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October 13, 2005  Vol. 353 No. 15

Perspective
1541-1544

In this series of essays, physicians write about the unprecedented scale and impact of the disaster caused by Hurricane Katrina. The authors discuss the immediate challenges they faced and address the public health concerns in the aftermath. Unexpected ...

1542
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When dawn broke on Tuesday, August 30, it was clear that everything was completely different. I looked out the window to discover that the hotel was surrounded by three to five feet of water, and there was water filling most of Canal Street. There was an ...

1544-1546
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Never before Hurricane Katrina has a disaster caused such a massive displacement of a U.S. population. Never before has the country seen so vividly the exposure and vulnerability of displaced persons — primarily the poor, the infirm, and the elderly. We ...

1545
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When Hurricane Katrina hit, my wife and I responded in a fashion common to many New Orleans residents: we “vertically evacuated” to the lower floors of one of the city's larger hotels. This had been a successful routine for many years. But when the storm ...

1547-1549
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The terms “malfeasance” and “negligence” have been bandied about by many who are frustrated by the official response to Hurricane Katrina. Beginning with the evacuation orders before the hurricane's landfall, some public officials appeared to be trying ...

1549
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On Tuesday, August 31, in the wake of Hurricane Katrina, Sylvester Donaldson (not his real name) landed at the emergency room of the Ochsner Clinic Foundation in New Orleans, desperately ill, having missed more than a week of dialysis treatments. He ...

1550-1553

The skyscraper housing the oldest continuously operating hospital in the country, New Orleans' Charity Hospital, was erected in 1936, to replace a centuries-old complex that had grown rapidly to keep pace with the health needs of impoverished southern ...

1551
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There is nothing that I had ever witnessed in the United States to which I could compare the scene outside the New Orleans Convention Center. Thousands upon thousands of people were collected on the boulevard — from infants to the elderly to people in ...

Original Articles
1555-1563

In this randomized trial in subjects between 15 and 65 years old, a new acellular pertussis vaccine was safe and had an efficacy of 92 percent against documented, symptomatic Bordetella pertussis infections. Among controls, the incidence of pertussis was 370 per 100,000 person-years. Vaccination of adults and adolescents could prevent pertussis and reduce the transmission of B. pertussis to young children.

1564-1573

Osteopontin, a matrix protein with a variety of functions, was identified in the malignant cells of pleural mesothelioma. Serum levels of osteopontin distinguished subjects with exposure to asbestos who did not have malignant disease from patients with exposure to asbestos who had pleural mesothelioma.

1574-1584

In this multicenter, randomized trial, neonates with moderate or severe hypoxic–ischemic encephalopathy randomly assigned to whole-body hypothermia had a significantly reduced risk of death or moderate or severe disability at 18 to 22 months of age. This study suggests that whole-body hypothermia may improve substantially the outcomes for infants with hypoxic–ischemic encephalopathy.

1585-1590

Antibodies against ganglionic acetylcholine receptors were detected in a patient with severe autonomic failure. Dramatic clinical improvement followed the removal of the antibodies by plasma exchange.

Review Article
1591-1603

Malignant mesothelioma is an aggressive tumor of serosal surfaces, such as the pleura and the peritoneum. This tumor was once rare, but its incidence is increasing worldwide, probably as a result of widespread exposure to asbestos, a factor with which it is associated. The authors review advances made in the past 5 to 10 years in the understanding, diagnosis, and management of mesothelioma.

Images in Clinical Medicine
1604
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A 52-year-old man from southern Louisiana with a history of nonalcoholic steatohepatitis presented to the emergency room with a report of severe bilateral lower-leg pain and swelling. He had ingested raw oysters three days before presentation. The pain ...

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This 38-year-old woman with rheumatoid arthritis had complete remission after therapy with methotrexate. Radiographs were taken to assess the treatment. This radiograph was taken one year before treatment.

Case Records of the Massachusetts General Hospital
1605-1613

A 60-year-old man was evaluated at the hospital because of renal failure. He had been well until a trip to Colorado three months earlier; one week after returning he reported fatigue, edema, and a rash on his arms and legs. Laboratory evaluation revealed anemia, renal insufficiency, microscopic hematuria, and proteinuria. Serum complement levels were decreased. A skin biopsy showed leukocytoclastic vasculitis. Testing for cryoglobulins and antineutrophil cytoplasmic antibodies was negative. A diagnostic procedure was performed.

