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April 11, 2002  Vol. 346 No. 15

Perspective
1102-1103

In the Book of Genesis, fish appeared in the waters on the fifth day of creation, after dry land and water separated. This may be the first reference to a functional, indeed lifesaving, food for humans. In the 19th century, New England ships harvested ...

Original Articles
1105-1112

It is uncertain whether male circumcision reduces the risk of penile human papillomavirus (HPV) infection and of cervical cancer in a man's female partner. The authors studied women and their male partners enrolled in seven case–control studies of cervical carcinoma in situ and cervical cancer in five countries in Europe, South America, and Asia. Circumcised men were significantly less likely than uncircumcised men to have penile HPV infection. Women whose partners had six or more lifetime sexual partners were less likely to have cervical cancer if their partners were circumcised than if they were uncircumcised.

1113-1118

Fish contains long-chain n–3 polyunsaturated fatty acids, which are believed to have antiarrhythmic properties and may reduce the risk of sudden death after myocardial infarction. This study shows that men without cardiovascular disease who have higher blood levels of n–3 fatty acids have a reduced risk of sudden death.

1119-1126

This randomized trial involved 160 patients with the acquired immunodeficiency syndrome (AIDS) and newly diagnosed cytomegalovirus retinitis. After four weeks, the response to induction therapy was satisfactory in 72 percent of patients who received oral valganciclovir, as compared with 77 percent of those who received intravenous ganciclovir. The median time to progression of retinitis was 160 days for the valganciclovir group and 125 days for the ganciclovir group.

Images in Clinical Medicine
1127

Figure 1. A 71-year-old man with a history of multiple myeloma and subsequent autologous bone marrow transplantation was evaluated for a facial rash in the distribution of the ophthalmic branch of the right trigeminal nerve (Panel A). The findings were ...

Special Articles
1128-1137

For surgical procedures, operative mortality varies inversely with the number of procedures performed at a hospital. This study quantified the relation between volume and outcome among Medicare patients for 14 different surgical procedures. The relative effect of surgical volume on outcome varied markedly among types of procedures. For pancreatic resection, the absolute difference in mortality rates between the highest-volume and the lowest-volume hospitals was over 12 percent, whereas for carotid endarterectomy, the difference was only 0.2 percent.

1138-1144
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Radical prostatectomy is commonly performed in men with early-stage prostate cancer. This study assessed the outcome of surgery in relation to the number of prostatectomy procedures performed at individual hospitals (hospital volume) and by individual surgeons (surgeon volume). Neither hospital volume nor surgeon volume was related to operative mortality. However, postoperative complications and late urinary complications were more common in patients treated at low-volume hospitals or by low-volume surgeons than in those treated at high-volume hospitals or by high-volume surgeons.

Clinical Practice
1145-1151

    A 60-year-old man with recently diagnosed type 2 diabetes mellitus has a serum creatinine level of 1.5 mg per deciliter (133 μmol per liter), and a dipstick test shows proteinuria (++). His blood pressure is 150/90 mm Hg. He smokes half a pack of cigarettes daily. What can be done to reduce the risk of progressive renal disease?

    Case Records of the Massachusetts General Hospital
    1152-1158

    Presentation of Case

    A 27-year-old woman was admitted to the hospital because of syncope and two intracardiac masses.

    The patient had been well until about three years before admission, when she had an episode of numbness in the lower left area of the ...

    Editorials
    1160-1161

      Male circumcision is probably one of the oldest surgical procedures and is still the most common. Globally, about one man in four is likely to undergo circumcision for various reasons.1 In the United States, an estimated 80 percent of all newborn boys ...

      1161-1164

      The volume–outcome hypothesis has created a policymaker's dilemma. In 1979, Luft and colleagues1 reported in the Journal that the number of procedures performed at a hospital (hospital volume) and mortality rates for many surgical procedures were ...

      Sounding Board
      1165-1168

      Primary care practitioners in several states have recently decided to restructure their practices in a way that enables them to see a much smaller number of patients and to spend more time with the ones they do see. Patients enrolled in these practices, ...

      Correspondence
      1169-1171

      To the Editor: The conclusions in the Abstract of the article by Mohr et al. (Nov. 15 issue)1 overstate the benefits of anticoagulation. They state that the authors “found no difference between aspirin and warfarin in the prevention of recurrent ischemic ...

      1171-1173

      To the Editor: The study by in 't Veld et al. (Nov. 22 issue)1 on the prevention of Alzheimer's disease with nonsteroidal antiinflammatory drugs (NSAIDs) includes no mortality data. It is entirely possible that patients who received long-term treatment ...

      1173-1174

      To the Editor: Cohn and Tognoni (Dec. 6 issue)1 found that the angiotensin-receptor blocker valsartan reduced the combined end point of mortality and morbidity and improved clinical signs and symptoms in patients with heart failure when it was added to ...

      1174-1175

      To the Editor: Dysphagia occurs in more than 50 percent of patients with Parkinson's disease.1 Although all the phases of swallowing can be involved, dysphagia due to hyperactivity of the upper esophageal sphincter is the prevalent abnormality.1

      ...

      1175-1176

      To the Editor: Dosing errors are among the most common types of medication errors.13 Errors by a factor of 10 (the administration of a dose 10 times or 1/10 as high as appropriate) are of particular concern.4 There is a greater chance that an infant or ...

      Book Reviews
      1177

      The term “movement disorders” refers to a heterogeneous group of neurologic conditions that share the clinical presentation of involuntary movements and that are presumed to arise from pathophysiologic abnormalities in the basal ganglia or extrapyramidal ...

      1177-1178
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      Few physicians talk about the clinical use of touch, and few medical schools teach it specifically, even though touch is a unique tool for diagnosis and therapeutic applications, as well as a means of communicating a caring attitude. In the poem “Line ...

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