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February 7, 2002  Vol. 346 No. 6

Perspective
390

Breathing and sleeping are two very basic processes. If you stop breathing for more than a few minutes, life itself stops. Sleep is a little more forgiving, but if you stop sleeping, or fail to achieve a truly rejuvenating sleep, it is not long before ...

Original Articles
393-403

This large clinical trial compared changes in diet and physical activity with metformin for the prevention of diabetes in persons at high risk for the disease. Although both interventions were effective in preventing diabetes, the lifestyle intervention was more effective than metformin.

404-412
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Both central sleep apnea and obstructive sleep apnea are characterized by episodes of apnea and hypopnea during sleep. Many patients also have associated arrhythmias and therefore receive permanent atrial pacemakers. This study found that, in such patients, atrial overdrive pacing at a rate 15 beats per minute above the base-line rate resulted in a substantial reduction in the frequency of episodes of apnea and hypopnea.

413-419

Salmonella enterica serotype choleraesuis is a cause of serious systemic infections. Data from a surveillance system in Taiwan document the rapid emergence of fluoroquinolone resistance in this serotype. The rate of resistance has reached 60 percent. Molecular typing indicates that the source of the resistant isolates is likely to be herds of swine raised for food.

420-427

The clinical and histologic features of high-grade gliomas in children are not always useful prognostic indicators. This study investigated the prognostic usefulness of evaluating gliomas in children for the presence of p53, a protein involved in numerous aspects of the life and death of a cell. Children with tumors that contained many p53-positive cells had a much poorer outcome than children with tumors that contained few or no p53-positive cells.

Images in Clinical Medicine
428
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Figure 1. Three years after radio-frequency ablation of the atrioventricular nodes, followed by the implantation of a dual-chamber pacemaker, a 59-year-old man had gradual onset of fever and left-sided chest discomfort. He had no history of ...

e2
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The lead, indicated by arrows, is in the left ventricular myocardium.

Review Article
429-437

Pneumonia remains a common and potentially serious infection in children. This review summarizes the problems involved in making the diagnosis and establishing a cause and offers a practical guide to treatment. Decisions should be based first on the age of the child, then on clinical and epidemiologic considerations, and finally, on the findings on chest radiography.

Clinical Problem-Solving
438-442

    A 59-year-old man with a history of a nonproductive cough and wheezing presents with increasing shortness of breath. His symptoms have not responded to treatment with bronchodilators and inhaled corticosteroids or to treatment for sinusitis and esophageal reflux, but they improve when he takes oral prednisone.

    Editorials
    444-445

    Sleep apnea, which is characterized by frequent episodes of apnea or hypopnea during sleep, is among the most common chronic disorders in adults. Sleep apnea associated with hypersomnolence is conservatively estimated to affect 2 to 4 percent of the ...

    446

    Each year thousands of reviewers contribute their expertise to peer review, a process that contributes critically to the quality of the Journal. The editors and the authors of the papers submitted to the Journal are grateful for the help of all our ...

    Sounding Board
    447-448

    This issue of the Journal contains two articles on Oregon's Death with Dignity Act. In a Health Policy Report, Steinbrook provides an overview of the 1994 Oregon law legalizing physician-assisted suicide. He discusses the effects of the law on the care of terminally ill patients and the various legal challenges that have been made to the law. The most recent challenge is the directive issued by the attorney general of the United States, John Ashcroft.

    Correspondence
    450-452

    To the Editor: Although physician-assisted suicide has been a legal option for terminally ill residents of Oregon since 1997,1 it remains highly controversial. On November 6, 2001, U.S. Attorney General John Ashcroft issued a new interpretation of the ...

    452-453

    To the Editor: The Deep-Brain Stimulation for Parkinson's Disease Study Group (Sept. 27 issue)1 reported the results of a prospective, double-blind, crossover study in patients with advanced Parkinson's disease, in whom electrodes were implanted in the ...

    453-455

    To the Editor: In their interesting study of the prognostic value of brain (B-type) natriuretic peptide in patients with acute coronary syndromes, de Lemos et al. (Oct. 4 issue)1 did not thoroughly assess the possible confounding effect of a well-...

    455

    To the Editor: In their article on prophylaxis against postoperative ileus with the use of ADL 8-2698, Taguchi et al. (Sept. 27 issue)1 refer to our report on intravenous methylnaltrexone, a peripheral opioid antagonist.2 We call attention to an error in ...

    455-456

    To the Editor: In their editorial (Sept. 20 issue),1 Huston and Peterson discuss developments in the debate about withholding proven treatment in clinical research. Unfortunately, the editorialists, citing the transcript of a television report in which ...

    456-457

    To the Editor: I am surprised that the authors of the letter entitled “Spironolactone in Addition to ACE Inhibition to Reduce Proteinuria in Patients with Chronic Renal Disease” (Sept. 20 issue)1 concluded that the reduction in proteinuria seen after the ...

    457

    To the Editor: Sabbà et al. (Sept. 20 issue)1 report the efficacy of tranexamic acid in reducing epistaxis in hereditary hemorrhagic telangiectasia. However, the title of their communication may be misleading. The authors do not mention the weight of the ...

    Book Reviews
    458

    A Medical History of African Americans and the Problem of Race, the first volume of An American Health Dilemma, is an ambitious and woefully overdue magnum opus. In it Byrd and Clayton present and analyze the historical roots of the apartheid that ...

    458-459

    The Unfit: A History of a Bad Idea is a valuable contribution to historical scholarship relating to the eugenics movements of the 19th and 20th centuries. Carlson recounts some of the familiar episodes described in several other books on eugenics ...

    Correction
    459

    Preimplantation Genetic Diagnosis by Comparative Genomic Hybridization Editorial, N Engl J Med 2001:345;1569-1571.. The sentence that begins at the bottom of page 1569 and continues on page 1570 should have read, “Currently, the most common techniques for ...

    Health Policy Report
    460-464

    The battle over physician-assisted suicide in Oregon never seems to end. On November 6, 2001, U.S. Attorney General John Ashcroft ruled that the Oregon law legalizing physician-assisted suicide violated the federal Controlled Substances Act, a 1970 law ...