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February 14, 2002  Vol. 346 No. 7

Perspective
466-468

Homocysteine is a simple amino acid that has recently received a great deal of attention as a risk factor for atherothrombotic vascular disease. There is reasonably compelling epidemiologic evidence of an association between the plasma homocysteine level ...

Original Articles
469-475

Within three years, 13 cases of pure red-cell aplasia, a rare disease, were identified in patients with chronic renal failure who were receiving recombinant human erythropoietin (epoetin): 12 in France and 1 in Britain. All patients had antibodies that inhibited erythropoiesis in vitro and bound to epoetin with high affinity. Despite the discontinuation of epoetin treatment, most of the patients remain transfusion-dependent.

476-483

A cohort of 1092 elderly subjects who were free of dementia were studied prospectively. After a median of eight years of follow-up, dementia had developed in 111 subjects. Even after adjustment for other known risk factors, an elevated plasma total homocysteine level at base line was an independent predictor of the development of clinical dementia, most cases of which were caused by Alzheimer's disease. The risk of Alzheimer's disease was nearly doubled for those with the highest plasma homocysteine levels.

484-490
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Pulmonary Langerhans'-cell histiocytosis in adults is a rare interstitial lung disease, and its course and outcome have not been well defined. In this study, the records of 102 adults with clearly established disease were reviewed. Over a median follow-up period of four years, 33 deaths occurred, about half of which were attributable to respiratory failure. The overall survival was significantly shorter than that expected for persons matched for sex and calendar year of birth.

491-496

This double-blind, placebo-controlled study evaluated the use of a conjugate vaccine containing the two most common capsular polysaccharides that confer virulence on S. aureus. Among adults receiving long-term hemodialysis, a single dose of the vaccine had an efficacy of 57 percent against S. aureus bacteremia from week 3 to week 40 after vaccination.

Images in Clinical Medicine
497
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Figure 1. A 49-year-old woman underwent a diagnostic workup for recurrent headaches. Computed tomography suggested the presence of an incidental aneurysm of the left internal carotid artery. This finding was confirmed by cerebral angiography, which ...

Special Article
498-505
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Spending on direct-to-consumer advertising of drugs tripled between 1996 and 2000, when it reached $2.5 billion. The majority of this advertising is on television. Highly selected drugs are targeted for this form of advertising, and the intensity of such advertising may fluctuate markedly over time (antihistamines, for example, are advertised seasonally).

Clinical Practice
506-512

A 66-year-old woman with stable angina and a history of depression smokes 25 cigarettes daily. She would like to stop smoking but is concerned about weight gain. She has made several unsuccessful attempts at quitting on her own. How should she be treated?

Case Records of the Massachusetts General Hospital
513-520

Presentation of Case

A 15-year-old boy was admitted to the hospital because of a retro-orbital mass.

The patient had been well until three weeks earlier, when he began to have right retro-orbital and frontal pain graded 2 to 3 on a scale of 1 to 10, with ...

Editorials
522-523

Whether judged by its therapeutic or economic impact, recombinant human erythropoietin (epoetin) is an extremely successful application of molecular genetic technology to the development of a therapeutic agent. Epoetin is remarkably effective in the ...

523-524

A decade ago, people who manufactured products for therapeutic or diagnostic use in medicine targeted their marketing campaigns only at health professionals. The reasoning was that the use of such products required medical sophistication beyond that found ...

524-526

During the past two decades, there has been an irreversible change in the nature of the doctor–patient relationship. Patients are seeking much more medical information and are actively participating in decisions affecting their health. Intruding into this ...

526-528

It has been almost five years since the Food and Drug Administration (FDA) issued guidelines clarifying the agency's broadcast requirements for the advertising of specific pharmaceutical agents directly to consumers on television.1 Previously, most direct-...

Sounding Board
529-531

The authors sharply criticize the now-common practice of marketing high-technology medical screening tests directly to the consumer. As a prominent example, they select electron-beam computed tomography to screen for lung cancer. The authors voice concern about the validity of such screening, the financial consequences, and potential ethical problems.

Correspondence
533-535

To the Editor: The study by Israel et al. (Sept. 27 issue)1 of bone thinning in women with asthma did not effectively control for the critical variables of the level of physical activity and the severity of asthma.

Comparisons between patients with mild ...

535-536

To the Editor: The report by Manges et al. (Oct. 4 issue)1 regarding the widespread distribution of multidrug-resistant Escherichia coli is both important and timely. We have found even higher rates of resistance to trimethoprim–sulfamethoxazole (TMP-SMX)...

536-538

To the Editor: Dishy et al. (Oct. 4 issue)1 report that polymorphisms of the β2-adrenergic receptor influence agonist-promoted desensitization of β2-adrenergic receptor–mediated vasodilatation. Desensitization can be an important homeostatic event but ...

538-539

To the Editor: Martin and colleagues (Oct. 4 issue)1 report a case of type 1 diabetes mellitus in a patient with profound B-cell deficiency. It is now clear that B-cell–deficient nonobese diabetic (NOD) mice exhibit profound resistance to spontaneous ...

539
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To the Editor: People all over the world were shocked by the disaster of September 11, 2001. I want to emphasize what the editors wrote about medical insurance in the Journal's editorial on the subject (Oct. 11 issue)1: “Victims and their families must ...

539-540

To the Editor: Bayer's voluntary withdrawal of cerivastatin from the U.S. market led to questions regarding the safety of all hydroxymethylglutaryl–coenzyme A reductase inhibitors, or statins. Myopathy and the rarer severe rhabdomyolysis are considered ...

Book Reviews
541-542

Pulmonary emphysema is a common, progressive, disabling disease that carries a high mortality rate. It occupies one end of the spectrum of chronic obstructive pulmonary disease (COPD), with chronic bronchitis at the other end of the spectrum. Invariably, ...

542

For those who care for patients in the intensive care unit (ICU), dealing with the complex medical and psychosocial issues surrounding death and the dying patient is a daily event. However, the necessary practical skills are rarely learned as part of ...

Correction
544

Characteristics of Patients with Uncontrolled Hypertension in the United States Original Article, N Engl J Med 2001:345;479-486.. On page 485, the standard errors for prevalence in Table 5 were incorrect. The corrected table appears below.