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April 14, 2005  Vol. 352 No. 15

Perspective
1511-1513
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Elie Wiesel writes, “This is one of those stories that invite fear. Now we know. During the period of the past century that I call Night, medicine was practiced in certain places not to heal but to ...”

1514-1516

The combination of underweight in children and overweight in adults, frequently coexisting in the same family, is a relatively new phenomenon in developing countries undergoing the nutrition transition. Dr. Benjamin Caballero describes this nutrition ...

1516-1518

    Patriots' Day, a Massachusetts holiday, is also the date of the annual Boston Marathon, a 42-km footrace. As traditional as the marathon itself, state Drs. Benjamin Levine and Paul Thompson, is the use of the event for research and of its runners as ...

    Original Articles
    1519-1528

    Daily treatment with a controller medication is currently recommended for patients with mild persistent asthma. These investigators compared lung function and the number of episodes of asthma in the presence and absence of daily treatment with either an inhaled corticosteroid or a leukotriene-receptor antagonist; all patients were instructed to initiate inhaled corticosteroid treatment should asthma symptoms arise. There were no significant differences among the groups in morning peak flow or the time to the first exacerbation of asthma.

    1529-1538

    Formation of the chromosomal translocation t(15;17) was studied in cases of acute promyelocytic leukemia (APL) that developed after treatment of cancer with mitoxantrone, a topoisomerase II poison. In the presence of the drug, topoisomerase II damaged DNA in ways that caused breakpoint “hot spots” capable of forming t(15;17).

    1539-1549

    Cardiac resynchronization improves left ventricular function and functional status in patients who have left ventricular systolic dysfunction and interventricular dyssynchrony due to a conduction delay. In a randomized trial comparing medical therapy alone with medical therapy plus cardiac resynchronization, combined therapy was associated with a significant reduction in the risk of death from any cause.

    1550-1556
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    The development of hyponatremia during a marathon may have grave consequences. In this study of 488 runners in the 2002 Boston Marathon, 13 percent had hyponatremia, and 0.6 percent had critical hyponatremia (serum sodium concentration, <120 mmol per liter). Weight gain during the race, longer racing time, and body-mass-index extremes were associated with hyponatremia. Better efforts to monitor and regulate fluid balance may reduce the frequency of this largely preventable condition.

    1557-1564

    This study implicates a variant of a gene encoding PMCA2, a plasma-membrane calcium pump, in the degree of severity of hearing loss caused by the mutation of another gene. The findings suggest that the mutant PMCA2 allele, which is carried by approximately 3 to 5 percent of persons of European descent, is a risk factor for presbycusis and noise-induced hearing loss. Studies to investigate this possibility are warranted.

    Review Article
    1565-1577

    A global resurgence of malaria has taken place as a result of a lapse in preventive efforts and the emergence of resistance to standard antimalarial drugs. New therapies are available, but because of social, economic, and clinical factors, the use of older drugs persists. This review considers current approaches to the prevention and treatment of malaria.

    Images in Clinical Medicine
    1578
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    A 33-year-old woman had dyspnea for six months, with intermittent fever. She was admitted to the hospital with worsening dyspnea, hypoxia, and patchy bilateral pulmonary consolidations. Computed tomography showed large, central pulmonary filling defects (...

    e14
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    A woman with a 25-year history of asthma underwent high-resolution multislice helical computed tomographic scanning. Videos before and after the inhalation of albuterol reveal an increase in the airway caliber from a segmental bronchus to an eighth-...

    Case Records of the Massachusetts General Hospital
    1579-1587

      A 32-year-old pregnant woman sought genetic counseling after her fetus had been found to have an abnormal karyotype. Ultrasonography for the evaluation of an ovarian cyst at 14 weeks of gestation showed increased fetal nuchal translucency; amniocentesis showed extra material on the short arm of fetal chromosome 18. The mother recalled a family history of birth defects. Diagnostic testing was performed, and the role of preimplantation genetic testing for future pregnancies was discussed.

