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September 2, 2004  Vol. 351 No. 10

Perspective
951-953

The way in which depression is confronted, discussed, and managed varies among social worlds. Dr. Arthur Kleinman examines how cultural meanings and practices shape the course of depression.

953-955

Culture plays a large role in shaping health-related values, beliefs, and behavior. Dr. Joseph R. Betancourt argues that cultural competence is not a panacea, but a necessary set of skills for physicians who wish to deliver high-quality care to all ...

955-957

Having "reached the conclusion that drastic changes are needed," Dr. Elias Zerhouni, the NIH director, plans to implement reforms. The NIH aims to implement new rules and better ethics oversight.

957-959

The sudden infant death syndrome (SIDS) was initially defined in 1969 with the goal of identifying infants who had similar characteristics before sudden death so that a common underlying mechanism of death might be discovered. The original definition was ...

959-962

Hypothalamic amenorrhea can be defined as the cessation of menstruation due to a dysfunction of hypothalamic signals to the pituitary gland, resulting in a failure of ovulation. Typically, young women who are affected by the condition have no obvious ...

Original Articles
963-970

This randomized trial compared local radiotherapy plus tamoxifen with tamoxifen alone in women 50 years of age or older who had undergone breast-conserving surgery for breast cancer. As compared with tamoxifen alone, radiotherapy plus tamoxifen substantially lowered the rate of local relapse. Overall survival at five years did not differ significantly between the two groups.

971-977

In this study, women 70 years of age or older who had early, estrogen-receptor–positive breast cancer underwent lumpectomy and were then randomly assigned to receive tamoxifen alone or with local irradiation. The only significant difference in outcome was in the probability of local recurrence at five years (4 percent in the tamoxifen group and 1 percent in the combined-treatment group).

978-986

This study, based on analyses of large, linked databases of maternal, perinatal, and birth and death records in Scotland, found a significant association between second-trimester maternal serum alpha-fetoprotein levels and the subsequent risk of the sudden infant death syndrome (SIDS) in singleton infants. This relationship was attenuated but remained significant after adjustment for infants' birth weight and gestational age at delivery.

987-997

Hypothalamic amenorrhea may be accompanied by low leptin levels. These investigators administered recombinant human leptin to eight women with hypothalamic amenorrhea. Six additional untreated subjects served as historical controls. Treatment with recombinant leptin increased mean luteinizing hormone levels and pulse frequency, improved ovarian variables, and resulted in ovulation in three women and in withdrawal bleeding in two.

Review Article
998-1012

    Cutaneous melanoma remains a management challenge. This year an estimated 55,000 Americans will receive a diagnosis of cutaneous melanoma, and 7900 will die from the disease. The authors of this review discuss the pathogenesis and management of cutaneous melanoma and provide perspective on treatment options.

    Images in Clinical Medicine
    1013
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    A 68-year-old man presented with pain in the right upper abdomen and a temperature above 39°C. Although he had recently undergone a five-day course of treatment with broad-spectrum antibiotics at another hospital, the patient's white-cell count was 13,010 ...

    e9
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    Echocardiography revealed left ventricular hypertrophy and an enlarged inferior vena cava.

    Clinical Problem-Solving
    1014-1019

      A 67-year-old obese man was seen by his physician because of a two-month history of shortness of breath, a nonproductive cough, and bilateral swelling of the lower extremities. He also reported the sensation of neck fullness, occasional wheezing, and an increase in dyspnea after meals.

      Editorial
      1021-1023

      Breast-conserving surgery followed by radiotherapy is the standard of care for women with small breast cancers who wish to avoid mastectomy. This approach achieves good local control, does not disturb the women's body image or impair survival,1 and has ...

      Clinical Implications of Basic Research
      1024-1026

        The provenance of the insulin-producing beta cell of the islet of Langerhans has been a long-standing source of debate. A recent study suggests that the beta cell itself, rather than a putative stem cell, gives rise to new beta cells.

        Correspondence
        1027-1030

        To the Editor: In their study of homocysteine as a predictive factor for hip fracture in older persons, McLean et al. (May 13 issue)1 do not thoroughly discuss the role of physical activity, which may influence the association between homocysteine levels ...

        1030-1031

        To the Editor: Schuelke et al. (June 24 issue)1 describe a child with muscle hypertrophy in association with a mutation in the myostatin gene. Another possible case of a myostatin mutation in an exceptionally strong child was described more than 2500 ...

        1031-1032

        To the Editor: Dr. Steinbrook (June 3 issue)1 joins the American College of Obstetricians and Gynecologists in urging “all obstetrician-gynecologists to provide advance prescriptions for emergency contraception to all women of reproductive age at every ...

        1032-1033

        To the Editor: In their review of autoimmune polyendocrine syndromes, Eisenbarth and Gottlieb (May 13 issue)1 do not, in our view, sufficiently discuss autoimmune hypoparathyroidism and recent advances in its understanding. Autoimmune hypoparathyroidism ...

        1033-1034

        To the Editor: Case 18-2004, discussed by Shellito et al. (June 10 issue),1 concerns the management of rectal cancer and contains the recommendation that adequate pathological examination of resection specimens requires retrieval of no fewer than 15 ...

        1034-1035

        To the Editor: Langerhans'-cell histiocytosis (LCH) is a rare disorder characterized by tissue infiltrates of CD1a+ Langerhans' cells, eosinophils, neutrophils, macrophages, and lymphocytes. Systemic treatments for refractory LCH are unsatisfactory and ...

        Book Reviews
        1036-1037

        Toward the end of the 18th century, Immanuel Kant argued that psychology could never be a science, because the mind, being immaterial, could not be measured. But less than 100 years later, Wilhelm Wundt established the first psychological laboratory to ...

        1037

        Writing one's life is a risky venture of memory, invention, and desire. With intellectual depth and formal rigor, Roy Vagelos and the historian Louis Galambos have written a serious and nourishing report of Vagelos's life in medicine, science, and the ...

        Corrections
        1038

        High-Bone-Mass Disease and LRP5 Correspondence, N Engl J Med 2004:350;2096-2099.. In the letter by Whyte et al., on page 2097, in the right-hand column, line 8 of the first full paragraph should have read “L1 to L4,” rather than “L1 to L7,” as printed. We ...

        1038

        Hypertrophic Obstructive Cardiomyopathy Clinical Practice, N Engl J Med 2004:350;1320-1327.. As a clarification to the information provided on page 1323 in Table 2 regarding the recommended doses of beta-blockers, the authors have submitted the following ...