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Table of contents for

September 28, 2006 Vol. 355 No. 13

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Original Articles

1307-1317

Sentinel-Node Biopsy or Nodal Observation in Melanoma

D.L. Morton and Others

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This large prospective study shows that sentinel-node biopsy can be an important part of the management of intermediate-thickness melanoma of the skin. The biopsy not only yields clinically important prognostic information but also identifies patients with nodal metastases whose survival can be prolonged by lymphadenectomy.

1318-1330

International Trial of the Edmonton Protocol for Islet Transplantation

A.M.J. Shapiro and Others

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Islet transplantation is an evolving therapy that may be considered for patients with type 1 diabetes mellitus complicated by severe hypoglycemia or labile diabetes, provided all other attempts to stabilize glycemic control have been exhausted. This multicenter trial confirms that islet transplantation using the Edmonton protocol can successfully restore long-term endogenous production of insulin and glycemic stability in such patients, but insulin independence is usually not sustainable.

1331-1338

Transmission of Human Herpesvirus 8 by Blood Transfusion

W. Hladik and Others

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Human herpesvirus 8 (HHV-8) is the cause of Kaposi's sarcoma, the most frequent AIDS-associated cancer. In this study of recipients of blood transfusions in Uganda, receipt of an HHV-8–seropositive blood product, as compared with a seronegative blood product, was associated with a 2.8% excess risk of seroconversion to HHV-8.

Review Articles

1339-1344

Medical Education: American Medical Education 100 Years after the Flexner Report

M. Cooke, D.M. Irby, W. Sullivan, and K.M. Ludmerer

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This article introduces a series of reports on medical education. It outlines the main areas of success and the problems that have arisen since the Flexner report was issued.

1345-1356

Medical Progress: The Tuberous Sclerosis Complex

P.B. Crino, K.L. Nathanson, and E.P. Henske

The tuberous sclerosis complex (TSC), a multisystem, autosomal dominant disorder affecting children and adults, results from mutations in one of two genes, TSC1 (encoding hamartin) or TSC2 (encoding tuberin). In this article, the current knowledge of the pathogenesis of the disease and its management are discussed.

Videos in Clinical Medicine

e12

Lumbar Puncture

M.S. Ellenby, K. Tegtmeyer, S. Lai, and D.A.V. Braner

Lumbar puncture is indicated for both diagnostic and therapeutic reasons. Knowledge of the contraindications, the pertinent anatomy, and the methods to minimize the risk of complications is necessary for the safe and efficient performance of lumbar puncture. This procedure video demonstrates how to perform a lumbar puncture.

Images in Clinical Medicine

1357

Intratracheal Melanoma Metastases

A. Bardia and R.D. Rao

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A 42-year-old woman with metastatic melanoma presented with a 1-month history of dyspnea and wheezing. The diagnosis of malignant melanoma had been made 6 years earlier on the basis of a biopsy of an enlarging mole on her left foot. The melanoma was 8.5 ...

e13

Plantar Melanoma — A False Vegetant Wart

V. De Giorgi and D. Massi

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This woman had a verrucous nodule on the sole of her foot that had been treated as a plantar wart for 2 years. Histopathological examination showed an amelanotic malignant melanoma.

Case Records of the Massachusetts General Hospital

1358-1368

Case 30-2006 — A 41-Year-Old Man with Dyspnea, Fever, and Lymphadenopathy

D.T. Scadden, V.V. Muse, and R.P. Hasserjian

A 41-year-old man was admitted to the hospital because of lymphadenopathy, fatigue, and fever, which had worsened during the previous 6 months, with weight loss and a recent onset of cough and dyspnea. He had had multiple sexual partners since a divorce 4 years earlier; there was no recent travel or exposure to ill persons. Evaluation disclosed cervical, axillary, and abdominal lymphadenopathy, hepatosplenomegaly, anemia, and thrombocytopenia. A diagnostic procedure was performed.

Editorials

1370-1371

Sentinel-Node Biopsy in Melanoma

C.M. Balch and N. Cascinelli

In this issue of the Journal, Morton and colleagues report the largest and most important trial of sentinel-lymph-node biopsy for melanoma conducted to date.¹ In the trial, 1269 patients with intermediate-thickness (1.2 to 3.5 mm) melanoma were randomly ...

1372-1374

Diabetes Cure — Is the Glass Half Full?

J.S. Bromberg and D. LeRoith

Nearly 80 years after the first clinical use of insulin, many important advances in the treatment of type 1 diabetes mellitus continue to be made. In this issue of the Journal, Shapiro et al.¹ report on a multinational, prospective trial to disseminate ...

1374-1375

A Good Teacher

J.M. Drazen

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Earlier this year, I learned that my high school chemistry teacher had died. This was not surprising, since he had been my teacher in 1961. What was rather astounding was the outpouring of appreciation from his former students that followed. All of us ...

1375-1376

A New Series on Medical Education

M. Cox and D.M. Irby

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Providing the “right” physician for the health care of the future will require substantial changes in the way doctors are educated. This view was voiced in a report from the Institute of Medicine's Committee on the Roles of Academic Health Centers in the ...

