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July 15, 2004  Vol. 351 No. 3

Perspective
207-209

The question is whether the destruction of human embryos in stem-cell research amounts to the killing of human beings. Professor Michael J. Sandel on the stem-cell debate.

209-211

The concern that shadows the free use of human stem cells derives from disquiet over their origins. Dr. Paul R. McHugh on the stem-cell debate.

211-213

Professor Debora Spar argues that the commercial consequences of U.S. policy are staggering. The future of stem-cell research is likely to be driven as much by markets as by science.

213-214

One hundred years ago, on July 15, Russia's most famous physician, Anton Pavlovich Chekhov, died of tuberculosis at 44 years of age in Badenweiler, Germany. His body was shipped to Moscow by train in a refrigerated car marked “For Oysters.” At the ...

215-216

The primary cause of death from cancer is the progressive growth of metastases that are resistant to conventional therapies. The site of metastasis from primary neoplasms is not random. Indeed, in 1889, Stephen Paget proposed that the process of ...

Original Articles
217-228

In a randomized, controlled trial in Thailand, pregnant women infected with the human immunodeficiency virus (HIV) type 1 received zidovudine treatment plus a single dose of either nevirapine or placebo. The rate of transmission of HIV to newborns was 2.8 percent in the nevirapine group and 6.3 percent in the placebo group. The rate was 1.9 percent in a group in which a single dose of nevirapine was also administered to the infants shortly after delivery.

229-240

After participating in a placebo-controlled trial of antiviral regimens to reduce mother-to-child transmission of the human immunodeficiency virus (HIV) in Thailand, some of the women began taking a nevirapine-containing regimen. After six months, the rate of viral suppression was lower among the mothers who had received intrapartum nevirapine than among those who had not received it (49 percent vs. 68 percent, P=0.03).

241-249

Despite knowledge that women with hypothyroidism should increase their usual levothyroxine dose during pregnancy, biochemical hypothyroidism still occurs. This study found that the levothyroxine requirement increased by a mean of 48 percent during the first half of pregnancy and that monitoring and dose adjustments were required until delivery.

250-259

Using combined immunohistochemical and fluorescence in situ hybridization techniques, these investigators found chromosomal abnormalities typical of B-cell lymphomas not only in the lymphoma cells but also in the microvascular endothelial cells in the lymphoma.

260-267
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Arterial thrombosis is an important complication of systemic lupus erythematosus. These investigators found that the presence of variant alleles of mannose-binding lectin (MBL), a serum protein involved in innate immune defense, increases the risk of arterial thrombosis, especially myocardial infarction, in patients with lupus. The results suggest that the common allelic forms of mannose-binding lectin may have a role in protecting against arterial thrombotic events.

Clinical Practice
268-277

    A 52-year-old woman with no history of venous thromboembolism presents with a four-day history of discomfort in her left calf. Proximal deep-vein thrombosis is diagnosed by compression ultrasonography. How should her case be managed?

    Images in Clinical Medicine
    278
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    A 20-year-old man was admitted to the hospital with a one-day history of fever and acute, painful symmetric polyarthritis that involved the wrists, elbows, and ankles. During the next two days, edema and palpable purpura developed over the dorsal aspect ...

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    After a laminectomy and posterior spinal fusion, subcutaneous emphysema and hypoxemia developed. A chest radiograph revealed no pneumothorax. Bilateral chest tubes were placed, but the hypoxemia did not improve.

    Case Records of the Massachusetts General Hospital
    279-287
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    A woman sought medical attention because of chest pain and shortness of breath. Physical examination and echocardiographic studies showed evidence of a pericardial effusion and cardiac tamponade. She was admitted to the hospital, and the effusion was drained, yielding fluid that was negative on culture and cytologic analysis. She had traveled to Kenya; a tuberculin skin test five months after the trip had been negative, but a test during hospitalization was positive.

    Editorials
    289-292

    Preventing transmission of human immunodeficiency virus type 1 (HIV-1) and caring for those already infected are essential services in any comprehensive program, and enhancing the mutually beneficial effect of each is an international goal.1 These ...

    292-294

    Those with sufficiently long memories must be somewhat bemused by the successive controversies surrounding the treatment of primary hypothyroidism, a condition viewed by many as simple, satisfying to manage, and very much within the purview of the primary ...

    Correspondence
    295-298

    To the Editor: The analyses presented by Danesh and colleagues (April 1 issue)1 do not support their conclusion that C-reactive protein is only a moderate risk factor for coronary heart disease. First, their comparison of risk factors relies on the odds ...

    298

    To the Editor: The article by Hviid et al. (April 1 issue)1 that suggests no link between childhood vaccination against measles, mumps, and rubella and type 1 diabetes has an important limitation that is all too common in clinical research. The study ...

    298-300

    To the Editor: In the pursuit of scientific truth, one of the most basic principles is the rigorous exclusion of preexisting bias. Without such exclusion, scientific investigation and experimentation have no validity. Blackburn's account of the recent ...

    300-301

    To the Editor: In their review article, Ginès et al. (April 15 issue)1 state that in patients with large-volume ascites, the “serum creatinine concentration is normal or only moderately higher than normal, indicating that the glomerular filtration rate ...

    301-302

    To the Editor: In the review of pediatric palliative care by Himelstein et al. (April 22 issue),1 it clearly is impossible to detail patient care in such a wide population. Thus, it is appropriate to mention one drug in each group, even though morphine, ...

    302-303

    To the Editor: With the recent decision of the Food and Drug Administration to ban the sale of ephedra in the United States, a broad discussion of the uses, risks, and regulation of herbal preparations has been kindled in the news media. We report a case ...

    Book Reviews
    304

    On Charles Darwin's birthday — February 12 — in 2001, two groups of scientists announced simultaneously that the human genome sequence had been completed. The public consortium, involving teams from six countries, published its results in Nature and made ...

    305-306

    Roy Porter died too young. One of the most distinguished and prolific medical historians of the day, Porter had recently taken early retirement from the Wellcome Trust Centre for the History of Medicine at University College London when, in the spring of ...

    Corrections
    306

    Sex Determination and Differentiation Review Article, N Engl J Med 2004:350;367-378.. On page 373, lines 22 through 25 in the first full paragraph of the right-hand column should have read, “patients with a translocation in the distal arm of chromosome ...

    306

    Case 5-2004: A 57-Year-Old Man with Slurred Speech and Left Hemiparesis Case Records of the Massachusetts General Hospital, N Engl J Med 2004:350;707-716.. On page 713, in the right-hand column, Panels A and B of Figure 5 should have been transposed. In ...

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