risk of Cardiovascular Death

Wayne A. Ray, Ph.D., Katherine T. Murray, M.D., Kathi Hall, B.S., Patrick G. Arbogast, Ph.D., and C. Michael Stein, M.B., Ch.B.
N Engl J Med 2012; 366:1881-1890May 17, 2012

Background
Although several macrolide antibiotics are proarrhythmic and associated with an increased risk of sudden cardiac death, azithromycin is thought to have minimal cardiotoxicity. However, published reports of arrhythmias suggest that azithromycin may increase the risk of cardiovascular death.

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2012 May 22 - Drotrecogin Alfa (Activated) in Adults with Septic Shock

V. Marco Ranieri, M.D., B. Taylor Thompson, M.D., Philip S. Barie, M.D., M.B.A., Jean-François Dhainaut, M.D., Ivor S. Douglas, M.D., Simon Finfer, F.R.C.P., Bengt Gårdlund, M.D., John C. Marshall, M.D., Andrew Rhodes, M.D., Antonio Artigas, M.D., Ph.D., Didier Payen, M.D., Ph.D., Jyrki Tenhunen, M.D., Ph.D., Hussein R. Al-Khalidi, Ph.D., Vivian Thompson, M.P.H., Jonathan Janes, M.B., B.Ch., William L. Macias, M.D., Ph.D., Burkhard Vangerow, M.D., and Mark D. Williams, M.D. for the PROWESS-SHOCK Study Group
May 22, 2012 (10.1056/NEJMoa1202290)


Background
There have been conflicting reports on the efficacy of recombinant human activated protein C, or drotrecogin alfa (activated) (DrotAA), for the treatment of patients with septic shock.

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2012 May 10 - An Electrocardiographic Sine Wave in Hyperkalemia

Daniel B. Petrov, M.D.N Engl J Med 2012; 366:1824 May 10, 2012
A 62-year old man with chronic renal insufficiency reported having reduced exercise tolerance for the previous week. The physical examination was unremarkable, but oxygen saturation was diminished. An electrocardiogram showed a regular rhythm, with a widened QRS complex in a sine-wave configuration, and there were no discernible P waves.

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2012 March 15 - Westermark Sign in Pulmonary Embolism

Anant Subramanian Krishnan, M.D., and Tristan Barrett, M.D. N Engl J Med 2012; 366:e16March 15, 2012
A 47-year-old woman presented to the emergency department with acute shortness of breath and hypoxemia. Her medical history included sex reassignment, for which she was taking estrogen, and a deep-vein thrombosis on the left side, for which she had required treatment with warfarin. She had a family history of fatal pulmonary emboli. 

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2012 March 1 - Placebo-Controlled Trial of Amantadine for Severe Traumatic Brain Injury

Joseph T. Giacino, Ph.D., John Whyte, M.D., Ph.D., Emilia Bagiella, Ph.D., Kathleen Kalmar, Ph.D., Nancy Childs, M.D., Allen Khademi, M.D., Bernd Eifert, M.D., David Long, M.D., Douglas I. Katz, M.D., Sooja Cho, M.D., Stuart A. Yablon, M.D., Marianne Luther, M.D., Flora M. Hammond, M.D., Annette Nordenbo, M.D., Paul Novak, O.T.R., Walt Mercer, Ph.D., Petra Maurer-Karattup, Dr.Rer.Nat., and Mark Sherer, Ph.D. N Engl J Med 2012; 366:819-826, March 1, 2012
Background
Amantadine hydrochloride is one of the most commonly prescribed medications for patients with prolonged disorders of consciousness after traumatic brain injury. Preliminary studies have suggested that amantadine may promote functional recovery. 

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2012 Feb 16 - Intramuscular versus Intravenous Therapy for Prehospital Status Epilepticus

Robert Silbergleit, M.D., Valerie Durkalski, Ph.D., Daniel Lowenstein, M.D., Robin Conwit, M.D., Arthur Pancioli, M.D., Yuko Palesch, Ph.D., and William Barsan, M.D. for the NETT Investigators. N Engl J Med 2012; 366:591-600February 16, 2012
Background
Early termination of prolonged seizures with intravenous administration of benzodiazepines improves outcomes. For faster and more reliable administration, paramedics increasingly use an intramuscular route.

