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August 1, 2002  Vol. 347 No. 5

Perspective
302-303

Any person, talented or handicapped, whose social skills have been severely deficient since very early childhood, who started to talk late or whose communicative use of language is inadequate, and who perseverates and lacks cognitive and behavioral ...

Original Articles
305-313
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Extreme obesity is a risk factor for heart failure. This analysis from the Framingham Heart Study assessed the risk associated with lesser degrees of obesity and overweight. There was a continuous increase in the risk of heart failure with increases in the body-mass index (an increase in risk of 5 percent for men and 7 percent for women for each increment of 1 in the body-mass index). Obesity accounts for about 11 percent of heart failure among men and 14 percent among women in the Framingham population.

314-321

Serious behavioral problems in children with autism are common and difficult to manage. Atypical antipsychotic medications are effective in treating adults with schizophrenia and have fewer side effects than traditional antipsychotic medications. This randomized trial examined whether risperidone improved behavior in children between the ages of 5 and 17 years who had autistic disorder with severe tantrums, aggression, or self-injurious behavior. At eight weeks, 69 percent of the children treated with risperidone had substantial improvement in behavior, as compared with 12 percent of those who received placebo. Fatigue, drowsiness, tremor, drooling, and increased appetite were mild but were more common among children taking risperidone.

322-329
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The number of effective, long-term treatments for pulmonary hypertension is limited. In this double-blind, randomized trial, an aerosolized form of iloprost, a stable analogue of the pulmonary vasodilator prostacyclin, was assessed over a 12-week period. Iloprost had a beneficial effect on the combined end point of the distance walked in six minutes and an improvement in the New York Heart Association functional class.

330-338

Bronchiolitis obliterans results in irreversible obstruction of the small airways and has known environmental and occupational causes. An investigation was initiated at a plant that produces microwave popcorn after signs and symptoms of bronchiolitis obliterans developed in eight employees. Among current workers at the plant, those exposed to high levels of diacetyl (2,3-butanedione), the principal additive that is used to give the popcorn its butter flavor, had more than three times the expected rate of airway obstruction and more than twice the expected rate of cough. There were strong relations between the degree of airway obstruction and the level of exposure to diacetyl.

Images in Clinical Medicine
339

Figure 1. A 47-year-old construction worker reported a two-month history of blanching of the second to fifth fingers and a recent ulcer on the tip of the third finger of his right hand. One week before the onset of symptoms, he had straightened a slab of ...

e2
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An 87-year-old woman with an increased alkaline phosphatase level.

Clinical Practice
340-346
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A 77-year-old man has a five-day history of burning and aching pain in his right side and a two-day history of erythema and clusters of clear vesicles, accompanied by headache and malaise. How should he be evaluated and treated?

Review Article
347-356

    At least 2000 persons are bitten by venomous snakes in the United States each year. This article reviews the diagnosis and management of bites from venomous snakes encountered in North America, but the same principles apply to management of snakebites elsewhere in the world. The review summarizes the complications of envenomation and explains the current recommendations for the use of antivenoms. It explains how to distinguish venomous from nonvenomous snakes.

    Editorials
    358-359

    As has been noted repeatedly by expert panels and the lay press, nearly 60 percent of the adult population of the United States is overweight or obese, with substantial resulting morbidity and mortality.1 Since obesity increases the risk of the most ...

    360-361

      Occupational airway diseases are common workplace injuries that include occupational asthma, bronchitis, reactive airways dysfunction syndrome, and byssinosis (an airway disease affecting textile workers). The population prevalence of these syndromes is ...

      Clinical Implications of Basic Research
      362-364

      Although some mechanisms by which acute pain evolves into a chronic syndrome are known, many others, including changes in the brain stem, thalamus, and cerebral cortex, are not understood. Moreover, even though chronic neuropathic and inflammatory pain ...

      Correspondence
      365-367

      To the Editor: Moss et al. (March 21 issue)1 describe a randomized, controlled clinical trial designed to test the expansion of the indications for implanting a cardiac defibrillator. The maker of the defibrillator paid for the trial, which was conducted ...

      367-368

      To the Editor: The results of the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) study, reported by Stone et al. (March 28 issue),1 convincingly validate primary stent implantation as a preferred strategy ...

      368-370

      To the Editor: Dorian and colleagues (March 21 issue)1 report increased rates of survival to hospital admission among patients treated with amiodarone for out-of-hospital ventricular fibrillation. Although their conclusion is consistent with their data ...

      370-371

      To the Editor: Alrajhi et al. (March 21 issue)1 report on the efficacy of systemic fluconazole for Old World cutaneous leishmaniasis caused by Leishmania major. Although this therapy was more efficacious than placebo, the rationale for the study is ...

      371

      To the Editor: The medical mystery in the June 13 issue1 involved a 76-year-old man with sinus node disease who was evaluated after an episode of syncope and who received a single-chamber pacemaker through the left subclavian approach. The medial pathway ...

      371-373

      To the Editor: On the basis of a trial that showed little effect of geriatric evaluation and management, Cohen et al. (March 21 issue)1 conclude that earlier studies might have overestimated the benefits of this type of geriatric care.2 This conclusion ...

      373-374

      To the Editor: Eiro et al. (Jan. 10 issue)1 report that therapy with a proton-pump inhibitor may be useful in correcting the metabolic abnormalities in patients with eating disorders involving self-induced vomiting. Although the loss of hydrogen ions ...

      374

      To the Editor: Primary invasive carcinoma of the vagina is rare, accounting for less than 3 percent of malignant tumors of the female genital tract. Vaginal intraepithelial neoplasia, a precursor of invasive vaginal carcinoma, is even less common.1 ...

      Book Reviews
      375

      Neonatal intensive care is one of the most dramatic recent advances in medicine. Every year, 53,000 babies are born prematurely in the United States. The newborn intensive care unit, with its sophisticated technology, has become the artificial womb for ...

      375-376
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      The editors of Febrile Seizures are correct: the time has come for a new book on this topic. The last multiauthored book on the subject (Karin B. Nelson and Jonas H. Ellenberg, eds. Febrile Seizures. New York: Raven Press, 1981) was produced more than 20 ...

      376-377
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      Pediatric urology is a relatively young subspecialty. The diagnosis and management of urologic disorders is continuously changing, as the pathophysiology of problems of the genitourinary system becomes better understood. The major urology textbooks ...

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