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September 22, 2005  Vol. 353 No. 12

Perspective
1197-1199

    The FDA has again postponed a decision about making emergency contraception available to women without a prescription. Drs. Alastair Wood, Jeffrey Drazen, and Michael Greene write that this deserves serious scrutiny, since it appears to reflect political ...

    1199-1202

    The health savings account reflects a philosophical shift in emphasis from collective to individual responsibility for the management and financing of care. Dr. James Robinson explains that HSAs form the core of the emerging “consumer-directed” insurance ...

    1202-1204
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    Dr. Thomas Lee and Kinga Zapert write that employers struggling with rising health care costs are implementing their strategy for the post–managed-care era — a shift of costs and responsibility to the consumer.

    1205-1207

      Fifty years ago this week, President Dwight D. Eisenhower was playing golf at the Cherry Hills Country Club when he started to complain about an upset stomach. Later that day the president was hospitalized for acute myocardial infarction. Drs. Franz ...

      Original Articles
      1209-1223

      This study compared the effectiveness of four second-generation antipsychotic agents (olanzapine, risperidone, quetiapine, and ziprasidone) with that of an older agent, perphenazine, in patients with chronic schizophrenia. Olanzapine was the most effective agent but was associated with greater weight gain and more adverse metabolic changes. Perphenazine was as effective as risperidone, quetiapine, and ziprasidone.

      1224-1235
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      This article describes a new method of detecting autoantibodies against prostate cancer antigens in the serum of patients with prostate cancer. The method could add information to the standard test for prostate-specific antigen.

      1236-1244

      This randomized trial involving patients with early syphilis in Tanzania found that treatment with 2 g of azithromycin led to cure rates that were similar to those for penicillin G benzathine at both nine months (97.7 percent and 95.0 percent, respectively) and six months (85.5 percent and 81.5 percent, respectively). This single-dose, oral regimen may be particularly useful in settings in which there are shortages of sterile equipment and trained personnel.

      1245-1251

      This report describes three young children who died with severe staphylococcal sepsis after a rapidly progressive course, with necrotizing pneumonitis, coagulopathy, and cardiovascular collapse. At autopsy, all three were found to have bilateral adrenal hemorrhage with infarction, known as the Waterhouse–Friderichsen syndrome. The findings in these three children are similar to those usually seen with fulminant meningococcemia.

      Clinical Practice
      1252-1260

        A 41-year-old man with dyslipidemia, hypertension, and a history of myocardial infarction four years previously comes to establish care. The total cholesterol level is 155 mg per deciliter (4.01 mmol per liter), the low-density lipoprotein cholesterol level 72 mg per deciliter (1.86 mmol per liter), the high-density lipoprotein (HDL) cholesterol level 28 mg per deciliter (0.72 mmol per liter), and the triglyceride level 277 mg per deciliter (3.13 mmol per liter). What strategies can increase his HDL cholesterol level?

        Review Article
        1261-1273

          Primary biliary cirrhosis, a slowly progressive autoimmune liver disease characterized by portal inflammation and an immune-mediated destruction of the intrahepatic bile ducts, leads to decreased bile secretion and the retention of toxic substances within the liver. This review considers new data concerning both the autoimmune responses involved and the treatment of primary biliary cirrhosis.

          Images in Clinical Medicine
          1274
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          A 67-year-old man presented with an asymptomatic swelling in the lateral surface of the left thigh three years after resection of a carcinoma of the left colon and synchronous liver metastasis (tumor–node–metastasis stage T3N2M1, according to ...

          e11
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          This 44-year-old woman with increasing dyspnea had Ebstein's anomaly, an abnormality in the development of the tricuspid valve. She had declined heart transplantation. On echocardiography, a small left ventricle is seen next to massively dilated right ...

          Case Records of the Massachusetts General Hospital
          1275-1284

            A 68-year-old man noted a rash followed by periorbital swelling and muscular weakness. Several months before his hospital admission, he had had involuntary weight loss, and his physician had noted anemia. The results of an evaluation for gastrointestinal cancer were negative. Abdominal computed tomography disclosed a mass involving the spleen and retroperitoneum. A diagnostic procedure was performed.

            Editorials
            1286-1288

            Since the discovery of the effects of chlorpromazine in the 1950s, treatment of schizophrenia has relied on antipsychotic drugs that target dopamine D2 receptors. The effectiveness of these agents in reducing the intensity of patients' delusions and ...

            1288-1290

            In 2000, the American Cancer Society inaugurated a yearly report on guidelines for cancer detection. The latest update, published in 2005,1 is identical to the previous versions in its recommendation regarding screening techniques that have not changed in ...

            1291-1293

            The demonstration in Tanzania of equivalent efficacy of azithromycin and penicillin G benzathine for treating early syphilis and presumed early latent syphilis (rapid plasma reagin titer, ≥1:8) represents a potentially useful advance in syphilis control. ...

            Correspondence
            1294-1297

            To the Editor: Solomon and colleagues (June 23 issue)1 report that in the Valsartan in Acute Myocardial Infarction Trial (VALIANT), 19 percent of patients with heart failure, left ventricular dysfunction, or both, after myocardial infarction who died ...

            1297-1298

            To the Editor: Richardson et al. (June 16 issue)1 showed that, in relapsed multiple myeloma, bortezomib improved survival in comparison with high-dose dexamethasone. According to Trippoli et al.2 and Sonneveld et al.,3 life expectancy for patients with ...

            1298-1300

            To the Editor: Bill-Axelson et al. (May 12 issue)1 state that disease-specific mortality after 10 years of follow-up was reduced by 5.3 percentage points among men assigned to radical prostatectomy, favoring radical prostatectomy over watchful waiting. ...

            1300

            To the Editor: The use of the Oncotype DX assay in the study reported by Paik et al. (Dec. 30 issue)1 is an example of a conflict of interest. Most of the authors of the report are employed by, receive consulting fees from, or hold equity positions or ...

            1301-1302

            Editor's note: We received many letters on the Perspective article by Charo (June 16 issue).1 We publish two from each end of the spectrum.

            To the Editor: With regard to the Perspective article by Charo on conscience clauses, I am disappointed by the ...

            1302-1303

            To the Editor: U.S. veterans over the age of 65 years may be eligible to enroll in both the Veterans Affairs (VA) health care system and Medicare health maintenance organizations (HMOs).13 Although dual use of the systems has been described,4 use of ...

            Book Reviews
            1304-1305
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            Two hundred fifty years after the birth of James Parkinson and 188 years since he wrote his seminal treatise on the “shaking palsy,” the field of Parkinson's disease is expanding in exponential fashion. Recent insights into the genetic causes of familial ...

            1305

            On the basis of the title of this book, the reader may wonder if the intent is to develop a theory of multiple sclerosis as a primary axonal disease, as some investigators have suggested. Actually, the editor writes in the preface that “the title . . . is ...

            1306-1307

            The history of multiple sclerosis is in many ways the history of how medicine has moved from the simple observation and classification of disease to the complex probing of biologic systems using sophisticated new techniques. The chief clinical feature of ...