Join the 200th Anniversary Celebration

Issue IndexA searchable index of tables of contents

Find An Issue

By Volume and Issue
By Date

Table of contents for

December 5, 2002  Vol. 347 No. 23

Perspective
1822-1823

The human heart has a complex electrical system that ensures coordinated propulsion of blood under a variety of physiologic conditions. Remarkable effort is expended with each heartbeat to maintain sinus rhythm. Arrhythmias are a system failure — and none ...

Original Articles
1825-1833
  • Free Full Text

There are two approaches to the treatment of atrial fibrillation: rate control, allowing atrial fibrillation to persist, and rhythm control, with cardioversion and antiarrhythmic drugs. This North American study found that, contrary to prevailing practice, rhythm control offered no survival advantage and was associated with higher rates of adverse drug effects than rate control.

1834-1840

This study is the European counterpart of the North American study of atrial fibrillation reported in this issue of the Journal. Although the European study was smaller, the findings in the two studies were quite similar. Rate control was not inferior to rhythm control and should be regarded as appropriate for the management of persistent atrial fibrillation.

1841-1848

In Papua New Guinea, approximately 2500 residents participated in a prospective, four-year study of the effects of a single dose of antifilarial drugs given annually for four years. The proportion of microfilariae-positive infections decreased by 86 to 98 percent, and the frequency of hydrocele declined from 15 percent to 5 percent.

Images in Clinical Medicine
1849

Figure 1. A 17-year-old Ethiopian girl presented with a four-month history of fever, malaise, and weight loss, as well as head, neck, and back pain and a two-week history of dyspnea, odynophagia, and diarrhea. Chest radiography revealed bilateral ...

e6
  • Free Full Text

A 57-year-old woman had progressive drowsiness one week after a biopsy because of axillary lymphadenopathy.

Special Article
1850-1859

There is considerable variation in the patterns of resistance to antituberculosis drugs around the world. This decision-analysis study incorporated data on region-specific drug-resistance profiles. The results show that detecting and treating latent tuberculosis in new immigrants to the United States with the appropriate regimens was cost-saving in the case of immigrants from seven regions and was highly cost effective for immigrants from other developing nations.

Clinical Practice
1860-1866

    A 44-year-old man who recently immigrated from Peru is found to have induration of 16 mm on a tuberculin skin test. He received bacille Calmette–Guérin vaccine as an infant and is asymptomatic. Chest radiography shows fibronodular opacities in the upper lobe. In another case, a 27-year-old schoolteacher born in the United States has induration of 17 mm on a tuberculin skin test, no symptoms, and a normal chest radiograph. How should these patients' cases be managed?

    Review Article
    1867-1875
    • Free Full Text

    Classic genetic tests indicate, either directly or indirectly, the presence of DNA variants associated with rare but highly penetrant disorders such as Huntington's disease or multiple endocrine neoplasia type 2. This article not only reviews these classic tests but also shows how novel genetic tests can reveal the presence of DNA variants that are more logically considered risk factors for a given condition.

    Clinical Problem-Solving
    1876-1881

      A 17-year-old boy awakes with left-sided pleuritic chest pain. He also notes mild dyspnea during track-and-field practice. Over the ensuing months, symptoms progress to dyspnea when he is at rest, accompanied by three-pillow orthopnea.

      Editorials
      1883-1884

      The concept that the restoration of sinus rhythm in patients with atrial fibrillation is always an important goal has been largely uncontested for many years. Now, in this issue of the Journal, two trials comparing heart-rate control with rhythm control ...

      1885-1886

      It was 1993 when the International Task Force for Disease Eradication identified lymphatic filariasis as one of only six diseases meeting the criteria for being eradicable or potentially eradicable.1 Since that time, efforts toward this goal have moved ...

      Correspondence
      1887-1889

      To the Editor: The report by Kenchaiah et al. (Aug. 1 issue)1 and the accompanying editorial by Massie2 show the important association between any increased body-mass index and the risk of heart failure. However, several reports have now indicated that ...

      1889-1890

      To the Editor: The retrospective analysis by Little et al. (Aug. 8 issue)1 provides further evidence of the transmission of drug-resistant human immunodeficiency virus type 1 (HIV-1)2 and attempts to relate detection of resistant virus before ...

      1890-1891

      To the Editor: The article reporting on risperidone use in children with autism (Aug. 1 issue)1 left many questions unanswered. Over an eight-week period, the treatment group had documented weight gains of about 6 lb (2.7 kg). The article indicates that ...

      1891-1892

      To the Editor: If Lamas et al. (June 13 issue)1 wished to compare dual-chamber pacing with single-chamber pacing in patients with sinus-node dysfunction, why did they not compare single-chamber right atrial pacing with dual-chamber pacing? This mode of ...

      1892-1893

      To the Editor: The best interpretation of the data presented by Groman et al. (Aug. 8 issue)1 is not that their patients had variant cystic fibrosis phenotypes in the absence of mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) ...

      1893-1895

      To the Editor: The article by Goodman et al. (May 16 issue)1 and the accompanying editorial by Grumbach2 criticize what these authors interpret as excessive concentrations of neonatologists in response to profit-maximizing behavior by hospitals — proof ...

      1895-1896

      To the Editor: In July 2000, a 58-year-old man infected with the human immunodeficiency virus (HIV) began treatment with highly active antiretroviral therapy, which initially consisted of zidovudine, lamivudine, and ritonavir-boosted indinavir. After ...

      Book Reviews
      1897

      Genetics, until recently the domain of molecular biologists, mathematicians, anthropologists, forensic scientists, pediatricians, and families concerned about rare and esoteric diseases, today captures the imagination of a wide spectrum of basic ...

      1898

      This book resulted from a meeting held under the aegis of the National Institute of Environmental Health Sciences at Research Triangle Park, North Carolina, September 17 through 20, 2000. The meeting brought together an interdisciplinary cadre of ...

      1898-1899

      A book that promises to summarize “the current status of research and practice” by its nature always falls short of the mark. There is no better example of such a book than this one on hormone-replacement therapy and cancer. Long-held notions about the ...

      1899-1900
      • Free Full Text

      The goal of this book is to provide a practical reference on the primary care of ambulatory women. After reading the book, I tested its usefulness in answering questions that arose in my office practice of family medicine and in my usual academic work. I ...

      Correction
      1902

      Small Abdominal Aortic Aneurysms Correspondence, N Engl J Med 2002:347;1112-1115.. In the reply from the authors, line 15 in the right-hand column of page 1114 should have read “relative risk in the immediate-repair group, 1.03,” rather than “relative ...