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October 9, 2003  Vol. 349 No. 15

Perspective
1399-1401

For many years hematologists have used the microscope to identify a complete remission of leukemia after treatment with chemotherapy. In a hematologic complete remission, we know that a large portion of the leukemic cells remain out of sight. These cells, ...

1401-1404

Cystic fibrosis is a heterogeneous condition caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene.1 The gene product, a regulated chloride channel, is expressed in the apical plasma membrane of secretory and ...

Original Articles
1405-1413
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In this multicenter study of first-trimester screening for trisomies 21 and 18, a combination of maternal age, maternal levels of free β human chorionic gonadotropin and pregnancy-associated plasma protein A, and ultrasonographic measurement of fetal nuchal translucency detected 78.7 percent of fetuses with trisomy 21, with a false positive rate of 5 percent. Such screening was also highly sensitive and specific for the identification of fetuses with trisomy 18.

1414-1422

These investigators followed a large birth cohort with the use of questionnaires, lung-function tests, and allergy skin tests from the age of 3 to 26 years. Almost three quarters of the study participants had wheezing at one point in the follow-up, and 15 percent had wheezing at all points in the follow-up.

1423-1432

Measurement of the transcripts of BCR-ABL, the key molecular abnormality in chronic myeloid leukemia (CML), provides an estimate of the burden of leukemic cells in a given patient. A profound reduction in blood levels of BCR-ABL transcripts was much more frequent among patients treated with imatinib than among those treated with interferon alfa plus cytarabine.

1433-1441

A small fraction of patients with cystic fibrosis have a genetic defect that introduces a premature stop codon into the CFTR gene; this results in a truncated protein that does not fulfill its normal biologic function.

Images in Clinical Medicine
1442
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A 77-year-old Chinese woman presented with an abnormality on a chest film obtained as part of her screening for immigration to the United States. A posteroanterior film showed a well-circumscribed mass, 8 cm in diameter, in the lower region of the ...

e14
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A woman with corticosteroid-dependent disease was admitted for weakness in both legs.

Clinical Practice
1443-1450

A healthy, sexually active, 35-year-old woman presents for advice about the use of oral contraceptives. She does not smoke cigarettes and has no personal or family history of venous thromboembolism, myocardial infarction, or stroke. Her blood pressure is 120/80 mm Hg. Should an oral contraceptive be prescribed, and if so, how should a formulation be chosen?

Review Article
1451-1464

An extraordinary series of discoveries about chronic myeloid leukemia (CML) has made this disease a model of the way in which bench and bedside research can unite and culminate in clinically important advances. This review brings the reader up to date on recent advances in understanding the biology of CML and how they have changed the management of the disease.

Clinical Problem-Solving
1465-1469

    A 62-year-old woman with a history of acute myelogenous leukemia, who had undergone transplantation of T-cell–depleted allogeneic bone marrow two years earlier, was admitted to the hospital because of an elevated bilirubin level that was thought to be secondary to graft-versus-host disease. Her serum sodium level was 124 mmol per liter.

    Editorials
    1471-1473

    An increased risk of fetal Down's syndrome (trisomy 21) is the most common reason for offering prenatal genetic diagnosis. The chance of giving birth to a child with Down's syndrome increases throughout a woman's reproductive years. Since the 1970s, an ...

    1473-1475

    Patients with asthma and their caregivers are currently faced with a remarkable paradox. Considerable progress has been made during the past 20 years in the pharmacotherapy, educational tools, and environmental measures available for the control of ...

    Correspondence
    1476-1479

    To the Editor: The conclusion drawn by Rodenhuis et al. (July 3 issue)1 — that high-dose therapy improves relapse-free survival among patients with 10 or more positive nodes — is untenable. The authors failed to apply the method specified in their ...

    1479-1480

    To the Editor: Regarding the article by Selzer et al. on the adverse effect of nitrous oxide (July 3 issue),1 I would like to point out that, in 1978, my colleagues and I showed that nitrous oxide inactivated vitamin B12 in vivo.2 My colleague John Amess,...

    1480-1481

    To the Editor: Rosenthal (July 17 issue)1 begins her article by considering the myth of Prometheus. She says that a vulture preyed daily on his self-renewing liver. Indeed, Greek mythology tells us that a bird ate Prometheus's liver, but older sources ...

    1481-1482
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    To the Editor: Regarding your editorial in the July 17 issue,1 I would like to extend my compliments and appreciation to you and your editorial staff for making the publication of stem-cell research a priority. My mother has been fighting Parkinson's ...

    1482

    To the Editor: Case 11-2003 (April 10 issue)1 describes a 14-year-old boy with recurrent cholangitis complicating ulcerative colitis. The authors state that this presentation is unusual in such a young patient. We report a similar experience of a ...

    1482-1483

    To the Editor: The Case Records on the 72-year-old man with giant-cell arteritis (July 10 issue)1 include a comment from a house officer: “As one of the house officers caring for this patient, I developed a relationship with him and his family. Probably ...

    1483-1484

    To the Editor: Reliable assessment of molecular remission after allografting for chronic myeloid leukemia requires assays capable of detecting one BCR-ABL–positive cell among 105 to 106 BCR-ABL–negative cells1 — a sensitivity achieved with nested reverse-...

    Book Reviews
    1485-1486

    The death of a child holds such sadness for many health care professionals that they will have trouble bringing themselves to read a book that so openly considers this tragedy. Yet it is critical that those same professionals delve into this book. Within ...

    1486-1487

    This book contains a wealth of information to assist physicians with the care of children who are in pain. The book has three sections, covering theoretical perspectives, treatment strategies, and particular problems. The first section deals with the ...

    1487

    Along with the many infirmities of old age, pain is a common occurrence. The causes of pain in the elderly, unlike those that affect younger adults, are often complex and not likely to be reversible. The physical discomfort of pain is only one facet of ...

    Corrections
    1487
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    Insulin Lispro Review Article, N Engl J Med 1997:337;176-183.. In Figure 2 on page 177, the last amino acid at the C-terminal end of the sequences for insulin lispro and human insulin should have been “Thr,” rather than “Tyr,” as printed.

    1487

    Tissue Plasminogen Activator in Cardiac Arrest with Pulseless Electrical Activity Original Article, N Engl J Med 2002:346;1522-1528.. In Table 3 on page 1524, the numbers and percentages of patients who received atropine should have been 108 (92.3) in the ...

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