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June 22, 2006  Vol. 354 No. 25

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Perspective
2637-2641

ADHD is a diagnosis that is increasingly being applied to adults. Once considered a disorder of the elementary-school years, ADHD is now thought to persist into adulthood, impairing functioning, in about 50 percent of cases. Dr. Susan Okie reports.

2642-2643
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Polarization of opinion about condoms may finally be starting to abate. Drs. Markus Steiner and Willard Cates write that we have strong evidence that condom use reduces the risk of transmission of HIV, gonorrhea and chlamydia, and herpes simplex virus in ...

Original Articles
2645-2654

In this prospective study of female university students, investigators from Seattle demonstrate that the consistent use of condoms by male partners from the initiation of female sexual activity decreases the incidence of female human papillomavirus (HPV) infection. The incidence of genital HPV decreased from 89.3 per 100 patient-years (for 5 percent condom use) to 37.8 per 100 patient-years (for 100 percent condom use).

2655-2666

Interstitial lung disease is a common complication of systemic sclerosis, but there is no widely accepted treatment. In this randomized, placebo-controlled trial, treatment with cyclophosphamide for one year was associated with a small but significant improvement in lung function and symptom outcomes. The long-term adverse effects of this treatment are unknown.

2667-2676

The pathophysiology of systemic sclerosis (scleroderma), an autoimmune disease characterized by injury of endothelial cells, and tissue fibrosis, is undefined. Patients with scleroderma were shown to have agonistic autoantibodies against the platelet-derived growth factor (PDGF) receptor. These autoantibodies have activity on fibroblasts and they may play a causal role in the pathogenesis of the disease.

2677-2688

In 4 of 15 patients with idiopathic atrial fibrillation, four novel, heterozygous mutations in GJA5 — the gene for the gap-junction protein connexin 40 — were identified. These supplement the list of mutations that cause atrial fibrillation and will improve our understanding of the molecular basis of atrial fibrillation.

Clinical Therapeutics
2689-2695
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A 16-year-old boy with a history of severe persistent asthma despite treatment with inhaled corticosteroids presents for evaluation. Treatment with omalizumab, a monoclonal anti-IgE antibody, is recommended. This agent has been found to reduce the frequency of exacerbations of asthma in clinical trials. It is not known how the efficacy of omalizumab compares with that of other available therapies. The drug is more expensive than other agents.

Images in Clinical Medicine
2696
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A 68-year-old woman requested medical attention for a sudden increase in hair growth that she had noticed 11 months earlier. She had lost more than 30 kg during this same period. Physical examination revealed fine lanugo hair all over her face (Panel A) ...

e26
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This 82-year-old man had acute respiratory distress after computed tomography of the thorax.

Case Records of the Massachusetts General Hospital
2697-2704

A 22-month-old boy was seen in the pediatric rheumatology clinic because of subcutaneous nodules on the legs, right hand, and neck that had been increasing in size and number during the preceding six weeks. The child was otherwise well. The lesions were firm, nontender, slightly mobile, and nonpigmented. A diagnostic procedure was performed.

Editorials
2706-2707
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Five years ago, the Journal introduced Clinical Practice, a series of review articles intended to provide practical guidance in the diagnosis, evaluation, and management of clinical problems at the interface of primary and specialty care. Our goal was to ...

2707-2709

Clinically significant interstitial lung disease affects patients with systemic sclerosis (scleroderma) and is a cause of morbidity and mortality in approximately 40 percent of these patients.1 Management of this condition remains difficult and ...

2709-2711

Scleroderma (systemic sclerosis) is characterized by the deposition and accumulation of excessive amounts of collagen and extracellular-matrix molecules, the dysfunction of microvascular endothelial cells, and altered immune tolerance. These interacting ...

2712-2714

Atrial fibrillation has always been the little sister to its ventricular counterpart — but during the past decade, it has captured our attention, mainly because it is so common. Atrial fibrillation affects nearly 2.5 million Americans, and this number ...

Legal Issues in Medicine
2715-2720

In response to the September 11, 2001, attacks and heightened concern about bioterrorism, the U.S. government increased research funding for developing countermeasures to bioterrorism and passed new biosafety legislation. In this article, Annas discusses the legal and ethical issues raised by two cases involving scientists accused of violating biosafety laws.

Clinical Implications of Basic Research
2721-2723

Mice deficient in Emilin1, an extracellular growth factor expressed in blood vessels, have hypertension. This observation, together with the finding that Emilin1 regulates the availability of transforming growth factor β (TGF-β), contributes to a growing body of evidence implicating TGF-β in hypertension.

Correspondence
2724-2725

To the Editor: Treanor et al. (March 30 issue)1 conducted a well-designed study of a poor vaccine produced by methods that are used in the labor-intensive manufacture of conventional inactivated influenza vaccine. This subvirion influenza A (H5N1) ...

2725-2726

To the Editor: Park-Wyllie and colleagues (March 30 issue)1 advise avoiding the use of gatifloxacin because of the increased risk of dysglycemia, and they suggest using alternative antibiotics, including other fluoroquinolones, that confer little or no ...

2726-2727

To the Editor: The review by McKay and Josephson (March 23 issue)1 covers most of the critical issues involved in pregnancy in recipients of solid-organ transplants. However, the rates of infections and their related complications are also high among ...

2727-2729

To the Editor: As clinical toxicologists, we recommend a few additions and corrections to the causes of anion-gap metabolic acidosis that are listed in the case of ethylene glycol poisoning described by Takayesu et al. (March 9 issue).1 Propylene glycol, ...

2729-2731

To the Editor: Pheochromocytoma occurs in approximately 1 percent of patients with neurofibromatosis type 1.1 Accordingly, germ-line mutations in the NF1 gene — the susceptibility gene for neurofibromatosis type 1 — are assumed to be one of the heritable ...

2731-2732

To the Editor: A 24-year-old man had pneumonia and respiratory distress in November 2003 and died four days after being hospitalized. Because the clinical manifestations were consistent with those of the severe acute respiratory syndrome (SARS) and ...

Book Reviews
2733-2734

The onset of ascites in a patient with cirrhosis signals the beginning of compromised quality and expectancy of life. This common complication of end-stage liver disease results from a complex pathogenesis that leads to marked renal sodium and water ...

2734-2735

Peter W. Kaplan's second edition of Neurologic Disease in Women reminds the general medical community that the sexes are not created equal. In this age of highly developed medical technology, with gene mapping and advanced therapeutic options hemmed in by ...

2735-2736

There is an international dispute among the World Health Organization, the European Group for the Study of Insulin Resistance, and the National Cholesterol Education Program regarding the existence of the metabolic syndrome. This multiauthored book offers ...

2736-2737

As the nation's only model of universal health care, the Medicare program is viewed by some people as a beacon of hope and by others as a doomed dinosaur. Wisely reformed, it might be part of the country's movement toward an effective, efficient, and ...