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  • Images in Clinical Medicine

    Hypertrophic Pulmonary Osteoarthropathy and Tripe Palms

    Figure 1.

    • January 26, 2012
    • Saeed H. and Massarweh S.
    • N Engl J Med 2012; 366:360
    • Free Full Text

    A 56-year-old female smoker presented with cough, a weight loss of 27 kg, and diffuse bone pain. There was digital clubbing, and the palms had a raised, velvety texture. There was a fixed, tender lump (4 cm in diameter) on the right lower leg and one over the lower lumbar spine.

  • Case Records of the Massachusetts General Hospital

    Case 2-2012 — A 63-Year-Old Woman with Dyspnea and Rapidly Progressive Respiratory Failure

    Presentation of Case. Dr. Susan K. Mathai (Internal Medicine): A 63-year-old woman was admitted to this hospital because of rapidly progressive respiratory failure. The patient had a history of Poland syndrome (agenesis of the right breast, pectoralis muscle, and the third and fourth costal…

    • January 19, 2012
    • Kotton D.N., Muse V.V., Nishino M.
    • N Engl J Med 2012; 366:259-269

      A 63-year-old woman was admitted to the hospital because of respiratory failure. She had a history of granulomatous polyangiitis and a breast implant that had recently become painful. Imaging revealed bilateral pulmonary infiltrates and a soft-tissue mass extending from the implant through the chest wall.

    • Correspondence

      Generalizing Lung-Cancer Screening Results

      To the Editor: The results of the National Lung Screening Trial (NLST) (ClinicalTrials.gov number, NCT00047385) (Aug. 4 issue) showed that screening of high-risk persons is very effective in reducing mortality from lung cancer. Persons with a history of cigarette smoking of at least 30 pack-years…

      • January 12, 2012
      • N Engl J Med 2012; 366:192-193
      • Free Full Text

      Investigators in the Rotterdam Study note that only about 30% of their study population met the entry criteria for the National Lung Screening Trial (NLST). Others at some risk were excluded; whether the 20% reduction in mortality seen in the NLST will transfer to other risk groups is unclear.

    • Clinical Problem-Solving

      Breathless

      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 50-year-old woman was admitted…

      • January 5, 2012
      • Gavin M.C., Morse D., Partridge A.H., Levy B.D., Loscalzo J.
      • N Engl J Med 2012; 366:75-81
      • CME
      • Video

      A 50-year-old woman presented with fatigue and shortness of breath. Dyspnea after moderate exertion had developed gradually, along with profound malaise and a nonproductive cough. In the 48 hours before admission, her shortness of breath had worsened.

    • Correspondence

      HRAS Mutation Mosaicism Causing Urothelial Cancer and Epidermal Nevus

      To the Editor: Mosaicism of an oncogenic AKT1 mutation causes Proteus syndrome, which is associated with epidermal nevi and an increased risk of cancer. The occurrence of oncogenic mutations in mosaicism may increase a person's risk for malignant conditions. Somatic RAS mutations occur in 30% of…

      • November 17, 2011
      • N Engl J Med 2011; 365:1940-1942
      • Free Full Text

      To the Editor: Mosaicism of an oncogenic AKT1 mutation causes Proteus syndrome, which is associated with epidermal nevi and an increased risk of cancer.1 The occurrence of oncogenic mutations in mosaicism may increase a person's risk for malignant ...

    • Case Records of the Massachusetts General Hospital

      Case 31-2011 — A 55-Year-Old Man with Oligometastatic Lung Cancer

      Presentation of Case. A 55-year-old man was seen in the cancer center at this hospital because of stage IV non–small-cell lung cancer (NSCLC). The patient had been well until approximately 5 months earlier, when headaches developed, followed by left-sided weakness, leftward drift while walking,…

      • October 13, 2011
      • Lanuti M., Sequist L.V., Sharma A., Mino-Kenudson M.
      • N Engl J Med 2011; 365:1426-1435
      • CME

      A 55-year-old man was seen at this hospital because of headaches, weakness of the left side of the body, and a mass in the brain. Chest CT showed a mass in the right lower lobe of the lung; biopsy revealed adenocarcinoma. Additional diagnostic testing was performed.

    • Perspective

      Slide Show: Graphic Warnings for Cigarette Labels

      Beginning in September 2012, the Food and Drug Administration will require larger, more prominent health warnings on all cigarette packaging and advertisements in the United States. These new labels mark the first change in cigarette warnings in more than 25 years and represent an important advance…

      • August 4, 2011
      • Koh H.K.
      • N Engl J Med 2011; 365:e10
      • Free Full Text
      • Slideshow

      Beginning in September 2012, the Food and Drug Administration will require larger, more prominent health warnings on all cigarette packaging and advertisements in the United States. These new labels mark the first change in cigarette warnings in more ...

