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Perspective
From an Ethics of Rationing to an Ethics of Waste Avoidance
Interview with Dr. Howard Brody on the ethics of rationing and waste avoidance in health care.
- May 24, 2012
- Brody H.
- N Engl J Med 2012; 366:1949-1951
- Free Full Text
Waste in U.S. health care — spending on interventions that don't benefit patients — amounts to at least 30% of health care spending and is a major driver of cost increases. So the ethical debate about cost containment is shifting focus from rationing to waste avoidance.
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Case Records of the Massachusetts General Hospital
Case 16-2012 — A 32-Year-Old Woman with HER2-Positive Breast Cancer
Right Mastectomy Specimen..
The residual high-grade invasive ductal carcinoma seen in the mastectomy specimen is in the form of single cells and cell clusters (Panel A, hematoxylin and eosin). Residual foci of high-grade ductal carcinoma in situ with comedonecrosis and calcification are seen (Panel B, hematoxylin and eosin).…
- May 24, 2012
- Baselga J., Smith B.L., Rafferty E.A., Bombonati A.
- N Engl J Med 2012; 366:2018-2026
A 32-year-old woman noted a crease in her right breast. Imaging studies showed a suspicious mass, and a biopsy specimen revealed infiltrating ductal carcinoma, positive for HER2. Staging showed liver lesions consistent with metastases. Management decisions were made.
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Case Records of the Massachusetts General Hospital
Case 16-2012 — A 32-Year-Old Woman with HER2-Positive Breast Cancer
Biopsy Specimen of the Right Breast..
A specimen from the core needle biopsy of the palpable mass in the right breast shows invasive ductal carcinoma (Panel A, hematoxylin and eosin). The high-grade invasive ductal carcinoma has clusters of pleomorphic cells infiltrating the stroma (Panel B, hematoxylin and eosin). The invasive tumor…
- May 24, 2012
- Baselga J., Smith B.L., Rafferty E.A., Bombonati A.
- N Engl J Med 2012; 366:2018-2026
A 32-year-old woman noted a crease in her right breast. Imaging studies showed a suspicious mass, and a biopsy specimen revealed infiltrating ductal carcinoma, positive for HER2. Staging showed liver lesions consistent with metastases. Management decisions were made.
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Case Records of the Massachusetts General Hospital
Case 16-2012 — A 32-Year-Old Woman with HER2-Positive Breast Cancer
Imaging Studies before and after Neoadjuvant Therapy..
A T1-weighted, fat-suppressed, gadolinium-enhanced MRI scan of the breasts shows a spiculated, enhancing mass corresponding to the palpable lump posteriorly (Panel A, arrowhead) and a second, unsuspected mass more anteriorly (arrow). An abdominal CT scan (Panel B) shows multiple contrast-enhanced…
- May 24, 2012
- Baselga J., Smith B.L., Rafferty E.A., Bombonati A.
- N Engl J Med 2012; 366:2018-2026
A 32-year-old woman noted a crease in her right breast. Imaging studies showed a suspicious mass, and a biopsy specimen revealed infiltrating ductal carcinoma, positive for HER2. Staging showed liver lesions consistent with metastases. Management decisions were made.
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Images in Clinical Medicine
Aquagenic Wrinkling of Palms in Cystic Fibrosis
A 17-year-old girl presented with a 10-year history of transient excessive wrinkling of her palms after brief exposure to water and sweating. She reported some uncomfortable tightness of the skin during these episodes. At the age of 2 years, the patient had received the diagnosis of cystic fibrosis…
- May 24, 2012
- Weibel L. and Spinas R.
- N Engl J Med 2012; 366:e32
- Free Full Text
A 17-year-old girl presented with a 10-year history of transient excessive wrinkling of her palms after brief exposure to water and sweating. She reported some uncomfortable tightness of the skin during these epi¬sodes.
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Original Article
Prednisone, Azathioprine, and N-Acetylcysteine for Pulmonary Fibrosis
Adverse Events..
- May 24, 2012
- The Idiopathic Pulmonary Fibrosis Clinical Research Network
- N Engl J Med 2012; 366:1968-1977
Many treatments used for idiopathic pulmonary fibrosis (IPF) have not been rigorously tested. This article reports discontinuation of treatment with prednisone, azathioprine, and N-acetylcysteine (NAC) because of increased mortality, as compared with N-acetylcysteine alone or placebo.
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Original Article
Prednisone, Azathioprine, and N-Acetylcysteine for Pulmonary Fibrosis
Safety End Points..
- May 24, 2012
- The Idiopathic Pulmonary Fibrosis Clinical Research Network
- N Engl J Med 2012; 366:1968-1977
Many treatments used for idiopathic pulmonary fibrosis (IPF) have not been rigorously tested. This article reports discontinuation of treatment with prednisone, azathioprine, and N-acetylcysteine (NAC) because of increased mortality, as compared with N-acetylcysteine alone or placebo.
