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September 23, 2004  Vol. 351 No. 13

Perspective
1275-1277

    During the past 12 months, poliovirus has been spreading to states in Nigeria that were previously free of poliomyelitis. Moreover, global surveillance for acute flaccid paralysis1 — involving the genomic sequencing of each wild poliovirus that is ...

    1277-1279

    Should the law let patients sue health plans for damages when plans deny coverage? Dr. M. Gregg Bloche explains how a ruling by the U.S. Supreme Court has returned this question to the forefront of the nation's political agenda.

    1279-1281

    Today, the teaching of anatomy is at a crossroads, explains Dr. Kitt Shaffer. As we explore new "virtual" methods of teaching anatomy, the educational challenges will be different for gross anatomy and microscopical anatomy.

    1281-1283

    Some errors occur because trust is overtly violated; others result from human fallibility or foibles. Dr. Sherwin B. Nuland relates his experience with a patient who was the victim of both types of errors.

    1283-1284

    It is a cliché of primary care pediatrics: on call in the winter, you find yourself on the telephone with a worried parent who is anxiously trying to describe a baby's symptoms — and then, in the background, you hear the barking. I regularly joke with ...

    Original Articles
    1285-1295

    Frank renal failure is known to be associated with a poor prognosis after myocardial infarction. This study, involving more than 14,000 patients, showed that renal dysfunction was an important predictor of outcome after myocardial infarction. The new findings add to our knowledge by showing that even mild degrees of renal dysfunction carry negative prognostic implications.

    1296-1305
    • Free Full Text

    End-stage renal disease increases the risks of death and of cardiovascular disease and the use of specialized health care, but the effects of less severe kidney dysfunction on these outcomes are not well defined. In this study of adults with known creatinine levels, the adjusted risks of death, cardiovascular events, and hospitalization were inversely proportional to the estimated glomerular filtration rate.

    1306-1313

    This placebo-controlled trial assessed the effectiveness of a single dose of dexamethasone in 720 children with mild croup who presented to the emergency department. Dexamethasone treatment was associated with more rapid resolution of symptoms, less loss of sleep, and a lower rate of return for medical care.

    Special Article
    1314-1322
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    In recent national surveys of voters' views on the importance of issues in the 2004 presidential campaign, voters ranked health care fourth after the economy and jobs, the war in Iraq, and terrorism. The health care issues of most concern were the availability and affordability of health care and health insurance.

    Clinical Practice
    1323-1331

      A healthy 50-year-old man notices that his face is drooping on the right side. On examination, facial asymmetry is evident, and some saliva has accumulated on the right side of the patient's mouth. When the patient attempts to close his eyes, his right eye does not close, although it rolls upward, and he is unable to show his teeth or inflate his cheek on the right. How should the patient be evaluated? Does he need immediate treatment?

      Images in Clinical Medicine
      1332
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      In April 1978, Dr. Andreas Grüntzig, of University Hospital, Zurich, told a patient who had a tightly narrowed left anterior descending coronary artery that he did not have enough experience to cite an accurate success rate for balloon angioplasty of this ...

      e12
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      A 64-year-old woman without symptoms underwent routine chest radiography, which revealed a well-circumscribed, low-density mass that measured 8 cm in diameter.

      Case Records of the Massachusetts General Hospital
      1333-1341

      A 37-year-old woman noted a gradual onset of numbness, first in her hands and then in her feet and legs, accompanied by weakness of the legs and difficulty balancing. She was otherwise well except for hypothyroidism, which had developed at the age of 15 years. On examination, there was decreased vibratory sensation and proprioception in the feet. A diagnostic test was performed.

      Editorials
      1343
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      The NIH proposes that publications from NIH-sponsored research be made available free to the public within six months. Drs. Jeffrey M. Drazen and Gregory D. Curfman explain the Journal's policy and encourage the NIH to adopt a model in which journals ...

