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October 30, 2003  Vol. 349 No. 18

Perspective
1691-1692

    Primary hyperparathyroidism is a state of excess secretion of parathyroid hormone and hypercalcemia, often with skeletal and renal complications. The disease usually results from a single parathyroid adenoma. Less commonly, tumors occur in multiple ...

    1693-1694

    I grasped the list of patients, fingering the crispness of the sheet that represented my first day of service on the medical wards. I knew that the sheet would soon be crumpled and covered with scrawl, as I scurried about, meeting 36 patients, 2 residents,...

    Original Articles
    1695-1702

    Fondaparinux is a pentasaccharide that selectively inhibits coagulation factor Xa. It is administered by subcutaneous injection and does not require laboratory monitoring. This large study compared fondaparinux and unfractionated heparin in the initial treatment of symptomatic pulmonary embolism. Fondaparinux was as effective and safe as heparin.

    1703-1712

    The efficacy of ximelagatran, an orally administered thrombin inhibitor, was compared with that of warfarin for thromboprophylaxis after total knee replacement. Both drugs were given for 7 to 12 days postoperatively, ximelagatran at a dose of 24 or 36 mg twice daily and warfarin with a target international normalized ratio of 2.5. The higher dose of ximelagatran was superior to warfarin in the prevention of venous thrombosis.

    1713-1721
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    Ximelagatran, a direct inhibitor of thrombin, is administered orally, and its use does not necessitate monitoring of coagulation. In this study, patients treated for venous thromboembolism with warfarin for six months were randomly assigned to receive ximelagatran or placebo. During the subsequent 18 months, the patients in the ximelagatran group had many fewer episodes of recurrent thromboembolism than those in the placebo group, without an increase in the frequency of bleeding.

    1722-1729

    Because mutations in the parafibromin gene (HRPT2) occur in a familial syndrome characterized by susceptibility to parathyroid carcinoma, such mutations were sought and found in patients with sporadic cases of parathyroid carcinoma. Moreover, germ-line mutations of HRPT2 were found in some patients with apparently sporadic parathyroid carcinoma.

    Images in Clinical Medicine
    1730
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    A 20-year-old, previously healthy woman presented with a progressively worsening headache. She had been well until three weeks earlier, when she started having an episodic, pulsating headache. Migraine was suspected, and treatment with a triptan and ...

    e17
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    A 16-year-old boy with back pain and an unusual history.

    Review Articles
    1731-1737

    Mercury poisoning still occurs as a result of accidental and occupational exposure. For the general population, however, the main concern is the possible adverse effect of exposure to mercury through fish consumption and the receipt of dental amalgams and thimerosal, a preservative used in vaccines. This review summarizes both the facts and the controversies surrounding exposure to methyl mercury, mercury vapor, and the ethyl mercury in thimerosal.

    1738-1749

    Schizophrenia has varied and ominous symptoms that generally begin in late adolescence or early adulthood and usually continue throughout life. This Drug Therapy article discusses the new generation of antipsychotic medications, as well as recent developments in brain imaging and in knowledge of the pathophysiology and molecular genetics of this devastating disease.

    Case Records of the Massachusetts General Hospital
    1750-1760

    Presentation of Case

    A 45-year-old woman came to the outpatient clinic for counseling because of concern about a family history of colonic polyps and cancer.

    The patient felt well and had had no abdominal pain, change in bowel habits, rectal bleeding, or ...

    Editorial
    1762-1764

    The seemingly magical transmutation of shed blood into a solid has fascinated inquisitive observers for millennia. Hippocrates, in De Carnibus, and Aristotle, in Meteorology, postulated that the phenomenon was due to cooling, and as late as the 1790s John ...

    Sounding Board
    1765-1769

    This Sounding Board article reviews the available evidence and concludes that — at least at present — cerebral palsy is not preventable in the vast majority of cases.

    Correspondence
    1770-1771

    To the Editor: In the T-20 vs. Optimized Regimen Only Study 1 (TORO 1), reported by Lalezari et al. (May 29 issue),1 enfuvirtide, when added to an optimized salvage antiretroviral regimen, increased by 12 percent the proportion of patients who had ...

    1772-1773

    To the Editor: Dr. Reefhuis and colleagues (July 31 issue)1 investigated the increased risk of bacterial meningitis in recipients of cochlear implants. To document the number of cases of postimplantation meningitis, the Ottawa Cochlear Implant Team ...

    1773-1774

    To the Editor: We have a concern regarding the report by Vincentelli et al. (July 24 issue)1 on acquired von Willebrand syndrome in aortic stenosis. What is the true clinical relevance of the documented laboratory findings? In their study, 9 of 42 ...

    1774-1776

    To the Editor: Ribic et al. (July 17 issue)1 investigated microsatellite instability as a predictor of a benefit from adjuvant chemotherapy in patients with stage II or stage III colon cancer, and their findings confirm that microsatellite instability ...

    1777

    To the Editor: Bunch and colleagues (June 26 issue)1 note that the quality of life of survivors after out-of-hospital cardiac arrest was, in most respects, similar to that of the general population. Patients who have undergone treatment after a life-...

    1777-1779

    To the Editor: The results from the study by Ganzini et al. (July 24 issue)1 were certainly thought provoking. However, it would have been interesting to learn how family members perceived the quality of the deaths of these patients. Physicians and ...

    1779

    To the Editor: During the past several months, I have evaluated three children between 8 and 10 years of age who presented with a two-to-three-day history of generalized headaches. In each case, the headache was dull and the pain fluctuated throughout ...

    Book Reviews
    1780
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    Oncologists tend, by nature and occupation, to be optimists, whereas pathologists are more inclined to be pessimists; to put it another way, oncologists are romantics, whereas pathologists are realists. Thus, oncologists point out that in the past few ...

    1780-1781

    In Seeds of Mortality, Justman cleverly interweaves his own experience as a patient with cancer with reflections on works of literature, the visual arts, and philosophy to create an insightful commentary on how cancer is viewed by American society. This ...

    1781-1782

    This book was issued as a report by the National Cancer Policy Board, which was established in 1997 by the Institute of Medicine and the National Research Council. The book is ambitious, and I approached it hoping to learn how to use our current knowledge ...

    Correction
    1782

    Binge Eating as a Phenotype of Melanocortin 4 Receptor Gene Mutations Correspondence, N Engl J Med 2003:349;606-609.. In the letter by Farooqi et al., the reference cited on the first line of the left-hand column of the text on page 608 should have been ...