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March 20, 2003  Vol. 348 No. 12

Perspective
1079-1080

“What the detective story is about,” said the great British mystery writer P.D. James in a 1986 interview, “is not murder but the restoration of order.” The same might be said for the medical version of the detective story, the report of a successful ...

1081-1082

The role of race in the cause and treatment of disease has been the subject of much discussion during the past year, in the pages of the Journal and elsewhere. Two Sounding Board articles in this issue of the Journal are the most recent contributions to ...

1083-1084

    Last month, a 17-year-old girl died at Duke University Medical Center after receiving a heart–lung transplant from an incompatible donor. Her blood type was O, the donor's was A, and the mismatch was not recognized until after the transplant operation was ...

    Original Articles
    1085-1095

    Melanocortin 4 receptor (MC4R) deficiency is the most common form of monogenic obesity. To examine the clinical spectrum and mode of inheritance, the investigators determined the MC4R nucleotide sequence in 500 probands with severe childhood obesity. Twenty-nine had mutations in MC4R — 23 were heterozygous and 6 were homozygous. Homozygotes were more severely affected than heterozygotes.

    1096-1103

    Mutations in the genes for the melanocortin 4 receptor (MC4R), the leptin receptor, and proopiomelanocortin have been identified as potential causes of monogenic obesity. This study examined phenotypic data and eating behavior in severely obese persons. Binge eating was a characteristic of all subjects with MC4R mutations, though not of carriers of other mutations.

    1104-1111
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    CD40 ligand is released from activated platelets and promotes inflammation and coagulation. In this study of patients with acute coronary syndromes, increased serum levels of soluble CD40 ligand were associated with an increased risk of death or nonfatal myocardial infarction. Increased soluble CD40 ligand levels also predicted a beneficial clinical response to the glycoprotein IIb/IIIa receptor inhibitor abciximab.

    1112-1121

    In the winter of 2002, an outbreak of conjunctivitis affected 698 students at Dartmouth College in New Hampshire, including 22 percent of all first-year students. Risk factors included close contact with an affected student, wearing contact lenses, and visiting or living in a fraternity or sorority house. After the institution of preventive measures and after spring break, the outbreak subsided.

    Images in Clinical Medicine
    1122
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    A 60-year-old man presented with epiphora, or an abnormal overflow of tears, caused by bilateral primary acquired nasolacrimal-duct obstruction. Computed tomography (CT) of the orbits and sinuses performed as part of the preoperative workup showed a ...

    Review Articles
    1123-1133

    Central venous catheters permit the measurement of hemodynamic variables that cannot be measured accurately by noninvasive means. They also allow delivery of medications and nutritional support. More than 15 percent of patients, however, have a serious mechanical, infectious, or thrombotic complication related to the use of a central venous catheter. This review explains strategies for minimizing the frequency of such complications. An accompanying video shows techniques for catheter insertion by the internal jugular and subclavian routes.

    1134-1149

      The members of the chromogranin–secretogranin family of peptide hormones, biogenic amines, and neurotransmitters are enclosed within vesicles in the neuroendocrine system and a variety of neurons. These granins, the chief of which is chromogranin A, participate in sympathoadrenal activity and serve as markers of neuroendocrine tumors, especially pheochromocytoma.

      Case Records of the Massachusetts General Hospital
      1150-1158

      Presentation of Case

      An 18-year-old man was admitted to the hospital because of back and leg pain and a nondiagnostic biopsy specimen from a paravertebral mass.

      The patient had been well until eight months earlier, when the back pain began. Despite the ...

      Editorials
      1160-1163

      There has been a dramatic increase in the worldwide prevalence of obesity, a disorder with complex genetic traits that is influenced by environmental factors and that predisposes affected persons to diseases such as diabetes mellitus, hypertension, stroke,...

      1163-1165

      Platelet activation is central to the formation of thrombus, which precipitates most unstable coronary syndromes. The angiographic severity of coronary stenoses may not predict the occurrence of acute cardiac events, since rupture of atheromatous plaque ...

