ABSTRACT: Angiotensin-converting enzyme inhibitors and ß-blockers are the cornerstone of heart failure medical therapy; unless contraindicated, start these agents as soon as possible after volume status has been optimized. Aldosterone receptor antagonists, angiotensin-receptor blockers, and a fixed-dose combination of hydralazine and isosorbide dinitrate (the last recommended especially for African Americans) can be used as add-on therapy. Prophylactic implantable cardioverter defibrillators reduce long-term mortality in symptomatic patients with a left ventricular ejection fraction (LVEF) of 35% or less. Cardiac resynchronization therapy improves symptoms and ventricular remodeling in some patients; indications include wide (more than 20 milliseconds) QRS complex on ECG, impaired LVEF (35% or less), and advanced heart failure symptoms (NYHA classes III and IV) despite optimal drug therapy. Measurement of natriuretic peptides and impedance cardiography both show promise for monitoring patients with heart failure and for guiding therapy, but definitive data to justify their routine use are still lacking.

In the late 1980s, "club drugs" were typically limited to the so-called rave/techno subculture.1 More recently, studies have shown the growing appeal of 3,4-methylenedioxymethamphetamine (MDMA), or ecstasy to middle-aged and older adults.

One day after he had been hit in the left eye with a drinking glass, a 48-year-old man sought medical attention. He could see only light and shadows with the eye.

A large right adrenal mass was noted incidentally on an MRI scan of the lumbar spine, which had been performed for other reasons in a 55-year-old non-obese woman. The bright heterogeneous mass (T2-weighted image) measured 6.2 3 6.2 3 4.1 cm and sat like the head of a serpent on the superior pole of the right kidney. Its margins were smooth, but signal intensity was increased on T2 weighting because of high water content. The left adrenal gland was normal.

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CHICAGO -- Although religious doctors are more likely to consider medicine a calling, that doesn't translate into caring for more underserved patients, a survey has revealed.

RESEARCH TRIANGLE PARK, N.C. -- Things may not be all quiet on the home front. When soldiers deploy for combat, child abuse and neglect increase as does stress for the spouses left behind, researchers here said.

WASHINGTON -- It should be a woman's right to know what oral contraceptive she is taking, according to the American College of Obstetricians and Gynecologists.

GRENOBLE, France -- Drug-eluting stents appear to pose a particular risk for thrombosis in diabetic patients on insulin therapy diabetes and those with multivessel coronary disease, researchers here found.

PHILADELPHIA -- The rising rate of Caesarean deliveries might be slowed by preventive labor induction, researchers here said.

LONDON -- Air polluted with even declining levels of black smoke and sulphur dioxide can still increases the risk of premature death, according to British health data.

SEATTLE -- Screening MRI had a higher rate of breast cancer detection than either mammography or ultrasound screening in high-risk women, but it nearly quadrupled the biopsy rate, researchers here found.

ROCKPORT, Me. -- Chief Justice John Roberts had a benign idiopathic seizure today at his summer home near here and was hospitalized as a precaution, according to the Supreme Court.

DURHAM, N.C. -- The response rate in renal cell carcinoma more than tripled with both an immunomodulator and an angiogenesis inhibitor compared with typical results with either drug alone, investigators here found.

RIGA, Latvia -- Percutaneous coronary intervention (PCI) with cutting balloon pre-treatment of lesions may be a good therapeutic option for left main artery stenosis, a transoceanic team of investigators affirmed.

ATLANTA -- A spike in outbreaks of cryptosporidiosis in 2006 has spurred the CDC to launch an initiative this summer to improve the safety of swimming pools and other recreational water facilities.

BALTIMORE -- Reading the written word may be mightier than lead poisoning, investigators here reported.

BOSTON -- New genetic contributors to multiple sclerosis have been uncovered for the first time in 35 years, according to researchers here.

ROCKVILLE, Md. -- Tegaserod (Zelnorm), the irritable bowel syndrome and constipation drug pulled from the market last spring, will make a limited return under an FDA plan that permits its use in certain symptomatic women younger than 55.

DALLAS -- A 30-minute, video-based cardiopulmonary resuscitation course (CPR) is as effective as a traditional 3-hour course, with possibly better retention at six months, researchers here found.