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October 10, 2002  Vol. 347 No. 15

Perspective
1131-1132

The primary therapy for acute pulmonary embolism is anticoagulation with heparin and warfarin to prevent additional thromboembolism. Traditional teaching relegates the use of thrombolysis to the rare situation in which massive pulmonary embolism causes ...

1133-1134

On August 9, 2002, the Department of Health and Human Services released the final version of the federal medical-privacy rule (Federal Register 67: 53182–53273, 2002). The release ended a tortuous process dating back to September 1997, when the secretary ...

Original Articles
1135-1142
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Sustained activation of the sympathetic nervous system contributes to the development and progression of heart failure. This study examined two polymorphisms in the β1- and α2C-adrenergic receptors, which are associated with an increase in sympathetic activity. In black subjects, these polymorphisms, particularly when both were present, markedly increased the risk of heart failure.

1143-1150
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Thrombolysis is known to be effective in the treatment of patients with massive pulmonary embolism, but its efficacy is less certain in patients with submassive pulmonary embolism. In this large, randomized trial, the combination of heparin and alteplase was found to be superior to heparin and placebo in the treatment of such patients.

1151-1160

Staphylococcal infections of the skin are more common in patients with atopic dermatitis than they are in normal persons or patients with psoriasis. In this study, the investigators hypothesized that the elevated rate of skin infections in atopic dermatitis could be attributed to reduced levels of the endogenous antimicrobial peptides LL-37 and human β-defensin 2. They found that the levels of these peptides were lower in skin from patients with atopic dermatitis.

Images in Clinical Medicine
1161
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Figure 1. A 52-year-old man with chronic left bundle-branch block presented with exertional syncope but no chest pain, palpitations, or dyspnea. His blood pressure was 95/60 mm Hg, and examination revealed signs of right ventricular failure and ascites. ...

Special Article
1162-1168
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This article reports a feasible strategy for identifying and counseling carriers of recessively inherited diseases in developing countries. The basis of the approach is testing the extended family of a person with an index case, usually a child with the disease.

Clinical Practice
1169-1174

    An otherwise healthy 17-month-old boy had a cold accompanied by two days of rhinorrhea, cough, and fever (temperature of up to 38.8°C). On day 5, he became fussy and woke up crying several times during the night. The following day he was afebrile, and a physical examination was normal except for findings of a slightly red left tympanic membrane with no middle-ear fluid and a bulging right tympanic membrane with white fluid behind it, obscuring the umbo. How should he be treated?

    Review Article
    1175-1186

    H. pylori is one of the most common bacterial infections in human beings, and its discovery 20 years ago altered the diagnosis and treatment of gastroduodenal disease. This review considers current knowledge about the epidemiology and transmission of H. pylori, as well as the role of this infectious agent in the pathogenesis of upper gastrointestinal tract disease. Diagnostic approaches, indications for therapy, and measures of therapeutic efficacy are reviewed.

    Case Records of the Massachusetts General Hospital
    1187-1194

    Presentation of Case

    A 61-year-old man was admitted to the hospital because of right hemiplegia, aphasia, and obtundation.

    According to the patient's family, he had been well at his home in Haiti until about one month earlier, when pain developed in his ...

    Editorials
    1196-1199

    Congestive heart failure is the eventual outcome of diverse myocardial insults, including postischemic remodeling, primary cardiomyopathies, and infections.1 Even for specific forms of myocardial injury, it remains difficult to predict the development of ...

    1199-1200

    Microbes surround us. However, most of the time we are unaware of them. Our epithelial surfaces, which provide the physical barrier separating us from the environment, are usually free of signs of a battle taking place. Over the past several years, we ...

    1200-1202

    The β-thalassemias are among the most common autosomal recessive disorders. They have a remarkably high frequency in the Mediterranean region, the Middle East, the Indian subcontinent, and East Asia. The β-thalassemias are not uncommon among persons of ...

    Clinical Implications of Basic Research
    1203-1204

    Cytotoxic T lymphocytes control viral infections by lysing infected cells and secreting soluble factors (cytokines) that enhance antiviral immunity and suppress infection. The importance of antiviral killer cells in controlling acute infection with human ...

    Correspondence
    1205-1206

    To the Editor: Imperiale et al. (June 6 issue)1 presented a well-designed and important study on the effectiveness of screening for colon cancer in persons 40 to 49 years of age. However, the conclusions appear perhaps to be driven more by cost than by ...

    1206-1207

    To the Editor: We concur with Lachmann et al. (June 6 issue)1 that therapeutic advances demand accurate typing of amyloid deposits.2 Our experience with 465 patients with sporadic, biopsy-proven, systemic amyloidosis indicates that immunoelectron-...

    1207-1208

    To the Editor: Perl et al. (June 13 issue)1 report that prophylaxis with mupirocin did not reduce the overall rate of Staphylococcus aureus infections at surgical sites but did significantly reduce the rate of nosocomial S. aureus infections. Although ...

    1208-1209

    To the Editor: In her review of the management of human immunodeficiency virus (HIV) infection during pregnancy (June 13 issue),1 Watts recommends addressing coexisting herpes simplex virus (HSV) infection as one would for a nonpregnant patient. However, ...

    1209-1210

    To the Editor: Fuchs (June 6 issue)1 correctly points out that new insurance plans that decrease sharing of risk within companies will erode the social-insurance qualities of employment-based health insurance. This argument leads to the impression that ...

    1210

    To the Editor: Hallett and colleagues (June 6 issue)1 describe kissing-triggered reactions to food allergens. We would like to point out that kissing may lead to allergic reactions to far more than food. Liccardi et al.2 recently reported the induction ...

    1210-1211

    To the Editor: Inhaled corticosteroids are increasingly being used for the prophylactic treatment of asthma in children. The benefits have been well documented; however, the potential risk of growth suppression has not been fully investigated. Recent ...

    1211-1212

    To the Editor: The United States leads all other countries in productivity with respect to medical research.13 However, the relative contributions of countries to research are changing over time.

    We examined different countries' shares of basic-science ...

    Book Reviews
    1213

    The antibiotic era, barely 60 years old, is increasingly challenged by the continued emergence of drug-resistant organisms. The variables that currently predict the level of resistance in a community (or a hospital) are the misuse of antibiotics and the ...

    1213-1214
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    Sepsis, defined in its broadest sense as the syndrome evoked by the host response to infection, remains one of the most challenging problems in intensive care medicine. According to the Centers for Disease Control and Prevention (CDC), 500,000 cases of ...

    1214-1215

    During the past two decades, travel medicine, a relatively new medical specialty, has grown in response to the enormous increase in international travel. The worldwide number of international tourist arrivals in 2001 was 693 million, which represented a ...

    1215-1216

    The contest between malaria and humans may have begun in prehominid primates, and it continues unabated to the present day, with no resolution in sight. Malaria prevails in Africa, South Asia, and the Amazon and continually threatens the developed world. ...