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July 8, 2004  Vol. 351 No. 2

Perspective
115-117
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Despite increases in funding, more infections continue to occur. The 15th International AIDS Conference in Bangkok, Thailand, faces the daunting task of reversing these trends.

117-120

This region has some of the fastest-growing rates of HIV infection in the world. AIDS is expected to kill about 20 million Russians by 2025.

120-121

    More than 70 percent of children who are treated for childhood cancer can be cured. For long-term survivors, possible late effects of treatment and their consequences for the quality of life are a major concern. Cardiotoxic effects of anthracyclines are ...

    122-124

    Syphilis. The name of this widespread and ancient disease is familiar to health care providers worldwide. This name recognition, however, belies the complexity of the disease, as well as the diagnostic and therapeutic challenges that continue to affect ...

    Original Articles
    125-135
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    This prospective study found that the risk of death from prostate cancer after radical prostatectomy was related to the rate of rise in the level of prostate-specific antigen (PSA) — the PSA velocity — during the year before the diagnosis of prostate cancer, the PSA level at the time of diagnosis, the clinical tumor stage, and the Gleason score. A velocity of at least 2.0 ng per milliliter during the year before the diagnosis augured a high risk of death despite radical prostatectomy.

    136-144

    In a randomized trial of women with severe twin-to-twin transfusion syndrome during midgestation, fetoscopic laser therapy (coagulation of placental vascular anastomoses) resulted in significantly higher survival rates of at least one twin and lower rates of neurologic abnormalities at six months of age than did amnioreduction (repeated removal of large volumes of amniotic fluid).

    145-153

    Doxorubicin is an efficacious treatment for childhood acute lymphoblastic leukemia (ALL), but it is toxic to myocardial cells and can cause cardiomyopathy. In this clinical trial, dexrazoxane, a free-radical scavenger, was found to reduce doxorubicin-induced myocardial injury, as indicated by cardiac troponin T levels before, during, and after therapy.

    154-158

    An HIV-infected patient in San Francisco with primary syphilis was treated with azithromycin, but the lesion did not resolve. The authors of this case report confirmed resistance to azithromycin and identified a mutation in the 23S rRNA genes of T. pallidum. The mutation was also found in samples collected in Baltimore, Seattle, and Dublin.

    Review Article
    159-169

    The combination of acute renal failure and sepsis is associated with an ominous 70 percent mortality. This article discusses the substantial progress in understanding the mechanisms of sepsis-associated acute renal failure.

    Images in Clinical Medicine
    170
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    A five-month-old girl was admitted to the hospital because of uncontrollable seizures. Her father had shaken her vigorously, allegedly in an attempt to rescue her from a choking spell. A computed tomographic scan of her head revealed a right frontal ...

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    A man with small-cell lung carcinoma had syncope and muffled heart sounds. The EKG showed low voltage with electrical alternans.

    Case Records of the Massachusetts General Hospital
    171-178

      This patient presented at the age of 55 years with prostate cancer, detected because of urinary symptoms and a rising prostate-specific antigen (PSA) level. He was well for seven years after local radiation therapy and androgen-deprivation treatment; then his PSA level began to rise, and metastatic lesions were detected. The care of this patient necessitated consideration of treatment options for patients with localized and advanced prostate cancer and hormone-refractory disease.

      Editorials
      180-181

      Measurement of prostate-specific antigen (PSA) has profoundly affected virtually all clinical aspects of prostate cancer. A sharp increase in both the incidence of age-adjusted prostate cancer (about 100 percent) and the proportion of patients with early ...

      182-184

      The twin-to-twin transfusion syndrome poses a major challenge for fetal therapy. Untreated, it results in inordinate perinatal mortality and morbidity. It affects two babies, both of whom are structurally normal. Because the connections mediating ...

      Clinical Implications of Basic Research
      185-187

        A recent study in a mutant mouse model shows that a small molecule can strengthen a critical calcium channel against the effects of chronic adrenergic stimulation and thus prevent ventricular arrhythmia.

        Correspondence
        188-189

        To the Editor: Block and colleagues1 (April 8 issue) found a significant reduction in intact parathyroid hormone levels in patients with uncontrolled secondary hyperparathyroidism who received cinacalcet. The primary end point of intact parathyroid ...

        190-192

        To the Editor: In their report on 10 years of alendronate therapy for osteoporosis in postmenopausal women, Bone et al. (March 18 issue)1 mention the long retention time of alendronate in bone as an advantage. This view is based on the fact that the ...

        192-193
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        To the Editor: We agree with Dr. Groopman (March 18 issue)1 that religious faith may be an essential part of coping with illness and death for many patients and doctors, affecting the quality of life if not medical outcomes. Although many patients raise ...

        193-195

        To the Editor: Dr. Darouiche (April 1 issue)1 discusses the treatment of infections associated with surgical implants but does not point out that postherniorrhaphy mesh infections constitute a significant proportion of such infections. Approximately 1 ...

        195-196
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        To the Editor: Roodman (April 15 issue)1 stated that in osteolytic metastases, the destruction of bone is mediated by osteoclasts rather than tumor cells, whereas the mechanisms of osteoblastic metastases and the factors involved are unknown. It would be ...

        196
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        To the Editor: Basaria and Salvatori (March 25 issue) present superb photographs of a patient with Pemberton's sign in Images in Clinical Medicine.1 However, the accompanying computed tomographic (CT) scan of the thyroid gland appears to have been ...

        197-198

        To the Editor: In a recent article in the Journal, Tian et al. showed the power of microarray data mining in finding new links between single genes (e.g., dickkopf1 [DKK1]) and clinical features of a disease (in the case of DKK1, bone lesions in multiple ...

        Book Reviews
        199

        A handbook that is intended to cover clinical research and practice in the area of eating disorders and obesity should be representative of the field, provide critical guidance, and be accessible to the nonspecialist. According to these criteria, this ...

        199-200

        Neuropathy is one of the earliest — and most common — chronic complications of diabetes. For some patients, the condition is simply an annoyance and results in occasional numbness and tingling here and there. But neuropathy can forebode infection, loss of ...

        Corrections
        200

        A Comparison of Two Intensities of Warfarin for the Prevention of Recurrent Thrombosis in Patients with the Antiphospholipid Antibody Syndrome Original Article, N Engl J Med 2003:349;1133-1138.. On page 1137, in the first row of Table 2 (“All patients”), ...

        200

        Antiplatelet Therapy for Ischemic Heart Disease Editorial, N Engl J Med 2004:350;277-280.. On page 278, in Table 1, under the heading “Patients undergoing PCI,” the cost of treatment with aspirin should be $0.04/day, rather than $0.12/day, as printed.

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