      Sounding Board
      1166-1170

        These two articles present contrasting views of the usefulness of the concept of race in biomedical research and clinical practice.

        1170-1175

        A debate has recently arisen over the use of racial classification in medicine and biomedical research. In particular, with the completion of a rough draft of the human genome, some have suggested that racial classification may not be useful for ...

        Correspondence
        1176-1177

        To the Editor: Yamada et al. (Dec. 12 issue)1 state that the identification of genotypes of the 4G–668/5G polymorphism of the gene encoding plasminogen-activator inhibitor type 1 may be a reliable means of predicting the risk of myocardial infarction in ...

        1177-1179

        To the Editor: Hulscher and colleagues' success with transhiatal and transthoracic surgical approaches for esophageal carcinoma (median survival, 1.8 and 2.0 years, respectively) explains why they found no difference between the two procedures (Nov. 21 ...

        1179-1181

        To the Editor: Bockarie et al. (Dec. 5 issue)1 provide encouraging new evidence that mass treatment with antifilarial drugs can interrupt transmission of Wuchereria bancrofti. However, their conclusion that this strategy can eliminate filarial lymphedema ...

        1181-1182

        To the Editor: In the studies of high-frequency ventilation reported in the August 29 issue by Johnson et al.1 and Courtney et al.,2 there were important differences in the application of conventional ventilation in the control groups, which may explain ...

        1182-1184
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        To the Editor: In their review article about typhoid fever, Parry et al. (Nov. 28 issue)1 describe the clinical features of infection with Salmonella enterica serotype typhi but do not mention renal failure as an important complication. We have reviewed ...

        1184-1185

        To the Editor: Physicians underestimate the degree to which medical care, which was formerly simple, ineffective, and safe, is now complex, effective, and unsafe. Blendon et al. (Dec. 12 issue)1 report that physicians are aware of medical errors but ...

        1185-1186

        To the Editor: We read with concern the analysis by Davidson et al. (Sept. 26 issue).1 They use the pooled placebo groups from two sepsis trials, divided into two groups — patients who either were receiving heparin at the time they entered the trial or ...

        1186-1187

        To the Editor: Fabry's disease is a rare, X-linked disorder characterized by subnormal or absent activity of the lysosomal hydrolase α-galactosidase A. A deficiency of α-galactosidase A leads to progressive lysosomal accumulation of glycosphingolipids (...

        1187-1188

        To the Editor: Bisphosphonates are used to inhibit bone resorption in postmenopausal women and to manage hypercalcemia associated with osteolytic bone cancer, metastases of breast cancer, multiple myeloma, and Paget's disease of bone. Pamidronate ...

        Book Reviews
        1189

        Margaret Spinelli has gathered a group of experts to examine the subject of maternal infanticide from biologic, psychosocial, legal, and cultural perspectives. Her book handles the material sensitively, with an eye toward prevention. It also serves as a ...

        1190

        The “shaken-baby syndrome” is a serious public health problem that escaped the radar of the medical, legal, and larger community for far too long. Silenced Angels sends the message that this syndrome is a completely identifiable and preventable public ...

        1190-1191

        This interesting collection of historical essays was presented at the University of Michigan in September 2000 at a symposium named for the first professor of pediatrics, David Murray Cowie. It is not intended to be a comprehensive history of pediatrics ...

        Corrections
        1192

        Adefovir Dipivoxil for the Treatment of Hepatitis B e Antigen–Negative Chronic Hepatitis B Original Article, N Engl J Med 2003:348;800-807. and Adefovir Dipivoxil for the Treatment of Hepatitis B e Antigen–Positive Chronic Hepatitis B Original Article, N ...

        1192

        Selective Estrogen-Receptor Modulators — Mechanisms of Action and Application to Clinical Practice Review Article, N Engl J Med 2003:348;618-629.. There was an error in Figure 2; a corrected figure is shown here.

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