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May 15, 2003  Vol. 348 No. 20

Perspective
1947-1948
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In November 2002, a businessman from the city of Foshan in the southern Chinese province of Guangdong may have been the first victim of a mysterious illness called severe acute respiratory syndrome (SARS). Guangdong Province, an agricultural area with a ...

1948-1951
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The discovery that a novel coronavirus is the probable cause of the newly recognized severe acute respiratory syndrome (SARS), reported by Ksiazek et al. (pages 1953–1966), Drosten et al. (pages 1967–1976), and Peiris et al.1 provides a dramatic example ...

1951-1952
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On February 28, the Vietnam French Hospital of Hanoi, a private hospital of about 60 beds, contacted the Hanoi office of the World Health Organization (WHO). A patient had presented with an unusual influenza-like virus. Hospital officials suspected an ...

Original Articles
1953-1966

This report summarizes the laboratory studies undertaken to identify the etiologic agent of the worldwide outbreak of the severe acute respiratory syndrome (SARS). In specimens from patients from seven countries, a coronavirus was identified by electron microscopy. The virus is only distantly related to previously sequenced coronaviruses. From serologic studies it appears that this virus has not previously circulated in humans.

1967-1976

This study used cell culture and molecular techniques to identify the infectious agent associated with SARS. A novel coronavirus was found in multiple samples from 18 patients but in no specimens from control subjects. In the patients there were high concentrations of viral RNA in sputum, a finding consistent with a highly infectious agent. Low concentrations of viral RNA were also detected in stool.

1977-1985

This report describes 10 epidemiologically linked patients in Hong Kong in whom SARS was diagnosed between late February and late March. They presented with fever, cough, malaise, dyspnea, and hypoxemia. Chest radiographs showed progressive airway disease. In the two patients who died, examination of the lungs showed diffuse alveolar damage.

1986-1994

Over a period of two weeks at a hospital in Hong Kong 69 patients and 69 health care workers were admitted to isolation wards because of SARS. Thirty-two of those with SARS required intensive care, and five died. This report describes the clinical and radiologic features of SARS, and it analyzes the predictors of a poor outcome.

1995-2005

In Canada, SARS was identified in 10 patients who presented with fever, malaise, and nonproductive cough. In most, there was lymphopenia and elevated levels of lactate dehydrogenase and creatine kinase. Five patients required mechanical ventilation, and three died. Laboratory studies of sputum samples found both human metapneumovirus and a novel coronavirus.

Images in Clinical Medicine
2006
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Soon after returning from Hong Kong, a previously healthy 48-year-old man began to have fever, malaise, dyspnea, and a nonproductive cough. His temperature was 38.5°C (101.3°F), and his arterial oxygen saturation was 92 percent while he was breathing room ...

Review Article
2007-2018

    Heart failure is a costly and deadly condition that currently affects nearly 5 million Americans. The incidence approaches 10 per 1000 population among persons older than 65 years of age. This review highlights current pathophysiological concepts and discusses available therapies for a range of patients — from those at risk to those with widespread disease.

    Case Records of the Massachusetts General Hospital
    2019-2027

    Presentation of Case

    A 47-year-old man was evaluated in the pulmonary clinic because of waxing and waning pulmonary lesions several years after treatment for seminoma.

    The patient had been well until five years earlier, when a left testicular seminoma was ...

    Editorials
    2029
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    On the Ides of March 2003, a physician was in transit from New York to Singapore by way of Germany. In Germany he was hospitalized and quarantined with a respiratory illness. The next day, the news media worldwide began to report on the spread of a major ...

    2030-2031

    Severe acute respiratory syndrome (SARS) was diagnosed in more than 1800 patients in 17 countries (including the United States and Canada) between February 1 and March 31, 2003. During this two-month period, the World Health Organization (WHO) coordinated ...

    e6

    Just over three weeks ago, the World Health Organization (WHO) issued a worldwide notice about the severe acute respiratory syndrome (SARS). It described a rapidly progressive, sometimes fatal pneumonia that appears to have arisen from Guangdong Province ...

