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November 7, 2002  Vol. 347 No. 19

Perspective
1474-1475

Vaccines represent one of the most effective interventions in medicine. They can protect whole populations from potentially dangerous diseases. Because vaccines are usually given to healthy people, especially children, any concern about the safety of ...

Original Articles
1477-1482

The measles, mumps, and rubella (MMR) vaccine contains a live, attenuated measles virus, and there have been claims that the vaccine is a cause of autism in young children. This study included all children born in Denmark from 1991 through 1998. Using national-registry data on autistic disorders, the investigators found no association between MMR vaccination and a subsequent diagnosis of autism (relative risk, 0.92; 95 percent confidence interval, 0.68 to 1.24) or a related disorder (relative risk, 0.83; 95 percent confidence interval, 0.65 to 1.07).

1483-1492

Regular exercise has well-established health benefits, some of which are mediated through changes in plasma lipoproteins. This study investigated the relative importance of the amount and the intensity of regular exercise in producing changes in plasma lipoproteins. The amount of exercise per week proved to have a greater effect on lipoproteins than did the intensity of exercise.

1493-1499
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Patients who are hypersensitive to aspirin have asthma, rhinosinusitis, and nasal polyposis. These findings have been attributed in part to the action of the cysteinyl leukotrienes at one of their receptors. Although aspirin can initiate the reaction, it can also be an effective treatment, since long-term exposure to aspirin leads to a desensitized state. In this study, the authors show that patients with aspirin-sensitive rhinosinusitis have enhanced expression of the cysteinyl leukotriene receptor CysLT1 on inflammatory cells in nasal-biopsy specimens and that desensitization with aspirin is associated with decreased expression of this receptor on these cells.

1500-1503

Several months after having zoster on the sacrum, a 71-year-old man had a transient ischemic attack with occlusion of the right anterior cerebral artery. Six months after having zoster in the ophthalmic distribution, a 76-year-old woman had sudden loss of vision in the left eye. In both cases, the acute vascular events were caused by the varicella–zoster virus, and in both, the deficits resolved after intravenous treatment with acyclovir.

Images in Clinical Medicine
1504

Figure 1. A 45-year-old man with autosomal dominant polycystic kidney disease presented to the urology clinic for consideration of bilateral nephrectomy as treatment for severe abdominal pain and distention. Magnetic resonance imaging of the abdomen (...

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A 71-year-old woman had a one-year history of dyspnea on exertion.

Clinical Practice
1505-1511

A 66-year-old man without diabetes has worsening hypertension. He has a serum creatinine level of 1.8 mg per deciliter (159 μmol per liter), proteinuria (2+), and a fasting serum low-density lipoprotein cholesterol level of 140 mg per deciliter (3.6 mmol per liter). He smokes half a pack of cigarettes per day. Ultrasonography reveals small, symmetric kidneys without hydronephrosis or cysts. How should this patient be evaluated and treated to slow the progression of kidney disease?

Review Article
1512-1520
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This review article launches our series on genomic medicine. It provides definitions of terms commonly used in genetics, delineates the distinction between genetics and genomics, and supplies examples of the ways in which genetic information can be used in the day-to-day care of patients. The mechanisms leading to the availability of more than 100,000 proteins from only approximately 30,000 genes are described. The various common types of mutations are identified and defined, and modes of inheritance — from simple mendelian to complex to mitochondrial — are detailed.

Editorials
1522-1524

Increasing levels of physical activity are associated with a decrease in cardiovascular events. Controlled clinical trials suggest that exercise has benefits in persons with coronary artery disease and in those with glucose intolerance.1 Exercise produces ...

1524-1526

About 15 million people in the United States have asthma. In a small percentage of them, variably estimated at between 3 percent and 10 percent, acute, severe asthma accompanied by rhinorrhea and sometimes associated with hives, flushing, or abdominal ...

1526-1527

Despite much journalistic hyperbole, the publication last year of nearly complete sequences of the human genome1,2 did not mean that the practice of medicine would be abruptly and radically transformed. Medicine has not been a gene-free art form in living ...

Correspondence
1528-1530

To the Editor: In their elegant study, Higashi et al. (June 20 issue)1 conclude that elevated angiotensin II levels in patients with renovascular hypertension constitute a principal cause of increased oxidative stress that results in impaired endothelium-...

1530-1531

To the Editor: Infante-Rivard et al. (July 4 issue)1 found no association between thrombophilic mutations and intrauterine growth restriction defined by a birth weight below the 10th percentile, as we2 and others3,4 have demonstrated, and they found an ...

1531-1532

To the Editor: The article by Briganti et al. (July 11 issue)1 reminds us that the original renal disease may recur in renal transplants and identifies recurrence of glomerulonephritis as an important cause of late allograft loss. The authors report that ...

1532

To the Editor: Kent and Poterucha (May 23 issue)1 present excellent angiographic images of an aberrant right subclavian artery, which was causing intermittent dysphagia. However, it is our opinion that angiography of the aorta could have been achieved ...

1533
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To the Editor: The otherwise excellent review of hypocapnia by Laffey and Kavanagh (July 4 issue)1 was somewhat diminished by an oversimplified discussion of the effects of hypocapnia on the cerebral circulation. We would like to add two points. First, ...

1533-1534

To the Editor: In his Clinical Practice article (March 28 issue),1 Stoller states that the use of methylxanthines in patients with exacerbations of chronic obstructive pulmonary disease (COPD) remains “unclear.” My colleagues and I disagree. In a meta-...

1534-1535
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To the Editor: Regarding the article on peanut allergy by Sampson (April 25 issue),1 one should note that although anaphylaxis is the hallmark of peanut allergy, this allergy can also manifest in the form of such chronic, non–life-threatening entities as ...

1535-1536

To the Editor: Allergy to peanuts is potentially fatal, affects 1 in 150 persons in the United States, and until recently was considered to be permanent.1,2 However, recent reports document a 20 percent rate of resolution by school age.3,4 We offer an ...

Book Reviews
1537-1538

Between 1914 and 1930, Karl Pearson devoted four volumes to a biography of his mentor, Francis Galton (Figure). The result was an unwieldy and deferential look at the man known as the father of eugenics. Duke University geneticist Nicholas Wright Gillham ...

1538-1539

Riveting page turners are more the exception than the rule in psychoanalytic explorations, and James Herzog has written a fine one in his Father Hunger. Right from the preface, we know that this will be a passionate and revelatory book about the “other” ...

1539-1540

In their introduction to this anthology of short literary works showing facets of life in medical care, Coles and Testa reflect fears that our medical schools are still not adequately preparing students to “understand and connect [with patients in] heart, ...

Correction
1542

Analgesics for the Treatment of Pain in Children Review Article, N Engl J Med 2002:347;1094-1103.. In Table 3, on page 1098, in the column for “Usual Starting Intravenous or Subcutaneous Doses and Intervals” for children weighing less than 50 kg, the dose ...