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Original Article
Registry of Transcatheter Aortic-Valve Implantation in High-Risk Patients
Aortic stenosis is now the most frequently diagnosed valvular disease. Surgical aortic-valve replacement is the definitive therapy for patients with severe symptomatic aortic stenosis. Operative mortality is low among selected elderly patients but increases with the number and severity of…
- May 3, 2012
- Gilard M., Eltchaninoff H., Iung B., et al.
- N Engl J Med 2012; 366:1705-1715
Data from a French registry of nearly 3200 transcatheter aortic-valve implantation (TAVI) procedures complement data from randomized clinical trials. This emerging technique shows promise in the treatment of high-risk patients with aortic stenosis.
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Images in Clinical Medicine
Fordyce's Angiokeratomas
Figure 1.
- March 29, 2012
- Machan M. and Tonkovic-Capin V.
- N Engl J Med 2012; 366:1240
- Free Full Text
During a routine full-body skin examination, a 60-year-old man was incidentally found to have numerous firm purple papules measuring 1 to 2 mm in diameter and covering the scrotum.
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Correspondence
Bleeding Risk with Dabigatran in the Frail Elderly
To the Editor: Since July 1, 2011, the thrombin inhibitor dabigatran has been available in New Zealand for stroke prevention in patients with atrial fibrillation. There are no restrictions on prescribing, and access is free to patients through government funding. Approximately 7000 patients started…
- March 1, 2012
- N Engl J Med 2012; 366:864-866
- Free Full Text
In an audit of patients who had bleeding events during treatment with dabigatran, common factors included advanced age, impaired renal function, low body weight, and prescriber error.
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Interactive Medical Case
A Startling Decline
An 89-year-old man presented with changes in cognition and personality. Six months earlier, he began to require help managing his finances and operating his computer. His family observed that he had a poor memory for recent events and found it difficult to express himself. During the next few…
- February 9, 2012
- Vaidya A., Dolan B.M., Edlow B.L., Rinne M.L., McGinnis S.M.
- N Engl J Med 2012; 366:e11
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- CME
An 89-year-old man was brought to the ER for evaluation of changes in his cognition and personality. He exhibited poor memory for recent events and difficulty expressing himself. Test your diagnostic and therapeutic skills at NEJM.org.
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Clinical Problem-Solving
Worth a Second Look
Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage. A 72-year-old man presented to his…
- February 2, 2012
- Berzin T.M., Greenberger N.J., Levy B.D., Loscalzo J.
- N Engl J Med 2012; 366:463-468
A 72-year-old man presented to his physician for evaluation of fatigue and weight loss. Over the previous 8 months, the patient had lost 16 kg (35 lb) and had begun having up to 10 loose stools per day. There was no history of blood in the stool, fever, chills, or rash.
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Images in Clinical Medicine
A Head Shot
Figure 1.
- December 29, 2011
- Safarova M.S. and Ezhov M.V.
- N Engl J Med 2011; 365:2519
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Cranial CT imaging revealed a metal foreign body at the edge of the foramen magnum in an 85-year-old man who had been hit by a bullet 82 years earlier. There was no evidence of neural damage.
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Case Records of the Massachusetts General Hospital
Case 36-2011 — A 93-Year-Old Woman with Shortness of Breath and Chest Pain
Presentation of Case. Dr. Pooja Agrawal (Emergency Medicine): A 93-year-old woman was seen in the emergency department at this hospital because of chest pain and shortness of breath. The patient had been in her usual state of health, with hypertension and chronic renal insufficiency, until the…
- November 24, 2011
- Senecal E.L., Rosenfield K., Caldera A.E., Passeri J.J.
- N Engl J Med 2011; 365:2021-2028
- Video
A 93-year-old woman was seen in the emergency department because of a 3-hour history of chest pain and shortness of breath. An electrocardiogram showed ST-segment elevations. A diagnostic procedure was performed.
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Special Article
Emergency Hospitalizations for Adverse Drug Events in Older Americans
Decreasing the number of preventable rehospitalizations by 20% by the end of 2013 is a goal of the $1 billion federal initiative Partnership for Patients, and the pursuit of this goal represents an opportunity to reduce harm to patients and reduce health care costs. Adverse drug events are a direct…
- November 24, 2011
- Budnitz D.S., Lovegrove M.C., Shehab N., Richards C.L.
- N Engl J Med 2011; 365:2002-2012
- Free Full Text
This national study estimated that nearly 100,000 elderly patients were hospitalized for adverse drug events annually from 2007 through 2009. Most resulted from use of common medications such as warfarin and insulin, and only 1% from medications designated as high-risk.
