New England Journal of Medicine -- Recent Issues

EARLY RELEASE: Cytogenetic Technology -- Genotype and Phenotype

Ledbetter, D. H. — 2008-09-10T13:57:03-07:00

(No abstract is available for this citation)

EARLY RELEASE: Recurrent Rearrangements of Chromosome 1q21.1 and Variable Pediatric Phenotypes

2008-09-10T13:57:25-07:00

Background Duplications and deletions in the human genome can cause disease or predispose persons to disease. Advances in technologies to detect these changes allow for the routine identification of submicroscopic ...

EARLY RELEASE: Long-Term Follow-up after Tight Control of Blood Pressure in Type 2 Diabetes

Holman, R. R., Paul, S. K., Bethel, M. A., Neil, H. A. W., Matthews, D. R. — 2008-09-10T00:05:19-07:00

Background Post-trial monitoring of patients in the United Kingdom Prospective Diabetes Study (UKPDS) examined whether risk reductions for microvascular and macrovascular disease, achieved with the use of improved blood-pressure control ...

EARLY RELEASE: 10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes

Holman, R. R., Paul, S. K., Bethel, M. A., Matthews, D. R., Neil, H. A. W. — 2008-09-10T00:05:43-07:00

Background During the United Kingdom Prospective Diabetes Study (UKPDS), patients with type 2 diabetes mellitus who received intensive glucose therapy had a lower risk of microvascular complications than did those ...

EARLY RELEASE: Effectiveness of Maternal Influenza Immunization in Mothers and Infants

2008-09-17T06:10:18-07:00

Background Young infants and pregnant women are at increased risk for serious consequences of influenza infection. Inactivated influenza vaccine is recommended for pregnant women but is not licensed for infants ...

EARLY RELEASE: Problems Associated with the Use of Thyrogen in Patients with a Thyroid Gland

Magner, J. — 2008-09-19T07:23:00-07:00

(No abstract is available for this citation)

EARLY RELEASE: Election TWOTHOUSANDEIGHT: Symptomatic Relief, but No Cure -- The Obama Health Care Reform

Antos, J. R. — 2008-09-24T13:27:42-07:00

(No abstract is available for this citation)

EARLY RELEASE: Election TWOTHOUSANDEIGHT: Primum Non Nocere -- The McCain Plan for Health Insecurity

Blumenthal, D. — 2008-09-24T13:28:08-07:00

(No abstract is available for this citation)

EARLY RELEASE: Perspective Roundtable: Health Care in the Next Administration

Cutler, D. M., Wilensky, G. R. — 2008-09-24T13:28:33-07:00

(No abstract is available for this citation)

EARLY RELEASE: Election TWOTHOUSANDEIGHT: Access to Quality and Affordable Health Care for Every American

McCain, J. — 2008-09-25T15:34:52-07:00

(No abstract is available for this citation)

EARLY RELEASE: Election TWOTHOUSANDEIGHT: Modern Health Care for All Americans

Obama, B. — 2008-09-25T15:35:11-07:00

(No abstract is available for this citation)

EARLY RELEASE: Single Reading with Computer-Aided Detection for Screening Mammography

2008-10-01T14:10:44-07:00

Background The sensitivity of screening mammography for the detection of small breast cancers is higher when the mammogram is read by two readers rather than by a single reader. We ...

PERSPECTIVE: Election TWOTHOUSANDEIGHT: Still in the Game -- Harnessing Employer Inventiveness in U.S. Health Care Reform

Galvin, R. S. — 2008-10-01T13:55:31-07:00

Employers, historically key players in the U.S. health care system, are as interested in debates over health care reform as they have ever been. The pressures they face -- the ...

PERSPECTIVE: Executive Physicals -- Bad Medicine on Three Counts

Rank, B. — 2008-10-01T13:55:31-07:00

In corporate boardrooms throughout the United States, executives are wrestling with the management of health care costs. They are demanding health care services that are effective and evidence-based and that ...

PERSPECTIVE: The Statins in Preventive Cardiology

Steinberg, D. — 2008-10-01T13:55:31-07:00

The discovery of the statins by Akira Endo and colleagues in 1976 opened the door to a new era in preventive cardiology.1 The importance of this discovery was recently underscored ...

ORIGINAL ARTICLE: Maraviroc for Previously Treated Patients with R5 HIV-1 Infection

2008-10-01T13:55:32-07:00

The CCR5 coreceptor may be a therapeutic target to block HIV infection. HIV-1-infected patients who had received previous antiretroviral treatment were enrolled in one of two phase 3, placebo-controlled, double-blind international studies of treatment with maraviroc (a CCR5 antagonist). Maraviroc significantly lowered the HIV-1 viral load and increased the CD4 cell count at 48 weeks.

ORIGINAL ARTICLE: Subgroup Analyses of Maraviroc in Previously Treated R5 HIV-1 Infection

2008-10-01T13:55:32-07:00

In key subgroups of the HIV-infected patients in the MOTIVATE 1 and MOTIVATE 2 studies, a consistent treatment benefit of maraviroc over placebo was seen at 48 weeks. These subgroups include patients with a low baseline CD4 cell count and a high HIV viral load at screening and those receiving no active background antiretroviral agents. In patients in whom maraviroc failed, the CXCR4-using virus was often present at failure.

