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July 21, 2005  Vol. 353 No. 3

Perspective
221-224

In March, a 21-year-old college student with an ICD manufactured by Guidant, collapsed and died. His physicians at the Minneapolis Heart Institute Foundation investigated and found other reports from Guidant of instances in which the Prizm 2 DR Model 1861 ...

225-227

    Advocates of public reporting have been spurred on by the occurrence of nosocomial infections in 5 to 10 percent of hospitalized patients. Drs. Robert Weinstein, Jane Siegel, and P.J. Brennan write that report cards assessing nosocomial infections will ...

    Original Articles
    229-237
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    More than 9000 women were followed for a median of 15 years after a diagnosis of benign breast disease. As compared with women in a SEER database, they had an increased risk of subsequent breast cancer, especially if the benign lesion showed signs of atypia. A family history of breast cancer and younger age at diagnosis also increased the risk. Cancers developed in either breast, but an excess number occurred in the same breast.

    238-248

    Statins reduce cardiovascular events in persons with type 2 diabetes mellitus. This study randomly assigned patients with type 2 diabetes receiving hemodialysis to receive 20 mg of atorvastatin per day or matching placebo. Atorvastatin reduced all cardiac events combined but not all cerebrovascular events combined or total mortality.

    249-254

    This report describes six patients who had postprandial symptoms of neuroglycopenia from endogenous hyperinsulinemic hypoglycemia after Roux-en-Y gastric bypass surgery. Hypoglycemic symptoms diminished in all patients after partial pancreatectomy. The authors speculate that hyperfunction of pancreatic islets did not lead to obesity but rather that beta-cell trophic factors may have increased as a result of gastric bypass.

    Special Articles
    255-264
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    In 2002, the JCAHO began requiring hospitals to report their performance on standardized measures of the quality of health care and began providing hospitals with feedback on their performance. This study documented substantial improvement between 2002 and 2004 in hospitals' performance for myocardial infarction, congestive heart failure, and pneumonia. Hospitals with a low level of performance at baseline had the largest improvements.

    265-274
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    This study examined hospitals' performance on standardized measures of the quality of care for acute myocardial infarction, congestive heart failure, and pneumonia. The quality of care varied among hospitals. Hospitals' performance on the measures for myocardial infarction and congestive heart failure was not closely correlated with performance on the pneumonia measure, suggesting that efforts to monitor the quality of care may need to include a wide range of medical conditions.

    Review Article
    275-285

    About 50 percent of women have histologic evidence of some degree of fibrocystic changes in the breast. This review article describes the spectrum of benign breast disorders, including those that increase the risk of malignant disease. The authors explain the evaluation and management of breast pain, breast discharge, and focal lesions, as well as the options that can prevent progression to breast cancer.

    Images in Clinical Medicine
    286
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    An 83-year-old man presented with a one-month history of an enlarging lump on his right nipple. It was asymptomatic. Physical examination revealed an 11-mm erythematous, well-circumscribed nodule attached to the right nipple, which had begun to ulcerate ...

    e3
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    This 70-year-old woman presented with an erythematous, scaly plaque that had replaced the areola of the left breast. No breast mass or lymphadenopathy was detected.

    Case Records of the Massachusetts General Hospital
    287-295

    An 81-year-old man was admitted to the hospital because he had had cough and fever for two weeks and had recently become confused. He had had chronic lymphocytic leukemia for six years. His mental status continued to deteriorate, with coma and respiratory arrest, and he died on the 12th hospital day.

    Editorials
    297-299

    The term “risk” appears in the title of more than 10,000 medical articles published in 2004 (2 percent of the total) — nine times as many as appeared in 1975. In this issue of the Journal, the article by Hartmann et al. on benign breast disease and the ...

    300-302

    As the obesity pandemic continues to worsen and medical interventions remain only moderately effective, bariatric surgery is at present the only method that reliably results in major, long-term weight loss.1,2 The most successful procedures durably reduce ...

    302-304

    Over the past few years, several large studies have shown,14 and the Institute of Medicine has emphasized,5 that the quality of health care in the United States is not nearly at the level that we should expect from the world's most expensive health care ...

    Sounding Board
    305-309

    A total of 83 percent of Medicare beneficiaries have at least one chronic condition. Recent legislation is a new initiative to improve the quality of care for beneficiaries with chronic conditions.

    Clinical Implications of Basic Research
    310-312

    A chimeric fusion protein inhibits the allergic reaction induced by cat allergen in a mouse model.

    Correspondence
    313-314

    To the Editor: Calin et al. (April 21 issue)1 report on ARLTS1, a novel tumor-suppressor gene with proapoptotic characteristics and a member of the ADP-ribosylation factor family. It is proposed that a protein-truncating mutation (G446A) predisposes ...

    314-315

    To the Editor: The review by Stam of thrombosis of the cerebral veins and sinuses (April 28 issue)1 did not include heparin-induced thrombocytopenia as one of the causes of thrombosis. This acquired hypercoagulability state results from the presence of ...

    315-317

    To the Editor: The data that Sugarman et al. (April 28 issue)1 collected in 2002 seriously underestimate the current costs of human-research oversight. Since 2002, more than 75 percent of academic medical centers have begun preparing for, have applied ...

    317-318

    To the Editor: Acetylcholinesterase inhibitors have long been known for their use as pesticides. Since the 1990s, acetylcholinesterase-inhibiting pharmaceuticals (donepezil, tacrine, galantamine, and rivastigmine) have been used to treat Alzheimer's ...

    318-321

    To the Editor: Premenopausal women who undergo high-dose chemotherapy have a very high risk of ovarian failure.1 Cryopreservation of ovarian tissue with subsequent autotransplantation has effectively preserved fertility in an animal model,2 but its ...

    Book Reviews
    322-324

    The belief that systems, more than individuals, are responsible for medical errors permeates current efforts to improve the quality of medical care and patient safety. Error reduction thus requires that systems be reformed, which necessitates far more ...

    324

    Why do physicians have such a difficult time talking to their patients about errors made in the course of patient care? This is the main question posed in John Banja's carefully written and useful book. The answer, the author suggests, is primarily “...