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Thyroid Screening and Childhood Cognitive Function
original article

In this randomized trial, antenatal screening (at a median gestational age of 12 weeks 3 days) and treatment for hypothyroidism did not result in improved cognitive function in children at 3 years of age.

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The Threat of Untreatable Gonococcal Infection
perspective

Gonorrhea, which disproportionately affects marginalized populations, is the second most commonly reported communicable disease in the United States. Over the past 3 years, the gonococcus has shown decreased susceptibility to our last line of antimicrobial defense.

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Preimplantation Genetic Screening and Diagnosis
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Maternal genetic contributions and the genetic status of the embryo can be analyzed by several methods, including fluorescence in situ hybridization, PCR assay, 24-chromosome single-nucleotidepolymorphism array, and comparative genomic hybridization.

Ulipristal Acetate vs. Placebo for Fibroids
original article

In this trial involving women with symptomatic fibroids who were planning to undergo surgery, treatment with the selective progesterone-receptor modulator ulipristal acetate was effective in controlling excessive bleeding and reducing fibroid size at 13 weeks.

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Ulipristal Acetate vs. Leuprolide Acetate for Fibroids
original article

In this trial comparing oral ulipristal acetate (5 mg or 10 mg daily) with once-monthly leuprolide acetate in women with symptomatic uterine fibroids before planned surgery, both doses of ulipristal acetate were noninferior to leuprolide acetate in controlling uterine bleeding.

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original article

The unusual occurrence of adenocarcinoma of the vagina in eight patients born in New England hospitals between 1946 and 1951 led the investigators to conduct a retrospective investigation in search of factors that might be associated with tumor appearance. Maternal ingestion of diethylstilbestrol during early pregnancy appears to have enhanced the risk.

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  • Editorial

    Maternal hypothyroidism in pregnancy has been associated with a range of adverse outcomes, most importantly miscarriage, preterm delivery, and reduced cognitive function in offspring. In surveys, almost half the obstetricians in private practices in Maine and the majority of obstetricians in a…

    • February 9, 2012
    • Brent G.A.
    • N Engl J Med 2012; 366:562 - 563

      Maternal hypothyroidism in pregnancy has been associated with a range of adverse outcomes, most importantly miscarriage, preterm delivery, and reduced cognitive function in offspring.1 In surveys, almost half the obstetricians in private practices in ...

    • Original Article

      Active secretion of thyroid hormone in the fetus does not start until about 18 to 20 weeks' gestation. Studies in animals suggest that until fetal hormone secretion begins, the fetus is dependent on circulating free thyroxine (T4) in the mother for growth and development, including central nervous…

      • February 9, 2012
      • Lazarus J.H., Bestwick J.P., Channon S., et al.
      • N Engl J Med 2012; 366:493 - 501
      • CME

      In this randomized trial, antenatal screening (at a median gestational age of 12 weeks 3 days) and treatment for hypothyroidism did not result in improved cognitive function in children at 3 years of age.

    • Perspective

      It is time to sound the alarm. During the past 3 years, the wily gonococcus has become less susceptible to our last line of antimicrobial defense, threatening our ability to cure gonorrhea and prevent severe sequelae. Gonorrhea is the second most commonly reported communicable disease in the United…

      • February 9, 2012
      • Bolan G.A., Sparling P.F., Wasserheit J.N.
      • N Engl J Med 2012; 366:485 - 487

        Gonorrhea, which disproportionately affects marginalized populations, is the second most commonly reported communicable disease in the United States. Over the past 3 years, the gonococcus has shown decreased susceptibility to our last line of antimicrobial defense.

      • Clinical Practice

        Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations. Stage. A 14-year-old…

        • February 2, 2012
        • Palmert M.R. and Dunkel L.
        • N Engl J Med 2012; 366:443 - 453
        • CME
        • Full Text Audio

        Puberty is considered delayed when it has not yet occurred at an age that is 2 to 2.5 SD later than average (traditionally, 14 years in boys and 13 years in girls). Constitutional delay of growth and puberty (CDGP) is the most common cause. Management of CDGP is discussed.

      • Original Article

        Uterine leiomyomas, or fibroids, are benign, hormone-sensitive, smooth-muscle tumors that occur in 20 to 40% of women of reproductive age. The most common symptoms are menorrhagia and iron-deficiency anemia, which may lead to chronic fatigue that may not be adequately controlled with iron…

        • February 2, 2012
        • Donnez J., Tatarchuk T.F., Bouchard P., et al.
        • N Engl J Med 2012; 366:409 - 420

          In this trial involving women with symptomatic fibroids who were planning to undergo surgery, treatment with the selective progesterone-receptor modulator ulipristal acetate was effective in controlling excessive bleeding and reducing fibroid size at 13 weeks.

