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July 1, 2004  Vol. 351 No. 1

Perspective
3-5
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Dr. Pamela Grim describes being a physician to the recruits at the Parris Island Marine training facility.

5-7
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Dr. Richard F. Mollica and his colleagues have cared for many torture survivors. He explains that medical professionals must take the lead in healing the wounds inflicted by the most extreme acts of human aggression.

8-10

    The two primary regulators of aldosterone secretion are potassium and the renin–angiotensin system. The latter is involved in volume homeostasis, with high salt intake suppressing the renin–angiotensin system and aldosterone levels and low salt intake ...

    10-12

    I had forgotten about it amidst the other tasks of medical-student life: exams, patient write-ups, the shirt I needed to iron. But an e-mail from my fellow student John reminded me that it was my turn to lead the journal club for our HIV–AIDS interest ...

    Original Articles
    13-22

    Most members of the military services returning from combat duty in Iraq and Afghanistan have experienced traumatic events such as being shot at, killing someone, and knowing someone who was injured or killed. Almost 20 percent of respondents to a survey of soldiers and Marines returning from Iraq suffered from post-traumatic stress disorder, but most had not sought or received treatment. Perceived barriers to treatment included concern about the stigma associated with mental illness and about possible harm to a career.

    23-32

    A randomized, controlled trial of pregnant women infected with the human immunodeficiency virus in Tanzania assessed the effects of multivitamin supplements.

    33-41

    Does aldosterone have a role in the pathogenesis of essential hypertension? This report from the Framingham Heart Study suggests that it may. Persons with serum aldosterone levels at the high end of the normal range had nearly double the risk of the development of hypertension within four years. Thus, serum aldosterone levels may contribute to the risk of hypertension.

    42-47

    A woman with diabetes and rheumatoid arthritis died from complications of severe myositis caused by infection with Brachiola algerae, a microsporidium normally found in insects. The patient had been treated with an immunosuppressive regimen that included infliximab, an inhibitor of tumor necrosis factor α.

    Clinical Practice
    48-55

      A 58-year-old man with type 2 diabetes mellitus has an asymptomatic plantar ulcer on the left foot that remains unhealed after four months. The ulcer measures 2 by 1 cm and is surrounded by callus under the first metatarsal head. Neurologic examination reveals loss of sensation of touch, pinprick, and vibration below the midcalf level bilaterally and the absence of ankle reflexes; the foot pulses are normal. How should this patient be evaluated and treated?

      Review Article
      56-67

      The prevalence of Alzheimer's disease is predicted to reach 13.2 million cases in the United States. This article considers current therapeutic approaches for Alzheimer's disease. Optimal management requires accurate diagnosis, which is increasingly based on an understanding of pathophysiology. Neuroprotective strategies, cholinesterase inhibitors, psychopharmacologic agents that may reduce behavioral disturbances, and newer agents such as memantine are discussed.

      Images in Clinical Medicine
      68
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      Which of these 50-year-old identical twins is the patient, and what is the diagnosis?

      Clinical Problem-Solving
      69-73

        A 39-year-old Sri Lankan man presented with a three-day history of headache, chills, diarrhea, nausea, vomiting, and neck stiffness. He reported having had vertigo, left-sided facial paresthesia, incoordination, and dysarthria, which had lasted for several minutes and then disappeared.

        Editorials
        75-77

        The data presented by Hoge and associates in this issue of the Journal 1 about members of the Army and the Marine Corps returning from Operation Iraqi Freedom or Operation Enduring Freedom in Afghanistan force us to acknowledge the psychiatric cost of ...

        78-80

        Readers could be forgiven for being confused by the literature on micronutrients and the pathogenesis of human immunodeficiency virus (HIV) disease. Micronutrients play important roles in maintaining immune function and neutralizing the reactive oxygen ...

        Health Policy Report
        81-92

        This report reviews South Africa's health policies over the past 10 years. After the country's transition to democracy, the government implemented health care reform to improve access to health care, especially for children. With 10 percent of South Africa's population infected with the human immunodeficiency virus (HIV), AIDS has had a devastating impact on health and the delivery of health care. Severely constrained financial resources frustrate efforts to improve South Africa's health care system and to implement optimal programs for the prevention and treatment of infection with HIV.

        Correspondence
        97-98

        To the Editor: During Operation Iraqi Freedom, an Iraqi combatant sustained substantial battlefield trauma to his right temporofrontal area, exposing the brain surface. He was brought to a surgical company of the U.S. 1st Marine Expeditionary Force. The ...

        98-100

        To the Editor: Milpied et al. (March 25 issue)1 provide further information about the benefits of high-dose chemotherapy plus autologous stem-cell support in the initial treatment of aggressive lymphoma. However, almost 50 percent of the patients were at ...

        100-102

        To the Editor: Coombes et al. (March 11 issue)1 report an important advantage in terms of disease-free survival with the use of adjuvant exemestane after initial treatment with tamoxifen. Adjuvant postmastectomy radiotherapy might have influenced the ...

        102

        To the Editor: In their review of acute lymphoblastic leukemia, Pui et al. (April 8 issue)1 discuss environmental factors that may interact with a genetic disposition to cause the disease. The authors claim that “exposure to residential magnetic fields ...

        103-104

        To the Editor: The pathogenesis and management of lipodystrophy in patients with human immunodeficiency virus (HIV) infection are discussed in Garg's review article (March 18 issue).1 However, the author should have noted that several lines of evidence ...

        105

        To the Editor: In our opinion, the mass described as a myxoid liposarcoma and shown in the January 29 Images in Clinical Medicine1 is not an example of that entity but, rather, an atypical lipomatous tumor (well-differentiated liposarcoma) with secondary ...

        105-106

        To the Editor: In the case of influenza presented by Todres and discussed by Gerberding et al. (March 18 issue),1 there are two points that need further examination. First, the obese patient had received at least 20 liters of fluid in 32 hours before he ...

        Book Reviews
        107

        As its title suggests, this book was written for interested nonmedical readers and for physicians other than neurologists, neuroscientists, or medical historians. But readers expecting a detailed analysis of the mind–body relationship should look ...

        108

        Karen Rader has written a valuable book. The story is that of inbred mice — their development, their adoption as the favored organism of mammalian geneticists, and the distribution system that arose to provide the research community with a variety of ...

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