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November 2, 2006  Vol. 355 No. 18

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Perspective
1845-1847

Congress recently called on the Centers for Medicare and Medicaid Services to implement a pay-for-performance system for hospitals, and there is strong interest in expanding such programs to individual physicians. Dr. Elliott Fisher writes that the rush ...

1847-1849

Cardiac surgery — most notably, coronary-artery bypass grafting (CABG) — is the longest-standing and most common focus of public report cards. Cardiac surgeons might feel that they are being subjected to a unique level of scrutiny, but Dr. Robert ...

Original Articles
1851-1862

In women with early breast cancer, adjuvant therapy with epirubicin plus the standard combination of cyclophosphamide, methotrexate, and fluorouracil (CMF) was shown to improve both relapse-free and overall survival, as compared with the standard CMF regimen alone.

1863-1872

In a large, national program of colorectal-cancer screening in Poland, men were about twice as likely as women to have advanced neoplasia detected on colonoscopy. The yield of colonoscopy among men 40 to 49 years of age was similar to that among women 55 to 59 years of age (in these differing age groups, one advanced neoplasia detected for every 23 men and 22 women screened).

1873-1884

Fifteen patients with severe heart failure underwent implantation of left ventricular assist devices followed by a specific pharmacologic regimen. Eleven patients had sufficient myocardial recovery to permit explantation of the device, and eight of these patients were alive and free of heart failure or transplantation more than 4 years later.

1885-1894

Maternal periodontal disease has been associated with an increased risk of preterm birth and low birth weight. In this randomized trial, nonsurgical treatment of periodontitis (including scaling and root planing) in pregnant women improved periodontal disease but did not significantly alter rates of preterm birth, low birth weight, or fetal growth restriction.

Special Article
1895-1902
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More than half the commercial health maintenance organizations (HMOs) in this national survey were found to use pay for performance in their provider contracts. This situation affects more than 80% of all those enrolled in the HMOs surveyed. These data are important and informative, because Medicare is moving closer to adopting pay for performance for physicians, health plans, and other institutions.

Clinical Practice
1903-1911

A 53-year-old woman with asthma and multilobar pneumonia is admitted with respiratory failure. She is intubated and treated with antibiotics, albuterol, and methylprednisolone. A random blood glucose measurement obtained on admission shows a level of 183 mg per deciliter (10.2 mmol per liter). After 3 hours in the intensive care unit, she has a capillary glucose level of 264 mg per deciliter (14.7 mmol per liter). She has no history of diabetes. Should her hyperglycemia be treated, and if so, how?

Images in Clinical Medicine
1912
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A 56-year-old man underwent a colonoscopy after a positive fecal occult-blood test. Colonoscopy revealed two pedunculated polyps, one in the ascending colon and one in the transverse colon. One polyp was removed with a polypectomy snare (Panel A), but ...

e20
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This 52-year-old man with diabetes reported a 3-month history of a pretibial rash. The lesions had begun to ulcerate but were not painful.

Clinical Problem-Solving
1913-1918

    A 21-year-old man presented to the emergency department after 2 days of pain in the right lower abdominal quadrant. The pain was dull and nonradiating, and it had increased in intensity during those 2 days. It was not worsened by food intake and was unrelated to bowel movements. He also noted that for the past month he had had exertional dyspnea with a cough productive of scanty yellow sputum.

    Editorials
    1920-1922
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    In 1976, Bonadonna and his colleagues published the results of their landmark trial of adjuvant chemotherapy for breast cancer.1 They showed that 12 months of postoperative chemotherapy consisting of cyclophosphamide, methotrexate, and fluorouracil (CMF) ...

    1922-1925

    Heart failure is increasing in incidence and prevalence, is expensive to treat, and is associated with substantial morbidity and mortality.1 In the nomenclature of the guidelines of the American Heart Association and the American College of Cardiology, ...

    1925-1927

      Preterm births (those occurring before 37 weeks of gestation) make up 12.5% of births in the United States. They account for 70% of perinatal deaths and nearly half of all long-term neurologic complications — the most important adverse outcomes of ...

      1927

      On February 9, 2006, we published an Expression of Concern1 about two articles we had published by Jon Sudbø et al.2,3 In the Expression of Concern, we indicated that we were awaiting the results of an investigation by Dr. Sudbø's institution. That ...

      Special Report
      1928-1933
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      Potential voters rated the importance of health care issues in the upcoming congressional elections below that of the economy, the Iraq war, and terrorism. They identified lack of insurance coverage and health care costs as the most important health care issues. The authors report that although Americans are concerned about the state of the health care system, health care issues are not likely to be a major factor in the 2006 elections.

      Correspondence
      1934

      To the Editor: In the article by Moser and Setaro (July 27 issue),1 the description of the Osler maneuver (to assess “pseudohypertension”) should be clarified. A positive result is reflected by the continued palpability of the radial artery (not of the ...

      1935
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      To the Editor: The review of dystonia by Tarsy and Simon (Aug. 24 issue)1 contains misleading statements about dystonia 3 (also referred to as X-linked dystonia–parkinsonism [XDP] and lubag), which is an important differential diagnosis in people of ...

      1935-1936

      To the Editor: Ordi et al. (Aug. 3 issue)1 confirm that the Holy Roman Emperor Charles V suffered from what physicians had long suspected was severe tophaceous gout.2 Lead poisoning may also have contributed to the decline and fall of this emperor.3 ...

      1936-1938

      To the Editor: In the Case Record presented in the August 10 issue,1 which describes the management of an overdose of amlodipine, Harris cites Kline et al.2 and states that “data from studies in animals and humans support the administration of insulin ...

      1938-1940

      To the Editor: We report tracheal replacement with fresh aortic allografts in two patients with large chemotherapy-resistant and radiotherapy-resistant tumors (mucoepidermoid and adenoid cystic carcinomas). These interventions were made on the basis of ...

      Book Reviews
      1941-1942

      In 2006, do we still need textbooks to learn how to diagnose and treat breast cancer? The first widely read American textbook on breast cancer was Cushman D. Haagensen's Diseases of the Breast, published in 1956 (Philadelphia: Saunders). Haagensen's ...

      1942

      Medical oncology has undergone profound changes in the past decade, driven in part by the explosive growth in the field of molecular biology. In turn, drug development has progressed from empirical screening to combinatorial chemistry, computer-aided ...

      1943
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      Of course, this is a very good book. Of course, it is very well presented. Of course, I shall use it for reference whenever I see an unusual type of lymphoma. Of course, it is a little behind the cutting edge; all textbooks are. Of course, it is ...

      Correction
      1944

      Sentinel-Node Biopsy or Nodal Observation in Melanoma Original Article, N Engl J Med 2006:355;1307-1317.. On page 1307, in the third line of the Results section, the parenthetical information should have read “hazard ratio for recurrence,” rather than “...