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August 18, 2005  Vol. 353 No. 7

Perspective
645-648

    In this essay, Dr. Atul Gawande writes that the physical examination is deeply intimate, and the way a doctor deals with the naked body — particularly when the doctor is male and the patient female — inevitably raises questions of propriety and trust.

    648-651
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    In the Supreme Court case Gonzales v. Raich, the justices ruled 6 to 3 that the federal government has the power to arrest and prosecute patients and their suppliers. Dr. Susan Okie explains that it is not yet clear what effect the Court's decision will ...

    Original Articles
    653-662

    Sirolimus-eluting stents and paclitaxel-eluting stents both reduce the risk of restenosis after percutaneous coronary intervention as compared with bare-metal stents. In a randomized trial, the two types of drug-eluting stents were compared in patients undergoing revascularization. The sirolimus-eluting stents were associated with fewer major adverse cardiac events at nine months, primarily as a result of reductions in the rates of clinical and angiographic restenosis.

    663-670

    Drug-eluting coronary-artery stents are more effective than bare-metal stents in reducing the frequency of coronary restenosis in patients with diabetes. In a randomized, controlled trial in patients with diabetes, the sirolimus-eluting stent was associated with a smaller extent of late luminal loss than was the paclitaxel-eluting stent, suggesting that the risk of restenosis was also reduced.

    Special Articles
    671-682

    This study compared treatments and outcomes after myocardial infarction according to sex and race from 1994 through 2002. As compared with white men, black men and both white and black women had lower rates of reperfusion therapy and coronary angiography, and black women had higher mortality. Sex and racial differences did not change substantially between 1994 and 2002.

    683-691
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    More than a decade ago, it was established that there were significant differences in the rates of major surgical procedures between blacks and whites. These investigators examined nine surgical procedures and found that the racial differences noted in 1992 persisted in 2001.

    692-700
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    In this study examining trends from 1997 to 2003 for white patients and black patients enrolled in Medicare managed care, performance on all nine quality measures improved for both blacks and whites, and racial disparities narrowed for seven of the nine measures. These findings suggest that efforts to improve care for all patients result in reductions in racial disparities.

    Review Article
    701-711

      Soft-tissue sarcomas have traditionally been managed by wide excisional surgery and radiotherapy, with chemotherapy reserved for advanced disease. However, advances in multidisciplinary care have improved the evaluation and treatment of patients with this uncommon tumor. Limb-conserving surgery, superior radiotherapy delivery, and novel adjuvant agents for specific tumors are now available. This article reviews the current understanding and treatment of soft-tissue sarcoma, with an emphasis on recent advances.

      Images in Clinical Medicine
      712
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      A 67-year-old woman reported having progressive shortness of breath over several months, three years after undergoing aortic-valve replacement for aortic insufficiency. The patient had migraine headaches for which she had received 2 mg of ergotamine ...

      e6
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      This 32-year-old woman, who was seven months pregnant, presented with blurring and greenish discoloration of central vision in the left eye.

      Case Records of the Massachusetts General Hospital
      713-722

      A 40-year-old man was admitted to the hospital because of fever and weight loss of two months' duration. He had been well until an episode of gastroenteritis, after which daily fever, anorexia, and weight loss developed. A laparoscopic appendectomy was performed, but symptoms persisted. Repeated imaging showed occlusion of the portal vein.

      Editorials
      724-727

      Since the inception of percutaneous coronary intervention (PCI), restenosis leading to repeated target-lesion revascularization has been the primary weakness of the procedure and has been repeatedly referred to as its Achilles' heel. Placement of a ...

      727-729

      During the past decade, hundreds of articles have been published documenting the existence of racial and ethnic disparities in health and health care — a data deluge that has led many observers to suggest that it is time to stop documenting disparities ...

      Clinical Implications of Basic Research
      730-731

      A nitric oxide–releasing polyurethane has biologic properties that warrant its further investigation as a potential material for vascular grafts.

      Correspondence
      732-733

      To the Editor: The landmark study by Smith et al. (May 26 issue)1 shows that measurement of exhaled nitric oxide (FeNO) can reduce the dose of inhaled corticosteroids in patients with asthma without impairing control of asthma and, in particular, ...

      734-735

      To the Editor: The study by Jouven and colleagues (May 12 issue)1 advances our understanding of the factors involved in the precipitation of sudden death. However, the authors' assertion that exercise-induced changes in heart rate “may have clinical ...

      735-737

      To the Editor: The analysis by Hannan and colleagues (May 26 issue)1 comparing coronary-artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) is seriously flawed. The data were derived retrospectively from two separate New York State ...

      737-738

      To the Editor: The study by Eghbali-Fatourechi et al. (May 12 issue)1 suggests the presence of circulating osteoblasts that potentially contribute to physiological bone formation. In addition to its association with bone modeling and remodeling, as ...

      738-739

      To the Editor: Talbot et al.1 (May 19 issue) find that in the absence of coexisting conditions such as diabetes, alcoholism, or infection with HIV, which are known to confer a high risk of invasive pneumococcal disease, the excess presence of invasive ...

      740

      To the Editor: Ramaekers et al. (May 12 issue)1 report 28 patients with the cerebral folate deficiency syndrome characterized by decreased levels of 5-methyltetrahydrofolate (5MTHF) in the cerebrospinal fluid caused by autoantibodies' blocking of folate ...

      740-741

      To the Editor: The potential role of vascular endothelial growth factor in malignant as well as nonmalignant pleural effusion1,2 prompted us to use bevacizumab, a monoclonal antibody against vascular endothelial growth factor, in a 68-year-old man with ...

      Book Reviews
      742-743

      These two books document the consequences of the lack of universal coverage for health care in the United States and then recommend national health insurance. Each book is readable and perceptive and offers fresh information and helpful syntheses of ...

      743-744

      Over the past century, powerful organizations, industries, and groups have mobilized to oppose the enactment of national health insurance in the United States. Although the players on the opposition team have changed, and their ideologies have shifted, ...

      Corrections
      744

      Sudden Death in Patients with Myocardial Infarction and Left Ventricular Dysfunction, Heart Failure, or Both Original Article, N Engl J Med 2005:352;2581-2588.. On page 2581, lines 9 and 10 in the Results section of the Abstract should have stated that “...

      744

      Bites of the Brown Recluse Spider Correspondence, N Engl J Med 2005:352;2029-2030.. In the letter by Swanson and Vetter, on page 2029 in the right-hand column, lines 7 through 12 of the second paragraph should have read, “Furthermore, the unverified ...

      744

      Standard and Increased-Dose BEACOPP Chemotherapy Compared with COPP-ABVD for Advanced Hodgkin's Disease Original Article, N Engl J Med 2003:348;2386-2395.. On page 2387, in Table 1, the dose of cyclophosphamide in the regimen of increased-dose BEACOPP ...

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