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September 4, 2003  Vol. 349 No. 10

Perspective
923-925

The Congressional Budget Office has estimated that all spending for prescription drugs by and on behalf of Medicare's eligible population will total $1.8 trillion during the period from 2004 through 2013. The House and Senate have approved bills that ...

926-928

New insights into the complex metabolic circuitry of energy homeostasis have refined our understanding of the pathophysiology of obesity. Some of these insights regarding energy homeostasis are based on the identification of new functions for peptides ...

928-930

In the case of Webb v. United States, the U.S. Supreme Court ruled that the 1914 Harrison Narcotic Drug Act made it illegal for physicians to prescribe narcotics for the purpose of keeping a patient “comfortable by maintaining his customary use.” For more ...

Original Articles
931-940

Chronic renal failure is a risk after transplantation of a nonrenal organ. This population-based cohort analysis evaluated the incidence, risk factors, and hazard of death associated with chronic renal failure in 69,321 patients who received nonrenal transplants between 1990 and 2000. During a median of 36 months, chronic renal failure had developed in 11,426 patients (16.5 percent). Of these patients, 28.9 percent required maintenance dialysis or renal transplantation.

941-948

The gut hormone peptide YY3–36 (PYY) has been shown to decrease appetite and caloric intake in subjects of normal weight, but it was not known whether obese people are resistant to PYY, as they are to leptin. In this double-blind, controlled, crossover trial, PYY levels were lower in obese subjects than in lean subjects. Infusion of PYY decreased appetite and food intake in both lean and obese subjects.

949-958

In a randomized, multicenter trial, office-based treatment of opiate-addicted persons for one month with buprenorphine or a combination of buprenorphine and naloxone (to discourage parenteral abuse of buprenorphine) was superior to placebo in reducing the frequency of opiate-positive urine tests and opiate cravings. Open-label follow-up for up to 52 weeks confirmed that the combination of buprenorphine and naloxone was safe and well tolerated.

959-967
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In this multicenter, double-blind, randomized, controlled trial, extremely preterm infants (born at less than 30 weeks of gestation) who remained dependent on supplemental oxygen at 32 weeks of postmenstrual age did not benefit from the use of a target oxygen-saturation range of 95 to 98 percent, as compared with the standard target range of 91 to 94 percent.

Images in Clinical Medicine
968
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On the third day of life, balloon dilatation of the pulmonary valve was performed in a full-term newborn with pulmonary atresia. Eight days later, asymptomatic, macular, blanchable erythema developed, involving areas of the head and neck and half of the ...

e10
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A 54-year-old man had fatigue, weight loss, and atrophy of the testes.

Review Articles
969-974

The use of genomic techniques has led to insights into the pathobiology of both common and uncommon diseases. This last installment in the Genomic Medicine series provides a number of examples of the ways in which genomics has served as a probe for disease biology.

975-986

The neuropsychiatric mechanisms of drug addiction are complex, fascinating, and clinically important. This article reviews the genetic factors, receptor-mediated processes, and anatomical structures involved in drug addiction.

Clinical Problem-Solving
987-992

    A 33-year-old man presented for evaluation of hemoptysis. He had been in his usual state of health until the day of presentation, when he had a transient cough productive of one tablespoon (approximately 15 ml) of bright red blood. He did not have associated chest pain or dyspnea. He reported that he had not had recent weight loss, fever, illness, or trauma and that he did not have a history of bleeding.

    Editorials
    994-996

    The clinical introduction of the immunosuppressive drug cyclosporine in the early 1980s revolutionized the field of organ transplantation. The adoption of cyclosporine-based immunosuppressive regimens dramatically improved survival among patients who ...

    996-998
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    To him who devotes his life to science, nothing can give more happiness than increasing the number of discoveries, but his cup of joy is full when the results of his studies immediately find practical applications.

    — Louis Pasteur

    This issue of the ...

    Correspondence
    999-1000

    To the Editor: The report on the National Emphysema Treatment Trial (May 22 issue)1 states that in the subgroup of patients with predominantly upper-lobe disease and low base-line exercise capacity, lung-volume–reduction surgery, as compared with medical ...

    1000-1002

    To the Editor: The studies by Samaha et al.1 and Foster et al.2 (May 22 issue) are intended to expand our knowledge about low-carbohydrate diets. One potential long-term concern about the low-carbohydrate diet is its relatively high protein load and the ...

    1002-1004
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    To the Editor: In their article on heart failure (May 15 issue),1 Jessup and Brozena do not discuss heart transplantation, which has become a mainstay of therapy for patients with end-stage heart disease. Considerable effort on behalf of clinicians and ...

    1004-1006

    To the Editor: In Case 16-2003, Friedlander et al. (May 22 issue)1 provide a comprehensive discussion of a patient who has a ring-enhancing, unilateral brain mass. What is disappointing is the absence of any mention of mycobacterium. Though relatively ...

    1006-1007

    To the Editor: Phosphate-based cathartic agents are commonly prescribed for bowel cleansing before colonoscopy. They may have serious side effects, including seizures and acute renal failure. Although the latter complication has been reported on at least ...

    Book Reviews
    1008

    Jonathan Edlow's book, Bull's-Eye: Unraveling the Medical Mystery of Lyme Disease, was published at a particularly fitting time. This year marks the 20th anniversary of the discovery by Burgdorfer, Benach, and Barbour of the causative agent of Lyme ...

    1009

    Imaging in rheumatology has come a long way from roentgenography. Bony structures are easily seen on plain radiographs, and therefore the assessment of disorders of the bones and joints was for many years highly dependent on radiographic findings. In ...

    1009-1010

    Although this book focuses on the history of the pancreas, it is a fascinating retreat into many other aspects of the history of medicine. John Howard and Walter Hess have spent their professional lives as academic pancreatic surgeons. Their book is the ...

    Corrections
    1010

    The Autistic-Spectrum Disorders Perspective, N Engl J Med 2002:347;302-303.. On page 302, lines 4 and 5 in the second paragraph of the left-hand column should have read “4 cases per 10,000 persons,” not “0.4 case per 10,000 persons,” as printed.

    1010

    The New Medical Malpractice Crisis Perspective, N Engl J Med 2003:348;2281-2284.. In the figure legend on page 2282, one of the sources of the data was omitted: “Trends in 2002 Rates for Physicians' Medical Professional Liability Insurance,” Medical ...

    1010

    Noninvasive Detection of Clinically Occult Lymph-Node Metastases in Prostate Cancer Original Article, N Engl J Med 2003:348;2491-2499.. The image shown in Figure 3E on page 2497 is incorrect; the correct image appears below.