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March 31, 2005  Vol. 352 No. 13

Perspective
1283-1285

A panel of experts advising the FDA rendered an ambivalent verdict on the future of COX-2 inhibitors. As Dr. Susan Okie reports, they voted unanimously that each of the drugs significantly increases users' risk of cardiovascular events. Nonetheless, the ...

1285-1287

Recent revelations about the adverse cardiovascular effects of COX-2 inhibitors have generally been framed as a story of regulatory failure, in which the FDA has failed in its mission to protect the public. Rebecca Eisenberg writes that this simplistic ...

1287-1290

Some aspects of the psychological experiences of war bind veterans together across temporal and national boundaries. Dr. Matthew Friedman states that while new treatments have changed the landscape of hope, we must prepare for some unprecedented ...

1289

Fifteen percent or more of some populations of veterans of the Vietnam War and the 1991 Gulf War have received diagnoses of post-traumatic stress disorder (PTSD).1,2 Given this history and the fact that U.S. troops in Iraq and Afghanistan are serving for ...

1290-1292

As of early February, the federal government has banned payments by drug companies to any employee of the NIH and has implemented broad restrictions on employees' outside activities and financial arrangements. In addition, the NIH is reviewing its ...

Original Articles
1293-1304

In men, low-dose aspirin prevents myocardial infarction but not stroke. In this large study of low-dose aspirin in healthy women, the opposite was found: there was no reduction in the risk of myocardial infarction, but the risk of stroke was significantly decreased owing to a reduction in the risk of ischemic stroke with a small increase in the risk of hemorrhagic stroke. Thus, low-dose aspirin for cardiovascular prevention appears to have different effects in men and women.

1305-1316

Stroke or transient ischemic attack due to intracranial arterial stenosis is usually treated with warfarin. The results of the current trial refute this practice and suggest that warfarin results in an increased mortality rate. Aspirin (1300 mg per day) is the recommended therapy.

1317-1323

In 15 renal-transplant recipients with a functioning graft and cutaneous Kaposi's sarcoma, cyclosporine was stopped and sirolimus was started. All skin lesions in all patients regressed within six months. The switch from cyclosporine to sirolimus did not destabilize the graft.

1324-1334

In a randomized trial, the combination of morphine and gabapentin led to better pain control than either agent alone in patients with diabetic neuropathy or postherpetic neuralgia. The dose of each agent was lower when used in combination than when used alone. Adverse effects were not more severe with the combined formulation.

Review Articles
1335-1342

    Most terrorist attacks have involved explosive devices. This review explains the mechanisms of blast injuries. Primary blast injuries may produce rupture of the tympanic membranes, pulmonary damage, air embolization, and rupture of a hollow viscus. There may also be blunt trauma, burns, toxic inhalations, and injuries caused by projectiles and the collapse of buildings. This article explains the strategies for the initial stabilization of patients and for identification of the severity of blast injuries, as well as approaches to treatment.

    1343-1356

      It is important to recognize chronic inflammatory demyelinating polyneuropathy, which has features in common with the acute variant of inflammatory demyelinating polyneuropathy (Guillain–Barré syndrome), since corticosteroids, intravenous immune globulin, plasma exchange, and immunosuppressive agents may ameliorate its course. This review summarizes present knowledge about clinical presentation, diagnostic criteria, and diagnostic procedures involved in assessing this condition, as well as its current management.

      Images in Clinical Medicine
      1357
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      A 59-year-old woman fell from a horse and injured her left elbow. Four days later she sought evaluation for persistent swelling of her arm. On examination, the patient had a small, clean wound over the olecranon; there were no signs of infection. Diffuse ...

      e13
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      A 57-year-old woman with chronic renal insufficiency had refused dialysis for two years. She was found in respiratory distress. Diffuse deposits of tiny white crystalline material were observed on her skin. Initial laboratory studies showed a blood urea ...

      Case Records of the Massachusetts General Hospital
      1358-1364

        A 73-year-old man was admitted to the hospital because of three days of fever and pain and weakness in his leg muscles that caused difficulty walking. He had begun taking atorvastatin several months earlier and had recently traveled to Cape Cod and South Carolina. There was mild leukopenia and thrombocytopenia, with elevated levels of creatine kinase. A diagnostic procedure was performed.