    • Editorial

      Better Evidence about Screening for Lung Cancer

      In October 2010, the National Cancer Institute (NCI) announced that patients who were randomly assigned to screening with low-dose computed tomography (CT) had fewer deaths from lung cancer than did patients randomly assigned to screening with chest radiography. The first report of the NCI…

      • August 4, 2011
      • Sox H.C.
      • N Engl J Med 2011; 365:455-457
      • Free Full Text

      In October 2010, the National Cancer Institute (NCI) announced that patients who were randomly assigned to screening with low-dose computed tomography (CT) had fewer deaths from lung cancer than did patients randomly assigned to screening with chest ...

    • Original Article

      Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening

      Lung cancer is an aggressive and heterogeneous disease. Advances in surgical, radiotherapeutic, and chemotherapeutic approaches have been made, but the long-term survival rate remains low. After the Surgeon General's 1964 report on smoking and health, mortality from lung cancer among men peaked and…

      • August 4, 2011
      • The National Lung Screening Trial Research Team
      • N Engl J Med 2011; 365:395-409
      • Free Full Text
      • CME

      The National Lung Screening Trial investigators report that persons undergoing three annual screening examinations with low-dose computed tomography had a 20% reduction in lung-cancer mortality as compared with those screened with annual chest radiography.

    • Correspondence

      Drug-Induced Effects on Erlotinib Metabolism

      To the Editor: A 78-year-old nonsmoking woman with a history of depression and dyslipidemia presented with a stage IV lung adenocarcinoma, harboring an activating mutation of the epidermal growth factor receptor (EGFR) (exon 19 deletion). Erlotinib was started at the recommended dose of 150 mg per…

      • July 28, 2011
      • N Engl J Med 2011; 365:379-380
      • Free Full Text

      A woman with lung cancer in whom the usual toxicities from erlotinib did not develop at the standard dose had a tumor response and side effects when the erlotinib dose was increased. Furthermore, the erlotinib dose had to be reduced when fenofibrate was stopped.

    • Case Records of the Massachusetts General Hospital

      Case 21-2011 — A 31-Year-Old Man with ALK-Positive Adenocarcinoma of the Lung

      Presentation of Case. A 31-year-old man was seen in the outpatient cancer center at this hospital because of dysphagia and a mediastinal mass. The patient had been well until approximately 3 months before this evaluation, when progressive difficulty swallowing (solid foods but not liquids)…

      • July 14, 2011
      • Shaw A.T., Forcione D.G., Digumarthy S.R., Iafrate A.J.
      • N Engl J Med 2011; 365:158-167
      • CME

      A 31-year-old man was seen at this hospital because of dysphagia and a mediastinal mass compressing the esophagus. CT images showed gastrohepatic and subcarinal lymphadenopathy and multiple lung nodules. A diagnostic procedure was performed, and management decisions were made.

    • Sounding Board

      Bending the Cost Curve in Cancer Care

      Annual direct costs for cancer care are projected to rise — from $104 billion in 2006 to over $173 billion in 2020 and beyond. This increase has been driven by a dramatic rise in both the cost of therapy and the extent of care. In the United States, the sales of anticancer drugs are now second…

      • May 26, 2011
      • Smith T.J. and Hillner B.E.
      • N Engl J Med 2011; 364:2060-2065
      • Free Full Text

      The current growth in the cost of cancer care is unsustainable. The authors provide data-driven proposals that have the potential to save money without compromising patient care.

    • Case Records of the Massachusetts General Hospital

      Case 14-2011 — A Woman with Asymmetric Sensory Loss and Paresthesias

      Presentation of Case. Dr. Sheila L. Arvikar (Medicine): A 52-year-old woman was seen in the neurology clinic at this hospital because of asymmetric sensory loss and paresthesias in both arms and legs as well as impaired dexterity. The patient had been well until 5 months earlier, when her hands and…

      • May 12, 2011
      • Chad D.A., Stone J.H., Gupta R.
      • N Engl J Med 2011; 364:1856-1865

        A 52-year-old woman was seen in the Neurology Clinic because of asymmetric sensory loss and paresthesias in both arms and legs, and impaired dexterity, of 5 months' duration, with asymmetric loss of tendon reflexes and no weakness. Diagnostic tests were performed.

