New England Journal of Medicine -- Recent Issues

EARLY RELEASE: Finding Money for Health Care Reform -- Rooting Out Waste, Fraud, and Abuse

Iglehart, J. K. — 2009-06-10T13:49:51-07:00

(No abstract is available for this citation)

EARLY RELEASE: Tobacco, Public Health, and the FDA

Curfman, G. D., Morrissey, S., Drazen, J. M. — 2009-06-22T12:29:00-07:00

(No abstract is available for this citation)

EARLY RELEASE: Rapid-Test Sensitivity for Novel Swine-Origin Influenza A (H1N1) Virus in Humans

Faix, D. J., Sherman, S. S., Waterman, S. H. — 2009-06-29T13:46:43-07:00

(No abstract is available for this citation)

EARLY RELEASE: The Persistent Legacy of the 1918 Influenza Virus

Morens, D. M., Taubenberger, J. K., Fauci, A. S. — 2009-06-29T13:48:09-07:00

(No abstract is available for this citation)

EARLY RELEASE: Severe Respiratory Disease Concurrent with the Circulation of H1N1 Influenza

2009-06-29T13:47:26-07:00

Background In the spring of 2009, an outbreak of severe pneumonia was reported in conjunction with the concurrent isolation of a novel swine-origin influenza A (H1N1) virus (S-OIV), widely known ...

EARLY RELEASE: Pneumonia and Respiratory Failure from Swine-Origin Influenza A (H1N1) in Mexico

2009-06-29T13:47:49-07:00

Background In late March 2009, an outbreak of a respiratory illness later proved to be caused by novel swine-origin influenza A (H1N1) virus (S-OIV) was identified in Mexico. We describe ...

EARLY RELEASE: Current Concepts: Historical Perspective -- Emergence of Influenza A (H1N1) Viruses

Zimmer, S. M., Burke, D. S. — 2009-06-29T13:48:28-07:00

(No abstract is available for this citation)

EARLY RELEASE: Prioritizing Comparative-Effectiveness Research -- IOM Recommendations

Iglehart, J. K. — 2009-06-30T13:06:56-07:00

(No abstract is available for this citation)

EARLY RELEASE: Comparative-Effectiveness Research -- Implications of the Federal Coordinating Council's Report

Conway, P. H., Clancy, C. — 2009-06-30T13:07:18-07:00

(No abstract is available for this citation)

EARLY RELEASE: Hearing Improvement after Bevacizumab in Patients with Neurofibromatosis Type 2

2009-07-08T13:56:18-07:00

Background Profound hearing loss is a serious complication of neurofibromatosis type 2, a genetic condition associated with bilateral vestibular schwannomas, benign tumors that arise from the eighth cranial nerve. There ...

PERSPECTIVE: Health Care TWOTHOUSANDNINE: A Strategy for Health Care Reform -- Toward a Value-Based System

Porter, M. E. — 2009-07-08T13:55:56-07:00

Despite many waves of debate and piecemeal reforms, the U.S. health care system remains largely the same as it was decades ago. We have seen no convincing approach to changing ...

PERSPECTIVE: Managing and Reducing Uncertainty in an Emerging Influenza Pandemic

Lipsitch, M., Riley, S., Cauchemez, S., Ghani, A. C., Ferguson, N. M. — 2009-07-08T13:55:56-07:00

The early phases of an epidemic present decision makers with predictable challenges1 that have been evident as the current novel influenza A (H1N1) virus has spread. The scale of the ...

PERSPECTIVE: Geographic Dependence, Surveillance, and Origins of the 2009 Influenza A (H1N1) Virus

Trifonov, V., Khiabanian, H., Rabadan, R. — 2009-07-08T13:55:56-07:00

In April 2009, a new strain of human H1N1 influenza A virus was identified in Mexico. According to the World Health Organization (), as of May 25, 2009, the virus ...

PERSPECTIVE: Forever Unprepared -- The Predictable Unpredictability of Pathogens

Sepkowitz, K. A. — 2009-07-08T13:55:56-07:00

The recent behavior of two infamous pathogens -- methicillin-resistant Staphylococcus aureus (MRSA) and this winter's pre-swine edition of influenza virus -- has proved an embarrassment to scientists everywhere. Both organisms ...

ORIGINAL ARTICLE: Inhibition of Poly(ADP-Ribose) Polymerase in Tumors from BRCA Mutation Carriers

2009-07-08T13:55:56-07:00

Inhibition of poly(adenosine diphosphate [ADP]-ribose) polymerase (PARP), a key enzyme for the repair of breaks in DNA, can lead to the accumulation of breaks in double-stranded DNA. The BRCA1 and BRCA2 proteins help to repair such breaks. In this phase 1 trial, the PARP inhibitor olaparib was shown to lack the severe toxic effects of conventional chemotherapy and to result in objective responses in tumors with a BRCA mutation.

ORIGINAL ARTICLE: Raxibacumab for the Treatment of Inhalational Anthrax

2009-07-08T13:55:56-07:00

Demonstration of a new, effective therapy for human anthrax disease is quite challenging, given the rarity of clinical illness. In this study, a monoclonal antibody against the protective antigen of anthrax toxin was shown to be beneficial in two animal models of anthrax infection; the dose required to achieve similar benefit in humans was determined.

