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April 28, 2005  Vol. 352 No. 17

Perspective
1739-1741
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A new era for online public access to the biomedical literature is about to begin, states Dr. Robert Steinbrook. As of May 2, the NIH has asked the investigators it funds to submit voluntarily to PubMed Central an electronic copy of any scientific report, ...

1741-1744

    The characterization of newly identified genes has led investigators to challenge previous models of the regulation of iron homeostasis in health and its dysregulation in disease. Drs. Robert Fleming and Bruce Bacon describe hepcidin and iron homeostasis.

    1744-1746

    Dr. John Goldman writes that this year, four research groups independently discovered that most patients with polycythemia vera and some with myelofibrosis and essential thrombocythemia have an identical acquired point mutation in the Janus kinase 2 (JAK2)...

    1746-1748
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    “Lung mass?” the patient said slowly. “What are you talking about?” In this essay, Dr. Danielle Ofri describes how a “routine visit” atmosphere was suddenly annihilated by the specter of cancer, and how the pleasantries of a getting-to-know-you meeting ...

    Original Articles
    1749-1759
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    During four consecutive winters, prospective surveillance was conducted in cohorts of 608 healthy elderly patients and 540 adults with chronic heart or lung disease, and viral studies were also performed in 1388 adults hospitalized for acute cardiopulmonary conditions. Respiratory syncytial virus (RSV) infections developed annually in 3 to 7 percent of healthy elderly patients and in 4 to 10 percent of high-risk adults. In the hospitalized cohort, RSV infection accounted for 11 percent of patients with pneumonia, 11 percent of those with chronic lung disease, and 7 percent of those with asthma.

    1760-1768

    The role of multidetector-row computed tomography (CT) in the diagnosis of pulmonary embolism remains to be determined. In this study, the combined use of multidetector-row CT and D-dimer assays allowed pulmonary embolism to be excluded without the need for lower-extremity ultrasonography.

    1769-1778

    Mutations in the HFE gene are associated with hemochromatosis. In this large study of an ethnically and racially diverse population, homozygosity for C282Y mutations in the HFE gene was more common in non-Hispanic whites (0.44 percent) than in Native Americans (0.11 percent), Hispanics (0.027 percent), blacks (0.014 percent), Pacific Islanders (0.012 percent), or Asians (0.000039 percent). Most C282Y homozygotes had elevated serum ferritin levels and transferrin saturation.

    1779-1790

    Polycythemia vera, essential thrombocythemia, and myelofibrosis are idiopathic myeloproliferative diseases. These investigators identified a mutation in a gene that encodes JAK2, a key signaling protein in hematopoietic progenitor cells. The mutation causes constitutive activation of JAK2, which in turn gives cells proliferative and survival advantages over normal cells.

    Review Article
    1791-1798

    Thrombosis of the cerebral veins and sinuses affects mainly young adults and children. This potentially disabling or fatal condition is usually not diagnosed until a week after the onset of symptoms. This review article describes the clinical presentations of the disorder such as those that occur after a head injury or lumbar puncture. Therapeutic options include anticoagulation, thrombolysis, and measures to control intracranial hypertension.

    Images in Clinical Medicine
    1799
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    A 74-year-old woman with a history of von Recklinghausen's disease presented with infiltrating lobular carcinoma of the left breast (T2N0M0 [stage IB], according to the tumor–node–metastasis [TNM] staging system). On physical examination, the patient had ...

    e16
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    This 24-year-old woman was 30 weeks' pregnant with twins. She vomited and noticed an acute onset of a large central scotoma in the right eye.

    Case Records of the Massachusetts General Hospital
    1800-1808

    A 48-year-old man came to the neurology clinic because of progressive weakness of his arms and legs and pain in the left leg. Enlargement of the sciatic nerve and multiple spinal nerve roots was seen on imaging studies. The patient's 29-year-old nephew had been given a diagnosis of neurofibromatosis; no other family members were known to be affected. A diagnostic procedure was performed.

    Editorials
    1810-1812

      It is ironic that respiratory syncytial virus (RSV) infection in adults, though recognized for several decades, has been overlooked, at least in part, because of the importance of RSV in the pediatric population. The report by Falsey et al. in this issue ...

      1812-1814

      Rapid and accurate diagnosis of pulmonary embolism will improve survival and quality of life because treatment decreases mortality and the likelihood that thromboembolic pulmonary hypertension or the post-thrombotic syndrome will develop. The paramount ...

      Clinical Implications of Basic Research
      1815-1816

      A member of the platelet-derived growth factor family (PDGF-CC) is necessary and sufficient to induce neovascularization in two models of ischemia.

      Correspondence
      1817-1819

      To the Editor: Stampfer et al. (Jan. 20 issue)1 suggest that “women who consume up to one drink per day have less cognitive impairment . . . than nondrinkers,” on the basis of the authors' data from the Nurses' Health Study and findings reported in the ...

      1819

      To the Editor: Nguyen et al. (Feb. 3 issue)1 report on the effect of the U.S. varicella vaccination program on disease-related mortality. The effectiveness of such programs also includes reducing severe varicella-associated complications. In Italy, from ...

      1819-1820

      To the Editor: Falini et al. (Jan. 20 issue)1 report an abnormal cytoplasmic localization of nucleophosmin (NPM) in 35 percent of specimens from patients with acute myelogenous leukemia. In these patients the NPM gene was mutated, which resulted in a ...

      1820-1822

      To the Editor: We believe Meyerhardt and Mayer's discussion of regional, targeted therapies for colorectal cancer (Feb. 3 issue)1 is incomplete. Regional infusion of interleukin-2 or interferon alfa through the hepatic artery, combined with chemotherapy, ...

      1822-1824
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      To the Editor: In regard to the review of insulin analogues by Hirsch (Jan. 13 issue),1 recurrent hypoglycemia is a major impediment to the achievement of good metabolic control, as defined by the Diabetes Control and Complications Trial.2 Furthermore, ...

      1824-1825

      To the Editor: We report a case of asymptomatic dissection of the descending aorta (type B aortic dissection) with silent renal hypoperfusion. A small, nonfunctioning kidney and a contralateral hypertrophied kidney were identified after symptomatic ...

      1825-1827

      To the Editor: An important concern with respect to protecting human research participants is that institutional review boards (IRBs) have insufficient resources.1 However, there are few reports of the actual costs of IRB review.24 To estimate the cost ...

      Book Reviews
      1828
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      When I was asked to review this book, I was taken aback, since I truly didn't understand what “infections of leisure” are. The title, although playful, does not quite capture the scholarliness of this multiauthored book, which is published by the American ...

      1828-1829

      In Howard Markel's engaging book, the second word of the title is a good clue that the author writes for the general reader rather than for the specialist. The book contains an introduction and an epilogue, with each of the six intervening chapters ...

      1829-1830

      At the start of the 20th century, tuberculosis was the second leading cause of death in the United States. One hundred years later, it does not figure among the top 20 causes. Improvements in housing and sanitation, decreased crowding, and the ...

      1830-1831

      During the past decade, there has been a substantial rise in the number of antibiotic-resistant infectious organisms. Antimicrobial resistance is important because of its effect on the success and cost of antimicrobial treatment and on the treatment of ...

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