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June 12, 2003  Vol. 348 No. 24

Perspective
2375-2376

The greatest derangement of the mind is to believe in something because one wishes it to be so.

— René J. Dubos, 1876

The two articles on Hodgkin's disease in this issue of the Journal — one by Aleman et al. (pages 2396–2406) and one by Diehl et al. (...

2377-2378

Ambulatory blood-pressure monitoring provides automated measurements of brachial-artery pressure over a 24-hour period while patients are engaging in their usual activities. This method has been used for more than 30 years in clinical research on ...

Original Articles
2379-2385

Women with a history of preterm delivery are at high risk for recurrence in subsequent pregnancies, and an effective strategy to reduce this risk has been lacking. In this randomized, placebo-controlled trial, weekly injections of 17 alpha-hydroxyprogesterone caproate reduced the risk of delivery before 37 weeks of gestation by one third among such high-risk women.

2386-2395

Advanced Hodgkin's disease is difficult to control or cure with chemotherapy. This large trial compared three regimens, one of which contained more than the standard doses of cyclophosphamide, etoposide, and doxorubicin. The increased-dose regimen improved five-year survival significantly as compared with the usual chemotherapy regimen.

2396-2406

Patients with advanced Hodgkin's lymphoma who were in complete remission after chemotherapy were assigned to receive involved-field radiotherapy or no further treatment. After a median follow-up of more than six years, survival was similar in the two groups.

2407-2415

In this prospective, multicenter study of treated hypertensive patients, ambulatory blood-pressure readings predicted the risk of cardiovascular events during five years of follow-up, even after adjustment for office-based blood-pressure measurements and other cardiovascular risk factors.

2416-2422

In chronic granulomatous disease of childhood, killing of microorganisms is impaired because of defects in the production of hydrogen peroxide. In this controlled study, 39 patients were treated in alternate years with either itraconazole or placebo, once per day. There were seven serious infections during treatment with placebo, and only one during treatment with itraconazole.

Images in Clinical Medicine
2423
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An 81-year-old woman was admitted with increasing generalized weakness, anorexia, and a weight loss of 7 kg (15 lb) over the previous three months. The only finding on physical examination was marked cachexia. Laboratory evaluation revealed anemia (...

Review Articles
2424-2430

More than 75,000 cases of Lyme disease are reported each year in Europe and the United States. Prophylactic treatment after tick bites is only one part of a plan for primary prevention. Other strategies include checking for ticks, use of acaricides, management of vegetation, use of repellents, and techniques to reduce deer and rodent populations. Reducing tick populations can help prevent all tick-borne illnesses.

2431-2442

Until recently, tamoxifen, a nonsteroidal antiestrogen, was the mainstay of endocrine treatment of breast cancer. However, new aromatase inhibitors that are many times more potent and specific than the first such agent, aminoglutethimide, are changing the management of breast cancer in postmenopausal women. This review discusses the role of aromatase inhibitors such as letrozole, anastrozole, and exemestane in the treatment of breast cancer.

Case Records of the Massachusetts General Hospital
2443-2451

Presentation of Case

A 15-year-old girl was admitted to the hospital because of pain in the left leg and back, pruritus, thoracic lymphadenopathy, and multiple pulmonary nodules.

The patient had been well until 11 months earlier, when she began to be ...

Editorials
2453-2455

It has become almost a platitude to lament the complexity and intractability of the problem of preterm delivery, the poor predictive value of screening tests for its occurrence, its resistance to attempted interventions, and its increasing rate.1 Preterm ...

2455-2456

In this issue of the Journal, Gallin and colleagues1 report the results of a clinical trial of itraconazole for the prevention of severe fungal infection in children and adults with chronic granulomatous disease. This trial required 10 years to enroll ...

Occasional Notes
2457-2463

The sequencing of the human genome has revealed an almost complete “parts list” for the study of the genetic basis of disease.1,2 The Online Mendelian Inheritance in Man data base lists more than 1000 human genes that have been implicated in specific ...

Correspondence
2464-2466

To the Editor: In their report on the use of celecoxib as compared with diclofenac plus omeprazole to reduce the risk of recurrent ulcer bleeding in patients with arthritis, Chan et al. (Dec. 26 issue)1 state that the probability of recurrent bleeding ...

2466-2467

To the Editor: The strong suggestion that aspirin has a chemopreventive effect was recently corroborated by Baron et al.1 and Sandler et al.2 (March 6 issue). Although the importance of the clinical outcome is clear, the molecular mechanism leading to ...

2468

To the Editor: I am concerned about the justification for the inclusion of a placebo group in the study by Marcellin et al. (Feb. 27 issue).1 No statement regarding the efficacy of interferon alfa was provided, although its side effects were highlighted. ...

2469

To the Editor: Lee and Atwood (March 6 issue)1 provide an example of a calcified left ventricular aneurysm visualized by computed tomography (CT). On closer inspection, the pattern of calcifications in the apical region of the left ventricle gives reason ...

2469-2470

To the Editor: With regard to the discussion by Friedmann et al. (March 20 issue)1 of a mediastinal germ-cell tumor in an 18-year-old man, a malignant mediastinal germ-cell tumor in a young man should raise the suspicion of Klinefelter's syndrome (47,XXY)...

2470-2471

To the Editor: In his article about the right to health and the nevirapine case in South Africa, Annas (Feb. 20 issue)1 ignores the reason why governments are reasonably and prudently reluctant to establish a right to health. In the two cases described, ...

2471-2472

To the Editor: The only treatment approved by the Food and Drug Administration for acute acetaminophen poisoning is a 72-hour protocol of oral N-acetylcysteine administration. Clinical experience suggests that this protocol may be excessive for many ...

2472-2474

To the Editor: A trial of vaccination against Lyme disease provided an opportunity for us to determine the relative frequencies of the presenting manifestations of Lyme disease and the outcomes of treatment in a large population.1 Our goal was to ...

Book Reviews
2475-2476

These days, practicing medicine in the United States is a mixed blessing. On the one hand, physicians still reap intangible rewards, including exhilaration from helping people, the privilege of sharing patients' joys and sorrows, and intellectual ...

2476-2477

Rohde and Wyon have put together a very useful book on community-based health care. It originated in the Symposium on Community-Based Health Care: Lessons from Bangladesh to Boston, held at the Harvard School of Public Health in November 2000. The ...

2477-2478

Technological Change in Health Care: A Global Analysis of Heart Attack analyzes the relation between outcomes and technological change in the treatment of acute myocardial infarction by comparing events that took place over the course of 20 years in 15 ...

2478-2479

This book addresses two questions. Why are there so many foreign scientists in training and research positions at the National Institutes of Health (NIH)? What is their effect on postdoctoral fellows, academic institutions, industry, and labor policies in ...