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Clinical Decisions -- Interactive Feature
graphic ABIM Maintenance of Certification Program
A 55-year-old internist who has never considered enrolling in the MOC program has received a communication from the American Board of Internal Medicine urging him to undergo the MOC process. Vote on whether the internist should enroll in the MOC program as currently configured and submit a comment to support your recommendation. Free Full Text

Related Editorial: Considering Recertification

Read the Vignette, consider the Recommendations, then cast your Vote.
Original Article
graphic Tumor-Associated Macrophages and Survival in Classic Hodgkin’s Lymphoma
A strong association was found between a poor outcome of treatment and an increased number of CD68+ cells in the microenvironment of Reed–Sternberg cells.
Original Article
graphic Low Diagnostic Yield of Elective Coronary Angiography
In this national registry of data on cardiac catheterization, only 38% of elective, diagnostic coronary angiograms showed obstructive lesions, and 39% of angiograms were interpreted as showing no disease, while the procedure exposes patients to substantial radiation. CME Exam
Original Article
graphic Whole-Genome Sequencing in a Patient with Charcot–Marie–Tooth Neuropathy
Genetic diagnosis of diseases that are genetically heterogeneous, such as Charcot–Marie–Tooth disease, can be a challenge. This study involves the sequencing of an affected person’s whole genome; the authors conclude that his disease was caused by mutations affecting SH3TC2. Free Full Text

Online FirstMarch 10, 2010 (DOI: 10.1056/NEJMoa0908094)

Related Editorial: Individual Genomes on the Horizon

Original Article
graphic Oral Ivermectin versus Malathion Lotion for Difficult-to-Treat Head Lice
In this trial of 812 patients in 376 households, oral ivermectin was found to be superior to topical malathion lotion in eradicating head-lice infestation. CME Exam
Original Article
graphic Use of the Thyroid Hormone Analogue Eprotirome in Statin-Treated Dyslipidemia
Eprotirome, a thyromimetic compound, was associated with decreased LDL levels in patients treated with statins.
Medical Progress
graphic Commotio Cordis
This review provides information on the clinical profile of commotio cordis, the physiological mechanisms underlying it, and steps that can be taken to prevent the event and to resuscitate the victim, should it occur. CME Exam
Case Records of the Massachusetts General Hospital
graphic A Man with Peripheral Neuropathy and Ascites
A 49-year-old man was admitted to this hospital because of ascites. During the previous 4 years, paresthesias and weakness of the lower legs and hands had developed, followed by difficulty breathing, peripheral edema, and during the past year, blurred vision, optic-disk edema, and ascites.
Clinical Implications of Basic Research
graphic Ameliorating Amyotrophic Lateral Sclerosis
A newly implicated molecular pathway in skeletal muscle regulates the formation of the neuromuscular junction and is implicated in a mouse model of amyotrophic lateral sclerosis.
Perspective
graphic The Missing Voice of Patients in Drug-Safety Reporting
A drug label’s “Adverse Reactions” section is based almost entirely on clinicians’ impressions of patients’ symptoms. Dr. Ethan Basch argues for collecting data directly from patients about symptoms they have while taking a drug.
Free Full Text
Perspective
How to Think about Future Health Care Spending
Congress makes explicit projections of federal government spending on health care over the next decade and the media dutifully report these numbers. Victor Fuchs warns us that lost in the din are two critical problems related to future spending — one empirical, the other conceptual. Free Full Text

Online FirstMarch 10, 2010 (DOI: 10.1056/NEJMp1000200)

Perspective
graphic Can the States Nullify Health Care Reform?
On February 1, Virginia joined numerous other states with pending legislation aimed at limiting, changing, or opposing national health care reforms. Timothy Jost asks, What is going on here? Free Full Text

Published Online February 10, 2010 (DOI: 10.1056/NEJMp1001345)

Perspective
Health Care Volunteers and Disaster Response — First, Be Prepared
Dr. Raina Merchant and colleagues provide an overview for health care professionals about how to volunteer to help in public health emergencies and disasters. Free Full Text

Published Online February 24, 2010 (DOI: 10.1056/NEJMp1001737)

FULL TABLE OF CONTENTS THIS WEEK IN THE JOURNAL Audio Icon AUDIO SUMMARY

Image of the Week graphic
Generalized Pruritus

A 50-year-old man presented with a 1-month history of mild, generalized pruritus. There were small, yellowish-brown flecks in the hair of the upper arm, chest, and axilla on the left side and in the pubic area.

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