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July 14, 2005  Vol. 353 No. 2

Perspective
113-116
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Dr. Eric Topol asks, How can a drug that is associated with higher rates of both renal dysfunction and death than placebo — and that costs 50 times as much as standard therapies — be given to more than 600,000 patients and be promoted throughout the ...

116-118

Membership on these committees is subject to detailed policies and procedures for managing potential conflicts of interest and for balancing possible conflicts against the agency's need for advisers with relevant scientific expertise. Dr. Robert ...

119-121

Dr. Barron Lerner writes that lobotomy exemplified a common characteristic of medical practice, in which doctors and patients have often felt the need to “do something” in the face of seemingly hopeless situations.

Original Articles
123-132

The efficacy of erlotinib in patients with non–small-cell lung cancer and relapse after treatment with conventional chemotherapy was tested in a placebo-controlled, double-blind trial. Erlotinib, an inhibitor of the epidermal growth factor receptor, was associated with responses in about 9 percent of patients and with prolonged survival in some cases.

133-144

This companion to the clinical trial of erlotinib in patients with non–small-cell lung cancer studied the epidermal growth factor receptor (EGFR) protein and gene (EGFR) in tumor specimens obtained from the participants. Expression of EGFR by the tumor was associated with responsiveness to the drug but not with increased survival. Neither the number of copies of EGFR nor mutational status was associated with responsiveness or survival.

145-155

Patients with high-grade atrioventricular block usually require the implantation of a permanent pacemaker. Retrospective studies have suggested that dual-chamber pacemakers reduce the risk of atrial fibrillation, stroke, heart failure, and death in this setting, as compared with single-chamber ventricular pacemakers. In a randomized trial comparing these two pacing methods, however, no significant advantage of dual-chamber pacing was demonstrated.

156-163

A 61-year-old immunocompetent woman had recurrent episodes of fever, lymphadenopathy, splenomegaly, synovitis, and rash. Although she was negative for human immunodeficiency virus infection, Kaposi's sarcoma developed. The relapsing inflammatory symptoms were associated with sharp increases in the levels of human herpesvirus 8 in plasma and of peripheral-blood mononuclear cells.

Clinical Practice
164-171

At her annual visit, a 60-year-old woman asks her physician whether she should have a bone-density test to screen for osteoporosis. The patient went through menopause at the age of 52 years and received postmenopausal hormone therapy for four years. She takes 500 mg of calcium twice daily and exercises regularly. She has no personal history of fractures, but her mother had a hip fracture at the age of 82. Her height is 63 in. and her weight is 120 lb. What should her physician advise?

Review Article
172-187

Tyrosine kinases, enzymes that catalyze the transfer of phosphate from ATP to tyrosine residues in polypeptides, are ubiquitous, numerous, and of considerable clinical interest because they participate in the development of cancer and have become choice targets for therapeutic intervention. This comprehensive review discusses the molecular and clinical aspects of tyrosine kinases.

Images in Clinical Medicine
188
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An 18-year-old man presented with symptoms that evolved over the course of three days and included fever, radicular back pain, vertigo, ataxia, headache, and left-sided hemiparesis. He reported that he had had skin swellings in a migratory pattern during ...

e2
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This man's new job required that he wear boots, which caused his feet to perspire. Erythema appeared, and itching became intense. A topical steroid provided temporary relief.

Case Records of the Massachusetts General Hospital
189-198

A four-week-old male infant was admitted to the hospital because of jaundice and abdominal distention. Magnetic resonance imaging revealed decreased signal in the liver, pancreas, and heart, with nodularity of the liver. A diagnostic procedure was performed.

Editorials
200-202

The development of small-molecule inhibitors of the epidermal growth factor receptor (EGFR), such as erlotinib and gefitinib, for the treatment of advanced non–small-cell lung cancer illustrates a pattern of initial overly enthusiastic interest, ...

202-204

Almost 50 years after the first report of the use of cardiac pacing, in the Journal, 1 pacing is playing an increasingly important role in the management of cardiac disease. Cardiologists have evaluated single-chamber, dual-chamber, and triple-chamber ...

Correspondence
205-206

To the Editor: A well-designed study aimed at showing the effect of cardiac resynchronization on mortality among patients with cardiac dyssynchrony, the Cardiac Resynchronization–Heart Failure (CARE-HF) Study (April 14 issue),1 demonstrated improvements ...

207-208

To the Editor: Patients with lung cancer who respond to gefitinib have been reported to have somatic mutations consisting of deletions in exon 19 and the L858R mutation in exon 21 of the epidermal growth factor receptor (EGFR) gene.1 In addition, a ...

208-209

To the Editor: A large amount of information suggests that mutations in the kinase domain of epidermal growth factor receptor (EGFR) are critical for the efficacy of EGFR kinase inhibitors.13 However, the effect of EGFR mutations on the response to ...

209-210

To the Editor: Lynch et al.1 and Paez et al.2 correlated the presence of somatic mutations in the tyrosine kinase domain of the gene that encodes the epidermal growth factor receptor (EGFR) with responsiveness to gefitinib in non–small-cell lung ...

Book Reviews
211

Most of us walk around oblivious to the time bombs that line our arteries. Indeed, atherosclerosis is, for the most part, a rather benign condition that affects, to some degree, virtually all the adult population both in developed countries and in many ...

212

The fact that cardiovascular disease, for the most part due to atherosclerosis, is the principal killer in Western societies is well known. However, how and why atherosclerotic plaques that develop over many decades rupture in an often unheralded manner — ...

212-214

Sir Thomas Lewis opined in 1933 that “the very essence of cardiovascular practice is the early detection of heart failure.” Heart failure at that time was a topic of substantial interest to physicians. In the past two decades that interest has been ...