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February 9, 2006  Vol. 354 No. 6

Audio Summary of this Issue

Perspective
545-548

The diabetes epidemic in the United States continues unabated, with a staggering toll in acute and chronic complications, disability, and death. Dr. Robert Steinbrook discusses New York City's novel response to the diabetes epidemic.

548-551

Dr. Sandeep Jauhar asks, is the demise of physical diagnosis a crisis or a natural evolution? Is the physical exam just fool's gold, carrying the luster of something valuable but worthless at its core?

551-553

Dr. Howard Markel contends that the stethoscope embodies the essence of doctoring: using science and technology in concert with the human skill of listening to determine what ails a patient.

553-555

In stroke, a complex of neurons, the microvessels that supply them, and the supportive cells may be a target of ischemic injury. Dr. Gregory del Zoppo writes that effective therapies for ischemic stroke may need to provide protection to the entire ...

Original Articles
557-566
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Extracts of the saw palmetto berry are widely used for symptoms of benign prostatic hypertrophy. This one-year randomized trial showed that saw palmetto was no more effective than placebo in ameliorating symptoms and signs of benign prostatic hypertrophy.

567-578

Treatment of advanced locoregional head and neck cancer with high-dose radiotherapy plus cetuximab was superior to radiotherapy alone in improving local control and overall survival.

579-587

This case–control study demonstrates a significant association between persistent pulmonary hypertension of the newborn and the use of selective serotonin-reuptake inhibitors (SSRIs) during the second half of pregnancy. There was no significant association between this outcome and the use of SSRIs during the first half of pregnancy or the use of non-SSRI antidepressants during pregnancy.

588-600
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This randomized placebo-controlled trial evaluated a free-radical–trapping agent (NXY-059) in patients with acute ischemic stroke. At 90 days, treatment with NXY-059 was associated with improvement according to the modified Rankin scale for disability (the primary outcome measure), but no significant benefit on the other outcome measures, including the National Institutes of Health Stroke Scale. Additional studies are needed to determine whether NXY-059 is beneficial in patients with stroke.

Clinical Practice
601-609

    A 55-year-old woman presents to the hospital with cellulitis. She reports a history of urticaria 30 years earlier associated with taking penicillin for a respiratory infection. Should cephalosporins be avoided? More generally, how should patients with a history of antibiotic allergy be evaluated and treated?

    Review Article
    610-621

    In this review, the authors discuss the properties of chemokines and their receptors and highlight the roles of these chemoattractants in selected clinical disorders.

    Images in Clinical Medicine
    622

    A woman with stage T3N0 anal carcinoma was treated with radiotherapy and concurrent chemotherapy with fluorouracil and mitomycin. The total dose of radiotherapy was 5940 cGy, with the high-dose area shaped as a rectangle measuring 8 cm by 10 cm (Panel A). ...

    e5
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    This 88-year-old man had undergone resection of adenocarcinoma of the rectum. He then presented with a three-month history of swelling of the legs.

    Case Records of the Massachusetts General Hospital
    623-630

    A 79-year-old woman had abrupt onset of pain in the shoulders, neck, and back two days after beginning treatment with ezetimibe. These symptoms persisted, and weakness developed despite discontinuing ezetimibe. The erythrocyte sedimentation rate was 90 mm per hour. Prednisone (20 mg daily) led to improvement in the muscle pain and weakness, but dyspnea and hoarseness developed, and she was admitted to the hospital. A diagnostic procedure was performed.

    Editorials
    632-634

    The desire to take medicine is one feature which distinguishes man, the animal, from his fellow creatures.

    — William Osler1

    The Food and Drug Administration (FDA) is the regulatory body charged with assessing the basic and clinical science underlying the ...

    634-636

    The treatment of head and neck cancer is complex and difficult, both technically and physically. Tumors in each site in the head and neck (oropharynx, hypopharynx, larynx, and oral cavity) have the same squamous tissue and biologic features, but their ...

    636-638

    Persistent pulmonary hypertension of the newborn (PPHN) is a serious condition that typically occurs in full-term or near-term infants. Before birth, the fetus receives oxygenated blood from the placenta; a high pulmonary arterial pressure results in low ...

    638

    In the issue of April 26, 2001, we published a study by Jon Sudbø et al.1 Figures 3B and 3C of that article, which purport to represent two different patients and stages of oral epithelial dysplasia, are in fact different magnifications of the same ...

    639

    Each year thousands of reviewers contribute their expertise to peer review, a process that contributes critically to the quality of the Journal. The editors and the authors of the papers submitted to the Journal are grateful for the help of all our ...

    Correspondence
    640-644

    To the Editor: With regard to the reports by Piccart-Gebhart and colleagues and Romond and colleagues (Oct. 20 issue)1,2 on adjuvant trastuzumab, I have two concerns. The first is that statistics based on immature data are not necessarily significant. As ...

    644-645

    To the Editor: In his editorial, Podolsky (Nov. 3 issue)1 suggests that monitoring with the use of magnetic resonance imaging (MRI) may be helpful in the care of patients with Crohn's disease who are receiving natalizumab therapy and are at risk for ...

    645-646

    To the Editor: In the review of long-acting methods of contraception by Peterson and Curtis (Nov. 17 issue),1 the discussion of hysteroscopic tubal sterilization was limited to a single, addendum-like sentence. Moreover, the authors seemed to ignore the ...

    646-648

    To the Editor: In his otherwise comprehensive and well-referenced review of the medical management of depression, Mann (Oct. 27 issue)1 notes both in the text and in the treatment algorithm (Figure 2 in the article) the use of thyroid hormone supplements ...

    648-649

    To the Editor: In August 2005, the Food and Drug Administration and Genentech issued warnings to physicians about cardiotoxicity associated with the monoclonal antibody trastuzumab (Herceptin), as observed in studies by the National Surgical Adjuvant ...

    Book Reviews
    650-651

    “Liability without fault” was the verdict in a 1958 lawsuit in the aftermath of the paralysis of children in the United States who had received a licensed polio vaccine manufactured by Cutter Laboratories. In The Cutter Incident, Paul Offit lays out the ...

    651-652

    Vaccines have been one of the great success stories in preventive medicine. Smallpox has been eradicated, polio has been eliminated from much of the world, and measles — which once killed several million children annually — has been markedly reduced. ...

    652-653

    It is difficult not to be impressed by the overwhelming accumulation of knowledge summarized in this excellent book. Ticks, irreverently referred to in chapter 1 as “primitive, obligate, blood-sucking parasites,” are vectors for an increasing number of ...

    653

    In this era of fear of microorganisms used as weapons by bioterrorists, the devastating consequences of an influenza pandemic, or drug-resistant bacterial infections, a small but clinically significant plague of invasive fungal infections has developed. ...