Join the 200th Anniversary Celebration

Issue IndexA searchable index of tables of contents

Find An Issue

By Volume and Issue
By Date

Table of contents for

April 22, 2004  Vol. 350 No. 17

Perspective
1703-1705

In June 2004, a clinical-skills examination will be added to Step 2 of the U.S. Medical Licensing Examination.

1705-1707

Phones seem antagonistic these days, [and] I'm not sure I can process health stuff that quickly. With e-mail I can address issues when I have the mental space. I have time to think and shape the question and keep a file. And my doctor . . . helps me think ...

1708-1709

    Resuscitations are events that are often clouded by desperation and frenzy and directed by persons with limited experience, who may feel a great burden of responsibility for the circumstances precipitating the respiratory or cardiac arrest. The ...

    1710-1712

    What does it mean to describe an infection as having airborne transmission, and what are the clinical implications? There is a fitting symmetry between the report by Yu et al. about airborne transmission of the severe acute respiratory syndrome (SARS) in ...

    Original Articles
    1713-1721

    This randomized trial of adjuvant therapy for early-stage adenocarcinoma of the lung compared treatment with tegafur plus uracil with observation. Among patients with tumors that were 2 cm or less in diameter, no difference was found, but overall survival among patients with tumors that were greater than 2 cm in diameter was improved by uracil–tegafur.

    1722-1730
    • Free Full Text

    Epinephrine is routinely used for resuscitation from cardiac arrest. In this study of cardiac arrest in children, standard-dose epinephrine (0.01 mg per kilogram of body weight) was compared with high-dose epinephrine (0.1 mg per kilogram) as rescue therapy for failed resuscitation. There was no significant difference between the two doses with respect to any of the outcomes measured.

    1731-1739

    This analysis used detailed airflow-dynamics studies to model the possible airborne spread of the virus in the large outbreak of the severe acute respiratory syndrome (SARS) in the Amoy Gardens housing complex in Hong Kong. The spatial distribution of the cases supports the hypothesis that a single index patient was the source of infection and the infection was spread by virus-laden aerosols.

    1740-1745

    This report describes a graduate student in microbiology in Singapore in whom fever and respiratory symptoms led to the diagnosis of infection with the severe acute respiratory syndrome (SARS) virus in September 2003. The student had worked with a vial of West Nile virus, but an epidemiologic investigation found SARS virus contaminating the vial.

    Clinical Practice
    1746-1751

      A 60-year-old woman is noted incidentally to have a calcium level of 10.8 mg per deciliter (normal range, 8.4 to 10.2 mg per deciliter). The parathyroid hormone level is 84 pg per milliliter (normal range, 10 to 65). She has never had a kidney stone or a fracture, and she feels well. Her urinary calcium excretion is normal. Her bone density is within 0.5 SD of the peak bone mass at the lumbar spine and the hip and is 1.0 SD below the peak bone mass at the forearm. How should her case be managed?

      Review Article
      1752-1762

        Each year, 500,000 children in the United States cope with life-threatening illness. These children and their families require comprehensive, compassionate, and developmentally appropriate palliative care. This review article discusses pediatric palliative care, which should intersect with the aims of curing and healing and become instrumental for improving quality of life.

        Images in Clinical Medicine
        1763
        • Free Full Text

        A 64-year-old Korean woman had a four-week history of dull pain in the lower abdomen that was worse on movement; she had no gastrointestinal or urogenital symptoms. The previous year, the patient had regularly undergone abdominal acupuncture with the use ...

        e15
        • Free Full Text

        This 23-year-old man had a history of tonic–clonic seizures.

        Case Records of the Massachusetts General Hospital
        1764-1775

          A female infant was born with a large, dark-red cutaneous lesion covering much of her trunk. A platelet transfusion was followed by dramatic enlargement of the lesion.

          Editorial
          1777-1779

          The treatment for stage I non–small-cell lung cancer, regardless of cell type, is wide surgical resection (lobectomy or pneumonectomy) of the involved area.1 Although the propensity of non–small-cell lung cancer to metastasize early is well recognized, ...

          Health Policy Report
          1780-1787

          This report reviews efforts to estimate and control the supply of physicians during the past century and examines the current debate among experts, who have made a wide range of projections of the number of physicians needed over the next 20 years. Some experts believe the United States will have a large surplus of physicians, and others predict a large shortage. In the absence of a consensus on how many doctors the country will need, new federal policies to manage the supply of physicians are unlikely.

          Correspondence
          1788-1790

          To the Editor: The case definition of croup given by Williams et al. in their study of metapneumovirus (Jan. 29 issue)1 seems misleading. The authors state that croup is an “acute lower respiratory tract infection characterized by hoarseness, cough, and ...

          1790-1791

          To the Editor: Infection control was a major issue for investigators attempting to minimize the emergence of monkeypox in the United States, as reported by Reed et al. (Jan. 22 issue).1 On June 7, 2003, three Illinois residents with a febrile rash ...

          1791-1793

          To the Editor: In the article by Khan et al. (Jan. 1 issue),1 the conclusion regarding the inferiority of graft patency in patients who have undergone off-pump bypass surgery is premature. Before initiation of the study, each of the two participating ...

          1794-1797

          To the Editor: The recent trial of interferon gamma-1b for idiopathic pulmonary fibrosis, reported by Raghu et al. (Jan. 8 issue),1 is a major accomplishment, despite the disappointing results. One may wonder, however, whether the selected end points ...

          1797

          To the Editor: In their review article on the severe acute respiratory syndrome (SARS) (Dec. 18 issue),1 Peiris et al. describe the “initial” chest radiograph as abnormal in 60 to 100 percent of cases, depending on the interval between the onset of fever ...

          1798
          • Free Full Text

          To the Editor: As a medical-malpractice defense attorney and former practicing anesthesiologist, I read with interest the report on malpractice by Studdert et al. (Jan. 15 issue).1 The authors note that “because they must absorb the costs of managing ...

          1798-1799

          To the Editor: Neurosarcoidosis occurs in less than 5 percent of patients with sarcoidosis, yet it can cause significant neurologic impairment.1,2 Although some patients have a rapid response to corticosteroids, many require prolonged treatment or ...

          Book Reviews
          1800

          This book was written “for those providing primary care,” including subspecialists, and it deals with infections “encountered in the outpatient setting” in adults. The editor has selected a niche for the book and has thereby avoided the question of ...

          1800-1801
          • Free Full Text

          Let such teach others who themselves excel . . .

          — Alexander Pope

          Emporiatrics, or travel medicine, as a specialty has been slow in evolving. The growing fascination with diverse cultures in extreme latitudes, with enthrallingly adventurous exploration,...

          1801-1803
          • Free Full Text

          Diarrhea is the most frequent health problem in travelers from industrialized countries who visit developing countries, especially in tropical areas of the world. The incidence of traveler's diarrhea ranges from 30 percent to 70 percent among short-term ...

          Corrections
          1803

          Effect of CD3δ Deficiency on Maturation of α/β and γ/δ T-Cell Lineages in Severe Combined Immunodeficiency Original Article, N Engl J Med 2003:349;1821-1828.. On page 1822, in the third full paragraph in the right-hand column, the last term listed in line ...

          1803

          Case 37-2003: A 79-Year-Old Man with Coronary Artery Disease, Peripheral Vascular Disease, End-Stage Renal Disease, and Abdominal Pain and Distention Case Records of the Massachusetts General Hospital, N Engl J Med 2003:349;2147-2155.. On page 2152, in ...