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July 10, 2003  Vol. 349 No. 2

Perspective
107-109

Multiple sclerosis is characterized by recurrent neurologic events (clinical relapses) that are attributable to multifocal lesions within the central nervous system. Lesions referred to as “active plaques” are characterized by the presence of inflammation ...

109-111

Thrombosis was identified as a complication of cancer by Trousseau in 1865, and the combination of the two conditions is still often called Trousseau's syndrome. Arterial and, more commonly, venous thrombosis is a frequent complication of cancer and ...

111-114

Generations of trainees have been taught that monochorionic twin placentas are monozygotic. A report by Souter et al. in this issue of the Journal (pages 154–158) invalidates this simple rule by convincingly demonstrating the association of a ...

Original Articles
115-124

Most kidney transplants fail because of chronic allograft nephropathy or the death of the recipient, but methods for predicting such an outcome have been lacking. This study evaluated the predictive value of the renal segmental arterial resistance index (the percentage reduction of the end-diastolic flow as compared with the systolic flow). A high resistance index (80 or higher) was associated with an increased risk of a reduction in creatinine clearance, allograft failure, or death.

125-138

In this study, DNA microarrays were used to examine gene-expression patterns in biopsy samples from normal and dysfunctional renal allografts. Subtypes of acute rejection, indistinguishable by light microscopy, could be distinguished by differences in immune activation and cellular proliferation. Dense CD20+ B-cell infiltrates were significantly associated with clinical glucocorticoid resistance and graft loss.

139-145

In this study of 103 patients with new neurologic symptoms, abnormalities on MRI, and cerebrospinal fluid findings that suggested multiple sclerosis, patients with antibodies to myelin oligodendrocyte glycoprotein (MOG) and myelin basic protein (MBP) were much more likely to have recurrent symptoms and progression to clinically definite multiple sclerosis than those without these antibodies.

146-153

Secondary prophylaxis against recurrent deep-vein thrombosis is important in patients with cancer, since these patients have an increased risk of recurrence. The researchers compared dalteparin, a low-molecular-weight heparin, with an oral anticoagulant drug for six months after the initial event and found fewer recurrences with heparin.

154-158
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It is generally accepted that monochorionic twins are exclusively monozygotic. The authors report a case of monochorionic twins of different sexes, conceived by in vitro fertilization, who proved to be dizygous.

Images in Clinical Medicine
159
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A 29-year-old woman was in spontaneous labor at term after an uncomplicated pregnancy. The second stage of labor was notable for persistent, severe, and variable decelerations in the fetal heart rate. She had spontaneous vaginal delivery of a 3.7-kg ...

e2

This series of radiographs begins at four years of age.

Review Article
160-169

Giant-cell arteritis typically involves extracranial branches of the aorta, such as the temporal and vertebral arteries. Temporal arteritis and polymyalgia rheumatica often coexist, and systemic manifestations of inflammation occur in virtually all forms of giant-cell arteritis. This article reviews the mechanisms that contribute to the causes of giant-cell arteritis, with an emphasis on immune-mediated injury to arteries.

Case Records of the Massachusetts General Hospital
170-180

Presentation of Case

A 72-year-old, right-handed man was admitted to the hospital because of recurrent neurologic symptoms.

The patient had been well until 10 days earlier, when he briefly had numbness of the right side of the mouth and tongue. That ...

Editorial
182-184

More than 90 percent of renal allografts transplanted today will still be functioning one year from now. This rate represents a remarkable improvement over one-year graft-survival rates of 70 percent in 1990.1 Despite this improvement in short-term ...

Clinical Implications of Basic Research
185-186

    Molecular mimicry is a model in which foreign antigens are sufficiently similar to native antigens to trigger an autoimmune response. A study involving the specificity of a T-cell receptor derived from a patient with multiple sclerosis indicates that molecular mimicry extends to complexes of proteins — a finding with implications for therapy.

    Correspondence
    187-188

    To the Editor: Our teaching hospital was the site of a major outbreak of the severe acute respiratory syndrome (SARS).1 We sequenced viral isolates cultured from clinical specimens from seven patients with SARS in this outbreak. The viral isolates were ...

    188-192

    To the Editor: Regarding the study by the Acute Respiratory Distress Syndrome (ARDS) Network, discussed by Steinbrook (April 3 issue),1 some may wonder whether the institutional review boards (IRBs) had enough information to evaluate the risks of this ...

    192-193

    To the Editor: In their article on the effects of luteinizing hormone–releasing hormone agonist in the treatment of adolescents with short stature, Yanovski et al. (March 6 issue)1 predict that the deficit in bone mineral density will not be recovered, ...

    193-194

    To the Editor: We disagree with Nussbaum and Ellis's statement that gene variations other than the APOE ε4 allele are elusive in the nonfamilial form of Alzheimer's disease (April 3 issue).1 The candidate-gene approach has already identified genes with a ...

    194-195

    To the Editor: Mantzouranis et al. (April 10 issue)1 call attention to a feature of the patchy epithelial inflammatory disease we name according to the area of prime involvement as asthma, allergic rhinitis, or eczema. In adults, the manifestation noted ...

    195-196

    To the Editor: Six weeks after being bitten by a deer tick, a pregnant 31-year-old woman began to have fever, chills, fatigue, and neck pain. During the fifth day of fever, she became jaundiced and was hospitalized. On physical examination, she was 37 ...

    Book Reviews
    197-198

    Bellevue Hospital, probably the oldest hospital in America, began to serve George II's New York subjects in 1736 as a Public Workhouse and House of Correction with six beds for the sick. Included in the cost of construction were 50 gallons of rum. Forced ...

    198-199

    This textbook has many strengths. It is our current choice for students in our own course on physical diagnosis, and its earlier editions have been our choice for more than 10 years. The overall design of the book has much to recommend it. It is probably ...

    199

    An injured spinal cord adversely affects more organ systems than virtually any other disease entity and requires the ongoing attention of physicians in multiple specialties. This comprehensive book details the wide range of care needed for the management ...

    199-201
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    Disaster medicine is perhaps the most interdisciplinary of all fields of medicine, and yet because disasters are relatively infrequent, few physicians are familiar with its principles, unique organizational demands, and clinical nuances. Because many of ...

    201-202

    Textbook of Ophthalmology is an impressive work. This 3000-page, four-volume set of books, edited by Sunita Agarwal and six others, was published in New Delhi in 2002. It contains 324 chapters written by more than 250 contributors and comes at the ...

    Correction
    202

    Hodgkin's Disease — Clinical Trials and Travails Perspective, N Engl J Med 2003:348;2375-2376.. In the left-hand column on page 2376, lines 1 to 4 should have read “the risk of a second cancer among previously untreated patients after MOPP alone is less ...

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