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February 10, 2005  Vol. 352 No. 6

Perspective
531-533

A quiet but burgeoning market in reproductive tourism stretches around the globe and already encompasses thousands of people. Debora Spar describes the explosive growth of high-tech reproduction that has led to a lopsided market in baby making and to ...

534-535

The majority of the financial support for continuing medical education in the United States comes from drug companies and other commercial entities. Dr. Robert Steinbrook reports on the Accreditation Council for Continuing Medical Education's updated "...

536-538

One of the most challenging problems in hematology is the heterogeneous group of disorders defined as myelodysplastic syndromes. Drs. Mario Cazzola and Luca Malcovati state that in the past 20 years, several therapeutic meteors have passed through the ...

Original Articles
539-548

Sudden emotional distress, such as that caused by an unexpected death, can sometimes produce severe transient left ventricular dysfunction. This stress-induced cardiomyopathy appears to be a form of myocardial stunning associated with marked sympathetic stimulation.

549-557

In a study of 43 patients with low-risk myelodysplastic syndromes, lenalidomide, a thalidomide derivative, ameliorated anemia and allowed the discontinuation of transfusions in over half the patients.

558-569

Although some kidney-transplant recipients with severe vascular rejection have antibodies against HLA antigens, others do not. Severe vascular rejection accompanied by accelerated hypertension, and even convulsions, resembles preeclampsia. Activating antibodies targeting the angiotensin II type 1 receptor have been found in preeclampsia, and the authors sought and detected such antibodies in patients with severe vascular rejection. These results suggest that a pathway mediated by a non-HLA, angiotensin II type 1 receptor may be involved in vascular rejection.

Special Articles
570-585

The authors estimate that routine HIV screening in health care settings with a 1 percent prevalence of HIV infection costs about $15,000 per quality-adjusted life-year gained. The cost remains below $50,000 when the prevalence of HIV is above 0.05 percent. When the potential benefits of reduced HIV transmission are excluded, screening populations with a 1 percent prevalence of HIV infection costs about $42,000 per quality-adjusted life-year gained.

586-595

This cost-effectiveness analysis compared routine screening for HIV with current detection of HIV through selective screening and patients who present with opportunistic infections. One-time screening cost $38,000 per quality-adjusted life-year gained when HIV prevalence is 1 percent, and $113,000 for the general population of the United States (0.1 percent prevalence). Screening for HIV has the potential to reduce the transmission of HIV and may be associated with lower cost-effectiveness ratios.

Clinical Practice
596-607

A 32-year-old man has a three-month history of difficulty sleeping. On questioning, he mentions that he drinks four to six glasses of wine three to four times per week. How should his case be assessed and managed?

Images in Clinical Medicine
608
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A 59-year-old woman had a six-month history of increasing shortness of breath. Echocardiography showed an abnormal mass in the right ventricle. Surgical resection was performed because of hemodynamic instability, and histologic evaluation revealed a ...

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A 17-year-old boy jumped over a fence and sustained an avulsion injury. The fifth finger was amputated, and the tendon of the flexor digitorum profundus muscle was completely pulled out. The finger was replanted microsurgically.

Case Records of the Massachusetts General Hospital
609-615

A 35-year-old man who had recently emigrated from Brazil had swelling and pain in his right nostril that had worsened over six months. A physical examination disclosed swelling and erythema of the right nasal vestibule, with tenderness and crusting. The lesion did not respond to antibiotic therapy. A biopsy disclosed necrotizing granulomatous inflammation without evidence of microorganisms. A diagnostic procedure was performed.

Editorials
617-619

Allograft rejection remains a major problem in renal transplantation, despite the substantial improvements in post-transplantation management that now result in fewer acute rejection episodes and better overall survival.1 Rejection can be an acute event ...

620-621

In the United States, HIV infection is generally discovered at an advanced stage, usually in the course of medical care and often during care for complications of AIDS. Earlier diagnosis would be far preferable, because it could speed access to ...

622

Each year thousands of reviewers contribute their expertise to peer review, a process that contributes critically to the quality of the Journal. The editors and the authors of the papers submitted to the Journal are grateful for the help of all our ...

Correspondence
623-624

To the Editor: We were pleased to see the article by Peters and colleagues (Oct. 21 issue)1 on exposure to traffic and the onset of myocardial infarction. The work they report is part of a larger study funded by the Health Effects Institute that also ...

624-627

To the Editor: To compare protected carotid-artery stenting with carotid endarterectomy, Yadav et al. (Oct. 7 issue)1 chose to study a group for which endarterectomy has been found to be only marginally better than medical therapy.2,3 Although the ...

627-628

To the Editor: Mannon et al. (Nov. 11 issue)1 describe the safety of anti–interleukin-12 antibody (anti–interleukin-12) for the treatment of active Crohn's disease. Among the 44 recipients of anti–interleukin-12 who could be evaluated at 18 weeks, no ...

628-630

To the Editor: The results of the placebo-controlled clinical trial of adjunctive dexamethasone in the treatment of tuberculous meningitis reported by Thwaites et al. (Oct. 21 issue)1 clearly indicate improved survival in the age group studied — patients ...

631

To the Editor: In Case 31-2004 (Oct. 14 issue),1 which involves a four-year-old boy with the hepatopulmonary syndrome, the minimal increase in the partial pressure of arterial oxygen (from 52 mm Hg while the boy was breathing room air to 69 mm Hg while ...

631-632

To the Editor: In an intriguing letter, Livingstone and Conway (Sept. 16 issue)1 propose that Rembrandt may have been stereoblind as a result of strabismus, as judged by the deviation of the pupils or the whites of the eyes in his self-portraits. We urge ...

633-634

To the Editor: A 57-year-old woman without hypertension or hypercholesterolemia who was receiving therapy with 75 mg of clopidogrel per day was admitted with transient dysarthria and diplopia. Initially, she had been treated with 100 mg of aspirin per ...

Book Reviews
635

Evidence that pediatric endocrinology has really come of age is the number of multiauthored books on the subject now on the market. Scientific progress inevitably makes many of the books outmoded, even when editors diligently strive to produce regular ...

636

Many young people and adults struggle with concerns about their body image and weight. According to the 2003 Youth Risk Behavior Survey, a national poll of high-school students that assessed various types of risk-related behavior, 6 percent of teenagers ...

636-638
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The miniature Stone Age statue of the Venus of Willendorf (circa 25,000 B.C.) is one of the earliest records of morbid obesity. If the Venus of Willendorf were alive today, she would certainly be interested in Obesity Surgery. This is not a textbook but, ...

638

We are living in a fast age with fast answers to complicated problems. As we drive to work we have “road rage,” and as we care for patients, a similar impatience can occur — a sort of “information rage,” whereby we are driven to make a quick decision, ...

Corrections
638

Continuing Medical Education (December 30, 2004;351:2889-92). On page 2889, statement B in Question 3 should have read, “Women should be screened for hepatitis B surface antigen,” rather than “Women should be screened for antibody to hepatitis B surface ...

638

Codeine Intoxication Associated with Ultrarapid CYP2D6 Metabolism Original Article, N Engl J Med 2004:351;2827-2831.. On page 2829, in Figure 1, the double arrows leading to codeine-6-glucuronide should have originated in the box representing codeine, ...

638

The Emergence of Physician-Owned Specialty Hospitals Health Policy Report, N Engl J Med 2005:352;78-84.. On page 83, under “A Temporary Compromise,” lines 5 and 6 of the first full paragraph should have read, “which President Bush signed into law on ...

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