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Correspondence
Bortezomib to Treat the TEMPI Syndrome
To the Editor: Recently, on the basis of a case series involving six patients, Sykes et al. described the TEMPI syndrome, a novel multisystem disease defined by telangiectasias, erythrocytosis with elevated erythropoietin levels, monoclonal gammopathy, perinephric-fluid collections, and…
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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…
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Perspective
Looking beyond Translation — Integrating Clinical Research with Medical Practice
One area of amazing recent medical advances has been childhood cancers, for which survival rates have quadrupled over the past four decades and now exceed 80%. This progress has been driven not only by the introduction of novel therapies but also by the remarkable level of patient and physician…
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…
- CME
Correspondence
Pulmonary Fibrosis, Bone Marrow Failure, and Telomerase Mutation
To the Editor: Telomeres protect the ends of chromosomes from erosion; telomerase ensures their integrity. We report a case of familial idiopathic pulmonary fibrosis and bone marrow failure associated with a mutation in telomerase reverse transcriptase (TERT). The patient was a 56-year-old lifelong…
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Original Article
Suicide and Cardiovascular Death after a Cancer Diagnosis
A large body of evidence suggests high levels of distress and psychiatric symptoms among patients who receive a diagnosis of cancer.– Patients with cancer have been shown to be at increased risk for suicide– and cardiovascular events.– However, most results have been interpreted to be…
Case Records of the Massachusetts General Hospital
Case 9-2012 — A 67-Year-Old Man with a Persistently Elevated PSA Level
Presentation of Case. A 67-year-old man was seen in the cancer center at this hospital because of a persistently elevated serum level of prostate-specific antigen (PSA). Seven and a half years earlier, the patient's serum level of PSA was elevated on routine testing at another institution (Table 1).…
- CME
Editorial
New Data on Prostate-Cancer Mortality after PSA Screening
After 11 years of follow-up in the European Randomized Study of Screening for Prostate Cancer (ERSPC), Schröder et al. report in this issue of the Journal that there has been little change in the apparent benefit of screening men for levels of prostate-specific antigen (PSA), as compared with an…
Original Article
Prostate-Cancer Mortality at 11 Years of Follow-up
Screening for prostate cancer has remained controversial, despite results showing a significant reduction in the rate of death from prostate cancer (relative reduction, 20%) among men offered screening for prostate-specific antigen (PSA). The European Randomized Study of Screening for Prostate…
- CME
The European Randomized Study of Screening for Prostate Cancer continues to show a 21% reduction in prostate-cancer mortality in the screening group, after 11 years of follow-up. The number of cancers that would need to be detected to prevent one prostate-cancer death is 37. Screening does not affect all-cause mortality.
Editorial
Tumor Heterogeneity and Personalized Medicine
In the past 10 years, the number of tools available to treat cancer has increased, as has our understanding of what makes some cancers tick. The standard old-time cancer treatments were largely predicated on attacking DNA, an approach fueled by the belief that tumor cells divide more rapidly than…
Correspondence
Germline JAK2 Mutation in a Family with Hereditary Thrombocytosis
To the Editor: The remarkable association between somatic JAK2 mutations and Philadelphia chromosome–negative myeloproliferative neoplasms is well established. However, JAK2 mutations occur in heterogeneous disorders, and current evidence suggests that they are secondary events in both sporadic…
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Original Article
Intratumor Heterogeneity and Branched Evolution Revealed by Multiregion Sequencing
Large-scale sequencing analyses of solid cancers have identified extensive heterogeneity between individual tumors.– Genetic intratumor heterogeneity has also been shown– and can contribute to treatment failure and drug resistance. Intratumor heterogeneity may have important consequences for…
Perspective
What's the Alternative? The Worldwide Web of Integrative Medicine
Out of curiosity, an impressionable woman in her 30s attends an integrative medicine exhibition; having recently had a child, she's been sleep-deprived and wants to investigate natural remedies. At the seminar, she wins a door prize — a blood test that promises to diagnose cancer. She was…
Clinical Practice
Lichen Planus
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 authors' clinical recommendations. Stage. A 53-year-old…
- CME
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Review Article
Mechanisms of Disease: IgG4-Related Disease
IgG4-related disease is a newly recognized fibroinflammatory condition characterized by tumefactive lesions, a dense lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells, storiform fibrosis, and, often but not always, elevated serum IgG4 concentrations. The disease was not recognized as…
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…
- CME
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…
Case Records of the Massachusetts General Hospital
Case 1-2012 — An 82-Year-Old Man with Persistent Ulcers on the Hands
Presentation of Case. Dr. Sarah Gee (Dermatology): An 82-year-old man was admitted to this hospital because of persistent skin lesions on the hands. The patient had a history of diabetes mellitus and recurrent hidradenitis suppurativa. Five weeks before admission, he was admitted to another…
Original Article
Germline Mutations in HOXB13 and Prostate-Cancer Risk
Prostate cancer is the most common noncutaneous cancer diagnosed in men in the United States, with more than 240,000 new cases expected in 2011. Despite the demonstration of a strong familial component, identification of the genetic basis for hereditary prostate cancer has been challenging. Linkage…
Original Article
Liberal or Restrictive Transfusion in High-Risk Patients after Hip Surgery
In the United States, more than 17 million red-cell units are collected annually, and 15 million units are transfused. Blood transfusions are frequently given to surgical patients and to the elderly. Yet, the indications for postoperative transfusion have not been adequately evaluated and remain…
- CME