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2012 Jan 19 - Pulmonary Cement Embolism after Vertebroplasty

Jean-Pierre Tourtier, M.D., and Sophie Cottez, M.D. N Engl J Med 2012; 366:258January 19, 2012
A 61-year-old man with spinal cord compression caused by a vertebral hemangioma underwent therapeutic laminectomy of the fifth vertebra and laminectomy and vertebroplasty of the fourth vertebra. During the vertebroplasty, polymethylmethacrylate cement leaked into the paravertebral vascular system. In the recovery room, the patient was mildly hypoxemic but otherwise asymptomatic.

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2012 Jan 19 - Cognitive and Neurologic Outcomes after Coronary-Artery Bypass Surgery

Ola A. Selnes, Ph.D., Rebecca F. Gottesman, M.D., Ph.D., Maura A. Grega, R.N., M.S.N., William A. Baumgartner, M.D., Scott L. Zeger, Ph.D., and Guy M. McKhann, M.D.
N Engl J Med 2012; 366:250-257January 19, 2012
Patients referred for coronary revascularization procedures are older and are likely to have more extensive extracardiac vascular disease than those referred for such procedures in the past. Despite these trends, mortality rates for coronary-artery bypass grafting (CABG), without concurrent procedures, have continued to decline.1 Nevertheless, adverse neurologic outcomes, including stroke and cognitive decline, remain a major concern for these older patients.

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2012 Jan 19 - Preliminary Study of Two Antiviral Agents for Hepatitis C Genotype 1

Anna S. Lok, M.D., David F. Gardiner, M.D., Eric Lawitz, M.D., Claudia Martorell, M.D., Gregory T. Everson, M.D., Reem Ghalib, M.D., Robert Reindollar, M.D., Vinod Rustgi, M.D., Fiona McPhee, Ph.D., Megan Wind-Rotolo, Ph.D., Anna Persson, Ph.D., Kurt Zhu, Ph.D., Dessislava I. Dimitrova, M.D., Timothy Eley, Ph.D., Tong Guo, Ph.D., Dennis M. Grasela, Pharm.D., Ph.D., and Claudio Pasquinelli, M.D., Ph.D.
N Engl J Med 2012; 366:216-224January 19, 2012

Background
Patients with chronic hepatitis C virus (HCV) infection who have not had a response to therapy with peginterferon and ribavirin may benefit from the addition of multiple direct-acting antiviral agents to their treatment regimen.

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2012 Jan 12 - Subclinical Atrial Fibrillation and the Risk of Stroke

Jeff S. Healey, M.D., Stuart J. Connolly, M.D., Michael R. Gold, M.D., Carsten W. Israel, M.D., Isabelle C. Van Gelder, M.D., Alessandro Capucci, M.D., C.P. Lau, M.D., Eric Fain, M.D., Sean Yang, M.Sc., Christophe Bailleul, M.D., Carlos A. Morillo, M.D., Mark Carlson, M.D., Ellison Themeles, M.Sc., Elizabeth S. Kaufman, M.D., and Stefan H. Hohnloser, M.D. for the ASSERT Investigators. N Engl J Med 2012; 366:120-129January 12, 2012
Background
One quarter of strokes are of unknown cause, and subclinical atrial fibrillation may be a common etiologic factor. Pacemakers can detect subclinical episodes of rapid atrial rate, which correlate with electrocardiographically documented atrial fibrillation. We evaluated whether subclinical episodes of rapid atrial rate detected by implanted devices were associated with an increased risk of ischemic stroke in patients who did not have other evidence of atrial fibrillation.

