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Thyroid Screening and Childhood Cognitive Function

February 9, 2012 | J.H. Lazarus
and Others

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.

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clinical implications of basic research

Gene Therapy Meets Stem Cells

February 9, 2012 | R.A. Sandhaus

The holy grail of gene therapy is the treatment of disease caused by genetic mutations. A recent study in mice provides proof of principle that alpha1-antitrypsin deficiency can be corrected, if not cured, by the infusion of autologous induced pluripotent stem cells.

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Let’s Move — Childhood Obesity Prevention from Pregnancy and Infancy Onward

April 22, 2010

The authors argue that to alter the course of the childhood obesity crisis, prevention efforts must target the youngest Americans — those under 2 years of age and preschoolers.

clinical practice

Delayed Puberty

February 2, 2012 | M.R. Palmert
and L. Dunkel

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.

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correspondence

CSF Glucose and Serum Glucose

February 9, 2012 | L.E. Nigrovic
and Others

Levels of glucose in the cerebrospinal fluid (CSF) are used to discriminate bacterial meningitis from viral meningitis. The relationship between levels of serum and CSF glucose in children is carefully examined in this study, which included more than 19,000 children.

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original article

Treatment of the Idiopathic Respiratory-Distress Syndrome with Continuous Positive Airway Pressure

June 17, 1971 | G.A. Gregory and Others

The investigators used CPAP to treat 20 infants severely ill with IRDS. Pao₂ increased in all, and 16 survived. CPAP had not been reported previously in the treatment of infants with IRDS.