ORIGINAL ARTICLE: Rates of Serious Infection after Changes in Regimens for Medical Abortion

Fjerstad, M., Trussell, J., Sivin, I., Lichtenberg, E. S., Cullins, V. — 2009-07-08T13:55:56-07:00

This retrospective analysis involving a large number of Planned Parenthood centers showed significant declines in the rates of serious infection related to medical abortion after changes in medical abortion procedures, including a shift from vaginal to buccal (or oral) administration of misoprostol and the initiation of additional infection-reduction measures.

ORIGINAL ARTICLE: Lack of Association between Folate-Receptor Autoantibodies and Neural-Tube Defects

2009-07-08T13:55:56-07:00

In this case-control study, which used stored blood samples to compare Irish women with a history of pregnancy complicated by neural-tube defect and women with a history of pregnancy without such a complication, there was no significant association between the presence or titer of autoantibodies against the folate receptor and case status. A second case-control study using fresh samples showed similar results. These results fail to confirm a previously reported strong association between maternal folate-receptor autoantibodies and pregnancy affected by a neural-tube defect.

ORIGINAL ARTICLE: Brief Report: Investigation of the Cause of Death in a Gene-Therapy Trial

2009-07-08T13:55:56-07:00

A 36-year-old woman with rheumatoid arthritis who was receiving systemic immunotherapy died from disseminated histoplasmosis while participating in a gene-therapy trial of a tumor necrosis factor {alpha} antagonist delivered through an adeno-associated viral vector delivery system and administered by intraarticular injection.

CLINICAL PRACTICE: Screening for Ovarian Cancer

Clarke-Pearson, D. L. — 2009-07-08T13:55:56-07:00

A 56-year-old woman presents to her physician, requesting screening for ovarian cancer. She reports the recent death of a friend from ovarian cancer at the age of 65 years. The patient has no family history of ovarian or breast cancer. The physical examination, including pelvic and rectal examination, is normal. Should the physician recommend screening for ovarian cancer?

IMAGES IN CLINICAL MEDICINE: Cutaneous Anthrax

Esfandbod, M., Malekpour, M. — 2009-07-08T13:55:56-07:00

A 17-year-old girl presented to the emergency department with a black necrotic lesion on her left cheek and periorbital edema. She had been well until 15 days before presentation, when ...

IMAGES IN CLINICAL MEDICINE: Traumatic Bleb

Vavvas, D., Brodowska, K. — 2009-07-08T13:55:56-07:00

A 38-year-old man was referred for evaluation of a large, pigmented lesion in the left eye for possible uveal melanoma. The patient reported that the growth had developed during the ...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 21-2009 -- A 61-Year-Old Woman with Abdominal Pain, Weight Loss, and Renal Failure

Neilson, E. G., Farris, A. B. — 2009-07-08T13:55:56-07:00

A 61-year-old woman was admitted to this hospital because of a 2-month history of abdominal pain and weight loss and an elevated serum creatinine level. On admission, physical examination was normal except for mild abdominal tenderness. Abdominal imaging revealed no specific abnormalities. Laboratory testing revealed anemia. The creatinine level initially fell after the administration of intravenous fluids but then rose and remained elevated. On the 8th day, erythema and pain developed in the left eye. A diagnostic procedure was performed.

EDITORIAL: Synthetic Lethality -- A New Direction in Cancer-Drug Development

Iglehart, J. D., Silver, D. P. — 2009-07-08T13:55:56-07:00

In this issue of the Journal, Fong et al. report the results of a phase 1 trial of a new cancer therapy involving 60 patients (ClinicalTrials.gov number, NCT00516373).1 Readers may ...

EDITORIAL: Protecting against Future Shock -- Inhalational Anthrax

Nabel, G. J. — 2009-07-08T13:55:56-07:00

In a world filled with pressing unmet medical needs, why would a physician want to protect against a disease that is rarely seen? Part of the answer can be deduced ...

EDITORIAL: Gene Therapy -- Still a Work in Clinical and Regulatory Progress

Hohmann, E. L. — 2009-07-08T13:55:56-07:00

In this issue of the Journal, Frank and colleagues present the case history and autopsy results of a widely publicized death in the summer of 2007 of a young woman ...

CORRESPONDENCE: Prostate-Cancer Screening

2009-07-08T13:55:56-07:00

To the Editor: The results of the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial (ClinicalTrials.gov number, NCT00002540) by ...

CORRESPONDENCE: Esomeprazole for Asthma

2009-07-08T13:55:56-07:00

To the Editor: In their article on the use of esomeprazole in patients with poorly controlled asthma (April 9 issue),1 ...

CORRESPONDENCE: Long-Acting Beta-Agonists in Asthma

Agarwal, A., Knobil, K., Kramer, J. M., O'Byrne, P. M., Drazen, J. M. — 2009-07-08T13:55:56-07:00

To the Editor: In her Perspective article, Kramer (April 16 issue)1 succinctly summarizes the decisions of the Food and Drug ...

CORRESPONDENCE: Prescribing Records and the First Amendment

Sullivan, L. W., Post, R. — 2009-07-08T13:55:56-07:00

To the Editor: Two thoughtful Perspective articles by Post and by Grande and Asch (Feb. 19 issue)1,2 address the potential ...

CORRESPONDENCE: Genetics of Type 1A Diabetes

Sepe, V., Loviselli, A., Bottazzo, G. F. — 2009-07-08T13:55:56-07:00

To the Editor: In their review article on the genetics of type 1A diabetes, Concannon et al. (April 16 issue),1 ...