ORIGINAL ARTICLE: Toll-like Receptor 3 and Geographic Atrophy in Age-Related Macular Degeneration

2008-10-01T13:55:32-07:00

A variant of the toll-like receptor 3 (TLR3) provides protection against geographic atrophy, or "dry" age-related macular degeneration, and reduces apoptosis of cultured retinal pigment epithelial cells on exposure to TLR3 ligand. Because double-stranded RNA is a ligand of TLR3, this finding gives rise to the hypothesis that viral infection causes this disease and to concerns about therapeutic intraocular injection of short interfering RNA.

ORIGINAL ARTICLE: Continuous Glucose Monitoring and Intensive Treatment of Type 1 Diabetes

2008-10-01T13:55:32-07:00

In this randomized study, patients undergoing intensive therapy for type 1 diabetes mellitus who had glycated hemoglobin levels of 7.0 to 10.0% were stratified into three prespecified age groups and were assigned to receive continuous glucose monitoring or usual monitoring. The primary outcome was the change in glycated hemoglobin levels after 26 weeks. Continuous glucose monitoring was associated with improved glycemic control in adults but not in children and adolescents with type 1 diabetes.

CLINICAL PRACTICE: Autosomal Dominant Polycystic Kidney Disease

Grantham, J. J. — 2008-10-01T13:55:32-07:00

Shortly after being elbowed in the flank during a basketball game, a 35-year-old healthy man has severe, colicky abdominal pain followed by gross hematuria. A renal ultrasound scan reveals bilateral polycystic kidneys and liver cysts. The blood pressure is 160/100 mm Hg. The serum creatinine concentration is 0.9 mg per deciliter (80 {micro}mol per liter). The pain subsides in 2 days with analgesics, rest, and fluids; the gross hematuria resolves in 4 days, although microscopic hematuria persists.

REVIEW ARTICLE: Drug Therapy: Hepatitis B Virus Infection

Dienstag, J. L. — 2008-10-01T13:55:32-07:00

More effective and less resistance-prone antiviral agents are now available to treat hepatitis B virus (HBV) infection. Profound, durable, therapeutic HBV DNA suppression to slow and reverse the progression of chronic HBV infection is important, given the evidence linking high-level HBV replication and the late consequences of chronic HBV infection. This article reviews strategies for treating HBV infection.

IMAGES IN CLINICAL MEDICINE: Ludwig's Angina

Heavey, J., Gupta, N. — 2008-10-01T13:55:32-07:00

A 58-year-old healthy man was evaluated for a toothache of 2 days' duration. He was treated with oral penicillin and an opiate analgesic and advised to have the affected teeth ...

IMAGES IN CLINICAL MEDICINE: Pneumopericardium

Karoui, M., Bucur, P. O. — 2008-10-01T13:55:32-07:00

A 47-year-old homeless man presented to the emergency department 1 week after the onset of chest pain. He was hemodynamically stable. The physical examination was unremarkable. A routine complete blood ...

CLINICAL PROBLEM-SOLVING: Variations on a Theme

Goldberger, Z. D., Weinberger, S. E., Nicosia, R. F., Saint, S., Young, B. A. — 2008-10-01T13:55:32-07:00

A 57-year-old man presented to the emergency department with a 2-week history of progressive dyspnea on exertion, edema of the legs, a nonproductive cough, and scant hemoptysis. He also reported occasional passage of bright red blood from his rectum and intermittent nausea and vomiting during the previous 4 days.

EDITORIAL: A New Class of Anti-HIV Therapy and New Challenges

Dolin, R. — 2008-10-01T13:55:32-07:00

The development of new drugs against human immunodeficiency virus type 1 (HIV-1) has resulted in combination therapy that can inhibit various steps of viral replication. Maraviroc is an example of ...

CORRESPONDENCE: Intensive Glucose Control in Type 2 Diabetes

2008-10-01T13:55:32-07:00

To the Editor: In the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study (June 12 issue),1 the intensive-therapy group ...

CORRESPONDENCE: Rhythm Control versus Rate Control for Atrial Fibrillation

Knecht, S., O'Neill, M. D., Verbeet, T., Roy, D., Talajic, M., Nattel, S. — 2008-10-01T13:55:32-07:00

To the Editor: In their article on rhythm control as compared with rate control for atrial fibrillation, Roy et al. ...

CORRESPONDENCE: In Utero and Early-Life Conditions and Adult Health and Disease

2008-10-01T13:55:32-07:00

To the Editor: In their article on the developmental origin of disease, Gluckman et al. (July 3 issue)1 state that ...

CORRESPONDENCE: A Case of Conjugal Azathioprine-Induced Contact Hypersensitivity

Cooper, H. L., Louafi, F., Friedmann, P. S. — 2008-10-01T13:55:32-07:00

To the Editor: A man in his early 30s presented with an intermittent eczematous eruption over the shaft of his ...

