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May 25, 2006  Vol. 354 No. 21

Audio Summary of this Issue

Perspective
2205-2208
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To overcome the impasse in the debate on medical liability, Senators Hillary Rodham Clinton and Barack Obama have introduced legislation, the National Medical Error Disclosure and Compensation (MEDiC) Bill, to direct reform toward the improvement of ...

2208-2211

What should be done about controlling LCMV in organ transplantation? Dr. C.J. Peters writes that one obvious way to reduce the risk of human infection with LCMV is to have suppliers of pet rodents screen their colonies for the infection.

Original Articles
2213-2224
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Hemodynamic monitoring is a common physiological intervention in patients with acute lung injury. In this randomized, controlled trial in which patient care was dictated by a specific hemodynamic protocol, there was no significant difference in 60-day mortality whether monitoring was performed with a pulmonary-artery catheter or a central venous catheter.

2225-2234

In this multicenter, randomized trial comparing primary peritoneal drainage with laparotomy for the management of perforated necrotizing enterocolitis in preterm infants with birth weights less than 1500 g, there were no significant differences between groups in mortality at 90 days, dependence on total parenteral nutrition at 90 days, or length of the hospital stay in surviving infants. These data do not support an advantage of either primary peritoneal drainage or laparotomy over the alternative approach among preterm infants with perforated necrotizing enterocolitis.

2235-2249

This report documents two clusters of lymphocytic choriomeningitis virus (LCMV) infection transmitted through solid-organ transplantation. Seven of the eight recipients died; one recipient, who received ribavirin and reduced levels of immunosuppression, survived. The signs of infection in the recipients included thrombocytopenia, coagulopathy, graft dysfunction, and either fever or leukocytosis.

Review Article
2250-2261

This review discusses advances in knowledge regarding the composition and structure of bone, the modeling and remodeling of bone, the formation of bone during growth and its reconstruction in adults, and how age-related abnormalities in these processes compromise the composition and structure of bone.

Videos in Clinical Medicine
e22

    Urethral catheterization may be indicated for diagnostic or therapeutic purposes: to decompress the bladder in patients with urinary retention, to permit irrigation to remove blood and clots from the urinary bladder, to obtain sterile urine for diagnostic purposes, to measure urinary output in critically ill patients or during surgical procedures, or to measure the residual urinary volume after voiding. This procedural video demonstrates how to perform male urethral catheterization.

    Images in Clinical Medicine
    2262
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    A 71-year-old man who had had rheumatic fever as a child presented with prosthetic-valve endocarditis. A mitral valvotomy had been performed 37 years before, and 21 years later, his mitral valve was replaced with a Starr–Edwards prosthesis. Lateral chest ...

    e23

    This 40-year-old diabetic woman presented with fever and diffuse abdominal pain.

    Case Records of the Massachusetts General Hospital
    2263-2271

    A 72-year-old woman had a sudden onset of slurred speech and left hemiparesis. Emergency medical services were called, and she was airlifted to a hospital. A multidisciplinary team of physicians discuss the emergency management of acute stroke.

    Editorials
    2273-2274

    The history of the use of the pulmonary-artery catheter (PAC) illustrates a great deal about physicians' often uncritical acceptance of technology in clinical applications. In 1956, Forssmann, Cournand, and Richards were awarded the Nobel Prize in ...

    2275-2276

    The occurrence of intestinal perforation is a catastrophic event at any age. Its occurrence in a very-low-birth-weight infant with necrotizing enterocolitis, however, is particularly hazardous. Unfortunately, the incidence of necrotizing enterocolitis ...

    Legal Issues in Medicine
    2277-2281

    Annas discusses the December 2005 U.S. District Court decision about a curricular change requiring the teaching of intelligent design in public schools in Dover, Pennsylvania. The judge ruled that intelligent design is not science and that the school board's curricular change served a religious purpose, in violation of the establishment clause of the First Amendment.

    Clinical Implications of Basic Research
    2282-2284

    Gastrointestinal stromal tumors have been shown to respond to imatinib mesylate in a manner dependent on immune-cell function. A new type of immune cell that shares characteristics with both natural killer cells and dendritic cells seems to mediate this response.

    Correspondence
    2285-2287

    To the Editor: The increased incidence of nephrolithiasis among patients taking supplemental calcium carbonate that was reported by Jackson et al. (Feb. 16 issue)1 might have been avoided if calcium citrate had been given. It has been shown that urinary ...

    2287-2288

    To the Editor: The findings of the Women's Health Initiative (WHI) trial of calcium and vitamin D supplementation and the risk of colorectal cancer reported by Wactawski-Wende et al. (Feb. 16 issue)1 are not surprising. The chief problem with the study, ...

    2289-2291

    To the Editor: In their study of circumferential pulmonary-vein ablation in patients with chronic atrial fibrillation, Oral et al. (March 2 issue)1 do not mention evaluation or discuss the potential complication of pulmonary-vein stenosis. In their ...

    2291-2293

    To the Editor: The observations of Muthukumar et al. (Dec. 1 issue)1 regarding the clinical usefulness of FOXP3 messenger RNA (mRNA) in predicting the outcome of renal-allograft rejection are thought-provoking, but we believe caution is needed. Although ...

    2293-2294
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    To the Editor: Gruchalla and Pirmohamed (Feb. 9 issue)1 recommend that before the initiation of cephalosporin therapy, skin testing should be performed for patients with a suspected history of IgE-mediated reactions to penicillins. We would like to add ...

    2294-2295

    To the Editor: On February 9, 2006, a Food and Drug Administration (FDA) advisory panel recommended that stimulant drugs prescribed for attention deficit–hyperactivity disorder (ADHD) carry warnings about the potential for an increased risk of sudden ...

    2296-2298

    To the Editor: Nissen (April 6 issue)1 recommends attaching a “black box” warning regarding serious cardiovascular risks to the labeling of stimulant medications used to treat attention deficit–hyperactivity disorder (ADHD). We agree that patient safety ...

    Book Reviews
    2299-2300

    Women under the Influence is a scholarly analysis of substance abuse among American women. This lucidly written book provides a perceptive and compassionate discussion of the factors that contribute to the abuse of a wide spectrum of substances and of ...

    2300-2301

    Drawing on his experience accumulated during a distinguished career researching the world's ubiquitous drug-abuse problems, Griffith Edwards attempts in Matters of Substance to summarize the essence of the relationship between humankind and addictive ...

    2301-2302

    As one who deals daily with the personal tragedies of patients who have addictive disorders, I find it useful to conceptualize addiction as the “cancer of behavior.” How else could one fathom the mother who buys cocaine for herself instead of food for her ...

    2303

    The effect of mental illness both within the United States and globally is astounding. Mental disorders account for 4 of the top 10 leading causes of disability worldwide, according to the Global Burden of Disease Study conducted by the World Health ...

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