Although cardiac myxomas are histologically benign, they may be lethal because of their strategic position. They can mimic not only every cardiac disease but also infective, immunologic, and malignant processes. Myxomas must therefore be included in the differential diagnosis of valvular heart disease, cardiac insufficiency, cardiomegaly, bacterial endocarditis, disturbances of ventricular and supraventricular rhythm, syncope, and systemic or pulmonary embolism. The symptoms depend on the size, mobility, and location of the tumor. Echocardiography, including the transesophageal approach, is the most important means of diagnosis; CT and MRI may also be helpful. Coronary arteriography in patients over 40 years of age is generally required to rule out concomitant coronary artery disease. Surgical removal of the tumor should be performed as soon as possible; the long-term prognosis is excellent, and recurrences are rare. In follow-up examinations as well, echocardiography is essential.

Randomized trials of radiotherapy and surgery for early breast cancer may have been too small to detect differences in long-term survival and recurrence reliably. We therefore performed a systematic overview (meta-analysis) of the results of such trials.

Antimicrobial therapy against H. pylori is indicated for all patients with documented peptic ulcer disease who have evidence of the infection. The regimen of first choice, selected on the basis of available studies, is triple therapy with bismuth, metronidazole, and tetracycline (Table 1). For patients who are known to have taken metronidazole previously, clarithromycin may be substituted for metronidazole. For patients with active, symptomatic peptic ulcers we also recommend an antisecretory drug to promote healing and relieve symptoms. Second-choice regimens consist of combinations of two antimicrobial drugs--metronidazole, amoxicillin, or clarithromycin--with an antisecretory agent, preferably an H+/K+-ATPase antagonist such as omeprazole. The combination of a single antimicrobial drug (especially amoxicillin) with omeprazole is less efficacious and cannot be recommended. Regardless of the antimicrobial regimen used, successful eradication of H. pylori infection markedly reduces the risk of recurrent peptic ulcers. If this therapeutic approach is taken with all patients with peptic ulcers, the recurrence of ulcers should become a rarity in medical practice.