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  • Special Article

    There is considerable geographic variation in health care spending across the United States,– and a recent study showed regional variation in prescription-drug spending for Medicare Part D enrollees. However, the sources of regional variation in drug spending are not well understood. Prescription-…

    • February 9, 2012
    • Donohue J.M., Morden N.E., Gellad W.F., et al.
    • N Engl J Med 2012; 366:530 - 538
    • Free Full Text

    This analysis of 2008 Medicare data shows that regional variation in drug spending is driven primarily by the use of more expensive drugs (i.e., brand-name rather than generic drugs) in the highest-spending geographic areas.

  • Correspondence

    To the Editor: In the Maintenance and Intermittent Inhaled Corticosteroids in Wheezing Toddlers (MIST) trial (ClinicalTrials.gov number, NCT00675584), Zeiger et al. (Nov. 24 issue) suggest that intermittent high-dose budesonide was equal in efficacy to daily low-dose budesonide in preschool-age…

    • February 9, 2012
    • N Engl J Med 2012; 366:570 - 571
    • Free Full Text

    To the Editor: In the Maintenance and Intermittent Inhaled Corticosteroids in Wheezing Toddlers (MIST) trial (ClinicalTrials.gov number, NCT00675584), Zeiger et al. (Nov. 24 issue)1 suggest that intermittent high-dose budesonide was equal in efficacy to ...

  • Correspondence

    To the Editor: Levels of glucose in the cerebrospinal fluid (CSF) are used to discriminate bacterial meningitis from viral meningitis. Children with bacterial meningitis typically have low levels of CSF glucose because of glycolysis by both white cells and the pathogen and impaired CSF glucose…

    • February 9, 2012
    • N Engl J Med 2012; 366:576 - 578
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    The relationship between levels of serum and cerebrospinal fluid glucose in children is carefully examined in this study, which included more than 19,000 children.

  • Correspondence

    To the Editor: Dooley et al. (Nov. 17 issue) report the efficacy of mycophenolate mofetil versus azathioprine as maintenance therapy for lupus nephritis and declare mycophenolate superior. Yet azathioprine was prescribed according to body weight, despite overwhelming evidence favoring the use of…

    • February 9, 2012
    • N Engl J Med 2012; 366:572 - 573
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    To the Editor: Dooley et al. (Nov. 17 issue)1 report the efficacy of mycophenolate mofetil versus azathioprine as maintenance therapy for lupus nephritis and declare mycophenolate superior. Yet azathioprine was prescribed according to body weight, ...

  • Correspondence

    To the Editor: In the Mechanisms of Disease article on systemic lupus erythematosus (SLE), Tsokos (Dec. 1 issue) notes that a lack of C1q leads to deficient clearance of waste material. I would like to add the role of C1q in the regulation of interferon-α production in response to immune complexes.…

    • February 9, 2012
    • N Engl J Med 2012; 366:573 - 574
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    To the Editor: In the Mechanisms of Disease article on systemic lupus erythematosus (SLE), Tsokos (Dec. 1 issue)1 notes that a lack of C1q leads to deficient clearance of waste material. I would like to add the role of C1q in the regulation of interferon-...

  • Correspondence

    To the Editor: While summarizing the use of extracorporeal membrane oxygenation (ECMO) in the acute respiratory distress syndrome (ARDS), Brodie and Bacchetta (Nov. 17 issue) suggest venoarterial ECMO as an alternative approach to standard venovenous ECMO when hemodynamic support is needed. In our…

    • February 9, 2012
    • N Engl J Med 2012; 366:575 - 576
    • Free Full Text

    To the Editor: While summarizing the use of extracorporeal membrane oxygenation (ECMO) in the acute respiratory distress syndrome (ARDS), Brodie and Bacchetta (Nov. 17 issue)1 suggest venoarterial ECMO as an alternative approach to standard venovenous ...

  • Correspondence

    To the Editor: Vemurafenib (PLX4032, Zelboraf) is a selective inhibitor of V600E BRAF. In phase 1, 2, and 3 clinical trials involving patients with tumors that have V600E BRAF mutations, vemurafenib was associated with consistent efficacy and improved survival. These data led to approval of…

    • February 2, 2012
    • N Engl J Med 2012; 366:480 - 481
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    The BRAF inhibitor, vemurafenib, is associated with photosensitivity. This small study identifies ultraviolet A (UVA) as the active agent. UVA blockers may be effective in preventing photosensitivity among patients taking vemurafenib.

