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March 3, 2005  Vol. 352 No. 9

Perspective
855-857

In September 2004, a federal appeals court upheld a class-action lawsuit on behalf of physicians who charged that their patients' insurance companies had conspired to curb reimbursement for the physicians' services. Drs. Aaron Kesselheim and Troyen ...

857-859

Robert Huckman and Gary Pisano state that the most obvious requirement for wide adoption of a medical innovation is that physicians should be willing to use it instead of existing techniques. As a result, many institutions began facing turf wars between ...

860-862

    Dr. James Cimino and Suzanne Bakken write about the wide spread effect of PDAs on health care today. These trends promise to continue as students and professionals in the fields of social work, nursing, and medicine struggle to get the accurate, current ...

    862-864

    The past 25 years have seen an astounding confluence of seven new observations that have resulted in fundamental changes in our understanding of this important disease, writes Dr. Thomas Bird.

    Original Articles
    865-874

    In this randomized trial involving 454 patients with pleural infections that required antibiotic therapy and chest-tube drainage, there was no benefit from the use of intrapleural streptokinase in terms of survival, the need for surgery, the length of the hospital stay, or the resolution of radiographic abnormalities.

    875-883

    Most patients with mitral regurgitation are asymptomatic at diagnosis, and the optimal timing of or need for mitral-valve surgery is uncertain. This study shows that the use of Doppler echocardiography to quantify mitral regurgitation accurately predicts the clinical outcome. Patients with an effective regurgitant orifice of 40 mm2 or more have an increased risk of death and should promptly be considered for surgery even if they have no symptoms. These findings could have a substantial effect on clinical practice.

    884-894

    Four genes have been implicated in Alzheimer's disease, yet collectively they are estimated to account for less than half the attributable risk. The results of this study implicate variants in the ubiquilin 1 gene on chromosome 9 as risk factors for late-onset Alzheimer's disease. Additional studies to confirm the association and to determine the magnitude and mechanism of the risk effect are warranted.

    Special Article
    895-904

    An analysis of 460 phase 1 oncology trials in adults sponsored by the Cancer Therapy Evaluation Program at the National Cancer Institute between 1991 and 2002, including 11,935 participants, found an overall response rate of 10.6 percent and a toxicity-related death rate of 0.5 percent. Response rates and death rates varied among the different types of trials.

    Review Article
    905-917

    Antithyroid drugs, which have been available for more than half a century, are important in the management of hyperthyroidism, particularly in patients with Graves' disease, who have a high response rate. Since the responses of patients vary and these agents have potentially serious side effects, a working knowledge of their complex pharmacology is required. This review article considers recent pharmacologic and clinical data related to the use of these compounds.

    Images in Clinical Medicine
    918
    • Free Full Text

    A 51-year-old woman presented with weight loss (despite good appetite), palpitations, tremor, and heat intolerance. On examination, she had typical features of Graves' disease, including a diffusely enlarged thyroid, periorbital edema, and proptosis, as ...

    e8
    • Free Full Text

    An 18-year-old man presented with a six-month history of an increasing mass on his back. He noticed serous drainage from a sore on the left lateral wall of his chest.

    Clinical Problem-Solving
    919-924

      A 48-year-old airline mechanic from Belize presented to the emergency department with fever and altered mental status. Two weeks earlier, fever, myalgias, and dry cough had developed. Maximal daily temperatures reached 41.1°C, and one week later he awakened unable to speak.

      Editorials
      926-928

      It is paradoxical that Hippocrates established in ancient times the clinical importance of pleural infections, yet only a few high-quality trials have studied this common condition during the intervening 2400 years. Just five years ago, published ...

      928-929

      The use of an evidence-based approach to the treatment of valvular heart disease has been hampered by the lack of rigorous data on predictors of the clinical outcome. The timing of surgery in patients with asymptomatic mitral regurgitation has been ...

      930-932

      Cancer is the most common cause of death in the United States, with more than 500,000 people succumbing each year.1 Despite dramatic advances in the treatment of certain cancers, the vast majority of patients with metastases die from the cancer. These ...

      Clinical Implications of Basic Research
      933-934

      A new compound counters infection with Mycobacterium tuberculosis in a mouse model.

      Correspondence
      935-937

      To the Editor: The low rates of survival among adults who received cord-blood transplants in the two observational studies reported by Laughlin et al. and Rocha et al. (Nov. 25 issue)1,2 are not representative of what is being achieved nowadays with ...

      937-939

      To the Editor: The results of the Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) Trial1 (Nov. 11 issue)1 are probably the product of an underpowered trial. Only 8290 of a planned 14,100 patients were enrolled, and the primary ...

      939-940

      To the Editor: Low birth weight resulting from intrauterine growth retardation is a known risk factor for the later appearance of insulin resistance. Hofman et al. (Nov. 18 issue)1 conclude that children who are small at birth because of prematurity, ...

      941-942

      To the Editor: Desai et al. (Nov. 25 issue) conducted a well-designed trial comparing radial-artery and saphenous-vein grafts.1 In contrast to our conclusions,2 they conclude that radial arteries had superior angiographic outcomes. However, on ...

      942-944

      To the Editor: We commend Cantor and Baum for calling attention to the problem of pharmacists' refusals to dispense emergency contraception (Nov. 4 issue).1 However, the authors' recommendation for resolving this problem by means of a notice or referral ...

      944
      • Free Full Text

      To the Editor: Were you aware that Ratiu and Talos, whose Web-only Image in Clinical Medicine appeared in the December 2 issue of the Journal, 1 had an article in the Journal of Neurotrauma in May 20042 with the same title (“The Tale of Phineas Gage, ...

      944-945

      To the Editor: Acute lymphangitis is caused most often by Streptococcus pyogenes and occasionally by a range of other bacteria.1 We describe a patient in whom acute lymphangitis developed, with no evidence of infection.

      The patient was a 27-year-old ...

      Book Reviews
      946-947

      Does the medical profession really need yet another textbook of medicine? The editors of ACP Medicine certainly think so, considering that they have produced this 2859-page book in two volumes, a joint venture between the American College of Physicians ...

      947-948

      The nature and scope of problems regarding health literacy — the degree to which the lay public has the capacity to obtain, process, and understand the basic information and services needed to make appropriate decisions regarding their health — are ...

      948

      It would be unusual to find more than a single chapter devoted to urticaria and angioedema in most medical textbooks, including those devoted to allergies and to dermatology. So at first blush, I wondered how one could even consider developing a nearly ...

      949

      The late Thomas Fitzpatrick, one of the leading dermatologists of the past 50 years, liked to quip that the three greatest problems faced by mankind were “the atom, the ovum, and the melanocyte.” Many people want their skin to be either lighter or darker ...

      Corrections
      950

      Clinical Features and Prognostic Factors in Adults with Bacterial Meningitis Original Article, N Engl J Med 2004:351;1849-1859.. On page 1853, in the right-hand column, lines 5 through 8 of the second full paragraph should have read, “N. meningitidis was ...

      950

      Military Medical Ethics Book Review, N Engl J Med 2005:352;312-314.. On page 312, in the last paragraph in the right-hand column, lines 1 through 3 should have read, “public health physicians Victor W. Sidel and Barry Levy, former officers in the Public ...

      950

      Early Vascular Risk Factor Modification in Type 1 Diabetes Editorial, N Engl J Med 2005:352;408-409.. On page 409, lines 3 and 4 of the right-hand column should have read, “From the Divisions of Endocrinology and Metabolism (B.A.P.) and Neurology (V.B.),” ...