CORRESPONDENCE: Anti-CTLA4 Antibody-Induced Lupus Nephritis

Fadel, F., Karoui, K. E., Knebelmann, B. — 2009-07-08T13:55:56-07:00

To the Editor: A 64-year-old man with a history of metastatic melanoma was admitted to our hospital for the nephrotic ...

CORRESPONDENCE: Spread of a Novel Influenza A (H1N1) Virus via Global Airline Transportation

2009-07-08T13:55:56-07:00

To the Editor: Throughout March and April 2009, international air travelers departing from Mexico were unknowingly transporting a novel influenza ...

BOOK REVIEW: Biobehavioral Approaches to Pain

Bouhassira, D. — 2009-07-08T13:55:56-07:00

According to the model that was developed in the 1960s by George Engel, behavioral medicine attempts to integrate social, psychological, and biologic sciences into the prevention, diagnosis, and treatment of ...

BOOK REVIEW: Triumph of the Heart: The Story of Statins

Koh, K. K. — 2009-07-08T13:55:56-07:00

The vascular endothelium is a metabolically active organ system that helps regulate cardiovascular homeostasis. In addition to being an anatomical barrier that prevents the influx of circulating blood into the ...

CORRECTIONS: This Week in the Journal

2009-07-08T13:55:56-07:00

This Week in the Journal (). In the first sentence of the summary titled "Inactivating PAPSS2 Mutations in a Patient with Premature Pubarche," the term "active sulfate ester DHEAS" should ...

CORRECTIONS: Androgen Deprivation in Prostate Cancer -- Step by Step

2009-07-08T13:55:56-07:00

Androgen Deprivation in Prostate Cancer -- Step by Step . The editorialist's affiliation was inadvertently omitted from page 2574. It should have read, "From the Division of Urology, University of ...

HEALTH LAW, ETHICS, AND HUMAN RIGHTS: Protecting Privacy and the Public -- Limits on Police Use of Bioidentifiers in Europe

Annas, G. J. — 2009-07-08T13:55:56-07:00

Two citizens who had been charged but not convicted of crimes in the United Kingdom challenged the government's right to keep their fingerprint and DNA information. The European Court of Human Rights ruled that the United Kingdom's laws governing the collection and retention of DNA profiles and samples by police violate human rights.

CME: Rates of Serious Infection after Changes in Regimens for Medical Abortion

2009-07-08T13:55:56-07:00

(No abstract is available for this citation)

CME: Screening for Ovarian Cancer

2009-07-08T13:55:56-07:00

(No abstract is available for this citation)

CME: Case 21-2009: A 61-Year-Old Woman with Abdominal Pain, Weight Loss, and Renal Failure

2009-07-08T13:55:56-07:00

(No abstract is available for this citation)

PERSPECTIVE: Health Care TWOTHOUSANDNINE: The Role of Medical Liability Reform in Federal Health Care Reform

Mello, M. M., Brennan, T. A. — 2009-07-01T14:03:06-07:00

Although enthusiasm for health care reform is resounding in Washington these days, the specific shape reform will take and the compromises that will have to be made along the way ...

PERSPECTIVE: Health Care TWOTHOUSANDNINE: A Win-Win Approach to Financing Health Care Reform

Gruber, J. — 2009-07-01T14:03:06-07:00

No hurdle facing health care reform in the United States today is more daunting than the problem of financing universal coverage. There is an inescapable logic of reform that lies ...

PERSPECTIVE: Health Care TWOTHOUSANDNINE: The Individual Mandate -- An Affordable and Fair Approach to Achieving Universal Coverage

Blumberg, L. J., Holahan, J. — 2009-07-01T14:03:06-07:00

Some of the most prominent shortcomings of the U.S. health insurance market are rooted in the fact that the system is a voluntary one. Outside the state of Massachusetts, which ...

PERSPECTIVE: A Higher Bar -- Vermont's New Law on Marketing Prescribed Products

Steinbrook, R. — 2009-07-01T14:03:06-07:00

As Congress continues to discuss the reform of physician-industry relations, individual states are enacting new laws. In July 2009, regulations on the conduct of pharmaceutical and medical-device manufacturers take effect ...

ORIGINAL ARTICLE: M-Type Phospholipase A2 Receptor as Target Antigen in Idiopathic Membranous Nephropathy

2009-07-01T14:03:06-07:00

In this study of patients with membranous nephropathy, serum samples from 70% of patients with idiopathic, but not secondary, membranous nephropathy were found to have antibodies against a 185-kD glycoprotein in nonreduced glomerular extracts, identified as the M-type phospholipase A2 receptor (PLA2R). PLA2R is present in normal podocytes and in immune deposits in patients with idiopathic membranous nephropathy, indicating that PLA2R is a major antigen in this disease.

ORIGINAL ARTICLE: Epidemiologic Study of In-Hospital Cardiopulmonary Resuscitation in the Elderly

2009-07-01T14:03:06-07:00

In this longitudinal study of hospitalized Medicare patients, there was no improvement in survival after cardiopulmonary resuscitation (CPR) during the period from 1992 through 2005. The overall rate of survival to discharge of patients who underwent in-hospital CPR was 18.3%. Survival after CPR was lower among black patients than among white patients.