  • Correspondence

    To the Editor: The study reported by Mathurin et al. (Nov. 10 issue) could have a strong impact on living-donor liver transplantation. Mandatory alcohol abstinence before deceased-donor liver transplantation serves two purposes: evaluation of compliance, including the likelihood of recidivism, and…

    • February 2, 2012
    • N Engl J Med 2012; 366:477 - 479
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    To the Editor: The study reported by Mathurin et al. (Nov. 10 issue)1 could have a strong impact on living-donor liver transplantation.

    Mandatory alcohol abstinence before deceased-donor liver transplantation serves two purposes: evaluation of compliance,...

  • Correspondence

    To the Editor: In 1934, a 10-year-old girl was hospitalized at the Children's Hospital of Boston for 1 1/2 years for Staphylococcus aureus osteomyelitis of the left femur. This was the preantibiotic era, so she did not receive any antibiotic therapy at that time but, instead, underwent multiple…

    • February 2, 2012
    • N Engl J Med 2012; 366:481 - 482
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    In this case report, Staphylococcus aureus was found to persist in an 85-year-old woman 75 years after the successful treatment of osteomyelitis during her childhood.

  • Correspondence

    To the Editor: Three randomized trials reported by Blanc et al. Havlir et al. and Abdool Karim et al. (Oct. 20 issue) consolidate the evidence base underpinning recommendations on when to start antiretroviral therapy (ART) in patients with human immunodeficiency virus (HIV)–associated…

    • February 2, 2012
    • N Engl J Med 2012; 366:474 - 476
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    To the Editor: Three randomized trials reported by Blanc et al.,1 Havlir et al.,2 and Abdool Karim et al.3 (Oct. 20 issue) consolidate the evidence base underpinning recommendations on when to start antiretroviral therapy (ART) in patients with human ...

  • Correspondence

    To the Editor: The study by Nguyen-Khac et al. (Nov. 10 issue) sidesteps old contentious issues regarding the use of glucocorticoid therapy in alcoholic hepatitis. Among the 8 references cited in support of glucocorticoid treatment, 2 in fact concluded that the therapy was of no benefit. In…

    • February 2, 2012
    • N Engl J Med 2012; 366:476 - 477
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    To the Editor: The study by Nguyen-Khac et al. (Nov. 10 issue)1 sidesteps old contentious issues regarding the use of glucocorticoid therapy in alcoholic hepatitis. Among the 8 references cited in support of glucocorticoid treatment, 2 in fact concluded ...

  • Correspondence

    To the Editor: Palefsky et al. (Oct. 27 issue) report an efficacy of 74.9% for the quadrivalent human papillomavirus (HPV) vaccine against anal intraepithelial neoplasia grade 2 or 3 related to HPV-6, 11, 16, or 18 in the per-protocol population of healthy men who have sex with men. Because anal…

    • January 26, 2012
    • N Engl J Med 2012; 366:378 - 379
    • Free Full Text

    To the Editor: Palefsky et al. (Oct. 27 issue)1 report an efficacy of 74.9% for the quadrivalent human papillomavirus (HPV) vaccine against anal intraepithelial neoplasia grade 2 or 3 related to HPV-6, 11, 16, or 18 in the per-protocol population of ...

  • Correspondence

    To the Editor: Reich and colleagues (Oct. 27 issue) concluded that briakinumab was more effective than methotrexate in patients with moderate-to-severe psoriasis and that the higher incidence of serious infections and cancers observed in the briakinumab group was not statistically significant.…

    • January 26, 2012
    • N Engl J Med 2012; 366:379 - 380
    • Free Full Text

    To the Editor: Reich and colleagues (Oct. 27 issue)1 concluded that briakinumab was more effective than methotrexate in patients with moderate-to-severe psoriasis and that the higher incidence of serious infections and cancers observed in the briakinumab ...

  • Correspondence

    To the Editor: Lymphatic malformations are uncommon congenital vascular anomalies that can cause complications including obstruction of vital organs and their function, recurrent infection, and disfigurement. Current procedural treatments are only partially successful, and lymphatic malformations…

    • January 26, 2012
    • N Engl J Med 2012; 366:384 - 386
    • Free Full Text

    Lymphatic malformations are rare but can cause significant clinical problems in addition to cosmetic disfigurement. Sildenafil was used in a child whose pulmonary hypertension was caused by lymphatic malformation; the result was a marked decrease in the lymphatic malformation.

