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October 18, 2001  Vol. 345 No. 16

Original Articles
1147-1154

This study of ground chicken, turkey, beef, and pork purchased from supermarkets in the Washington, D.C., area showed that 20 percent of the samples contained salmonella of 13 different serotypes. Eighty-four percent of the isolates were resistant to at least one antibiotic, and more than half were resistant to three or more antibiotics.

1155-1160

Quinupristin-dalfopristin was approved two years ago for use in vancomycin-resistant Enterococcus faecium infections, but a related streptogramin has been used for decades as a growth promoter in farm animals. In this study, cultures of samples from chickens purchased at supermarkets in four states identified quinupristin-dalfopristin–resistant E. faecium in at least 17 percent of the samples in each state. Low-level resistance in E. faecium was also identified in 1 percent of 334 stool samples from outpatients.

1161-1166

Antibiotic-resistant organisms are often found in retail meats, but it has been unclear whether the ingestion of these organisms has any clinical consequences. Resistant strains of E. faecium obtained from raw chicken and pork were ingested by 12 healthy volunteers. Various concentrations of these strains were isolated from stool samples for up to two weeks.

1167-1175

Up to half of people with classic Ehlers–Danlos syndrome, a condition marked by hyperextensible skin, hypermobile joints, and tissue fragility, have mutations of the genes for type V collagen, raising the possibility that other genes may also be involved. Because tenascins are extracellular-matrix proteins with high levels of expression in connective tissues affected in the Ehlers–Danlos syndrome, these investigators searched for genetic defects in tenascin-X as a potential cause. Tenascin-X deficiency was found in 5 unrelated patients with the Ehlers–Danlos syndrome (of 151 screened), all of whom had distinct mutations in the tenascin-X gene.

Images in Clinical Medicine
1176
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Figure 1. A 78-year-old woman has colicky right-flank pain associated with nausea and vomiting. What does the abdominal radiograph show?

Review Articles
1177-1183

Streptococcus pneumoniae accounts for half of all cases of acute otitis media, and it remains a major cause of illness and death in children. The strategies for prevention now include the use of a conjugate vaccine to induce immunity in infants, who are the group at highest risk.

1184-1192

The French neurologist Georges Gilles de la Tourette first described this syndrome, which consists of motor tics sometimes accompanied by uncontrollable noises or utterances, attention-deficit–hyperactivity disorder, obsessive–compulsive disorder, and poor impulse control. Although the pathogenesis of the disorder remains obscure, tics may be treated effectively with haloperidol or pimozide, and other clinical features may also respond to pharmacologic therapy.

Case Records of the Massachusetts General Hospital
1193-1200

Presentation of Case

A 77-year-old man was transferred to this hospital because of worsening bilateral air-space disease and acute renal failure.

He had stopped smoking 30 years before admission. He had mild chronic obstructive pulmonary disease; ...

Editorials
1202-1203

Antimicrobials have been used in food animals in North America and Europe for nearly half a century. Among the most common are drugs that are either identical to or related to those administered to humans, including penicillins, tetracyclines, ...

1203-1205

In 1972, the first biochemical abnormality to be identified in a form of the Ehlers–Danlos syndrome, a deficiency of lysyl hydroxylase, a collagen-modifying enzyme, was described in the Journal.1 Many other forms of the syndrome have since been ...

Clinical Implications of Basic Research
1206-1207

    The genomic sequences of more than 30 bacterial species, including virtually all important human pathogens, have been deciphered. The pneumococcus, discovered in 1880 virtually simultaneously by Pasteur in France and Sternberg in the United States and ...

    Correspondence
    1209-1211

    To the Editor: Ridker and colleagues (June 28 issue)1 demonstrated that the rate of acute coronary events among subjects with a base-line low-density lipoprotein (LDL) cholesterol level below 149.1 mg per deciliter and a C-reactive protein level above ...

    1211-1212

    To the Editor: Green et al. (June 28 issue)1 may have severely underestimated how the changes in medicine and society have affected emergency medicine. In their reanalysis of the monthly prevalence of illness in the community and the roles of various ...

    1212-1213

    To the Editor: Rogan et al. (May 10 issue)1 conclude that chelation therapy with succimer for children with lead levels of 20 to 44 μg per deciliter is valueless. However, an important methodologic weakness of their study is that succimer therapy failed ...

    1213-1214

    To the Editor: PC-SPES is a commercially available nutritional supplement containing eight herbs that is used by many patients with prostate cancer. It has potent estrogenic activity and substantial antineoplastic effects in patients with prostate ...

    1214-1215

    To the Editor: A 63-year-old man with a dense left hemiplegia from a stroke two and a half years earlier was seen in the clinic in May 2000 with clinical evidence of relapsed malignant melanoma of the scalp. Stage II malignant melanoma over the vertex ...

    Book Reviews
    1216
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    Adrenal Disorders reflects developments in the understanding of adrenal physiology that have gathered momentum in the past 10 years and parallel major advances in molecular biology. The book includes new insights into a number of clinical conditions, ...

    1216-1217
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    The use of imaging technology in the investigation of disorders of the head and neck has increased awareness of nodular thyroid disease in all areas of medicine. But are there enough important unanswered questions about thyroid cancer and has there been ...

    1217-1218

    One of the highlights among the remarkable achievements in medicine over the past four decades has been the development of antihypertensive agents. Since the introduction of these agents into clinical practice, cardiovascular mortality in this country has ...