Health Law, Ethics, and Human Rights

1377-1382

Hunger Strikes at Guantanamo — Medical Ethics and Human Rights in a “Legal Black Hole”

G.J. Annas

The author describes the U.S. military's practice of force-feeding prisoners on hunger strikes at Guantanamo Bay. He discusses the controversy surrounding this practice and the ethical issues facing physicians involved in the force-feeding of prisoners.

Clinical Implications of Basic Research

1383-1385

Key Role for a Viral Lytic Gene in Kaposi's Sarcoma

R. Yarchoan

A gene that mediates lytic infection by the human herpesvirus (i.e., HHV-8) may be critical to tumorigenesis.

Correspondence

1386-1388

Treatment of Gastric Cancer

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To the Editor: In the study by Cunningham et al. (July 6 issue),¹ the effect of down-staging of tumor is unclear. At surgery, there were more patients with advanced disease according to tumor stage and nodal status in the surgery group than in the ...

1388-1389

Condom Use and the Risk of HPV Infection

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To the Editor: The inverse relationship between the frequency of condom use and the incidence of human papillomavirus (HPV) infection, reported by Winer et al. (June 22 issue),¹ may be due to variation in the prevalence of HPV infection among sex ...

1390-1391

Homocysteine Lowering and Cognitive Performance

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To the Editor: McMahon et al. (June 29 issue)¹ report that lowering plasma homocysteine concentrations by means of treatment with B vitamins did not improve the cognitive performance of healthy elderly volunteers with elevated homocysteine ...

1392-1395

Retinol-Binding Protein 4 and Insulin Resistance

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To the Editor: Graham et al. (June 15 issue)¹ report that serum levels of retinol-binding protein 4 (RBP4) correlated with the magnitude of insulin resistance in various subjects. However, RBP4 and plasma insulin levels were dissociated in subjects who ...

1395-1396

Molecular Mechanisms in Melanoma

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To the Editor: The review of melanoma by Miller and Mihm (July 6 issue)¹ clearly characterizes the linear progression of melanocytic lesions, from the morphologic perspective to the molecular perspective.²,³ However, the genetic alterations would have ...

1396-1397

Alemtuzumab for Refractory Celiac Disease

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To the Editor: Vivas et al. (June 8 issue)¹ describe a patient with refractory celiac disease who had a response to treatment with alemtuzumab. It is not clear whether the percentage of aberrant intraepithelial lymphocytes decreased while the patient was ...

1397-1399

Autoimmunity after Islet-Cell Allotransplantation

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To the Editor: A 52-year-old man with a 36-year history of type 1 diabetes mellitus complicated by hypoglycemia unawareness received two intrahepatic islet-cell allografts. The glycated hemoglobin value before transplantation was 9.3%. He received 400,...

Book Reviews

1400

To the Marrow

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In the almost 40 years since the first successful bone marrow transplantation was performed, many books have been written about the process, its ethical and moral issues, and the reflections of patients and donors. Why, then, is Robert Seder's To the ...

1401-1402

The Troubled Dream of Genetic Medicine: Ethnicity and Innovation in Tay–Sachs, Cystic Fibrosis, and Sickle Cell Disease

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The associations of Tay–Sachs disease with ethnicity and of cystic fibrosis and sickle cell disease with race have been mined before, as the extensive references in this book testify. The authors are particularly interested in the role of ethnicity and ...

1402

Kendig's Disorders of the Respiratory Tract in Children

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Kendig's Disorders of the Respiratory Tract in Children was originally published nearly 40 years ago and is now in its seventh edition. In their preface, the editors refer to it as “the bible” of pediatric pulmonology. Although improving on the “bible” ...

1403

Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice

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Pediatric nephrologist Ron Hogg has gathered contributors from the international community of pediatric nephrology — some of whom have been instrumental in the development of this subspecialty — to examine the field in the context of recent clinical ...

Perspective

1297-1300

Delaying Generic Competition — Corporate Payoffs and the Future of Plavix

M. Shuchman

In August, pharmacies began selling a cheaper, generic version of the blockbuster antiplatelet agent Plavix (clopidogrel). Dr. Miriam Shuchman explains why this was good news for patients but to those who produce and market the drug, it was a financial ...

1300-1303

Crisis in the Emergency Department

A.L. Kellermann

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The power and sophistication of terrorist bombings have increased dramatically, but America's emergency and trauma care system has deteriorated to an alarming degree. Dr. Arthur Kellermann writes that strengthening disaster response is a key priority.

1303-1305

Focus on Research: The Continuing Risk of Transfusion-Transmitted Infections

M.A. Blajchman and E.C. Vamvakas

An emerging agent can threaten the safety of the blood supply. Drs. Morris Blajchman and Eleftherios Vamvakas write that the risk of transfusion-transmitted infection is not static, as new agents continue to emerge and old ones change their properties and ...

e14

Audio Interview: Pay for Performance — Recommendations of the Institute of Medicine

E. Fisher and K. Davis

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Dr. Elliott Fisher and Karen Davis discuss the pay-for-performance concept and its usefulness in the Medicare system

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September 28, 2006 Vol. 355 No. 13

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