      1344
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      No event provides stronger evidence of democracy at work than a national election campaign in which the incumbent must defend his or her past record and future plans. The open debate between incumbent and challenger allows voters to identify and evaluate ...

      1344-1346

      The prevalence of end-stage renal disease continues to rise in the United States. Even more disturbingly, the current number of patients with early chronic kidney disease — the pool from which future end-stage renal disease patients will emerge — exceeds ...

      Legal Issues in Medicine
      1347-1352

      In June 2004, the U.S. Supreme Court ruled that managed-care organizations are not liable when patients have medical complications resulting from decisions to deny coverage for treatments recommended by the patients' doctors. In this article, Wendy Mariner discusses the implications of the Supreme Court decision for physicians and patients.

      Correspondence
      1353-1354

      To the Editor: Fawzi and coworkers (July 1 issue)1 demonstrate the benefit of multivitamin supplementation in pregnant women with human immunodeficiency virus (HIV) infection. What is most impressive is that the effects of vitamins on the immune system, ...

      1354-1357

      To the Editor: Klein and colleagues (June 17 issue)1 report an absence of effects of abdominal liposuction on cardiovascular risk factors, inflammatory markers, and insulin resistance in obese women. We would suggest alternative explanations for their ...

      1358-1360

      To the Editor: We are grateful to the Journal for putting on the record1 the undisclosed conflicts of interest of two of the authors of the report by Kainer et al. (June 17 issue).2 Specifically, the associations were Dr. Archibald's employment with ...

      1360-1361
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      To the Editor: The data reported by O'Dell (June 17 issue)1 and by Olsen and Stein (May 20 issue)2 on biologic drugs for the treatment of rheumatoid arthritis reveal many points of uncertainty. First, the number of randomized trials that have compared ...

      1361

      To the Editor: The interesting case of systemic tuberculosis infection reported by Jha et al. (June 3 issue)1 requires clarification. The authors report that two physicians involved in the patient's care had positive tests for mycobacterium exposure and ...

      1361-1364

      To the Editor: Tegaserod (Zelnorm, Novartis Pharmaceuticals) is a partial serotonin 5-hydroxytryptamine4 (5-HT4)–receptor agonist approved by the Food and Drug Administration (FDA) for the short-term treatment of constipation-predominant irritable bowel ...

      1364

      To the Editor: I wish to report yet one more use for the ubiquitous Post-it, this time as an aid in cardiac physical diagnosis. The adhesive on Post-it notes consists of tiny spheres that are sticky individually. Because these spheres make only ...

      Book Reviews
      1365

      Paul Bloom's premise in Descartes' Baby is that we are natural-born dualists. As infants, we instinctively divide the world into physical objects and mental states, and we reason differently about the two. Babies find it perfectly natural for a person to ...

      1365-1366

      For a long time, we have been taught that the oocyte in adult mammals is virtually inactive, that it essentially remains in a resting state until the periovulatory period. Evidence that has emerged in recent years paints an entirely different picture. ...

      1366-1367

      Written from a social-science perspective, this book deals with the causes and consequences of low birth weight (less than 2500 g). Using low birth weight as an example, the book addresses the “overstated separation between nature and nurture by ...

      Corrections
      1367

      The Nature of Small-Airway Obstruction in Chronic Obstructive Pulmonary Disease Original Article, N Engl J Med 2004:350;2645-2653.. On page 2647, in Table 1, under the column heading “Characteristic,” the FEV1:FVC entry should not be followed by “(% of ...

      1367
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      Semper Fi Perspective, N Engl J Med 2004:351;3-5.. On page 4, in the left-hand column, fifth full paragraph, line 8 should have read “maxillary fracture,” rather than “mandibular fracture,” as printed. We regret the error. Also on page 4, in the right-...

      1367

      A Randomized Trial of Multivitamin Supplements and HIV Disease Progression and Mortality Original Article, N Engl J Med 2004:351;23-32.. On page 26, in Table 1, under the column heading Multivitamins + Vitamin A, the CD8+ cell count should have read 748±...