ORIGINAL ARTICLE: Preoperative Staging of Lung Cancer with Combined PET-CT

2009-07-01T14:03:06-07:00

Combined positron-emission tomography and computed tomography (PET-CT) plus conventional staging was compared with conventional staging alone for preoperative staging of non-small-cell lung cancer (NSCLC). The end point was the number of futile thoracotomies in each group (with futility defined as a result other than potentially curable NSCLC). Preoperative staging of NSCLC with PET-CT was found to reduce the total number of thoracotomies and the number of futile thoracotomies.

ORIGINAL ARTICLE: Renal and Retinal Effects of Enalapril and Losartan in Type 1 Diabetes

2009-07-01T14:03:06-07:00

This study aimed to determine whether early administration of drugs that block the renin-angiotensin system slows the progression of change in glomerular mesangial fractional volume and retinopathy progression of two steps or more, according to the retinopathy severity scale. Early blockade of the renin-angiotensin system did not modify nephropathy progression in patients with type 1 diabetes but had important effects in slowing retinopathy.

SPECIAL ARTICLE: The Effect of Medicare Part D on Drug and Medical Spending

Zhang, Y., Donohue, J. M., Lave, J. R., O'Donnell, G., Newhouse, J. P. — 2009-07-01T14:03:06-07:00

This study examined expenditures on drugs and other medical services before and after the implementation of Medicare Part D. For patients who had no drug coverage before Part D, the increase in drug spending after the implementation of Part D was approximately offset by a decrease in other medical spending. Improved access to medications may achieve savings in nonpharmacy costs because of better control of chronic illness.

REVIEW ARTICLE: Current Concepts: Rhabdomyolysis and Acute Kidney Injury

Bosch, X., Poch, E., Grau, J. M. — 2009-07-01T14:03:06-07:00

The causes of acute rhabdomyolysis include trauma, drugs, toxins, and certain infections. Acute kidney injury is a dangerous complication of severe rhabdomyolysis. This review summarizes current views on the pathogenesis of myoglobin-induced kidney injury as well as on its prevention and treatment.

IMAGES IN CLINICAL MEDICINE: Telltale Triangle of Pneumoperitoneum

Huang, M.-Y., Chang, W.-H. — 2009-07-01T14:03:06-07:00

A 56-year-old man presented to the emergency department with a 3-day history of diarrhea and dull epigastric pain. The diarrhea had responded to antidiarrheal agents. However, the epigastric pain had ...

IMAGES IN CLINICAL MEDICINE: Tattoo Allergy

Cook, J., Metcalf, J. — 2009-07-01T14:03:06-07:00

A 40-year-old man presented with intractable pruritus within portions of a tattoo imprinted with red ink on the left leg (Panel A). The intense localized itching had begun approximately 4 ...

CLINICAL PROBLEM-SOLVING: A Fragile Balance

Bitton, A., Yialamas, M., Levy, B. D., Katz, J. T., Loscalzo, J. — 2009-07-01T14:03:06-07:00

A 31-year-old man presented to the emergency department with pain in the left shoulder. He had tripped over his backpack shoulder strap earlier in the day and noted immediate severe pain around his left shoulder. Physical examination revealed bony point tenderness over the humeral head and limited range of motion due to pain; crepitus was present. Shoulder radiographs revealed an impacted fracture of the left humerus and evidence of osteopenia.

EDITORIAL: Human Idiopathic Membranous Nephropathy -- A Mystery Solved?

Glassock, R. J. — 2009-07-01T14:03:06-07:00

Just over 50 years ago, the late David Jones1 identified (using the periodic acid-Schiff and methenamine silver stains) the unique glomerular pathologic features of membranous nephropathy, thus distinguishing it from ...

EDITORIAL: Diabetes Complications and the Renin-Angiotensin System

Perkins, B. A., Aiello, L. P., Krolewski, A. S. — 2009-07-01T14:03:06-07:00

The hypothesis that inhibition of the renin-angiotensin system may be effective in preventing diabetic nephropathy was based on a large body of evidence.1 Positive findings from studies in animal models ...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Cardiomyocyte Renewal

Parmacek, M. S., Epstein, J. A. — 2009-07-01T14:03:06-07:00

A recent study upends the hypothesis that cardiomyocytes are not renewed after the first weeks of life.

CORRESPONDENCE: Glucose Control in Critically Ill Patients

2009-07-01T14:03:06-07:00

To the Editor: In the Normoglycemia in Intensive Care Evaluation-Survival Using Glucose Algorithm Regulation (NICE-SUGAR) study (ClinicalTrials.gov number, NCT00220987), reported ...

CORRESPONDENCE: Racial Differences in Heart Failure

Drazner, M. H., Bibbins-Domingo, K., Hulley, S. B. — 2009-07-01T14:03:06-07:00

To the Editor: It is not known whether concentric hypertrophy is a common precursor to systolic dysfunction in human hypertensive ...

CORRESPONDENCE: Rosuvastatin in Patients Undergoing Hemodialysis

2009-07-01T14:03:06-07:00

To the Editor: In their article on A Study to Evaluate the Use of Rosuvastatin in Subjects on Regular Hemodialysis: ...

CORRESPONDENCE: Cetuximab for Metastatic Colorectal Cancer

2009-07-01T14:03:06-07:00

To the Editor: As a gastroenterologist who claims to have been the first physician in Connecticut to give fluorouracil to ...