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Images in Clinical Medicine
Deep Sulcus Sign
Figure 1.
- February 9, 2012
- Sabbar S. and Nilles E.J.
- N Engl J Med 2012; 366:552
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A 23-year-old man who been a passenger in a minivan was brought to the ER after a high-speed road accident. He had transient hypotension and tachycardia, which improved after the administration of intravenous fluids.
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Clinical Implications of Basic Research
Gene Therapy Meets Stem Cells
Stem cell–based therapies have the potential to repair and even correct the defects related to human diseases. Although tantalizing niche applications have moved forward in the clinical setting, progress seems to be slow, and ethical challenges have yet to be definitively addressed. The goal of…
- February 9, 2012
- Sandhaus R.A.
- N Engl J Med 2012; 366:567 - 569
The holy grail of gene therapy is the treatment of disease caused by genetic mutations. A recent study in mice provides proof of principle that alpha₁-antitrypsin deficiency can be corrected, if not cured, by the infusion of autologous induced pluripotent stem cells.
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Correspondence
Sildenafil for Severe Lymphatic Malformations
To the Editor: Lymphatic malformations are uncommon congenital vascular anomalies that can cause complications including obstruction of vital organs and their function, recurrent infection, and disfigurement. Current procedural treatments are only partially successful, and lymphatic malformations…
- January 26, 2012
- N Engl J Med 2012; 366:384 - 386
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Lymphatic malformations are rare but can cause significant clinical problems in addition to cosmetic disfigurement. Sildenafil was used in a child whose pulmonary hypertension was caused by lymphatic malformation; the result was a marked decrease in the lymphatic malformation.
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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.
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Images in Clinical Medicine
Pulmonary Cement Embolism after Vertebroplasty
Figure 1.
- January 19, 2012
- Tourtier J.-P. and Cottez S.
- N Engl J Med 2012; 366:258
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A 61-year-old man with spinal cord compression underwent therapeutic laminectomy of the fifth vertebra and laminectomy and vertebroplasty of the fourth vertebra. During the vertebroplasty, polymethylmethacrylate cement leaked into the paravertebral vascular system.
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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.
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Images in Clinical Medicine
Paragonimiasis
Figure 1.
- January 12, 2012
- Arango Barrientos M. and Uriza Carrasco A.
- N Engl J Med 2012; 366:165
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An 18-year-old man presented with a 1-year history of episodic hemoptysis. He otherwise felt well, with no dyspnea, fever, night sweats, weight loss, pedal edema, rash, or evidence of bleeding elsewhere. He took no medications. Laboratory examination ...
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Images in Clinical Medicine
Lung Herniation after Cough-Induced Rupture of Intercostal Muscle
Figure 1.
- January 5, 2012
- O'Shea M. and Cleasby M.
- N Engl J Med 2012; 366:74
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A 40-year-old woman with asthma presented with pleuritic chest pain of acute onset. She had been coughing markedly for 2 weeks and had been treated with antibiotics for a lower respiratory tract infection. There was no history of trauma.
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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
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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.
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Original Article
Low-Molecular-Weight Heparin and Mortality in Acutely Ill Medical Patients
Venous thromboembolism is an important complication in hospitalized patients.– It is estimated that if thromboprophylaxis is not administered, objectively diagnosed deep-vein thrombosis — with the potential for fatal pulmonary embolism — will develop in 10 to 20% of medical patients and in 40…
- December 29, 2011
- Kakkar A.K., Cimminiello C., Goldhaber S.Z., et al.
- N Engl J Med 2011; 365:2463 - 2472
- CME
Thromboprophylaxis with low-molecular-weight heparin is known to prevent deep-vein thrombosis in acutely ill medical patients. This large trial showed no effect of enoxaparin on 30-day mortality, which was virtually identical in the active-treatment and placebo groups.
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Images in Clinical Medicine
Pneumopericardium Associated with a Peptic Ulcer
Figure 1.
- December 22, 2011
- Andrianov A. and Nissenbaum M.A.
- N Engl J Med 2011; 365:2412
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A 63-year-old man with a history of peptic ulcer and recent use of NSAIDs presented to the emergency department with acute shortness of breath and chest pain. He had hypotension and tachycardia.
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Perspective
Smoking and the First Amendment
On June 22, 2009, President Barack Obama signed the Family Smoking Prevention and Tobacco Control Act into law. For the first time, Congress had given the Food and Drug Administration (FDA) authority to directly regulate tobacco products, with the aim of improving public health. And indeed,…
- December 22, 2011
- Outterson K.
- N Engl J Med 2011; 365:2351 - 2353
- Free Full Text
On November 7, a federal judge in Washington, D.C., issued a preliminary injunction blocking some key provisions of the Family Smoking Prevention and Tobacco Control Act as unconstitutional restrictions on commercial speech. The battle may end up in the Supreme Court.
