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November 24, 2005  Vol. 353 No. 21

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Perspective
2209-2211

The 1918 virus spread rapidly around the world and was associated with mortality measured in the thousands per 100,000 population. Dr. Robert Belshe describes what the 1918 virus teaches us about avian H5N1 influenza.

2212-2214

The achievements of modern biomedical research have also increased people's ability to misuse discoveries in ways that could threaten the public health or national security. Dr. Robert Steinbrook writes about the occasionally uneasy relation between ...

2214-2215

Meng-Kin Lim writes that all technological advances — from knives and forks to airplanes and rockets — have been exploited for destructive ends. Inherent in every scientific discovery is the “dual use” dilemma.

2215-2217

More than 90 percent of the approximately 650 cases diagnosed yearly in the United States affect infants and toddlers. Drs. Brian Kushner and Nai-Kong Cheung explain that random genetic mutations, rather than environmental factors, appear to be causative.

Original Articles
2219-2228

This 24-week randomized, open-label, noninferiority trial compared oral mycophenolate mofetil with monthly intravenous cyclophosphamide as induction therapy for active lupus nephritis. Mycophenolate mofetil appeared more effective than intravenous cyclophosphamide in inducing remission of lupus nephritis, with a more favorable safety profile.

2229-2242

Idiopathic pulmonary fibrosis is a progressive disorder characterized by loss of lung function; there is no effective treatment. In this multinational, randomized, placebo-controlled trial with all patients receiving azathioprine and prednisone, acetylcysteine was shown to slow the rate of deterioration of lung function. There was no effect on survival.

2243-2253

More than 900 samples of neuroblastoma were screened for loss of chromosomal material at two loci, 1p36 and 11q23. These abnormalities were associated with high-risk features of neuroblastoma or a poor clinical outcome.

2254-2261

Beta-blockers prevent variceal bleeding in patients with cirrhosis who already have esophageal varices. In this randomized, placebo-controlled trial, timolol (a nonselective beta-blocker) did not prevent esophageal varices in patients with cirrhosis who had portal hypertension.

Review Article
2262-2269

    Basal-cell carcinoma is the most common malignant tumor, and its incidence is increasing. This review explains the treatment options, including four surgical approaches, topical therapy, photodynamic therapy, and radiation. Recent research on the pathogenesis is also summarized.

    Images in Clinical Medicine
    2270
    • Free Full Text

    A 37-year-old woman had an eating disorder characterized by frequent episodes of self-induced vomiting. She presented after accidentally swallowing a kitchen fork while attempting to induce emesis. Radiographs of the thorax show the location reached by ...

    e19
    • Free Full Text

    This 47-year-old man with a history of compensated cirrhosis due to chronic hepatitis B infection presented for routine evaluation.

    Case Records of the Massachusetts General Hospital
    2271-2280

    A 62-year-old, previously healthy woman had a seizure, which was followed by persistent aphasia. Imaging studies showed bright lesions on T2-weighted and diffusion-weighted imaging, involving the cortex and the white matter, with normal perfusion. A brain biopsy showed changes consistent with ischemia. Over the course of the next year, hearing loss and slowly progressive dementia developed. A diagnostic procedure was performed.

    Editorials
    2282-2284

    Systemic lupus erythematosus is a chronic, life-threatening disease that predominantly affects women of childbearing age. Its pathogenesis includes autoantibody-mediated organ damage and antiphospholipid-antibody–mediated hypercoagulability. Among ...

    2285-2287

    Idiopathic pulmonary fibrosis (IPF) is a progressive disease characterized by fibrosis and remodeling of the lung parenchyma. The median survival of patients with the disease is about three years after diagnosis or five years after the onset of symptoms. ...

    2288-2290

    Variceal bleeding is the most feared complication of portal hypertension in patients with cirrhosis and is a major cause of death. Treatments frequently include endoscopic banding or sclerotherapy of esophageal varices in parallel with splanchnic ...

    Legal Issues in Medicine
    2291-2296

    The U.S. Supreme Court recently ruled that Congress has the authority under the commerce clause to prohibit the medicinal use of homegrown marijuana, even in states, such as California, that have passed statutes permitting such use. In this article, George Annas explains the Court's rationale for its ruling and discusses the implications of the case.

    Clinical Implications of Basic Research
    2297-2299

      A newly discovered protein induces intestinal growth; manipulating this system could have therapeutic implications for intestinal disorders.

      Correspondence
      2300-2301

      To the Editor: The report by Wheeler et al. (Sept. 1 issue)1on an outbreak of hepatitis A arouses concern because of the number of people infected from a single contaminated food and because of the severity of the disease, reflected in the rates of ...

      2301-2303

      To the Editor: The report by Gulati et al. (Aug. 4 issue)1and the accompanying editorial by Kraus and Douglas2 claim that the nomogram for predicting exercise capacity in women according to age and level of metabolic equivalents (MET) is unique. However, ...

      2303-2304
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      To the Editor: With regard to the article by Clark et al. (Aug. 18 issue),1 we would like to call attention to the usefulness of fine-needle aspiration biopsy for soft-tissue sarcoma. In their article, the authors point out that fine-needle aspiration ...

      2304-2305

      To the Editor: In her discussion of Case 24-2005 (Aug. 11 issue),1 Dr. Ryan recommended adjuvant therapy with anastrozole (Arimidex) for a postmenopausal woman with hormone-receptor–positive breast cancer. Although the Arimidex, Tamoxifen Alone or in ...

      2305-2306

      To the Editor: Linezolid belongs to a family of antimicrobial agents (oxazolidinones) that inhibit bacterial protein synthesis by preventing the fusion of 30S and 50S ribosomal subunits.1 Hyperlactatemia, metabolic acidosis, and peripheral neuropathy are ...

      2306-2307

      To the Editor: The opportunity to study the effects of refeeding after prolonged fasting is rare. We recorded anthropometric, biochemical, and endocrine changes during the refeeding period after a much-publicized 44-day fast by David Blaine, a ...

      Book Reviews
      2308-2310

      Epidemic poliomyelitis first appeared in the United States a century ago, at a time when America was rapidly evolving from its postcolonial agrarian roots toward industrialization, urbanization, and the ascension of the middle class. Polio, a new “...

      2310

      Comprehensive textbooks for a medical specialty are difficult to write or update in these times because of the rapid pace of discoveries and of the evolution of concepts and because of the large number of review articles in international journals that ...

      2311

      Bone metastasis is an important clinical problem affecting approximately 350,000 people in the United States. After tumors have metastasized to bone, the cancer becomes incurable. In clinical trials in the past, bone metastases were not considered ...

      Corrections
      2311

      Abatacept for Rheumatoid Arthritis Refractory to Tumor Necrosis Factor α Inhibition Original Article, N Engl J Med 2005:353;1114-1123.. On page 1121, in Figure 3B, the key was incorrectly labeled. The light blue bars represent abatacept, and the dark blue ...

      2311

      Severe Sepsis and Therapy with Activated Protein C Editorial, N Engl J Med 2005:353;1398-1400.. On page 1398, in the right-hand column, the P value in line 15 of the first full paragraph should have read “P=0.06,” rather than “P=0.006,” as printed.