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May 1, 2003  Vol. 348 No. 18

Perspective
1735-1736

The development of heart failure in patients with aortic stenosis is associated with a high mortality rate — unless aortic-valve replacement is performed. There is an especially high risk of death among patients with aortic stenosis and a decreased ...

Original Articles
1737-1746

In 2000, a protein–polysaccharide pneumococcal conjugate vaccine was recommended for use in infants and young children. Surveillance data show that from 1998 to 2001 the rate of invasive disease declined by 69 percent among children less than two years of age. There were also smaller but significant reductions in pneumococcal disease in adults.

1747-1755

This population-based, retrospective study of more than 47,000 older persons assessed the effectiveness of pneumococcal vaccination. Vaccination was associated with a significant reduction in the risk of pneumococcal bacteremia, but over three years of follow-up there was no reduction in the risk of community-acquired pneumonia (hazard ratio, 1.07).

1756-1763

In critically ill patients with aortic stenosis and left ventricular dysfunction, vasodilator therapy has been considered to be contraindicated because of concern that it could cause hypotension. In this study, nitroprusside was administered to 25 such patients under carefully monitored conditions and, contrary to traditional teaching, was found to cause substantial improvement in the cardiac index and other hemodynamic variables.

1764-1775

Mutations of immunoglobulin genes in chronic-lymphocytic-leukemia (CLL) cells augur a good outcome, whereas the absence of mutations indicates a poor prognosis. The presence of ZAP-70 on CLL cells correlated with unmutated immunoglobulin genes and a poor prognosis, whereas its absence indicated the presence of mutated genes and a good outcome.

Images in Clinical Medicine
1776

A 68-year-old man presented with acute thoracic, abdominal, and back pain and progressive shock. In the past, he had undergone repair of an abdominal aortic aneurysm, bilobar wedge resection, and chest-wall resection because of a left-sided Pancoast's ...

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Multislice spiral computed tomography shows severe stenosis of the distal left main coronary artery.

Review Articles
1777-1785

Hematologic cancers — that is, leukemias and lymphomas — usually result from somatic mutations in hematopoietic cells rather than heritable mutations. Many of these cancers have been classified on the basis of their morphology and the presence of tumor marker antigens. This review explains complementary DNA expression profiling, a genomic approach to the diagnosis of such tumors, with certain leukemias and lymphomas used as examples.

1786-1795

This review summarizes the current approaches to the management of withdrawal in patients addicted to sedatives such as alcohol or benzodiazepines, opioids, or stimulants such as amphetamines or cocaine. Included are details of detoxification regimens and guidelines for recognizing and managing the most common complications.

Editorial
1797-1799

The typical patient with chronic lymphocytic leukemia (CLL) presents to his physician at the time of a routine physical examination as an asymptomatic man who has reached the time in his life when he can enjoy the fruits of his working years. He learns ...

Sounding Board
1800-1802
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Human immunodeficiency virus (HIV) infection and AIDS affect 42 million people worldwide. If the current projections are correct, 100 million more people will contract the disease by the end of the decade, and 45 million more people will die from AIDS-...

1802-1805
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President George W. Bush's recent pledge of $15 billion to fight human immunodeficiency virus (HIV) infection and AIDS is another welcome sign of the increased priority placed on the global epidemic. The announcement calls for a strong focus on prevention ...

1806-1809
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In the State of the Union address of January 2003, President George W. Bush announced an unprecedented five-year, $15 billion Emergency Plan for AIDS Relief1 to provide highly active antiretroviral therapy (HAART) to up to 2 million patients infected with ...

Correspondence
1810-1812

To the Editor: Lin et al. (Jan. 23 issue)1 implicate lead exposure in the progression of renal disease on the basis of the effect of EDTA chelation. However, there are compelling experimental data implicating iron (mobilized from endogenous sources and ...

1812-1814

To the Editor: Hoberman et al. (Jan. 16 issue)1 attribute the small effect of renal ultrasonography in the clinical management of febrile urinary tract infections to the widespread use of prenatal ultrasonography. However, reports and images from ...

1814

To the Editor: Zhang et al. (Jan. 16 issue)1 report that the presence of intratumoral T cells, detected by immunohistochemical analysis, correlates with an improved clinical outcome in patients with advanced ovarian carcinoma. However, it is not clear ...

1815-1816

To the Editor: In the article by Maron et al. (Jan. 23 issue)1 about the effect of left ventricular outflow tract obstruction on the clinical outcome in hypertrophic cardiomyopathy, the authors conclude that patients with obstructive hypertrophic ...

1816-1818

To the Editor: Tinetti (Jan. 2 issue)1 discusses the benefit of targeted interventions in reducing the occurrence of falls in elderly persons. We believe vitamin D status deserves greater emphasis. Myopathy associated with vitamin D insufficiency ...

1818-1820

To the Editor: In their interesting review article on regional analgesia for labor and delivery, Eltzschig et al. (Jan. 23 issue)1 state that the decision to receive any form of analgesia is personal and should be made by the patient in consultation with ...

1820-1821

To the Editor: Vesicoenteric fistula usually develops as a complication of colonic diverticulitis, although other conditions, such as colorectal cancer, Crohn's disease, and bladder cancer, may be associated with it. Urinary symptoms such as pneumaturia ...

1821-1822

To the Editor: Thalidomide is used to treat multiple myeloma because of its apoptotic1 and antiangiogenic2 properties. Common side effects of thalidomide in patients with multiple myeloma include sedation and peripheral neuropathy.3 We describe a case of ...

Book Reviews
1823-1824

The death of Roy Porter at the age of 55 years in early 2002 was a grievous loss for both the scholarly community and the general public. One of the most prolific historians of his generation, Porter wrote and edited about 80 books. In a world of ...

1824-1825

This is a gripping insider's story of the Human Genome Project, revealing both the exciting science leading to it and the battle to keep the results, “the heritage of humanity,” secure from control by private interests. As the authors state in the preface,...

1825-1826

The Double-Edged Helix takes a cautious look at the effects of genetic discoveries on society. It warns that neither society nor genetics is governed by simple cause-and-effect mechanisms and that this complexity creates potential for both benefit and ...