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December 11, 2003  Vol. 349 No. 24

Perspective
2283-2285
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Gallo and Montagnier describe the discovery of the cause of AIDS.

2285-2287

It is ironic and instructive that in the age of cellular and molecular biology, great advances in our understanding of the pathophysiology of cardiovascular disease continue to be made by pathologists who perform meticulous and imaginative studies. The ...

2288-2290

Long-term survival of kidney transplants (renal allografts) has changed little during the past decade, despite dramatic improvements in short-term survival. Most late renal allograft loss, other than that associated with the death of the patient, has been ...

2290-2292

Cross-sectional imaging of the body has such an important role in the diagnosis of disease and the care of patients today that it is easy to overlook how recently the technology was developed and integrated into clinical practice. This year's Nobel Prize ...

Original Articles
2293-2303

AIDS Clinical Trials Group study 384 was a large study with six treatment groups that examined initial treatment of human immunodeficiency virus type 1 (HIV-1) infection with one of two four-drug regimens or one of four combinations of two consecutive three-drug regimens. In this issue of the Journal, there are two reports. The first report shows that the zidovudine–lamivudine–efavirenz regimen is superior to the other three drug regimens for initial treatment. The second indicates that a four-drug regimen does not increase the duration of successful treatment.

2304-2315

Although many drugs are approved for the treatment of human immunodeficiency virus type 1 (HIV-1) infection, the cause of the acquired immunodeficiency syndrome (AIDS), they belong to just four different classes: nucleoside or nucleotide reverse-...

2316-2325

Unstable coronary-artery plaques, which are prone to rupture, are believed to have a key role in the pathogenesis of acute myocardial infarction. Hemorrhage into plaques is one mechanism by which they become unstable and progress. This study provides evidence that plaque hemorrhage causes plaques to become unstable by inducing the formation of cholesterol crystals and the recruitment of macrophages.

2326-2333
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Chronic allograft nephropathy has become the dominant cause of kidney-transplant failure in the present era of improved immunosuppression. This prospective study examined 961 kidney-transplant–biopsy specimens obtained sequentially during the first 10 years after transplantation from 120 recipients with type 1 diabetes. Nephrotoxicity, implicated in late, ongoing injury, was almost universal at 10 years, even in grafts with excellent early histologic findings.

2334-2339

Three patients with hypereosinophilia and severe eosinophilic dermatitis in whom a variety of conventional treatments were ineffective had a rapid response to infusions of a humanized anti–interleukin-5 antibody. None of the patients had evidence of a clonal T-cell disorder or a myeloproliferative disease.

Images in Clinical Medicine
2340
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A 35-year-old man with human immunodeficiency virus infection was admitted because of weight loss, fatigue, anorexia, and chronic, watery, nonbloody diarrhea. The workup for diarrhea revealed steatorrhea (110 g of fat per 24 hours). The patient had a ...

e23
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This man first presented with pain in his toes and in one fingertip.

Case Records of the Massachusetts General Hospital
2341-2349

    Presentation of Case

    A 12-year-old girl was admitted to the hospital because of fever, vomiting, and an abrupt onset of unresponsiveness.

    She had been well until one week earlier, when a cough, sore throat, and rhinorrhea developed. Laboratory values ...

    Editorial
    2351-2352

    It has often been stated that the central questions in therapy for human immunodeficiency virus (HIV) infection are the same now as they were when the epidemic started. When do we start therapy, what do we start with, when should we switch, what ...

    Sounding Board
    2353-2356

    Every year there are approximately 2200 to 3000 cases of invasive meningococcal disease in the United States. Because of its low cost effectiveness and other limitations, routine use of the meningococcal vaccine is not recommended. However, individual choices may differ from public policy considerations. If parents were aware of this option, many might choose to pay for vaccination in order to protect adolescents and young adults from this devastating infection. Parents and patients need information about the availability of all effective vaccines.

    Clinical Implications of Basic Research
    2357-2359

    A promising new method of silencing gene expression has been shown to be an effective therapy in two mouse models of autoimmune hepatitis and hepatitis B infection.

    Correspondence
    2360-2361

    To the Editor: Hylek and colleagues (Sept. 11 issue)1 report that in patients with nonvalvular atrial fibrillation who were admitted with stroke, an international normalized ratio (INR) of less than 2.0 was associated with a greater severity of stroke ...

    2362

    To the Editor: Askie et al. (Sept. 4 issue)1 report the effects of oxygen-saturation targeting at 32 weeks of postmenstrual age on outcomes in premature infants. First, why did the authors define “standard saturation” as 91 to 94 percent and “high ...

    2362-2363

    To the Editor: Lu et al. (Sept. 18 issue)1 report human immunodeficiency virus (HIV) infection presenting as monoclonal gammopathy of undetermined significance (MGUS) in a 46-year-old man and argue that young patients with MGUS should be screened for HIV ...

    2363-2364
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    To the Editor: In Dr. Mehler's discussion of the physiological complications of bulimia nervosa (Aug. 28 issue),1 he emphasizes the diagnostic usefulness of urinary electrolyte measurements and concludes that low urinary potassium and sodium ...

    2364

    To the Editor: In their excellent review of the molecular epidemiology of tuberculosis, Barnes and Cave (Sept. 18 issue)1 recommend that the Centers for Disease Control and Prevention (CDC) support newer, more rapid genotyping tests. In fact, the CDC is ...

    2365

    To the Editor: Camí and Farré (Sept. 4 issue)1 provide a comprehensive review of the neuronal and behavioral mechanisms involved in drug addiction. Their information on the potential for abuse of cannabinoids, however, is outdated. The authors claim that,...

    2365-2366

    To the Editor: The insights provided by Korner and Leibel (Sept. 4 issue)1 into the interplay between the digestive and nervous systems are cogent, but the figure in their article seems to contain an error or, at least, an oversimplification. A neuron ...

    2366-2367

    To the Editor: The detection of aspergillus galactomannan antigenemia is a method used in the diagnosis of invasive aspergillosis.1,2 Some transient false positive reactions have been reported with the use of enzyme-linked immunosorbent assays in ...

    2367-2368

    To the Editor: We report the case of a 34-year-old man who presented with a two-month history of painful keratotic plaques that involved the skin surrounding the ears, the nose, and the soles in association with polyarthritis. He had had a diarrheal ...

    Book Reviews
    2369

    The only thing missing from this book is a question mark in the title. Better Than Prozac is about the long road that neuropsychopharmacology has traveled and about hopes for its future, particularly with respect to creating better drugs. Drugs that treat ...

    2369-2370

    Prozac on the Couch is a creative, intelligent, and provocative challenge to the notion that biologic psychiatry has replaced psychoanalysis as the dominant therapeutic model in psychiatry. Tracing treatments for depression, anxiety, and other mental ...

    2370-2371

    Schizophrenia is a worldwide public health problem that carries substantial personal and social burdens. As the fourth leading cause of disability among adults, schizophrenia compromises the social and occupational functions of those who have this ...

    2371-2372

    Historically, epidemiologic contributions to research on schizophrenia have involved descriptive studies of the incidence and prevalence of the disease and associated risk factors, as well as longitudinal studies of its course and outcome. The ...