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February 6, 2003  Vol. 348 No. 6

Perspective
487-488

    Cocaine use has been associated with both acute and chronic cardiovascular diseases. These include acute myocardial infarction, myocardial ischemia (both silent ischemia and ischemia associated with angina), acceleration of the development of ...

    489-490

    It is now clear that virtually all squamous-cell cervical carcinomas contain one of 18 types of human papillomavirus (HPV) DNA, as shown definitively in the article by Muñoz et al. in this issue of the Journal (pages 518–527). Although the observation ...

    Original Articles
    491-499

    High-risk patients undergoing angiography are susceptible to nephrotoxic effects. This randomized, double-blind, prospective study evaluated the frequency of nephropathy in patients with diabetes and base-line serum creatinine concentrations of 1.5 to 3.5 mg per deciliter. They received either the iso-osmolar, dimeric, nonionic contrast medium iodixanol or the low-osmolar, nonionic, monomeric contrast medium iohexol. The increase in creatinine and the rate of frank nephropathy were significantly lower among those who received the iso-osmolar agent.

    500-509

    Proliferation of smooth-muscle cells in pulmonary arterioles is central to the pathogenesis of pulmonary hypertension. In this study, a signaling pathway involved in smooth-muscle proliferation was found to be altered in patients with nonfamilial forms of pulmonary hypertension. The pathway includes angiopoietin-1, a molecule that signals the recruitment of smooth-muscle cells, its receptor TIE2, and bone morphogenetic protein receptor type 2.

    510-517
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    Three hundred two patients with cocaine-associated chest pain who were at low to intermediate risk were discharged from a chest-pain observation unit after 9 to 12 hours of observation and were followed for 30 days. There were no deaths from cardiovascular causes and only four nonfatal myocardial infarctions (all four in patients who continued to use cocaine). In contrast, an acute coronary syndrome was diagnosed in 20 of 42 high-risk patients who were directly admitted to the hospital (and thus not included in the study).

    518-527

    The type of human papillomavirus (HPV) in exfoliated cervical cells from almost 2000 women with cervical cancer and a similar number of control women from nine countries was determined by the polymerase chain reaction in 11 studies. Of the 33 types of HPV that were assayed, 18 were classified as high-risk or probable high-risk types and 12 as low-risk types. Odds ratios for cervical cancer that exceeded 200 were associated with HPV 16, 59, 33, and 18.

    Images in Clinical Medicine
    528
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    A 32-year-old Kenyan woman presented in Boston with a three-month history of cough that was initially productive of thick, gray sputum that had gradually become blood-tinged. She had low-grade fevers. Chest radiography revealed an apparent elevation of ...

    e2
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    • Video

    Videos show the artery before and after the repair.

    Review Articles
    529-537

    There is substantial variability among individual patients in the responses to pharmaceutical agents. Among the sources of variation in response are genetic differences in the enzymes responsible for drug metabolism, differences in the targets of the drug, and differences in genes that lead to side effects. Two articles in this issue — a Genomic Medicine article and a Drug Therapy review — discuss a number of clinically relevant inherited variants that affect drug action or side effects; the study of such variants forms the basis of the field of pharmacogenetics.

    538-549

    It is well recognized that different patients respond in different ways to the same medication. These differences are often greater among members of a population than they are within the same person at different times (or between monozygotic twins).1 The ...

    Editorials
    551-553

    In this issue of the Journal, Aspelin et al.1 report findings from a prospective, randomized, double-blind trial that compared iodixanol, a third-generation, iso-osmolar, dimeric, nonionic iodinated contrast agent, with iohexol, a low-osmolar, monomeric, ...

    553-556

    One of the most striking features of modern medicines is how often they fail to work. Even when they do work, they are often associated with serious adverse reactions. Indeed, adverse reactions to drugs rank as one of the leading causes of death and ...

    Correspondence
    557

    To the Editor: We wish to point out that our letter to the editor in the September 5 issue1 contained a description of clinical material from one patient that was also included in an article on a series of patients that was published shortly thereafter ...

    557-560

    To the Editor: The positive effect of hyperbaric-oxygen treatment on cognitive sequelae after carbon monoxide poisoning, reported by Weaver et al. (Oct. 3 issue),1 has important implications for patients and their physicians. Since facilities for the ...

    560-563

    To the Editor: Gaspoz et al. (June 6 issue)1 present an interesting perspective on the problem of escalating health care costs. Their comparison between the cost effectiveness of aspirin and that of clopidogrel is commendable, given the increasing focus ...

    564
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    To the Editor: The article on RNA interference by Kitabwalla and Ruprecht (Oct. 24 issue)1 is most timely in view of the excitement produced by the recent demonstration that small interfering RNAs (siRNAs) have important functions in RNA cleavage ...

    564-566

    To the Editor: Recent letters to the Journal from Leis et al.1 and Glass et al.2 (Oct. 17 issue) as well as reports by others3 have described a poliomyelitis-like syndrome occurring in patients with West Nile virus infection. In these patients, acute ...

    566-567
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    To the Editor: The photograph by Gregory Curfman entitled “Echternach, Luxembourg” (Nov. 28 issue)1 was taken on July 7, 2002, during the first stage (Luxembourg to Luxembourg) of the most recent Tour de France.2,3 On the right side of the image, it is ...

    567-568

    To the Editor: We report a case of fatal melanoma that had been transferred in a donated kidney and that occurred 16 years after surgery for primary melanoma in the donor. A woman with polycystic disease received a renal transplant in May 1998. The graft ...

    Book Reviews
    569-570

    At a time when seemingly irreconcilable global conflicts, daily threats of terrorism, and continuous reports of violence against children have pushed environmental stress past the boiling point, it should be no surprise that rates of depression and other ...

    570-571

    Psychological trauma is a surprisingly common experience. It shocks, terrifies, and confuses its victims, forcing them to modify their emotional responses, their behavior, and frequently, their core beliefs. Nevertheless, more often than not, it is ...

    571-572

    Homosexual orientation often emerges during the throes of adolescence, when it can increase the potential risks, both physical and psychological, faced by young people who are encountering the challenge of accepting a new identity. In recent years, mental ...