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October 28, 2004  Vol. 351 No. 18

Perspective
1815-1819

The editors asked President Bush and Senator Kerry to respond to two questions regarding health care.

1820-1822

Dr. Robert Steinbrook observes that despite the support for public registration, the prospects for mandatory registration are uncertain.

1822-1824

If an anthropologist were to stumble into this room between 6 and 8 p.m. this evening, he might find the telltale signs of a ritual: a group of residents and interns huddled around a table, scribbling hieroglyphics on scraps of paper.

(Figure)

To a ...

1824-1826

Dr. Danielle Ofri writes of feeling vaguely vertiginous from the regulations that govern house-staff training. She suggests that our energy should be directed toward making this octopus of a system work.

1826-1828

The history of community-acquired bacterial meningitis arguably represents the best example of the salutary effect of the introduction of antimicrobial agents. Before the use of specific antiserums, the outlook for patients with bacterial meningitis was ...

Original Articles
1829-1837

In this study of interns' errors in the ICU, interns made 36 percent more serious errors when working on a traditional schedule (every-third-night call) than when working on a schedule that limited scheduled work to approximately 16 consecutive hours. Most errors were intercepted or did not harm patients.

1838-1848

Interns made 36 percent more serious errors when working on a traditional schedule than when on an intervention schedule.

1849-1859

In this prospective, nationwide study conducted in the Netherlands, the classic triad of fever, stiff neck, and a change in mental status was present in less than half of 696 episodes of bacterial meningitis. The overall mortality rate was 21 percent, but more than 10 percent of survivors had disabilities such as deafness or hemiparesis.

Review Article
1860-1873

    Multiple myeloma, a plasma-cell neoplasm characterized by skeletal destruction, renal failure, anemia, and hypercalcemia, remains incurable. However, recent advances in its treatment, in particular, the use of thalidomide and such new drugs as bortezomib and CC-5013, are promising. This article discusses current therapy for multiple myeloma.

    Images in Clinical Medicine
    1874
    • Free Full Text

    A 76-year-old woman was admitted with an exacerbation of chronic obstructive pulmonary disease. Her condition improved with bronchodilators, prednisolone, an antibiotic, oxygen, and supportive measures. Two years previously, she had presented with ...

    e16

    An 87-year-old woman presented with fever and shock. She had had diarrhea, then constipation, then diffuse abdominal pain.

    Case Records of the Massachusetts General Hospital
    1875-1882

      A 34-year-old man was found unconscious and apparently having a seizure. Imaging studies showed a lesion in the right frontal lobe of the brain, with characteristics of a malignant tumor. The authors discuss new approaches to the diagnosis and management of malignant glial tumors.

      Editorial
      1884

      I grew up with the one-doctor–one-patient paradigm. When I admitted a patient, I took the case as my personal responsibility. I did my best to get to know the patient and his or her family, the medical problem at hand, and the best way to approach it. If ...

      Health Policy Report
      1885-1890

      In this article, Blumenthal describes the nature of current relationships between doctors and the pharmaceutical industry. The report analyzes how financial relationships — which may involve gifts, free meals, consulting fees, or lecture honoraria — influence physicians' prescribing decisions and how the relationships between physicians and drug companies are likely to change in the future.

      Legal Issues in Medicine
      1891-1900

      Studdert et al. describe recent efforts by the federal government and professional organizations to tighten the regulation of financial associations between physicians and the pharmaceutical industry. Payments to doctors (including gifts and consulting fees) by drug companies are violations of the federal anti-kickback law if the payments have the potential to increase the recipients' prescriptions for the companies' products. The Office of the Inspector General, the Pharmaceutical Research and Manufacturers of America, and physicians' organizations have issued guidelines prohibiting many types of financial relationships that have been common.

      Clinical Implications of Basic Research
      1901-1904

        The genomic sequences of the malarial vector, parasite, and host — the three components of the malarial transmission system — have been known for at least two years. It may be possible to counter the disease by harnessing this genomic information to launch a strategic attack on the parasite during vulnerable stages of its life cycle.

        Correspondence
        1905-1908

        To the Editor: The Saline versus Albumin Fluid Evaluation (SAFE) Study (May 27 issue)1 debunks a 1998 meta-analysis associating albumin with increased mortality in critical care populations.2 Regrettably, this trial may spawn a new misconception: that ...

        1908-1909

        To the Editor: Lipshultz et al. (July 8 issue)1 show that dexrazoxane reduces the cardiac toxicity of doxorubicin without compromising the antileukemic effects. Although dexrazoxane is a promising cardioprotective agent, physicians might suspect that it ...

        1909

        To the Editor: Edwards et al. (June 17 issue)1 show that the anti-CD20 monoclonal antibody rituximab provides effective therapy for rheumatoid arthritis. They report that the effects of rituximab are not associated with changes in serum immunoglobulin ...

        1910-1911

        To the Editor: Øhlenschlæger et al. (July 15 issue)1 reported that they did not find a significant association between arterial thrombosis and the presence of antiphospholipid antibodies. However, no mention was made of whether arterial thrombosis was ...

        1911-1913

        To the Editor: In his review article on Alzheimer's disease (July 1 issue),1 Cummings states that there is “increasing consensus” that the production of beta-amyloid (Aβ) peptide is “central to the pathogenesis of Alzheimer's disease.” He neglects to ...

        1913-1914

        To the Editor: Mathur and Grodinsky, in Images in Clinical Medicine (June 10 issue),1 present a case in which bilateral dislocation of the intraocular lenses was examined by computed tomography (CT). We appreciate the images of this traumatic finding. ...

        1914-1915

        To the Editor: Percutaneous transluminal septal myocardial ablation is increasingly being used to treat hypertrophic cardiomyopathy. Reported complications have included atrioventricular block, extensive myocardial infarction, and death.1,2 Contrast-...

        Book Reviews
        1916-1917
        • Free Full Text

        This book will go a long way toward redressing the widespread ignorance of the clinical and functional significance of the pericardium. The author, a master physiologist-cum-clinician in the mold of Louis Katz and William Dock, has produced a treasure ...

        1917

        In contrast to the abundance of literature on coronary artery disease available to guide the clinician in his or her management of such disease, large-scale randomized, controlled trials are rare when it comes to valvular heart disease. Much of what is ...

        1918

        Cancer is not a single genetic disease but, rather, hundreds of diseases consisting of various combinations of genetic alterations. Many types of genetic alterations contribute to neoplastic transformation. The evidence for this statement has now become ...

        1918-1919

        This extremely useful book describes the potential mechanisms underlying the macrovascular and microvascular complications of diabetes, the clinical manifestations of such abnormalities, and effective strategies for treatment. The information in its 500-...