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Original Article
Prednisone, Azathioprine, and N-Acetylcysteine for Pulmonary Fibrosis
Characteristics of the Patients at Baseline..
- May 24, 2012
- The Idiopathic Pulmonary Fibrosis Clinical Research Network
- N Engl J Med 2012; 366:1968-1977
Many treatments used for idiopathic pulmonary fibrosis (IPF) have not been rigorously tested. This article reports discontinuation of treatment with prednisone, azathioprine, and N-acetylcysteine (NAC) because of increased mortality, as compared with N-acetylcysteine alone or placebo.
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Original Article
Prednisone, Azathioprine, and N-Acetylcysteine for Pulmonary Fibrosis
Timeline until Death during the 60-Week Study Period, According to Study Group..
Shown are follow-up data for patients from randomization until death (from left to right). Each set of bars represents one patient who died, including eight patients receiving combination therapy and one patient receiving matched placebo. For each patient, three bars are plotted (for N…
- May 24, 2012
- The Idiopathic Pulmonary Fibrosis Clinical Research Network
- N Engl J Med 2012; 366:1968-1977
Many treatments used for idiopathic pulmonary fibrosis (IPF) have not been rigorously tested. This article reports discontinuation of treatment with prednisone, azathioprine, and N-acetylcysteine (NAC) because of increased mortality, as compared with N-acetylcysteine alone or placebo.
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Original Article
Prednisone, Azathioprine, and N-Acetylcysteine for Pulmonary Fibrosis
Kaplan–Meier Curves for the Time until Death, Disease Progression, or Hospitalization..
Shown are the time until death (Panel A), until a composite of death or disease progression (defined as a decrease in the forced vital capacity of ≥10%) (Panel B), or until a composite of death or hospitalization (Panel C). Combination therapy refers to a three-drug regimen consisting of…
- May 24, 2012
- The Idiopathic Pulmonary Fibrosis Clinical Research Network
- N Engl J Med 2012; 366:1968-1977
Many treatments used for idiopathic pulmonary fibrosis (IPF) have not been rigorously tested. This article reports discontinuation of treatment with prednisone, azathioprine, and N-acetylcysteine (NAC) because of increased mortality, as compared with N-acetylcysteine alone or placebo.
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- Save
Original Article
Prednisone, Azathioprine, and N-Acetylcysteine for Pulmonary Fibrosis
Enrollment and Outcomes..
DLCO denotes carbon monoxide diffusing capacity, FVC forced vital capacity, IPF idiopathic pulmonary fibrosis, and NAC N-acetylcysteine.
- May 24, 2012
- The Idiopathic Pulmonary Fibrosis Clinical Research Network
- N Engl J Med 2012; 366:1968-1977
Many treatments used for idiopathic pulmonary fibrosis (IPF) have not been rigorously tested. This article reports discontinuation of treatment with prednisone, azathioprine, and N-acetylcysteine (NAC) because of increased mortality, as compared with N-acetylcysteine alone or placebo.
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Clinical Therapeutics
Anti-CD20 Antibody Therapy for B-Cell Lymphomas
A Typical Regimen of Rituximab with Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone (R-CHOP)..
- May 24, 2012
- Maloney D.G.
- N Engl J Med 2012; 366:2008-2016
A 62-year-old man receives a diagnosis of diffuse large B-cell lymphoma; treatment with a regimen including the anti-CD20 antibody rituximab is recommended. Rituximab has been shown to improve progression-free survival when added to standard chemotherapy regimens for lymphoma.
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Clinical Therapeutics
Anti-CD20 Antibody Therapy for B-Cell Lymphomas
Mechanisms of Action of Anti-CD20 Antibodies..
Anti-CD20 antibodies bind to the CD20 molecule on the surface of the malignant B cell in non-Hodgkin's lymphoma (NHL), leading to cell death. Three mechanisms of action of anti-CD20 antibodies have been proposed. In complement-dependent cytotoxicity, the first component of complement (C1) binds to…
- May 24, 2012
- Maloney D.G.
- N Engl J Med 2012; 366:2008-2016
A 62-year-old man receives a diagnosis of diffuse large B-cell lymphoma; treatment with a regimen including the anti-CD20 antibody rituximab is recommended. Rituximab has been shown to improve progression-free survival when added to standard chemotherapy regimens for lymphoma.
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Images in Clinical Medicine
Meconium-like Ileus in Cystic Fibrosis
A 19-year-old woman with type 1 diabetes mellitus and suspected cystic fibrosis presented with a 1-day history of acute abdominal pain. Plain radiography revealed evidence of a mechanical obstruction (Panel A). Abdominal computed tomography with intravenous contrast material showed diffuse…
- May 24, 2012
- Lin L.-Y. and Wong J.-U.
