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Table of contents for

August 14, 2003  Vol. 349 No. 7

Perspective
627-628
Childhood Leukemia — Successes and Challenges for Survivors
J.V. Simone

    I was a brand-new fellow in pediatric hematology–oncology, in July 1963, when I first cared for a child with acute leukemia. By then, with chemotherapy we were able to induce temporary remissions in many patients, but none of them were cured.

    At that time,...

    629-630
    Trial Design and Patient Safety — The Debate Continues
    R. Steinbrook

      On July 3, 2003, nearly a year after it first became involved, the Office for Human Research Protections (OHRP) of the Department of Health and Human Services released its decision about two disputed multicenter clinical trials of treatment for the acute ...

      Original Articles
      631-639
      Comparison of Low-Intensity Warfarin Therapy with Conventional-Intensity Warfarin Therapy for Long-Term Prevention of Recurrent Venous Thromboembolism
      C. Kearon and Others
      • Free Full Text

      In an attempt to reduce the risk of bleeding, some have recently proposed lowering the intensity of anticoagulant therapy with warfarin for the prevention of recurrent venous thromboembolism. This randomized trial found that low-intensity warfarin therapy is not as effective as conventional-intensity therapy in the prevention of recurrent thromboembolic events. Furthermore, low-intensity therapy did not reduce the risk of bleeding complications.

      640-649
      Extended Follow-up of Long-Term Survivors of Childhood Acute Lymphoblastic Leukemia
      C.-H. Pui and Others
      • Free Full Text

      Survivors of acute lymphoblastic leukemia who had been in complete remission for at least 10 years and had not received radiation therapy had a negligible risk of recurrent leukemia and a survival equal to that of the general U.S. population. Survivors who had undergone cranial or craniospinal irradiation had slightly reduced rates of health insurance coverage, employment, and (among women) marriage.

      650-657
      Psychiatric Hospitalizations among Survivors of Cancer in Childhood or Adolescence
      L. Ross and Others
      • Free Full Text

      This nationwide Danish study found no evidence that survivors of childhood or adolescent cancer were susceptible to serious psychiatric disorders later in life, except for survivors of brain tumor.

      658-665
      Methotrexate versus Cyclosporine in Moderate-to-Severe Chronic Plaque Psoriasis
      V.M.R. Heydendael and Others
      • Free Full Text

      Although methotrexate and cyclosporine are both effective treatments for psoriasis, their comparative efficacy has not been established. This trial compared the two drugs and found them to be similarly effective. Each was associated with specific but limited side effects.

      Images in Clinical Medicine
      666
      Pulsus Paradoxus
      L.A. Wu and R.A. Nishimura
      • Free Full Text

      A 45-year-old woman with a history of Hodgkin's lymphoma that had been treated with mantle-field irradiation 20 years earlier presented with pleuritic chest pain, progressive dyspnea, and presyncope. Notable findings on physical examination included ...

      e7
      Systemic Mastocytosis
      A. Deb and A. Tefferi
      • Free Full Text

      A 44-year-old woman had neck and lower back pain, watery diarrhea, and episodes of flushing.

      Special Article
      667-674
      Estimating the Number of Potential Organ Donors in the United States
      E. Sheehy and Others
      • Free Full Text

      Waiting lists for organ transplantation are growing. This study examined numbers of potential organ donors and actual organ donations from 1997 through 1999 in areas of the United States that are served by 36 organ-procurement organizations. Hospitals with 150 or more beds had significantly higher proportions of potential donors and actual donors than smaller hospitals; 19 percent of hospitals accounted for 80 percent of all potential donors.

      Clinical Practice
      675-683
      Care of Patients Receiving Long-Term Anticoagulant Therapy
      S. Schulman

        A 75-year-old man with diabetes mellitus is found to have chronic atrial fibrillation, and warfarin therapy is begun for the prevention of thromboembolic stroke. How should the anticoagulant therapy be initiated and managed?

        Review Article
        684-690
        Current Concepts: Acute Cardiac Tamponade
        D.H. Spodick

          Acute cardiac tamponade is life threatening and requires prompt pericardial drainage. This review explains the manifestations of tamponade, including a presentation in which the diagnostic finding of pulsus paradoxus is absent, and variant forms, such as low-pressure tamponade and regional tamponade.

          Case Records of the Massachusetts General Hospital
          691-700
          Case 25-2003 — A Newborn Boy with Petechiae and Thrombocytopenia
          J.F. Modlin, P.E. Grant, R.S. Makar, D.J. Roberts, and K.S. Krishnamoorthy

            Presentation of Case

            A newborn boy was admitted to a special-care nursery because of petechiae and thrombocytopenia.

