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  • Editorial

    The Debate over Thyroid-Function Screening in Pregnancy

    Maternal hypothyroidism in pregnancy has been associated with a range of adverse outcomes, most importantly miscarriage, preterm delivery, and reduced cognitive function in offspring. In surveys, almost half the obstetricians in private practices in Maine and the majority of obstetricians in a…

    • February 9, 2012
    • Brent G.A.
    • N Engl J Med 2012; 366:562 - 563

      Maternal hypothyroidism in pregnancy has been associated with a range of adverse outcomes, most importantly miscarriage, preterm delivery, and reduced cognitive function in offspring.1 In surveys, almost half the obstetricians in private practices in ...

    • Original Article

      Antenatal Thyroid Screening and Childhood Cognitive Function

      Active secretion of thyroid hormone in the fetus does not start until about 18 to 20 weeks' gestation. Studies in animals suggest that until fetal hormone secretion begins, the fetus is dependent on circulating free thyroxine (T4) in the mother for growth and development, including central nervous…

      • February 9, 2012
      • Lazarus J.H., Bestwick J.P., Channon S., et al.
      • N Engl J Med 2012; 366:493 - 501
      • CME

      In this randomized trial, antenatal screening (at a median gestational age of 12 weeks 3 days) and treatment for hypothyroidism did not result in improved cognitive function in children at 3 years of age.

    • Clinical Practice

      Delayed Puberty

      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 14-year-old…

      • February 2, 2012
      • Palmert M.R. and Dunkel L.
      • N Engl J Med 2012; 366:443 - 453
      • CME
      • Full Text Audio

      Puberty is considered delayed when it has not yet occurred at an age that is 2 to 2.5 SD later than average (traditionally, 14 years in boys and 13 years in girls). Constitutional delay of growth and puberty (CDGP) is the most common cause. Management of CDGP is discussed.

    • Review Article

      Current Concepts: Cognitive and Neurologic Outcomes after Coronary-Artery Bypass Surgery

      Patients referred for coronary revascularization procedures are older and are likely to have more extensive extracardiac vascular disease than those referred for such procedures in the past. Despite these trends, mortality rates for coronary-artery bypass grafting (CABG), without concurrent…

      • January 19, 2012
      • Selnes O.A., Gottesman R.F., Grega M.A., et al.
      • N Engl J Med 2012; 366:250 - 257
      • CME

      For patients undergoing coronary-artery bypass grafting (CABG), adverse neurologic outcomes, including stroke and cognitive decline, are major concerns. Even mild cognitive deficits before surgery may be a marker for cerebrovascular disease and increased risk.

    • Original Article

      ADHD Drugs and Serious Cardiovascular Events in Children and Young Adults

      Medications that are used to treat attention deficit–hyperactivity disorder (ADHD) are prescribed for more than 2.7 million children in the United States each year and have been considered to be relatively safe.– However, reports of adverse events from Canada and the United States that have…

      • November 17, 2011
      • Cooper W.O., Habel L.A., Sox C.M., et al.
      • N Engl J Med 2011; 365:1896 - 1904

        This large study found no increased risk of cardiovascular events in children and young adults using attention deficit–hyperactivity disorder (ADHD) drugs. Although the data are compatible with nearly a doubling of risk, the study was underpowered and the absolute event rate was quite low.

      • Editorial

        Transplantation for Alcoholic Hepatitis — Time to Rethink the 6-Month “Rule”

        Liver transplantation for alcoholic liver disease has been controversial since the advent of the procedure. The perception that alcohol-related liver disease is self-inflicted, combined with concerns about recidivism to alcohol use and poor adherence to post-transplantation care, has led the public…

        • November 10, 2011
        • Brown R.S.
        • N Engl J Med 2011; 365:1836 - 1838

          Liver transplantation for alcoholic liver disease has been controversial since the advent of the procedure. The perception that alcohol-related liver disease is self-inflicted, combined with concerns about recidivism to alcohol use and poor adherence to ...

        • Clinical Practice

          Depression during Pregnancy

          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 24-year-old…

          • October 27, 2011
          • Stewart D.E.
          • N Engl J Med 2011; 365:1605 - 1611
          • CME
          • Full Text Audio

          Evaluation and treatment (with psychotherapy, antidepressant therapy, or both) of women with depression during pregnancy are described. Data on potential benefits and risks of antidepressant medications in pregnancy are reviewed; overall, the absolute risks are small.

