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August 29, 2002  Vol. 347 No. 9

Perspective
630-631
  • Video

Human survival depends on the exchange of fresh air with carbon dioxide in the blood. Since this exchange takes place in the alveoli, one of the first concepts taught in respiratory physiology is that the size of each breath, the tidal volume, must exceed ...

Original Articles
633-642

Respiratory distress is common in premature infants. Many of these infants require mechanical ventilatory support for the first few weeks of life, but the best way to deliver this support is not known. In this randomized trial performed in the United Kingdom, there was no difference between the two ventilatory strategies in terms of survival, the need for oxygen treatment at 28 days of life, or other benefits or complications of ventilation.

643-652

This randomized study, performed at multiple centers in the United States, compared high-frequency oscillatory ventilation with synchronized intermittent mandatory ventilation in babies who required mechanical ventilatory assistance. Ventilators were adjusted according to strict validated protocols. Among 234 infants assigned to high-frequency oscillatory ventilation, as compared with 250 assigned to synchronized intermittent mandatory ventilation, a small but significantly greater proportion were alive and not requiring supplemental oxygen at 36 weeks of postmenstrual age (P=0.046); there was no significant difference in the incidence of adverse events between the two groups.

653-659

Nephrogenic adenomas are benign growths in the urothelial mucosa that can cause hematuria or dysuria. Their origin is unknown. This detailed study of nephrogenic adenomas from recipients of kidney grafts showed that in all cases the adenoma had the sex chromosomes of the donor kidney and the immunohistochemical features of renal tubular cells.

Images in Clinical Medicine
660
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Figure 1. A 6-day-old infant with a 48-hour history of facial lesions had been born at 37 weeks of gestation after a spontaneous vaginal delivery without complications. According to her mother, the newborn was thriving and had had no behavioral changes ...

Special Article
661-666
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This study assessed associations between state requirements for insurance coverage of in vitro fertilization services and the utilization and outcomes of such services. Fertility clinics in states that required complete coverage performed significantly more in vitro fertilization cycles involving the transfer of fresh embryos than clinics in states that required partial coverage or none. The percentage of cycles that resulted in live births was lower in the states that required complete or partial coverage, but these states also had a lower number of embryos transferred per cycle and a lower rate of pregnancies with three or more fetuses.

Clinical Practice
667-671

    A 16-year-old boy is brought by his parents to his primary care physician because of a decline in school performance, which began at least three years earlier but has become more severe in the past year. He reports boredom, a lack of enjoyment and motivation, poor selfesteem, a feeling of hopelessness, difficulty sleeping, poor concentration, and passive thoughts of suicide without a plan or intent. How should he be treated?

    Case Records of the Massachusetts General Hospital
    672-680

    Presentation of Case

    A 5 1/2-year-old boy was admitted for video electroencephalographic monitoring to investigate his seizures.

    The boy had been born to a 21-year-old woman by spontaneous vaginal delivery after an uncomplicated, full-term, second ...

    Editorials
    682-684

    Bronchopulmonary dysplasia, also known as chronic lung disease of infancy, is an important cause of illness in preterm infants. This condition, usually defined by the need for supplemental oxygen at 36 weeks of postmenstrual age, affects nearly one third ...

    684-686

    Nephrogenic adenomas, which are rare intraurothelial lesions that occur in the bladder, ureter, or urethra, most often present with hematuria or discomfort on voiding. Some patients have no symptoms at all, but occasionally, obstruction develops. These ...

    686-688

    Not long ago, in vitro fertilization was the stuff of science fiction.1 Even after the birth of the first baby from in vitro fertilization in 1978, such births were initially few and far between, and there was skepticism about the future of in vitro ...

    Correspondence
    689-690

    To the Editor: I am alarmed by the high rate of vaccinia-vaccine–associated morbidity (>30 percent) in the study by Frey et al. (April 25 issue).1 In their study, there were three deviations from prior standard procedures for vaccinia vaccination25 that ...

    690-691
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    To the Editor: In Table 1 of their article, Breman and Henderson (April 25 issue)1 list secondary syphilis as a maculopapular eruption, noting that it has frequently been confused with smallpox. In general, it is more difficult to differentiate ...

    691-692

    To the Editor: Bicknell's Sounding Board article (April 25 issue)1 includes some factual errors. Smallpox is not transmitted during its preeruptive period. It spreads only from overtly ill persons.2,3 Ring vaccination is not just for small outbreaks. It ...

    692

    To the Editor: Boylston (April 25 issue)1 reminds us that clinical trials have been around a long time and that they are available to all, and he cites William Watson's contribution to the understanding of smallpox in 1767 as perhaps the first. But I ...

    692-693

    To the Editor: Radiation treatment undoubtedly reduces the risk of recurrence of in-stent restenosis. However, the findings of Waksman et al. (April 18 issue)1 should be taken in the context of two facts. First, although the greatest need for target-...

    693-696
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    To the Editor: The attempt of Birkmeyer et al. (April 11 issue)1 to correlate low procedure-specific hospital volume with increased mortality has methodologic and interpretive problems. The investigators used data from the Medicare Provider Analysis and ...

    696
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    To the Editor: The Image in Clinical Medicine entitled “Bronchial Cast” (March 28 issue)1 describes a patient who had had respiratory symptoms for six months and who expectorated a bronchial cast. However, the authors do not mention the outcome. Was the ...

    696-697

    To the Editor: We disagree strongly with the conclusions of Cothren et al. (April 4 issue)1 about the benefits of the polymerized hemoglobin-based oxygen carrier PolyHeme in critically ill patients with anemia who refuse transfusions. Hemoglobin-based ...

    697-698

    To the Editor: Babesia divergens is the primary cause of human babesiosis in Europe, resulting in fatality rates of 42 percent among persons who have undergone splenectomy and 5 percent among persons with intact spleens.1 The known vector tick, Ixodes ...

    Book Reviews
    699

    Despite its title, this book is not the story of a deliberate hunt for a killer virus. It is the story of the almost accidental opening of new vistas in virology that led to a Nobel prize. It is the story of the boy from Brooklyn who became the persistent,...

    699-700

    This is a comprehensive, informative, and well-referenced monograph on the main proteins involved in iron metabolism, including transferrin, ferritin, lactoferrin, and the iron-transport proteins and on the relevant aspects of iron absorption and cellular ...

    700

    This book covers many of the topics in vascular medicine that currently are prominent in the scientific, clinical, and lay press. Part I deals with mechanisms of hypercoagulability; the roles of cells, cytokines, and inflammation in the pathogenesis of ...