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January 8, 2004  Vol. 350 No. 2

Perspective
99-101

Polycythemia vera is a chronic clonal hematopoietic–stem-cell disorder of unknown cause characterized by autonomous bone marrow function. Among the long-term consequences of this unregulated hematopoiesis are the extramedullary production of blood, ...

101-103

In 1991, a randomized trial funded by the Medical Research Council demonstrated that folic acid supplementation before pregnancy and during its early stages markedly reduced the risk of neural-tube defects in newborns.1 This finding — which indicated that ...

103-104

Federal regulations that affect science and health are frequently controversial. Whether the topic is air pollution, stem-cell research, clean needles for injection-drug users, or pharmaceutical advertising, powerful economic and social interests are ...

Original Articles
105-113

Epinephrine is recommended for use in the resuscitation of patients with cardiac arrest. In this clinical trial, vasopressin, as compared with epinephrine, improved the rates of survival to hospital admission and discharge, but only among patients with asystolic cardiac arrest. There was no advantage to vasopressin therapy in patients with ventricular fibrillation or pulseless electrical activity.

114-124

Venous and arterial thromboses are major complications of polycythemia vera, but there is lingering uncertainty about the best means of thromboprophylaxis. This randomized trial showed that low-dose aspirin (100 mg daily) reduced the risk of thrombotic events, as compared with a placebo, without causing excessive bleeding.

125-133

In 1999, we published the results of a preliminary study of long-term treatment with interferon gamma-1b and low-dose prednisolone in patients with idiopathic pulmonary fibrosis. These investigators report the results of a follow-on study of 330 patients with corticosteroid-unresponsive idiopathic pulmonary fibrosis who were randomly assigned to receive subcutaneous interferon gamma-1b or placebo. After a median of more than one year, interferon gamma-1b therapy did not improve progression-free survival, measures of lung function, gas exchange, or the quality of life.

134-142

The mechanism by which periconceptional folate supplementation reduces the incidence of neural-tube defects in the fetuses of women without clinical folate deficiency is unknown. After developing an assay for autoantibodies against the folate receptor, the authors found these autoantibodies in 9 of 12 women with a current or previous pregnancy complicated by a neural-tube defect, as compared with 2 of 20 women with an uncomplicated pregnancy. The autoantibodies blocked the binding of [3H]folic acid to folate receptors in vitro.

Special Article
143-150

There is concern that in order to reduce expenditures, for-profit health plans may restrict patients' access to care, especially expensive operative procedures. This study of Medicare beneficiaries found the opposite. Among beneficiaries enrolled in for-profit plans, the rates of use of some costly operative procedures were higher than among beneficiaries in not-for-profit plans; the rates of use of other procedures were similar.

Review Article
151-164

Polycystic kidney diseases are inherited renal disorders due mainly to mutations in genes that regulate the development and function of cells that line renal tubules. This review outlines the clinical importance of polycystic kidney diseases and discusses the cell biology and molecular mechanisms that cause the formation of hundreds of cystic lesions in the renal parenchyma.

Images in Clinical Medicine
165
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A 75-year-old man with idiopathic pulmonary fibrosis was admitted because of progressive shortness of breath. He stated that he had not had new cough, fever, chest pain, palpitations, orthopnea, or paroxysmal nocturnal dyspnea. His home oxygen requirement ...

e1
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A 14-year-old girl with pain and decreased acuity in the left eye.

Case Records of the Massachusetts General Hospital
166-176

Presentation of Case

A 49-year-old left-handed woman was evaluated in the neurology clinic because of painful asymmetric neuropathy.

The patient had been well until several years earlier, when numbness developed in the right hand. A right carpal-tunnel–...

Editorials
178-179

In the patient–physician interaction, the physician applies his or her skills and then makes recommendations that he or she believes are in the patient's best interest. Sometimes the picture is crystal clear, and the medical pathway largely unambiguous. ...

