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  • Review Article

    The autosomal recessive cerebellar ataxias are a group of little known and often neglected diseases that are best understood by following a practical, multidisciplinary approach that focuses on clinical rather than molecular considerations. This review focuses on the main forms in which cerebellar…

    • February 16, 2012
    • Anheim M., Tranchant C., Koenig M.
    • N Engl J Med 2012; 366:636 - 646
    • CME
    • Video

    Autosomal recessive cerebellar ataxia must be considered in any child or young adult with a progressive disorder of gait or balance or with hypotonia or excessive clumsiness. This review presents a practical approach to these neurodegenerative diseases.

  • Original Article

    Gene mutation is an important cause of cardiomyopathy. Mutations in eight sarcomere-protein genes cause hypertrophic cardiomyopathy, detected in 40 to 70% of patients. Variations in more than 40 genes, most of which encode components of the sarcomere, the cytoskeleton, or the nuclear lamina, have…

    • February 16, 2012
    • Herman D.S., Lam L., Taylor M.R.G., et al.
    • N Engl J Med 2012; 366:619 - 628

      Titin, an important protein in the sarcomere, is the largest human protein. This study identified mutations in the titin gene that result in a truncated protein as important causes of dilated cardiomyopathy.

    • Original Article

      Participation in long-distance running races has increased annually in the United States. In 2010, there were approximately 2 million participants in marathon and half-marathon races, as compared with fewer than 1 million participants in 2000. This increase has been driven in part by heightened…

      • January 12, 2012
      • Kim J.H., Malhotra R., Chiampas G., et al.
      • N Engl J Med 2012; 366:130 - 140
      • CME

      The authors report on a U.S. registry of cardiac arrests during marathons and half-marathons. The rate of arrest was equal to or lower than rates for other strenuous physical activities. The most common cause was hypertrophic cardiomyopathy or coronary artery disease.

    • Case Records of the Massachusetts General Hospital

      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.

    • Correspondence

      To the Editor: Tyrosine kinase inhibitors with potent properties against vascular endothelial growth factor (VEGF) signaling pathway (VSP inhibitors) are effective antitumor agents in metastatic renal-cell carcinoma and are now increasingly used in the treatment of other tumors. Although VSP…

      • October 27, 2011
      • N Engl J Med 2011; 365:1649 - 1650
      • Free Full Text

      To the Editor: Tyrosine kinase inhibitors with potent properties against vascular endothelial growth factor (VEGF) signaling pathway (VSP inhibitors) are effective antitumor agents in metastatic renal-cell carcinoma and are now increasingly used in the ...

    • Original Article

      Inflammatory disorders of the skin and gut, including eczema, psoriasis, and celiac disease, have been linked to changes in barrier function and immune responses, by means of genetic and functional studies. Large case–control studies combined with genomewide association studies have identified…

      • October 20, 2011
      • Blaydon D.C., Biancheri P., Di W.-L., et al.
      • N Engl J Med 2011; 365:1502 - 1508

        A mutation that abrogates the function of ADAM17, an enzyme that cleaves cell-surface proteins such as tumor necrosis factor α, was found to be associated with inflammatory skin and bowel disease in a pair of siblings.

      • Case Records of the Massachusetts General Hospital

        Presentation of Case. Dr. Jason E. Faris (Medicine): A 66-year-old woman was admitted to this hospital because of cardiac and renal failure. The patient had been well until approximately 6 months earlier, when dyspnea on exertion and leg edema developed. A diagnosis of congestive heart failure was…

        • September 22, 2011
        • Raje N.S., Steele D.J.R., Lawrimore T.M., Johri A.M., Sohani A.R.
        • N Engl J Med 2011; 365:1129 - 1138
        • CME

        Cardiac and renal failure developed in a 66-year-old woman. Echocardiography suggested infiltrative cardiomyopathy, lytic bone lesions were seen on imaging, and elevated serum free light chains were detected. A diagnostic procedure was performed.

      • Correspondence

        To the Editor: A 70-year-old man with chronic renal disease, splenomegaly, and eosinophilia presented with transient weakness in the left arm, visual disturbances, disequilibrium, and anomia. Magnetic resonance imaging of the brain showed findings consistent with numerous, small embolic strokes.…

        • July 14, 2011
        • N Engl J Med 2011; 365:187 - 188
        • Free Full Text

        In this case report, eosinophilic endomyocardial disease was diagnosed in a patient on the basis of immunohistochemical evidence of eosinophil granule protein deposition in the heart, even in the absence of eosinophilic infiltration on cardiac biopsy.

      • Clinical Therapeutics

        Foreword. This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are…

        • June 30, 2011
        • Bern C.
        • N Engl J Med 2011; 364:2527 - 2534
        • CME

        A 42-year-old woman presents after donating blood and receiving a report that she is positive for Chagas' disease. Chagas' disease is caused by a parasite and is endemic in many parts of Latin America.

      • Review Article

        Inherited cardiomyopathies are a major cause of heart disease in all age groups, often with an onset in adolescence or early adult life. Not only the patients but also their families can be severely burdened by these illnesses. More than 20 years ago, the first "disease gene" for hypertrophic…

        • April 28, 2011
        • Watkins H., Ashrafian H., Redwood C.
        • N Engl J Med 2011; 364:1643 - 1656

          This review gives an account of the molecular mechanisms that underlie various forms of inherited cardiomyopathies. Numerous, rare mutations occur in each category, and different mutations in the same genes can produce different phenotypes.

