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October 23, 2003  Vol. 349 No. 17

Perspective
1587-1589

A growing understanding of the importance of the rupture of atherosclerotic plaque in the pathogenesis of coronary events has led to the identification of an expanding array of markers of plaque vulnerability.1,2 Reports of markers of inflammation and ...

1589-1592

The ontogeny of human gonadotropin secretion is remarkable for surges in pulsatile secretion during the neonatal period and in early childhood, followed by a period of quiescence (the so-called juvenile pause), which reflects the inhibition of the ...

1592-1594

The prescription of medications has long been the most frequent therapeutic intervention in medicine. In 2000 in the United States, 173 million people filled 2.2 billion outpatient prescriptions, accounting for $103 billion in expenditures. Because all ...

Original Articles
1595-1604

Inflammation appears to have a key role in acute coronary syndromes. Myeloperoxidase, an enzyme that generates reactive oxygen species, is released from leukocytes on activation, and plasma levels of myeloperoxidase may serve as a marker of inflammation. In this study, plasma myeloperoxidase levels were found to be predictive of subsequent coronary events in patients with chest pain, even when patients were initially negative for troponin T.

1605-1613

Reactive oxygen species may have a role in the pathogenesis of atherosclerosis, and antioxidant enzymes that degrade these species may protect against atherosclerosis. In this study, the activity of one such enzyme, glutathione peroxidase 1, as measured in red cells, was found to be inversely correlated with the risk of subsequent coronary events.

1614-1627
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Puberty does not occur in patients with idiopathic hypogonadotropic hypogonadism. This study investigated mutations in a candidate gene encoding a G protein–coupled receptor (GPR54). Affected members of an index pedigree were homozygous for an L148S mutation; an unrelated proband had two separate mutations, R331X and X399R. Isolated hypogonadotropic hypogonadism was also present in a knockout mouse that was engineered to lack this gene.

1628-1635

In a large cohort study, 969 patients had an allergic reaction to a sulfonamide antibiotic, 96 (9.9 percent) of whom subsequently had a reaction after receiving a sulfonamide nonantibiotic. However, this rate was lower than that for reactions after receiving a penicillin.

Images in Clinical Medicine
1636
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A 47-year-old man with no history of cardiac disease presented to a hospital, reporting severe substernal chest pressure associated with bilateral arm weakness. A standard 12-lead electrocardiogram (Panel A) showed marked ST-segment elevation in leads V1, ...

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A woman with known mediastinal sarcoidosis and pain in the left upper quadrant.

Special Article
1637-1646

A reduction in historically high rates of hospital use was one goal of the Veterans Affairs (VA) system's 1995 introduction of primary care and capitated payment. This study of veterans with chronic disease showed that from 1994 through 1998, hospital use declined by 50 percent and urgent care visits fell by 35 percent. Mortality rates did not increase.

Clinical Practice
1647-1655

    A 59-year-old man with bilateral olecranon-bursa tophi has frequent bouts of acute gouty arthritis, including three in the past year. Serum uric acid levels are consistently above 9 mg per deciliter. He is moderately obese and has mild, untreated hypertension. Allopurinol was discontinued after a maculopapular rash developed. How should this patient be treated?

    Case Records of the Massachusetts General Hospital
    1656-1663

    Presentation of Case

    A 37-year-old man was admitted to the hospital because of collapse.

    The patient was unmarried and unemployed and was a former smoker. He had abused alcohol since the age of 13 years and had been admitted for detoxification on numerous ...

    Editorial
    1665-1667

    During the past decade, the Department of Veterans Affairs (VA) undertook a major reform of its health care system, one that is increasingly relevant as the United States confronts rapidly rising health care spending and persistent gaps in the quality of ...

    Correspondence
    1668-1671

    To the Editor: Woodcock et al.1 and Terreehorst et al.2 (July 17 issue) hoped to show the value of reducing the concentrations of house-dust-mite allergen in the homes of people with allergic asthma and rhinitis. However, they simply affirmed that ...

    1671

    To the Editor: In their report on postmenopausal bone loss and bone size, Ahlborg and colleagues (July 24 issue)1 used the rate of fractures in each quartile of medullary expansion in correlation with the bone mineral density, the section modulus, and ...

    1672-1673

    To the Editor: Punglia and colleagues (July 24 issue)1 assert that prostate biopsy should be the gold standard for evaluating the sensitivity and specificity of the prostate-specific antigen (PSA) test. This suggestion is not appropriate; clinically ...

    1673-1674

    To the Editor: Despite the unexpectedly high prevalence of celiac disease found in the study by Mäki et al. (June 19 issue),1 their use of endomysial and tissue transglutaminase antibodies as the sole serologic markers probably underestimated the ...

    1674

    To the Editor: In the report on their randomized, placebo-controlled, phase 2 trial evaluating bevacizumab, Yang et al. (July 31 issue)1 conclude that bevacizumab significantly prolongs the time to progression of metastatic renal-cell cancer. I believe ...

    1674-1676

    To the Editor: In the Clinical Practice article by Fihn on acute uncomplicated urinary tract infection in women (July 17 issue),1 the recommendations for treatment appear to be somewhat out of date. First, the expected rates of clinical failure among ...

    1676-1679

    To the Editor: Zoledronic acid (Zometa, Novartis Pharmaceuticals) is a potent bisphosphonate that inhibits bone resorption. In trials of treatment for bone metastases, 9 to 15 percent of the patients who received 4 mg of zoledronic acid over a 15-minute ...

    Book Reviews
    1680-1681

    “Food safety is political.” So claims the title of the introduction to Marion Nestle's book Safe Food, and this assertion is solidly confirmed in the pages that follow. In her instructive monograph, Nestle exposes the political workings of the system that ...

    1681-1682

    There was a time when it could be said, with some confidence, that “now that infectious diseases have been controlled by antibiotics, we can turn our attention to more interesting problems” (medical grand rounds, Peter Bent Brigham Hospital, 1955) and ...

    1682-1683

    The study of environmental exposures and children's health goes back to the 19th century, when there were isolated reports of acute effects associated with heavy exposures. However, only in the past several decades have environmental exposures been ...

    1683-1684

    A large group of disorders affect the muscles, nerves, neuromuscular junctions, and motor neurons. These neuromuscular diseases are common in both children and adults, but because of their complex presentation their diagnosis and treatment can require not ...