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Correspondence
Acutely Injured Patients on Dabigatran
To the Editor: Trauma remains the fourth leading cause of death in the United States, with 40,000 deaths annually in persons over the age of 65. U.S. trauma centers are seeing an increasing number of severely injured elderly patients, and hemorrhagic complications and head injuries account for a…
- November 24, 2011
- N Engl J Med 2011; 365:2039-2040
- Free Full Text
The new oral direct thrombin inhibitor, dabigatran, is proving to be problematic in acutely injured patients, since it may promote bleeding and its effect cannot be easily reversed.
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Case Records of the Massachusetts General Hospital
Case 34-2011 — A 75-Year-Old Man with Memory Loss and Partial Seizures
Presentation of Case. A 75-year-old physician was seen in an outpatient office at this hospital because of memory loss and episodes of near-syncope. The patient had been generally well, except for mild and gradual memory loss, until 7 months earlier, when episodes of diffuse tingling and a…
- November 10, 2011
- Cash S.S., Larvie M., Dalmau J.
- N Engl J Med 2011; 365:1825-1833
A 75-year-old man was seen because of memory loss and episodes of near-syncope, with word-finding difficulty and unilateral twitching. MRI with contrast material revealed hyperintensity and mild expansion of the left hippocampus, without enhancement.
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Clinical Implications of Basic Research
Can Age-Associated Memory Decline Be Treated?
Many older adults believe that their memory is not as good as it was when they were younger. An epidemiologic study in Finland documented that 76% of persons over the age of 60 years reported problems with their memory. Age-associated memory decline has been well studied and refers to changes in…
- October 6, 2011
- D'Esposito M. and Gazzaley A.
- N Engl J Med 2011; 365:1346-1347
Many older adults believe that their memory is not as good as it was when they were younger. An epidemiologic study in Finland documented that 76% of persons over the age of 60 years reported problems with their memory.¹ Age-associated memory decline has ...
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Perspective
Reducing Unnecessary Hospitalizations of Nursing Home Residents
It's a common scenario: a 90-year-old resident of a U.S. nursing home — call her Ms. B. — has moderately advanced Alzheimer's disease, congestive heart failure with severe left-ventricular dysfunction, and chronic pain from degenerative joint disease. She develops a nonproductive cough and a…
- September 29, 2011
- Ouslander J.G. and Berenson R.A.
- N Engl J Med 2011; 365:1165-1167
- Free Full Text
Studies suggest that many hospitalizations of U.S. nursing home residents are inappropriate, avoidable, or related to conditions that could be treated outside hospitals — and they cost over $4 billion per year. But the causes of these hospitalizations are complex.
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Review Article
Franklin H. Epstein Lecture: Sirtuins, Aging, and Medicine
Foreword. Franklin H. Epstein, M.D. served the New England Journal of Medicine for more than 20 years. A keen clinician, accomplished researcher, and outstanding teacher, Dr. Epstein was Chair and Professor of Medicine at Beth Israel Deaconess Medical Center, Boston, where the Franklin H. Epstein,…
- June 9, 2011
- Guarente L.
- N Engl J Med 2011; 364:2235-2244
In this year's Franklin H. Epstein Lecture, Leonard Guarente summarizes the many biologic properties of the sirtuin family of deacetylases and explains why enhancement or inhibition of specific sirtuins may influence many common diseases and longevity.
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Original Article
Ranibizumab and Bevacizumab for Neovascular Age-Related Macular Degeneration
In 2005, clinical trials established the efficacy of ranibizumab, (Lucentis, Genentech) for the treatment of neovascular age-related macular degeneration (AMD), the leading cause of legal blindness in the United States. While awaiting approval for ranibizumab from the Food and Drug Administration,…
- May 19, 2011
- The CATT Research Group
- N Engl J Med 2011; 364:1897-1908
- Free Full Text
- CME
This comparison of ranibizumab and bevacizumab to treat neovascular age-related macular degeneration showed equivalent efficacy in maintaining visual acuity. Bevacizumab was associated with more serious adverse events (mainly hospitalizations).
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Clinical Implications of Basic Research
Fatty Acids and Retinopathy
Two common eye diseases that cause blindness are age-related macular degeneration (AMD) and diabetic retinopathy. Retinopathy of prematurity causes a lifetime of visual impairment. A recent study by Sapieha and colleagues implicates a precise molecular mechanism that underlies a hypothesis: that…
- May 19, 2011
- Chew E.Y.