CORRESPONDENCE: Dengue Hemorrhagic Fever Transmitted by Blood Transfusion

2008-10-01T13:55:32-07:00

To the Editor: Dengue, the most common vectorborne viral infection worldwide,1 is predominantly transmitted by the Aedes aegypti mosquito. We ...

BOOK REVIEW: Is There a Doctor in the House? Market Signals and Tomorrow's Supply of Doctors

Goodman, D. C. — 2008-10-01T13:55:32-07:00

Do we need more doctors in the United States? The current debate surrounding this question has all the elements of a great policy drama. It is a topic that affects ...

BOOK REVIEW: Intern: A Doctor's Initiation

Treadway, K. — 2008-10-01T13:55:32-07:00

Intern is an excellent, well-written book in which Sandeep Jauhar describes his first 2 years of internship and residency in internal medicine at New York Hospital (now New York-Presbyterian Hospital), ...

BOOK REVIEW: Fighting the Diseases of Poverty

Hillemeier, M. — 2008-10-01T13:55:32-07:00

The world's poorest people face formidable health challenges. According to the Population Reference Bureau, the average life expectancy in sub-Saharan Africa is 49 years, which lags far behind the North ...

HEALTH LAW, ETHICS, AND HUMAN RIGHTS: Toxic Tinkering -- Lethal-Injection Execution and the Constitution

Annas, G. J. — 2008-10-01T13:55:32-07:00

In the 2008 U.S. Supreme Court case, Baze v. Rees, the Court ruled that Kentucky's three-drug protocol (sodium thiopental, pancuronium bromide, and potassium chloride) for lethal injection does not constitute cruel and unusual punishment and does not violate the U.S. Constitution. The author summarizes the seven separate opinions written by the justices and discusses the implications of the decision.

CME: Continuous Glucose Monitoring and Intensive Treatment of Type 1 Diabetes

2008-10-01T13:55:32-07:00

(No abstract is available for this citation)

CME: Autosomal Dominant Polycystic Kidney Disease

2008-10-01T13:55:32-07:00

(No abstract is available for this citation)

PERSPECTIVE: Storm over Statins -- The Controversy Surrounding Pharmacologic Treatment of Children

de Ferranti, S., Ludwig, D. S. — 2008-09-24T13:55:29-07:00

In July of this year, the American Academy of Pediatrics (AAP) released revised recommendations for the management of hypercholesterolemia in children (see table).1 Within days after publication, the new policy ...

PERSPECTIVE: Election TWOTHOUSANDEIGHT: Campaign Contributions, Lobbying, and the U.S. Health Sector -- An Update

Steinbrook, R. — 2008-09-24T13:55:29-07:00

The 2008 U.S. presidential election is already the most expensive ever, with overall fund-raising surpassing that for the 2004 contest and the Democrats holding a large lead in the money ...

ORIGINAL ARTICLE: Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic Stroke

2008-09-24T13:55:30-07:00

Intravenous thrombolysis with alteplase improves the outcomes after acute stroke when alteplase is given within 3 hours after the onset of symptoms. In this randomized trial involving patients who presented between 3 and 4.5 hours after the onset of stroke, clinical outcomes were modestly better in patients treated with alteplase than in patients given placebo (favorable outcome in 52% vs. 45% of patients).

ORIGINAL ARTICLE: Drug-Eluting or Bare-Metal Stents for Acute Myocardial Infarction

2008-09-24T13:55:30-07:00

In an analysis of patients undergoing coronary-artery stenting for acute myocardial infarction in Massachusetts, recipients of drug-eluting stents were compared with recipients of bare-metal stents in propensity-matched cohorts. Mortality rates and repeat target-vessel revascularization rates at 2 years were significantly lower with drug-eluting stents. The rates of reinfarction were reduced in patients with myocardial infarction without ST-segment elevation who were treated with drug-eluting stents.

ORIGINAL ARTICLE: Intensive Lipid Lowering with Simvastatin and Ezetimibe in Aortic Stenosis

2008-09-24T13:55:30-07:00

In this randomized, placebo-controlled trial, the combination of simvastatin and ezetimibe had no effect on the progression of aortic stenosis, despite substantial lowering of low-density lipoprotein cholesterol. There was a reduction in the need for coronary bypass surgery in the simvastatin-ezetimibe group, but unexpectedly, active treatment was also associated with an increased incidence of cancer.

SPECIAL ARTICLE: Analyses of Cancer Data from Three Ezetimibe Trials

2008-09-24T13:55:30-07:00

The Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) trial involving the combination of ezetimibe and simvastatin in patients with aortic stenosis suggested an increased incidence of cancer associated with the use of active therapy. The current analysis of two other ongoing trials of ezetimibe and simvastatin does not support the suggestion of an increased incidence of cancer but does show increased cancer mortality.

REVIEW ARTICLE: Molecular Origins of Cancer: Lung Cancer

Herbst, R. S., Heymach, J. V., Lippman, S. M. — 2008-09-24T13:55:30-07:00

The Molecular Origins of Cancer series continues with this review of molecular and genetic mechanisms of lung cancer. The authors review genetic susceptibility to lung cancer and four genes of importance in the evolution of the disease: EGFR, KRAS, the PI3K-Akt-mTOR complex, and TITF1. They also discuss gene profiling and protein profiling, with emphasis on the clinical value of these methods.

