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February 13, 2003  Vol. 348 No. 7

Perspective
579-580

How great are the risks? Should women stop taking estrogen and progestin?

581-582

Vascular endothelial cells form a lining — one cell thick — for all the blood vessels in the body, providing a critical interface between the vessel itself and blood-borne elements. From this location, the endothelium regulates a host of essential ...

Original Articles
583-592

This prospective, open-label, randomized study compared the outcomes in hypertensive subjects 65 to 84 years of age who received therapy with angiotensin-converting–enzyme (ACE) inhibitors or diuretic agents. The rate of cardiovascular events or death from any cause was lower among male subjects who received ACE inhibitors.

593-600

Endothelial progenitor cells are mononuclear cells of bone marrow origin that enter the circulation and may help maintain the vascular endothelium. This study found an inverse correlation between the number of circulating progenitor cells and cardiovascular risk and a direct correlation with endothelial function in the brachial artery.

601-608

In this observational study of patients who received multiple infusions of infliximab for Crohn's disease refractory to conventional treatment, antibodies against infliximab developed in 61 percent of patients. Antibodies decreased infliximab concentrations and the duration of response. Antibodies were less likely to develop in patients who were also receiving immunosuppressive agents.

Images in Clinical Medicine
609
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A 79-year-old man was admitted with atypical chest pain and electrocardiographic changes characteristic of an anterior myocardial infarction. The chest radiograph showed a widened mediastinum, raising the possibility of a thoracic aortic dissection. ...

Clinical Practice
610-617

A 50-year-old black man has a blood pressure of 160/110 mm Hg on repeated measurements. He is 9 kg (20 lb) overweight, has a family history of hypertension, and smokes one pack of cigarettes daily. How should this patient be evaluated and treated?

Review Article
618-629

The selective estrogen-receptor modulators, or SERMs, chemically diverse nonsteroid compounds, have tertiary structures that permit binding to the estrogen receptor. These compounds have either selective agonist or antagonist effects, depending on the target tissue. This article reviews current information concerning the molecular basis of SERM action and the tissue-selective agonist–antagonist effects of this class of medication. The article also offers a perspective on the therapeutic uses of SERMs and compares the SERMs with estrogen and nonestrogen alternatives.

Case Records of the Massachusetts General Hospital
630-637

Presentation of Case

A 16-year-old girl was admitted to the hospital because of pleuritic chest pain.

Bilateral imbrication of the hip capsules had been performed 15 months earlier at this hospital because of recurrent bouts of hip dislocation. Evaluation ...

Editorials
639-641

Not infrequently, on release of the results of major multicenter trials, the lay press promulgates an immediate response before physicians have had time to assess the peer-reviewed paper. By the next morning, physicians are greeted by a multitude of ...

642

Each year thousands of reviewers contribute their expertise to peer review, a process that contributes critically to the quality of the Journal. The editors and the authors of the papers submitted to the Journal are grateful for the help of all our ...

Clinical Implications of Basic Research
643-644

Pathogens employ a variety of methods to evade the immune response, and human immunodeficiency virus type 1 (HIV-1) is exceptionally capable in this regard. A recent study demonstrates why antibodies generated against the commonly exposed HIV-1 glycoprotein 120 are usually unable to prevent infection and, in so doing, uncovers a new means of viral evasion. The surface of glycoprotein 120 is remarkably flexible, making it difficult for antibodies to get a grip. This finding has implications for the development of an effective HIV-1 vaccine.

Sounding Board
645-650

    In contrast to observational studies, randomized clinical trials of hormone-replacement therapy have not shown a cardioprotective effect. The authors propose several methodologic and biologic explanations for these discrepant results.

    Health Policy Report
    651-656

    Nosocomial, or hospital-acquired, infections (more appropriately called health care–associated infections) are today by far the most common complications affecting hospitalized patients. Indeed, the Harvard Medical Practice Study II found that a single ...

    Correspondence
    657-660

    To the Editor: As a primary care physician who performs breast-cancer screening as a large part of my preventive care practice, I was interested in the data on breast-conserving surgery for breast cancer reported by Veronesi et al. (Oct. 17 issue).1 Such ...

    660

    To the Editor: Levy et al. (Oct. 31 issue)1 report that the incidence of heart failure has declined among women but not among men, whereas survival after its onset has improved in both sexes. In an accompanying editorial, Redfield states, “If we are to ...

    661-663

    To the Editor: The report by Rathore et al. (Oct. 31 issue)1 emphasizes differences according to sex in the outcomes of digoxin therapy in patients with congestive heart failure. Their post hoc analysis showed that outcomes differed between men and ...

    663-664

    To the Editor: Gross et al. (Oct. 3 issue)1 provide a timely study of the effects of the November 1998 Master Settlement Agreement with tobacco companies. Unfortunately, their summary of state efforts does not include Arkansas, a state with one of the ...

    664-666
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    To the Editor: In his Health Policy Report on the debate over residents' work hours (Oct. 17 issue),1 Steinbrook notes that “for teaching hospitals, the work-hour limits are an unfunded mandate.” Although many argue that such limitations may adversely ...

    666-667

    To the Editor: As commissioner of the Chicago Department of Public Health and an important figure in my book, Heat Wave, John Wilhelm has a distinctive view of whether he and the administration for which he works responded adequately to the 1995 disaster,...

    667-668

    To the Editor: Ectopic ovaries are characterized by their attachment to an area above the level of the common iliac vessels.1 Although they may occur in women with a normal uterus, the incidence is reported to be as high as 20 percent when the uterus is ...

    668-669

    To the Editor: In pregnancy, sepsis is a potentially severe threat to both mother and fetus. We describe a case of Serratia marcescens chorioamnionitis associated with bacteremia and spontaneous abortion.

    A 38-year-old woman (gravida 1, para 0) with a 19-...

    Book Reviews
    670-671

    Students who read about Harry Harlow in textbooks of psychology or animal behavior are usually presented with two impressions: appealing pictures of young rhesus monkeys clinging tightly to cloth- or wire-covered mother surrogates equipped with small ...

    671-672

    Fitzhugh Mullan has compiled a remarkable set of oral histories about what he calls “big doctoring,” the dedication of primary care clinicians — whether physicians, nurse practitioners, or physician's assistants — to advancing the well-being of their ...

    672-673

    Those of us who are old enough to have experienced the 1960s but young enough to remember them with fondness and clarity will recall a time of great ferment. There was an air of excitement and possibility, but it was tinged with anxiety about losing a ...

    Corrections
    674

    Rules for Making Human Tumor Cells Review Article, N Engl J Med 2002:347;1593-1603.. In Figure 1 on page 1597, the top box on the right side should have read p14ARF rather than p19ARF; on the left side of the figure, there should have been a barred line (...

    674

    Herbal Medicines — What's in the Bottle? Perspective, N Engl J Med 2002:347;1997-1998.. In the figure on page 1997, the percentage of the amount indicated on the label for C1 should be 65.7 rather than 67.5, as printed. We regret the error.