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May 23, 2002  Vol. 346 No. 21

Perspective
1606-1607

The spectrum of acute mountain sickness ranges from mild, nonspecific symptoms to high-altitude pulmonary edema and high-altitude cerebral edema. Most deaths from high-altitude illness occur with high-altitude pulmonary edema, the risk of which is related ...

Original Articles
1609-1615

In this study of 170 women with a BRCA1 or BRCA2 mutation that greatly increases the risk of ovarian and breast cancer, 98 elected to undergo salpingo-oophorectomy and 72 chose to undergo surveillance. During a follow-up of about two years, the risks of both breast and ovarian cancer were considerably lower among the women who underwent the surgical procedure than among those who chose surveillance.

1616-1622

Among 551 women with a disease-associated mutation in the BRCA1 or BRCA2 gene who were followed for at least eight years, the at least incidence of ovarian cancer was significantly lower in the group that underwent prophylactic bilateral oophorectomy than in the comparison group of women who did not undergo the surgery. In a subgroup of these women, prophylactic oophorectomy also reduced the risk of breast cancer.

1623-1630

Patients who undergo gastric bypass surgery have dramatic and sustained weight loss. They feel less hungry after eating, although they still perceive foods with high caloric value as enjoyable. Ghrelin is an orexigenic hormone whose levels in normal subjects increase before meals and decrease after meals. In this study of patients who achieved stable weight after gastric bypass surgery, circulating ghrelin levels were low and did not show meal-related periodicity.

1631-1636

High-altitude pulmonary edema occurs in otherwise healthy persons when they are at high elevations. Since β-adrenergic agonists increase clearance of alveolar fluid and attenuate pulmonary edema in animal models, these investigators studied the effect of inhaled salmeterol (a β-adrenergic agonist) or placebo in 37 subjects who were prone to high-altitude pulmonary edema. In addition, nasal transepithelial potential difference, a marker of fluid clearance in distal airways, was studied in 33 mountaineers who were susceptible to this condition and 33 who were resistant to the condition. Prophylactic inhalation of salmeterol halved the incidence of high-altitude edema in susceptible subjects. Nasal transepithelial potential difference was significantly lower in susceptible subjects.

Images in Clinical Medicine
1637
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Figure 1. A 45-year-old woman had had intermittent dysphagia for two years. Physical examination revealed a blood pressure of 104/72 mm Hg in the right arm and 120/80 mm Hg in the left. A barium swallow revealed an aberrant right subclavian artery ...

Special Article
1638-1644
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Physicians in the Netherlands described on a questionnaire the deaths of their patients with amyotrophic lateral sclerosis. Of the 203 patients, 35 (17 percent) had chosen euthanasia and died that way. An additional six patients died as a result of suicides that involved assistance from a physician. The choice of euthanasia or physician-assisted suicide was not associated with the patient's income or educational level.

Clinical Practice
1645-1650

    An eight-year-old girl is sent home after the school nurse detects head lice. She will not be permitted to return to school until the absence of infestation is documented. What treatment strategy is most likely to allow her to return to school with a minimal risk of infecting her classmates?

    Case Records of the Massachusetts General Hospital
    1651-1658

    Presentation of Case

    A 41-year-old woman was admitted to the hospital because of an intracranial mass.

    The patient had been in excellent health until one week earlier, when a global headache developed, accompanied by generalized weakness, a sensation of ...

    Editorials
    1660-1662

    The BRCA1 and BRCA2 genes encode proteins that participate in the cellular response to DNA damage; inactivating mutations in these genes heighten susceptibility to breast and ovarian cancers. The mechanism underlying this tissue specificity is not ...

    1662-1663

    Recent years have witnessed explosive growth in knowledge of the physiologic factors regulating appetite and body weight.1 Among these are neural, metabolic, and endocrine signals from the periphery that reflect the short- and long-term status of energy ...

    1663-1665

    During the past decade, patients with the uncommon disease amyotrophic lateral sclerosis (ALS) have had a prominent role in the debate about physician-assisted suicide and voluntary active euthanasia. In Canada and Great Britain, patients with ALS have ...

    Correspondence
    1667-1669

    To the Editor: I would like to propose a hypothesis that may account for the findings of Borghi et al. (Jan. 10 issue).1 The low-protein, low-salt diet they studied may have reduced the urinary monosodium urate concentration. An increase in urinary ...

    1669-1671

    To the Editor: In their article in the January 10 issue, Shore et al. report that they identified heterozygous inactivating GNAS1 mutations in 13 of 18 probands in six families with progressive osseous heteroplasia (POH).1 The defective allele in their ...

    1671-1672

    To the Editor: Booton and Jacob (Jan. 10 issue)1 present an elegant and illustrative case of bronchioloalveolar carcinoma (also referred to as bronchoalveolar-cell carcinoma) of the lung. However, their statement that a “transbronchial biopsy led to the ...

    1672-1674

    To the Editor: Ransohoff and Sandler (Jan. 3 issue)1 underestimate the cost of colonoscopy. Medicare reimbursement to the physician may average $380, but the total cost is much higher if reimbursement to health care professionals and the hospital are ...

    1674

    To the Editor: The review by Annas of the new federal regulations for medical privacy and medical research (Jan. 17 issue)1 made it clear that there must be a mechanism to protect the privacy of patients. However, there has been a major effort over the ...

    1674-1675

    To the Editor: We report the development of hyperammonemic encephalopathy in a patient with multiple myeloma.

    A 43-year-old woman with stage IIIA light-chain multiple myeloma presented to the hospital with lethargy and a left molar mass. She had not ...

    1676
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    To the Editor: Spinning is an aerobic activity performed on a stationary bicycle and carried out in groups in enclosed rooms, with instructors increasing and intensifying the workout by varying the resistance of the bike, altering the pace, or “jumping,” ...

    Book Reviews
    1677

    Several decades ago, most patients with uncorrected or corrected congenital heart disease did not survive to adulthood. As a result, they were cared for almost exclusively by pediatricians and pediatric cardiologists. Cardiologists trained to care for ...

    1677-1678

    Public awareness of prostate cancer has substantially increased over the past decade. Screening based on the measurement of prostate-specific antigen in serum has revolutionized the detection and management of prostate cancer. Therapeutic options include ...

    Corrections
    1678

    Paternally Inherited Inactivating Mutations of the GNAS1 Gene in Progressive Osseous Heteroplasia Original Article, N Engl J Med 2002:346;99-106.. Line 2 of the legend for Figure 3 should have read, “mutated GNAS1 genomic DNA from patients” rather than “...

    1678

    Protecting Research Subjects — The Crisis at Johns Hopkins Health Policy Report, N Engl J Med 2002:346;716-720.. Table 1, “Suspensions of Federally Supported Research,” should have included the following entry: “September 1999” in the column entitled “...