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March 27, 2003  Vol. 348 No. 13

Perspective
1199-1200

Patients with sustained high-grade eosinophilia without an evident cause usually receive the diagnosis of hypereosinophilic syndrome, a high-sounding term that only masks our ignorance. Apart from the consistent presence of hypereosinophilia, the clinical ...

Original Articles
1201-1214

A fusion between the PDGFRA and FIP1L1 genes was found in some cases of the hypereosinophilic syndrome, a fatal disorder in which eosinophils invade and destroy various organs. The fusion protein is a constitutively active tyrosine kinase, which explains the effect of imatinib, an inhibitor of tyrosine kinases, in the disease. The immortalization of hematopoietic cells by the fusion protein indicates its role in causing the syndrome.

1215-1222

Silent brain infarcts (i.e., infarcts without associated neurologic symptoms) are common, and their clinical significance is unclear. In this population-based study, elderly people without dementia underwent cognitive testing and magnetic resonance imaging in 1995 to 1996 and again in 1999 to 2000. Dementia was more than twice as likely to develop in participants who had silent brain infarcts at base line.

1223-1232

Pain occurring after central nervous system or peripheral-nerve injury is known as neuropathic pain and is notoriously difficult to treat. Many physicians have avoided the use of opiates to treat this type of pain for fear of addiction or loss of efficacy due to tolerance. In this eight-week study, patients with neuropathic pain who were treated with high-strength levorphanol tablets had less intense pain than patients assigned to low-strength tablets but had more side effects.

1233-1241

Obstructive sleep apnea may exacerbate the manifestations of heart failure, because it causes hypoxia and activation of the sympathetic nervous system, leading to increases in the heart rate and blood pressure. In this study, continuous positive airway pressure was found to reduce systolic blood pressure and increase left ventricular function in patients with heart failure and obstructive sleep apnea.

Images in Clinical Medicine
1242
  • Free Full Text

A four-year-old girl was brought to her pediatrician by her parents because of intermittent bilious emesis, which had started two weeks earlier. There were no other changes in her bowel or bladder habits, and she had not lost weight. Her parents reported ...

Clinical Practice
1243-1255

    A 67-year-old woman who had been in excellent health noticed the onset of burning pain in the left great toe two years before evaluation. The pain subsequently extended to involve both feet, from the toes to the heels, and was associated with numbness, tingling, and burning. The discomfort has become severe, is present throughout the day, and disrupts sleep. A physical examination reveals normal muscle strength, muscle-stretch reflexes, proprioception, and vibratory sensation; only pinprick sensation in the toes and feet is diminished. How should this patient be evaluated and treated?

    Review Article
    1256-1266

    The answer to this frequently asked question is addressed in this review article, which focuses on common respiratory tract infections that are spread from person to person. The author concentrates on community-based contagion rather than nosocomial infections or agents that have received recent attention principally because of their actual or potential role in biologic terrorism.

    Case Records of the Massachusetts General Hospital
    1267-1275

    Presentation of Case

    A 72-year-old man was transferred to this hospital from another hospital because of rapidly progressive leukemia and multiorgan failure.

    The patient had lost an unknown amount of weight during the preceding two months, but he was ...

    Editorials
    1277-1278

      An epidemiologic study by Vermeer et al. in this issue of the Journal indicates that “silent” strokes are a risk factor for dementia.1 Recurrent strokes during the three to four years of follow-up in this study appear to have been the mechanism of — or at ...

      1279-1281

      Chronic neuropathic pain is a serious problem resulting from injury to the central or peripheral nervous system; it affects more than 2 million Americans. Despite advances in our understanding of the pathophysiology and molecular biology of neuropathic ...

      Clinical Implications of Basic Research
      1282-1283

      The discovery of the DNA code touched off an explosion of our knowledge of the molecular basis of human diseases and sparked ideas about treating inherited diseases with genes. Unfortunately, the first widely publicized attempt at gene therapy, in which ...

      Correspondence
      1284-1286

      To the Editor: The authors of the recently published Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial (Dec. 5 issue)1 conclude that rhythm control offers no advantage over rate control, although they saw a trend toward ...

      1287-1288

      To the Editor: Mora-Duarte and colleagues (Dec. 19 issue)1 fail to demonstrate that caspofungin can be considered a first-line treatment for most candida infections, because they did not use fluconazole as the comparison drug. Although Walsh, in the ...

      1288-1289

      To the Editor: Patient factors that influence physicians' referrals may have exaggerated differences in outcomes between generalists and specialists in the study by Ayanian and colleagues (Nov. 21 issue).1 Results from observational studies such as this ...

      1289-1292

      To the Editor: We applaud the rigorous decision analysis by Khan et al. (Dec. 5 issue),1 who demonstrated the cost effectiveness of screening and treating recent immigrants from countries where tuberculosis is prevalent for latent tuberculosis infection. ...

      1292-1293

      To the Editor: I was perturbed by the recommendation of Jasmer et al. (Dec. 5 issue)1 that an asymptomatic, low risk, 27-year-old schoolteacher with a 17-mm induration on intradermal tuberculin skin test “should not be treated.” The authors state, “One ...

      1294
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      To the Editor: The unqualified recommendation by Wisner et al. (July 18 issue)1 that women with postpartum depression should be given antidepressants is inappropriate. Antidepressants should indeed be considered, but many women who have recently given ...

      1294-1295

      To the Editor: It has been almost 40 years since a medical student was tested on his or her bedside manner before being licensed to practice medicine. In 1964, this portion of licensure testing was discontinued because of questions of fairness and ...

      Book Reviews
      1296-1297

      “The single most important fiscal issue facing the developed world is its aging population.” So write Gruber and Wise in chapter 2 of this excellent and most timely product of a 1999 conference. The mandate of the conference was to “consider the ...

      1297-1298

      Neurologic diseases in the geriatric population have become a major health problem, both because of our success in treating nonneurologic diseases and because of the advancing wave of aging baby boomers. In addition, neurons are postmitotic, which makes ...

      1298-1299
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      The major challenges facing the field of cancer research are its epidemiologic study, the technology revolution, and the incremental gains in survival flowing from increasingly complex and lengthy treatments. There is the danger that our focus on ...

      1299-1300

      Had I set out to write a book about Jews and medicine, I would have selected 10 or 12 of the best-known names. I would have devoted a chapter to each of them, beginning with interesting tidbits about their childhood, continuing with their education, and ...

      Correction
      1300

      Case Records of the Massachusetts General Hospital (Case 34-2002) Case Records of the Massachusetts General Hospital, N Engl J Med 2002:347;1433-1440.. In the first paragraph of the Differential Diagnosis on page 1435, line 13 should have read “posterior-...

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