IMAGES IN CLINICAL MEDICINE: Periungual Fibromas

Dacunha, A. — 2008-09-24T13:55:30-07:00

A 36-year-old woman with mild mental retardation and facial angiofibromas presented for evaluation of recurrent seizures, which she reported having had since childhood. Periungual fibromas were seen in the feet. ...

IMAGES IN CLINICAL MEDICINE: New-Onset Clubbing Associated with Lung Cancer

Faller, B. A., Atkinson, J. P. — 2008-09-24T13:55:30-07:00

A 45-year-old woman with a 27-pack-year history of smoking presented for evaluation of progressive distal finger enlargement and polyarthralgias, which had developed over a period of 18 months. During the ...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 30-2008 -- A 47-Year-Old Woman with a Mass in the Breast and a Solitary Lesion in the Spine

Gradishar, W. J., Bellon, J. R., Gadd, M. A., D'Alessandro, H. A., Braaten, K. — 2008-09-24T13:55:30-07:00

A 47-year-old premenopausal woman came to this hospital for treatment of breast cancer. A mass that measured 5 cm in diameter was present in the left breast; needle biopsies showed infiltrating ductal carcinoma that was grade 2 of 3, hormone receptor-positive, HER2/neu-negative. An evaluation of the staging disclosed a solitary lesion in the T6 vertebral body, which was asymptomatic. A management decision was made.

EDITORIAL: Thrombolytic Therapy for Acute Stroke -- Not a Moment to Lose

Lyden, P. — 2008-09-24T13:55:30-07:00

Stroke, the most common cause of disability in the world among adults, remains the only neurologic disorder for which physicians are potentially able to completely reverse disabling deficits.1 Thrombolytic therapy, ...

EDITORIAL: Calcific Aortic Stenosis -- Time to Look More Closely at the Valve

Otto, C. M. — 2008-09-24T13:55:30-07:00

Calcific aortic stenosis is a progressive disease that results in stiff valve leaflets with eventual obstruction to left ventricular outflow. Once symptoms occur, valve replacement is the only effective treatment, ...

EDITORIAL: Ezetimibe and Cancer -- An Uncertain Association

Drazen, J. M., D'Agostino, R. B., Ware, J. H., Morrissey, S., Curfman, G. D. — 2008-09-24T13:55:30-07:00

The randomized clinical trial is considered to be the most reliable tool to assess the efficacy and safety of new drugs. At times, however, randomized trials detect adverse events that ...

EDITORIAL: Identifying and Addressing Safety Signals in Clinical Trials

Fleming, T. R. — 2008-09-24T13:55:30-07:00

Interventions for the prevention or treatment of disease that are based on our understanding of the pathobiologic features of the illness can provide benefit in how a patient feels or ...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Cell Therapies for Muscular Dystrophy

Blau, H. M. — 2008-09-24T13:55:30-07:00

A specific type of satellite cell can engraft dystrophic tissue in a mouse model of Duchenne's muscular dystrophy and can improve the strength and duration of muscle contractility.

CORRESPONDENCE: Polygenes, Risk Prediction, and Targeted Prevention of Breast Cancer

Wilkins, R. J., Teixeira, L., Julien, C., Guimiot, F., Jernstrom, H. — 2008-09-24T13:55:30-07:00

To the Editor: In their discussion of polygenics and breast cancer, Pharoah et al. (June 26 issue)1 do not mention ...

CORRESPONDENCE: Correction: Graves' Disease

2008-09-24T13:55:30-07:00

To the Editor: In his Clinical Practice article on Graves' disease, Brent (June 12 issue)1 comments on the combined use ...

CORRESPONDENCE: Retractions: Retraction: Barlogie et al. Duration of Survival in Patients with Myeloma Treated with Thalidomide. N Engl J Med 2008;359:210-2.

Barlogie, B., Shaughnessy, J. D., Crowley, J. — 2008-09-24T13:55:30-07:00

To the Editor: We wish to retract our letter to the editor, "Duration of Survival in Patients with Myeloma Treated ...

CORRESPONDENCE: Zoledronic Acid Infusion and Orbital Inflammatory Disease

Sharma, N. S., Ooi, J.-L., Masselos, K., Hooper, M. J., Francis, I. C. — 2008-09-24T13:55:30-07:00

To the Editor: Bisphosphonates are being used increasingly for the prevention and treatment of osteoporosis, hypercalcemia of malignant disease, and ...

BOOK REVIEW: Insomnia: A Cultural History; Insomniac

Turek, F. W. — 2008-09-24T13:55:30-07:00

In an interesting coincidence, these two books on insomnia were written not by experts in the field but by two professors in the humanities. You might then expect the books ...

BOOK REVIEW: High Society: How Substance Abuse Ravages America And What to Do About It

Gejman, P. V. — 2008-09-24T13:55:30-07:00

Joseph A. Califano, Jr., has had a distinguished career as a civil servant and was the secretary of Health, Education, and Welfare under President Jimmy Carter. In his latest book, ...

