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May 13, 2004  Vol. 350 No. 20

Perspective
2023-2026
  • Audio

"My cough got worse and worse. It never occurred to me to stop seeing patients." Dr. Perri Klass tells her own story.

2026-2029

This spring, most U.S. medical schools will administer some type of professional oath to about 16,000 men and women who receive medical degrees. Dr. Howard Markel explains the complexities of the Hippocratic Oath.

2029-2032

I recently helped my father to die. He was an engineer, independent, always on the go and in charge. He began to deteriorate rapidly from an ill-defined dementing illness, and his confusion and intermittent agitation did not respond to the standard ...

Original Articles
2033-2041
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Patients with homocystinuria, a rare autosomal recessive disease characterized by very high plasma homocysteine levels, frequently have osteoporosis and fractures — an observation that led the authors to examine the association between homocysteine levels and osteoporotic fracture in the context of normal aging. The multivariable-adjusted relative risk of incident osteoporotic fracture was 1.4 (95 percent confidence interval, 1.2 to 1.7) for each increase of 1 SD in the natural-log–transformed homocysteine level.

2042-2049

This article examines the association between the total homocysteine concentration and the risk of hip fracture in Framingham Study participants during a median follow-up period of 12.3 years for men and 15.0 years for women. Age-adjusted incidence rates for hip fracture increased progressively from the lowest to the highest quartile of homocysteine. For men in the highest quartile, the risk increased by a factor of almost four, and for women, by 1.9.

2050-2059
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Concern about the possibility of inadequate resection and recurrent cancer with the use of laparoscopically assisted colectomy prompted this randomized trial comparing laparoscopically assisted with open surgery for colon cancer. The trial involved 863 patients and 66 surgeons at 48 hospitals. Rates of cancer recurrence, operative complications, and survival were similar in the two groups.

Special Article
2060-2067

In this study, the lifetime risk of reactivation tuberculosis among persons in the United States who have had a positive tuberculin skin test was estimated from published data. The lifetime risk is 20 percent or higher among persons with skin-test induration of 10 mm or greater and either human immunodeficiency virus infection or evidence of old, healed tuberculosis.

Review Article
2068-2079

This review considers the pathogenesis, scope, and treatment of autoimmune polyendocrine syndromes. Although some of the component disorders such as thyroid autoimmunity and celiac disease are common, others such as Addison's disease and myasthenia gravis are rare.

Images in Clinical Medicine
2080
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A 29-year-old man had a one-month history of weakness of the left hand and painful paresthesias involving the radial half of his palm, as well as the palmar aspect of his thumb and index and middle fingers. These symptoms developed immediately after the ...

e18
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Computed tomographic examination showed a communicating hydrocephalus.

Case Records of the Massachusetts General Hospital
2081-2087

A 31-year-old man noted fluctuating, painless testicular enlargement over a period of two months. There was no evidence of feminization, and the levels of the β subunit of human chorionic gonadotropin and alpha-fetoprotein were normal. The discussants review the differential diagnosis of testicular enlargement in a young adult, the diagnostic testing needed to establish a diagnosis, and the treatment of the unusual lesion that was ultimately diagnosed.

Editorials
2089-2090

Osteoporotic fractures are a major health problem in the industrialized nations, a problem that is likely to become even greater throughout the world as the population ages. One way to prevent osteoporotic fractures is to identify risk factors that can be ...

2091-2092

Technological advances, which are followed by long periods of catch-up while clinicians learn how to use the new techniques appropriately, often precede true medical progress. Such certainly appears to be the case for minimally invasive surgery. Early on, ...

Clinical Implications of Basic Research
2093-2094

A recent study shows how a virulence factor of Streptococcus pyogenes activates leukocytes and ultimately damages host tissue.

Correspondence
2095-2096

To the Editor: Roberts and colleagues (Feb. 5 issue)1 report that matching at the HLA-DR locus has significant effects on the survival of cadaveric renal grafts, whereas matching at the HLA-A and B loci has only small effects. They conclude that the ...

2096-2099

To the Editor: Boyden et al. (May 16, 2002, issue)1 report cosegregation of a syndrome of high bone density, jaw enlargement, and torus palatinus with a missense mutation — a G-to-T substitution at position 512, encoding a glycine-to-valine substitution ...

2099-2100

To the Editor: The optimal duration of clopidogrel therapy after percutaneous coronary intervention is the subject of ongoing debate. Stone et al. (Jan. 15 issue)1 report the efficacy of paclitaxel-eluting stents as compared with bare-metal stents in ...

2100-2101

To the Editor: The proliferation of “me-too” drugs leads to beneficial cost reductions, as Lee notes in his Perspective article (Jan. 15 issue),1 but it may also put patients at risk. Each me-too drug comes to the market with limited clinical experience ...

2101-2102

To the Editor: In their editorial on antiplatelet therapy for ischemic heart disease, Lange and Hillis (Jan. 15 issue)1 assert that in all patients who undergo percutaneous coronary intervention, clopidogrel should be added to aspirin for 9 to 12 months ...

2102-2104

To the Editor: In their review of acute chemical emergencies, Kales and Christiani (Feb. 19 issue)1 mention intravenous dosages of nerve-agent antidotes, but not intramuscular autoinjectors: the MARK I kit (atropine, 2 mg, plus 2-pralidoxime chloride, ...

2104

To the Editor: We respectfully disagree with two points in Robertson's comprehensive review of islet transplantation (Feb. 12 issue)1: the assertions that patients with diabetes and autonomic insufficiency have a “dramatically shortened life span” and ...

2105-2106

To the Editor: In 2002, 51 percent of persons with tuberculosis in the United States were foreign-born; 19 percent of them had been in the United States for less than one year.1 To prevent persons with potentially infectious tuberculosis from entering ...

Book Reviews
2107-2108

Victorian euphemism had its uses. What we in our clinically literal era refer to as sexually transmitted infections once carried a more evocative label: “social diseases.” On the evidence adduced in social psychologist Catherine Campbell's remarkable book,...

2108-2109

Lawrence O. Gostin notes in his new book, The AIDS Pandemic, that AIDS has provoked more legislation and litigation than any other disease in modern history. As evidenced by this compilation of previously published essays, it would be equally true to say ...

2109-2111

This book is a collection of lectures given at a two-day symposium in 2002 with the intriguing theme “Opioids, the Janus Drugs, and the Relief of Pain.” Janus, the dual-faced Roman god, was chosen to symbolize the promise and problem that opioids ...

2111

The Hippocratic Oath, like Handel's Messiah, is heard once a year. At medical school graduation ceremonies around the nation, 20,000 voices intone modernized, bowdlerized versions of the ancient pledge. For the rest of the year, it goes silent, except for ...