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January 27, 2005  Vol. 352 No. 4

Perspective
323-325

The greatest worry is that human-to-human transmission may begin to occur if there is a change in the viral genome. Even without genetic change, writes Dr. Arnold Monto, some inefficient spread among humans may now be expected.

325-328

Recent events offer an opportunity to consider the appropriate role of the promotion of prescription drugs. Ernst Berndt states that although changes in FDA policy are promising, industry must also address the imbalance between risk information and ...

328-330

Dr. Eric Cassell discusses a recent biography of Stanley Milgram that details the "obedience experiments" that made him famous. Milgram's research carries implications for important issues in medicine: the role of inappropriate obedience as a source of ...

330-332

Wegener's syndrome is a rare systemic disorder that involves multiple organs. Dr. Paul Bacon writes that uncovering the driving forces behind both the persistence of granulomata and the shift from localized to systemic disease is a major challenge.

Original Articles
333-340

This investigation was conducted in Thailand after a young girl and her mother died from acute viral pneumonia and an aunt with whom the girl had lived also had severe viral pneumonia. Samples from the mother and aunt were positive for avian influenza (H5N1) infection.

341-350
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Apart from glycemic control, there is no treatment for diabetic neuropathy. Thus, identifying potentially modifiable risk factors is crucial for the development of new therapies.

351-361
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This randomized trial examined the effect of adding etanercept to standard therapy in order to maintain disease remissions in patients with Wegener's granulomatosis. Only 49 percent of patients remained in remission throughout the trial, and etanercept did not result in a higher rate of sustained remission than placebo.

362-372

Hypertrophic cardiomyopathy is usually caused by mutations in sarcomere proteins, but in some patients such mutations are not found. This study identified mutations in genes encoding enzymes involved in glycogen metabolism as causes of hypertrophic cardiomyopathy. Thus, glycogen storage diseases may sometimes present as hypertrophic cardiomyopathy, owing to accumulation of glycogen-filled vacuoles in myocytes.

Clinical Practice
373-379

A 47-year-old woman with a history of breast cancer presents with confusion and dehydration. The serum calcium level is 18.0 mg per deciliter. She has postural hypotension and low central venous pressure. The serum phosphorus level is 5.0 mg per deciliter, the blood urea nitrogen level 80 mg per deciliter, the serum creatinine level 2.0 mg per deciliter, and the albumin level 3.3 g per deciliter. Bone scintigraphy reveals no evidence of skeletal involvement by the tumor. How should she be treated?

Review Article
380-391

    The β-lactamases are the major bacterial defense of gram-negative bacteria against β-lactam antibiotics. This review details the many types of β-lactamases, explains how they can be detected, and summarizes information on the genetics of this form of resistance. The authors also suggest strategies for clinical management and prevention of this difficult type of antibiotic resistance.

    Images in Clinical Medicine
    392
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    A 33-year-old woman presented with malaise, bloody nasal discharge, nasal crusting, and arthralgia. On examination, disconjugate gaze and protrusion of the right eye with scleritis were found. Serologic evaluation revealed elevated acute-phase reactants. ...

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    A 56-year-old man who had undergone replacement of the mitral and aortic valves then underwent aortobifemoral bypass surgery. The postoperative course was complicated by retroperitoneal bleeding.

    Case Records of the Massachusetts General Hospital
    393-403

      A 14-year-old boy was evaluated because of slow growth and delayed puberty. His growth chart showed that about four years earlier his rate of weight gain had slowed from approximately the 50th to the 25th percentile. He was otherwise asymptomatic. Hand radiographs showed a bone age of 12 years 6 months. A diagnostic procedure was performed.

      Editorials
      405-407

      As the year 2004 progressed, so did conditions favoring the start of an influenza pandemic. The first warning came in January, when Thailand and Vietnam reported fatal human cases of avian influenza caused by the H5N1 strain of influenza A virus. That ...

      408-409

      The discovery of insulin some 80 years ago changed type 1 diabetes from an imminently lethal disease to a chronic condition, and clinical care evolved from preventing death to preventing disability. Large-scale studies defined the natural history of the ...

      Correspondence
      410-414

      To the Editor: In the important study by Walsh et al. (Sept. 30 issue),1 the most unexpected finding was the difference in response rates between the liposomal amphotericin B group and the caspofungin group among patients who had aspergillosis at ...

      414-415

      To the Editor: Solomon et al. (Nov. 4 issue)1 suggest that the ocular chlamydia that causes trachoma can be eliminated by a single mass antibiotic treatment. Two years after distributing oral azithromycin in a village, they identified only a single ...

      415-416

      To the Editor: In their recent articles on rising health care costs, economists Paul Ginsburg (Oct. 14 issue)1 and Joseph Newhouse (Oct. 21 issue)2 and presidential candidates John Kerry and George Bush (Oct. 28 issue)3 do not directly address the well-...

      416-418
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      To the Editor: In his Clinical Practice article on Bell's palsy, Gilden (Sept. 23 issue)1 recommends treatment of the patient in the vignette with oral prednisone. The Cochrane Collaboration2 has pointed out that the statement of the American Academy of ...

      418-419

      To the Editor: In their review of pulmonary hypertension, Farber and Loscalzo (Oct. 14 issue)1 suggest that chronic hypoxia causes pulmonary hypertension by producing structural changes in the vasculature. This widely accepted view postulates two major ...

      419-420

      To the Editor: In reference to the discussion of pernicious anemia in Case 30-2004 (Sept. 23 issue),1 the practice in the United Kingdom for many years has been a regimen of four intramuscular injections of 1000 μg of hydroxocobalamin (an injectable form ...

      420-421

      To the Editor: West Nile virus is a flavivirus that has caused seasonal outbreaks of disease in humans since its introduction into the United States in 1999. The clinical presentation is highly variable, ranging from asymptomatic disease to mild ...

      Book Reviews
      422

      In the absence of well-reasoned skepticism, medical practice can become enraptured with the potential of new technological advances. In this insightful how-to book on health care, Welch provides a comprehensive overview of current challenges in cancer ...

      422-423

      In this excellent and timely book, George Prendergast has created a primer for academically trained laboratory scientists about the challenges of developing modern drugs. The growing expectation among the public that scientific advances in cancer research ...

      424

      Several outstanding books describe the science and clinical practice of hematopoietic stem-cell transplantation (HSCT), but information in these works generally is based on data collected from studies in adult patients. HSCT plays an important role in the ...

      425

      Modern therapy for childhood cancer is a double-edged sword. With judicious combinations of chemotherapy, radiotherapy, and surgery, as well as supportive care, physicians can design treatment protocols that will secure long-term disease-free survival in ...