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March 10, 2005  Vol. 352 No. 10

Perspective
959-962
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Drs. Eduard Verhagen and Pieter Sauer state that of the 200,000 children born in the Netherlands every year, about 1000 die during the first year of life. For 600 of these infants, death is preceded by a medical decision regarding the end of life. The ...

962-964

    One of the principal referral centers for people injured in the tsunami was Takuapa Hospital, a general hospital in Phangnga with 177 beds. Dr. Charnkij Wattanawaitunechai, Sharon Peacock, and Dr. Pornlert Jitpratoom describe the disaster management in a ...

    965

    When my team arrived on the east coast of Sumatra, Indonesia, two weeks after the tsunami, dry land was scarce. Although the largest settlement camps had formed around mosques and schools in dry areas, the camp to which my team was assigned was wet. ...

    966-968

    One of the most remarkable tales of a concealed drug addiction began more than a century ago and involves a brilliant young doctor. Dr. Howard Markel writes about William Stewart Halsted, who by the age of 33 faced both professional and literal extinction ...

    Original Articles
    969-977

    Hospitalized patients may be at risk for venous thromboembolism as a result of bed rest, cancer, or major surgery, yet not all such patients receive prophylaxis against deep-vein thrombosis. An electronic alert system, which prompted physicians to prescribe prophylaxis to patients at risk for deep-vein thrombosis, was determined not only to increase the use of prophylactic measures but also to reduce the risk of venous thromboembolism.

    978-986

    Medulloblastoma in young children has a poor prognosis. Furthermore, cognitive function in survivors is often impaired owing to treatment with cranial radiotherapy. This study obtained promising results in children undergoing intensive chemotherapy alone.

    987-996

    Most patients with glioblastoma multiforme, the most common primary malignant brain tumor in adults, die within two years of the diagnosis, despite surgery and radiotherapy. This trial compared postoperative radiotherapy with postoperative radiotherapy plus temozolomide, an alkylating agent. The combined treatment was safe and reduced the risk of death by 37 percent.

    997-1003

    In this companion to the randomized trial of temozolomide in glioblastoma, also reported in this issue of the Journal, the methylation status of the promoter of the MGMT (O6-methylguanine–DNA methyltransferase) DNA-repair gene in glioblastoma was determined. Methylation of the promoter silences the gene and thereby inhibits the repair of DNA damaged by temozolomide. Patients with a tumor that contained a methylated MGMT promoter benefited more from the drug than patients whose tumor contained an unmethylated MGMT promoter.

    Clinical Practice
    1004-1010

    A 23-year-old nurse presents for evaluation after having five episodes of syncope at work during the previous three months. All the episodes occurred while she was standing and were characterized by a feeling of light-headedness lasting one to two seconds and then an abrupt loss of consciousness. Two of the episodes caused falls that resulted in facial trauma. The syncope was brief and not associated with incontinence; it was followed by severe fatigue but no confusion. How should the patient be evaluated and treated?

    Review Article
    1011-1023

    New therapeutic strategies have emerged along with our understanding that disturbances of iron homeostasis, impaired proliferation of erythroid progenitor cells, and blunted erythropoietin response occur in anemia of chronic disease. This review discusses advances in our knowledge of the causes and management of the condition.

    Images in Clinical Medicine
    1024
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    A 32-year-old woman presented with a three-day history of tenderness and swelling of the left breast. Physical examination revealed a subcutaneous fibrous lesion that was linear and cordlike. The patient was given nonsteroidal antiinflammatory drugs. The ...

    e9
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    This 33-year-old man had had a burn injury to his arm as a child. He presented with a rapidly growing ulcer in the burn scar.

    Case Records of the Massachusetts General Hospital
    1025-1032

    A 59-year-old woman was incidentally found to have an adrenal cortical nodule on abdominal computed tomography for evaluation of a colovesical fistula. Two years earlier, she had been found to have mild hypertension, which proved difficult to control with antihypertensive medication. She was slightly obese. How should she be evaluated?

    Editorials
    1034-1036

    One of the most consistent findings in health research is the gap between evidence and practice. It is estimated that the care received by 30 to 40 percent of patients in the United States and the Netherlands does not conform to currently available ...

    1036-1038

    Primary brain tumors often resist treatment; the most common brain tumor in adults, glioblastoma, kills patients within a median of a year after diagnosis, even with aggressive surgical resection and radiotherapy. This dismal outcome has not substantially ...

    Correspondence
    1039-1041

    To the Editor: Hohnloser et al. (Dec. 9 issue),1 who conducted the Defibrillator in Acute Myocardial Infarction Trial (DINAMIT), assume that implantable cardioverter–defibrillator (ICD) therapy early after myocardial infarction decreases the rate of ...

    1041-1043

    To the Editor: Taylor et al. (Nov. 11 issue)1 show that isosorbide dinitrate plus hydralazine increased survival in a group of black patients with heart failure. The authors state that a retrospective analysis of the Vasodilator Heart Failure Trial (...

    1044-1046

    To the Editor: I have been interested in the coverage by the media of the studies of intradermal influenza vaccination by Belshe et al.1 and Kenney et al.2 (Nov. 25 issue). We had quite similar findings — albeit without a control group — over 50 years ...

    1046-1047

    To the Editor: The National Vaccine Advisory Committee, of which I am a member, agrees with the Institute of Medicine (IOM) vaccine-financing committee1 that legislative measures and additional funding are needed, but we differ with its recommendations ...

    1047-1048

    To the Editor: The medical mystery in the January 20 issue1 involved a seven-month-old boy who had congenital Cushing's syndrome and a severe acneiform rash (Figure 1A), with growth of pubic hair. The child's motor development was grossly delayed. ...

    1048-1049

    To the Editor: Spontaneous coronary dissection is a rare but serious complication in the peripartum and postpartum periods.1,2 However, we disagree with Frimerman and Meisel (Nov. 11 issue)3 about the diagnosis in the Images in Clinical Medicine article....

    1049-1050

    To the Editor: We report the case of a nulliparous, 70-year-old woman with long-standing type 2 diabetes mellitus who had regression of the disease during treatment of chronic myeloid leukemia with imatinib, an antineoplastic agent. Type 2 diabetes ...

    Book Reviews
    1051-1052

    From the first to the last chapter, from AIDS to zoster, this book is a gem. It covers the field of vaccines from basic to clinical science and on to public health and the implementation of vaccines, focusing on the successes but not avoiding the areas ...

    1052-1053

    The term “paradigm shift” became something of a cliché in the late 20th century, but there are few who would argue with its use to describe the revolution in global thinking that occurred less than five years ago, when the world community decided that it ...

    1054-1055

    Two theses form the structure of this book: that the Black Death was the bubonic form of the rodent disease Yersinia pestis and was spread by fleas, and that it killed 60 percent or more of Europe's population with its first strike alone. To sustain these ...

    1055-1056

    Alfred Jay Bollet is a distinguished academic rheumatologist who has chaired the department of medicine at two medical schools. The first edition of Plagues and Poxes, published in 1987, focused on the waxing and waning of specific diseases and their ...

    Corrections
    1056

    Immunosuppressive Drugs for Kidney Transplantation Review Article, N Engl J Med 2004:351;2715-2729.. On page 2720, in Table 2, the mechanism of action of azathioprine should have read, “Converts 6-mercaptopurine to 6-thioinosine-5'-monophosphate,” rather ...

    1056

    The Threat of an Avian Influenza Pandemic Perspective, N Engl J Med 2005:352;323-325.. On page 324, in Panel B of the figure, the label “Neuraminidase inhibitor” should have been attached to a blue oval, rather than to a gold stalk representing ...

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