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May 19, 2005  Vol. 352 No. 20

Perspective
2043-2047
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Dr. Susan Okie writes about patients who have received traumatic brain injuries while fighting in the war in Iraq.

2047-2048

Each year, 10.7 million children under the age of five years die — 4 million during the first four weeks of life. Another 3.3 million are stillborn. Dr. Jelka Zupan discusses perinatal mortality in the less developed countries, which account for 98 ...

Original Articles
2049-2060

Cystatin C is a cysteine protease inhibitor that is freely filtered by the glomerulus and is therefore a measure of renal function. In this study of elderly persons, the serum cystatin C level was a better predictor of the risk of death and cardiovascular disease than was the serum creatinine level. Cystatin C is a useful alternative measure of renal function, as well as an effective prognostic tool.

2061-2068

A prior study of colon-cancer screening in men demonstrated that 30 percent of advanced colonic neoplasias found on colonoscopy would have been missed by flexible sigmoidoscopy. In this parallel study of women, the yield of flexible sigmoidoscopy was even lower: 65 percent of advanced lesions found on colonoscopy would have been missed by flexible sigmoidoscopy.

2069-2081

Asymptomatic newborns in whom infantile Krabbe's disease was diagnosed at or before birth and who underwent transplantation of umbilical-cord blood had progressive myelination and substantial gains in several developmental skills, although they continued to have substantial delays in gross motor function and language.

2082-2090

This case–control study in Tennessee assessed 635 persons 2 to 49 years of age with invasive pneumococcal disease and 6350 matched controls. Among those with asthma, the risk of invasive pneumococcal disease was about twice that among the controls; among those with high-risk asthma, the risk was more than three times as great. Asthma appears to be an independent risk factor for invasive pneumococcal disease. These data suggest that asthma should be an additional indication for pneumococcal vaccination.

Special Article
2091-2099

This cluster-randomized trial in rural Pakistan compared perinatal and maternal outcomes in control districts with the outcomes in districts in which traditional birth attendants were trained and were issued disposable delivery kits and in which obstetrical teams provided outreach clinics for antenatal care. Perinatal mortality was reduced significantly in the intervention districts.

Clinical Practice
2100-2109

    A seven-year-old girl is 130 cm tall (the 90th percentile for girls of the same age) and weighs 34.6 kg (above the 95th percentile), with a body-mass index of 20.5 (above the 95th percentile). Physical examination reveals no abnormalities aside from her excess weight. She eats fast food and drinks soft drinks regularly, has limited exercise, and watches television or uses the computer for hours each day. What should you advise?

    Images in Clinical Medicine
    2110
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    A three-year-old boy was playing with a small plastic ball while riding in the backseat of a motor vehicle driven by his father. The father heard a gasp, saw that the child was unconscious, and pulled to the side of the road. He suspected the child had ...

    e19
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    This 67-year-old man from Jamaica had a nodule excised from his left foot, and he was told he had a fungal infection. He did not seek medical attention until years later when he was unable to walk.

    Case Records of the Massachusetts General Hospital
    2111-2119
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    An 80-year-old man was admitted to the hospital because of shortness of breath. He had pleural effusions, edema of the legs, and a history of atrial fibrillation, several episodes of congestive heart failure, and increasing proteinuria. Laboratory studies revealed nephrotic-range proteinuria and an IgG paraprotein. A diagnostic procedure was performed.

    Editorials
    2121

    The war in Iraq has resulted in an unprecedented number of traumatic brain injuries to U.S. soldiers. As described by Okie in this issue of the Journal, 1 these soldiers have been saved from what in the past might have been a lethal injury by a ...

    2122-2124

    Chronic kidney disease is an important problem in the elderly and is associated with a high risk of kidney failure, cardiovascular disease, and death.1,2 The disorder is indicated either by a glomerular filtration rate (GFR) of less than 60 ml per minute ...

    2124-2126

    Krabbe's disease, or globoid-cell leukodystrophy, is an inborn error of lipid metabolism first described in 1916 in two children with spasticity who died in infancy and were found to have “diffuse sclerosis” of the brain.1 Prominent features of the brain ...

