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December 22, 2005  Vol. 353 No. 25

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Perspective
2633-2636
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The neuraminidase inhibitors provide valuable defenses against pandemic and seasonal influenza. Dr. Anne Moscona writes that misuse of oseltamivir could rob us of the advantages that neuraminidase inhibitors provide, by favoring the emergence of ...

2636-2637

A request for oseltamivir must be examined from both the perspective of individual patient–physician encounters and that of public health. Drs. Allan Brett and Abigail Zuger explain that the current supply of oseltamivir is inadequate to meet the demand ...

2637-2639

Dr. Fernando Martinez describes the evidence that indicates that regular treatment with long-acting beta-agonists is associated with increased risks of severe exacerbations of asthma and of death from asthma in a small but not inconsequential subgroup of ...

2640-2641

The clinical response to immunotherapy for metastatic colorectal cancer remains unsatisfactory. Dr. Giorgio Parmiani writes that one of the main drawbacks in the development of effective immunotherapy for colorectal cancer is the lack of an adequate ...

Original Articles
2643-2653
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In an analysis of data from the observational Epidemiology of Diabetes Interventions and Complications study obtained a mean of 17 years after the end of the Diabetes Control and Complications Trial, the prevalence of cardiovascular disease was far lower among patients with type 1 diabetes who received intensive therapy than among those who received conventional therapy. Intensive diabetes therapy has long-term beneficial effects on the incidence of cardiovascular disease in patients with type 1 diabetes.

2654-2666

In this study of patients with colorectal cancer, pathological signs of early metastatic invasion augured a poor prognosis, whereas the absence of these signs was associated with a good prognosis. Patients whose tumors had no signs of early metastatic invasion had evidence of a T-cell–driven immune response.

2667-2672

Influenza A (H5N1) virus with an amino acid substitution in neuraminidase that conferred high-level resistance to oseltamivir was isolated from two Vietnamese patients who died of influenza despite antiviral treatment. Resistance to oseltamivir can emerge with treatment that is initiated early and at the recommended dose. These findings may have therapeutic implications for the control of avian influenza.

Special Article
2673-2682

In this large case−control study, disciplinary action among practicing physicians was found to be associated with nonprofessional behavior among students in medical school. The strongest associations were with severe irresponsibility during medical school. The findings underscore the need to evaluate medical school applicants and, once they have matriculated, to teach and instill professionalism as a critical component of the medical school curriculum.

Review Article
2683-2695

The therapeutic promise of nitric oxide (NO), a potent vasodilator, remains uncertain for adults, and licensed indications are restricted to pediatric practice. This review considers the biologic actions of inhaled nitric oxide, the clinical indications for its administration in adults, and an assessment of its potential therapeutic development.

Images in Clinical Medicine
2696
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A 75-year-old woman was admitted to the hospital due to severe nausea and vomiting. she had a 12-year history of type 2 diabetes with erratic glucose control complicated by severe bilateral retinopathy and peripheral neuropathy. Symptoms of bloating had ...

e22
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A healthy Nigerian man living in the United States noticed something wiggling in his right eye while he was driving.

Case Records of the Massachusetts General Hospital
2697-2705
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A 63-year-old woman from Cameroon was referred to infectious-disease specialists because of a positive serologic test for syphilis and persistent peripheral-blood eosinophilia. In addition, a routine chest radiograph had shown a dilated aorta with calcification. Stool examination disclosed parasitic infections, which were treated, but eosinophilia persisted. A diagnostic test was performed.

Editorials
2707-2709

Improved glycemic control reduces the risks of early microvascular complications, such as retinopathy, nephropathy, and neuropathy, in patients with diabetes.1,2 Such patients also have a markedly increased risk of macrovascular complications — myocardial ...

2709-2711

At probably no point in the history of modern medicine have physicians and medical educators been pulled by so many demands of accountability from such diverse constituencies. Although these demands are varied and sometimes even contradictory, all the ...

Clinical Implications of Basic Research
2712-2713

Azathioprine is an immunosuppressant commonly used to treat transplant recipients. A recent study suggests that it renders the DNA of skin cells more sensitive to ultraviolet A radiation.

Correspondence
2714-2718

To the Editor: The Invasive versus Conservative Treatment in Unstable Coronary Syndromes (ICTUS) trial reported by de Winter et al. (Sept. 15 issue)1 shows that an early invasive strategy was not superior to a conservative strategy in patients who had ...

2718

To the Editor: Lowsky et al. (Sept. 29 issue)1 report a conditioning regimen associated with an impressively low incidence of graft-versus-host disease (GVHD). However, the dynamics of engraftment are unclear. The authors mention that “donor T cells ...

2719-2720

To the Editor: With respect to the review article on primary biliary cirrhosis by Kaplan and Gershwin (Sept. 22 issue),1 we would like to emphasize the value of alternative noninvasive methods for the diagnosis of this disorder, such as multiphasic ...

2720-2722

To the Editor: With regard to the article by Stossel (Sept. 8 issue),1 the road of collaboration between academia and industry is dappled with episodes of squabbling and success. One such episode is known as the “insulin famine.” In the wake of the ...

2722-2723

To the Editor: We report on a series of nine patients with hyperlipidemia and either chronic myeloid leukemia or the hypereosinophilic syndrome, in eight of whom plasma lipid levels normalized within one month after imatinib therapy (at a dose of 400 mg ...

Book Reviews
2724-2725

The field of bioethics is at a crossroads. When the field began in the United States, back in the late 1960s, it was not yet a field. Rather, bioethics began as a cacophony of a variety of voices in different disciplines, united primarily by common ...

2725-2726

The 1960s and 1970s are widely regarded as a watershed in the history of bioethics. The exposure of research scandals during these years generated widespread public controversy. The outcry was followed by a series of federal commissions and regulations ...

2726

Despite the fact that the United States has millions of uninsured citizens, despite abundant evidence of unequal access to care, and despite the enormous expenditures for medical care at the end of life, assisted suicide and euthanasia are the ethical ...

2727

In this devastating anatomy lesson on loss, which received a 2005 National Book Award, respected essayist Joan Didion skillfully dissects her struggle with the denial, pain, and rage that followed the sudden death of her husband of nearly 40 years, writer ...

Corrections
2728
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Chronic Stable Angina Clinical Practice, N Engl J Med 2005:352;2524-2533.. On page 2527, in the left-hand column, lines 15 through 17 of the third full paragraph should have read “. . . they have a similar benefit after primary angioplasty for acute ST-...

2728
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Cancer of the Skin Book Review, N Engl J Med 2005:352;2657.. In Pennington and Leffell's review of the book by Darrell S. Rigel, the photomicrograph, which does not appear in the book being reviewed, does not show skin tissue with melanoma, as stated in ...

2728

Stem-Cell Research — Signposts and Roadblocks Perspective, N Engl J Med 2005:353;1-5.. On page 2, the figure legend should have read: “Nebraska has a law prohibiting the use of funds from tobacco-settlement dollars for embryonic stem-cell research. There ...

2728

Osteonecrosis of the Jaw and Bisphosphonates Correspondence, N Engl J Med 2005:353;99-102.. On page 101, lines 5 through 8 of the letter by Tarassoff and Hei should have read, “As the developer of Aredia (pamidronate) and Zometa (zoledronic acid), we have ...