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March 25, 2004  Vol. 350 No. 13

Perspective
1275-1276

It is rare that a field of scientific research can simultaneously represent a domain of fundamental discovery in human biology and potentially have major effects on human health and the quality of life. Human embryonic stem cells serve not only as a ...

1277-1278

The lymphomas are a heterogeneous group of cancers of the lymphoid system that are of increasing importance to the medical community. There has been a threefold increase in the incidence of these tumors for reasons that are incompletely understood, and ...

1278-1280

After the first observation of surfactant deficiency in infants who were dying of the respiratory distress syndrome (also known as hyaline membrane disease), a series of investigations led to effective therapies, including surfactant therapy given at ...

1281-1283

Under normal conditions, most of the sodium chloride filtered by the kidney (often more than 99 percent) is reabsorbed, and one can think of the tubular functions that permit this reabsorption as involving salt (solute) and water (solvent). When salt is ...

1283-1286

One afternoon last December, I took a tour of my hospital with Deborah Yokoe, an infectious-disease specialist, and Susan Marino, a medical technologist by training. They work in our infection-control unit. Their full-time job is to stop the spread of ...

Original Articles
1287-1295

This study of the treatment of aggressive lymphoma in patients 60 years old or younger compared cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), the standard treatment, with an immediate course of high-dose chemotherapy plus transplantation of autologous hematopoietic stem cells. The high-dose therapy was superior to CHOP for patients at high intermediate risk.

1296-1303

This study describes the genetic cause of some cases of fatal surfactant deficiency in newborns. The gene encoding ATP-binding cassette transporter A3 (ABCA3) was mutated in 76 percent of a selected sample of 21 patients, and the patients with such mutations had abnormal lamellar bodies — the subcellular vesicles in which surfactant is stored.

1304-1313

In an earlier placebo-controlled trial, dexamethasone was administered to neonates as a treatment for respiratory distress syndrome. When children who had participated in that trial were about eight years of age, the investigators conducted a second study to determine the long-term effects of treatment. Children in the dexamethasone group were shorter, had smaller head circumferences, and had poorer scores than control children on a number of tests of cognitive and motor function.

1314-1319

Mutations in genes encoding chloride transporters cause Bartter's syndrome. An antenatal form associated with salt wasting and deafness has been observed in persons with mutations in BSND, the gene encoding barttin, a protein controlling the membrane insertion of two distinct chloride transporters. This report describes a child with the syndrome yet a normal BSND gene. The child had mutations in each of two genes encoding the chloride transporters ClC-Ka and ClC-Kb. The data provide strong evidence that barttin regulates ClC-type chloride channels and thus provide new insight into renal salt handling.

Clinical Practice
1320-1327

    A 28-year-old man presents with a two-year history of increasing dyspnea on strenuous exertion and is found to have hypertrophic cardiomyopathy, with a septal thickness of 23 mm and a left ventricular outflow gradient of 80 mm Hg. There is no family history of hypertrophic cardiomyopathy or sudden death. Forty-eight-hour Holter monitoring shows infrequent premature ventricular contractions. How should this patient be treated?

    Review Article
    1328-1337

    This review of the life cycle of the Epstein–Barr virus (EBV) explains how EBV establishes lifelong infection in a host with protective immunity against the virus. The authors also discuss the role of EBV in the development of post-transplantation lymphoma, Hodgkin's disease, and Burkitt's lymphoma.

    Images in Clinical Medicine
    1338
    • Free Full Text

    A 58-year-old woman with a 20-year history of goiter presented with a two-month history of progressive dyspnea on exertion, occasional stridor, and a choking sensation while supine. She had previously been asymptomatic. Physical examination revealed a ...

    e12

    During the colonoscopy, this man reported abdominal discomfort, and profound abdominal distention developed.

    Case Records of the Massachusetts General Hospital
    1339-1347

    Presentation of Case

    Dr. Bimalangshu R. Dey: A 58-year-old man with a large sacral ulcer was admitted to the hospital for chemotherapy to treat acute myeloid leukemia.

    The patient had had recurrent infections of a pilonidal cyst for 20 years; the ...

    Editorials
    1349-1351

    Physicians caring for pregnant women and their preterm infants have used corticosteroids since Liggins and Howie reported in 1972 that prenatal betamethasone decreased the incidence of the respiratory distress syndrome and increased the survival of ...

    1351-1352
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    Although there has been a lot of debate about the use of human embryonic stem cells, there has been little action until very recently, when a group from South Korea described the derivation of human embryonic stem cells obtained from a cloned blastocyst.1 ...

    Special Report
    1353-1356

    This report, first published online on March 3, 2004, discusses the procedures used to develop 17 lines of human embryonic stem cells from the inner cell masses of blastocysts. These cell lines are available to researchers under a Material Transfer Agreement; according to current regulations, the cells cannot be used for research supported by federal funds. These cells are expected to facilitate research on a variety of serious chronic diseases.

    Correspondence
    1357-1359

    To the Editor: Zuger's article (Jan. 1 issue)1 about physicians' dissatisfaction is fascinating but does not mention that health care is increasingly dominated by large organizations whose leaders may sometimes be incompetent, self-interested, and even ...

    1359-1361

    To the Editor: In the United States, the incidence of breast cancer in men 65 years of age or older is 5.5 cases per 100,000 man-years.1 The finding, reported by McConnell et al. (Dec. 18 issue),2 that four men had breast cancer after treatment with ...

    1361-1362

    To the Editor: Lin et al. (Dec. 4 issue)1 conclude that recipients of allogeneic bone marrow who have the interleukin-10 (IL10) –592A/A genotype have a lower risk of severe acute graft-versus-host disease (GVHD) than recipients who have the –592C/C ...

    1362-1363

    To the Editor: Abuzzahab et al. (Dec. 4 issue)1 describe two children with sequence changes in the gene encoding the insulin-like growth factor I (IGF-I) receptor and conclude that these mutations caused their growth retardation. One child had two ...

    1363-1364
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    To the Editor: Enzinger and Mayer (Dec. 4 issue)1 provide an extensive review of esophageal cancer. However, they fail to mention one very important aspect of care that is routinely assessed in the United Kingdom2: nutritional support of patients at the ...

    1364-1365

    To the Editor: Members of the Ewing's family of tumors are characterized by rearrangements involving the EWS gene on chromosome 22q12 and fusion partners from the ETS oncogene family, most frequently FLI1 on chromosome 11q24 (frequency, 85 percent) or ...

    1366-1367

    To the Editor: Quasispecies are known in RNA viruses such as hepatitis C virus and human immunodeficiency virus.1 Owing to poor fidelity of RNA polymerases, RNA-virus populations typically contain genetic variants that form a heterogeneous virus pool. ...

    Book Reviews
    1368

    Many new medical interventions raise important questions about the goals of medicine and the moral legitimacy of medical enhancement. Most interventions that cure, treat, or prevent diseases can also enhance or change human beings. Plastic surgery can ...

    1368-1370

    Many people have heard of Semmelweis, whose fame rests on having shown in the 1840s that deaths from puerperal fever (an infection following childbirth) at the Vienna Lying-in Hospital could be reduced by making doctors and medical students wash their ...

    1370-1371

    The Abuse of Man describes numerous unethical human experiments that were performed from the 18th century to the present. On its cover is a photograph taken in 1942 at the Dachau concentration camp of two Nazi “doctors,” Holzloehner and Rascher, ...