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April 8, 2004  Vol. 350 No. 15

Perspective
1483-1486

In 1991, a violent military coup unseated Haiti's first democratically elected government. An estimated 5000 people died, and hundreds of thousands more were displaced during the three years when military and paramilitary groups ruled the country. It was ...

1486-1488

This first report clearly demonstrates that racial, ethnic and socioeconomic disparities are national problems that affect health care at all points in the process, at all sites of care, and for all medical conditions — in fact, disparities in the health ...

1489-1491

In June 2003, the Medicine and Healthcare Products Regulatory Agency of the British Department of Health warned physicians to avoid the off-label use of paroxetine, a selective serotonin-reuptake inhibitor (SSRI) antidepressant, for the treatment of ...

1491-1494

In the past decade, high-density lipoproteins (HDL) have emerged as a new potential therapeutic target for the treatment of cardiovascular disease. The key role of HDL as a carrier of excess cellular cholesterol in the reverse cholesterol transport ...

Original Articles
1495-1504

This study compared moderate lipid lowering with pravastatin and intensive lipid lowering with atorvastatin in patients after an acute coronary syndrome. Over a mean follow-up period of two years, those treated with the intensive lipid-lowering regimen had better outcomes.

1505-1515

Low levels of high-density lipoprotein (HDL) cholesterol increase the risk of coronary heart disease. The authors of this study investigated a novel method of raising HDL cholesterol levels. Torcetrapib is a potent inhibitor of cholesteryl ester transfer protein, a plasma glycoprotein that conveys cholesteryl esters from HDL to low-density lipoprotein (LDL). Over the main four-week study period, this drug markedly increased levels of HDL cholesterol, whether or not the patient was also taking atorvastatin to lower LDL cholesterol.

1516-1525

Hypercalcemia and hyperphosphatemia often complicate secondary hyperparathyroidism therapy in patients who are receiving dialysis. Unlike vitamin D and calcium, calcimimetic agents target the calcium-sensing receptor. This study reports the safety and effectiveness of the calcimimetic agent cinacalcet in patients receiving dialysis who had uncontrolled hyperparathyroidism. The mean parathyroid hormone values decreased 43 percent with cinacalcet therapy but increased 9 percent with placebo, and the calcium–phosphorus product declined with cinacalcet but not placebo.

Clinical Practice
1526-1534

A 45-year-old fair-skinned woman has noted increasing sallowness, roughness, fine wrinkles, and mottled hyperpigmentation on her face. She is bothered by these changes and is worried about the development of nonmelanoma skin cancer. What treatments may minimize skin aging and lower the risk of skin cancer?

Review Article
1535-1548

    This comprehensive survey emphasizes how recent advances in the knowledge of molecular mechanisms involved in acute lymphoblastic leukemia have influenced diagnosis, prognosis, and treatment.

    Images in Clinical Medicine
    1549
    • Free Full Text

    A 45-year-old woman who had received local anesthesia underwent injection of abdominal subcutaneous fat into the vertical glabellar frown lines to remove wrinkles. Within a minute after the procedure, she had a severe frontal headache and right ...

    e13
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    A 55-year-old man presented with increasing abdominal girth, a weight loss of 4.5 kg, and anorexia and nausea.

    Case Records of the Massachusetts General Hospital
    1550-1559

      A 12-year-old boy was admitted to the hospital with a two-day history of a rash and of swelling of the face, hands, and feet. On admission, he was afebrile and hypertensive, with pitting edema of the legs. Laboratory studies disclosed hematuria, proteinuria, urinary casts, and elevated blood urea nitrogen and creatinine levels. The discussant reviews the differential diagnosis of acute renal failure in children.

      Editorials
      1561-1562

        The recent decision by the Food and Drug Administration (FDA) to postpone a decision on the proposal to switch levonorgestrel emergency contraception (sold under the brand name Plan B) to over-the-counter status suggests that the FDA's decision-making ...

        1562-1564

        In the management of atherosclerotic vascular disease, statin drugs have already surpassed all other classes of medicines in reducing the incidence of the major adverse outcomes of death, heart attack, and stroke. A decade ago, their effectiveness was ...

        1565-1567

        In people with a reduced glomerular filtration rate, the serum parathyroid hormone level is often secondarily elevated as a result of reduced serum levels of calcium and 1,25-dihydroxyvitamin D3 and an increased serum phosphate level (referred to as ...

        Sounding Board
        1568-1570

        Do members of disadvantaged minority groups receive poorer health care than whites? Overwhelming evidence shows that they do.1 Among national policymakers, there is bipartisan acknowledgment of this bitter truth. Department of Health and Human Services (...

        Correspondence
        1571-1575

        To the Editor: Roman et al.1 and Asanuma et al.2 (Dec. 18 issue) document accelerated development of atherosclerosis in patients with systemic lupus erythematosus (SLE), the implication being that atherosclerosis causes ischemic heart disease.3 Other ...

        1575-1576

        To the Editor: Vissing and Haller (Dec. 25 issue)1 show that sucrose ingestion before exercise can markedly improve aerobic exercise tolerance in patients with McArdle's disease. However, as the authors note, this strategy may lead to increased insulin ...

        1576-1577

        To the Editor: In the article on acute infectious diarrhea by Thielman and Guerrant (Jan. 1 issue),1 we did not find any information on the role of probiotics. Treatment of acute infectious diarrhea is probably the main application of probiotic therapy ...

        1577
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        To the Editor: The Six Cities Study by Dockery et al.1 has captured renewed attention (Jan. 8 issue).2,3 Claiming to identify an increased mortality rate in Steubenville, Ohio, as compared with the rate in Portage, Wisconsin, the authors posited that air ...

        1577

        To the Editor: In our review of the book Christian Science on Trial (Dec. 25 issue),1 we inadvertently misrepresented the views of physicians Larry Dossey and Andrew Weil. We made the following statement: “If the materialism of modern medicine tends to ...

        1577-1579

        To the Editor: In view of recent concern about the recurrence of severe acute respiratory syndrome (SARS) in Guangdong, China, we would like to highlight the tremendous importance of sensitivity in testing for the SARS-associated coronavirus (SARS-CoV). ...

        1579-1582

        To the Editor: The cholesterol-lowering statin drugs are contraindicated in pregnancy1; therefore, few data exist regarding their safety in human gestation. We reviewed 178 cases of first-trimester statin exposure reported to the Food and Drug ...

        Book Reviews
        1583-1584

        The debate in America over abortion and research with human embryos is so polarized that it is easy to forget that today's passionately held views of the intrinsic moral status of the embryo are but the latest in an ever-evolving understanding of human ...

        1584-1585

        During the past decade, the perspectives of nuclear medicine have been totally transformed. This field is no longer only an imaging specialty that provides some functional information; it is progressively acquiring a central role in the understanding of ...

        1585-1586

        Apart from the money, is the Nobel Prize worthwhile? Dr. Raymond Damadian, who claims to have discovered magnetic resonance imaging (MRI), seems to think so, because he went public with an expensive campaign of full-page advertisements in the New York ...

        Correction
        1586

        “Me Too” Products — Friend or Foe? Perspective, N Engl J Med 2004:350;211-212.. On page 212, in the table, the FDA approval date for the proton-pump inhibitor omeprazole should have been September 1989, not January 1999, as printed.