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March 17, 2005  Vol. 352 No. 11

Perspective
1063-1066

Questions have been raised about the FDA's ability to fulfill one of its fundamental missions — to ensure that the benefits of prescription drugs outweigh their risks. In this article, Dr. Susan Okie investigates the FDA's ills.

1067-1070

    Given that scholars and researchers continue to rely on information, the work now performed by medical libraries will not disappear. But how, where, and by whom will it be done? Dr. Donald Lindberg and Betsy Humphreys envision one evolutionary scenario ...

    1068

    The library at my medical school has never been a better place to work. The journals are shelved in perfect order. The copying machines have no lines. Quiet, comfortable places in which to read are plentiful. The reason: hardly anyone goes there anymore.

    (...

    Original Articles
    1071-1080

    Using data from a clinical trial of celecoxib to prevent colorectal adenomas, these investigators analyzed cardiovascular events over a three-year follow-up period. There was a dose-related increase in the risk of a composite outcome of death from cardiovascular causes, myocardial infarction, stroke, or heart failure. The hazard ratio was 2.3 with a 200-mg dose and 3.4 with a 400-mg dose. These results raise concern that the use of celecoxib is associated with a serious risk of cardiovascular events.

    1081-1091

    When administered to patients for pain control after coronary-artery bypass surgery, valdecoxib and its intravenous prodrug, parecoxib, were found to be associated with an increased risk of cardiovascular thromboembolic events. These findings add to the growing concern that the use of COX-2 inhibitors increases the risk of cardiovascular events, particularly in persons who are at risk for such events.

    1092-1102

    In a clinical trial of chemoprevention for colorectal adenomas, the use of rofecoxib was found to be associated with a significantly increased risk of cardiovascular events, primarily myocardial infarctions and ischemic cerebrovascular events. Although rofecoxib has been removed from the market by the manufacturer, these data need to be carefully considered in making decisions about any future use of rofecoxib.

    1103-1111

    Neurologic deterioration followed by fatal encephalitis occurred in four patients who had received kidneys, liver, and an artery segment from the same donor. Multiple studies showed evidence of rabies virus in both central nervous system tissues from the four recipients and nerve tissue in the transplanted organs. The donor was thought to have been well before a subarachnoid hemorrhage. It was later learned that he had told friends of being bitten by a bat.

    Review Article
    1112-1120

    The serotonin syndrome is a potentially life-threatening drug reaction that may result from therapeutic medication use, self-poisoning, or interactions between drugs.

    Images in Clinical Medicine
    1121
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    A 41-year-old woman with a history of alcohol abuse, hypertension, and type 1 diabetes mellitus complicated by retinopathy, nephropathy, and end-stage renal disease presented with a five-month history of alopecia and fine, brittle scalp hair, diarrhea, ...

    e10
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    An afebrile 26-year-old man presented with a two-day history of a sore throat. He was unable to eat solids because of pain.

    Case Records of the Massachusetts General Hospital
    1122-1129

      A 10-year-old boy had pain in the right thigh that interfered with activities, awoke him at night, and was only slightly relieved by acetaminophen. Magnetic resonance imaging and radionuclide bone scans showed a large area of abnormality within the femur. Computed tomography–guided (CT) biopsy was not completed because of the patient's agitation, but CT images showed a small lytic lesion in the cortex surrounded by dense bone. A diagnostic and therapeutic procedure was performed.

      Editorials
      1131-1132

      This issue of the Journal contains three articles about the adverse cardiovascular effects of agents that selectively inhibit one form of prostaglandin endoperoxide synthase, commonly known as cyclooxygenase-2 (COX-2).13 This is part of a long bench-to-...

      1133-1135

      Approximately six years after the cyclooxygenase-2 (COX-2) inhibitors were approved for use in the United States, the results of three randomized, placebo-controlled trials provide new evidence about the cardiovascular risks of rofecoxib, celecoxib, and ...

      1135-1137

      Obesity has clearly become a major personal and public health problem for Americans; it affects many aspects of our society. In this issue of the Journal, Olshansky et al.1 make an important contribution to national discussions of the future of longevity ...

      Special Report
      1138-1145

      For the past 100 years or so, there has been a general trend toward increasing life expectancy in developed countries. In this Special Report, the authors argue that obesity, and perhaps infectious diseases, will lead to a decrease in life expectancy in the 21st century.

