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  • Images in Clinical Medicine

    An Electrocardiographic Sine Wave in Hyperkalemia

    Figure 1.

    • May 10, 2012
    • Petrov D.B.
    • N Engl J Med 2012; 366:1824
    • Free Full Text

    A 62-year-old man with chronic renal insufficiency reported having reduced exercise tolerance for the previous week. The physical examination was unremarkable, but oxygen saturation was diminished.

  • Correspondence

    Spurious Elevations of Vitamin B12 with Pernicious Anemia

    To the Editor: Within a 3-week period, two women, 46 and 48 years of age, presented with peripheral neuropathy and associated pancytopenia with macrocytic anemia. Clinical suspicion for pernicious anemia was high, but vitamin B12 levels were 1644 pg per milliliter (1228 pmol per liter) and 1321 pg…

    • May 3, 2012
    • N Engl J Med 2012; 366:1742-1743
    • Free Full Text

    To the Editor: Within a 3-week period, two women, 46 and 48 years of age, presented with peripheral neuropathy and associated pancytopenia with macrocytic anemia. Clinical suspicion for pernicious anemia was high, but vitamin B12 levels were 1644 pg per ...

  • EditorialOnline First

    TODAY — A Stark Glimpse of Tomorrow

    Caloric intake that exceeds energy expended and its consequences, particularly development of type 2 diabetes mellitus, is emblematic of a climate change for modern medicine — a phenomenon so complex, embedded in culture and economics, and intertwined with conflicts between individual freedom and…

    • April 29, 2012
    • Allen D.B.
    • 10.1056/NEJMe1204710
    • Free Full Text

    Caloric intake that exceeds energy expended and its consequences, particularly development of type 2 diabetes mellitus, is emblematic of a climate change for modern medicine — a phenomenon so complex, embedded in culture and economics, and intertwined ...

  • Case Records of the Massachusetts General Hospital

    Case 13-2012 — A 62-Year-Old Man with Paresthesias, Weight Loss, Jaundice, and Anemia

    Presentation of Case. Dr. Norifumi Kamo (Medicine): A 62-year-old man was admitted to this hospital because of paresthesias, weight loss, jaundice, and anemia. The patient had been well until approximately 2 months before admission, when numbness, tingling ("pins and needles"), and burning in his…

    • April 26, 2012
    • Puig A., Mino-Kenudson M., Dighe A.S.
    • N Engl J Med 2012; 366:1626-1633
    • CME

    A 62-year-old man was admitted to this hospital because of paresthesias, weight loss, jaundice, and anemia. Diagnostic test results were received.

  • Case Records of the Massachusetts General Hospital

    Case 4-2012 — A 37-Year-Old Man with Muscle Pain, Weakness, and Weight Loss

    Presentation of Case. Dr. Ian J. Barbash (Medicine): A 37-year-old man was admitted to this hospital because of muscle pain and weakness. The patient had been well until the evening before admission, when mild diffuse myalgias developed. He awoke in the morning with diffuse muscle cramps and…

    • February 9, 2012
    • Rhee E.P., Scott J.A., Dighe A.S.
    • N Engl J Med 2012; 366:553-560
    • CME

    A 37-year-old man was admitted to this hospital because of 12 hours of muscle pain and weakness, resulting in the inability to rise from bed. Brief episodes of similar symptoms had occurred during the past month. He reported blurred vision, gynecomastia, and weight loss.

  • 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.

    • Perspective

      Assessing Supplement Safety — The FDA's Controversial Proposal

      Recently, a well-respected dietary-supplement company in Utah announced the recall of Zotrex, a sexual enhancement supplement labeled as containing "Ophioglossum polyphyllous." The problem with Zotrex was twofold: not only is no species of ophioglossum (adder's tongue) an established dietary…

      • February 2, 2012
      • Cohen P.A.
      • N Engl J Med 2012; 366:389-391
      • Audio

      By law, dietary supplements whose ingredients were not sold in the United States before 1994 require demonstration of a “reasonable expectation of safety” — a currently unenforced requirement. Will the FDA's proposed new guidance in this area be adequate?

