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October 24, 2002  Vol. 347 No. 17

Perspective
1306-1307

In the late 1950s, two sets of observations led to the recognition of a new cardiac disease. One was the discovery, by cardiovascular surgeons and cardiologists, of patients with subaortic pressure gradients at cardiac catheterization but without evidence ...

Original Articles
1309-1317

In patients undergoing coronary-artery bypass surgery, aspirin is often avoided during the perioperative period because of concern about bleeding. This large, multicenter, observational study found that aspirin therapy initiated within 48 hours after surgery was associated with reduced mortality and fewer ischemic complications affecting the heart, brain, kidneys, and gastrointestinal tract. There was no excess bleeding.

1318-1325
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A total of 279 women who were referred for hysterectomy because of benign disease were randomly assigned to undergo subtotal or total abdominal hysterectomy. Twelve months after surgery, the two groups had similar improvements in urinary symptoms and measures of urodynamic testing; neither type of surgery had adverse effects on bowel or sexual function. Total abdominal hysterectomy resulted in a longer hospital stay. Cyclical bleeding occurred postoperatively in 7 percent of the subtotal-hysterectomy group.

1326-1333

Some patients with hypertrophic cardiomyopathy and left ventricular outflow tract obstruction do not have a response to medical therapy with beta-blockers or calcium-channel blockers. Surgical myomectomy is sometimes recommended. These investigators report preliminary observations on nonsurgical reduction of the hypertrophied septum by the injection of alcohol into the septal perforator vessels, causing controlled infarction of the septum.

Images in Clinical Medicine
1334
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Figure 1. Chest pain and diaphoresis developed in an 81-year-old woman with chronic renal insufficiency and hypertension. Although the chest pain resolved, she saw her primary care physician three days later because of profound fatigue. She had a loud ...

Special Article
1335-1341

In 2001, the International Committee of Medical Journal Editors (ICMJE) called for independence of authors from industry sponsors and full disclosure of the sponsors' role in research. This national survey reveals that the vast majority of medical schools' clinical-trial agreements with industry sponsors do not adhere to the ICMJE guidelines regarding trial design, access to data, and publication rights.

Clinical Practice
1342-1349

An asymptomatic 45-year-old Hispanic man has a fasting plasma glucose level of 142 mg per deciliter (7.9 mmol per liter) on initial evaluation and 139 mg per deciliter (7.7 mmol per liter) on reevaluation. Other than a steady gain in weight since college and borderline hypertension, his medical history is unremarkable. He is 175 cm (5 ft 9 in.) tall and weighs 95 kg (209 lb; body-mass index, 31.2), and his blood pressure is 138/88 mm Hg. Physical examination is notable only for abdominal obesity and absent ankle reflexes. How should this patient be treated?

Case Records of the Massachusetts General Hospital
1350-1357

Presentation of Case

A 28-year-old woman was admitted to the hospital because of ocular inflammation, fever, and headache.

The patient had been well until three weeks earlier, when a cough developed, initially productive of yellow sputum, with rhinorrhea ...

Editorials
1359-1360

Until a few years ago, we did not understand the pivotal role of platelets in orchestrating the process of inflammation. The discovery in 1998 that CD40 ligand is shed from activated platelets to directly initiate inflammation of the vessel wall1 was a ...

1360-1362

Hysterectomy is second only to cesarean section as the most frequently performed major operation in the United States. An estimated 633,000 hysterectomies are performed annually.1 Rates of hysterectomy vary significantly among regions, with a sixfold ...

1362-1363

Clinical research in the United States is commonly performed under contracts between institutions and commercial sponsors. Often the investigator who actually does the research is not a direct party to the contract, but its language will govern the ...

Clinical Implications of Basic Research
1364-1367

A recently discovered type of RNA, small interfering RNA, silences messenger RNA (the transcript of an active gene) by binding to specific sequences in the messenger RNA. Small interfering RNAs can block the replication of HIV in vitro by triggering the degradation of specific viral messenger RNAs. This work reveals new possibilities for controlling not only HIV infection but also the growth of cancer cells.

Sounding Board
1368-1371

    “Is the university–industrial complex out of control?” The editorial that appeared under this eye-catching title in Nature in January 2001 came to the conclusion that links between academia and industry are of increasing concern to academics and to ...

    1371-1375

      Ties between academic medical centers and commercial entities are increasing in number and magnitude. These ties have the potential to benefit the public through the development of novel diagnostic and therapeutic techniques. They can also be quite problematic, since the goals of an academic medical center and those of a commercial entity may differ in many respects. In this article, leaders of major academic medical institutions provide guidance on the successful management of several specific points of interaction.

      Correspondence
      1376-1377

      To the Editor: With the use of gene profiling in patients with diffuse large-B-cell lymphoma, Rosenwald et al. (June 20 issue)1 found that overall survival after anthracycline-based chemotherapy differed significantly among the three gene-expression ...

      1377-1379
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      To the Editor: There may be an alternative explanation for the observations made by Panting et al. (June 20 issue)1 in their elegant study of patients with cardiac syndrome X. Although the heart-rate response to adenosine infusion is not given, the ...

      1379-1381

      To the Editor: Cummings et al. (May 23 issue)1 report that, unlike diet-induced weight loss, weight reduction after gastric bypass is associated with markedly low levels of ghrelin. We would caution against concluding, as they do, that suppression of ...

      1381

      To the Editor: Molina et al. (June 20 issue)1 report a two-week study confirming the activity of fumagillin against intestinal microsporidiosis in 12 immunosuppressed adults, 10 of them with advanced human immunodeficiency virus (HIV) infection. Ten ...

      1381-1382
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      To the Editor: In his article on head lice (May 23 issue),1 Roberts discusses several possible treatments. On the basis of in vitro studies of both sensitive and resistant head lice as well as clinical experience in the United States, topical malathion ...

      1382-1384

      To the Editor: The way medicine is practiced in the United States has a strong influence on the rest of the world, for better or for worse. Rumors that Congress may allow a hypothetically regulated market system therefore arouse concern in many ...

      1384

      To the Editor: Paromomycin and diloxanide furoate are the drugs recommended for the treatment of asymptomatic Entamoeba histolytica infection.1 These agents have been used in clinical practice for more than 30 years. The efficacy of either agent against ...

      Book Reviews
      1385-1386

      Between 1901 and 1904, Ivan Pavlov (Figure) was nominated on four successive occasions for the Nobel Prize in Physiology or Medicine. In 1904, his candidacy was at last successful: Pavlov was awarded the prize in recognition of his research on the ...

      1386-1387

      Americans are fascinated with the mysteries of consciousness. Periodic accounts of unexpected awakenings stimulate media attention. They fill the pages of our newspapers, headline the nightly news, and provide plots for Hollywood. The ethical and legal ...

      1387-1388

      Parkinson's disease affects about a million people in the United States, a number that will increase as the population ages. It has been a force in the transformation of neurology from a specialty restricted to diagnosis into one with active therapies. It ...

      Correction
      1390

      Derivation of Nephrogenic Adenomas from Renal Tubular Cells in Kidney-Transplant Recipients Original Article, N Engl J Med 2002:347;653-659.. The last sentence in the left-hand column of page 654 should have read, “Three female and three male patients who ...

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