            The boy had been delivered at this hospital at 39 weeks' gestation to a 32-year-old woman who had had premature rupture of the membranes ...

            Editorials
            702-704
            Secondary Prophylaxis with Warfarin for Venous Thromboembolism
            H.R. Büller and M.H. Prins

              There are two phases in the treatment of patients with symptomatic venous thromboembolism: initial treatment and secondary prophylaxis. Initial therapy usually consists of either subcutaneous low-molecular-weight heparin or intravenous unfractionated ...

              704-706
              Disparity between Solid-Organ Supply and Demand
              A.J. Langone and J.H. Helderman

                More patients die awaiting solid-organ transplantation than currently receive viable organs. Perhaps a victim of its own success, transplantation is the treatment of choice for failed organ function. Despite the burgeoning demand for transplanted organs, ...

                Correspondence
                707-708
                Managing SARS
                • Free Full Text

                To the Editor: With regard to the article by Wenzel and Edmond (May 15 issue),1 the management of suspected cases of severe acute respiratory syndrome (SARS) is not harmless. Recently, we admitted a man who had returned from Saigon and had pneumonia ...

                708-709
                SARS in Hong Kong
                • Free Full Text

                To the Editor: Lee et al. (May 15 issue)1 describe the clinical and laboratory features of 138 cases of suspected severe acute respiratory syndrome (SARS) in Hong Kong. It is striking that 44.8 percent of the patients had thrombocytopenia, 45.0 percent ...

                709
                A Novel Coronavirus and SARS
                • Free Full Text

                To the Editor: Ksiazek et al. (May 15 issue)1 report that there is antibody cross-reactivity between serum from a patient with severe acute respiratory distress syndrome (SARS) and antibodies that are reactive with group I coronaviruses. This finding ...

                709-711
                Pseudo-SARS
                • Free Full Text

                To the Editor: We evaluated a possible case of severe acute respiratory syndrome (SARS) that involved issues of hospital admission, an inconsistent travel history, and possible enforced isolation. Some of the problems were similar to those described in a ...

                711-712
                SARS and the Internet
                • Free Full Text

                To the Editor: Your editorial (May 15 issue)1 describes the speed and power of the Internet in communicating to the world knowledge about severe acute respiratory syndrome (SARS) and the progression of the epidemic. This access is indispensable to those ...

                712-714
                Pneumococcal Vaccination in Older Adults
                • Free Full Text

                To the Editor: Jackson et al. (May 1 issue)1 demonstrate that the polysaccharide pneumococcal vaccine did not reduce the incidence of pneumonia among older adults — a finding that is consistent with the results of the previous blinded, randomized, ...

                714-716
                The Conjugate Vaccine and Invasive Pneumococcal Disease
                • Free Full Text

                To the Editor: Whitney and colleagues (May 1 issue)1 observed, among adults, a decline in the rates of invasive pneumococcal disease caused by 7-valent conjugate serotypes but not by nonconjugate vaccine serotypes. They cautiously suggest that ...

                716-717
                Molecular Mechanism of a Frequent Genetic Form of Deafness
                • Free Full Text

                To the Editor: The genes encoding the two major connexins of the cochlea are contiguous on human chromosome 13 (GJB2 and GJB6) and on mouse chromosome 14 (Cx26 and Cx30, respectively). Biallelic GJB2 mutations account for a large proportion of cases of ...

                717-718
                Hypercholesterolemic Aortic-Valve Disease
                • Free Full Text

                To the Editor: We report a case of atherosclerosis in the aortic valve of a seven-year-old boy with familial hypercholesterolemia. This boy, born on August 7, 1949, had familial hypercholesterolemia type IIb and asthma. At birth, he had prominent ...

                Book Reviews
                719
                Clinical Mycology
                • Free Full Text

                The diagnosis and treatment of invasive fungal infections are no longer relegated to a few experts at academic medical centers. On the contrary, the increasing incidence of such infections has made it crucial that a broad spectrum of clinicians become ...

                719-720
                Mucocutaneous Manifestations of Viral Diseases
                • Free Full Text

                Since the 1980s, human immunodeficiency virus (HIV), viral hepatitis, infection with the Ebola and Marburg viruses, and the threat of smallpox have had a major effect on world health. The increasing rate of travel to and from both easily accessible and ...

                720-721
                Opportunistic Infections: Treatment and Prophylaxis
                • Free Full Text

                The challenges in writing a book about opportunistic infections parallel the complexities of treating a patient who is at risk for such infections. Traditionally, a team of specialists takes on these therapeutic challenges, just as collaborating authors ...

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