CORRECTIONS: Genetics of Warfarin Response

2008-09-24T13:55:30-07:00

Genetics of Warfarin Response . The final sentence in the letter from Mannucci et al. (p. 2743) should have read, "Unfortunately, the primary outcomes of this trial are not bleeding ...

CORRECTIONS: Brain-Derived Neurotrophic Factor and Obesity in the WAGR Syndrome

2008-09-24T13:55:30-07:00

Brain-Derived Neurotrophic Factor and Obesity in the WAGR Syndrome . The abstract (p. 918) included a trial-registration number, but since the article reported a further analysis of trial data, not ...

CME: Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic Stroke

2008-09-24T13:55:30-07:00

(No abstract is available for this citation)

CME: Intensive Lipid Lowering with Simvastatin and Ezetimibe in Aortic Stenosis

2008-09-24T13:55:30-07:00

(No abstract is available for this citation)

CME: Case 30-2008: A 47-Year-Old Woman with a Mass in the Breast and a Solitary Lesion in the Spine

2008-09-24T13:55:30-07:00

(No abstract is available for this citation)

PERSPECTIVE: Beyond Pay for Performance -- Emerging Models of Provider-Payment Reform

Rosenthal, M. B. — 2008-09-17T13:55:36-07:00

Escalating costs and the growing imbalance between primary and specialty care have increased the urgency of calls for fundamental reform of the health care payment system. At the core of ...

PERSPECTIVE: No Place Like Home -- Testing a New Model of Care Delivery

Iglehart, J. K. — 2008-09-17T13:55:36-07:00

Seeking ways to slow the growth of Medicare spending and to better coordinate the health care it finances, the federal government is preparing to test the concept of the "medical ...

PERSPECTIVE: Building a Medical Neighborhood for the Medical Home

Fisher, E. S. — 2008-09-17T13:55:36-07:00

Recent efforts to improve primary care in the United States have focused largely on the development and implementation of practice models and payment reforms intended to create a "medical home" ...

ORIGINAL ARTICLE: Accuracy of CT Colonography for Detection of Large Adenomas and Cancers

2008-09-17T13:55:36-07:00

In this comparison of CT colonography and optical colonoscopy in 2600 asymptomatic study participants 50 years of age or older at 15 centers, 90% of large colorectal adenomas and adenocarcinomas detected by optical colonoscopy were also detected on CT colonography, and 10% were missed by CT colonography.

ORIGINAL ARTICLE: Five-Year Risk of Colorectal Neoplasia after Negative Screening Colonoscopy

2008-09-17T13:55:36-07:00

In this study of subjects who had no adenomas or cancers on baseline screening colonoscopy, advanced adenomas were detected in only 1.3% of those who returned for rescreening after 5 years. These findings support a rescreening interval of 5 years or longer for patients at average risk who have normal findings on colonoscopy.

ORIGINAL ARTICLE: Telmisartan to Prevent Recurrent Stroke and Cardiovascular Events

2008-09-17T13:55:36-07:00

In a multicenter trial, 20,332 patients who had recently had an ischemic stroke were randomly assigned to receive either telmisartan or placebo. All patients also received medications for blood-pressure control at the investigators' discretion. At a mean follow-up of 2.5 years, there was no significant difference between the two study groups in the rates of recurrent stroke or major cardiovascular events.

ORIGINAL ARTICLE: Aspirin and Extended-Release Dipyridamole versus Clopidogrel for Recurrent Stroke

2008-09-17T13:55:36-07:00

In this large clinical trial, aspirin plus extended-release dipyridamole was found to have an efficacy similar to that of clopidogrel in the prevention of recurrent stroke. However, aspirin plus extended-release dipyridamole resulted in more bleeding, including intracranial bleeding. The results will help guide therapy for secondary stroke prevention.

CLINICAL PRACTICE: Food Allergy

Lack, G. — 2008-09-17T13:55:36-07:00

A 3-year-old boy is admitted to the hospital with hives and wheezing after eating chocolate mousse. At 18 months of age, contact urticaria developed after he put his hand into a cake mix containing egg. He also has a history of chronic rhinitis, nocturnal cough, severe eczema, and a previous hospitalization for recurrent wheezing. How should this child be evaluated and treated?

REVIEW ARTICLE: Mechanisms of Disease: Platelets, Petechiae, and Preservation of the Vascular Wall

Nachman, R. L., Rafii, S. — 2008-09-17T13:55:36-07:00

This review concerns functional contacts between platelets and endothelial cells, with emphasis on the maintenance of vascular integrity by proangiogenic cytokines and growth factors released by platelets. These molecules bind to receptors on the surface of endothelial cells, thereby stabilizing the vascular-endothelium cadherin complex.

IMAGES IN CLINICAL MEDICINE: Primary Small-Bowel Enterolithiasis

Wroblewski, R. L., Sticca, R. P. — 2008-09-17T13:55:36-07:00

A 53-year-old woman with a 2-year history of intermittent abdominal pain, diarrhea, and constipation presented for evaluation. Her medical history was significant for congenital imperforate anus requiring a colostomy at ...

