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December 25, 2003  Vol. 349 No. 26

Perspective
2479-2480

Multiple myeloma is a cancer in which immunoglobulin-producing plasma cells undergo clonal expansion. Its characteristic feature is the monoclonal, or M, spike, usually detectable in serum or urine by protein electrophoresis. Malignant plasma cells have ...

2481-2482

Carbohydrates are often stored as glycogen in the body. Pathways for the synthesis and breakdown of glycogen (see Figure) permit the maintenance of a steady blood glucose level and provide a source of energy. There are 14 recognized glycogen storage ...

Original Articles
2483-2494

This study found that plasma cells from the bone marrow of patients with myeloma and osteolytic lesions expressed high levels of the DKK1 gene and produced the DKK1 protein, whereas plasma cells from patients without bone lesions did not overexpress the gene or produce the protein.

2495-2502

This investigation of the treatment of multiple myeloma compared one cycle of high-dose chemotherapy plus a single autologous stem-cell transplantation with two cycles of high-dose chemotherapy, each followed by stem-cell transplantation. The double-transplantation regimen had a substantial survival benefit.

2503-2509

Lack of glycogen phosphorylase in patients with McArdle's disease blocks muscle glycogenolysis, resulting in low exercise tolerance and often in muscle injury, particularly in the first minutes of exercise. As the investigators in this single-blind, randomized, placebo-controlled trial hypothesized, ingesting sucrose before exercise increased the availability of glucose and therefore improved exercise tolerance in patients with the disease.

2510-2518

This prospective cohort study compared the performance of two clinical decision rules for evaluating cervical-spine injury. As compared with the NEXUS Low-Risk Criteria (which are widely recommended), the Canadian C-Spine Rule was more sensitive and more specific for clinically important injury and would have resulted in fewer orders for cervical-spine radiographs.

Review Articles
2519-2526

The transportation of illicit drugs by concealment within the body is now a common practice, and it has implications for clinical care. Body packers may ingest dozens of packets containing life-threatening doses of heroin, cocaine, or amphetamines. These smugglers may then present to physicians for evaluation while in legal custody or because of drug-induced toxic effects or obstruction or perforation of the gastrointestinal tract. This review provides guidance for the recognition and management of this clinical problem, which often also poses ethical and legal challenges for the clinician.

2527-2539

    In acquired pulmonary alveolar proteinosis, lipids and proteins accumulate within the alveoli because alveolar macrophages cannot catabolize surfactants. Surprisingly, alveolar macrophages require granulocyte–macrophage colony-stimulating factor (GM-CSF) to perform this function. Autoantibodies against GM-CSF may cause pulmonary alveolar proteinosis.

    Images in Clinical Medicine
    2540
    • Free Full Text

    An 81-year-old man had had mild dysphagia for several years. During the six months before admission, the dysphagia worsened, and he had occasional hemoptysis. For several days before admission he had increasing shortness of breath and throat tightness, ...

    e25
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    A 78-year-old man with fever, vomiting, and a distended abdomen.

    Case Records of the Massachusetts General Hospital
    2541-2549

    Presentation of Case

    A 14-month-old boy was admitted to the hospital because of recurrent abdominal distention, vomiting, and diarrhea.

    The boy had been born at another hospital at 34 weeks' gestation and weighed 2.56 kg at birth. He had been admitted to ...

    Editorials
    2551-2553

    Contrary to a widely held belief, multiple myeloma is not a rare, rapidly fatal disorder that affects only elderly patients. Instead, it is the second most common hematologic cancer after non-Hodgkin's lymphoma — more than 50,000 patients in the United ...

    2553-2555

    Clinicians currently order imaging studies for most patients with blunt head or neck trauma if there is even a remote possibility of cervical-spine injury, in order to avoid missing a potentially disabling fracture, dislocation, or ligamentous injury. The ...

    Sounding Board
    2556-2559

    Patients, prescribers, and policymakers often assume that the most serious short-term adverse effects of a drug are identified in pre-marketing studies, so recognition of unexpected harm after widespread use raises concern about “failures of the system.” ...

    Clinical Implications of Basic Research
    2560-2562

    The discovery of a molecule that interferes with a component of the insulin-signaling pathway provides a target for drug development.

    Correspondence
    2563-2565

    To the Editor: Ojo et al. (Sept. 4 issue)1 describe a growing problem: renal failure after nonrenal transplantation. However, the authors use a calculated glomerular filtration rate (from the Modification of Diet in Renal Disease [MDRD] study2), which ...

    2565-2567

    To the Editor: In their report on the withdrawal of mechanical ventilation in anticipation of a patient's death, Cook et al. (Sept. 18 issue)1 state that their findings “suggest that the process of withdrawal of life support is attentive to patients' ...

    2567-2568

    To the Editor: The study by Fudala et al. (Sept. 4 issue)1 may have underestimated the percentage of urine specimens that were positive for opioids in both groups. Urinary drug testing was performed with the use of an immunoassay and did not include gas ...

    2568-2570

    To the Editor: The article by Crowther et al. (Sept. 18 issue)1 addresses an important question in the field of hematology. However, the results cannot be used to conclude that moderate-intensity anticoagulation is not inferior to high-intensity ...

    2570
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    To the Editor: Wilschanski et al. (Oct. 9 issue)1 report that full-length cystic fibrosis transmembrane conductance regulator (CFTR) protein was expressed more effectively on the surface of nasal epithelial cells after gentamicin treatment than after ...

    2570-2572

    To the Editor: Alemtuzumab (Campath-1H) is a humanized monoclonal antibody directed against CD52, a glycosylated peptide antigen that is expressed on normal lymphocytes and highly expressed on chronic lymphocytic leukemia cells. It has been shown to have ...

    2572-2573

    To the Editor: The use of recombinant human erythropoietin in patients with kidney disease is widespread and has been associated with few complications. Recent reports have suggested that the incidence of pure red-cell aplasia is increasing among ...

    Book Reviews
    2574-2575

    This book is not so much a critical assessment of Christian Science as it is a densely researched narrative of how this unusual, but enduring, form of medicine and religion developed. Through detailed accounts of testimony given in various legal ...

    2575-2576

    “What kept me going was, I think, that writing for me is a way of understanding what is happening to me, of thinking hard things out,” the poet May Sarton wrote. “. . . Perhaps it is the need to remake order out of chaos over and over again. For art is ...

    2576-2577

    Painting is silent poetry, and poetry is painting with the gift of speech.

    Simonides, 556–468 B.C.

    Other physicians who are writers provoke readers with dramatic scenes from the vantage point of the bedside, but Rafael Campo uses a palette of poetry to ...

    Correction
    2577

    A Comparison of Two Intensities of Warfarin for the Prevention of Recurrent Thrombosis in Patients with the Antiphospholipid Antibody Syndrome Original Article, N Engl J Med 2003:349;1133-1138.. On page 1136, in Table 1, the number (percentage) of ...