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April 24, 2003  Vol. 348 No. 17

Perspective
1623-1624

    Laboratory investigators have long known that animals in which energy intake is reduced to about 60 percent of the intake of animals that are fed as much as they want have a considerably lower incidence of cancer than the control animals. This finding ...

    Original Articles
    1625-1638
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    Excess weight increases the risk of death from all causes and from cardiovascular disease. Some evidence suggests that adiposity also increases the risk of death from cancer. This prospective study of more than 900,000 men and women confirms that obesity is a significant risk factor for death from cancer generally and from cancer in several specific sites.

    1639-1646

    Cardiomyopathy often has devastating consequences in children. This Australian study found an incidence of 1.24 cases per 100,000 person-years at risk from 1987 to 1996 among children under 10. Among cases of dilated cardiomyopathy, lymphocytic myocarditis was an important cause. Hypertrophic cardiomyopathy was about half as common as dilated cardiomyopathy. A myocardial disorder known as left ventricular noncompaction was also found.

    1647-1655

    Cardiomyopathy in children is a serious disorder that often results in cardiac transplantation or death. This study was based on a 1996–1999 registry of cases in New England and in Texas, Oklahoma, and Arkansas. The overall annual incidence was 1.13 cases per 100,000 children, but the incidence was much higher among infants than in other age groups. Dilated and hypertrophic cardiomyopathies predominated. The incidence was higher in boys than in girls and in blacks than in whites.

    1656-1663

    Fibroblast growth factor 23 (FGF-23) appears to be involved in phosphate regulation by the kidney. It has been hypothesized that this factor is elevated in oncogenic osteomalacia and X-linked hypophosphatemia, and the authors developed an immunometric assay to study this issue.

    1664-1670

    The Usher syndrome, the most frequent cause of deafness and concurrent blindness, occurs with increased frequency in Ashkenazi Jews. The authors of this study demonstrated a founder mutation for the most common form of the type 1 Usher syndrome that probably occurred 350 years ago.

    Images in Clinical Medicine
    1671
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    An 89-year-old woman was referred for an upper gastrointestinal examination because of dysphagia, epigastric pain, and frequent belching. A single-contrast barium examination of the patient's esophagus showed a constricted, twisted lumen (upper arrow). ...

    Clinical Practice
    1672-1680

      A 44-year-old woman in good health, who has no family history of breast or ovarian cancer, asks about mammography. She had a normal screening mammogram 18 months ago but has recently read that mammograms may not be useful. What should her physician advise?

      Review Article
      1681-1691

        Skin cancers are the most common tumors in patients who have received organ transplants. This review discusses the epidemiology, pathogenesis, and management of squamous-cell and basal-cell carcinomas, cancers of the anogenital region, Kaposi's sarcoma, melanoma, neuroendocrine skin carcinoma, and cutaneous manifestations of lymphoma in transplant recipients.

        Case Records of the Massachusetts General Hospital
        1692-1701

        Presentation of Case

        A 14-month-old boy was admitted to the hospital because of hepatomegaly, left-sided ptosis, and a bony lump on the forehead.

        The patient had been constipated for several months, passing one hard stool every two or three days with ...

        Editorials
        1703-1705

        Improvements in the treatment of congenital heart disease are among the most impressive medical achievements of the second half of the 20th century. In 1950, patent ductus arteriosus and aortic coarctation were the only correctable lesions, and the ...

        1705-1708

        Oncogenic osteomalacia has fascinated physiology-minded physicians for decades. The traditional name for this peculiar disorder connotes its classification as a paraneoplastic phenomenon. Such a characterization is a bit off the mark, however, in that the ...

        Clinical Implications of Basic Research
        1709-1711

        Rheumatoid arthritis is a chronic destructive disease of joints, characterized by inflammation, synovial hyperplasia, and abnormal cellular and humoral immune responses. Although several types of cells have been proposed to trigger synovial inflammation, ...

        Occasional Notes
        1712-1714

        “It is the molecule which has style, quite as much as the scientists,” Francis Crick wrote in 1974, for the 21st anniversary of the elucidation of the structure of deoxyribonucleic acid, DNA.1 Austerely elegant, stupendously parsimonious, and shocking in ...

        Correspondence
        1715-1717

        To the Editor: The study by van de Vijver et al. (Dec. 19 issue)1 is of considerable interest with respect to the biology of breast cancer. However, from the point of view of the individual patient and her physician, the sensitivity and specificity of ...

        1717-1719

        To the Editor: Keller et al. (Jan. 9 issue)1 report that patients with hypertension have fewer nephrons than do age-matched normotensive controls. Is hypertension therefore predetermined by a low nephron number, and, if so, how does this occur? Reduction ...

        1719-1722

        To the Editor: Mukamal et al. (Jan. 9 issue)1 report on the roles of drinking pattern and type of alcohol consumed in coronary heart disease in men. Although alcohol consumption reduces mortality from coronary heart disease, it has not been shown to have ...

        1722-1724

        To the Editor: The concept that phenylketonuria may be cured by tetrahydrobiopterin, the cofactor of phenylalanine hydroxylase, rather than by dietary protein restriction, has generated a number of therapeutic attempts. Muntau et al. (Dec. 26 issue)1 ...

        1724-1725

        To the Editor: In explaining the association between increased body-mass index and a higher risk of retention of a surgical instrument or sponge, Gawande et al. (Jan. 16 issue)1 suggest that the increased risk may reflect “the amount of room there is in ...

        1725-1726

        To the Editor: Shevell's scholarly and articulate review of the Hallervorden–Spatz syndrome (Jan. 2 issue)1 is to be applauded, but he should reconsider the contention that Hallervorden's eponym should be discarded because of his ethical transgressions ...

        1726-1727
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        To the Editor: First described in 1968, pacemaker twiddler's syndrome refers to permanent malfunction of a pacemaker due to the patient's manipulation of the pulse generator.1 The sequence of symptoms begins with the patient's deliberate or subconscious ...

        Book Reviews
        1728-1729

        Fifty years ago, a young South African student who was destined to win the Nobel prize made the short pilgrimage from Oxford to Cambridge to pay his respects to a chemical model on display in Room 103 of the Cavendish Laboratory. It was, Sydney Brenner ...

        1729-1730

        This biography illuminates one of the most mysterious protagonists in a fascinating story of fibers, photographs, and feelings, in which biology is revolutionized with the discovery of the double-helix structure of DNA. Rosalind Franklin, Maddox's “dark ...

        Correction
        1730

        Magnesium Sulfate for Preeclampsia Perspective, N Engl J Med 2003:348;275-276.. On page 276, the figure legend should have read “Autopsy Specimen from a 40-Year-Old Woman with Severe Preeclampsia and Acute Intraparenchymal and Intraventricular Hemorrhage” ...