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April 18, 2002  Vol. 346 No. 16

Perspective
1182-1183

Over the past two decades, percutaneous coronary intervention has revolutionized the treatment of symptomatic coronary artery disease, sparing countless patients the need for surgical revascularization. This year, up to a million procedures are likely to ...

Original Articles
1185-1193

Gene therapy was used in five boys with X-linked severe combined immunodeficiency disease. In this disorder, a mutation disables the common γ (γc) chain, a component of five cytokine receptors that are essential for the development of T cells and natural killer cells. The disease is fatal within the first year of life unless treated with bone marrow transplantation. The immune system was restored in four patients, who remain well and have required no further treatment during follow-up of up to two years.

1194-1199

Obstructive lesions in saphenous-vein bypass grafts are a common long-term complication of coronary bypass surgery. Stenting is often performed, but its benefit is limited by restenosis. This placebo-controlled trial evaluated treatment with intravascular gamma radiation for the prevention of in-stent restenosis in coronary bypass grafts. Radiation therapy reduced the rate of restenosis and the rate of subsequent revascularization over a 12-month period.

1200-1206
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In a longitudinal study at an elementary school in Pittsburgh, group A streptococci with resistance to erythromycin were unexpectedly identified in surveillance throat cultures in January 2001. Through May 2001, nearly half the isolates were resistant to erythromycin, and 22 of 46 children with resistant isolates had multiple cultures that were positive for this resistant streptococcus.

1207-1210

A patient infected with the human immunodeficiency virus (HIV) who had xerostomia and enlargement of the parotid glands underwent a diagnostic biopsy of a labial salivary gland. Within six days, a rapidly growing, fungating mass had appeared at the biopsy site. The lesion had the histologic features of Kaposi's sarcoma and contained antigens of human herpesvirus 8. After treatment with local radiotherapy, the lesion resolved.

Images in Clinical Medicine
1211
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Figure 1. A 77-year-old woman was referred for the evaluation of an abnormal shadow on the left cardiac border on chest x-ray films that had gradually developed over a seven-year period (arrow in Panel A). She had no history of Kawasaki's disease or chest ...

Review Articles
1212-1220

    Schistosomiasis is a parasitic-worm infection that affects about 200 million people in 74 countries. Despite major advances in treatment and control, this tropical disease continues to spread to new geographic areas. This review summarizes the manifestations of this disease, its diagnosis, medical treatment, and prophylaxis, and the prospects for a vaccine.

    1221-1231

    Alcohol abuse is the most common cause of fatty liver disease, but it is now apparent that fat deposition in the liver, and its consequences, may occur without alcohol abuse. The principal risk factors are obesity, non-insulin-dependent diabetes mellitus, and hyperlipidemia. The disorder has a wide clinical spectrum, ranging from asymptomatic steatosis to steatohepatitis, fibrosis, and cirrhosis. This article provides a broad overview of this increasingly recognized liver disease.

    Case Records of the Massachusetts General Hospital
    1232-1239

    Presentation of Case

    A 50-year-old man was admitted to the Tropical and Geographic Medicine Center of this hospital because of eosinophilia and fluctuating hepatic lesions.

    The patient had been well until 10 months earlier, when he was splashed in the ...

    Editorials
    1241

    In this issue of the Journal, readers will find a quiz based on the article entitled “Nonalcoholic Fatty Liver Disease,” by Angulo. This marks the beginning of a new continuing-medical-education (CME) program that will feature questions on three of the ...

    1241-1243

    Infants with severe combined immunodeficiency are unable to mount an adaptive immune response, because they have a profound deficiency of lymphocytes. These babies usually die within a year from a sustained onslaught of opportunistic infections, but death ...

    1243-1245

    Too often antibiotics, remarkable therapies that can cure deadly and disabling infections, are used to satisfy patients' needs rather than out of clinical necessity. This practice translates into the excessive use of antibiotics for acute respiratory ...

    Correspondence
    1247-1248

    To the Editor: Goodwin et al. (Dec. 13 issue)1 report that support groups do not improve survival among women with metastatic breast cancer. We applaud this work but would like to raise several issues regarding its goals and conclusions. The ...

    1248-1251

    To the Editor: Hasbun et al. (Dec. 13 issue)1 show that in adults with suspected meningitis, clinical findings can guide the decision to perform cranial computed tomography (CT) before lumbar puncture. However, the results should not form the basis for ...

    1251-1252

    To the Editor: Petersdorf et al. (Dec. 20 issue)1 suggest that for patients with chronic myelogenous leukemia for whom a donor with an HLA class I mismatch cannot be avoided, “the preferred . . . mismatch should be at a locus for which the recipient is ...

    1252-1253

    To the Editor: Portal–mesenteric venous thrombosis, a devastating complication of hypercoagulable states, is a good target for minimally invasive treatment. Kumar et al. (Dec. 6 issue)1 ignored a growing body of work indicating that catheter-based ...

    1253-1254

    To the Editor: In a 34-year-old woman with a history of alcohol abuse, cardiomyopathy, and AIDS, acute respiratory failure developed as a result of Escherichia coli sepsis and pneumonia. Initial laboratory studies revealed a pH of 7.2, a bicarbonate ...

    1254-1255

    To the Editor: The popliteal-artery entrapment syndrome is a potentially serious but rare cause of ischemia of the legs.1 It occurs predominantly in young persons and is due to an abnormal anatomical relation between the popliteal artery and the ...

    Book Reviews
    1256

    If you wanted to cause an epidemic of multidrug-resistant tuberculosis in a country, what would you do? First, you would create a social and economic environment that promotes poverty and inequity. Second, you would temporarily subject those who have ...

    1256-1257
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    What is malaria? The answer to this seemingly simple question is, in fact, quite complex, for it depends to a large extent on who is infected. It is particularly difficult for reference books to describe a “typical” patient with malaria, since plasmodium ...

    1257-1258

    More than 2 billion people worldwide are infected with either hepatitis B virus (HBV) or hepatitis C virus (HCV) or both, and an estimated 500 million (about 3 million in the United States alone) have chronic infection with these viruses. The principal ...

    Corrections
    1258

    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 87-year-old man in generation III ...

    1258

    Bosentan Therapy for Pulmonary Arterial Hypertension Original Article, N Engl J Med 2002:346;896-903.. On page 896, the dose in the fifth line of the Methods section of the Abstract should have read, “62.5 mg of bosentan twice daily for 4 weeks,” not “...