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January 13, 2005  Vol. 352 No. 2

Perspective
115-117

Malaria kills up to 3 million people per year worldwide. Jeffrey Sachs writes that the goals of the U.N. Millennium Project will not be met in large areas of the world if we continue with business as usual.

117-119

Dr. Gail Morrison discusses the cost of medical education, which has been spiraling upward for the past 20 years. How, she asks, do we stop this vicious circle of increasing tuition and student debt?

119-121

Déjà vu, short-lived amnesia, the epigastric aura, hallucinations of smell, disorders of language, and out-of-body experiences can all be pointers to a disturbance of function in the temporal lobes. The elegance of clinical neurology, writes Dr. Adam ...

121-124

    A ruptured cerebral aneurysm is an intracranial catastrophe, associated with very high morbidity and mortality. Drs. Dilantha Ellegala and Arthur Day describe how outcomes have substantially improved over the past 30 years.

    Original Articles
    125-134

    Interns often work shifts lasting more than 24 hours. Since they usually get little sleep under such circumstances, they are at high risk for motor vehicle crashes. This study found that interns have more than double the risk of being in a motor vehicle crash after working an extended shift, as compared with the risk after a normal shift.

    135-145
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    Neurologic deficits are common after surgery for subarachnoid hemorrhage due to a ruptured intracranial aneurysm. In this study, the use of mild intraoperative hypothermia (target body temperature, 33°C) to prevent neurologic deficits after surgery had no protective effect. However, the patients enrolled in this study were at relatively low risk, and it is unclear whether intraoperative hypothermia may have benefits in higher-risk patients.

    146-153

    Among a large cohort of patients with cerebral arteriovenous malformations, the risk of cerebral hemorrhage declined significantly after radiosurgery, even before there was angiographic evidence of obliteration of the malformation. The risk of hemorrhage declined further after angiographic obliteration, although it was not eliminated.

    154-164
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    A study of the records of more than 50,000 men with newly diagnosed prostate cancer found that androgen-deprivation treatment, either as gonadotropin-releasing hormone agonists or orchiectomy, increases the risk of fracture and of hospitalization due to fracture.

    Clinical Practice
    165-173

    A mother brings in her eight-year-old son for evaluation after he is suspended from riding the school bus for jumping out of his seat, teasing other children, and not following directions. He spends two to three hours a night with homework that he never successfully completes. His mother wants to know whether he has attention deficit–hyperactivity disorder. How should he be evaluated and treated?

    Review Article
    174-183

    In the 1990s, the value of glycemic control in the management of diabetes became incontrovertible. The interest in producing insulin formulations that are safer than previous formulations and that more closely duplicate the basal and mealtime components of endogenous insulin secretion has yielded insulin analogues with action profiles that afford more flexible treatment regimens and a lower risk of hypoglycemia. This article examines the use of these newer insulins in clinical practice.

    Images in Clinical Medicine
    184
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    A 47-year-old man with chronic schizophrenia was hospitalized after prolonged hypothermia. The initial electrocardiogram revealed Osborn waves (arrowheads) similar in amplitude to the R waves. Characteristic sinus bradycardia and prolongation of the QRS ...

    e2
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    A 23-year-old woman from Cameroon had nonpainful, mobile, firm lumps in both breasts. Mammography showed multiple serpiginous calcifications.

    Case Records of the Massachusetts General Hospital
    185-194

    A 35-year-old woman noticed unsteadiness of gait that worsened over several days, followed by a headache and nausea. She increasingly lost her balance, and on one occasion she fell.

    Editorial
    196-197

    Policies can be very difficult to change, and advocates of change who claim a logical or scientific foundation need valid, reliable, and convincing data. An example of the process is the policy of regulating truck drivers' hours of service in order to ...

    Correspondence
    198-199

    To the Editor: The statement from the International Committee of Medical Journal Editors (ICMJE) with respect to the registration of clinical trials (Sept. 16 issue)1 advocates the use of www.clinicaltrials.gov as a registry. I am astonished by this ...

    199-200

    To the Editor: Go et al. (Sept. 23 issue)1 estimated the glomerular filtration rate (GFR) with the simplified four-variable Modification of Diet in Renal Disease (MDRD) formula. Almost half the subjects in their study population (41.7 percent) did not ...

    200-201

    To the Editor: Petrylak et al. (Oct. 7 issue)1 conclude that combination treatment with docetaxel and estramustine should be used as initial therapy for androgen-independent metastatic prostate cancer. Several key points that are necessary to reach this ...

    201-203

    To the Editor: Two articles in the September 23 issue, by Bloche1 and Mariner,2 give the impression that the issue of managed-care liability is settled — that the Supreme Court has “made up its mind” to immunize managed-care organizations (MCOs) from ...

    203-204
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    To the Editor: Piccirillo (Aug. 26 issue)1 recommends that acute bacterial sinusitis be treated with 500 mg of amoxicillin three times daily. Pneumococcus is an important cause of this condition and, at present, 40 percent of pneumococci in the United ...

    205
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    To the Editor: Hotez et al. (Aug. 19 issue)1 suggest waiting for socioeconomic reforms to eliminate hookworm infection, a condition that afflicts 740 million persons. However, chronic anemia is an enormous handicap and limits the prospects of a better ...

    205-207
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    To the Editor: In her otherwise excellent review of thiazolidinediones, Dr. Yki-Järvinen (Sept. 9 issue)1 states that “the effects of rosiglitazone or pioglitazone on the size of LDL [low-density lipoprotein] particles have not been studied in a double-...

    207-208

    To the Editor: We wish to report initial success in treating a boy with surfactant protein C deficiency. The patient was first admitted to the hospital at five months of age with severe respiratory distress that followed a viral respiratory infection. ...

    Book Reviews
    209-210

    Because the structural role of the skeletal system is obvious, and because the hardness of mineralized bone matrix and the prolonged duration of adult bone mass emphasize its solidity, the dynamic and multifunctional nature of the skeleton are not an ...

    210-211

    Cambridge, England, where the authors of Soft Tissue Rheumatology are from, is known for its scientifically rigorous approach to medicine, and this book is very effective at capturing the current knowledge in the field of soft-tissue rheumatology. The ...

    211

    Male reproductive health has become an important focus of health services in many countries. Poor semen quality is a widespread problem, and both young and elderly men often seek medical advice regarding symptoms of hypogonadism, including sexual ...

    211-212

    This book — whose authors include 10 Chicago urologists, 12 other U.S. urologists, and an eminent urologist from Ireland — reviews the anatomy, pathophysiology, and causes of benign prostatic hypertrophy, or hyperplasia (BPH), and discusses the assessment ...

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