        • Clinical Practice

          Treating Smokers in the Health Care Setting

          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 45-year-old…

          • September 29, 2011
          • Fiore M.C. and Baker T.B.
          • N Engl J Med 2011; 365:1222 - 1231
          • CME
          • Full Text Audio

          Strategies to facilitate smoking cessation are reviewed, including documentation of smoking status for all patients, regular assessment of readiness to quit, counseling, and medications. Use of these strategies is guided by a patient's willingness and by coexisting conditions.

        • Original Article

          Placebo-Controlled Trial of Cytisine for Smoking Cessation

          Tobacco smoking contributes to some 5 million premature deaths each year worldwide. It is highly addictive, with more than 95% of unaided attempts at cessation failing to last 6 months. Every year that a smoker delays quitting beyond the mid-30s, the person loses 3 months of life expectancy. The…

          • September 29, 2011
          • West R., Zatonski W., Cedzynska M., et al.
          • N Engl J Med 2011; 365:1193 - 1200

            Cytisine is a low-cost medication that is potentially beneficial in smoking cessation. In this placebo-controlled trial, 12-month abstinence rates were 8.4% among participants randomly assigned to 4 weeks of cytisine and 2.4% among participants assigned to placebo.

          • Perspective

            Moving beyond Parity — Mental Health and Addiction Care under the ACA

            Enactment of the Mental Health Parity and Addiction Equity Act in 2008 was the culmination of a decades-long effort to improve insurance coverage for mental health and addiction treatment. The law's passage constituted a critical first step toward bringing care for people with mental health and…

            • September 15, 2011
            • Barry C.L. and Huskamp H.A.
            • N Engl J Med 2011; 365:973 - 975
            • Free Full Text

            Enactment of the Mental Health Parity and Addiction Equity Act in 2008 improved insurance coverage for mental health and addiction treatment. Now, the Affordable Care Act could affect the financing and delivery of such care even more profoundly.

          • Perspective

            Drunk Driving, Distracted Driving, Moralism, and Public Health

            In 1980, Candy Lightner gave a speech about a 13-year-old girl who was killed by a drunk driver with several previous arrests for driving while intoxicated (DWI). She ended by saying, "That little girl was my daughter." "The audience gasped," Lightner later reported. "The press jumped up and ran…

            • September 8, 2011
            • Lerner B.H.
            • N Engl J Med 2011; 365:879 - 881
            • Free Full Text

            Can we blend the moral passion of anti–drunk-driving activism with epidemiologically based strategies for saving lives on the roads? The history of efforts to prevent automobile crashes offers lessons on various approaches and their possible synergy.

          • Review Article

            Current Concepts: Drug-Resistant Epilepsy

            Fifty million people in the world have epilepsy, and there are between 16 and 51 cases of new-onset epilepsy per 100,000 people every year. A community-based study in southern France estimated that up to 22.5% of patients with epilepsy have drug-resistant epilepsy. Patients with drug-resistant…

            • September 8, 2011
            • Kwan P., Schachter S.C., Brodie M.J.
            • N Engl J Med 2011; 365:919 - 926
            • CME

            Nearly a quarter of patients with seizures have drug-resistant epilepsy. This review examines how this diagnosis should be established and how to recognize pseudoresistance. It explains possible mechanisms of drug-resistant epilepsy and presents treatment strategies.

          • Correspondence

            “Bath Salts” Intoxication

            To the Editor: The abuse of psychoactive "bath salts" (PABS) has become commonplace, and patients with PABS overdoses are presenting to emergency departments with increasing frequency. The primary ingredient of the synthetic designer drugs in these bath salts, which are not related to any hygiene…

            • September 8, 2011
            • N Engl J Med 2011; 365:967 - 968
            • Free Full Text

            This letter highlights recreational ingestion of bath salts containing methylenedioxypyrovalerone, a potent central nervous system stimulant. Intoxication that results in extreme sympathetic stimulation and profoundly alters mental status may be fatal.

          • Clinical Practice

            Care of the Adult Patient after Sexual Assault

            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 20-year-old…

            • September 1, 2011
            • Linden J.A.
            • N Engl J Med 2011; 365:834 - 841
            • Free Full Text
            • CME
            • Full Text Audio

            This article reviews the treatment of patients presenting for care after sexual assault, including guidance for evidence collection in case of prosecution, psychological support for the victim, and prevention of pregnancy and sexually transmitted infections.

          • Case Records of the Massachusetts General Hospital

            Case 26-2011 — A 7-Year-Old Boy with a Complex Cyst in the Kidney

            Presentation of Case. A 7-year-old boy was seen in an outpatient clinic at this hospital because of a complex cyst in the kidney. The patient was born by vaginal delivery after an uncomplicated 38-week gestation. His birth weight was 3.04 kg. A diagnosis of tuberous sclerosis complex (TSC) was made…

            • August 25, 2011
            • Paul E., Thiele E.A., Shailam R., Rosales A.M., Sadow P.M.
            • N Engl J Med 2011; 365:743 - 751
            • CME

            A 7-year-old boy with tuberous sclerosis complex was seen because of an increasingly complex cyst in the left kidney, seen on serial imaging studies. A diagnostic procedure was performed.