    • Review Article

      Mechanisms of Disease: Iron Overload in Human Disease

      Iron-overload disorders are typically insidious, causing progressive and sometimes irreversible end-organ injury before clinical symptoms develop. With a high index of suspicion, however, the consequences of iron toxicity can be attenuated or prevented. Some iron-overload disorders are quite common…

      • January 26, 2012
      • Fleming R.E. and Ponka P.
      • N Engl J Med 2012; 366:348-359
      • CME

      Iron is both essential and toxic. The authors review how the body absorbs, uses, and loses iron and explore both common and unusual causes of iron overload and treatment of the resulting disorders.

    • Clinical Implications of Basic Research

      Closing the Iron Gate

      Genetic hemochromatosis is a prevalent iron-overload disease resulting from inadequate production of the iron-regulatory hormone hepcidin. Recently, Preza and colleagues developed an oral, biologically active hepcidin mimic that offers a new experimental approach to treating hemochromatosis and…

      • January 26, 2012
      • Andrews N.C.
      • N Engl J Med 2012; 366:376-377

        Ferroportin permits the uptake of dietary iron by cells of the intestinal epithelium into the circulation. Hepcidin targets ferroportin for lysosomal destruction. A recent study shows that an engineered minihepcidin reduces levels of iron in the serum and liver.

      • Case Records of the Massachusetts General Hospital

        Case 33-2011 — A 56-Year-Old Man with Hypophosphatemia

        Presentation of Case. Dr. Eric Hesse (Harvard School of Dental Medicine): A 56-year-old man was seen in the outpatient endocrinology and oral-surgery clinics of this hospital because of recurrent hypophosphatemia. The patient had been well until 19 years earlier, when rib pain developed and a left…

        • October 27, 2011
        • Bergwitz C., Collins M.T., Kamath R.S., Rosenberg A.E.
        • N Engl J Med 2011; 365:1625-1635
        • CME

        A 56-year-old man presented with recurrent bone pain, stress fractures, and hypophosphatemia. A tumor of the jaw had been resected in the past, with resolution of symptoms. Studies of the jaw revealed no recurrent tumor. Diagnostic tests were performed.

      • Perspective

        The 2010 Dietary Guidelines — The Best Recipe for Health?

        The 2010 U.S. Dietary Guidelines were issued earlier this year, though they received little notice in the press. The lack of attention is troubling in a country in the throes of a nutritional crisis manifested most conspicuously in the form of an obesity epidemic that threatens to reverse recent…

        • October 27, 2011
        • Willett W.C. and Ludwig D.S.
        • N Engl J Med 2011; 365:1563-1565
        • Free Full Text

        The new U.S. dietary guidelines may have limited direct educational influence, but they will affect Americans' diets through federal food policies and food-assistance programs. The new guidelines represent a mix of progress and lost opportunities.

      • Perspective

        Individual Responsibility or a Policy Solution — Cap and Trade for the U.S. Diet?

        Chronic illness accounts for as much as three quarters of the cost of medical care in the United States, and diseases such as obesity, hypertension, and diabetes, although complex in etiology, are at least partially rooted in our unhealthy diet. The routine overconsumption of foods containing large…

        • October 27, 2011
        • Lewis K.H. and Rosenthal M.B.
        • N Engl J Med 2011; 365:1561-1563
        • Free Full Text

        Overconsumption of foods containing excessive salt, sugar, and unhealthful fats poses a public health threat in the United States. A possible policy approach to addressing the threat that recognizes our free-market ideals is “cap and trade” of unhealthy ingredients.

      • Clinical Implications of Basic Research

        Cancer Cachexia and Fat–Muscle Physiology

        Cachexia affects the majority of patients with advanced cancer and is associated with a reduction in treatment tolerance, response to therapy, quality of life, and duration of survival. It is a multifactorial syndrome caused by a variable combination of reduced food intake and abnormal metabolism…

        • August 11, 2011
        • Fearon K.C.H.
        • N Engl J Med 2011; 365:565-567

          Cancer cachexia involves loss of muscle and fat. A recent study shows that preventing lipolysis in a mouse model of cachexia results in protection against muscle loss and thus points to the existence of molecular cross talk between fat and muscle.

        • Original Article

          Mutations in CYP24A1 and Idiopathic Infantile Hypercalcemia

          Vitamin D plays a central role in calcium homeostasis and bone metabolism. Vitamin D supplementation or food fortification for the prevention of rickets is advocated routinely for all infants. Although vitamin D is potentially dangerous in very high doses, the margin of safety between the daily…

          • August 4, 2011
          • Schlingmann K.P., Kaufmann M., Weber S., et al.
          • N Engl J Med 2011; 365:410-421
          • Free Full Text

          Mutations in a vitamin D–metabolizing enzyme were found in patients with idiopathic infantile hypercalcemia. The mutations may explain the patients' vitamin D sensitivity and may be a genetic risk factor for symptomatic hypercalcemia in otherwise healthy infants given vitamin D.

