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February 28, 2002  Vol. 346 No. 9

Perspective
642

Osteoporosis affects millions of postmenopausal women in the United States alone. For white women who reach 50 years of age, the lifetime risk of vertebral fracture is about one in three, and that for hip fracture is one in six. One tenth to one fifth of ...

Original Articles
645-652

The t(9;22) translocation that forms the Philadelphia chromosome of chronic myelogenous leukemia (CML) also forms a fusion gene, BCR-ABL. The new gene encodes an abnormal tyrosine kinase, which causes the leukemia. Imatinib mesylate inhibits the function of the BCR-ABL protein and can induce remission of CML. This large trial found that imatinib induced cytogenetic and hematologic responses in most patients in whom standard therapy with interferon alfa had failed.

653-661

Bisphosphonates ameliorate osteoporosis, yet gastrointestinal side effects have limited patients' adherence to oral regimens. Intermittent intravenous therapy is effective, but the optimal interval between doses is unknown. This study examined five intravenous regimens of the potent bisphosphonate zoledronic acid (a total of 1 to 4 mg in one to four doses over the course of one year) and compared them with placebo in postmenopausal women with low bone mineral density.

662-667

Patients with severe hemophilia A in whom inhibitors of factor VIII developed during replacement treatment were found to have IgG antibodies with the ability to hydrolyze factor VIII. Such antibodies were found in more than half the patients with an inhibitor against factor VIII.

668-675

In the weeks after a group of 23 young adults returned from a trip to Jamaica, eosinophilic meningitis developed in 12. Symptoms included headache, neck pain, visual disturbances, and hyperesthesias. Nine of the travelers required hospitalization. A case–control study showed that consumption of a Caesar salad at one dinner was strongly associated with the development of aseptic meningitis.

Images in Clinical Medicine
676
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Examination of a 74-year-old man with a one-year history of mild, stable angina revealed a murmur consistent with the presence of aortic regurgitation.

Clinical Practice
677-682

    A 60-year-old man is evaluated for a heart murmur. He jogs regularly and has no cardiac symptoms. Examination reveals a delayed carotid upstroke and a grade 3/6 late-peaking systolic ejection murmur. Echocardiography shows normal systolic function and a heavily calcified aortic valve, with a peak Doppler transvalvular gradient of 64 mm Hg and a calculated valve area of 0.7 cm2.

    Review Article
    683-693

    This review discusses the development and uses of imatinib mesylate, a protein tyrosine kinase inhibitor useful in the treatment of chronic myelogenous leukemia and gastrointestinal stromal tumors that was recently approved by the Food and Drug Administration. Imatinib targets platelet-derived growth factor receptor, inhibits the fusion product of the Philadelphia chromosome, and targets c-kit, a protein tyrosine kinase. The drug may also be effective in the treatment of other tumors that express platelet-derived growth factor receptor or c-kit.

    Case Records of the Massachusetts General Hospital
    694-700

    Presentation of Case

    A 47-year-old woman was admitted to the hospital because of recurrent hypercalcemia.

    The patient had been admitted 14 years earlier because of hyperparathyroidism, with an increased level of calcium (12.3 mg per deciliter [3.1 mmol ...

    Editorial
    702-703

    Inhibitory antibodies to factor VIII arise in more than 20 percent of patients with hemophilia A who receive replacement therapy with factor VIII protein.1 Since these antibodies profoundly complicate the treatment of hemophilia, understanding how they ...

    Correspondence
    705-707

    To the Editor: I am surprised that the target systolic blood pressures in three studies of the renoprotective effects of angiotensin-receptor blockers in patients with type 2 diabetes (Sept. 20 issue)13 exceeded the threshold of less than 130 mm Hg ...

    707-708

    To the Editor: Herndon et al. (Oct. 25 issue)1 report that propranolol attenuates hypermetabolism and reverses muscle-protein catabolism in patients with severe burns. However, these conclusions must be critically examined, because the findings may be ...

    708-709

    To the Editor: Mange et al. (Oct. 25 issue)1 report on the survival of shipped and locally transplanted cadaveric renal allografts. On the basis of their findings, the authors conclude that national shipment of such allografts “increases the risk of ...

    709-710
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    To the Editor: In his article on essential tremor (Sept. 20 issue),1 Louis does not mention alcohol. Ethanol in small doses usually stops the tremor, and this finding may be useful in diagnosis. Some people may use ethanol to hide their tremor; they risk ...

    710
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    To the Editor: The review of Tourette's syndrome by Jankovic (Oct. 18 issue)1 contains a Venn diagram (Figure 1 of the article) that may be misleading. The figure suggests that Tourette's syndrome lies at the intersection of tics, attention-deficit–...

    710-711

    To the Editor: Reviews of the accomplishments in the fight against the human immunodeficiency virus (HIV) such as those in the June 7 issue13 cannot help but sound self-congratulatory when there are more than 30 million people with untreated AIDS — a ...

    711

    To the Editor: There is no clearly established strategy for the treatment of a patient with cardiomyopathy and a symptomatic aneurysm of the thoracic aorta. We report the successful use of an approach combining aortic surgery and the implantation of a ...

    712-713

    To the Editor: Chronic myelomonocytic leukemia and myelofibrosis with myeloid metaplasia are hematopoietic stem-cell disorders for which there is no effective drug therapy. Imatinib mesylate (Gleevec, Novartis, Basel, Switzerland), formerly known as ...

    Book Reviews
    714

    A variety of hematologic cancers have served as examples of how to cure the disease by a step-by-step application of new treatments as they become available, but it must be admitted that during the past 10 years there have been no real breakthroughs in ...

    714-715

    Hepatobiliary Diseases: Pathophysiology and Imaging was edited by two Japanese professors of medicine, one American professor of radiology, and one Japanese professor of radiology. Most of the 23 contributing authors are Japanese; 1 is a pathologist and ...

    715

    The discovery of prostate-specific antigen (PSA), a serine protease, was one of the most important accomplishments in urologic oncology in the past 15 years. In a relatively short time and in an extraordinary way, this tumor marker affected virtually all ...

    Correction
    715

    Prothrombotic Coagulation Abnormalities Preceding the Hemolytic–Uremic Syndrome Original Article, N Engl J Med 2002:346;23-32.. On page 32, the grant support was omitted. It should have read, “Supported by National Institutes of Diabetes and Kidney ...

    Health Policy Report
    716-720

    In June 2001, Ellen Roche, a healthy young technician at the Johns Hopkins Asthma and Allergy Center, died during an asthma study. The tragedy prompted several intensive investigations of research oversight at Johns Hopkins and led to the temporary suspension of all federally funded research projects at the institution. In this Health Policy Report, Steinbrook provides a detailed discussion of the outcome of the investigations, the response from Johns Hopkins, and the wider lessons for all involved in clinical investigation.