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March 6, 2003  Vol. 348 No. 10

Perspective
879-880

Awareness of the substantial morbidity and mortality attributable to colorectal cancer has focused attention on early detection and prevention through screening and on other strategies such as chemoprevention. Among several agents under evaluation, ...

881-882

Although executives and physicians at the Beth Israel Deaconess Medical Center in Boston have had reason to take great pride in their advanced clinical computing system, they recently had a wake-up call when the system suffered a full-scale failure. ...

Original Articles
883-890

In this randomized, double-blind trial, daily ingestion of aspirin reduced the incidence of colorectal polyps among patients with previous colorectal cancer. Of 258 patients in the placebo group who underwent colonoscopy, polyps were found in 70, whereas 43 of 259 patients in the aspirin group were found to have polyps.

891-899

Patients with a history of colonic adenomas were randomly assigned to receive daily aspirin or placebo. As compared with placebo, receipt of 81 mg of aspirin per day was associated with a 19 percent reduction in the risk of recurrent adenomas. The 325-mg dose was not beneficial.

900-907
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Among more than 15,000 women in a community-based cohort, both cesarean section and vaginal delivery were associated with increased risk of urinary incontinence later in life. Furthermore, moderate or severe incontinence was more than twice as likely after vaginal delivery as after cesarean section, after adjustment for age and other potential confounders.

908-917

Treatment with a luteinizing hormone–releasing hormone (LHRH) agonist increases adult height in children with precocious puberty. This study was designed to determine whether LHRH-agonist therapy would increase adult height in short adolescents with normally timed puberty. The adolescents had an increase of 0.6 in the standard-deviation score for height, as compared with the initially predicted adult height; however, bone mineral density was decreased.

Images in Clinical Medicine
918
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A 70-year-old man with a history of a myocardial infarction, hormone-refractory metastatic prostate cancer, and chronic renal insufficiency presented with chest pain. Electrocardiography revealed atrial fibrillation and ST-segment elevation in the ...

e3
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  • Video

This video shows a pseudoaneurysm of the lateral wall.

Review Articles
919-932
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Colorectal cancers among patients with a familial risk of this disorder account for approximately one of five cases of this disease. Many cases can be prevented by the identification of those at risk and the use of appropriate colonoscopic screening. This article, part of the Genomic Medicine series, provides an in-depth review of the two most common forms of familial colorectal cancer.

933-940

This review article describes the use of electrocardiograms in facilitating the clinical care of patients with acute myocardial infarction. Analysis of patterns of ST-segment elevation can help in making decisions about reperfusion therapy. Correct identification of arrhythmias and new conduction abnormalities is an important challenge.

Editorials
942-945

In a 1953 editorial entitled “The Need for an Inhibitor of Gonadotropin,” Lawson Wilkins noted that a “method of suppressing the secretion of pituitary gonadotropins . . . might lead to the prevention or control of sexual precocity.”1 Almost 30 years ...

945
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In a letter in this issue of the Journal, Coats et al.1 request that their article, “Nonsurgical Reduction of the Interventricular Septum in Patients with Hypertrophic Cardiomyopathy,”2 which was published on October 24, 2002, be retracted. The reason for ...

Sounding Board
946-950

    Some women would prefer an elective cesarean delivery to labor. The authors of this Sounding Board article review the arguments for and against elective cesarean delivery. They conclude that the available data do not support the routine recommendation of this approach but that they do support a physician's acceding to a request for cesarean delivery made by an informed patient.

    Correspondence
    951

    To the editor: On October 24, 2002, an article about septal ablation with alcohol for hypertrophic cardiomyopathy was published in the Journal.1 The majority of those named as authors of the article did not have an opportunity to review and verify the ...

    951-954

    To the Editor: The publication of a controlled epidemiologic study on the measles, mumps, and rubella (MMR) vaccine and autism (Nov. 7 issue)1 represents a major advance. The great volume of material circulating on the Internet about a possible link ...

    954-957

    To the Editor: The study by de Gans and van de Beek and their colleagues (Nov. 14 issue)1 demonstrates the benefits of dexamethasone in adults with bacterial meningitis. The authors conclude by recommending dexamethasone for all adults with acute ...

    957-958

    To the Editor: Harding et al. (Nov. 14 issue)1 conclude that treatment of asymptomatic bacteriuria in women with diabetes does not appear to reduce complications and that screening and treatment are therefore not needed. However, Table 3 of their article ...

    958-959

    To the Editor: The analysis by Jain et al. (Aug. 29 issue)1 of insurance coverage for in vitro fertilization, based on data published by the Centers for Disease Control and Prevention (CDC),2 was limited by the use of aggregate-level data and the ...

    959-960

    To the Editor: Berde and Sethna (Oct. 3 issue)1 provide an excellent summary of developmental differences in pharmacology that dictate the appropriate use of analgesics in pediatric patients. However, there are gaps in the data required to support the ...

    960-961

    To the Editor: We are told in Case 29-2002 (Sept. 19 issue)1 that the patient's urine contained 15 to 20 red cells per high-power field and 100 mg of protein per deciliter but that he did not have nephritis, yet a renal biopsy was not performed before ...

    961-964

    To the Editor: Physician-assisted suicide for terminally ill residents of Oregon has been legal since October 1997.1 Although it has been challenged several times in court and by a referendum, the Oregon Death with Dignity Act remains in effect at this ...

    Book Reviews
    965-966

    Robert Burt has written a provocative and disturbing book that should be read by all professionals involved in end-of-life care. He suggests that dying patients, their families, and their physicians are “all vulnerable to unruly psychological forces ...

    966-967

    The Health of the Country is an illuminating medical perspective on the settlement of the American frontier from the Louisiana Purchase to the start of the Civil War. Through the use of letters, scientific reports, and travel literature, Valenčius is ...

    967-968

    In only two decades, the epidemic of human immunodeficiency virus (HIV) infection and AIDS has progressed from being a medical curiosity to its current status as a global killer, changing the family structures, economic development, and even the security ...