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In This Issue of Archives of Internal Medicine |

In This Issue of Archives of Internal Medicine FREE

Arch Intern Med. 2001;161(11):1375. doi:10.1001/archinte.161.11.1375.
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WHAT KILLED MOZART?

Wolfgang Mozart had been sick for 2 weeks prior to his death in 1791. Several people in Vienna at that time had many of the same symptoms as Mozart (fever, rash, edema without dyspnea, inflamed extremities, all with clear mentation). Various articles have suggested arsenic poisoning, acute rheumatic fever, renal failure, Henoch-Schönlein purpura, and infective endocarditis as possible causes. In this article, Hirschmann suggests a new theory about Mozart's death.

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CONSEQUENCES OF ASYMPTOMATIC BACTERIURIA IN WOMEN WITH DIABETES MELLITUS

In this study of 636 diabetic women with and without asymptomatic bacteriuria, Geerlings et al monitored their tendency to develop urinary tract infections (UTIs), renal function disturbances, and secondary diabetic complications during 18 months of follow-up.

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IS PATIENTS' PERCEPTION OF TIME SPENT WITH PHYSICIAN A DETERMINANT OF AMBULATORY PATIENT SATISFACTION?

The results of this study by Lin et al showed that most patients surveyed in an academic primary care clinic spent more time with their physician than expected. Satisfaction correlated with time spent. Physicians felt rushed in 10% of visits although this was rarely detected by patients.

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ENDOSCOPY FOR ACUTE NONVARICEAL UPPER GASTROINTESTINAL TRACT HEMORRHAGE: IS SOONER BETTER?

There is a lack of consensus regarding the ideal time to perform upper endoscopy after a patient presents with nonvariceal upper gastrointestinal tract hemorrhage (UGTH). Early endoscopy has been advocated for its ability to provide prompt diagnosis, risk stratification, and therapeutic hemostasis, yet opponents contend that scant evidence exists to support a mortality benefit, regardless of timing. They note that a policy of early endoscopy may be difficult and expensive to implement. In this systemic review of the literature, Spiegel et al found that early endoscopy is safe and effective for all risk groups, and may reduce the financial burden of hospital length-of-stay.

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USE OF STATINS AND THE SUBSEQUENT DEVELOPMENT OF DEEP VEIN THROMBOSIS

Some of the benefit of statins in preventing cardiovascular disease may be their antithrombotic properties. Little is known about the effect of these drugs on the development of deep vein thrombosis (DVT). Ray et al conducted a retrospective cohort study of 125 862 men and women aged 65 years and over. They found that prescribed statins were associated with a 22% relative reduction in the risk for DVT compared to control subjects. This benefit appeared to be only significant in women. Prescription of nonstatin lipid-lowering agents was not associated with a decrease in DVT risk. A randomized clinical trial might optimally evaluate the efficacy of statins for the primary and secondary prevention of DVT.

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ECHOCARDIOGRAPHIC EXAMINATION OF WOMEN PREVIOUSLY TREATED WITH FENFLURAMINE: LONG-TERM FOLLOW-UP OF A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL

In this study by Davidoff et al, the authors studied 619 women previously randomized to fenfluramine or placebo as part of a smoking cessation study. Echocardiograms were performed up to 4.9 years after fenfluramine therapy of 3 months' duration. There were no significant differences in the prevalence of aortic or mitral regurgitation, or in aortic or mitral mobility or thickening. There were also no differences in clinical cardiovascular status. There was no evidence of drug-related heart disease up to 4.9 years after anorexigenic therapy in patients randomly assigned to receive fenfluramine at the recommended dose for up to 3 months.

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POSTMENOPAUSAL ESTROGEN USE, TYPE OF MENOPAUSE, AND LENS OPACITIES: THE FRAMINGHAM STUDIES

In this study, Worzala et al used the Framingham Heart and Eye Study data to examine the relationship between postmenopausal estrogen use and the occurrence of age-related lens opacities (nuclear, cortical, and posterior subcapsular). The study included 529 women aged 66 to 93 years. Longer duration of postmenopausal estrogen therapy was inversely associated with the presence of nuclear lens opacities. Women who had estrogen for 10 years or longer had a 60% reduction in risk compared with nonusers. The risk of posterior subcapsular opacities was significantly increased for women who had undergone surgical menopause compared with women who had natural menopause. Age at menopause was not associated with the occurrence of lens opacities.

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