      Editorials
      1589-1591

      Current national1 and international2 guidelines recommend regularly scheduled treatment with inhaled corticosteroids for patients with mild persistent asthma. This recommendation is supported by solid evidence that such treatment achieves and maintains ...

      1591-1594

      Therapy-related acute myeloid leukemia (AML), often presenting as therapy-related myelodysplasia, is the most serious long-term complication of cancer chemotherapy. This disease offers a unique opportunity to study leukemogenesis by relating specific ...

      1594-1597

      One quarter to one third of patients with congestive heart failure have some form of intraventricular conduction abnormality that is manifested as an increased QRS duration on the electrocardiogram.1,2 The most common pattern is left bundle-branch block. ...

      1598-1599

      Since the early days of modern genetics, researchers have largely shut their ears to the “background noise” of genetic modifiers that modulate the expression of mendelian traits. Because modifier genes complicate regular patterns of inheritance and ...

      Clinical Implications of Basic Research
      1600-1602

      Deleting a gene critical to the development of Plasmodium berghei in the liver transforms the sporozoite — the infectious stage of the pathogen — into an organism that acts as a vaccine.

      Correspondence
      1603-1605

      To the Editor: Ridker and colleagues (Jan. 6 issue)1 suggest that statin therapy be targeted to achieve a C-reactive protein (CRP) level of less than 2.0 mg per liter in patients with a recent acute coronary syndrome. Having examined the data presented ...

      1605-1607

      To the Editor: Paik et al. (Dec. 30 issue)1 imply that their multigene assay provides more objective and reproducible information than an assigned tumor grade. Any RNA-based gene-expression profile of neoplasms is heavily dependent on tumor cellularity. ...

      1607-1608

      To the Editor: Rappley's review of attention deficit–hyperactivity disorder (Jan. 13 issue)1 omits important diagnoses that can mimic attention-deficit disorders — sleep disorders and convulsive disorders. Increased daytime behavioral problems occur with ...

      1608-1610

      To the Editor: As noted by Rupprecht and Gibbons (Dec. 16 issue),1 delay before postexposure prophylaxis against rabies is initiated may result in treatment failure and death.2 The incubation period for rabies in dogs could be much longer than 10 days. ...

      1610

      To the Editor: In Case 38-2004 (Dec. 16 issue),1 Richardson et al. provide an excellent discussion of the treatment options available for patients with multiple myeloma. In my opinion, the diagnostic workup for the patient is missing two important tests ...

      1611

      To the Editor: In reply to the letter from Grass (Jan. 13 issue),1 we would like to clarify that www.clinicaltrials.gov was expanded in October 2004 to allow for the registration of any clinical trial that has been approved by a human subjects review ...

      1611-1613

      To the Editor: Recent studies suggesting that C-reactive protein (CRP) may be an important risk marker for cardiovascular disease have stimulated the demand for testing. Nevertheless, many physicians may be unfamiliar with high-sensitivity CRP ...

      1613-1614

      To the Editor: Hyperthermia has long been recognized as a cause of altered mental status after a marathon, but in recent years exercise-associated hyponatremia has become increasingly common.1 In 2003, there was an unexpected increase in the number of ...

      Book Reviews
      1615

      Irrespective of the difficulty in determining its incidence, misconduct in research — fraud, falsification, and plagiarism — has a corrosive effect on the scientific enterprise. It violates the norms of scientific integrity, leads researchers down ...

      1615-1616

      Armed with support from the Robert Wood Johnson Foundation, Deyo and Patrick make a well-documented — if depressing — argument that doctors, scientists, and laypersons alike are far too easily seduced by industry hype for merely new (as opposed to truly ...

      1616-1617

      The controversy at the center of this book regarding the use of placebo in trials in developing countries came to light in 1997. The studies in question were evaluating the efficacy of zidovudine in the prevention of perinatal transmission of HIV, even ...

      1618-1619

      The essays in this book arose from a conference dedicated to the “History of Human Experimentation during the Twentieth Century,” held in 2001 at the University of Lübeck in Germany. Eight of the 23 contributors (including the editors) live in Germany; ...

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