- N Engl J Med 2012; 366:2017
- Free Full Text
A 19-year-old woman with type 1 diabetes mellitus and suspected cystic fibrosis presented with a 1-day history of acute abdominal pain. Plain radiography revealed a typical mechanical obstruction.
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Original Article
Effect of Estrogen on Pseudomonas Mucoidy and Exacerbations in Cystic Fibrosis
Mucoid and Nonmucoid Pseudomonas Species and Estradiol Levels in Women with Cystic Fibrosis..
Panel A shows the percentage of patients who were colonized with mucoid versus nonmucoid pseudomonas species during exacerbations throughout the menstrual cycle. Pseudomonas species were cultured from undiluted sputum samples obtained from women with cystic fibrosis who were undergoing…
- May 24, 2012
- Chotirmall S.H., Smith S.G., Gunaratnam C., et al.
- N Engl J Med 2012; 366:1978-1986
Pseudomonas aeruginosa is an important pathogen in patients with cystic fibrosis. In this report, data suggest that estrogen may play a role in the modulation of virulence factors in P. aeruginosa and thus affect clinical exacerbations in women with cystic fibrosis.
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Original Article
Effect of Estrogen on Pseudomonas Mucoidy and Exacerbations in Cystic Fibrosis
Effect of Oral Contraceptives on the Number of Courses of Antibiotics Required per Year in Women with Cystic Fibrosis..
Available data from the Cystic Fibrosis Registry of Ireland for 239 women (≥18 years of age) were obtained for the years 2001 through 2010, but only years when registry ascertainment was more than 55% (2006–2009) are shown. The mean numbers of courses of antibiotics (oral or intravenous) that…
- May 24, 2012
- Chotirmall S.H., Smith S.G., Gunaratnam C., et al.
- N Engl J Med 2012; 366:1978-1986
Pseudomonas aeruginosa is an important pathogen in patients with cystic fibrosis. In this report, data suggest that estrogen may play a role in the modulation of virulence factors in P. aeruginosa and thus affect clinical exacerbations in women with cystic fibrosis.
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- Save
Original Article
Effect of Estrogen on Pseudomonas Mucoidy and Exacerbations in Cystic Fibrosis
Exacerbations and Estradiol Levels in Women with Cystic Fibrosis..
Panel A shows the number of infective exacerbations according to the time of the menstrual cycle, as recorded for 44 women with cystic fibrosis and plotted against circulating estradiol levels (as measured in 6 women with cystic fibrosis). Shown are means and the range of values. The asterisk…
- May 24, 2012
- Chotirmall S.H., Smith S.G., Gunaratnam C., et al.
- N Engl J Med 2012; 366:1978-1986
Pseudomonas aeruginosa is an important pathogen in patients with cystic fibrosis. In this report, data suggest that estrogen may play a role in the modulation of virulence factors in P. aeruginosa and thus affect clinical exacerbations in women with cystic fibrosis.
- PDF
- Save
Original Article
Effect of Estrogen on Pseudomonas Mucoidy and Exacerbations in Cystic Fibrosis
Alginate Production and Mucoid Conversion in Pseudomonas aeruginosa Induced by Estradiol and Estriol..
In Panel A, P. aeruginosa strain 01 (PA01) or P. aeruginosa clinical isolates from patients with and those without cystic fibrosis (CF) were treated for either 3 days or 4 weeks with daily subculture in fresh broth containing ethanol, testosterone, estradiol, or estriol (10 nM for each subculture).…
- May 24, 2012
- Chotirmall S.H., Smith S.G., Gunaratnam C., et al.
- N Engl J Med 2012; 366:1978-1986
Pseudomonas aeruginosa is an important pathogen in patients with cystic fibrosis. In this report, data suggest that estrogen may play a role in the modulation of virulence factors in P. aeruginosa and thus affect clinical exacerbations in women with cystic fibrosis.
- PDF
- Save
Original Article
A Randomized Trial of Urodynamic Testing before Stress-Incontinence Surgery
Clinical Diagnosis..
- May 24, 2012
- Nager C.W., Brubaker L., Litman H.J., et al.
- N Engl J Med 2012; 366:1987-1997
This trial assessed the utility of preoperative urodynamic testing in women with uncomplicated stress–predominant urinary incontinence. Women having office evaluation alone had 1-year treatment-success rates noninferior to those of women also having urodynamic testing.
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Original Article
A Randomized Trial of Urodynamic Testing before Stress-Incontinence Surgery
Outcomes..
- May 24, 2012
- Nager C.W., Brubaker L., Litman H.J., et al.
- N Engl J Med 2012; 366:1987-1997
This trial assessed the utility of preoperative urodynamic testing in women with uncomplicated stress–predominant urinary incontinence. Women having office evaluation alone had 1-year treatment-success rates noninferior to those of women also having urodynamic testing.
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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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