        • Editorial

          The 2011 report from the Agency for Healthcare Research and Quality on comparative management of uterine fibroids noted, "Despite the prevalence and possible complications of uterine fibroids, few published studies examining the effectiveness of treatment strategies exist." Few therapies are…

          • February 2, 2012
          • Stewart E.A.
          • N Engl J Med 2012; 366:471 - 473

            The 2011 report from the Agency for Healthcare Research and Quality on comparative management of uterine fibroids noted, “Despite the prevalence and possible complications of uterine fibroids, few published studies examining the effectiveness of treatment ...

          • Original Article

            Uterine leiomyomas, or fibroids, are the most common benign uterine tumors in women of reproductive age. In addition to anemia caused by heavy bleeding, fibroids can cause pelvic pain, pressure, dysmenorrhea, reduced quality of life, and infertility. Current management strategies consist mainly of…

            • February 2, 2012
            • Donnez J., Tomaszewski J., Vázquez F., et al.
            • N Engl J Med 2012; 366:421 - 432
            • CME

            In this trial comparing oral ulipristal acetate (5 mg or 10 mg daily) with once-monthly leuprolide acetate in women with symptomatic uterine fibroids before planned surgery, both doses of ulipristal acetate were noninferior to leuprolide acetate in controlling uterine bleeding.

          • Original Article

            Sex cord–stromal tumors and germ-cell tumors account for less than 10% of ovarian cancers. Unlike epithelial ovarian cancers, both sex cord–stromal tumors and germ-cell tumors can also occur in the testicle; testicular germ-cell tumors are the most common cancer in boys and men of European…

            • January 19, 2012
            • Heravi-Moussavi A., Anglesio M.S., Cheng S.-W.G., et al.
            • N Engl J Med 2012; 366:234 - 242

              Primitive cancers have so-called hot-spot mutations in DICER1 that alter the function of DICER1, an enzyme that processes microRNA. Some of these cancers harbor a loss-of-function mutation in the other DICER1 allele, suggesting a new mutational mechanism of oncogenesis.

            • Perspective

              On December 7, 2011, Health and Human Services (HHS) Secretary Kathleen Sebelius instructed Food and Drug Administration (FDA) Commissioner Margaret Hamburg not to approve the application for over-the-counter sales of Plan B One-Step, a single-dose emergency contraceptive. Dr. Hamburg issued her…

              • January 12, 2012
              • Wood A.J.J., Drazen J.M., Greene M.F.
              • N Engl J Med 2012; 366:101 - 102
              • Free Full Text

              On December 7, Health and Human Services Secretary Kathleen Sebelius overruled an FDA decision to approve over-the-counter sales of Plan B One-Step. Although the drug can be used safely without medical supervision, it apparently poses unacceptable political risks.

            • Review Article

              Among both prospective parents and providers of medical care, genetic and social concerns peak during the perinatal period. Advances in genomics and assisted reproductive technology have created new opportunities to detect genetic disorders and susceptibilities at multiple times during perinatal…

              • January 5, 2012
              • Bodurtha J. and Strauss J.F.
              • N Engl J Med 2012; 366:64 - 73
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              Advances in genomic technologies and methods of assisted reproduction have opened up new possibilities for testing and screening of prospective parents, their fertilized eggs, their fetuses, and their newborn babies.

            • Original Article

              Ovarian cancer is the fourth most common cause of cancer-related deaths in women, with an estimated 200,000 cases and 125,000 deaths occurring annually worldwide. For the past decade, the standard treatment for women with advanced ovarian cancer has been surgery and platinum-based chemotherapy.…

              • December 29, 2011
              • Perren T.J., Swart A.M., Pfisterer J., et al.
              • N Engl J Med 2011; 365:2484 - 2496

                The addition of bevacizumab to chemotherapy (15 mg/kg for six cycles) followed by extended therapy with bevacizumab every 3 weeks for a total of 15 months of treatment improved progression-free survival by 4 months in incompletely resected stage III or IV ovarian cancer.

              • Original Article

                Epithelial ovarian cancer and related cancers lead to 15,000 deaths in the United States annually, representing the fifth leading cause of death from cancer among women. The poor prognosis is usually attributed to advanced stage at diagnosis and inadequate chemotherapy. Vascular endothelial growth…

                • December 29, 2011
                • Burger R.A., Brady M.F., Bookman M.A., et al.
                • N Engl J Med 2011; 365:2473 - 2483

                  Incorporating bevacizumab in a chemotherapy regimen (7.5 mg/kg every 3 weeks for five or six cycles) and then continuing bevacizumab alone for a total of 12 months of treatment extended progression-free survival in advanced and high-risk early-stage ovarian cancer.

                • Correspondence

                  To the Editor: On July 19, the Institute of Medicine released a historic report outlining key preventive health services for women to be covered by insurers under the Affordable Care Act (ACA) without consumer cost sharing. Particularly notable was the report's inclusion of contraception, with the…

                  • December 22, 2011
                  • N Engl J Med 2011; 365:2438 - 2439
                  • Free Full Text

                  The IOM recommends including contraception among the preventive services for women to be covered without patient cost sharing. Reforms in medical education and primary care delivery are needed to ensure safe, effective, and appropriate contraceptive care.

