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April 21, 2005  Vol. 352 No. 16

Perspective
1627-1630

In February, the U.S. Supreme Court agreed to consider the legality of the Bush administration's effort to outlaw physician-assisted suicide in Oregon. With recent events focusing national attention on end-of-life decisions, the Court's acceptance of ...

1630-1633
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The story of Terri Schiavo should be disturbing to all of us, writes Dr. Timothy Quill. Distortion by interest groups, media hyperbole, and manipulative use of videotape characterized this case and demonstrate what can happen when a patient becomes more a ...

1632

If you haven't seen Million Dollar Baby and plan to do so, stop reading. There is much to like about the film. As a father of athletic young women, I loved the physicality of the young female fighter's boxing scenes, though I live in dread of the sucker ...

1633-1636

Drs. Samiran Nundy and Chandra Gulhati discuss a new rule enacted by the government of India that allows foreign pharmaceutical companies and other interested parties to conduct clinical trials of new drugs in India at the same time that trials of the ...

Original Articles
1637-1645

Since Chlamydia pneumoniae is believed to be involved in the pathogenesis of coronary artery disease, this study investigated whether antibiotic therapy with azithromycin to eliminate C. pneumoniae would reduce the risk of coronary events. There was no beneficial effect associated with azithromycin. This study, along with that reported by Cannon et al. in this issue of the Journal, does not support the idea that C. pneumoniae has a significant pathogenic role in coronary artery disease.

1646-1654

Studies have suggested that infection with Chlamydia pneumoniae may have a role in the pathogenesis of coronary artery disease. This study casts doubt on the idea, since two years of treatment with gatifloxacin, an antibiotic with bactericidal activity against C. pneumoniae, had no beneficial effect on clinical outcomes. This study complements the results of the study by Grayston et al. reported in this issue of the Journal, which led to a similar conclusion.

1655-1666

In this randomized trial of children with polyarticular juvenile rheumatoid arthritis, methotrexate achieved slightly better outcomes than leflunomide; at 16 weeks the respective rates of 30 percent improvement were 89 percent and 68 percent. In each group, the clinical improvement observed at 16 weeks was maintained at 48 weeks.

1667-1676

ARLTS1 is a member of a large family of genes that encode proteins with a variety of functions, such as membrane and vesicular transport. These investigators provide evidence that ARLTS1 is a tumor-suppressor gene and that a polymorphic variant of ARLTS1 is associated with familial cancer.

Clinical Practice
1677-1684

A 66-year-old man was suddenly unable to speak, follow directions, or move his right arm and leg. He received tissue plasminogen activator within 90 minutes. Four days later, his speech was limited to effortful answers of yes or no. He could not walk or use his right arm, and self-care tasks required maximal assistance. What advice would you offer him and his family regarding rehabilitation for his disabilities?

Review Article
1685-1695

In this review article, Göran Hansson, a pioneer in the study of the role of inflammation in atherosclerosis and coronary artery disease, summarizes new ideas on the pathogenesis of acute coronary syndromes.

Images in Clinical Medicine
1696
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A 22-year-old woman with a history of a seizure disorder presented to the emergency department after having a rash for three days and a fever for one day. The rash began as a maculopapular distribution on the neck and chest and rapidly progressed to ...

e15
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A 23-year-old woman with swelling in her right third finger was prescribed cephalexin and indomethacin for tenosynovitis. Over the next several days, a painful rash developed on the patient's extremities.

Case Records of the Massachusetts General Hospital
1697-1704

    A 30-year-old woman had a two-month history of increasing pain in the left side of her chest and in her arm and shoulder, followed by cough, hemoptysis, and pleuritic chest pain. Chest radiographs showed an infiltrate in the lingula of the left lung. Her symptoms improved minimally with antibiotic therapy. Radiographs of the chest disclosed a large anterior mediastinal mass. A diagnostic procedure was performed.

    Editorial
    1706-1709

    Two large, high-quality, and convincingly negative clinical trials for the secondary prevention of coronary heart disease,1,2 published in this issue of the Journal, raise questions as to whether we are at the end of the road or should move on to new ...