- N Engl J Med 2011; 364:1970-1971
Neovascularization is a pathogenic event common to retinopathy of prematurity and age-related macular degeneration. A recent study uncovers a mechanism that mediates a nutritional effect on this process in mice.
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Editorial
Bevacizumab versus Ranibizumab for AMD
For 5 years, patients and clinicians have wrestled with the choice between two drugs for the treatment of neovascular age-related macular degeneration (AMD), a common cause of irreversible blindness among the elderly worldwide. Vision loss results from the abnormal growth and leakage of blood…
- May 19, 2011
- Rosenfeld P.J.
- N Engl J Med 2011; 364:1966-1967
For 5 years, patients and clinicians have wrestled with the choice between two drugs for the treatment of neovascular age-related macular degeneration (AMD), a common cause of irreversible blindness among the elderly worldwide. Vision loss results from ...
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Perspective
Electroconvulsive Therapy in the Spotlight
In January, the Food and Drug Administration (FDA) convened a meeting of its Neurological Devices Advisory Panel to help it decide how to classify electroconvulsive therapy (ECT) devices, a decision that could determine the future of ECT in the United States. The meeting revealed sharp differences…
- May 12, 2011
- Goodman W.K.
- N Engl J Med 2011; 364:1785-1787
The FDA's Neurological Devices Advisory Panel recently recommended keeping electroconvulsive therapy (ECT) devices in class III, the highest risk category. The FDA's regulatory decisions about the devices could determine the future of ECT in the United States.
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Perspective
Improving the Allocation System for Deceased-Donor Kidneys
On February 16, 2011, the Organ Procurement and Transplantation Network (OPTN), the federal contractor responsible for overseeing solid-organ allocation in the United States, released for public comment three proposed concepts for the allocation of kidneys from deceased donors: using a Kidney Donor…
- April 7, 2011
- Leichtman A.B., McCullough K.P., Wolfe R.A.
- N Engl J Med 2011; 364:1287-1289
The Organ Procurement and Transplantation Network has proposed new concepts for the allocation of kidneys from deceased donors that would introduce an element of matching of the estimated future survival of transplanted kidneys and with that of recipients.
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Correspondence
Kidney Allocation and the Aging Immune Response
To the Editor: Organ allocation is a critical component in the success of transplantation. The increasing discrepancy between supply and demand is one of the most important problems in renal transplantation. Despite intensive efforts, donation rates have not increased recently. Moreover,…
- April 7, 2011
- N Engl J Med 2011; 364:1369-1370
- Free Full Text
To the Editor: Organ allocation is a critical component in the success of transplantation. The increasing discrepancy between supply and demand is one of the most important problems in renal transplantation. Despite intensive efforts, donation rates have ...
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Perspective
Risk, Prognosis, and Unintended Consequences in Kidney Allocation
The gap between the supply and demand of transplantable kidneys is growing, leaving policymakers eager to maximize the benefit of every kidney transplanted. Recently, a proposal for changing the way kidneys from deceased donors are allocated was proffered for public comment by the Kidney Committee…
- April 7, 2011
- Hippen B.E., Thistlethwaite J.R., Ross L.F.
- N Engl J Med 2011; 364:1285-1287
Proposed changes to the allocation system for deceased-donor kidneys rely on unvalidated models that may unfairly reduce transplantation opportunities for some patients, inappropriately benefit others, and have unintended consequences for donation by living donors.
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Medical Meetings Pediatrics Conferences and Meetings

2012 Certifying Examinations of the American Board of Pediatrics

The general pediatrics examination will be held in various cities, Oct. 16-18. Registration for first-time applicants is ongoing through May 3. Registration for re-registrants is ongoing through May 24. The following subspecialty examinations will be held in various cities: "Hospice and Palliative Medicine" (Oct. 4); "Pediatric Transplant Hepatology" (Oct. 11); "Pediatric Cardiology" (Nov. 7); "Pediatric Pulmonology" (Nov. 8); "Medical Toxicology" (Nov. 12); and "Pediatric Critical Care Medicine" (Nov. 14). Registration for first-time applicants is ongoing through April 30. Registration for re-registrants is ongoing through June 15.

Contact the American Board of Pediatrics, 111 Silver Cedar Court, Chapel Hill, NC 27514-1513; or call (919) 929-0461; or fax (919) 918-7114 or (919) 929-9255; or see http://www.abp.org .

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