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October 26, 2006  Vol. 355 No. 17

Audio Summary of this Issue

Perspective
1753-1755

The IOM committee assessed the U.S. drug-safety system and identified a number of serious problems, including a lack of clear regulatory authority, chronic underfunding, organizational difficulties, and a scarcity of post-approval data. Dr. Bruce Psaty ...

1756-1759

A diverse group of business leaders and public officials intends to radically transform the physician's role. To motivate patients to take charge of their own care, they're aiming for a wholesale shift of medical costs to consumers. Dr. M. Gregg Bloche ...

1759-1761

The Wiskott–Aldrich syndrome is a well-recognized triad of eczema, bleeding diathesis, and recurrent infections that occurs in boys. Drs. Jennifer Puck and Fabio Candotti write that although it is rare, the syndrome offers rich historical, clinical, and ...

Original Articles
1763-1771
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More than 30,000 participants were enrolled in a screening program for lung cancer based on spiral computed tomography. Stage I lung cancer was detected in 412 participants; their estimated 10-year survival rate after surgical resection was almost 90%.

1772-1779
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Eleven patients with extensive pemphigus vulgaris that was resistant to conventional therapy had responses to a combination of rituximab plus intravenous immune globulin. After 6 months of this combined treatment, all 11 patients were in remission and required no therapy.

1780-1789

In a series of patients with venous thromboembolism who had been treated with anticoagulation for at least 3 months, d-dimer testing was performed 1 month after the discontinuation of anticoagulation. Patients with an abnormal d-dimer level were randomly assigned either to resume or to stop anticoagulation. The group resuming anticoagulation had a significantly lower rate of subsequent venous thromboembolism and major bleeding.

1790-1793

The authors show that three brothers with the severe phenotype of the Wiskott–Aldrich syndrome, who were described by Wiskott in 1937, were homozygous for a mutation in the WAS gene.

Review Articles
1794-1799

This article in the Medical Education series describes the problems with and success in trying to teach one of the core values of medicine, professionalism. As we better define professionalism, the authors say, it becomes easier to teach.

1800-1810

This review discusses the autoantibodies in pemphigus vulgaris and pemphigus foliaceus and the clinical and pathological similarities among these forms of pemphigus, bullous impetigo, and the staphylococcal scalded-skin syndrome.

Videos in Clinical Medicine
e18

    Lacerations are among the most common reasons for visits to emergency departments; over 11 million such wounds are treated each year in the United States. Although most lacerations will heal without treatment, laceration repair reduces infection, scarring, and patient discomfort. Various methods may be used to repair lacerations. This video demonstrates suturing, the most common method of wound closure.

    Images in Clinical Medicine
    1811
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    A healthy 39-year-old man with persistent influenza-like symptoms underwent chest radiography, which showed two pericardial masses (Panels A and B, arrows). Computed tomography (CT) showed that the masses (one 3.3 by 3.3 cm and the other 2.9 by 2.0 cm) ...

    e19
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    This 66-year-old man with class IV heart failure had had pulmonary tuberculosis 60 years earlier. Fluoroscopy and echocardiography confirmed another diagnosis.

    Case Records of the Massachusetts General Hospital
    1812-1819

    A 43-year-old man was evaluated as an outpatient for hypogonadism, new-onset diabetes, arthralgias, and fatigue. The patient was in his usual state of health until fatigue and decreased libido gradually developed 6 months before evaluation. An initial workup revealed hyperglycemia and elevated levels of liver enzymes and serum ferritin. A diagnostic procedure was performed.

    Editorials
    1821
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    Over the past 5 years, a series of recalls of high-profile prescription medications has aroused serious concern about the safety of the nation's drug supply. Faced with a crisis of confidence, the Food and Drug Administration (FDA) in 2004 called on the ...

    1822-1824

    We are all well acquainted with the frightfully high incidence of lung cancer and the short survival of patients after the diagnosis has been made. The extremely low survival rate is attributable in part to the advanced stage of the disease at the time of ...

    Clinical Implications of Basic Research
    1825-1827

    Induction of the expression of a splicing protein reverses myotonia in a mouse model of myotonic dystrophy.

    Correspondence
    1828-1831

    To the Editor: Owan et al.1 and Bhatia et al.2 (July 20 issue) suggest that the rate of survival among patients who have heart failure with preserved ejection fraction may be similar to that among patients with systolic heart failure. Although neither ...

    1831-1832

    To the Editor: Parker et al. (Aug. 3 issue)1 describe the largest documented outbreak of measles in the United States since 1996, which is of considerable epidemiologic interest. It is surprising that few of the cases were confirmed by laboratory ...

    1832-1833

    To the Editor: As a general practitioner in England, I and the practice in which I work were directly affected by the changes made in 2004 by the introduction by the National Health Service of a pay-for-performance contract for family practitioners, as ...

    1833-1834

    To the Editor: In the table about congenital diarrheal disorders in the Perspective by Binder (July 20 issue),1 congenital sodium diarrhea is attributed to mutations in the gene encoding the sodium–hydrogen exchanger (NHE) isoform 3 (SLC9A3, also known ...

    1834-1836

    To the Editor: We report two cases of hypomagnesemic hypoparathyroidism associated with the use of proton-pump inhibitors, in which patients presented with carpopedal spasm in association with severe hypomagnesemia and hypocalcemia without an appropriate ...

    Book Reviews
    1837-1838
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    Pandemic diabetes mellitus, predominantly type 2 diabetes, gained front-page recognition in the New York Times and other major print media this year after the ominous prediction by Dr. Martin Silink, president-elect of the International Diabetes ...

    1838-1839

    It is difficult to think of a single physiologic or pathologic process that is not dramatically influenced by the microcirculation, the smallest functional unit of the cardiovascular system. The microcirculation is where the interaction between blood and ...

    1839-1840

    Thrombosis is the leading cause of death in the Western world, with more than half of the population dying of myocardial infarction, stroke, or pulmonary embolism. No longer merely the domain of hematology, the field of hemostasis and thrombosis is now an ...

    Corrections
    1840

    Diagnostic Performance of Digital versus Film Mammography for Breast-Cancer Screening Original Article, N Engl J Med 2005:353;1773-1783.. On page 1775, the first paragraph should have read, “To establish a reference standard, participants were classified ...

    1840

    Condoms and Sexually-Transmitted Infections (June 22, 2006; 354:2642-3). On page 2643, the figure was incorrectly labeled “Dysplastic Cell Showing Features of HPV Infection.” We regret the error.

    1840

    Soluble Endoglin and Other Circulating Antiangiogenic Factors in Preeclampsia Original Article, N Engl J Med 2006:355;992-1005.. On page 1003, in Figure 4B, the 95% confidence interval of the adjusted odds ratio for term preeclampsia among women with a ...

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