    Legal Issues in Medicine
    1710-1715

    The parents of Terri Schiavo, a Florida woman who was in a persistent vegetative state, objected to her husband's decision to discontinue artificial nutrition, and a protracted legal battle ensued. The Florida courts ordered the removal of Schiavo's feeding tube to provide care consistent with her wishes. The judicial decisions in the Schiavo case were consistent with legal precedent, but the interference in the case by the legislative and executive branches of the Florida and U.S. governments was unprecedented.

    Correspondence
    1716-1718

    To the Editor: Chan et al. (Jan. 20 issue)1 conclude that aspirin plus a proton-pump inhibitor is superior to clopidogrel in the prevention of recurrent ulcer bleeding. The authors of the study and Cryer, in an accompanying editorial,2 state that the ...

    1718-1720

    To the Editor: Landon et al. (Dec. 16 issue)1 report an increased risk of hypoxic–ischemic encephalopathy, but not perinatal death, among the infants of women who attempted vaginal birth after prior cesarean delivery as compared with those who underwent ...

    1720-1721

    To the Editor: Gragoudas and coworkers (Dec. 30 issue)1 report that in a trial of pegaptanib in patients with exudative macular degeneration, patients treated with intravitreal injections of 0.3 mg of active substance had less functional deterioration ...

    1721-1722

    To the Editor: In their review of metabolic and cardiovascular risk factors affecting patients infected with the human immunodeficiency virus (HIV), Grinspoon and Carr (Jan. 6 issue)1 recommend the guidelines of the National Cholesterol Education Program ...

    1723-1724

    To the Editor: In Case 35-2004, Moschella et al. (Nov. 18 issue)1 discuss a patient with nephrogenic fibrosing dermopathy. There is growing evidence that the fibrosis may not be restricted to the skin but may be systemic, often involving the subcutaneous ...

    1724-1725

    To the Editor: Activating mutations of the DNA sequence encoding the catalytic kinase domain of the epidermal growth factor receptor (EGFR) have been shown to underlie responsiveness to gefitinib in some cases of non–small-cell lung cancer.13 Oncogenic ...

    1725-1726

    To the Editor: Waldenström's macroglobulinemia is a lymphoproliferative disorder characterized by a lymphoplasmacytic bone marrow infiltrate and high levels of a monoclonal IgM in serum.1 A number of chemotherapeutic agents and, more recently, monoclonal ...

    Book Reviews
    1727

    The prevailing system for the diagnosis of anxiety disorders in the United States derives from the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), published by the American Psychiatric Association in 1980. DSM-III ...

    1727-1728
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    This book is “state of the art,” an observation that is both a compliment and a caution. The editors have brought together many of the leading researchers in the field to assemble an authoritative reference that will be useful for students, residents, ...

    1728-1729

    “Consciousness is the guarantor of all we hold to be human and precious. Its permanent loss is considered equivalent to death, even if the body persists in its vital signs.” It is with this allusion to the permanent vegetative state that Gerald Edelman ...

    1730

    Especially since the 14th Dalai Lama received the Nobel Peace Prize in 1989, the Tibetan tradition has gained center stage in the West. This book is a simple and well-written introduction to the Tibetan variant of Buddhism, a global religion that has ...

    Corrections
    1731

    Angiotensin-Receptor Blockade versus Converting–Enzyme Inhibition in Type 2 Diabetes and Nephropathy Original Article, N Engl J Med 2004:351;1952-1961.. On page 1952, in the Abstract, the first sentence of the Results section should have stated (with ...

    1731
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    Bell's Palsy Correspondence, N Engl J Med 2005:352;416-418.. Line 3 of the letter by Djalilian should have referred to “neurotologists,” rather than “neurologists,” as printed.

    1731
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    The Unturned Stone Clinical Problem-Solving, N Engl J Med 2005:352;489-494.. On page 492, the histologic specimens shown in Figures 2 and 3 were from the distal ileum, not from the colon, as indicated in the legend for Figure 2. Colonic biopsy specimens ...

    1731

    Acquired Acrodermatitis Enteropathica Images in Clinical Medicine, N Engl J Med 2005:352;1121.. The coauthor's name should have read Shail Busbey, rather than Bushey, as printed. We regret the error.

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