  • Correspondence

    To the Editor: Vesikari et al. (Oct. 13 issue) report an efficacy of 89% for a trivalent inactivated vaccine with an oil-in-water adjuvant (ATIV) in children 6 to 71 months of age against vaccine-matched strains. However, the efficacy of the trivalent inactivated vaccine without adjuvant (TIV) in…

    • January 26, 2012
    • N Engl J Med 2012; 366:383 - 384
    • Free Full Text

    To the Editor: Vesikari et al. (Oct. 13 issue)1 report an efficacy of 89% for a trivalent inactivated vaccine with an oil-in-water adjuvant (ATIV) in children 6 to 71 months of age against vaccine-matched strains. However, the efficacy of the trivalent ...

  • Correspondence

    To the Editor: Sumithran et al. (Oct. 27 issue) describe the long-term persistence of hormonal adaptations to weight loss. We believe that the results of this study could support alternative conclusions. In our opinion, the sustained hormonal changes that were observed could be explained completely…

    • January 26, 2012
    • N Engl J Med 2012; 366:380 - 382
    • Free Full Text

    To the Editor: Sumithran et al. (Oct. 27 issue)1 describe the long-term persistence of hormonal adaptations to weight loss. We believe that the results of this study could support alternative conclusions. In our opinion, the sustained hormonal changes ...

  • Correspondence

    To the Editor: Understanding the role of medications in preventing hospital-acquired Clostridium difficile infections is important. The article by Loo et al. (Nov. 3 issue) raises two questions. First, we submit that it is not only the patient's exposure to medications that may increase risk but…

    • January 19, 2012
    • N Engl J Med 2012; 366:276 - 277
    • Free Full Text

    To the Editor: Understanding the role of medications in preventing hospital-acquired Clostridium difficile infections is important. The article by Loo et al. (Nov. 3 issue)1 raises two questions. First, we submit that it is not only the patient's ...

  • Correspondence

    To the Editor: Alzheimer's disease is the most common progressive neurodegenerative disorder and a leading cause of dementia in the elderly. The genetic causes of Alzheimer's disease are complex, and only four mendelian genes have indisputably been associated with the disease. Mutations in genes…

    • January 19, 2012
    • N Engl J Med 2012; 366:283 - 284
    • Free Full Text

    A hexanucleotide repeat expansion in the gene C9ORF72 has been implicated in the development of amyotrophic lateral sclerosis and frontotemporal dementia. The variant has also been found in a small percentage of patients with probable late-onset Alzheimer's disease.

  • Correspondence

    To the Editor: The Perspective article by Curfman and Redberg (Sept. 15 issue) is much too optimistic, as is the Institute of Medicine (IOM) report on which it is based. Both fail to acknowledge that the 510(k) process that the Food and Drug Administration (FDA) uses for approving ("clearing") new…

    • January 19, 2012
    • N Engl J Med 2012; 366:280
    • Free Full Text

    To the Editor: The Perspective article by Curfman and Redberg (Sept. 15 issue)1 is much too optimistic, as is the Institute of Medicine (IOM) report2 on which it is based. Both fail to acknowledge that the 510(k) process that the Food and Drug ...

  • Correction

    A Phase 3 Trial of Bevacizumab in Ovarian Cancer Original Article, N Engl J Med 2011;365:2484-2496. In the Patients subsection of Results (page 2487), the final sentence should have read, ". . . and 26% had more than 1.0 cm of residual disease after surgical debulking," rather than ". . . and…

    • January 19, 2012
    • N Engl J Med 2012; 366:284
    • Free Full Text

    A Phase 3 Trial of Bevacizumab in Ovarian Cancer Original Article, N Engl J Med 2011;365:2484-2496. In the Patients subsection of Results (page 2487), the final sentence should have read, “. . . and 26% had more than 1.0 cm of residual disease after ...

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Medical Meetings Conferences and Meetings

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).

Contact AASLD, 1001 North Fairfax St., Suite 400, Alexandria, VA 22314; or call (703) 299-9766; or see http://www.aasld.org .

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