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Interactive Medical Case
Breathless
A 50-year-old woman presented with fatigue and shortness of breath. One week before presentation, she experienced the gradual onset of dyspnea after moderate exertion, profound malaise, and a non-productive cough. In the 48 hours before admission, her shortness of breath worsened, such that she was…
- December 22, 2011
- Ross J.J., Vaidya A., Gavin M.C., Morse D., Partridge A.H.
- N Engl J Med 2011; 365:e47
- Free Full Text
- CME
A 50-year-old woman presented with fatigue and shortness of breath. One week before presentation, she experienced the gradual onset of dyspnea after moderate exertion, profound malaise, and a non-productive cough. In the 48 hours before admission, her ...
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Case Records of the Massachusetts General Hospital
Case 39-2011 — A Woman in Her 90s with Unilateral Ptosis
Presentation of Case. Dr. Xuemei Cai (Medicine): A woman in her 90s was seen in the emergency department at this hospital because of ptosis of the left eyelid. The patient had been in her usual health until 4 days earlier when, on awakening, she was unable to open her left eye. She reported no…
- December 22, 2011
- Venna N., Gonzalez R.G., Zukerberg L.R.
- N Engl J Med 2011; 365:2413 - 2422
A woman in her 90s came to the ER because of acute unilateral ptosis. During the next 8 weeks, weakness of the neck, fatigue, choking, and difficulty breathing developed, progressing to respiratory failure and death. An autopsy was performed.
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Original Article
CPAP for the Metabolic Syndrome in Patients with Obstructive Sleep Apnea
Obstructive sleep apnea is a highly prevalent but underrecognized clinical problem. The Wisconsin Sleep Cohort Study estimated a prevalence of 24% among men and 9% among women in that state. In an urban setting in northern India, the prevalence of obstructive sleep apnea and the obstructive sleep…
- December 15, 2011
- Sharma S.K., Agrawal S., Damodaran D., et al.
- N Engl J Med 2011; 365:2277 - 2286
Patients in this randomized, double-blind trial in India were treated for the obstructive sleep apnea syndrome with 3 months of continuous positive airway pressure (CPAP) or sham CPAP. CPAP therapy lowered blood pressure and ameliorated metabolic abnormalities.
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Perspective
The Risks and Benefits of Indacaterol — The FDA's Review
In July 2011, the Food and Drug Administration (FDA) approved Arcapta Neohaler (indacaterol maleate powder), a long-acting beta-agonist (LABA), at a dose of 75 μg once daily as a bronchodilator for patients with chronic obstructive pulmonary disease (COPD). Since the European Medicines Agency (EMA)…
- December 15, 2011
- Chowdhury B.A., Seymour S.M., Michele T.M., et al.
- N Engl J Med 2011; 365:2247 - 2249
- Free Full Text
- Audio
In July, the FDA approved Arcapta Neohaler (indacaterol maleate powder), a long-acting beta-agonist, at a daily dose of 75 μg for chronic obstructive pulmonary disease. Why was this dose selected, after the European Medicines Agency approved 150-μg and 300-μg doses?
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Images in Clinical Medicine
Disappearance of a Breast Prosthesis during Pilates
Figure 1.
- December 15, 2011
- Fong T.C. and Hoffmann B.
- N Engl J Med 2011; 365:2305
- Free Full Text
A 59-year-old woman with a history of breast cancer who had undergone bilateral mastectomy and placement of breast prostheses reported that her “body swallowed one of the implants” during a Pilates stretching exercise. The patient reported no chest pain or dyspnea.
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Case Records of the Massachusetts General Hospital
Case 38-2011 — A 34-Year-Old Man with Diarrhea and Weakness
Presentation of Case. Dr. Andrew Courtwright (Medicine): A 34-year-old man was admitted to this hospital because of diarrhea and weakness. Three days before admission, weakness developed in the patient's right hand, followed by increasing weakness in the left hand. During the next 2 days, weakness…
- December 15, 2011
- Ryan E.T., Cronin C.G., Branda J.A.
- N Engl J Med 2011; 365:2306 - 2316
- CME
A 34-year-old man was admitted to the hospital because of weakness, chronic diarrhea, and weight loss. Initial laboratory evaluation revealed a leukocytosis and hypokalemia. A diagnostic procedure was performed.
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Images in Clinical Medicine
Thrombosis of a Mechanical Mitral Valve
Figure 1.
- December 15, 2011
- Harris K.C. and Campbell A.I.M.
- N Engl J Med 2011; 365:e45
- Free Full Text
- Video
An 8-year-old girl with a history of congenital mitral stenosis and mitral-valve replacement presented with dyspnea on exertion, fatigue, and orthopnea. On examination, she had tachypnea, a heart rate of 130 bpm, and oxygen saturation of 85 to 87% while breathing ambient air.
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Special Article
The Relationship between Hospital Admission Rates and Rehospitalizations
Unplanned readmissions after hospitalization are costly and reflect suboptimal patient outcomes. Policymakers have focused on reducing readmissions as a way to both lower costs and improve outcomes. Evidence of suboptimal care at hospital discharge and shortly thereafter, has prompted clinical…
- December 15, 2011
- Epstein A.M., Jha A.K., Orav E.J.
- N Engl J Med 2011; 365:2287 - 2295
- Free Full Text
Hospital readmission rates are thought to reflect the quality of transitional care. In this study, readmission rates for congestive heart failure and pneumonia were associated with overall hospitalization rates. Interventions may best be focused on reducing incentives to use hospital services.
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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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