IMAGES IN CLINICAL MEDICINE: Colonic Saccular Diverticula

Steensma, E. A., Wu, F. M. — 2008-09-17T13:55:36-07:00

A 61-year-old woman with severe pulmonary hypertension and an 8-year history of the CREST syndrome (calcinosis, Raynaud's phenomenon, esophageal involvement, sclerodactyly, and telangiectasia) and with a positive anticentromere-antibody test was ...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 29-2008 -- A 19-Year-Old Man with Weight Loss and Abdominal Pain

Goldstein, M. A., Herzog, D. B., Misra, M., Sagar, P. — 2008-09-17T13:55:36-07:00

A 19-year-old man was admitted to this hospital because of acute abdominal pain, which had begun the previous day. Imaging studies disclosed dilatation of the colon and small bowel, with no obstruction or free air. Administration of fluids and laxatives resulted in resolution of the pain. The patient had had anorexia nervosa since the age of 14 years and had recently lost several kilograms of weight. He was admitted to the psychiatric inpatient unit, and a treatment plan was established.

EDITORIAL: Colorectal Cancer Screening on Stronger Footing

Fletcher, R. H. — 2008-09-17T13:55:36-07:00

Screening for colorectal cancer has lagged behind other cancer screening, but it is now in a dynamic phase. New screening tests are available, and there is stronger evidence of their ...

EDITORIAL: Stroke Prevention -- Insights from Incoherence

Kent, D. M., Thaler, D. E. — 2008-09-17T13:55:36-07:00

If clinical trials were sporting contests, then it would be fair to say that low-dose aspirin plus extended-release dipyridamole (Aggrenox) was the clear favorite against clopidogrel going into the Prevention ...

CORRESPONDENCE: Correction: Socioeconomic Inequalities in Health in 22 European Countries

2008-09-17T13:55:36-07:00

To the Editor: Mackenbach et al. (June 5 issue)1 present interesting findings on the magnitude of socioeconomic inequalities in health ...

CORRESPONDENCE: Contaminated Heparin

2008-09-17T13:55:36-07:00

To the Editor: Kishimoto et al. (June 5 issue)1 report that contamination of heparin with oversulfated chondroitin sulfate (OSCS) can ...

CORRESPONDENCE: Femoral Venous Catheterization

Albers, M. J., Torri, A., Tabas, J. A., Tsui, J. Y., Collins, A. B. — 2008-09-17T13:55:36-07:00

To the Editor: In their article and video on the placement of a femoral venous catheter, Tsui et al. (June ...

CORRESPONDENCE: Diagnosis of Poorly Differentiated Thyroid Cancer with Radioiodine Scanning after Thyrotropin Alfa Stimulation

Juweid, M., O'Dorisio, T., Milhem, M. — 2008-09-17T13:55:36-07:00

To the Editor: Poorly differentiated thyroid cancers are rare and can be difficult for surgeons, endocrinologists, and pathologists to identify.1 ...

BOOK REVIEW: Adolescent Rheumatology

Lazarus, H. — 2008-09-17T13:55:36-07:00

Pediatric rheumatology has a quality that sets it apart from other pediatric subspecialties. In some respects, this quality is determined by the limited number of board-certified practitioners caring for an ...

BOOK REVIEW: Pediatric Inflammatory Bowel Disease

Motil, K. J. — 2008-09-17T13:55:36-07:00

Gastrointestinal disease in children is often the orphan of clinical inquiry and scientific investigation. This book provides a thorough update of the pathophysiology and clinical features of gastrointestinal disease in ...

BOOK REVIEW: Obesity Epidemiology

Gordon-Larsen, P. — 2008-09-17T13:55:36-07:00

Obesity is ultimately the result of an imbalance between energy intake and energy expenditure, but this simplistic equation belies the fact that obesity is also a multifactorial disease with complex ...

BOOK REVIEW: Autism Spectrum Disorders in Infants and Toddlers: Diagnosis, Assessment, and Treatment

Enahoro, R. — 2008-09-17T13:55:36-07:00

The earliest symptoms of autism spectrum disorders often appear before a child's second birthday, but most children with autism are not diagnosed until they are in preschool or elementary school. ...

CORRECTIONS: Socioeconomic Inequalities in Health in 22 European Countries

2008-09-17T13:55:36-07:00

Socioeconomic Inequalities in Health in 22 European Countries

We have discovered an error in the mortality data from England; this error is related to an ambiguity in the labels of ...

CME: Five-Year Risk of Colorectal Neoplasia after Negative Screening Colonoscopy

2008-09-17T13:55:36-07:00

(No abstract is available for this citation)

CME: Food Allergy

2008-09-17T13:55:36-07:00

(No abstract is available for this citation)

CME: Case 29-2008: A 19-Year-Old Man with Weight Loss and Abdominal Pain

2008-09-17T13:55:36-07:00

(No abstract is available for this citation)

PERSPECTIVE: Election TWOTHOUSANDEIGHT: Speaking Truth to Power -- The Need for, and Perils of, Health Policy Expertise in the White House

Hacker, J. S. — 2008-09-10T14:05:39-07:00

President Harry Truman once famously wished for a one-handed economist, because the ones advising him were forever saying, "On the one hand . . . but on the other hand. ...

