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March 13, 2003  Vol. 348 No. 11

Perspective
975-976

In this issue of the Journal, Leung et al. (pages 986–993) report results with a new drug to reduce the risk of anaphylactic reactions to food. In a multicenter, phase 2 study, TNX-901, a monoclonal antibody to IgE, increased the threshold of sensitivity ...

Original Articles
977-985
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The prevalence of peanut allergy is increasing. The authors investigated factors associated with peanut allergy in a large cohort from which both children with allergy and control children were drawn. There was an association between the presence of peanut allergy and the use on infants of skin preparations containing peanut oils; also associated with the subsequent development of peanut allergy were intake of soy milk or soy formula and the presence of an oozing, crusted rash.

986-993

Injections of TNX-901 may provide protection after ingestion of peanut.

994-1004

Imatinib, an inhibitor of the mutant tyrosine kinase that causes chronic myeloid leukemia (CML), is effective in patients with chronic-phase CML who have no response to the standard treatment, interferon alfa. In this study of 1106 patients with previously untreated chronic-phase CML, imatinib was superior to a combination of interferon alfa and cytarabine as initial therapy.

1005-1015

Carcinoid tumors release vasoactive compounds, including serotonin, which may be toxic to heart valves. Right-sided valves are especially vulnerable. In this study, the progression of heart-valve disease was associated with higher peak urinary levels of 5-hydroxyindoleacetic acid (a serotonin metabolite) and treatment with cytotoxic chemotherapy.

Images in Clinical Medicine
1016
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An 80-year-old man underwent esophagogastroduodenography with barium contrast medium to investigate long-standing dysphagia. During the examination, the patient aspirated contrast material into his lungs. Forty-eight hours later, he presented with a dry ...

Special Article
1017-1026

Since 1890, the Massachusetts Medical Society has sponsored the Shattuck Lecture at its annual meeting. The 2002 lecturer, Dr. Robert S. Schwartz, discusses advances in the basic science of immunology that, in time, changed clinical practice and summarizes the new treatments they spawned.

Clinical Practice
1027-1032

A 53-year-old man awoke in the morning with acute dizziness. He staggered to the bathroom, where he vomited repeatedly. When he was seen at the local emergency department 12 hours later, he had left-beating nystagmus in all positions of gaze but otherwise no focal neurologic findings. How should he be evaluated and treated?

Case Records of the Massachusetts General Hospital
1033-1044

Presentation of Case

A 35-year-old man with end-stage renal disease and a history of failed renal transplantation was admitted to the hospital for another transplantation.

When the patient was 10 years old, diabetes mellitus type 1 developed, resulting in ...

Editorials
1046-1048

About 80 years ago, Carl Prausnitz injected into his abdominal skin a small amount of serum from his colleague, Heinz Küstner. When Prausnitz subsequently ate some cooked fish to which Küstner (but not Prausnitz) was allergic, hives developed at the sites ...

1048-1050

Chronic myeloid leukemia (CML) is a clonal stem-cell disorder in which the reciprocal translocation t(9;22) generates two novel fusion genes: BCR-ABL on the derivative 22q– (Philadelphia) chromosome, and ABL-BCR on chromosome 9q+. The ABL gene product is ...

Health Policy Report
1051-1056

This article describes a method of investigating and learning from adverse events. Careful investigation and systems analysis can identify the factors that set the stage for a medical error. The author argues that the process of understanding adverse events leads to improvements in care and reductions in errors and that insensitive and inadequate handling of an incident can result in additional harm to patients and families. He outlines practical strategies to minimize the trauma resulting from adverse events.

Correspondence
1057-1059

To the Editor: We were surprised to read, in the article by Mangano and colleagues (Oct. 24 issue),1 that the routine use of aspirin on the day of coronary bypass surgery is not the standard of care, given the 20-year-old evidence that starting aspirin ...

1059-1061

To the Editor: In the analysis by Ridker et al. (Nov. 14 issue),1 several methodologic issues merit attention before claims of superiority for C-reactive protein in the prediction of cardiovascular risk can be substantiated. First, the authors did not ...

1061-1063

To the Editor: Lassen et al. (Sept. 5 issue)1 note the high risk of venous thrombosis in patients with leg injury requiring immobilization, as well as previous studies of prophylaxis in this population. Given this high risk, none of the participants in ...

1063-1064

To the Editor: Keyomarsi et al. (Nov. 14 issue)1 present the exciting and powerful finding that the levels of cyclin E in breast-cancer cells, as measured with the Western blot assay, correlate strongly with prognosis; however, there is a potential ...

1064-1066

To the Editor: Weenig et al. (Oct. 31 issue)1 stress the need for extensive investigations in cases of skin ulcers that are suggestive of pyoderma gangrenosum. However, their recommendation of colonoscopy in Table 3 of their article is unclear. We ...

1066-1067
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To the Editor: In Burke's review of genetic testing (Dec. 5 issue),1 Tables 1 and 2 offer examples of genetic tests. The tables are intended to be illustrative, not exhaustive, and most entries are based on information from GeneTests–GeneClinics at http:/...

1067-1069

To the Editor: Delayed-onset heparin-induced thrombocytopenia, a newly described syndrome of immune-mediated thrombocytopenia that begins several days after heparin therapy has been discontinued,1,2 is caused by IgG antibodies that are reactive against ...

Book Reviews
1070-1071

Field handbooks abound for every conceivable medical specialty, and Conflict and Catastrophe Medicine: A Practical Guide could easily fill this role for relief medicine. But what is special about this work is not its relatively brief medical section. It ...

1071-1072
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This excellent second edition is an update of the highly successful first edition of The Pituitary, published in 1995. For the pituitary, a small gland albeit the “master gland” of the endocrine system, a surprising amount has changed since then. There ...

1072-1073

The field of hematology is growing increasingly complex, especially in the area of hemostatic and thrombotic disorders. Paradoxically, however, the number of practicing clinical hematologists in the United States has been static or has even decreased. ...

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