        • Clinical Practice

          Glucocorticoid-Induced Bone Disease

          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 author's clinical recommendations. Stage. A 55-year-old…

          • July 7, 2011
          • Weinstein R.S.
          • N Engl J Med 2011; 365:62-70
          • CME
          • Full Text Audio

          This article reviews the risks of osteoporosis and osteonecrosis associated with glucocorticoid use, which are present even in the absence of low bone mineral density, and discusses strategies to reduce the risk of fractures and the data to support the strategies.

        • Review Article

          Drug Therapy: n–3 Fatty Acids in Cardiovascular Disease

          Cardiovascular disease is the leading cause of death worldwide, and preventive approaches, particularly achievable dietary changes, have major public health implications. An increased dietary intake of n–3 (polyunsaturated) fatty acids is one such dietary approach. This review discusses advances…

          • June 23, 2011
          • De Caterina R.
          • N Engl J Med 2011; 364:2439-2450

            CVD is the leading cause of death worldwide; preventive approaches can have major public health implications. An increased dietary intake of n–3 fatty acids is one such approach. This review discusses current knowledge of n–3 fatty acids.

          • Perspective

            Front-of-Package Nutrition Labeling — An Abuse of Trust by the Food Industry?

            On January 24, 2011, two major food-industry trade associations, the Grocery Manufacturers of America (GMA) and the Food Marketing Institute, announced a new and voluntary nutrition-labeling system that major food and beverage companies would use on the front of packages to "help busy consumers…

            • June 23, 2011
            • Brownell K.D. and Koplan J.P.
            • N Engl J Med 2011; 364:2373-2375
            • Free Full Text

            On January 24, two food-industry trade associations announced a new voluntary nutrition-labeling system that major food and beverage companies would use on the front of packages to “help busy consumers make informed choices.” But is the program good for public health?

          • Original Article

            Changes in Diet and Lifestyle and Long-Term Weight Gain in Women and Men

            Because efforts to lose weight pose tremendous challenges, primary prevention of weight gain is a global priority. Since weight stability requires a balance between calories consumed and calories expended, the advice to "eat less and exercise more" would seem to be straightforward. However, weight…

            • June 23, 2011
            • Mozaffarian D., Hao T., Rimm E.B., Willett W.C., Hu F.B.
            • N Engl J Med 2011; 364:2392-2404
            • Free Full Text
            • CME

            This study followed 120,877 U.S. women and men for 12 to 20 years to examine relationships between diet, lifestyle, and weight change. Participants gained an average of 3.35 lb every 4 years. Specific diet and lifestyle factors were independently associated with weight gain.

          • Original Article

            Early-Childhood Membranous Nephropathy Due to Cationic Bovine Serum Albumin

            Membranous nephropathy is the most common cause of the nephrotic syndrome in adults but is rare in children. The central pathogenesis involves the formation of subepithelial immune deposits that are responsible for functional impairment of the glomerular capillary wall. Two major antigens have been…

            • June 2, 2011
            • Debiec H., Lefeu F., Kemper M.J., et al.
            • N Engl J Med 2011; 364:2101-2110
            • Free Full Text

            BSA ingested in food can escape the intestinal barrier and induce antibovine serum albumin antibodies. The authors of this study identified circulating BSA in patients with membranous nephropathy and in immune deposits in four children.

          • Editorial

            Milk and Membranous Nephropathy

            Membranous nephropathy is a common cause of the nephrotic syndrome in adults, but it is rare in children, and the prognosis is highly variable.– The diagnosis is based on renal-biopsy findings, including characteristic immune-complex deposits along the glomerular basement membranes and thickened…

            • June 2, 2011
            • Fogo A.B.
            • N Engl J Med 2011; 364:2158-2159

              Membranous nephropathy is a common cause of the nephrotic syndrome in adults, but it is rare in children, and the prognosis is highly variable.1–3 The diagnosis is based on renal-biopsy findings, including characteristic immune-complex deposits along the ...

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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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