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2012 Jan 12 - Cardiac Arrest during Long-Distance Running Races

Jonathan H. Kim, M.D., Rajeev Malhotra, M.D., George Chiampas, D.O., Pierre d'Hemecourt, M.D., Chris Troyanos, A.T.C., John Cianca, M.D., Rex N. Smith, M.D., Thomas J. Wang, M.D., William O. Roberts, M.D., Paul D. Thompson, M.D., and Aaron L. Baggish, M.D. for the Race Associated Cardiac Arrest Event Registry (RACER) Study Group. N Engl J Med 2012; 366:130-140January 12, 2012
Background
Approximately 2 million people participate in long-distance running races in the United States annually. Reports of race-related cardiac arrests have generated concern about the safety of this activity.

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2012 Jan 5 - Thrombin-Receptor Antagonist Vorapaxar in Acute Coronary Syndromes

Pierluigi Tricoci, M.D., Ph.D., Zhen Huang, M.S., Claes Held, M.D., Ph.D., David J. Moliterno, M.D., Paul W. Armstrong, M.D., Frans Van de Werf, M.D., Harvey D. White, D.Sc., Philip E. Aylward, M.D., Lars Wallentin, M.D., Ph.D., Edmond Chen, M.D., Yuliya Lokhnygina, Ph.D., Jinglan Pei, M.S., Sergio Leonardi, M.D., Tyrus L. Rorick, R.N., Ann M. Kilian, B.S., Lisa H.K. Jennings, Ph.D., Giuseppe Ambrosio, M.D., Ph.D., Christoph Bode, M.D., Angel Cequier, M.D., Jan H. Cornel, M.D., Rafael Diaz, M.D., Aycan Erkan, M.D., Ph.D., Kurt Huber, M.D., Michael P. Hudson, M.D., Lixin Jiang, M.D., J. Wouter Jukema, M.D., Ph.D., Basil S. Lewis, M.D., A. Michael Lincoff, M.D., Gilles Montalescot, M.D., José Carlos Nicolau, M.D., Ph.D., Hisao Ogawa, M.D., Matthias Pfisterer, M.D., Juan Carlos Prieto, M.D., Witold Ruzyllo, M.D., Peter R. Sinnaeve, M.D., Ph.D., Robert F. Storey, M.D., D.M., Marco Valgimigli, M.D., Ph.D., David J. Whellan, M.D., Petr Widimsky, M.D., Dr.Sc., John Strony, M.D., Robert A. Harrington, M.D., and Kenneth W. Mahaffey, M.D. for the TRACER Investigators
N Engl J Med 2012; 366:20-33
January 5, 2012
Background
Vorapaxar is a new oral protease-activated–receptor 1 (PAR-1) antagonist that inhibits thrombin-induced platelet activation.

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2012 Jan 5 - Rivaroxaban in Patients with a Recent Acute Coronary Syndrome

Jessica L. Mega, M.D., M.P.H., Eugene Braunwald, M.D., Stephen D. Wiviott, M.D., Jean-Pierre Bassand, M.D., Deepak L. Bhatt, M.D., M.P.H., Christoph Bode, M.D., Paul Burton, M.D., Ph.D., Marc Cohen, M.D., Nancy Cook-Bruns, M.D., Keith A.A. Fox, M.B., Ch.B., Shinya Goto, M.D., Sabina A. Murphy, M.P.H., Alexei N. Plotnikov, M.D., David Schneider, M.D., Xiang Sun, Ph.D., Freek W.A. Verheugt, M.D., and C. Michael Gibson, M.D. for the ATLAS ACS 2–TIMI 51 Investigators. N Engl J Med 2012; 366:9-19 January 5, 2012
Background
Acute coronary syndromes arise from coronary atherosclerosis with superimposed thrombosis. Since factor Xa plays a central role in thrombosis, the inhibition of factor Xa with low-dose rivaroxaban might improve cardiovascular outcomes in patients with a recent acute coronary syndrome.

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2012 Jan 5 - A Tale of Coronary Artery Disease and Myocardial Infarction

Elizabeth G. Nabel, M.D., and Eugene Braunwald, M.D.N Engl J Med 2012; 366:54-63 January 5, 2012
...Medical knowledge in the 18th and 19th centuries was grounded in clinical observation and anatomical dissection. Cardiovascular science emerged in the physiological era of the late 19th and early 20th centuries, first in Europe and subsequently in North America.

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