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June 17, 2004  Vol. 350 No. 25

Perspective
2539-2542

Dr. Robert Steinbrook examines how insurers and employers have struggled to respond to vastly increased spending.

2542-2544

The regulation of body weight adheres to the principles of thermodynamics: a positive energy balance causes weight gain, and weight loss occurs when the energy expenditure exceeds intake. More than half the adults in the United States are overweight or ...

2544-2546

The 2003 Institute of Medicine report Microbial Threats to Health: Emergence, Detection, and Response lists “advances in medical technologies, such as blood transfusions and organ transplants,” as one reason for “new or enhanced microbial threats.” ...

2546-2548

CD20 protein is expressed on the surface membrane of pre-B lymphocytes and mature B lymphocytes. The protein is located in the B-cell membrane, with 44 amino acids exposed in the extracellular space. Rituximab is a chimeric anti-CD20 antibody whose ...

Original Articles
2549-2557

This study evaluated the effect of large-volume abdominal liposuction on metabolic risk factors for coronary heart disease in women with abdominal obesity. Liposuction altered neither insulin sensitivity nor the plasma concentrations of C-reactive protein, interleukin-6, tumor necrosis factor α, or adiponectin. There also was no significant effect on other risk factors for coronary heart disease.

2558-2563

In a follow-up study of over 800 adults who had completed a course of oral anticoagulation after a first episode of venous thromboembolism, the risk of a recurrent venous thromboembolism was substantially higher among men than among women.

2564-2571

This investigation identified 14 patients who had major clostridium infections after undergoing tissue-allograft transplantation, including a 23-year-old man who died of sepsis after receiving cadaveric cartilage. These infections were transmitted through tendon or cartilage transplants from the same tissue bank.

2572-2581

Rituximab is a monoclonal antibody that selectively depletes CD20+ B cells. In this randomized trial involving patients with poorly controlled rheumatoid arthritis despite methotrexate treatment, rituximab was found to be an intriguing new therapy for alleviating symptoms in rheumatoid arthritis. However, use of rituximab led to serious infections in some cases.

Clinical Practice
2582-2590

    An 85-year-old man with New York Heart Association class IV heart failure, hypertension, and moderate Alzheimer's disease, who lives at home with his 84-year-old wife, is admitted to the hospital after a hip fracture. His postoperative course is complicated by pneumonia, delirium, pressure ulcers on his heels and sacrum, and weight loss. What might the patient's physician do to address his needs, alleviate his suffering, and facilitate his discharge from the hospital and his care at home?

    Review Article
    2591-2602

    A better understanding of the pathophysiology of rheumatoid arthritis, together with influential trials aimed at treating early stages of the disease, has altered therapy. This article considers approaches that have resulted in markedly better clinical outcomes, including early diagnosis and treatment; the advent of combinations of disease-modifying antirheumatic drugs and agents that target cytokines; and recognition and treatment of important coexisting conditions, particularly cardiovascular disease and osteoporosis.

    Images in Clinical Medicine
    2603
    • Free Full Text

    A 12-year-old boy with acute myelogenous leukemia that had been diagnosed two months earlier presented to a hospital with fever and leg pain. He had received intravenous cytarabine two weeks earlier. He was pancytopenic, with a total leukocyte count of ...

    e23
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    This man underwent an ablative procedure for supraventricular arrhythmias. A painful ulceration developed on his right arm four months later.

    Case Records of the Massachusetts General Hospital
    2604-2612

    A boy was seen by his physician because of a one-week history of profound fatigue. He had mild fever, muscle aches, and chest pain but no gastrointestinal or respiratory symptoms. He was taking no medications and had no known allergies. A complete blood count revealed marked eosinophilia but no other abnormalities.

    Editorial
    2614-2616

    In 1856 Rudolph Virchow identified three primary risk factors — commonly called Virchow's triad — for venous thromboembolism: venous stasis, hypercoagulability, and endothelial injury.1 Other risk factors have since been added to the list, and ...

    Correspondence
    2617-2618

    To the Editor: Williams et al. (March 4 issue)1 propose that GB virus C (GBV-C) interferes with the progression of human immunodeficiency virus (HIV) infection. Previous cross-sectional studies have shown that HIV-infected patients with GBV-C viremia ...

    2618-2621

    To the Editor: Roden (March 4 issue)1 provides a concise review of drug-induced prolongation of the QT interval. However, in Table 2 of the article, which lists risk factors for torsade de pointes, diet and fasting are not mentioned. There have been ...

    2621

    To the Editor: In their review of the persistence of the Epstein–Barr virus (EBV) and the origins of associated lymphomas (March 25 issue),1 Thorley-Lawson and Gross state, “There is no satisfactory explanation of how EBV participates in the pathogenesis ...

    2622

    To the Editor: According to Table 1 in Wilson's review of polycystic kidney disease (Jan. 8 issue),1 the MCKD2 gene has not been identified when, in fact, it has, and a genetic test is currently available. MCKD2 involves the mutation of a common urinary ...

    2622-2623
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    To the Editor: In the Clinical Problem-Solving article by Bliss et al. (March 4 issue),1 which involved a case of Lemierre's syndrome, the discussant mentions that the patient's “tonsillar exudates, fever, anterior cervical adenopathy, and absence of ...

    2623-2624

    To the Editor: The discussants in Case 7-2004 (Feb. 26 issue)1 comprehensively review hereditary melanoma arising from inherited CDKN2A mutations, but they fail to mention the increased risk of pancreatic cancer associated with germ-line CDKN2A ...

    2624-2625

    To the Editor: We present a case of bone marrow transplantation and liver transplantation from the same living donor for cirrhosis due to infection with the hepatitis C virus (HCV). In North America, cirrhosis due to HCV infection is the most common ...

    2625-2626

    To the Editor: In April 2002, a 54-year-old man presented with thoracic pain and respiratory distress; a mediastinal mass, 7.7 by 6 cm, was found on positron-emission tomographic and computed tomographic scanning. Further examination showed elevated ...

    Book Reviews
    2627

    In this book, Jerome Groopman shares with readers what he has learned about the need to keep hope alive, especially in the face of serious illness. The key themes he explores are the extent to which hope features in the experience of patients with chronic ...

    2627-2628

    Head and neck cancer is a devastating illness. This year, the disease will develop in about 46,000 people and cause 12,000 deaths in the United States alone. More than 600,000 cases are predicted worldwide. These numbers cannot describe the physical, ...

    Correction
    2628

    Single versus Double Autologous Stem-Cell Transplantation for Multiple Myeloma Original Article, N Engl J Med 2003:349;2495-2502.. On pages 2498, 2499, and 2500, the legends for Figures 1, 2, and 3, respectively, should have stated, “Tick marks indicate ...

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