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November 10, 2005  Vol. 353 No. 19

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Perspective
1989-1992

Dr. Troyen Brennan writes that the practice of internal medicine can be isolating. Lacking the clear-cut outcomes of one-time interventions like surgery, internists work from day to day essentially without signposts indicating success or failure.

1992-1993

Time-limited certification is now a reality for all boards recognized by the American Board of Medical Specialties. Dr. Richard Baron asks, What if I used this process to benchmark and improve the quality of the care I give?

1994-1997
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Like gross anatomy class and the first night on call as an intern, the medical specialty board examination is a rite of passage for physicians. Dr. Robert Steinbrook reports that in 2005, board certification is in the midst of two fundamental changes.

1997-1999

Glioblastoma multiforme is one of the most aggressive and recalcitrant cancers. Drs. Henry Friedman and Darell Bigner write that the constellation of genetic aberrations greatly reduces the likelihood that an agent directed at a single target in ...

Original Articles
2001-2011

In a large study comparing different strategies for screening for Down's syndrome, first-trimester combined screening (measurement of nuchal translucency, pregnancy-associated plasma protein A [PAPP-A], and the free beta subunit of human chorionic gonadotropin [fβhCG]) at 11 weeks was better than second-trimester quadruple screening (measurement of alpha-fetoprotein, hCG, unconjugated estriol, and inhibin A). Strategies combining first-trimester and second-trimester screening provide high detection rates at acceptable false positive rates. These findings will help guide the choice of screening strategies for Down's syndrome.

2012-2024

A small proportion of glioblastomas respond to gefitinib or erlotinib (tyrosine kinase inhibitors). Some of these responsive tumors have a mutant variant of the epidermal growth factor receptor (EGFR), and some unresponsive tumors lack PTEN, a regulator of the pathway that a mutant EGFR activates. The simultaneous presence in glioblastoma cells of mutant EGFR and PTEN was associated with responsiveness to tyrosine kinase inhibitors.

2025-2033

Central sleep apnea is common among patients who have heart failure and increases the risk of death in this setting. In the Canadian Continuous Positive Airway Pressure trial, continuous positive airway pressure (CPAP) therapy administered to patients with heart failure was found to reduce the severity of central sleep apnea and increase the left ventricular ejection fraction, but did not improve survival.

2034-2041

Obstructive sleep apnea is a form of sleep-disordered breathing in which the upper airway closes repeatedly during sleep. In an observational cohort study, the risk of stroke or death from any cause was significantly increased among patients with sleep apnea, independent of other cardiovascular risk factors. More severe sleep apnea was associated with greater risk.

Review Article
2042-2055

    This review discusses recent advances in the understanding of the ways in which different organs detect and respond to acute changes in oxygen tension. A group of specialized tissues constitutes an oxygen-sensing system that responds rapidly to even minor changes in oxygen tension.

    Images in Clinical Medicine
    2056
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    A 57-year-old man was referred to our hospital because of an acute onset of right flank pain. An intravenous urogram showed normal excretion from the left kidney, a calculus in the right pelvis, and a phlebolith in the right pelvis at 3 minutes after ...

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    This 48-year-old man with metastatic colon cancer was treated with cetuximab, a monoclonal antibody to EGFR. An eruption of sterile papules and pustules with adherent crust developed on his face, chest, and back.

    Case Records of the Massachusetts General Hospital
    2057-2066

    A rash developed in a 10-year-old girl and became confluent and bullous, with sloughing, after she was given carbamazepine for a seizure. Oral and conjunctival sloughing followed, with pancytopenia, gastrointestinal hemorrhage, and respiratory failure. After a protracted course of management in the burn unit, reepithelialization occurred, and the patient recovered fully.

    Editorials
    2068-2070

    Prenatal genetic diagnosis for numerical chromosomal abnormalities (aneuploidy) was once simple. In the 1970s, women who were at least 35 years of age at delivery were offered an invasive procedure, amniocentesis, and 25 to 30 percent of trisomy 21 ...

    2070-2073

    Sleep occupies a third of our lives. The cardiovascular implications of normal and disturbed sleep, and of sleep apnea1 in particular, have only recently gained prominence. Central sleep apnea is characterized by intermittent loss of respiratory drive, ...

    Sounding Board
    2074-2077

    Although we have successfully sequenced the human genome, progress toward defining the genetic basis of disease has been limited by the availability of people willing to share their phenotypic information along with their genotypic information. In this article, the authors offer a proposal to increase participation in genetic studies.

    Clinical Implications of Basic Research
    2078-2080

    A molecule found on the surface of commensal bacteria is critical to the development of the immune system.

    Correspondence
    2081-2085

    To the Editor: The Special Articles by Jha et al.,1 Vaccarino et al.,2 and Trivedi et al.3 (Aug. 18 issue) generate serious misconceptions. Reducing the disparity in health outcomes between black patients and white patients is very important. The ...

    2085-2086

    To the Editor: The recent trial of belatacept in renal transplantation (Aug. 25 issue)1 reveals three cases of post-transplantation lymphoproliferative disorder. Two of the patients with the disorder had a primary Epstein–Barr virus (EBV) infection. The ...

    2086-2087

    To the Editor: We urge caution regarding the conclusion of Keymeulen et al. (June 23 issue)1 in reporting their study of CD3-antibody therapy for new-onset type 1 diabetes mellitus that treatment with ChAglyCD3 preserves residual beta-cell function. ...

    2088

    To the Editor: The excellent review of nuclear receptors by Shulman and Mangelsdorf (Aug. 11 issue)1 mentioned that the study of patients with mutations in PPARγ, the gene encoding peroxisome-proliferator–activated receptor γ (PPARγ), which is rare, can ...

    2088-2089

    To the Editor: Proteinuria may develop in renal-transplant recipients who have converted from treatment with calcineurin inhibitors to treatment with sirolimus1; the mechanism of this occurrence is unknown. We hypothesized that the antiangiogenic ...

    2089-2090

    To the Editor: At a recent case conference with a distinguished visiting professor, a fellow in allergy and immunology presented the case of an infant with diarrhea; an unusual rash (“alligator skin”); multiple immunologic abnormalities, including low T-...

    Book Reviews
    2091-2092

    Although more than 100 biographies of Hideyo Noguchi (1876–1928) have been published in Japanese, this book is the first one to be translated into English. As a Japanese microbiologist and immunologist, I think that Peter Durfee has produced an excellent ...

    2092-2093

    There are only two books that I consider to be required reading for practitioners in infectious diseases: Rats, Lice and History by Hans Zinsser (Boston: Little, Brown, 1984) and Emerging Infections: Microbial Threats to Health in the United States by ...

    2093-2094

    When studying history, one typically considers political leaders and the environment in which important decisions were made; when studying science, facts and key experiments are most often the focus of attention. However, it may be equally important to ...

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