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November 22, 2001  Vol. 345 No. 21

Original Articles
1515-1521

In this prospective cohort study of 6989 subjects 55 years old or older, the risk of Alzheimer's disease was reduced significantly among those who were long-term users of nonsteroidal antiinflammatory drugs. There was no significant reduction in risk among those with less than 24 months' cumulative use of these medications, and there was no evidence of a protective effect against the development of vascular dementia.

1522-1528

In a cohort of 1028 children and adolescents infected with human immunodeficiency virus type 1 (HIV-1), the use of combination therapy including protease inhibitors increased from 7 percent in 1996 to 73 percent in 1999. Over the four-year period, mortality declined from 5.3 percent to 0.7 percent. This analysis was adjusted for multiple potentially confounding variables; the authors estimate that the use of combination therapy including protease inhibitors in HIV-1–infected children reduces the risk of death by 67 percent.

1529-1536
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This double-blind, placebo-controlled trial involved 2032 patients with asthma. The participants received the inactivated influenza vaccine and placebo in random order, with a mean of 22 days between injections. The frequency of exacerbations of asthma was similar in the two weeks after influenza vaccination (28.8 percent) and after the placebo injection (27.7 percent).

1537-1541

Embryos that are transferred after in vitro fertilization frequently fail to implant in the uterus; in many cases, this failure is due to chromosomal abnormalities in the embryo. The current methods of diagnosis of aneuploidy cannot detect many chromosomal abnormalities. This report on the case of a 38-year-old woman with a long history of infertility describes the use of comparative genomic hybridization to determine that all the chromosomes of a single embryo were free of aneuploidy, resulting in the birth of a healthy infant.

Images in Clinical Medicine
1542
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Figure 1. A 55-year-old man had a one-month history of painless jaundice. Endoscopic ultrasonography showed a 2.5-cm lesion in the head of the pancreas. Biopsy of the pancreas confirmed the diagnosis of adenocarcinoma. A digital subtraction angiographic ...

Clinical Practice
1543-1547

    A healthy 33-year-old woman who works in an office asks whether she should receive influenza vaccine. What should she be advised?

    Review Article
    1548-1557

    Fenoldopam is a peripherally acting dopamine-receptor agonist that has vasodilator and diuretic actions. Given intravenously, it is an effective treatment for patients with severe hypertension, including those with hypertensive encephalopathy and perioperative hypertension. This review summarizes the pharmacologic characteristics of fenoldopam and its efficacy as a treatment for patients with severe hypertension.

    Case Records of the Massachusetts General Hospital
    1558-1565

    Presentation of Case

    A 57-year-old man was admitted to the hospital, for the sixth time, in January because of fever and cough.

    The patient had a 25-year history of seronegative rheumatoid arthritis and a 20-year history of diabetes mellitus type 2, ...

    Editorials
    1567-1568

    In this issue of the Journal, in 't Veld and colleagues1 report the results of a long-term prospective study of the relation between the use of nonsteroidal antiinflammatory drugs (NSAIDs) and the onset of Alzheimer's disease. This important article ...

    1568-1569

    It has been nearly 20 years since the first cases of AIDS were reported in children in the United States, and the face of pediatric human immunodeficiency virus type 1 (HIV-1) infection has changed markedly. During the first 15 years of the epidemic, ...

    1569-1571

    Currently, the most common techniques for prenatal diagnosis are amniocentesis, performed between 14 and 22 weeks' gestation, and chorionic-villus sampling, performed between 14 and 20 weeks' gestation. Although generally regarded as safe, both of these ...

    Correspondence
    1573-1575

    To the Editor: In the randomized Treat Angina with Aggrastat and Determine Cost of Therapy with an Invasive or Conservative Strategy–Thrombolysis in Myocardial Infarction 18 (TACTICS–TIMI 18) trial, Cannon et al. (June 21 issue)1 compared the effects of ...

    1575-1576

    To the Editor: In their article on the cardiovascular complications of cocaine use, Lange and Hillis (Aug. 2 issue)1 have not presented a balanced review of the controversial aspects of the management of acute coronary syndromes, particularly myocardial ...

    1576
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    To the Editor: In the Clinical Problem-Solving article by Nallamothu et al. (Aug. 2 issue),1 the discussant rightly points to the need for a rapid diagnosis of cardiac tamponade. However, among all the complex and costly tests listed, there is no mention ...

    1576-1577

    To the Editor: In his editorial (Aug. 2 issue), Dr. Welch addresses the misuse of private medical records and states that “no other developed nation would tolerate this abridgment of individual rights.”1 In a harmless but frightening way, the AstraZeneca ...

    1577

    To the Editor: In an otherwise excellent discussion of strychnine poisoning in Case 12-2001 (April 19 issue),1 a diagnosis is assigned that is unsupported by the data provided. The case concerned a 16-year-old boy with confusion. The boy, who was born in ...

    1577-1578

    To the Editor: Langerhans'-cell histiocytosis, previously called histiocytosis X, is an accumulation of dendritic Langerhans' cells and granulomatous lesions in various organs; its cause is unknown. The three-year survival rate among children with ...

    Book Reviews
    1579

    Remarkable progress has been made in the understanding and management of congenital heart disease since the first edition of Congenital Diseases of the Heart was published 25 years ago. With the ability of cardiac ultrasonography to define the anatomy of ...

    1579-1580

    Interest in biochemical markers in cardiology has increased tremendously in the past decade. Previously, biochemical markers were used mainly for retrospective verification of acute myocardial infarction. However, as more specific and sensitive markers of ...

    1580
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    Several large textbooks of cardiology — or more accurately, cardiovascular disease — have been published in the past few years. This book is an entirely new textbook with a modern and carefully constructed format.

    Books on cardiology during the earlier ...

    Corrections
    1580

    This Week in the Journal (August 23, 2001;345:553-4). In the figure that accompanies the editor's summary of The Pathogenesis of Vasodilatory Shock on page 554, the arrow next to “Vasopressin” should have pointed down, not up, as printed. We regret the ...

    1580

    Gastroesophageal Variceal Hemorrhage Review Article, N Engl J Med 2001:345;669-681.. On page 671, in Table 1, the units for albumin should have read, “g/dl,” not “g/liter,” as printed. We regret the error.

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