Sparse outcome data exist for genetic males who are assigned female sex at birth to overcome severe phallic inadequacy occurring in cloacal exstrophy, a rare, complex pelvic defect. This article reports the subsequent sexual identity of 16 genetic males, 14 of whom were assigned to female sex soon after birth. Eight of 14 subjects assigned to female sex declared themselves male over time; the 2 raised as males remained so.

Children who are born genetically and hormonally male may identify themselves as males despite being raised as females and undergoing feminizing genitoplasty at birth. The practice of reassigning genetic males to female sex because of phallic inadequacy may complicate already complex neonatal conditions and should be reconsidered.

In June 2003, monkeypox was diagnosed in several patients in the midwestern United States who presented with fever, sweats, skin lesions, and lymphadenopathy. This investigation describes the initial 11 patients in the outbreak, all of whom had contact with ill pet prairie dogs from the same distributor.

This report documents an outbreak of monkeypox in humans in the Western Hemisphere. The infection was traced to rodents imported from West Africa.

This large international trial, conducted in 33 countries, showed that postoperative cisplatin-based chemotherapy improved overall survival among patients with completely resected non–small-cell lung cancer. The benefit was small but statistically significant.

Given the high incidence of lung cancer worldwide, small improvements in the survival rate stand to benefit many patients.

A 21-year-old student from New Hampshire presented with two tender, 2-cm nodules that developed after she became febrile during a stay in the Republic of Congo, where she had cared for chimpanzees. The diagnosis of tanapox was established with the use of electron microscopy and polymerase-chain-reaction analysis of tissue samples. The poxvirus infection is endemic to equatorial Africa and has been diagnosed in North America only rarely. It must be distinguished from smallpox, monkeypox, and several other infections that represent major public health problems.

Despite years of research, the five-year survival rate among patients with lung cancer is a mere 14 percent. Lung cancer is divided into two major types — non–small-cell lung cancer and the more aggressive small-cell lung cancer. This review considers the treatment of each type in the framework of multidisciplinary management and recent clinical trials.

Lung cancer may be curable in its early stages, and most patients derive some benefit from treatment, such as longer survival or amelioration of symptoms.

This review elucidates the molecular mechanisms of sex determination and sex differentiation with examples from embryology, animal models, and clinical syndromes. Sex reversal, defective masculinization, pseudohermaphroditism, and syndromes involving the gonads and other organs are some of the clinical problems discussed.

Payment incentives as a part of physicians' compensation are commonplace but have been aimed predominantly at restricting expensive services. A novel concept is the payment of physicians for providing high-quality care, on the basis of explicit measures of quality. Such a system has recently been adopted in the United Kingdom. The authors believe that the idea is worth pursuing, but they point out important impediments and challenges to its successful implementation.

A recent study shows that crystalline uric acid acts as an immunologic adjuvant by triggering the maturation of dendritic cells, which can then prime the T-cell response.