                • Perspective

                  Over the past 60 years, U.S. mortality from cervical cancer has dropped by 70%, thanks to a successful screening program. In 1995, the American College of Obstetricians and Gynecologists (ACOG)recommended screening with the Papanicolaou (Pap) smear and pelvic examination at the initiation of sexual…

                  • December 8, 2011
                  • Feldman S.
                  • N Engl J Med 2011; 365:2145 - 2147

                    In the past 2 years, four major U.S. health care organizations have issued new guidelines on cervical-cancer screening. Although there are differences among them, all agree on some points, including that screening shouldn't begin before age 21 in immunocompetent women.

                  • Clinical Practice

                    Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations. Stage. A 22-year-old…

                    • December 8, 2011
                    • Templeton A. and Grimes D.A.
                    • N Engl J Med 2011; 365:2198 - 2204
                    • Free Full Text
                    • CME
                    • Full Text Audio

                    In early pregnancy, medical abortion avoids surgery but is associated with more pain and bleeding and a slightly higher risk of incomplete abortion. Data show that neither type of abortion increases the risk of long-term mental health problems or breast cancer or adversely affects fertility.

                  • Perspective

                    The end of 2011 marks the 50th anniversary of a constellation of events that transformed the way we think about drug safety. A half-century ago, the Food and Drug Administration (FDA) did not have authority to require a manufacturer to meet meaningful efficacy standards or demonstrate that a new…

                    • December 8, 2011
                    • Avorn J.
                    • N Engl J Med 2011; 365:2151 - 2153
                    • Free Full Text
                    • Audio

                    Fifty years ago, a constellation of events transformed the way we think about drug safety. Key among them: the actions of Frances Kelsey at the FDA, who kept thalidomide off the U.S. market, sparing Americans an epidemic of limb-reduction birth defects.

                  • Case Records of the Massachusetts General Hospital

                    Presentation of Case. Dr. Edwin C. Huang (Obstetrics and Gynecology): A 33-year-old woman was admitted to the intensive care unit (ICU) at this hospital 16.5 hours post partum because of leukocytosis and gram-positive rods in the blood. The patient had received routine prenatal care at this…

                    • November 17, 2011
                    • Soper D.E., Lee S.I., Kim J.Y., McDonald A.G.
                    • N Engl J Med 2011; 365:1916 - 1924
                    • CME

                    A 33-year-old woman was admitted to the ICU 16.5 hours post partum because of leukocytosis and gram-positive rods in the blood. Diagnostic test results were received, and management decisions were made.

                  • Images in Clinical Medicine

                    Figure 1.

                    • November 10, 2011
                    • van Wijk J.P.H. and ter Braak E.W.M.T.
                    • N Engl J Med 2011; 365:e39
                    • Free Full Text

                    A 21-year-old woman was referred for secondary amenorrhea, abdominal pain, and weight gain. Laboratory tests showed elevated serum estradiol (23,501 pmol per liter), suppressed luteinizing hormone (<0.1 IU per liter), and inappropriately high follicle-...

                  • Correspondence

                    To the Editor: The definitive diagnosis of fetal aneuploidy and genomic imbalances requires invasive collection of fetal cells through amniocentesis or chorionic villus sampling. These methods are associated with fetal loss and parental anxiety. Analyses of DNA in maternal plasma have shown the…

                    • November 10, 2011
                    • N Engl J Med 2011; 365:1847 - 1848
                    • Free Full Text

                    This proof-of-principle study shows that it is possible to detect a genetic microdeletion carried by a fetus through analysis of DNA in circulating maternal blood.

                  • Images in Clinical Medicine

                    Figure 1.

                    • November 10, 2011
                    • Heyman S.R.G. and Vervloessem D.
                    • N Engl J Med 2011; 365:1824
                    • Free Full Text

                    A neonate presented after birth with scrotal and right inguinal ecchymosis. He had been born at term after a difficult vaginal delivery that ultimately required both fundal pressure and vacuum extraction. The thorax was not manipulated during birth.

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                  American Association for the Study of Liver Diseases

                  The following courses will be offered in Atlanta, unless otherwise indicated: "Hepatitis Single Topic Conference: HCV Direct Antiviral Agents (DAA): Concepts, Development and Optimal Use" (March 16 and 17); "The Henry M. and Lillian Stratton Basic Research Single Topic Conference: Mitochondria and Hepatotoxicity" (June 8 and 9); "Clinical Research Single Topic Conference: Acetaminophen Poisoning" (June 9 and 10); and "63rd Annual Meeting of the American Association for the Study of Liver Diseases: The Liver Meeting 2012" (Boston, Nov. 9-13).

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