    Legal Issues in Medicine
    2127-2132

    George Annas reviews international and U.S. laws and U.S. Supreme Court decisions relevant to torture in wartime. He also discusses the controversy over physicians' roles in the torture of prisoners in the prisons at Abu Ghraib and Guantanamo Bay and argues that physicians have a special responsibility to prevent and report torture.

    Correspondence
    2133-2134

    To the Editor: The trial conducted by Mayer et al. (Feb. 24 issue),1 showing that recombinant activated factor VII (rFVIIa) is beneficial for treating acute intracerebral hemorrhage, for which treatment options are extremely limited, is very exciting. ...

    2134-2135

    To the Editor: List et al. (Feb. 10 issue)1 report encouraging results with regard to the efficacy of lenalidomide, a thalidomide analogue, in the treatment of patients with myelodysplastic syndromes and symptomatic anemia whose condition failed to ...

    2136

    To the Editor: Kobayashi et al. (Feb. 24 issue)1 report that a second mutation in the gene encoding the epidermal growth factor receptor (EGFR), one resulting in a threonine-to-methionine substitution at amino acid position 790 (T790M), was associated ...

    2137-2139

    To the Editor: Sanders et al.1 and Paltiel et al.,2 in their reports on the cost-effectiveness of screening for HIV infection (Feb. 10 issue), have added another level of evidence in support of broader HIV testing. It appears that the benefits of routine ...

    2139-2140
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    To the Editor: In his review of unhealthy alcohol use (Feb. 10 issue),1 Dr. Saitz does not address the important role that biomarkers can play in identifying and treating alcohol-use disorders. At least some patients with alcohol-use disorders are unable ...

    2140-2141
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    To the Editor: AIDS is a well-known predisposing condition for generalized histoplasmosis, which had been ruled out in the patient described in the Clinical Problem-Solving article by Goulet et al. (Feb. 3 issue).1 Idiopathic CD4+ lymphocytopenia2 is ...

    2141-2142

    To the Editor: Zidovudine was the first drug approved for the treatment of HIV infection and is still a mainstay of antiretroviral therapy. Patients taking zidovudine have an increase in the mean corpuscular volume, a variable that is often used to ...

    Book Reviews
    2143-2144
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    Is it really worth $40 per pack to smoke cigarettes? According to Duke University health economists, $40 is the real cost that a 24-year-old smoker should consider each time he or she purchases a pack of cigarettes. This amounts to $220,000 for men and $...

    2144-2145

    On February 27, the Framework Convention on Tobacco Control came into force, 90 days after ratification by the 40th signatory to this first health treaty negotiated under the auspices of the World Health Organization. The treaty codifies policy approaches ...

    2145-2146

    Chronic sleep deprivation, which probably affects at least one third of American adults, causes daytime sleepiness and disrupts daily life. Episodes of acute sleep deprivation may be even more common and occur across a spectrum of ages and occupations. In ...

    2146

    In the preface to this book, the authors point out that for thousands of years humans have used psychoactive substances to modify their perceptions and mood. Indeed, some observers believe that such behavior may be a defining characteristic of the human ...

    Corrections
    2146

    Elevated Plasma Factor VIII and D-Dimer Levels as Predictors of Poor Outcomes of Thrombosis in Children Original Article, N Engl J Med 2004:351;1081-1088.. On page 1084, in Table 1, the range for factor VIII among patients who had no initial elevation in ...

    2146

    Amiodarone or an Implantable Cardioverter–Defibrillator for Congestive Heart Failure Original Article, N Engl J Med 2005:352;225-237.. On page 226, in the right-hand column, line 8 of the first full paragraph should have read “aldosterone-receptor blocker,...

    2146

    U.K. Controlled Trial of Intrapleural Streptokinase for Pleural Infection Original Article, N Engl J Med 2005:352;865-874.. On page 870, in Figure 1, the number of patients receiving placebo who completed the trial should have been 221, not 206, as ...

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