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Table of contents for

May 29, 2003  Vol. 348 No. 22

Perspective
2171-2172
HIV Infection — A New Drug and New Costs
R. Steinbrook

    Although combination antiretroviral therapy has dramatically improved the lives of patients with human immunodeficiency virus (HIV) infection, viral strains that are resistant to multiple medications are a serious problem. Enfuvirtide, the new ...

    2173-2174
    West Nile Virus — Not a Passing Phenomenon
    D.L. Morse

      As private citizens and as public health professionals, we are enthralled by the new, the unknown, and the catastrophic. This is especially true for epidemics that appear suddenly, spread rapidly, and cause severe illness. History and literature provide ...

      Original Articles
      2175-2185
      Enfuvirtide, an HIV-1 Fusion Inhibitor, for Drug-Resistant HIV Infection in North and South America
      J.P. Lalezari and Others
      • Free Full Text

      Enfuvirtide (T-20) is a peptide that binds to glycoprotein 41 and inhibits the entry of human immunodeficiency virus type 1 (HIV-1) into CD4+ cells. In this randomized, open-label trial, patients who were treated with enfuvirtide plus an optimized antiretroviral regimen had significantly greater reductions in viral load and greater increases in CD4+ cell counts. Eosinophilia was a common finding; bacterial pneumonia was more common in enfuvirtide-treated patients.

      2186-2195
      Efficacy of Enfuvirtide in Patients Infected with Drug-Resistant HIV-1 in Europe and Australia
      A. Lazzarin and Others
      • Free Full Text

      This randomized study, conducted in Europe and Australia, included 335 patients in the enfuvirtide group and 169 in a control group treated with only an optimized antiretroviral regimen. All patients had previously received multiple anti-HIV regimens. At 24 weeks, there was a greater decrease in the plasma viral load and a greater increase in the CD4+ cell count in the enfuvirtide group.

      2196-2203
      Transmission of West Nile Virus from an Organ Donor to Four Transplant Recipients
      M. Iwamoto and Others
      • Free Full Text

      This investigation documents severe West Nile virus infections in four recipients of organs from a single donor. Three of the recipients had encephalitis. The probable source of infection in the donor was a blood transfusion from a blood donor with West Nile virus viremia.

      2204-2207
      Brief Report: Pernicious Anemia with Neuropsychiatric Dysfunction in a Patient with Sickle Cell Anemia Treated with Folate Supplementation
      M. Dhar, R. Bellevue, and R. Carmel
      • Free Full Text

      This case report describes a woman with sickle cell disease in whom routine folate supplementation masked the development of cobalamin deficiency, with full-blown neuropsychiatric complications and an increased frequency of painful crises.

      Images in Clinical Medicine
      2208
      Neurologic Manifestations of Vitamin B12 Deficiency
      K. Scherer
      • Free Full Text

      A 56-year-old woman presented with a four-month history of progressive cognitive decline, weakness, incoordination, and gait disturbance. She had a score of 12 of 28 on the Mini–Mental State Examination, moderate weakness, and severe ataxia; reflexes, ...

      Special Articles
      2209-2217
      Regionalization and the Underuse of Angiography in the Veterans Affairs Health Care System as Compared with a Fee-for-Service System
      L.A. Petersen, S.-L.T. Normand, L.L. Leape, and B.J. McNeil
      • Free Full Text

      The Veterans Affairs (VA) health care system offers some invasive procedures, such as cardiac angiography, at selected hospitals. This study showed that the underuse of cardiac angiography after myocardial infarction was more common among VA patients than among Medicare fee-for-service patients. This difference was explained by the availability of cardiac catheterization on site.

      2218-2227
      Effect of the Transformation of the Veterans Affairs Health Care System on the Quality of Care
      A.K. Jha, J.B. Perlin, K.W. Kizer, and R.A. Dudley
      • Free Full Text

      To improve the efficiency and quality of care, in 1995, the Veterans Health Administration launched a program that included increased use of information technology, performance measurement and reporting, realigned payment policies, and integration of services. After the implementation of this program, the quality of preventive, acute, and long-term care substantially improved.

      Review Article
      2228-2238
      Mechanisms of Disease: Novel Therapies Based on Mechanisms of HIV-1 Cell Entry
      J.M. Kilby and J.J. Eron

        Inhibitors of human immunodeficiency virus type 1 (HIV-1) enzymes are central to the treatment of HIV-1 infection, but the development of resistant viruses remains a problem. Another approach is to thwart the entry of the virus into cells by preventing the fusion of the viral envelope with the cell surface. This article reviews the way in which HIV-1 enters cells and potential means of denying the virus admission to cells.

        Case Records of the Massachusetts General Hospital
        2239-2247
        Case 17-2003 — A 38-Year-Old Woman with Fever, Headache, and Confusion
        M.S. Hirsch and B. Werner

          Presentation of Case

          A 38-year-old woman was admitted to the hospital in early August 2002 because of fever and confusion.

          The patient had been well until four days earlier, when a headache gradually developed and increased in intensity, accompanied by ...

          Editorials
          2249-2250
          Fusion Inhibition — A Major but Costly Step Forward in the Treatment of HIV-1
          K.T. Tashima and C.C.J. Carpenter

            Two studies reported in this issue of the Journal 1,2 provide heartening news of the success of a new antiretroviral drug in decreasing plasma human immunodeficiency virus (HIV) RNA levels in patients for whom the available combination antiretroviral ...

            2251-2252
            The Right Care
            S. Jencks

              The yawning chasm between what we know and what we do for patients is no longer news; indeed, the repeated evidence is somewhat numbing. We are far less sure what to do next.

