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April 1, 2004  Vol. 350 No. 14

Perspective
1379-1380

In late September 2001, I was asked to serve on the President's Council on Bioethics. My initial instinct was not to accept, because I was concerned that the Bush Administration would not be interested in considering fully the potential of certain ...

1380-1382

A hundred thousand persons, upon the smallest computation, have been inoculated in these realms. The number who have partaken of its benefits throughout Europe and other parts of the globe are incalculable; and it now becomes too manifest to admit of ...

1382-1384

Perhaps the earliest link between oral leukoplakia and cancer was made by James Paget, for whom Paget's disease was named; he also recognized the connection between oral leukoplakia and smoking. Leukoplakia is a clinical term that refers to an oral ...

1384-1386

    In May 2002, thousands of vials of Procrit (epoetin) labeled as containing 40,000 units were found to contain only 2000 units, and later that year, other vials of Procrit were found to contain nothing but Miami tap water. In the spring of 2003, there were ...

    Original Articles
    1387-1397

    This large, prospective study calls into question the value of the C-reactive protein (CRP) concentration in the prediction of coronary events. In contrast to previous research, this study found that the strength of the CRP concentration as a predictor is relatively moderate and that it adds little to the predictive value of standard coronary risk factors, such as the cholesterol concentration, smoking status, and blood pressure.

    1398-1404
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    This case–control study of all children born in Denmark from 1990 through 2000 examined detailed information on vaccinations and the occurrence of type 1 diabetes. Using Poisson regression models, the investigators estimated rate ratios for diabetes among all children according to vaccination status. There appeared to be no association between any type of vaccination and diabetes mellitus.

    1405-1413

    This study showed that complete resection of oral leukoplakia with aneuploidy does not reduce the risk of oral cancer or the risk of death from oral cancer. (In aneuploidy, the number of chromosomes is not an exact multiple of the normal diploid number — for example, 49 chromosomes.)

    Special Article
    1414-1421

    Governments and ethics boards increasingly require written informed consent from all subjects before enrollment in clinical registries. The authors of this article examine the effect of a comprehensive effort to obtain informed consent on the participation rate in the prospective Registry of the Canadian Stroke Network. The overall participation rate was 39.3 percent during phase 1 of the project and 50.6 percent during phase 2. Obtaining written consent was costly, leading to selection bias.

    Review Articles
    1422-1429

    About half of all nosocomial infections are associated with indwelling devices. Infections associated with implanted surgical devices are particularly difficult to deal with because they can require prolonged antibiotic treatment and repeated surgical procedures. This review summarizes the diagnostic challenges and explains the approaches to managing infections that are associated with various devices, including prosthetic heart valves, vascular grafts, pacemakers and defibrillators, and joint prostheses.

    1430-1441

      Ductal carcinoma in situ of the breast (also called intraductal carcinoma), a clonal proliferation of malignant-appearing cells within the mammary duct lumens without evidence of invasion beyond the epithelial basement membrane, is the precursor lesion of invasive breast cancer. In the past 20 years, concomitant with the wide use of screening mammography, its detected incidence has risen dramatically. Data from large cohort studies and randomized trials have emerged to guide treatment. This review summarizes progress in the understanding, pathogenesis, and treatment of ductal carcinoma in situ.

      Images in Clinical Medicine
      1442
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      A Peace Corps volunteer lived in rural Gambia. Several painless ulcers developed on his lower legs.

      Clinical Problem-Solving
      1443-1448

        A 68-year-old man originally from the Philippines presented with a three-month history of increasing dyspnea on exertion and orthopnea. He also reported an unintentional weight loss of 7 kg (15 lb), night sweats, and abdominal bloating.

        Editorials
        1450-1452

        In this issue of the Journal, Danesh and colleagues report that elevated levels of C-reactive protein (CRP) are associated with only a moderate increase in the risk of coronary heart disease (CHD).1 Although these findings are in line with those of other ...

        1452-1453

          Medical progress is possible largely because we learn from our successes and our failures. Researchers often make an assessment of where things stand for a given medical condition through disease registries that attempt to include everyone who has ...

          Health Policy Report
          1454-1460

          About 1000 committees advise the federal government. Many of them address scientific, technical, and medical issues. There is a continuing dispute about whether the administration of President George W. Bush has compromised the system of advisory ...

          Clinical Implications of Basic Research
          1461-1463

          There are two experimental approaches to treat cancer through tweaking the immune system; both depend on T lymphocytes' having access to tumor. A recent study involving a mouse model demonstrates the importance of accessibility and is thus relevant to both approaches.

          Correspondence
          1464-1466

          To the Editor: The color image accompanying the editors' summary of the article by Tian et al. (Dec. 25 issue)1 provides information that would be helpful in any future study on dickkopf 1 (DKK1) gene expression in multiple myeloma. The image is a whole-...

          1466-1467

          To the Editor: Attal et al. (Dec. 25 issue)1 report that double autologous stem-cell transplantation improves overall survival among patients with multiple myeloma, especially those who do not have a very good partial response after a first ...

          1467-1469

          To the Editor: Stiell et al. (Dec. 25 issue)1 report the sensitivity of the National Emergency X-Radiography Utilization Study (NEXUS) low-risk criteria (NLC) for important cervical-spine injury to be 90.7 percent. This figure dramatically contrasts with ...

          1469

          To the Editor: Although Schneider et al. (Jan. 8 issue)1 state that the results of their analysis of the rates of use of high-cost procedures is “counterintuitive,” I suggest that their data are an expected result of physician-reimbursement structures. ...

          1470-1471
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          To the Editor: I read Gillick's article on advance care planning (Jan. 1 issue)1 with particular interest. When my husband had a cardiac arrest and fell onto my shoulder during a Pittsburgh Steelers football game on September 28, 2003, he did not have a ...

          1471
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          To the Editor: Although we applaud the insights in Gawande's Perspective article, “Dispatch from India” (Dec. 18 issue),1 we would like to point out that his experience of conditions in Indian hospitals was, of necessity, a limited one. A two-month visit ...

          1472

          To the Editor: In Images in Clinical Medicine (Dec. 11 issue),1 Lee and Chandraratna provide evidence of dry gangrene in the right foot of a 62-year-old man and evidence of a mobile arch atheroma. They suggest that thromboembolism from atheroma is an ...

          1472-1473

          To the Editor: Although progressive stenosis of the arterial lumen constitutes the basis for ischemic symptoms in atherosclerotic vascular disease, acute vascular events are for the most part associated with instability of the plaque and formation of an ...

          Book Reviews
          1474-1475

          Our views of atherogenesis have evolved dramatically during the past several decades. The cholesterol hypothesis of the 1950s and 1960s led to the theory of endothelial injury in the 1970s and 1980s, which, in turn, developed into the concept that ...

          1475

          Atherosclerosis is a big killer. No longer just the area of interest of cardiologists looking for a fixed narrowing in a coronary artery of a patient with angina, it is the target disease to beat for diabetologists, lipidologists, doctors specializing in ...

          1476

          In 1985, J. Willis Hurst suggested that a short biographical and historical profile of a major contributor to the understanding and treatment of heart disease be included in the monthly issues of the journal Clinical Cardiology, of which C. Richard Conti ...

          Correction
          1476

          Emergency Contraception Clinical Practice, N Engl J Med 2003:349;1830-1835.. On page 1830, the statement in line 4 of the second paragraph under the heading “The Clinical Problem” should have read “was associated with a 24 percent probability that a ...