        • Original Article

          Coronary artery disease is an important contributor to the rise in the prevalence of heart failure and in associated mortality and morbidity.– It has not been clearly established whether coronary-artery bypass grafting (CABG) has a role in improving the symptoms and the rate of survival of…

          • April 28, 2011
          • Bonow R.O., Maurer G., Lee K.L., et al.
          • N Engl J Med 2011; 364:1617 - 1625
          • Free Full Text
          • CME

          Patients with CAD and LV dysfunction were assigned to receive either medical therapy alone or medical therapy plus CABG. There was no evidence of significant interaction between myocardial viability and treatment assignment.

        • Original Article

          It is estimated that 5.8 million patients in the United States and 15 million in Europe have heart failure. Coronary artery disease is the most common substrate for heart failure in industrialized nations. However, the role of coronary-artery bypass grafting (CABG) in the treatment of patients with…

          • April 28, 2011
          • Velazquez E.J., Lee K.L., Deja M.A., et al.
          • N Engl J Med 2011; 364:1607 - 1616
          • Free Full Text
          • CME

          Patients with CAD and LV dysfunction were assigned to either medical therapy alone or medical therapy plus CABG. At 5 years, there was no significant difference between the two study groups in the rate of death from any cause.

        • Editorial

          The question of how best to treat patients with multivessel coronary artery disease and left ventricular dysfunction has challenged physicians for years. Although most clinicians are comfortable recommending revascularization when there is angina, extensive coronary disease, and a left ventricular…

          • April 28, 2011
          • Fang J.C.
          • N Engl J Med 2011; 364:1671 - 1673

            The question of how best to treat patients with multivessel coronary artery disease and left ventricular dysfunction has challenged physicians for years. Although most clinicians are comfortable recommending revascularization when there is angina, ...

          • Case Records of the Massachusetts General Hospital

            Presentation of Case. Dr. Caroline L. Sokol (Medicine): A 47-year-old man with systemic lupus erythematosus (SLE) and progressive cardiac failure was transferred to this hospital after a cardiac arrest. One year before admission, dyspnea, leg edema, and abdominal distention gradually developed, and…

            • April 14, 2011
            • Newton-Cheh C., Lin A.E., Baggish A.L., Wang H.
            • N Engl J Med 2011; 364:1450 - 1460
            • Video

            A 47-year-old man with systemic lupus erythematosus (SLE) was transferred to the hospital after cardiac arrest. Electrocardiography showed ST elevation, a long QT interval, and left ventricular hypertrophy (LVH). Echocardiography showed LVH and mitral-valve regurgitation.

          • Case Records of the Massachusetts General Hospital

            Presentation of Case. Dr. Gyanprakash A. Ketwaroo (Medicine): A 77-year-old man with a history of ischemic cardiomyopathy was admitted to this hospital in midspring because of increasing dyspnea, weakness, and diaphoresis. The patient had been in his usual state of health until 3 days before…

            • February 24, 2011
            • Tsibris A.M.N., Shepard J.-A.O., Zukerberg L.R.
            • N Engl J Med 2011; 364:759 - 767

              A 77-year-old man was admitted to the hospital because of increasing dyspnea, weakness, and diaphoresis. Tachycardia, hypotension, hypoxemia, and fever developed, and he was admitted to the coronary care unit. The next day, a diagnostic test result was received.

            • Clinical Therapeutics

              Foreword. This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are…

              • January 13, 2011
              • Brittenham G.M.
              • N Engl J Med 2011; 364:146 - 156
              • CME
              • Interactive/Multimedia

              A 16-year-old boy with sickle cell anemia requires long-term red-cell transfusion. Prophylactic iron-chelating therapy is recommended. Iron chelators bind to plasma and intracellular iron and cause its excretion into urine or bile.

            • Clinical Implications of Basic Research

              A deficiency of cardiomyocytes underlies most cases of heart failure, and scientists have long sought to repopulate the heart with new cardiomyocytes. Most attempts at remuscularization have been based on the transplantation of stem cells or their derivatives, and success has been modest to date. A…

              • January 13, 2011
              • Murry C.E. and Pu W.T.
              • N Engl J Med 2011; 364:177 - 178

                The transdifferentiation of one differentiated cell type into another is the focus of much research activity. A recent study shows that mouse fibroblasts can be transdifferentiated, albeit with low efficiency, into cardiomyocytes.

              • Clinical Problem-Solving

                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 73-year-old man presented with a…

                • October 7, 2010
                • Miller A.L., Falk R.H., Levy B.D., Loscalzo J.
                • N Engl J Med 2010; 363:1464 - 1469
                • CME

                A 73-year-old man presented with a history of progressive, symmetric edema that began in the lower extremities and extended to involve his thighs, scrotum, and arms. He had dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea, as well as chest pressure on mild exertion.

              • Original Article

                Hypertrophic cardiomyopathy is caused by mutations in genes encoding sarcomere proteins. With a prevalence of approximately 1 case per 500 persons in the general population, hypertrophic cardiomyopathy is the most common monogenic cardiac disorder. The clinical diagnosis depends on the…

                • August 5, 2010
                • Ho C.Y., López B., Coelho-Filho O.R., et al.
                • N Engl J Med 2010; 363:552 - 563
                • Free Full Text

                This study shows that myocardial fibrosis is an early characteristic of hypertrophic cardiomyopathy caused by sarcomere mutations. The C-terminal propeptide of procollagen type I was shown to be a serum biomarker of early myocardial fibrosis.

              • Clinical Problem-Solving

                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 62-year-old woman presented to a…

                • August 5, 2010
                • Jessel P., Safdar N., McCune W.J., Saint S., Kaul D.R.
                • N Engl J Med 2010; 363:574 - 579
                • CME

                A 62-year-old woman presented to a community hospital with nausea, vomiting, diarrhea, and fever, all of 1 week's duration. She had a history of psoriasis and psoriatic arthritis, hypertension, hyperlipidemia, possible fibromyalgia, and degenerative lumbar disk disease.

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