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January 9, 2003  Vol. 348 No. 2

Perspective
99-100

    Dissecting the pathogenesis of primary, or “essential,” hypertension has proved elusive. In recent years, the hypothesis that having relatively fewer nephrons renders an otherwise healthy person more susceptible to renal disease, hypertension, or both has ...

    Original Articles
    101-108
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    The presence of a relatively low number of nephrons at birth, which may gradually damage the kidney as a result of the increased workload per nephron, has been proposed as a major contributor to the development of hypertension. The authors tested this hypothesis by comparing histologic findings and the number and volume of glomeruli in 10 middle-aged white patients with a history of primary hypertension or left ventricular hypertrophy (or both) with those in 10 normotensive controls; all the subjects had died in accidents. Patients with hypertension had fewer glomeruli, a larger glomerular volume, and more severe arteriolosclerosis than did the controls.

    109-118

    It is widely accepted that moderate alcohol consumption protects against coronary heart disease. This large study in men adds new information by assessing the roles of the drinking pattern and the type of beverage consumed. Men who drank alcohol at least three to four times per week had a reduced risk of myocardial infarction. The association was strongest with beer and liquor, the predominant types of beverage consumed by this population.

    119-128

    This report describes a community-based outpatient treatment program for patients with chronic, multidrug-resistant tuberculosis. Probable cures were achieved in 55 of 66 patients who completed at least four months of individualized therapy. Predictors of a poor outcome were a low hematocrit and low body-mass index.

    Images in Clinical Medicine
    129
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    A 23-year-old man presented with a two-month history of hypertension. At 18 years of age, he had sustained an injury to the left flank while playing college football. His blood pressure was 180/100 mm Hg. Magnetic resonance imaging of the abdomen showed a ...

    Special Article
    130-137
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    This study of data from national surveys of patients in 1987 and 1997 documents an increase in visits to nonphysician clinicians (e.g., nurse practitioners, physician assistants, and physical therapists) during this period. The increase was explained by a rise in the proportion of patients who received care from both physicians and nonphysician clinicians.

    Review Article
    138-150

    Sepsis is the leading cause of death in critically ill patients in the United States. Yet the individual host response to septicemia is variable, depending on the patient's immune response, age, nutritional status, and coexisting conditions, as well as on the virulence of the organism and the size of the inoculum. This review examines evolving concepts of sepsis and discusses new and potential therapies. Recent clinical advances include therapy with activated protein C, stringent control of blood glucose, and early goal-directed therapy to treat cellular oxygen deficit. Future therapies may be focused on modulating the immune response in the light of the characteristics of the specific pathogen, the genetic profile of the patient, and the duration of the disease.

    Case Records of the Massachusetts General Hospital
    151-161

    Presentation of Case

    A 43-year-old man was admitted to the hospital because of fever, night sweats, weight loss, and headache.

    The patient had reportedly been well until 15 days earlier, when fever developed. A physician prescribed an unknown medication, ...

    Editorials
    163-164

    A number of epidemiologic studies have found an association of alcohol intake with a reduced risk of cardiovascular disease. These observations have been purported to explain the so-called French paradox: the lower rate of cardiovascular disease in France ...

    164-166

    In recent decades, fundamental changes in the organization and financing of medical services in the United States, combined with social and demographic changes, have set the stage for a substantially altered division of labor in health care.1 At the ...

    Clinical Implications of Basic Research
    167-169

    In sepsis, activation of the complement system introduces large amounts of C5a into the circulation. The excess of this peptide paralyzes neutrophils and increases susceptibility to infection. In tissues, by contrast, C5a has effects on neutrophils that protect against infection. Neutralization of circulating C5a by an antibody protects against the lethal effects of sepsis in an animal model.

    Correspondence
    170-171

    To the Editor: In their article comparing prostatectomy with watchful waiting, Holmberg et al. (Sept. 12 issue)1 present their analysis according to the intention-to-treat principle, but the true treatment effect might be larger than that observed ...

    171-174
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    To the Editor: Investigators in the Allergy and Endotoxin (ALEX) Study have shown previously that exposure to stables and farm milk during the first year of life protects against asthma and hay fever at 6 to 13 years of age, plausibly through exposure to ...

    174-175

    To the Editor: Boyd et al. (Sept. 19 issue)1 estimated that the heritability of mammographic density was 60 percent among Australian twins and 67 percent among American twins. Although twin studies reveal little about the mode of inheritance, we ...

    175-176

    To the Editor: Martyny et al. (Sept. 12 issue)1 provide a very useful review of respiratory protection; however, a few points should be noted. Some self-contained breathing apparatuses, such as rebreathers, can last several hours. The note that air-...

    176-177

    To the Editor: There was no mention of human immune globulin therapy in the discussion of the patient who died from group A streptococcal toxic shock syndrome and necrotizing fasciitis (Case 28-2002) (Sept. 12 issue).1 Yet timely immune globulin therapy ...

    177-178

    To the Editor: Mutations in the YMDD (tyrosine, methionine, aspartate, aspartate) motif of the DNA polymerase resulting in phenotypic hepatitis B virus (HBV) resistance to lamivudine monotherapy have been observed after two years in 50 percent of ...

    178-179

    To the Editor: The role of hepatitis C virus (HCV) and human herpesvirus 8 (HHV-8), two B-cell–tropic viruses, in B-cell proliferation1 is illustrated by the following unusual case of plasma-cell leukemia. In 1995, a 32-year-old man with a history of ...

    Book Reviews
    180-181

    On the first page of this big book, the editors tell us that “there have been major advances in the understanding of motor and non-motor operations of the cerebellum.” But one must read between the lines of this and other books that summarize our ...

    181-182

    The trajectory of discovery in science and medicine is rarely linear. On the contrary, it is nearly always erratic, with peaks of insight, troughs of wrong hypotheses, midcourse corrections, and ultimate enlightenment. In this profusely illustrated coffee-...

    182-183

    In 1987, William F. Brown and Charles F. Bolton wrote the first edition of their now classic textbook, Clinical Electromyography, which was substantially expanded in 1993 on the basis of increased knowledge of neuromuscular diseases. The book is one of ...

    Corrections
    186

    Availability of Neonatal Intensive Care and Neonatal Mortality Correspondence, N Engl J Med 2002:347;1893-1895.. In some copies of the Journal, the first sentence of the editorialist's reply on page 1895 was obscured. The sentence should have read “The ...

    186

    Cyclin E and Survival in Patients with Breast Cancer Original Article, N Engl J Med 2002:347;1566-1575.. On page 1572, the curves in Figure 3C were incorrect. The corrected Panel C appears below.

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