PERSPECTIVE: Military Medical Ethics -- Physician First, Last, Always

Annas, G. J. — 2008-09-10T14:05:39-07:00

The global war on terror has brought renewed attention to the question of whether physicians in the U.S. military are physicians first, soldiers first, or physician-soldiers, or whether some other ...

PERSPECTIVE: The Ethics of Interrogation -- The U.S. Military's Ongoing Use of Psychiatrists

Marks, J. H., Bloche, M. G. — 2008-09-10T14:05:39-07:00

In May 2006, the American Psychiatric Association (APA) adopted a position statement prohibiting psychiatrists from "direct participation" in the interrogation of any person in military or civilian detention -- including ...

PERSPECTIVE: Assessing the Cardiovascular Safety of Diabetes Therapies

Goldfine, A. B. — 2008-09-10T14:05:39-07:00

The Endocrinologic and Metabolic Drugs Advisory Committee for the Food and Drug Administration (FDA), of which I am a member, convened in early July to consider whether data on long-term ...

ORIGINAL ARTICLE: A Randomized Trial of Arthroscopic Surgery for Osteoarthritis of the Knee

2008-09-10T14:05:39-07:00

This randomized trial showed no benefit of the addition of arthroscopic treatment to optimized physical and medical therapy and provided evidence that arthroscopic surgery is not indicated for the treatment of osteoarthritis of the knee.

ORIGINAL ARTICLE: Incidental Meniscal Findings on Knee MRI in Middle-Aged and Elderly Persons

2008-09-10T14:05:39-07:00

In this cross-sectional study involving magnetic resonance imaging (MRI) of the right knee in middle-aged and older men and women, more than a third of the participants had a meniscal tear or meniscal destruction or resection; many of these persons reported having had no knee pain or stiffness in the previous month. Meniscal damage was particularly common in persons with radiographic evidence of osteoarthritis. Clinicians should take into consideration the high prevalence of incidental meniscal findings when ordering or interpreting this test in older patients with knee pain.

ORIGINAL ARTICLE: Platinum-Based Chemotherapy plus Cetuximab in Head and Neck Cancer

2008-09-10T14:05:39-07:00

This randomized trial of the treatment of advanced head and neck cancer tested the efficacy of adding cetuximab, an antibody against the epidermal growth factor receptor, to standard therapy (platinum-based chemotherapy). As compared with standard chemotherapy alone, cetuximab plus chemotherapy prolonged median overall survival by almost 3 months.

ORIGINAL ARTICLE: Brief Report: NHERF1 Mutations and Responsiveness of Renal Parathyroid Hormone

2008-09-10T14:05:39-07:00

Impaired reabsorption of phosphate by renal tubules increases the risks of nephrolithiasis and bone demineralization. On the basis of data from animals, the sodium-hydrogen exchanger regulatory factor 1 (NHERF1) appears to control renal phosphate transport. The authors sequenced NHERF1 in people with nephrolithiasis or bone demineralization and identified three mutations, suggesting a previously unrecognized cause of renal phosphate loss in humans.

REVIEW ARTICLE: Medical Progress: Recent Advances in Head and Neck Cancer

Haddad, R. I., Shin, D. M. — 2008-09-10T14:05:39-07:00

There are more than half a million incident cases of squamous-cell carcinoma of the head and neck worldwide each year, primarily affecting the oropharynx, oral cavity, hypopharynx, and larynx. This review considers the biologic features of these tumors, including the role of human papillomavirus as a risk factor for cancer of the oropharynx. New therapies are considered, along with management approaches.

CLINICAL THERAPEUTICS: Gonadotropin-Releasing Hormone Agonists for Endometriosis

Olive, D. L. — 2008-09-10T14:05:39-07:00

A 36-year-old woman with a presumptive diagnosis of endometriosis presents with long-standing pelvic pain that is not relieved by means of oral contraceptives or medroxyprogesterone. Treatment with a gonadotropin-releasing hormone agonist is recommended. Gonadotropin-releasing hormone agonists profoundly suppress gonadotropin secretion and sex-steroid production. Side effects include loss of bone mineral density and memory impairment.

IMAGES IN CLINICAL MEDICINE: Extracapsular Hemorrhage from a Parathyroid Adenoma

Zillikens, M. C., Wijbenga, A. — 2008-09-10T14:05:39-07:00

A healthy 34-year-old woman presented with an acute, painful swelling and bluish discoloration of the anterior neck with no associated trauma. She reported having fatigue, anorexia, and depression during the ...

