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June 19, 2003  Vol. 348 No. 25

Perspective
2487-2488

    In recent years, the adoption of a multidisciplinary approach to the care of patients with cancer has changed the landscape of oncologic practice. Using this model, surgeons, oncologists, radiologists, pathologists, and others work closely to determine ...

    2489-2490

    The past 15 years, since the cloning of the gene for amyloid precursor protein, have witnessed breathtaking advances in our understanding of the pathophysiology of Alzheimer's disease, the most common cause of dementia. Most findings point to a final ...

    Original Articles
    2491-2499

    Two methods were compared for the detection of small lymph-node metastases in men with prostate cancer: conventional magnetic resonance imaging (MRI) and MRI performed 24 hours after the intravenous injection of lymph-node–seeking nanoparticles containing an iron oxide core. The latter method proved superior to conventional MRI in sensitivity and specificity.

    2500-2507

    In this prospective study, integrated positron-emission tomography (PET) and computed tomography were more accurate for the radiographic assessment of disease stages in non–small-cell lung cancer than the use of either technique alone or simultaneous visual inspection of the two types of images.

    2508-2516

    In a prospective study of 469 elderly subjects who were free of dementia at base line, activities such as reading, playing board games, and playing musical instruments were associated with a significant reduction in the risk of dementia. Participation in physical activities was not associated with any reduction in the risk of dementia.

    2517-2524

    This study of Finnish schoolchildren found that the presence of serum autoantibodies can be used to identify celiac disease and reported a prevalence of 1 case in 99 children.

    Images in Clinical Medicine
    2525
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    A 77-year-old man with diabetes presented with a four-day history of fever and worsening left-sided neck and shoulder pain accompanied by numbness and paresthesias in the fingers of the hand on the same side. Physical examination revealed severely ...

    Special Article
    2526-2534
    • Free Full Text

    Information technology can improve patient safety by preventing errors and facilitating rapid response to adverse events. Computerized prescribing by physicians reduces the rate of medication-related errors. Systems that automatically page clinicians about serious laboratory abnormalities and remote monitoring of patients in intensive care units also appear promising.

    Clinical Practice
    2535-2542

      A 60-year-old man undergoes chest radiography during an evaluation for pneumonia, and a 1.5-cm nodule is discovered. He is a heavy smoker but has no history of lung disease. The results of a physical examination are unremarkable. How should he be evaluated?

      Review Article
      2543-2556

        Defects in type IV collagen, a collagenous protein involved in the formation of basement membranes, have been implicated in hereditary Alport's syndrome and acquired Goodpasture's syndrome. Mutations in genes corresponding to the building blocks of type IV collagen cause Alport's syndrome, whereas autoantibodies against structures that are usually hidden in the recesses of collagen IV cause Goodpasture's syndrome.

        Case Records of the Massachusetts General Hospital
        2557-2566

        Presentation of Case

        A five-day-old girl was admitted to the hospital because of a worsening rash from birth and leukocytosis with blasts.

        The infant was delivered at 40 weeks' gestation by a 24-year-old woman (gravida 2, para 2), who had immigrated from ...

        Editorials
        2568-2570

        Celiac disease is an immune-mediated enteropathy triggered by the ingestion of gluten-containing grains (including wheat, rye, and barley) in genetically susceptible persons. The disease is associated with HLA-DQ2 in 90 to 95 percent of cases and with HLA-...

        2570-2572

        If the Institute of Medicine is right, then at the very least, 100 patients will die in hospitals in the United States today because of injuries from their care, not from their diseases. How many will die tomorrow?

        Tom Nolan, one of the leading quality-...

        Clinical Implications of Basic Research
        2573-2574

        The mechanism by which some types of cereal proteins trigger celiac disease (also known as gluten-sensitive enteropathy) is unknown. A strong candidate has now been put forward: a 33-amino-acid peptide that resists digestion. The peptide is susceptible to degradation by a bacterial enzyme, raising the possibility of a new therapeutic approach.

        Correspondence
        2575-2577

        To the Editor: Heeschen et al. (March 20 issue)1 show that troponin T and soluble CD40 ligand independently predict the outcome in patients with acute coronary syndromes and that the increased risk conferred by elevated CD40 ligand levels is reduced by ...

        2577-2578

        To the Editor: Martin et al. (March 20 issue)1 and, in her Perspective article, Zuger2 correctly observe that the “wired” Dartmouth campus provided effective electronic means of collecting data that might have helped contain the outbreak of ...

        2578-2579
        • Free Full Text

        To the Editor: In his Perspective article “A Death at Duke” (March 20 issue),1 Dr. Campion observes, “Systems do not become safer when those involved are told, `Be more careful' or `try harder.'” As an attorney who has spent 25 years representing ...

        2579-2580

        To the Editor: Taupenot et al. (March 20 issue)1 state in their review article that the prognostic value of chromogranin A immunoreactivity in colorectal cancer has not been established. In fact, four out of five studies identify extensive neuroendocrine ...

        2580

        To the Editor: Vincent's thoughtful discussion of adverse events and our response to them (March 13 issue)1 should be mandatory reading for all residents, attending physicians, and dentists. He correctly suggests that the academic health care culture ...

        2581-2582
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        To the Editor: The article on race and genomics by Cooper et al. (March 20 issue)1 claims that multilocus interactions are “both mathematically and biologically implausible” as risk factors for complex disease. This statement stands in strong opposition ...

        2582-2583
        • Free Full Text

        To the Editor: It seems unjustified to refer to a radiographic study using barium sulfate suspension as “A Deadly Examination,” as Fruchter and Dragu do (March 13 issue).1 The patient in this case may have died because of the aspiration of gastric ...

        2583-2584

        To the Editor: Studies of hereditary inflammatory disorders have identified novel genes and pathways that may be involved in inflammation and apoptosis generally. Mutations in one such gene, variously named NALP3, CIAS1, and PYPAF1, were recently ...

        Book Reviews
        2585

        Is failure of parity conservation in physics the reason conservatives are called right-wingers and liberals are called left-wingers? If the very concept eludes you, you need to read Chris McManus's grand unified theory of asymmetry. Professor of ...

        2585-2586

        Deborah Hayden's Pox: Genius, Madness, and the Mysteries of Syphilis is the biography of an infection that has fascinated and frustrated clinicians for more than half a millennium. The book is a repository of all that had been forgotten about a sinister ...

        2586-2587

        Historical research at its best is a treasure hunt for the past, illuminated in lost documents that turn up in unexpected ways and in surprising places. Jonathan Andrews and Andrew Scull were alerted to the case book of John Monro, an 18th-century “Mad-...

        2588

        Alcohol has always had a special role in the United States. From 1620, when the Puritans were forced to land on Plymouth Rock because the Mayflower had almost run out of beer, until 1933, when Prohibition was repealed in an unprecedented move, the use of ...

        Corrections
        2588

        Alzheimer's Disease and Parkinson's Disease Review Article, N Engl J Med 2003:348;1356-1364.. On page 1358, in Figure 2, the boxed “I” in the top left corner should be an “L.”

        2588

        Molecular Diagnosis of the Hematologic Cancers Review Article, N Engl J Med 2003:348;1777-1785.. On page 1780, the sentence beginning on line 4 of the left-hand column should have read “The quartile of patients with the lowest level of proliferation-...