Acute respiratory distress syndrome is the extreme manifestation of acute lung injury. Both these conditions complicate many medical and surgical conditions, not all of which affect the lung directly and are therefore encountered by clinicians working outside the critical care setting . . . Join discussion...

In this week's BMJ, Mant and colleagues and Fitzmaurice and colleagues present the results of the SAFE (screening for atrial fibrillation in the elderly) study. They assess how accurately general practitioners, practice nurses, and an interpretive computer program can diagnose atrial fibrillation on an electrocardiogram (ECG), and they report on the effectiveness of screening patients aged 65 and over for atrial fibrillation in British general practice.1 2 The prevalence of atrial fibrillation rises with age from 1.5% in people in their 60s to more than 10% in those over 90. People with atrial fibrillation have double the mortality and a four to fivefold higher risk of stroke than those without fibrillation. About a quarter of all strokes in elderly people are caused by atrial fibrillation. Strokes caused by atrial fibrillation are often severe and lead to high mortality and a low quality of life.3 Join discussion...

A 61-year-old man was admitted to this hospital because of recurrent fevers. He had been well until approximately 3.5 months earlier, when chills, fevers, and fatigue developed. He had no cough or production of sputum. He saw his primary care physician, who sent him to the emergency department of another hospital. A chest radiograph revealed a left basilar opacity, and a diagnosis of community-acquired pneumonia was made. A 5-day course of azithromycin was begun. His symptoms persisted, and he was admitted to the same hospital 5 days later. A chest radiograph . . . Join discussion...

A 66-year-old man presented with edema, which had developed over the previous month. The urinary sediment showed fatty casts (Panel A), with typical "Maltese crosses" under polarized light (Panel B), and was otherwise unremarkable, with no sign of nephritis. Laboratory evaluation revealed hypoalbuminemia (2.2 g of albumin per deciliter), hypercholesterolemia (369 mg of cholesterol per deciliter [9.5 mmol per liter]), and a serum creatinine level of 1.0 mg per deciliter (88 µmol per liter); a spot urine sample showed a protein-to-creatinine ratio of 13. A diagnosis of idiopathic membranous nephropathy was made on the basis of a renal biopsy and . . . Join discussion...

A previously healthy 12-year-old boy presented with abdominal pain, vomiting, and abdominal distention of 3 days' duration. On physical examination, hyperpigmented macules were seen on his lips (Panel A). A computed tomographic scan showed proximal jejunojejunal (Panel B, arrow) and ileocolic intussusceptions. Surgical exploration revealed dilatation of the small bowel and necrosis of the jejunal intussusceptum. Resection of this segment and a short ileal intussusceptum containing a large polyp was performed, followed by primary anastomosis. Pathological evaluation showed multiple hamartomatous polyps in the necrotic jejunum and an ileal polyp 3.5 cm in diameter. The diagnosis was Peutz–Jeghers syndrome, an autosomal Join discussion...

Atherothrombosis describes the occurrence of both atherosclerosis and thrombosis in an artery, a common feature of peripheral arterial disease.1 It is estimated that 1 in 16 U.S. residents who were at least 40 years of age in 2000 (approximately 8.5 million persons) had peripheral arterial disease.2 Although claudication is frequent in and seriously limits the lifestyle of patients with peripheral arterial disease, the most common cause of death in these patients is from coexisting atherothrombo Join discussion...

High resolution views of a receptor molecule that is implicated in cancer offer a clear target for the development of a new class of cancer drugs, Yale School of Medicine researchers report July 27 in Cell. It is also anticipated that the new family of drugs may be applied for the treatment of gastrointestinal stromal tumor (GIST) cancers that are resistant to Gleevec and Sutent. Although these drugs would target the same receptors as Gleevec and Sutent, they would do so by a different mechanis Join discussion...

Clinical trials are underway with the first new vaccine against TB in over 80 years. If successful, the tests will have major implications for TB control and could lead to the development of a new vaccine ready to use within eight years. The need to control TB has become more urgent with the resurgence of the disease in many parts of the world, including a 10% rise in England, Wales and Northern Ireland, and the emergence of multi-drug resistant strains. TB, which is caused by the M. tuberculo Join discussion...

Oncogenic osteomalacia is a rare syndrome that is usually driven by small, mesenchymal tumors that express phosphatonins, proteins that decrease the abundance of sodium–phosphate cotransporters in the proximal renal tubule. This decrease causes renal phosphate wasting and leads to the clinical features of oncogenic osteomalacia, which include hyperphosphaturia, hypophosphatemia, reduced or abnormal serum 1,25-dihydroxyvitamin D levels, and osteomalacia.1,2 The standard treatment of oncogenic o Join discussion...

A new method of adult stem cell growth, designed in the Area of Cellular Therapy of the University Clinic (University of Navarra), has demonstrated its efficacy for its capacity to grow cornea stem cells. So Ana Fernández Hortelano, ophthalmologist at the Hospital demonstrated on applying the growth technique in treating diseases of the cornea, using stem cells, in 70 test animals (rabbits). The aim of the procedure was to regain the damaged epithelium and thus restore transparency to the cornea Join discussion...