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July 6, 2006  Vol. 355 No. 1

Audio Summary of this Issue

Perspective
1-9
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Drs. Alexi Wright and Ingrid Katz write that abortion supporters fear that Roe may soon be overturned. If that happens, states will have to choose whether to ban or protect abortion.

4-5

In our current cultural climate, the right of women to obtain contraceptives is being called into question. Dr. Rebekah Gee writes that advocacy on behalf of patients is part of our mission as physicians.

Original Articles
11-20

In a randomized trial, overall survival was longer among patients with resectable gastric cancer who received preoperative and postoperative chemotherapy than among those who underwent surgery alone.

21-30
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Exposure to air pollution has been associated with the loss of lung function in epidemiologic studies. In this study, exposures of individual children were assessed through the measurement of carbon in macrophages and were shown to be related to exposure to local pollution and to lung function.

31-40
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In this report, investigators from the New Vaccine Surveillance Network, sponsored by the Centers for Disease Control and Prevention, prospectively assessed the pediatric burden of undiagnosed influenza infection in inpatient and outpatient settings. In children presenting with fever or an acute respiratory tract infection, influenza was clinically diagnosed only 28 percent of the time in the inpatient setting and 13 percent of the time in the outpatient setting.

Special Article
41-50

In this study of more than 20,000 nonsurgical patients receiving mechanical ventilation at 37 acute care hospitals from 2002 to 2003, higher hospital volume was associated with improved survival. After adjustment for the severity of illness and the characteristics of the hospitals, mortality in the hospital was 34 percent in hospitals in the lowest quartile in terms of the number of patients receiving mechanical ventilation per year and 26 percent in the highest quartile.

Review Article
51-65

    This review summarizes the molecular and genetic lesions underlying the progression from benign nevus to malignant melanoma.

    Images in Clinical Medicine
    66
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    A 30-year-old man had a pleomorphic adenoma removed from his left parotid gland. His postoperative course was uncomplicated. Two months later, he noted that his left cheek became wet while he was eating. Believing that saliva was being discharged from the ...

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    Herpes zoster in the right T11–T12 dermatomes developed in a 75-year-old man. Four weeks later, he noticed a protrusion of the right abdominal wall.

    Clinical Problem-Solving
    67-74

      A 52-year-old woman experienced the sudden onset of bilateral arm tingling and numbness, and noted that the words on her computer screen appeared “mixed up.” She improved over the next 24 hours, but then difficulty swallowing and slurred speech developed, progressing over the next three days to no speech.

      Editorials
      76-77

      Gastric and gastroesophageal adenocarcinomas are important health problems. A 2005 analysis1 of the worldwide incidence of and mortality from cancer showed that 934,000 cases of gastric cancer occurred in 2002 and that 700,000 patients die annually of ...

      78-79

      Residents in urban areas may be worried about the air they breathe. In recent reports, air pollution has been linked to increased mortality, an increased risk of asthma, and decreased development of lung function in childhood. In this issue of the Journal,...

      79-81

      Influenza is an uncontrolled epidemic disease that occurs every winter. Epidemics, which vary in severity, are measured by excess mortality, but influenza is always the leading cause of acute respiratory tract infections that lead to health care visits or ...

      Health Policy Report
      82-88

      The author reviews the history of employer-sponsored health insurance in the United States and outlines how it became the cornerstone of the nation's health care system. He discusses the implications of employer-based insurance for access to and the affordability and quality of health care.

      Clinical Implications of Basic Research
      89-90

      A recent trio of studies involving mouse models of type 1 diabetes rules against the spleen as a potential source of therapeutic beta cells and refocuses attention on how best to cultivate the recovery of host beta cells.

      Correspondence
      95-96

      To the Editor: Aristotle proclaimed more than 2300 years ago that “nature abhors a vacuum.” This dictum seems to be confirmed by the study by Kyaw et al. (April 6 issue)1 showing that the rate of antibiotic-resistant invasive pneumococcal infections ...

      96-98

      To the Editor: Johnston et al. (April 13 issue)1 report that the treatment of exacerbations of asthma with the ketolide telithromycin (a semisynthetic derivative of erythromycin) is associated with a clinical benefit; the underlying mechanism of effect ...

      98

      To the Editor: In the discussion of biologic differences between male and female fertility (April 6 issue),1 Federman states that women are fertile for only 12 hours each month. Although the egg is viable for 12 hours or less, the window of fertility in ...

      99-100

      To the Editor: In his discussion of why some physicians participate in executions (March 23 issue),1 Gawande makes contradictory and thus unpersuasive statements. Although he believes that “some human beings . . . do such evil as to deserve to die,” he ...

      101-102

      To the Editor: The use of acronyms to name clinical trials is increasingly popular yet controversial.1,2 We evaluated whether the naming of a trial with an acronym is associated with a distinctive effect on research, measured as the citation rate after ...

      Book Reviews
      103

      This impressive four-volume vade mecum (reference manual), which includes contributions from 279 authors from 21 countries, is both comprehensive and timely. It has arrived when forensic medicine and forensic science have been all but eliminated from the ...

      103-104

      The field of forensic neuropathology has, in large measure, come into its own during the past 30 to 40 years. The first book bearing this title (Forensic Neuropathology: Lesions of the Brain and Spinal Cord of Medico-Legal Importance. Mundelein, Ill.: ...

      105

      The improved treatment of brain tumors and our increasing understanding of the biologic changes that lead to their formation have fueled a growing interest in this large group of uncommon neoplasms. Many books devoted to this topic have been published ...

      106
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      Contact dermatitis includes two distinct subgroups: allergic contact dermatitis and irritant contact dermatitis. Allergic contact dermatitis has been extensively studied, and methods of determining allergy have been well documented through patch-testing ...

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