          • Special Article

            Malpractice Risk According to Physician Specialty

            Despite tremendous interest in medical malpractice and its reform,– data are lacking on the proportion of physicians who face malpractice claims according to physician specialty, the size of payments according to specialty, and the cumulative incidence of being sued during the course of a…

            • August 18, 2011
            • Jena A.B., Seabury S., Lakdawalla D., Chandra A.
            • N Engl J Med 2011; 365:629 - 636
            • Free Full Text
            • CME

            In this analysis of data from a national liability insurer, 7.4% of physicians faced a malpractice claim each year, although 78% of claims did not result in payments to claimants. The authors estimate that 75 to 99% of physicians will face a malpractice claim by the age of 65.

          • Perspective

            Smoking and Mental Illness — Breaking the Link

            "My doctor told me I'm too stressed out to quit smoking," remarked a woman hospitalized with severe depression. "Well, 43 years later, I'm still stressed and I'm still smoking." This woman's dilemma is all too familiar to health care providers and patients seeking the ideal time to treat tobacco…

            • July 21, 2011
            • Prochaska J.J.
            • N Engl J Med 2011; 365:196 - 198
            • Free Full Text

            Many clinicians see smoking and mental illness as inextricably linked and believe that smoking in the mentally ill is particularly challenging to treat. Such myths have contributed to the devastating consequences of tobacco use in this population.

          • Editorial

            Meaningful Placebos — Controlling the Uncontrollable

            In this issue of the Journal, Wechsler et al. report data from a study that compared four interventions involving patients with asthma (ClinicalTrials.gov number, NCT01143688). They found that three of the interventions — active albuterol, sham albuterol, and sham acupuncture — were all equally…

            • July 14, 2011
            • Moerman D.E.
            • N Engl J Med 2011; 365:171 - 172

              In this issue of the Journal, Wechsler et al.1 report data from a study that compared four interventions involving patients with asthma (ClinicalTrials.gov number, NCT01143688). They found that three of the interventions — active albuterol, sham albuterol,...

            • Clinical Implications of Basic Research

              SHANK3, the Synapse, and Autism

              Autism spectrum disorders present a paradox of great heterogeneity and great specificity. Well over 100 genetic disorders yield an autism phenotype, most through specific but distinct mechanisms, and many of which affect the synapse. SHANK3 (SH3 and multiple ankyrin repeat domains 3) is known to be…

              • July 14, 2011
              • Herbert M.R.
              • N Engl J Med 2011; 365:173 - 175

                Variants of SHANK3, a gene encoding a structural component of the postsynaptic density, have been associated with autism. Mice engineered to carry mutant genes showed autism-like behavioral features that included repetitive grooming and disinclination to socialize.

              • Case Records of the Massachusetts General Hospital

                Case 18-2011 — A 35-Year-Old HIV-Positive Woman with Headache and Altered Mental Status

                Presentation of Case. Dr. Mikael Rinne (Neurology): A 35-year-old right-handed woman with human immunodeficiency virus (HIV) infection was admitted to this hospital because of headache and altered mental status after a motor vehicle accident. Earlier that day, while driving without a seatbelt, the…

                • June 16, 2011
                • Costello D.J., Gonzalez R.G., Frosch M.P.
                • N Engl J Med 2011; 364:2343 - 2352
                • CME

                A 35-year-old woman with stable HIV infection was admitted to this hospital because of headache and altered mental status. Brain imaging revealed diffuse white-matter abnormalities. A diagnostic test was performed.

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              Medical Meetings Conferences and Meetings

              American Association for the Study of Liver Diseases

              The following courses will be offered in Atlanta, unless otherwise indicated: "Hepatitis Single Topic Conference: HCV Direct Antiviral Agents (DAA): Concepts, Development and Optimal Use" (March 16 and 17); "The Henry M. and Lillian Stratton Basic Research Single Topic Conference: Mitochondria and Hepatotoxicity" (June 8 and 9); "Clinical Research Single Topic Conference: Acetaminophen Poisoning" (June 9 and 10); and "63rd Annual Meeting of the American Association for the Study of Liver Diseases: The Liver Meeting 2012" (Boston, Nov. 9-13).

              Contact AASLD, 1001 North Fairfax St., Suite 400, Alexandria, VA 22314; or call (703) 299-9766; or see http://www.aasld.org .

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