    Clinical Implications of Basic Research
    2032-2033

    Refrigerated platelets have better in vitro function than those stored at room temperature,1 but once transfused, they are rapidly cleared from the circulation. Thus, platelets are currently stored at room temperature for up to five days. Unfortunately, ...

    Correspondence
    2034-2035

    To the Editor: The use of systemic corticosteroids in patients with the severe acute respiratory syndrome (SARS) is of serious concern. Lee and colleagues report anecdotal success in their article on SARS elsewhere in this issue.1 And in the recent Web ...

    2035

    To the Editor: The outbreak of a new, potentially severe, infectious disease, without known cause or treatment, is a stressful challenge, both for patients and for physicians. Our only therapeutic weapons may be individual protection by means of masks, ...

    2035-2037

    To the Editor: The study by Sandham et al. (Jan. 2 issue)1 showed no improvement in outcome resulting from goal-directed therapy guided by pulmonary-artery catheter in high-risk surgical patients. The main targets (an oxygen-delivery index of 550 to 600 ...

    2037-2039

    To the Editor: The article by Yáñez-Mó et al. (Jan. 30 issue)1 is timely, since there have been many recent reports showing similar epithelial-to-mesenchymal transitions in inflammatory and malignant processes.2 We would, however, like to address several ...

    2039-2040

    To the Editor: Kirschke et al. and Srinivasan et al. (Jan. 16 issue)1,2 report contamination associated with a defect in bronchoscopes in the United States. A similar event occurred in Lyons, France, during the same period. From March 5, 2001, to October ...

    2040-2041

    To the Editor: Muñoz et al. (Feb. 6 issue)1 classified human papillomavirus (HPV) types 81 and 73 as low-risk and high-risk HPV types, respectively, on the basis of their relative frequency in cervical cancer. This is in agreement with our previous ...

    2041-2043
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    To the Editor: The review by Weinshilboum on the inheritance of drug response (Feb. 6 issue)1 focuses on the pharmacogenetics of drug metabolism as an important factor in the variability of drug effects among persons. An aspect of this topic that is not ...

    2044-2045
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    To the Editor: Gnann and Whitley (Aug. 1 issue)1 state that serologic testing for the human immunodeficiency virus (HIV) may be appropriate for healthy persons with herpes zoster who are younger than 50 years of age. Herpes zoster develops in more than ...

    2045-2046

    To the Editor: We recently encountered two patients with Waldenström's macroglobulinemia1 who had a marked increase in the serum concentration of IgM M component during treatment with cladribine.2 Patient 1, a 78-year-old woman, reported shortness of ...

    Book Reviews
    2047-2048

    As the field of cancer epidemiology becomes increasingly broad and complex, studies are being conducted to examine how environmental exposure, lifestyle choices, and genetic susceptibilities influence the risk of cancer. It is not easy to keep abreast of ...

    2048

    Every year, approximately 3500 children are given a diagnosis of acute leukemia, as compared with about 11,000 adults. Thus, one might expect that in a book devoted to the treatment of the acute leukemias, most of the chapters would discuss acute leukemia ...

    2048-2049

    Over the course of the past two decades, dramatic gains in knowledge have led directly to improvements in the early diagnosis of prostate cancer and to more effective treatment with fewer adverse effects. Even so, prostate cancer continues to kill tens of ...

    2049-2050

    Management of Urologic Malignancies focuses on a simplified approach to treating patients with cancers of the genitourinary tract. The goal, as stated in the preface, is for the book to serve as a reference source for the clinician, regardless of whether ...

    Correction
    2050

    Shattuck Lecture — Diversity of the Immune Repertoire and Immunoregulation Special Article, N Engl J Med 2003:348;1017-1026.. On page 1023, in Table 1, sirolimus and its principal mode of action should not have been included. On page 1024, in Figure 5, ...

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