        Editorials
        1366-1368
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        Recently, in New York, the geneticist Luigi Luca Cavalli-Sforza began a brilliant seminar with this introduction: “To understand the present, you have to understand history, and to understand biology, you have to understand evolution, because evolution is ...

        1368-1370

        The Warfarin–Aspirin Symptomatic Intracranial Disease (WASID) Trial, funded by the National Institute of Neurological Disorders and Stroke and reported by Chimowitz et al.1 in this issue of the Journal, was a careful comparison of these two therapies in ...

        1371-1373

        Improvements in immunosuppressive therapy during the past decade have brought us closer to the day when long-term acceptance of organ allografts will be routine. These achievements, however, have run up against an important limitation: death of the ...

        1373-1375

        Neuropathic pain is a complex, costly condition resulting from a primary lesion or dysfunction in any part of the nervous system, from the peripheral receptor to the brain. Degenerative spine disease, diabetes, herpes zoster, compression and entrapment ...

        Clinical Implications of Basic Research
        1376-1378

        A screening assay of FDA-approved drugs identified ceftriaxone and other β-lactam antibiotics as potential therapies for amyotrophic lateral sclerosis (ALS) and other neurologic disorders. The results of experiments in a mouse model of ALS provide support for this hypothesis and suggest that ceftriaxone could also be used to delay the onset of ALS.

        Correspondence
        1379-1381

        To the Editor: Berkley et al. (Jan. 6 issue)1 studied the prevalence and outcome of bacteremia among 19,339 children admitted to a rural hospital in Kenya. Most of the children were less than five years of age. Applying rigorous methods despite difficult ...

        1381-1384

        To the Editor: Hu et al. (Dec. 23 issue)1 show that both increased adiposity and reduced physical activity are strong and independent predictors of death from all causes in the Nurses' Health Study. We observed very similar findings among both men and ...

        1384-1385

        To the Editor: Although comparing the performance of a test of fecal DNA with that of a fecal occult-blood test is appealing, it would have been better if Imperiale et al. (Dec. 23 issue)1 had chosen to use fecal occult-blood tests with higher ...

        1386

        To the Editor: The measurements of motor responses after treatment with levodopa reported by the Parkinson Study Group (Dec. 9 issue)1 were taken too soon. The brief half-life of blood-borne levodopa is not related to the very slow rates of accumulation ...

        1387

        To the Editor: Emre et al. (Dec. 9 issue)1 report “moderate improvements” with rivastigmine in patients with dementia associated with Parkinson's disease. We believe that the small size of the effect, significant side effects, and overlooked biases in ...

        1387-1388

        To the Editor: In her Perspective article (Dec. 23 issue),1 Okie reviews the dilemma raised by illness on the Supreme Court. The public's right to know the health status of the justices reflects issues similar to those raised by a president's illness.2,3 ...

        1388-1389

        To the Editor: Most Americans, like Mullan, in the Perspective article on the Latin American School of Medicine (Dec. 23 issue),1 do not see the whole picture of Cuban medicine. President Fidel Castro may be generous to international students, but he ...

        1389-1390
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        To the Editor: A 52-year-old woman underwent Holter monitoring to evaluate palpitations. She did not report any other symptoms. Physical examination was unremarkable. An electrocardiogram obtained with the patient at rest was normal, with a rate of 90 ...

        Book Reviews
        1391-1392

        The primary aim of this book is to codify the risks of reproductive technologies, both for children and for society. In the process, health law professor Philip Peters defines the obligations of society, parents, physicians, other health care providers, ...

        1392-1393

        In September 2004, a woman from Belgium gave birth to a child after receiving an ovarian-tissue transplant. This was a culmination of several efforts to preserve fertility in women who undergo treatment for cancer. Radiotherapy and chemotherapy are ...

        1393-1394

        The fear of genetic discrimination in life insurance pervades much of the discussion about the issue. Although editor Mark Rothstein does not ignore this fear, he has drawn together a group of authors who present intelligent and well-reasoned views of the ...

        1394

        For several years, Genetic Disorders and the Fetus has belonged with the classic textbooks on the shelf of every geneticist involved in genetic medicine. Because the book approaches each topic in depth, it is an invaluable reference not only for ...

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