CORRESPONDENCE: Moyamoya Disease and Moyamoya Syndrome

Derdeyn, C. P., Pollak, L., Scott, R. M., Smith, E. R. — 2009-07-01T14:03:06-07:00

To the Editor: As the principal investigator of a National Institutes of Health (NIH)-funded natural-history study involving North American adults ...

CORRESPONDENCE: BRAF Mutation in Metastatic Colorectal Cancer

Tol, J., Nagtegaal, I. D., Punt, C. J.A. — 2009-07-01T14:03:06-07:00

To the Editor: We recently found that progression-free survival was shorter among patients with metastatic colorectal cancer treated with chemotherapy, ...

BOOK REVIEW: Fixing My Gaze: A Scientist's Journey into Seeing in Three Dimensions

Ropper, A. H. — 2009-07-01T14:03:06-07:00

Seeing the three-dimensional world with two-dimensional retinas presents the brain with two problems. To locate an object in space requires depth perception, which can be acquired from one eye alone ...

BOOK REVIEW: Diagnostic Microbiology of the Immunocompromised Host

Hillyard, D. R. — 2009-07-01T14:03:06-07:00

Laboratory medicine has no more urgent role than in the diagnosis and management of infections in immunocompromised patients. For this vulnerable population, clinical algorithms are logically rooted in the need ...

CORRECTIONS: Triple-Reassortant Swine Influenza A (H1) in Humans in the United States, 2005-2009

2009-07-01T14:03:06-07:00

Triple-Reassortant Swine Influenza A (H1) in Humans in the United States, 2005-2009 (10.1056/NEJMoa9093812; published on May 7, 2009, at NEJM.org). In the list of authors, the name Susan Vagasky, D.V.M., ...

CORRECTIONS: Emergence of a Novel Swine-Origin Influenza A (H1N1) Virus in Humans

2009-07-01T14:03:07-07:00

Emergence of a Novel Swine-Origin Influenza A (H1N1) Virus in Humans (10.1056/NEJMoa0903810; published on May 7, 2009, at NEJM.org). In the second paragraph of the Demographic and Clinical Features subsection ...

CME: Epidemiologic Study of In-Hospital Cardiopulmonary Resuscitation in the Elderly

2009-07-01T14:03:07-07:00

(No abstract is available for this citation)

CME: Rhabdomyolysis and Acute Kidney Injury

2009-07-01T14:03:07-07:00

(No abstract is available for this citation)

CME: A Fragile Balance

2009-07-01T14:03:07-07:00

(No abstract is available for this citation)

PERSPECTIVE: Health Care TWOTHOUSANDNINE: A Lifeline for Primary Care

Bodenheimer, T., Grumbach, K., Berenson, R. A. — 2009-06-24T13:56:21-07:00

Primary care in the United States needs a lifeline. In 2009, for the 12th straight year, the number of graduating U.S. medical students choosing primary care residencies reached dismally low ...

PERSPECTIVE: Health Care TWOTHOUSANDNINE: Easing the Shortage in Adult Primary Care -- Is It All about Money?

Steinbrook, R. — 2009-06-24T13:56:22-07:00

As Americans debate health care reform, it is easy to forget that success may depend as much on the availability of primary care physicians for adults as on the specifics ...

PERSPECTIVE: CMS's Landmark Decision on CT Colonography -- Examining the Relevant Data

Dhruva, S. S., Phurrough, S. E., Salive, M. E., Redberg, R. F. — 2009-06-24T13:56:22-07:00

In an unprecedented endorsement of evidence-based medicine, the Centers for Medicare and Medicaid Services (CMS) recently decided to deny coverage of computed tomographic (CT) colonography for cancer screening, concluding that ...

PERSPECTIVE: A New Era of For-Profit Hospice Care -- The Medicare Benefit

Iglehart, J. K. — 2009-06-24T13:56:22-07:00

To ensure that a reluctant medical community would embrace Medicare at its inception in 1965, Congress declared that any willing provider could participate. Since that time, the vast majority of ...

ORIGINAL ARTICLE: Routine Early Angioplasty after Fibrinolysis for Acute Myocardial Infarction

2009-06-24T13:56:22-07:00

In a randomized trial, 1059 patients with an acute myocardial infarction with ST-segment elevation presented to hospitals that did not have the capability of performing percutaneous coronary intervention (PCI) and received fibrinolysis. They were then assigned to either immediate transfer to a PCI center for catheterization or transfer only if fibrinolysis failed. The immediate-transfer strategy was associated with significantly fewer ischemic complications at 30 days.

ORIGINAL ARTICLE: Mutation of FOXL2 in Granulosa-Cell Tumors of the Ovary

2009-06-24T13:56:22-07:00

Somatically acquired mutations, which contribute to tumorigenesis, are usually specific to tumor tissue. Sequencing of the whole transcriptome -- the entire set of messenger RNAs -- in ovarian granulosa-cell tumors implicated a somatic mutation in FOXL2 in a large majority of the tumors that were analyzed.

ORIGINAL ARTICLE: Treating Childhood Acute Lymphoblastic Leukemia without Cranial Irradiation

2009-06-24T13:56:22-07:00

This large trial of acute lymphoblastic leukemia in children aimed to determine whether intensive systemic and intrathecal chemotherapy could obviate the need for prophylactic central nervous system irradiation, which is associated with distressing late complications. The results show that, with meticulous monitoring of responses and toxic effects, it is possible not only to avoid cranial irradiation but also to improve the overall outcome.

