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November 15, 2001  Vol. 345 No. 20

Original Articles
1435-1443

Mechanical left ventricular assist devices have been used as a bridge to cardiac transplantation, but not as long-term therapy. In this study of patients with severe heart failure who were not candidates for transplantation, left ventricular assist was compared with optimal medical therapy. The one-year survival rate was 52 percent in the device group and 25 percent in the medical-therapy group. The device permitted patients to be ambulatory and improved the quality of life.

1444-1451

Patients who have had an ischemic stroke are at risk of having another. Warfarin is the treatment of choice for the prevention of recurrent cardioembolic stroke. In this study, warfarin and aspirin were compared in the prevention of recurrent ischemic stroke due to causes other than cardioembolism. There was no significant difference between the warfarin and aspirin groups in either the rate of recurrence of ischemic stroke or the rate of hemorrhagic complications.

1452-1457

Chronic infection often develops in people who are infected with the hepatitis C virus (HCV). Such infection is difficult to eradicate and can eventually lead to end-stage liver disease. In this study, 44 patients with acute hepatitis C received 24 weeks of treatment with interferon alfa-2b in an attempt to prevent chronic infection. At the end of therapy, as well as 24 weeks later, 43 of the patients had undetectable levels of HCV RNA in serum.

1458-1463

A 19-year-old woman with an aggressive lymphoma received a bone marrow transplant from her sister. Three and a half years later subcutaneous panniculitic T-cell lymphoma was diagnosed in the donor; the same rare tumor appeared in the recipient four and a half years after transplantation. The tumors had identical molecular features.

Images in Clinical Medicine
1464
  • Free Full Text

Figure 1. A 55-year-old man had blue-gray discoloration of the auricular and periauricular areas of his ears. In 1985, he had had a large anterior myocardial infarction during aortic-valve replacement. Three years later, he had begun to take 400 mg of ...

Review Articles
1465-1472

    One cause of pulmonary hypertension is chronic thromboembolic obstruction of the pulmonary arteries. If this condition is recognized, thromboendarterectomy can lead to improvements in hemodynamics and in survival.

    1473-1482

      This review article summarizes important changes in our approach to the serious public health problem of sudden death from ventricular arrhythmias.

      Case Records of the Massachusetts General Hospital
      1483-1488

      Presentation of Case

      An 81-year-old man was transferred to the hospital because of bradycardia, hypothermia, and increasing confusion.

      A platelet count of 85,000 per cubic millimeter had been discovered five years before admission, but no cause had been ...

      Editorials
      1490

      The tragic events of September 11 have affected all our lives. In this issue of the Journal, we provide a quantitative look, in a Special Report by Schuster et al.,1 at the initial reactions of Americans to these events. The data from the survey conducted ...

      1490-1493

      Statistics on the human and economic impact of the syndrome of heart failure in the United States have been well described, but they deserve further emphasis.1 The incidence of heart failure approaches 10 per 1000 population after the age of 65 years, so ...

      1493-1495

      This year in the United States, 450,000 people will have a first ischemic stroke.13 For these patients (including those receiving thrombolytic therapy), the primary therapeutic goals will be rehabilitation and the prevention of another stroke. The ...

      1495-1497

      Infection with the hepatitis C virus (HCV) is now the most frequent cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma in the United States and most Western nations.13 Population-based surveys show that 1 to 2 percent of adults in the ...

      Correspondence
      1498-1500

      To the Editor: At first glance, the data of Meijers-Heijboer and colleagues (July 19 issue)1 appear to support the position that prophylactic mastectomy reduces the risk of breast cancer in carriers of a BRCA mutation. On close reading of the article, ...

      1500-1501

      To the Editor: Kreitman et al. (July 26 issue)1 report that an anti-CD22 recombinant immunotoxin (BL22) induced complete remissions in 11 of 16 patients with hairy-cell leukemia that was resistant to cladribine. Although BL22 represents an exciting new ...

      1501-1502

      To the Editor: When discussing indications for the treatment of latent tuberculosis infection, Small and Fujiwara (July 19 issue)1 follow the joint statement of the American Thoracic Society and the Centers for Disease Control and Prevention (CDC)2 in ...

      1502-1503

      To the Editor: Arzoo et al. (July 19 issue)1 report on a 23-year-old woman with Langerhans'-cell histiocytosis and severe pain due to osteolytic lesions, who had a good response to a 90-mg infusion of pamidronate. Although the literature on the use of ...

      1503-1504

      To the Editor: Portal hypertension is a frequent consequence of cirrhosis and may lead to dilated venous collaterals. Usually, varices due to portal hypertension develop in the lower esophagus, stomach, or rectum and rarely in other parts of the ...

      1504

      To the Editor: I have a private practice, with two other family physicians, in an office in the financial district of lower Manhattan, five blocks (300 m) from the site of the World Trade Center. Most of our patients work or live in lower Manhattan, ...

      Book Reviews
      1505

      The first impression this book makes is one of hugeness: it is huge in size, huge in scope, and huge in vision. This set of volumes, which weighs in at 16 kg (35 lb) and is too large to carry to one's car without advance planning, is no vade mecum. In the ...

      1506

      Barrett's esophagus, a medical curiosity since its initial description in the early 1950s, has emerged as an intensively studied condition. Several factors might explain this transformation. First, Barrett's esophagus is one of the most easily studied ...

      Corrections
      1506

      Mutation in the Gene for Bone Morphogenetic Protein Receptor II as a Cause of Primary Pulmonary Hypertension in a Large Kindred Original Article, N Engl J Med 2001:345;319-324.. On page 321, Figure 1 should have shown the 43-year-old man in generation III ...

      1506

      Effects of Clopidogrel in Addition to Aspirin in Patients with Acute Coronary Syndromes without ST-Segment Elevation Original Article, N Engl J Med 2001:345;494-502.. On page 502, 20 lines from the bottom of the left-hand column, “B. Pontillo” should have ...

      Special Report
      1507-1512

      After the September 11 terrorist attacks, Americans experienced symptoms of psychological stress. This survey of U.S. adults performed just five days after the attacks quantifies the extent of the stress reactions.

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