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September 18, 2003  Vol. 349 No. 12

Perspective
1107-1109

It has been almost 10 years and 2000 articles since the publication of the article identifying the etiologic agent of Kaposi's sarcoma, a virus appropriately called Kaposi's sarcoma–associated herpesvirus (KSHV) or, more recently, human herpesvirus 8. In ...

1109-1110

In the more than 30 years that I have been practicing medicine, the most difficult task for me has been speaking to the family members of patients whose health is failing. In the 1970s, there was less medical technology that I could use to help my ...

1110-1112

In this issue of the Journal, Kofoed et al. (pages 1139–1147) describe a novel mechanism for impaired growth in the form of a mutation in the gene for the intracytoplasmic protein signal transducer and activator of transcription 5b (STAT5b). The mutation ...

Original Articles
1113-1122

Human herpesvirus 8 (HHV-8) is believed to cause Kaposi's sarcoma, and the vascular lesions of Kaposi's sarcoma resemble the plexiform lesions of primary pulmonary hypertension. In this study, molecular evidence of HHV-8 was found in the lung tissue of 10 of 16 patients with primary pulmonary hypertension, but in none of 14 patients with secondary pulmonary hypertension.

1123-1132

The reasons underlying physicians' decisions to withdraw mechanical ventilation from patients in anticipation of their death were examined in this observational study. A daily accounting of potential reasons for withdrawal was scored and compared with the eventual outcome. Patients who required vasoactive medications, patients who physicians predicted either had a slim chance of survival or would have severe cognitive impairment if they survived, and patients perceived by their physicians as not wanting life support were those in whom ventilation was withdrawn in anticipation of death.

1133-1138

Warfarin can prevent recurrent thrombosis in patients with the antiphospholipid antibody syndrome, but the intensity of anticoagulation is an unsettled matter. In this randomized trial, patients with the syndrome were assigned to moderate- or high-intensity warfarin. The high-intensity regimen was no more effective than the moderate-intensity regimen.

1139-1147

This report documents that the syndrome of growth hormone insensitivity (severe short stature, increased secretion of growth hormone, but low serum concentrations of insulin-like growth factor I [IGF-I] and IGF–binding protein 3) in a teenage girl was due to a homozygous missense mutation in the gene for STAT5b, an essential component of the actions of growth hormone, as well as many other cytokine-induced functions.

Images in Clinical Medicine
1148
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A 49-year-old woman presented with a 12-month history of progressive exertional dyspnea and hoarseness. She had received a diagnosis of primary pulmonary hypertension after an uneventful pregnancy and delivery 22 years earlier. At that time, right heart ...

e12
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A 52-year-old man had been receiving hemodialysis for 11 years.

Review Articles
1149-1156

The ability to determine the genotype of Mycobacterium tuberculosis is changing our understanding of the dynamics of tuberculosis transmission. This review summarizes the methods of genotyping and explains how they can assist clinical management. These techniques can be used to evaluate tuberculosis-control programs and provide clues to the pathogenesis of tuberculosis infection.

1157-1167

For those using drugs to treat infants and children, the integration of developmental pharmacology is crucial to appropriate clinical practice. Changes in metabolic capacity, distribution sites, and organ function all affect the way in which medications are handled in the very young. This review examines the developmental changes that profoundly affect the responses of children to medications and related therapies.

Case Records of the Massachusetts General Hospital
1168-1175

Presentation of Case

A 60-year-old man was evaluated in the clinic in mid-June because of fever, rigors, and sweats.

The patient had been well until 10 days earlier, when anorexia, a sore throat, diffuse myalgia, arthralgia, headache, malaise, and fever (...

Editorial
1177-1179

Two decades after the presence of anticardiolipin antibodies and a syndrome of spontaneous thrombosis and fetal death were linked,1 and after the publication of approximately 3500 reports in which the term “antiphospholipid syndrome” has been used, we ...

Sounding Board
1180-1184
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Advances in bioinformatics and genetics have made collections of biologic specimens and medical information valuable for pharmacogenomic research.1 As a result, many large-scale data banks for genomics have emerged in the United States and abroad.2 These ...

Correspondence
1185-1186

To the Editor: The results reported by Harisinghani et al. (June 19 issue)1 may have been influenced by the limited dissection of lymph nodes in their study. In most patients, only obturator nodes were dissected, yielding 334 nodes from 80 patients — an ...

1186-1187

To the Editor: In the study by Diehl et al. (June 12 issue),1 the median duration of chemotherapy from the first to the last day of drug administration in the group assigned to cyclophosphamide, vincristine, procarbazine, and prednisone alternating with ...

1187-1188

To the Editor: We disagree with Aleman et al. (June 12 issue)1 that involved-field radiotherapy does not improve the outcome after a complete response to chemotherapy in patients with advanced Hodgkin's lymphoma. The authors used two additional cycles of ...

1188-1190

To the Editor: Lardinois et al. (June 19 issue)1 state that the accuracy of positron-emission tomography (PET) in lymph-node staging is only 49 percent. At least 15 patients had N0 disease on tumor–node–metastasis staging (i.e., IA or IB disease). If it ...

1190-1191

To the Editor: To determine whether itraconazole prevents fungal infections, Gallin et al. (June 12 issue)1 used treatment alternation as the basis for inference but did not consider that the group with greater exposure would, by chance alone, tend to ...

1192

To the Editor: Hayes and Piesman (June 12 issue)1 state that an important strategy for preventing the late-stage manifestations of Lyme disease is the early diagnosis and treatment of erythema migrans. In Europe, in contrast to North America, a special ...

1192-1193

To the Editor: Various hematologic disorders, including plasma-cell dyscrasia,1 are increasingly being diagnosed in patients with human immunodeficiency virus (HIV) infection. Monoclonal gammopathy of undetermined significance (MGUS), generally ...

Book Reviews
1194

The field of neurology was long infamous for a lack of therapeutic options. But those sere days have passed into history, and the field is now vibrant with new treatments and with hope even for patients with the worst neurodegenerative diseases and ...

1194-1195

It was six men of Indostan

To learning much inclined,

Who went to see the Elephant

(Though all of them were blind),

That each by observation

Might satisfy his mind.

John Godfrey Saxe (1816-1887)

Pediatric psychopharmacology has been a much maligned and ...

1196-1197

Consciousness is all the rage. It seems to pop up everywhere. It is now a legitimate subject of study. No longer can it be talked about only in nooks and crannies at conferences. One can publicly hold one of many, sometimes completely contradictory, ...

1197

There are more than 5000 languages in the world. One of the extraordinary features of the developing human brain is its capacity, under the right circumstances, to learn any of those languages regardless of their linguistic complexity or syntactic ...