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December 6, 2001  Vol. 345 No. 23

Original Articles
1655-1659

Metastatic renal-cell cancer resists cytotoxic chemotherapy and radiotherapy but can respond to various forms of immunotherapy. This prospective, randomized trial found that nephrectomy plus immunotherapy with interferon alfa-2b can prolong survival over that with immunotherapy alone.

1660-1666

Invasive fungal infections cause substantial morbidity and mortality in preterm infants. In this single-center, double-blind, placebo-controlled trial, extremely-low-birth-weight preterm infants who were given the antifungal agent fluconazole prophylactically for six weeks had significantly lower rates of fungal colonization and systemic fungal infection than control infants, without development of resistance to fluconazole or adverse effects on liver enzymes.

1667-1675

Angiotensin II may contribute to the progression of heart failure. In this trial, valsartan, an angiotensin-receptor blocker, reduced the need for hospitalization for heart failure but had no effect on overall mortality. According to a post hoc analysis, patients treated with valsartan who were also receiving both an angiotensin-converting–enzyme (ACE) inhibitor and a beta-blocker had increased mortality; patients receiving one or neither of these types of drugs had reduced mortality.

Images in Clinical Medicine
1676

Figure 1. An obese 82-year-old woman with a history of hypertension and type 2 diabetes mellitus had had dyspnea on exertion and swelling of her legs for three to four months. Transthoracic echocardiography revealed a right atrial mass with extension into ...

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A liver abscess with a fishbone in a man with abdominal pain.

Clinical Practice
1677-1682

A 65-year-old man requires resection of an abdominal aortic aneurysm. He has a remote history of myocardial infarction and rare episodes of angina. Recent coronary angiography revealed more than 70 percent stenosis of the left circumflex artery. What can be done to minimize this patient's risk of perioperative cardiac complications?

Review Articles
1683-1688

    Mesenteric venous thrombosis usually involves the superior mesenteric vein, with the danger of bowel infarction. The newer imaging techniques allow earlier diagnosis. A predisposing condition (such as a prothrombotic state, pancreatitis, and recent abdominal surgery) can be identified in most patients. Treatment involves anticoagulation, and surgery may be avoided if the correct diagnosis is made early.

    1689-1697

    The potent mineralocorticoid aldosterone has a multifaceted role in the pathogenesis of congestive heart failure. In addition to its contribution to salt and water retention, it also promotes organ fibrosis. Although angiotensin-converting–enzyme inhibitors have important therapeutic benefit in heart failure, they do not eliminate the effects of aldosterone. Thus, recent studies have underscored the value of aldosterone-receptor antagonists, such as spironolactone, in the treatment of chronic heart failure. This review article gives an in-depth update on the mechanisms of action of aldosterone and their implications for therapy.

    Editorial
    1699-1700

    Most patients who die of cancer die because of metastatic disease, and therefore removal of the primary tumor in patients who already have evidence of metastasis seems illogical, at least in the absence of symptoms caused by the primary tumor. Many ...

    Sounding Board
    1701-1704

      “Equality between mental health coverage and other health coverage is an affordable and effective objective,” according to a 1999 report by the Surgeon General.1 On the basis of this conclusion and because of the limited effect of the Mental Health Parity ...

      Correspondence
      1706-1707

      To the Editor: Modan and colleagues (July 26 issue)1 conclude that oral contraceptives do not protect against ovarian cancer in Israeli Jewish women carrying BRCA mutations. We have shown, in two studies of Jewish and non-Jewish women with BRCA mutations,...

      1707-1708
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      To the Editor: The review of autoimmunity by Davidson and Diamond (Aug. 2 issue)1 leaves many points open for debate. The field has never properly come to grips with the question of whether antibodies can damage or impair intact cells by binding to ...

      1708-1709

      To the Editor: The review article by FitzGerald and Patrono (Aug. 9 issue)1 on the coxibs, selective inhibitors of cyclooxygenase-2 (COX-2), included a table listing pharmacokinetic and metabolic features as well as drug interactions. According to the ...

      1709-1710

      The medical mystery in the October 18 issue1 involved a 78-year-old woman with hypertension and diabetes who was hospitalized with cellulitis of her left lower leg. Colicky right-flank pain associated with nausea and vomiting developed. Intravenous ...

      1710

      To the Editor: The letter by Boyer et al. (Aug. 9 issue)1 decrying the prevalence of “partisan” sites on illicit-drug use neglected to mention that theoretically objective government sites contain misinformation about drugs as well. For example, the ...

      1711-1712

      To the Editor: In this issue of the Journal, Flanigan et al.1 report the results of a randomized trial conducted by the Southwest Oncology Group (SWOG), which compared interferon alone with nephrectomy followed by interferon for the treatment of ...

      Book Reviews
      1713
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      Neurologic disease complicating human immunodeficiency virus (HIV) infection is common. Clinically significant neurologic disease ultimately affects up to 60 percent of HIV-infected persons, and pathological evidence of nervous system involvement at ...

      1714

      Severe Community Acquired Pneumonia is part of a series entitled “Perspectives on Critical Care Infectious Diseases.” The editor states that “the specific objective of this Series is to update therapeutic implications and discuss controversial topics in ...

      Corrections
      1716

      Treatment of Chronic Hepatitis C in Active Drug Users Sounding Board, N Engl J Med 2001:345;215-217.. On page 215, the sentence that begins 14 lines from the bottom of the right-hand column should have read, “Ho and colleagues reported that 68 percent of ...

      1716

      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 494, at the end of the Results section of the abstract, the percentages of ...