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March 30, 2006  Vol. 354 No. 13

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Perspective
1337-1339

On February 20, 2006, editor-in-chief John Hoey and senior deputy editor Anne Marie Todkill were fired from the CMAJ. Drs. Miriam Shuchman and Donald Redelmeier write that the CMA has been divided over whether it wants an independent scientific journal ...

1339-1341

A recent survey quantifies what many of us have seen firsthand: the new Medicare drug benefit is having a troubled infancy. Dr. Jerry Avorn discusses the continuing debate over whether its early spasticity was caused by inept management of its birth or a ...

Original Articles
1343-1351
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This trial involving 451 healthy adults assessed responses to two intramuscular doses of a subvirion H5N1 influenza vaccine. At the highest dose (90 μg of hemagglutinin), 54 percent of the subjects had neutralization antibody titers of 1:40 or greater. The subvirion vaccine did not cause severe side effects, and in most subjects, it generated neutralizing-antibody responses typically associated with protection against influenza. A conventional subvirion H5 influenza vaccine may be effective in preventing influenza A (H5N1) disease (avian influenza) in humans.

1352-1361

Gatifloxacin has been associated with both hypoglycemia and hyperglycemia. This study examined dysglycemia-related health outcomes associated with the use of various antibiotics in adults 66 years of age or older in Ontario, Canada. As compared with the use of other broad-spectrum oral antibiotics, including other fluoroquinolones, gatifloxacin use among outpatients appears to be clearly associated with both subsequent hypoglycemia and subsequent hyperglycemia.

1362-1369

Serum from almost 80 percent of the residents of Olmsted County, Minnesota, was screened for the presence of a monoclonal gammopathy of undetermined significance. Small amounts of monoclonal immunoglobulin were found in 3.2 percent of persons 50 years of age or older and in 5.3 percent of persons 70 years of age or older.

1370-1377

This study reports the association of a mutant form of contactin-associated protein-like 2 (CASPR2) and epilepsy, cortical dysplasia, and developmental decay among children in an Old Order Amish population. It suggests that mutant CASPR2 causes epilepsy and influences cortical architecture.

Special Article
1378-1386

To improve insurance coverage of mental health and substance-abuse services, the Federal Employees Health Benefits Program required parity between behavioral health and general medical benefits beginning in January 2001. This study found that the parity policy was not associated with an increase in the use of behavioral health services or an increase in spending for patients who used these services.

Review Article
1387-1401

This review summarizes recent advances in our knowledge of the glomerular filter and the causes of hereditary proteinuria syndromes.

Images in Clinical Medicine
1402

A 61-year-old woman whose medical history was notable for hypertension and type 2 diabetes reported a two-day history of increasing dull pain in the right flank and nonbloody, bilious vomiting. Physical examination revealed no abdominal masses, ...

e12
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This man presented with crampy pain in the right lower quadrant after a trip to Hungary. A colonoscopy revealed multiple mobile 1-cm worms.

Case Records of the Massachusetts General Hospital
1403-1409

A 66-year-old woman was found to have Barrett's esophagus with high-grade dysplasia and focal intramucosal adenocarcinoma. Her morbid obesity made her a poor candidate for esophagectomy. A pathologist and a gastroenterologist discuss the pathophysiology and management of Barrett's esophagus.

Editorials
1411-1413

Avian influenza A (H5N1) virus poses an important pandemic threat. A study by the Congressional Budget Office estimates that the consequences of a severe pandemic could, in the United States, include 200 million people infected, 90 million clinically ill, ...

1413-1415

The medical community and the public have been buffeted by a steady stream of news linking the use of widely prescribed medications with serious health risks. The latest in this barrage of unsettling reports is an article by Park-Wyllie et al. that ...

1415-1417

People with private health insurance who seek care for mental health conditions generally face higher coinsurance and more limits to coverage — including limits on the numbers of outpatient visits and inpatient days — than do those who require care for ...

Clinical Implications of Basic Research
1418-1420

A recent study identifies molecular events pivotal to infection by Rickettsia conorii.

Correspondence
1421-1422

To the Editor: On November 2, 2005, fever, chills, and cough developed in a previously healthy woman who was four months pregnant. Chickens and ducks in her household had become ill and had died during October. From October 25 through October 30, the ...

1422-1423

To the Editor: Six weeks after an occupational needle-stick injury, a 35-year-old man presented to a clinic in the Los Angeles area for testing to rule out acute infection with the human immunodeficiency virus (HIV). The patient had no other risk factors ...

1423-1424

To the Editor: De Jong et al. (Dec. 22 issue)1 report resistance to oseltamivir in two of three recent deaths from influenza A (H5N1) virus infection and recommend investigation into new antiviral drugs for use either alone or in combination with ...

1424-1426

To the Editor: As Rutgeerts et al. mention in their article about infliximab for ulcerative colitis (Dec. 8 issue),1 nocturnal fecal incontinence in patients who have an ileoanal pouch is, indeed, an “inconvenience” that is reminiscent of their ...

1426-1429

To the Editor: In the editorial, with Dr. Wood, on registration of clinical trials (Dec. 29 issue),1 you unfairly criticize Pfizer and falsely claim that companies challenge the “spirit of the law.” Pfizer's record is demonstrably excellent. Section 113 ...

1429-1432

To the Editor: In their review article on community-acquired bacterial meningitis (Jan. 5 issue), van de Beek et al.1 suggest that when bacterial meningitis is probable but neuroimaging is not available, lumbar puncture should be given preference in ...

1432-1433

To the Editor: In the Case Records presented in the December 8 issue,1 the statement by the discussant, “the only identified cause of Brugada syndrome is an abnormality in the cardiac sodium channel,” as well as the entire discussion, would have been ...

1433-1434

To the Editor: The patient in the medical mystery in the February 2 issue1 had encrusted pyeloureteritis and cystitis caused by Corynebacterium urealyticum. Multiple urine cultures revealed the presence of corynebacterium species that were subsequently ...

Book Reviews
1435-1436

The third edition of Pathology of the Lung has been renamed Thurlbeck's Pathology of the Lung in honor of the late William “Whitey” Thurlbeck, senior editor of the first two editions and an internationally recognized pulmonary pathologist. Thurlbeck was ...

1436

Textbooks on pulmonary physiology are represented at one extreme by introductory monographs and on the other by the American Physiological Society's inaccurately titled Handbook of Physiology, with its dense volumes on the respiratory system that are 20 ...

1437

This book on dyspnea will be useful to a wide audience of clinicians, and the book's subtitle, “Mechanisms, Measurement, and Management,” reveals its important focus. The appealing chapter on the history of dyspnea by Kieran Killian tells the story from ...

1437-1438

Malignant mesothelioma is an uncommon neoplasm usually associated with exposure to asbestos. Because of its low incidence, thorough reviews of the topic are hard to find. Harvey Pass and colleagues have edited an up-to-date, comprehensive book that ...