ORIGINAL ARTICLE: Brief Report: Isolated Familial Hypogonadotropic Hypogonadism and a GNRH1 Mutation

2009-06-24T13:56:22-07:00

The authors investigated whether mutations in the gene encoding gonadotropin-releasing hormone 1 (GNRH1) might cause idiopathic hypogonadotropic hypogonadism (IHH). They identified a homozygous GNRH1 frameshift mutation in a teenage brother and sister, both of whom had normosmic IHH. This isolated autosomal recessive GnRH deficiency, reversed by pulsatile GnRH administration, shows the pivotal role of GnRH in human reproduction.

CLINICAL PRACTICE: Alpha1-Antitrypsin Deficiency

Silverman, E. K., Sandhaus, R. A. — 2009-06-24T13:56:22-07:00

A 60-year-old white man presents for evaluation of progressive dyspnea. He is a former smoker with a 20-pack-year smoking history and a 10-year history of chronic obstructive pulmonary disease (COPD). There is no family history of COPD. Severe airflow obstruction is seen on spirometry, with a forced expiratory volume in 1 second that is 40% of the predicted value. Should he be evaluated for alpha1-antitrypsin (AAT) deficiency? If AAT deficiency is documented, how should his case be managed?

REVIEW ARTICLE: Medical Progress: Alcoholic Hepatitis

Lucey, M. R., Mathurin, P., Morgan, T. R. — 2009-06-24T13:56:22-07:00

The association between alcohol intake and alcoholic liver disease has been well documented, although cirrhosis of the liver develops in only a small proportion of heavy drinkers. This review focuses on alcoholic hepatitis, a treatable form of alcoholic liver disease. Since up to 40% of patients with severe alcoholic hepatitis die within 6 months after the onset of the clinical syndrome, appropriate diagnosis and treatment are essential.

IMAGES IN CLINICAL MEDICINE: Ingested Magnets

Avolio, L., Martucciello, G. — 2009-06-24T13:56:22-07:00

A 9-year-old boy ingested 23 magnets (Panel A). Four days later, he had clinical and surgical evidence of intestinal perforation and peritonitis due to pressure necrosis of the bowel. In ...

IMAGES IN CLINICAL MEDICINE: Lipomatosis of the Tongue

Murakami, H., Tamasawa, N. — 2009-06-24T13:56:22-07:00

An 88-year-old man presented with diffuse, painless swelling of the lateral borders of his tongue (Panel A). The swelling had been slowly increasing during the previous 20 years. Yellowish tumors ...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 20-2009 -- A 79-Year-Old Woman with a Blistering Cutaneous Eruption

Avram, M. M., Hoang, M. — 2009-06-24T13:56:22-07:00

A 79-year-old woman was admitted to the burn unit of this hospital because of a blistering cutaneous eruption. Five days before admission, itching on her head and back and skin lesions on her abdomen developed. Hydroxychloroquine, which she had begun taking 2 weeks earlier, was discontinued, but the rash spread to her back, arms, and legs and became painful; fever, headache, and sore throat with dysphagia developed. A diagnostic procedure was performed.

EDITORIAL: Routine Angioplasty after Fibrinolysis -- How Early Should "Early" Be?

Verheugt, F. W.A. — 2009-06-24T13:56:22-07:00

Reperfusion therapy has represented a great leap forward in the management of myocardial infarction with ST-segment elevation. Its goal is early and complete recanalization of the infarct-related artery to salvage ...

EDITORIAL: Cancer Genomes on a Shoestring Budget

Shendure, J., Stewart, C. J. — 2009-06-24T13:56:22-07:00

In a remarkably short time, the use of massively parallel technologies has greatly reduced the cost of DNA sequencing.1 Already, these technologies have permitted the whole-genome sequencing of several persons2,3,4 ...

CORRESPONDENCE: Arrhythmogenic Right Ventricular Cardiomyopathy

2009-06-24T13:56:22-07:00

To the Editor: Although the article by Asimaki et al. (March 12 issue)1 is provocative, we remain unconvinced that arrhythmogenic ...

CORRESPONDENCE: Ozone Exposure and Mortality

2009-06-24T13:56:22-07:00

To the Editor: Jerrett et al. (March 12 issue)1 report a significant increase in death from respiratory causes in association ...

CORRESPONDENCE: Growth in Care Provided by Hospitalists

2009-06-24T13:56:22-07:00

To the Editor: The analysis by Kuo et al. (March 12 issue)1 quantifies the unprecedented growth in care provided by ...

CORRESPONDENCE: Medical Evaluation before Electroconvulsive Therapy

Tavares, A. R., Volpe, F. M., Welch, C. A., Tess, A. V., Smetana, G. — 2009-06-24T13:56:22-07:00

To the Editor: Tess and Smetana (April 2 issue)1 do not include neuroimaging in their routine evaluation of patients before ...

CORRESPONDENCE: Ethical and Scientific Implications of the Globalization of Clinical Research

Adler, J. R., Andrews, C. A., Glickman, S. W., Cairns, C. B., Schulman, K. A. — 2009-06-24T13:56:22-07:00

To the Editor: In their article, Glickman et al. (Feb. 19 issue)1 examine the growing phenomenon of clinical trials being ...

