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January 1, 2004  Vol. 350 No. 1

Perspective
3-4

In 1883, the eminent Viennese surgeon Theodor Billroth declared, “Let no man who hopes to retain the respect of his medical brethren dare to operate on the human heart.” Billroth articulated what was at that time common knowledge. The heart was the ...

4-7

Eicosanoids are lipid mediators of inflammation; they include a variety of compounds (prostaglandins, thromboxanes, leukotrienes, hydroxy- and epoxy-fatty acids, lipoxins, and isoprostanes) that are derived from the ubiquitous 20-carbon atom arachidonate (...

7-8

One hundred years ago, the odds that a visit to the doctor would result in a measurable improvement in a patient's condition were slim. But the mere fact that modern physicians are far more likely to be able to influence the course of illness in a ...

9-10

In terms of dollars, the number of people affected, and the political stakes involved, the Medicare prescription-drug bill is the most important health care legislation passed by Congress since the enactment of Medicare and Medicaid in 1965. The six-month ...

Original Articles
11-20

This controlled trial was conducted in 1484 heterosexual couples in whom one partner had symptomatic genital herpes simplex virus type 2 (HSV-2) infection. Daily treatment of the infected partner with valacyclovir was associated with a lower rate of acquisition of HSV-2 by the uninfected partner (1.9 percent, vs. 3.6 percent in the placebo group).

21-28

The use of cardiopulmonary bypass in coronary-artery surgery (“on pump”) provides a bloodless operative field and a nonbeating heart but may carry a risk of neurocognitive dysfunction. Thus, there has been interest in “off-pump” surgery as an alternative. This single-center study found that the rate of graft patency at three months was lower with off-pump surgery than with on-pump surgery (88 percent vs. 98 percent).

29-37

Inflammation is believed to have a key role in atherosclerosis. Leukotrienes are important inflammatory mediators generated from arachidonic acid by the enzyme 5-lipoxygenase. This study found that variant genotypes of the 5-lipoxygenase gene, which lacked the common allele, were associated with an increase in intima– media thickness of the carotid artery. A diet high in arachidonic acid further increased the effect of the gene on this measurement.

Clinical Practice
38-47

    An otherwise healthy 23-year-old man presents after the acute onset of watery diarrhea that has persisted for two days. He reports associated nausea and cramping but no emesis and is febrile, with a temperature of 38.7°C (101.7°F). How should he be evaluated and treated?

    Review Article
    48-58

    The risk of blindness from diabetic retinopathy, the most severe ocular complication of diabetes, has greatly diminished, owing to advances in management. This review discusses the spectrum of clinical manifestations of diabetic retinopathy, with particular attention to new aspects of management. Since diabetes is common, diabetic retinopathy remains an important medical problem for affected patients and those caring for them.

    Images in Clinical Medicine
    59
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    A man with abdominal distention and a history of psychosis.

    Clinical Problem-Solving
    60-65

      A 51-year-old woman was admitted to a community hospital with a six-week history of progressive shortness of breath. She had initially noted dyspnea when climbing stairs at work, and by the time of admission it prevented her from walking approximately 4.6 m (15 ft).

      Editorial
      67-68

      One of the main lessons of antiviral-drug therapy is that the drugs that inhibit viral replication are frequently more effective at preventing viral disease than they are at treating established disease. Acyclovir, for example, when taken on a daily basis,...

      Special Report
      69-75

      This article reviews the subjective and objective indicators of dissatisfaction with medical practice. Discontent seems to have increased substantially during the past two decades, after a period of unprecedented satisfaction within the medical profession. Some of the sources of dissatisfaction include pressures from managed-care systems, the malpractice crisis, aggravation with bureaucratic red tape, and constant time pressures. However, most physicians still take satisfaction in their work.

      Correspondence
      80-82

      To the Editor: In the Clinical Practice article about early Alzheimer's disease, Dr. Kawas (Sept. 11 issue)1 discusses testing for reversible causes of dementia. More than 15 years ago, it was conclusively shown that true reversibility of dementia, ...

      82-84

      To the Editor: In their Clinical Practice article on suspected pulmonary embolism, Fedullo and Tapson (Sept. 25 issue)1 state that a positive computed tomographic (CT) angiogram in patients with a low clinical probability of pulmonary embolism confirms ...

      84-85

      To the Editor: In their trial of a 9-valent pneumococcal conjugate vaccine in children with human immunodeficiency virus infection and those without infection, Klugman and colleagues (Oct. 2 issue)1 found an increased risk of asthma among vaccinees. We ...

      85-86

      To the Editor: Biobanks are a crucial resource for the advancement of genomic discoveries into clinical care. A charitable-trust model for biobanks, proposed by Winickoff and Winickoff (Sept. 18 issue),1 has merit. However, the premise that this model is ...

      86-87

      To the Editor: Lardinois et al. (June 19 issue)1 state that tumor and nodal staging is more accurate with integrated positron-emission tomography and computed tomography (PET–CT) than with CT or PET alone. In their study, PET alone was visually ...

      87-88

      To the Editor: In their letter to the editor, Doorenbos et al. (Aug. 21 issue)1 describe seven cases of severe pseudohypocalcemia after gadolinium-enhanced magnetic resonance angiography with the use of gadodiamide. Their report represents an important ...

      88-89

      To the Editor: A 63-year-old woman with a history of non-Hodgkin's lymphoma that had been treated 25 years previously, as well as a history of hypertension, hypercholesterolemia, transient ischemic attack, and acute myelogenous leukemia with induction of ...

      Book Reviews
      90-91

      John Snow has long been revered, most notably by anesthetists and public health workers, for the pioneering medical work he did in the 19th century. But the majority of writings about Snow (who was my husband's great great uncle) have focused on either ...

      91-92

      At least since 1926, when Paul de Kruif's Microbe Hunters hit the best-seller lists, tales of medical discovery, detection, and invention have proved popular. Mavericks, Miracles, and Medicine, written as a complement to the television miniseries of the ...

      92

      For a molecular biologist, Stephen O'Brien has led an adventuresome life. Tears of the Cheetah recounts how the pursuit of molecular biology in his laboratory led to some of his far-flung pursuits. He collected sperm from wild East African cheetahs on the ...

      Correction
      92

      Combination Estrogen–Progestin Oral Contraceptives Clinical Practice, N Engl J Med 2003:349;1443-1450.. In Table 1, on page 1444, the entry “norgestimate” should not have been followed by a footnote symbol (‡), as printed. All the products listed in this ...

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