              In this light, two articles in this issue of the Journal take on a special ...

              2252-2254
              Case Records of the Massachusetts General Hospital — Continuing to Learn from the Patient
              N.L. Harris

                Virtually every physician in the world has, at one time or another, read the Case Records of the Massachusetts General Hospital (the reports of the Clinicopathological Conferences [CPCs]) in the Journal. Based on the case method of teaching medicine ...

                2254
                Notice of Duplicate Publication
                G.D. Curfman, S. Morrissey, and J.M. Drazen

                  Publication of the same research data in two or more journals (duplicate, or redundant, publication) is a practice that does not serve the interest of the medical community. Virtually all medical journals have policies against duplicate publication, and ...

                  Correspondence
                  2255-2256
                  Inappropriate Advertising of Dietary Supplements
                  • Free Full Text

                  To the Editor: With regard to Dr. Drazen's Perspective article on the inappropriate advertising of dietary supplements (Feb. 27 issue),1 a recent survey, conducted by Harris Interactive for Robert Butler and the International Longevity Center, showed ...

                  2256-2257
                  Human Growth Hormone and Aging
                  • Free Full Text

                  To the Editor: Vance's discussion of growth hormone (Feb. 27 issue)1 omits important reports in the literature. The combination of growth hormone and exercise (unlike exercise alone) has been shown to increase type II muscle fibers in the elderly2 — an ...

                  2257-2259
                  Nephropathy Induced by Contrast Medium
                  • Free Full Text

                  To the Editor: The article by Aspelin et al. (Feb. 6 issue)1 regarding the lower incidence of contrast-medium–induced nephropathy in patients with diabetes and a serum creatinine concentration of 1.5 to 3.5 mg per deciliter who were treated with ...

                  2259
                  Selective Estrogen-Receptor Modulators
                  • Free Full Text

                  To the Editor: The review article by Riggs and Hartmann on selective estrogen-receptor modulators (SERMs) (Feb. 13 issue)1 does not discuss a SERM approved by the Food and Drug Administration for the treatment of ovulatory dysfunction. Clomiphene citrate ...

                  2259-2262
                  Is the Match Illegal?
                  • Free Full Text

                  To the Editor: Chae (Jan. 23 issue)1 raises several interesting and important points in his analysis of the lawsuit attacking the matching process of the Accreditation Council for Graduate Medical Education (ACGME). He suggests, however, that the Match ...

                  2262-2263
                  Readability of Informed-Consent Forms
                  • Free Full Text

                  To the Editor: Paasche-Orlow and colleagues report on the readability of informed-consent forms (Feb. 20 issue).1 An important and interesting problem that we are now encountering is that sponsoring companies approach informed-consent documents as legal ...

                  2263-2264
                  Residents' Suggestions for Reducing Medical Errors
                  • Free Full Text

                  To the Editor: The Sounding Board article by Volpp and Grande (Feb. 27 issue)1 addresses the effects of hospital inefficiency on the hours worked by residents and, ultimately, on errors in care. A study we undertook to quantify the time spent by members ...

                  2264
                  Cardiac Rupture
                  • Free Full Text

                  To the Editor: In their Image in Clinical Medicine, Redfern and Smart (Feb. 13 issue)1 describe a case of cardiac rupture in a man who initially presented with atypical chest pain and electrocardiographic signs of myocardial infarction. During subsequent ...

                  2265-2266
                  A Mutation Conferring Resistance to Imatinib at the Time of Diagnosis of Chronic Myelogenous Leukemia
                  • Free Full Text

                  To the Editor: Acquired resistance to imatinib mesylate caused by kinase-domain mutations is common in patients with chronic myelogenous leukemia who are treated with the drug.1 Until now, such mutations have been reported only at the time of clinically ...

                  Book Reviews
                  2267-2268
                  Pathology of the Female Reproductive Tract
                  • Free Full Text

                  The roots of pathology are those of medicine itself and extend back beyond recorded history. However, surgical pathology as we recognize it is only about 100 years old, born of the union of microscopy and surgical observation. But where does gynecologic ...

                  2268-2269
                  Connective Tissue and Its Heritable Disorders: Molecular, Genetic, and Medical Aspects
                  • Free Full Text

                  I was genuinely thrilled at the prospect of reviewing the second edition of this multiauthored work covering the biology and pathology of connective tissues. The second edition, despite being 450 pages longer than the first edition, is a real pleasure for ...

                  2269-2270
                  Osteoporosis: Pathophysiology and Clinical Management
                  • Free Full Text

                  Two hundred million women suffer from osteoporosis worldwide (a third of all women between 60 and 70 years of age and two thirds of all women over 80 years of age), with a lifetime risk of fracture between 30 and 40 percent. In men, the lifetime risk of ...

                  2270-2271
                  Hypertension in Pregnancy
                  • Free Full Text

                  In an era of electronic media, do hardcover monographs still have a role? I believe that works like Hypertension in Pregnancy force a reply of yes. The editors have elicited chapters from experts with long experience in research in the field and recent ...

                  Correction
                  2271
                  Eplerenone, a Selective Aldosterone Blocker, in Patients with Left Ventricular Dysfunction after Myocardial Infarction
                  • Free Full Text

                  Eplerenone, a Selective Aldosterone Blocker, in Patients with Left Ventricular Dysfunction after Myocardial Infarction Original Article, N Engl J Med 2003:348;1309-1321.. On page 1309, in the second line of the Methods section of the Abstract, the number ...

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