CORRESPONDENCE: Molecular Outcome Prediction in Diffuse Large-B-Cell Lymphoma

Alizadeh, A. A., Gentles, A. J., Lossos, I. S., Levy, R. — 2009-06-24T13:56:22-07:00

To the Editor: Lenz et al. (Nov. 27 issue)1 report the results of an important study of gene expression and ...

BOOK REVIEW: Obesity in Youth: Causes, Consequences, and Cures

Gutin, B. — 2009-06-24T13:56:22-07:00

The title and subtitle of this book promise a comprehensive examination of an important public health problem. However, the editors immediately disabuse readers of this notion by stating that the ...

BOOK REVIEW: Body Image, Eating Disorders, and Obesity in Youth: Assessment, Prevention, and Treatment

Mitchell, J. E. — 2009-06-24T13:56:22-07:00

This is the second edition of a book that was well received when it was first published. It has been updated substantially and now has a focus on problems of ...

CORRECTIONS: Primary Biliary Cirrhosis Associated with HLA, IL12A, and IL12RB2 Variants

2009-06-24T13:56:22-07:00

Primary Biliary Cirrhosis Associated with HLA, IL12A, and IL12RB2 Variants . Table 2 was inadvertently omitted from the article as printed in the June 11 issue; it appears here and ...

CME: Routine Early Angioplasty after Fibrinolysis for Acute Myocardial Infarction

2009-06-24T13:56:22-07:00

(No abstract is available for this citation)

CME: Alpha1-Antitrypsin Deficiency

2009-06-24T13:56:22-07:00

(No abstract is available for this citation)

CME: Alcoholic Hepatitis

2009-06-24T13:56:22-07:00

(No abstract is available for this citation)

PERSPECTIVE: Health Care TWOTHOUSANDNINE: Congressional Action on Health Care Reform -- An Update

Iglehart, J. K. — 2009-06-17T13:56:14-07:00

The pursuit of health care reform continues to gather steam, as Democrats, with a nudge from President Barack Obama, set an ambitious target for action -- House and Senate passage ...

PERSPECTIVE: The Signature Features of Influenza Pandemics -- Implications for Policy

Miller, M. A., Viboud, C., Balinska, M., Simonsen, L. — 2009-06-17T13:56:14-07:00

Vast amounts of time and resources are being invested in planning for the next influenza pandemic, and one may indeed have already begun. Data from past pandemics can provide useful ...

PERSPECTIVE: Rescuing the Safety Net

Spivey, M., Kellermann, A. L. — 2009-06-17T13:56:14-07:00

As the recession deepens, layoffs are swelling the ranks of the uninsured. Despite federal stimulus support for state Medicaid programs, some cash-strapped states have cut Medicaid payments, and others are ...

PERSPECTIVE: Left Atrial Appendage Occlusion -- Closure or Just the Beginning?

Maisel, W. H. — 2009-06-17T13:56:14-07:00

More than 3 million Americans have atrial fibrillation, which increases their risk of stroke by a factor of 5.1,2 Patients with atrial fibrillation account for one of every six strokes, ...

ORIGINAL ARTICLE: Emergence of a Novel Swine-Origin Influenza A (H1N1) Virus in Humans

Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team — 2009-06-17T13:56:14-07:00

On April 15 and April 17, a novel swine-origin influenza A (H1N1) virus was identified in two epidemiologically unlinked patients in the United States. The same strain of the virus was identified in Mexico, Canada, and elsewhere. This report describes all confirmed cases in the United States through May 5 and delineates the associated clinical syndrome and key virology.

ORIGINAL ARTICLE: Triple-Reassortant Swine Influenza A (H1) in Humans in the United States, 2005-2009

2009-06-17T13:56:14-07:00

Influenza is known to infect several different hosts, including humans, birds, and pigs. The influenza genome is structured in a way that allows for rapid recombination between strains across host species. In this report, 11 sporadic episodes of human infection from novel swine-associated influenza viruses are documented and the associated clinical illness and virologic characteristics are described.

ORIGINAL ARTICLE: Evaluation of Universal Antenatal Screening for Group B Streptococcus

2009-06-17T13:56:14-07:00

Invasive group B streptococcal disease is a leading cause of illness in the first week of life. Universal culture-based screening in the third trimester of pregnancy was recommended in the United States in 2002. This study shows that this policy has been associated with a decrease in the incidence of group B streptococcal disease. Populations that may benefit from additional preventive measures are identified.

ORIGINAL ARTICLE: Brief Report: Immunodeficiency Associated with FCN3 Mutation and Ficolin-3 Deficiency

2009-06-17T13:56:14-07:00

This report describes a man with repeated severe bacterial pulmonary infections, bronchiectasis, pulmonary fibrosis, warts, and a cerebral abscess. He was homozygous for a variant of the FCN3 gene, which encodes ficolin-3, a member of the lectin pathway of complement activation that binds surface molecules on bacteria and acetylated compounds and is involved in sequestration and removal of dying cells. A lack of ficolin-3 may cause immunodeficiency disease. Ficolin-3 could not be detected in the patient's serum.