      • Perspective

        Early Accelerated Approval for Highly Targeted Cancer Drugs

        The striking results of recent phase 1 trials of targeted cancer drugs have provoked serious discussion about shortening the road to drug approval. A typical cancer drug takes 7 years from entry into human trials to approval by the Food and Drug Administration (FDA), which requires proof of…

        • March 24, 2011
        • Chabner B.A.
        • N Engl J Med 2011; 364:1087-1089

          Since we can define subgroups of patients who have high rates of response and disease control in phase 1 trials of targeted cancer drugs, the traditional long pathway to FDA approval of these drugs is increasingly under fire for medical and ethical reasons.

        • Correspondence

          Retraction: A Genomic Strategy to Refine Prognosis in Early-Stage Non–Small-Cell Lung Cancer. N Engl J Med 2006;355:570-80.

          To the Editor: We would like to retract our article, "A Genomic Strategy to Refine Prognosis in Early-Stage Non–Small-Cell Lung Cancer," which was published in the Journal on August 10, 2006. Using a sample set from a study by the American College of Surgeons Oncology Group (ACOSOG) and a…

          • March 24, 2011
          • N Engl J Med 2011; 364:1176
          • Free Full Text

          To the Editor: We would like to retract our article, “A Genomic Strategy to Refine Prognosis in Early-Stage Non–Small-Cell Lung Cancer,”1 which was published in the Journal on August 10, 2006. Using a sample set from a study by the American College of ...

        • Clinical Therapeutics

          Treatment of Non–Small-Cell Lung Cancer with Erlotinib or Gefitinib

          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…

          • March 10, 2011
          • Cataldo V.D., Gibbons D.L., Pérez-Soler R., Quintás-Cardama A.
          • N Engl J Med 2011; 364:947-955
          • CME

          A 64-year-old woman receives the diagnosis of metastatic non–small-cell lung cancer (NSCLC), which has progressed during treatment with carboplatin, paclitaxel, and bevacizumab. Erlotinib therapy is recommended.

        • Images in Clinical Medicine

          Malignant Pericardial Effusion

          Figure 1.

          • March 3, 2011
          • Xiong W. and Shi C.
          • N Engl J Med 2011; 364:e18
          • Free Full Text
          • Video

          A 48-year-old man with a history of alcohol and tobacco abuse presented to the emergency department with a 2-month history of progressive dyspnea. Physical examination revealed distention of the jugular vein and an enlarged left cervical lymph node. An ...

        • Editorial

          Crizotinib — Latest Champion in the Cancer Wars?

          Three articles in this issue of the Journal report on the therapeutic potential of a new kid on the kinase inhibitor block: crizotinib, an ATP-competitive inhibitor of the anaplastic lymphoma kinase (ALK) receptor tyrosine kinase. Kwak et al. summarize a study involving patients with non–small…

          • October 28, 2010
          • Hallberg B. and Palmer R.H.
          • N Engl J Med 2010; 363:1760-1762

            Three articles in this issue of the Journal report on the therapeutic potential of a new kid on the kinase inhibitor block: crizotinib, an ATP-competitive inhibitor of the anaplastic lymphoma kinase (ALK) receptor tyrosine kinase.

            Kwak et al.1 summarize a ...

          • Original Article

            Anaplastic Lymphoma Kinase Inhibition in Non–Small-Cell Lung Cancer

            Specific genetic lesions that drive the proliferation of cancer cells render some cancers sensitive to therapeutic inhibitors targeting the mutated pathway. For example, inhibitors of the epidermal growth factor receptor (EGFR) have produced consistent responses in a subgroup of patients with…

            • October 28, 2010
            • Kwak E.L., Bang Y.-J., Camidge D.R., et al.
            • N Engl J Med 2010; 363:1693-1703
            • Free Full Text

            A small group of patients with non–small-cell lung cancer have genetic lesions that activate anaplastic lymphoma kinase (ALK). Crizotinib, an orally bioavailable ALK kinase inhibitor, produced a 57% response rate in this subgroup, with mild grade 1 or 2 toxic effects.

          • Original Article

            Brief Report: EML4-ALK Mutations in Lung Cancer That Confer Resistance to ALK Inhibitors

            EML4-ALK is a fusion-type protein tyrosine kinase that is present in 4 to 5% of cases of non–small-cell lung cancer and is generated as a result of a small inversion within the short arm of human chromosome 2.– EML4-ALK undergoes constitutive dimerization through interaction between the coiled…

            • October 28, 2010
            • Choi Y.L., Soda M., Yamashita Y., et al.
            • N Engl J Med 2010; 363:1734-1739
            • Free Full Text

            The molecular basis of the resistance of anaplastic lymphoma kinase (ALK)–driven lung cancer to the ALK inhibitor, crizotinib, was identified in a patient whose tumor initially responded to crizotinib treatment and then, after 5 months, progressed despite continued treatment.

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          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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