IMAGES IN CLINICAL MEDICINE: Strongyloides stercoralis Hyperinfection

Gorman, S. R., Craven, D. E. — 2008-09-10T14:05:39-07:00

A 46-year-old man with Raynaud's disease who emigrated from Cambodia 30 years ago presented with a 2-month history of myalgias, exertional dyspnea, and an elevated level of creatine kinase. An ...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 28-2008 -- An 8-Day-Old Infant with Congenital Deafness, Lethargy, and Hypothermia

Staley, K. J., Sims, K. B., Grant, P. E., Hedley-Whyte, E. T. — 2008-09-10T14:05:39-07:00

An 8-day-old boy was admitted to this hospital because of weakness and lethargy. He had been hospitalized briefly after birth because of respiratory distress, and sensorineural deafness was noted, but his postnatal course had been otherwise normal. On the day before admission, he became lethargic and hypothermic, with grunting respirations; lumbar puncture at another facility disclosed blood in the cerebrospinal fluid, and he was transferred to this hospital. Imaging studies disclosed intracerebral hemorrhage and edema. Coma developed, and the infant died on the fifth hospital day. An autopsy was performed.

EDITORIAL: Arthroscopic Surgery for Osteoarthritis of the Knee?

Marx, R. G. — 2008-09-10T14:05:39-07:00

Orthopedic surgeons perform arthroscopic surgery in many joints of the extremities, most commonly the knee. Two or three incisions are routinely made, each measuring approximately 7 mm. The knee is ...

EDITORIAL: Renal Phosphate-Transporter Regulatory Proteins and Nephrolithiasis

Levi, M., Bruesegem, S. — 2008-09-10T14:05:39-07:00

Nephrolithiasis is a common disorder, and idiopathic hypercalciuria is the most frequent metabolic disorder associated with nephrolithiasis.1 Several studies have shown that subjects with idiopathic hypercalciuria have phosphaturia or renal ...

EDITORIAL: Reviewers for the Journal, January-June 2008

2008-09-10T14:05:39-07:00

Each year thousands of reviewers contribute their expertise to peer review, a process that contributes critically to the quality of the Journal. The editors and the authors of the papers ...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Turning Thought into Action

Hochberg, L. R. — 2008-09-10T14:05:39-07:00

Two monkeys have been trained to control a robotic arm to feed themselves by means of electrodes implanted into their motor cortexes.

CORRESPONDENCE: Hypothermia Therapy after Traumatic Brain Injury in Children

2008-09-10T14:05:39-07:00

To the Editor: Hutchison et al. (June 5 issue)1 report that hypothermia therapy that was initiated within 8 hours after ...

CORRESPONDENCE: Aprotinin and Lysine Analogues in High-Risk Cardiac Surgery

2008-09-10T14:05:39-07:00

To the Editor: Fergusson et al. (May 29 issue)1 report the findings of the Blood Conservation Using Antifibrinolytics in a ...

CORRESPONDENCE: Informing Candidates for Transplantation about Donor Risk Factors

Fishman, J. A., McCullough, L. B., Halpern, S. D., Shaked, A., Caplan, A. L. — 2008-09-10T14:05:39-07:00

To the Editor: In discussing informed consent for organ transplantation, Halpern et al. (June 26 issue)1 blend two important but ...

CORRESPONDENCE: Case 16-2008: A Woman with Bone Pain

Kumar, H. K.V.S., Jayaraman, M., Modi, K. D., Ish, C., Demay, M. B. — 2008-09-10T14:05:39-07:00

To the Editor: The diagnosis of secondary hyperparathyroidism in the case discussed by Demay and colleagues (May 22 issue)1 is ...

CORRESPONDENCE: PTH Mutation with Primary Hyperparathyroidism and Undetectable Intact PTH

2008-09-10T14:05:39-07:00

To the Editor: We describe a case of hypercalcemia associated with the secretion of an abnormally truncated parathyroid hormone (PTH) ...

BOOK REVIEW: Gender and Health: The Effects of Constrained Choices and Social Policies

Loue, S. — 2008-09-10T14:05:39-07:00

We take for granted that on average, women in the United States live longer than men, even though they are subject to more chronic disease during their lifetimes. Research findings ...

BOOK REVIEW: Stroke: Practical Management

Bousser, M.-G. — 2008-09-10T14:05:39-07:00

Stroke is the third leading cause of death worldwide. In industrialized countries it accounts for 10 to 12% of all deaths, but two thirds of deaths from stroke now occur ...

BOOK REVIEW: Acute Heart Failure

Drexler, H. — 2008-09-10T14:05:39-07:00

Acute heart failure is a major health issue, accounting for a large proportion of patients admitted to hospitals. Patients with recent hospitalizations for acute heart failure are at high risk ...

BOOK REVIEW: Atrial Fibrillation: From Bench to Bedside

Page, R. L. — 2008-09-10T14:05:39-07:00

Atrial fibrillation has become the focus of intense investigation over the past several years, owing to its clinical importance, an increased understanding of its pathophysiology, and the development of new ...

CME: A Randomized Trial of Arthroscopic Surgery for Osteoarthritis of the Knee

2008-09-10T14:05:39-07:00

(No abstract is available for this citation)

CME: Gonadotropin-Releasing Hormone Agonists for Endometriosis

2008-09-10T14:05:39-07:00

(No abstract is available for this citation)

CME: Recent Advances in Head and Neck Cancer

2008-09-10T14:05:39-07:00

(No abstract is available for this citation)