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January 26, 2006  Vol. 354 No. 4

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Perspective
321-324
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The developments in the laboratory of Woo Suk Hwang of Seoul National University in South Korea are profoundly disappointing to all scientists. Dr. Evan Snyder and Jeanne Loring write that although the events of Hwang's story provide a case study of some ...

324-326

Among other things, the debacle in South Korea has focused renewed attention on oocyte donation. Dr. Robert Steinbrook describes the process of oocyte retrieval and controversies surrounding egg donation.

327-329

Dr. Andrew Bomback writes that the prognostic implications of a patient's smell can be as important as those of the white-cell count or costophrenic angles. Smells also indicate in which direction a patient is headed.

329-331

The body of evidence that is sufficient to demonstrate efficacy for a new drug is rarely large enough to provide absolute assurance that harmful side effects do not exist. David Hunter explains the relevance of ongoing surveillance to detect adverse ...

Original Articles
333-342

In a population of almost 184,000 prospectively studied participants, the risk of lung cancer was ascertained according to the level of cigarette smoking and ethnic or racial background. Among those who smoked no more than 30 cigarettes per day, the relative risk of lung cancer was highest among African Americans and native Hawaiians, as compared with whites, Hispanics, and Japanese Americans.

343-352

Outcomes among recipients of single or dual kidney transplants from donors older than 60 years of age that were allocated on the basis of preimplantation histologic evaluation (for the presence or absence of parenchymal, vascular, or other abnormalities) were compared with outcomes among matched recipients of single grafts from older or younger donors without histologic evaluation. The survival and function of dual or single kidney grafts from older donors were excellent when transplantation was based on the results of biopsy before implantation.

353-365
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The antifibrinolytic agent aprotinin is often used to control blood loss in patients undergoing cardiac surgery. This observational study found that the use of aprotinin is associated with an increased risk of serious end-organ damage. In patients undergoing cardiac surgery, aprotinin should be replaced by aminocaproic acid or tranexamic acid.

Special Article
366-378

This 14-state study compared mortality rates at hospitals with a level 1 trauma center and hospitals without a trauma center among patients with moderate-to-severe injuries. After adjustment for baseline differences in patients' characteristics, the one-year mortality rate was significantly lower at trauma centers than at non–trauma centers (10 percent vs. 14 percent).

Clinical Practice
379-386

A 71-year-old man with type 2 diabetes and hypertension is referred for coronary angiography. Medications include metformin and a thiazide. Before the angiogram, his serum creatinine level is 1.8 mg per deciliter (160 μmol per liter), yielding an estimated glomerular filtration rate of 40 ml per minute per 1.73 m2 of body-surface area. What can be done to reduce the risk that an angiographic contrast agent will worsen his kidney function?

Review Article
387-396

    Rupture of an intracranial aneurysm is the leading cause of subarachnoid hemorrhage not due to trauma. This review summarizes both the approach to establishing the diagnosis and treatment options, including the placement of intravascular coils to arrest the bleeding. Common management problems include vasospasm, hydrocephalus, and rebleeding.

    Images in Clinical Medicine
    397
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    A 72-year-old man presented for evaluation of progressive dyspnea and cough. He reported smoking one to two packs of cigarettes a day since the age of 15 years. Standard chest radiography showed a suspicious lesion in the right thoracic cavity. Computed ...

    e4

    In the emergency department after a high-speed motorbike collision, this patient's blood pressure was 70/35 mm Hg. He did not respond to advanced resuscitation; results of an emergency laparotomy were normal. Radiography of the cervical spine was then ...

    Case Records of the Massachusetts General Hospital
    398-406

    A 63-year-old woman who had recently emigrated from the Dominican Republic sought medical attention because of the recent onset of dark urine, pruritus, and epigastric pain. Imaging studies revealed a complex cystic mass in the head of the pancreas, with stenosis of the common bile duct. Stenting of the obstruction was followed by resolution of jaundice; two months later, the pancreatic mass had resolved, but new intraabdominal lymphadenopathy had appeared. A diagnostic procedure was performed.

    Editorials
    408-411

    It is well known that disease does not affect the population equally. Assessing variation in the rates of disease according to demographic factors such as sex and race or ethnicity is the basis of epidemiologic research and affects clinical and public ...

    411-413

    In this issue of the Journal, Remuzzi et al.1 report on the important challenge of maximizing success when transplanting kidneys from older donors while minimizing poor outcomes due to the risk of receiving older kidneys. This Italian group reports ...

    413-415

    Since its inception in 1988, the Multicenter Study of Perioperative Ischemia Research Group has examined a number of critical issues concerning the outcomes of cardiac surgery and anesthesia. The group's database is a powerful research tool. Its power ...

    Correspondence
    416-417

    To the Editor: Rubenfeld and colleagues (Oct. 20 issue)1 discuss the incidence and outcomes of acute lung injury in a large, population-based cohort study. The authors provide data on the known risk factors of acute lung injury and convincingly suggest ...

    417-419

    To the Editor: Ashen and Blumenthal (Sept. 22 issue)1 state that caution is recommended with the use of high-dose niacin in patients with diabetes, because niacin may increase glucose levels. However, the Arterial Disease Multiple Intervention Trial (...

    419-420

    To the Editor: The Medical Mystery in the December 1 issue1 involved a 71-year-old man with lower-extremity ecchymosis (Figure 1) and gingivitis (Figure 2, arrows). He was a retired Army man living alone with a modest income. He had poor nutritional ...

    420

    To the Editor: Pinero et al. (Nov. 3 issue)1 describe a 74-year-old man with Parkinson's disease in whom severe mitral regurgitation developed after a relatively short course of treatment with cabergoline, an ergot dopamine agonist. Cabergoline is used ...

    421-422

    To the Editor: The use of data on self-reported race in health research has been highly debated.1,2 For example, Burchard et al. recently argued that important information on disease susceptibility may be derived from the use of data on self-reported ...

    422-423

    To the Editor: Parkinson's disease is characterized by resting tremor, rigidity, and bradykinesia caused by the loss of dopaminergic neurons in the substantia nigra, a good response to levodopa, and the presence of Lewy bodies. The recently identified ...

    424-425

    To the Editor: Most cases of Parkinson's disease are considered sporadic and idiopathic, although there is evidence of familial aggregation, and several monogenic forms have been identified.1 Recently, several pathogenic mutations in the highly conserved ...

    Book Reviews
    426-427

    Is alcohol dependence, as alcoholism has come to be known, one disease? Is it many? Is it a disease at all, or just a moral failing? For how much of their behavior should alcoholics be held accountable? What is the best treatment, and who should be ...

    427-428

    Subjective health complaints are common in all societies, and pain and fatigue are among the most frequent. Pain is a valid ticket to receiving health care. Although pain has been extensively researched and pain clinics are numerous, fatigue is still ...

    428-429

    In the latter half of the 20th century, there was a steep increase in the prevalence of diagnosed major depressive disorder; soon, this disorder is expected to become the second-largest contributor to the global burden of disease. What accounts for this ...