      Clinical Implications of Basic Research
      1146-1147

      Achieving appropriate levels of gene expression at the right time and the right place is an important goal of gene therapy. A new study shows one way to meet this goal.

      Correspondence
      1148-1149

      To the Editor: Hsu et al. report on a study (Dec. 2 issue)1 of catheter ablation and its effect on rhythm control in patients with atrial fibrillation and heart failure to support the notion that drug-free maintenance of sinus rhythm may be superior to ...

      1150-1151

      To the Editor: Alboni and colleagues (Dec. 2 issue)1 present data from a prospective study investigating the strategy of rhythm control in patients with paroxysmal atrial fibrillation by self-administration of antiarrhythmic agents (the “pill-in-the-...

      1151-1153

      To the Editor: In their article about cardiovascular events after acute infections (Dec. 16 issue),1 Smeeth et al. do not discuss alternative, time-honored explanations for the occurrence of cardiovascular events within three days after acute infections. ...

      1153-1154

      To the Editor: Altered nuclear transfer is a procedure that has been proposed as a morally acceptable means of procuring human embryonic stem cells.1 In their Perspective article, Melton et al. (Dec. 30 issue)2 appear to misunderstand, and therefore ...

      1154

      To the Editor: The Perspective article by Markel (Dec. 30 issue)1 contains two incorrect assertions. Galen, perhaps the first physician to base medicine on nature rather than on miracles or metaphysics, was born in Pergamum (now Bergama, Turkey), the ...

      1154-1155
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      To the Editor: In their review article on acute pericarditis, Lange and Hillis (Nov. 18 issue)1 estimate that in 9 of 10 patients with acute pericarditis, the cause of the disease is either idiopathic or viral. We suggest that this may change when the ...

      1155-1157
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      To the Editor: Simons (Nov. 18 issue)1 provides a comprehensive review of the advances in drug therapy with histamine H1-receptor antagonists. However, the author states that there is no current evidence supporting the use of such therapy for asthma — a ...

      1157-1158

      To the Editor: Polyomavirus type BK nephropathy is an aggressively destructive disease occurring in up to 8 percent of patients with renal allografts,1,2 with rates of graft loss within one year of 30 to 65 percent.3,4 There is no therapy with proven ...

      Book Reviews
      1159-1160

      Michael Marmot's book offers a drink from the fire hose of social epidemiology. If you want to understand why the health of people living in the United States, the richest and most powerful country in world history, lags far behind the health of people in ...

      1160-1161

      Love thy neighbor: an American paradox? The United States has one of the highest levels of church attendance in the world, but when it comes to health care, it seems that churchgoers find it difficult to love their neighbors in the way that secular ...

      1161-1162

      One of my favorite articles in the medical literature appeared in these pages a little more than a decade ago. “The Last Well Person” (N Engl J Med 1994;330:440-1) was an Occasional Note written by a Tennessee physician, Clifton Meador. It was a fictional ...

      1162-1163
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      Peter Curtis-Prior's 57-chapter book took five years to prepare and contains contributions from 106 authors. Its length reflects how ubiquitous essential fatty acids and their metabolites are in human and animal tissues. The clinical implications of ...

      Corrections
      1163
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      Multiple Myeloma Review Article, N Engl J Med 2004:351;1860-1873.. On page 1869, in the second full paragraph in the left-hand column, lines 11 through 12 should have read, “a decrease in the levels of the proteins that inhibit apoptosis,” rather than “...

      1163
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      Acute Pericarditis Clinical Practice, N Engl J Med 2004:351;2195-2202.. On page 2198, in the right-hand column, lines 8 through 13 should have read, “ST-segment elevation also may be seen in patients with an early repolarizing pattern. The most reliable ...

      1163

      Rofecoxib, Merck, and the FDA Correspondence, N Engl J Med 2004:351;2875-2878.. In the letter by Topol, in Table 1 on page 2878, the 95 percent confidence interval for the number of total deaths and cardiovascular events in study group 090 should have ...

      1163

      Oral Erythromycin and the Risk of Sudden Death Correspondence, N Engl J Med 2005:352;301-304.. In the letter by Schoenholtz, lines 1 through 4 of the second full paragraph on page 302 should have read, “Between thioridazine and haloperidol are the `...

      e11
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      Tinea Circinata Images in Clinical Medicine, N Engl J Med 2005:352;e6.. In the legend for this image, which appeared only in the Web version of the Journal, the coauthor's name should have read “Anthony Papadopoulos,” rather than “Papadopolous,” as ...