Editorials
1615-1617

There is increasing evidence and awareness that pertussis is not just a disease of children. Although most severe disease and almost all mortality occur in young infants, the overall disease burden is increasingly shifting to adolescents and adults.1 ...

1617-1618

In this issue of the Journal, Pass et al.1 remind us yet again that the fallout from the once uncontrolled use of asbestos will remain with us for years to come. Thankfully, primary prevention of mesothelioma and the far more prevalent consequence of ...

1619-1620

Hypoxic–ischemic encephalopathy is an important cause of death and disability in full-term infants. The incidence of moderate or severe hypoxic–ischemic encephalopathy has remained essentially unchanged over the past 20 years, at 1.5 to 2 per 1000 live ...

Sounding Board
1621-1623

Dr. Elias Zerhouni, director of the National Institutes of Health, discusses translational and clinical research and presents a new plan to provide additional financial support for this important area of investigation.

Clinical Implications of Basic Research
1624-1625

A new candidate vaccine, designed to prevent infection by Mycobacterium tuberculosis, protects against a virulent and prevalent isolate in a mouse model.

Correspondence
1626-1628
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To the Editor: In the article by Van Meurs et al. (July 7 issue)1 on the use of inhaled nitric oxide for preterm infants with severe respiratory failure, the authors suggest that inhaled nitric oxide is ineffective in infants weighing less than 1500 g. ...

1629-1630

To the Editor: Crowther and colleagues ( June 16 issue)1 conclude that treatment of gestational diabetes mellitus reduces serious perinatal morbidity. However, we have some reservations.

For one, blood glucose monitoring and more attentive care of the ...

1630-1631

To the Editor: Lau et al. (June 30 issue)1 studied pegylated interferon for the treatment of hepatitis B e antigen (HBeAg)-positive chronic hepatitis B. Overall, HBeAg seroconversion was highest among patients treated with pegylated interferon ...

1632-1633

To the Editor: In the review article by Snead and Gibson (June 30 issue)1 on the recreational use of γ-hydroxybutyric acid (GHB), it is stressed that GHB is undetectable in current toxicologic screens and that specific analyses may not be rapidly ...

1633-1634

To the Editor: I am disappointed with the Journal for publishing articles by Bloche and Marks (January 6 and July 7 issues)1,2 that are critical of U.S. military health professionals without devoting equal space to opposing views. To do so is akin to ...

1634-1635

To the Editor: The profession of medicine has developed codes of ethical conduct over thousands of years. A central element of such codes is expressed in the imperative to “do no harm.” Disclosures with regard to the treatment of detainees by licensed ...

1635-1636

To the Editor: Public baths and swimming pools need to be disinfected, and this is usually accomplished by chlorination of the water. Exposure to chlorinated pools, however, may affect the lung epithelium and, along with other factors, may be associated ...

Book Reviews
1637

Long ago, Sir William Osler stated that it matters more what kind of patient has the disease, than what kind of disease it is. Getting to know the patient requires understanding his or her story and the meaning behind it — thus, the importance of paying ...

1637-1638

Many physicians may not be aware of internist George Engel's early concept of the biopsychosocial medical model, but a British professor of psychological medicine, Peter White, has tried to remedy that in the book Biopsychosocial Medicine.

Engel proposed ...

1638-1639

This multiauthored book covers a broad range of topics related to neurodevelopment and psychosis. In its current form, the neurodevelopmental hypothesis of schizophrenia proposes that pathogenic mechanisms operate long before the first episode of ...

1639-1640

Personality disorders are enigmatic in psychiatry, and many of the key features of these illnesses also cause frustration in other branches of medicine. Recent studies have shown that personality disorders, especially the one seen most frequently in ...

Corrections
1640

Independent Clonal Origins of Distinct Tumor Foci in Multifocal Papillary Thyroid Carcinoma Original Article, N Engl J Med 2005:352;2406-2412.. On page 2409, in the left-hand column, line 8 of the first paragraph should have read “5'...

1640

Atorvastatin in Patients with Type 2 Diabetes Mellitus Undergoing Hemodialysis Original Article, N Engl J Med 2005:353;238-248.. On page 243, in the continuation of Table 1, the dose of erythropoietin per week (IU) should have read “6225” for the placebo ...

1640

Bar Coding for Patient Safety Perspective, N Engl J Med 2005:353;329-331.. On page 331, in the middle column, lines 11 through 15 should have read, “Bar coding has reduced drug errors by more than 50 percent, preventing approximately 20 dispensing errors ...