179-181

Cardiac arrest remains a major health problem in the United States and other Western nations. Of the approximately 1000 sudden deaths that occur each day in the United States, it is estimated that as many as 20 to 40 percent result from asystolic cardiac ...

181-183

Idiopathic pulmonary fibrosis, defined pathologically as usual interstitial pneumonia, is a fatal disease that occurs most commonly among persons who are 60 years of age or older and in otherwise good health. Usual interstitial pneumonia progressively ...

Sounding Board
184-186

    . . . with respect to his own feelings and circumstances, the most ordinary man or woman has means of knowledge immeasurably surpassing those that can be possessed by anyone else.

    — John Stuart Mill, On Liberty, 1859

    The signing into law of the Partial-...

    Clinical Implications of Basic Research
    187-188

    A recent study shows that the gene that is mutated in familial cylindromatosis represses tumor necrosis factor α (TNF-α) signaling — a finding that may have implications for preventing the disease.

    Correspondence
    189-192

    To the Editor: Both Black et al.1 and Finkelstein et al.2 (Sept. 25 issue) measured markers of bone turnover, but neither group took osteoprotegerin into consideration as a possibly relevant player in bone remodeling. Osteoprotegerin, a secreted member ...

    192-194

    To the Editor: Wells and colleagues (Sept. 25 issue)1 report on the use of D-dimer testing in patients with suspected deep-vein thrombosis. Patients with a low pretest probability of deep-vein thrombosis and a negative result on the D-dimer test did not ...

    194-195

    To the Editor: Cool et al. (Sept. 18 issue)1 suggest that human herpesvirus 8 (HHV-8) has a role in the pathogenesis of primary pulmonary hypertension. We performed tests for HHV-8 antibodies in plasma samples from 49 patients with primary pulmonary ...

    195-197

    To the Editor: Schwartz et al. (Oct. 16 issue)1 report that a substantial proportion of cases of malaria in returned travelers are characterized by a late onset. The authors conclude that the usual chemoprophylactic agents do not prevent such cases and ...

    197
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    To the Editor: The Image in Clinical Medicine by Ahmed and Gunaratnam (Oct. 2 issue)1 is not completely accurate regarding the pathophysiological mechanism of melanosis coli and the related terminology. The pigmentation is triggered by deposits of ...

    197

    To the Editor: The summary of the article on fondaparinux for symptomatic pulmonary embolism in This Week in the Journal (Oct. 30 issue)1 shows the chemical structure of fondaparinux and refers to it as a pentasaccharide. Although it is true that ...

    198-199

    To the Editor: In a 16-year prospective cohort study of six cities in the northeastern and midwestern United States beginning in the 1970s, Dockery et al.1 reported that long-term exposure to ambient fine particles (with an aerodynamic diameter of 2.5 μm)...

    Book Reviews
    200

    In a field characterized by much competition, Clinical Hematology and Oncology is unique. First, this multiauthored book combines clinical cancer medicine with a guide through all aspects of hematology, including coagulation disorders and transfusion ...

    200-201

    Prognostic and Predictive Factors in Breast Cancer is a well-written, compact reference book. All 25 contributors are from Europe, including 16 from the United Kingdom, which makes the book heavily weighted toward European references and standards. ...

    201-202

    Three percent of the American population is living with cancer. Many of these patients have pain that is due to the disease or to the treatment they are receiving for it. Annually, more than 500,000 persons have terminal cancer, and 60 to 80 percent of ...

    202-203

    Hepatocellular carcinoma, although uncommon in the United States, is one of the few forms of cancer that is rising in incidence in the developed Western world. The second edition of this book consists of 36 chapters that are printed on nearly 500 pages of ...

    Correction
    203

    Valsartan, Captopril, or Both in Myocardial Infarction Complicated by Heart Failure, Left Ventricular Dysfunction, or Both Original Article, N Engl J Med 2003:349;1893-1906.. On page 1896, in Table 1, the entry “Left ventricular ejection fraction” should ...

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