CLINICAL THERAPEUTICS: Autologous Hematopoietic Stem-Cell Transplantation for Multiple Myeloma

Harousseau, J.-L., Moreau, P. — 2009-06-17T13:56:14-07:00

A 59-year-old man is diagnosed with multiple myeloma. It is recommended that he receive induction therapy followed by high-dose melphalan with autologous hematopoietic stem-cell transplantation. Such transplantation improves the remission rate in myeloma by allowing for the administration of a chemotherapy dose that would otherwise be lethal. This approach is considered appropriate only for relatively young patients without major coexisting illnesses.

IMAGES IN CLINICAL MEDICINE: Combined-System Disease

Heilman, C. B., Zerris, V. A. — 2009-06-17T13:56:14-07:00

A 76-year-old woman presented with a 3-month history of bilateral numbness and tingling in her hands and feet. She also noted tingling along her spine on forward flexion of the ...

IMAGES IN CLINICAL MEDICINE: Perforated Umbilical Hernia

Miryala, R., Neilan, R. — 2009-06-17T13:56:14-07:00

A 68-year-old man with alcoholic cirrhosis, portal hypertension, ascites, and an umbilical hernia presented to the emergency department after an episode of coughing that was followed by a rush of ...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 19-2009 -- A 63-Year-Old Woman with Carcinoma of the Gastroesophageal Junction

2009-06-17T13:56:14-07:00

A 63-year-old woman was seen for management of adenocarcinoma of the gastroesophageal junction. Two months earlier, dysphagia had developed. Endoscopic, radiologic, and pathological evaluation disclosed adenocarcinoma at the gastroesophageal junction, associated with Barrett's esophagus, and possible metastatic cancer in a regional lymph node. A treatment plan was established.

EDITORIAL: H1N1 Influenza A Disease -- Information for Health Professionals

2009-06-17T13:56:14-07:00

In the first 2 weeks in April, cases of infection with an untypable influenza A virus began to be identified in Mexico and southern California.1 Although the exact sequence of ...

EDITORIAL: Implications of the Emergence of a Novel H1 Influenza Virus

Belshe, R. B. — 2009-06-17T13:56:15-07:00

In this issue of the Journal, there are two reports of recent transmissions of swine influenza viruses in humans. One group of viruses, described by Shinde et al.,1 are triple ...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: A New Target for Tumor Therapy

Jain, R. K. — 2009-06-17T13:56:15-07:00

Blocking an oxygen sensor in the endothelial cells that line the blood vessels of tumors may reduce tumor and endothelial hypoxia and repress metastasis.

CORRESPONDENCE: Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting

2009-06-17T13:56:15-07:00

To the Editor: With regard to the results of the SYNTAX (Synergy between PCI [percutaneous coronary intervention] with Taxus and ...

CORRESPONDENCE: Melamine-Contaminated Powdered Formula and Urolithiasis

2009-06-17T13:56:15-07:00

To the Editor: The article by Guan et al.,1 the accompanying editorial by Langman,2 and the letter to the Editor ...

CORRESPONDENCE: Pulmonary Rehabilitation

Seijo, L. M., Casaburi, R., ZuWallack, R. — 2009-06-17T13:56:15-07:00

To the Editor: In their Clinical Therapeutics article, Casaburi and ZuWallack (March 26 issue)1 do not discuss the BODE index ...

CORRESPONDENCE: Primary Open-Angle Glaucoma

2009-06-17T13:56:15-07:00

To the Editor: With regard to the review article on primary open-angle glaucoma by Kwon et al. (March 12 issue),1 ...

CORRESPONDENCE: Preservation of Fertility in Patients with Cancer

2009-06-17T13:56:15-07:00

To the Editor: With regard to the review article by Jeruss and Woodruff (Feb. 26 issue)1: we appreciate the increased ...

CORRESPONDENCE: B-Cell-Depleting Induction Therapy and Acute Cellular Rejection

2009-06-17T13:56:15-07:00

To the Editor: B-cell depletion is an effective treatment for a number of autoimmune diseases in which B cells were ...

BOOK REVIEW: Birth Day: A Pediatrician Explores the Science, the History, and the Wonder of Childbirth

Stubblefield, P. G. — 2009-06-17T13:56:15-07:00

This book is an entertaining combination of a memoir, an explanation of the physiology and evolution of childbearing, a discussion of fetal and newborn physiology, and a history of the ...

BOOK REVIEW: Small for Gestational Age: Causes and Consequences

Eichenwald, E. C. — 2009-06-17T13:56:15-07:00

Normal fetal growth is determined by a number of factors. These include genetic potential, nutritional status of the mother, placental function and transfer of nutrients, and intrauterine hormones and growth ...

BOOK REVIEW: Normal at Any Cost: Tall Girls, Short Boys, and the Medical Industry's Quest to Manipulate Height

Aranoff, G. S., Oberfield, S. E. — 2009-06-17T13:56:15-07:00

Susan Cohen and Christine Cosgrove, the authors of this compelling book, tell the story of how doctors treat tall and short children, and of how such treatment has evolved during ...

CME: Emergence of a Novel Swine-Origin Influenza A (H1N1) Virus in Humans

2009-06-17T13:56:15-07:00

(No abstract is available for this citation)

CME: Autologous Hematopoietic Stem-Cell Transplantation for Multiple Myeloma

2009-06-17T13:56:15-07:00

(No abstract is available for this citation)

CME: Case 19-2009: A 63-Year-Old Woman with Carcinoma of the Gastroesophageal Junction

2009-06-17T13:56:15-07:00

(No abstract is available for this citation)