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November 9, 2006  Vol. 355 No. 19

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Perspective
1949-1952

In approving drug-eluting stents, the FDA obliged manufacturers to track all subjects in their pivotal clinical trials for 5 years. Dr. Miriam Shuchman discusses the recent data that challenge the golden reputation of drug-eluting stents.

1952-1955

Between August 19 and September 5, symptomatic enteritis from Shiga toxin–producing E. coli O157:H7 infection was reported in 199 persons in 26 states in association with consumption of fresh spinach or spinach-containing products. Dr. Dennis Maki asks ...

1956-1957

Dr. Nicholas White writes that the main reason malaria-related mortality has increased while mortality associated with most other treatable and preventable infections has decreased is the continued deployment of ineffective antimalarial drugs in the face ...

Original Articles
1959-1966
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Resistance to chloroquine is a major challenge in the treatment of falciparum malaria. In 1993, Malawi replaced chloroquine with sulfadoxine–pyrimethamine for malaria treatment. After the return of chloroquine-susceptible falciparum malaria to Malawi, investigators studied the reemergent clinical efficacy of chloroquine and found that it was approximately 99% effective.

1967-1977
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Induction therapy reduces the frequency of acute rejection and delayed graft function. In this study in patients at high risk for acute rejection or delayed graft function who received a cadaveric renal transplant induction therapy with rabbit antithymocyte globulin reduced the incidence and severity of acute rejection, but not the incidence of delayed graft function, as compared with a monoclonal interleukin-2 receptor antibody. Patient and graft survival were similar in the two groups.

1978-1990

In this sham-controlled trial of neurostimulation of the internal globus pallidus for primary dystonia, neurostimulation improved movement, disability, and quality-of-life scores. Adverse events were common; 18% of patients had infections at the stimulator site, seroma, or lead breakage or dislodgment, and 12% had dysarthria.

1991-2002

In the Nurses' Health Study, the risk of coronary heart disease during 20 years of follow-up was not increased among participants with the lowest levels of carbohydrate intake. It is not clear whether the findings apply to low-carbohydrate diets undertaken specifically to lose weight.

Special Article
2003-2011

In the 116th Shattuck Lecture, Nobel laureate Ferid Murad explains how nitric oxide was discovered to be a biologically important molecule and outlines its multiple roles.

Review Article
2012-2020

Spinal epidural abscesses are often initially misdiagnosed, particularly in neurologically intact patients. Epidural infections can cause injury to the spinal cord. The incidence of these infections has increased with increasing use of spinal instrumentation, vascular access, and injection drugs. This review explains the diagnostic and therapeutic challenges and how to avoid spinal cord infarction.

Videos in Clinical Medicine
e21

    Abdominal paracentesis can establish the cause of ascites or rule out spontaneous bacterial peritonitis in patients with ascites. Large-volume paracentesis in hemodynamically stable patients with tense or refractory ascites can alleviate discomfort or respiratory compromise. This procedure video demonstrates how to perform paracentesis.

    Images in Clinical Medicine
    2021
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    A 54-year-old man with a history of parenteral substance abuse, hepatitis C virus infection, and poor peripheral venous access presented to the emergency department with a history of progressive pain, swelling, and discoloration of his left thumb. Four ...

    e22
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    This 45-year-old man presented with 3 days of colicky abdominal pain, nausea, and vomiting. He had been admitted 36 months earlier because of a similar episode. Computed tomography demonstrated a small-bowel stricture with an intraluminal radiopaque mass.

    Case Records of the Massachusetts General Hospital
    2022-2031
    • Video

    A 72-year-old woman awoke from sleep with nausea that worsened during a 24-hour period. Evaluation disclosed pulmonary infiltrates, an elevated granulocyte count, hypoxemia, and hypotension; antibiotics were administered. Blood drawn later showed elevated levels of cardiac enzymes, and an electrocardiogram showed ST-segment elevation. Hypoxemia and hypotension worsened. A diagnostic procedure was performed.

    Editorial
    2033-2035

    In this issue of the Journal, Brennan et al.1 compare the safety and efficacy of two induction therapies commonly used in kidney transplantation: rabbit antithymocyte globulin and basiliximab. Induction refers to the administration of an intensive ...

    Health Policy Report
    2036-2041

    Researchers patented their discovery that elevated homocysteine levels are associated with vitamin B12 and folate deficiency. The right to hold a patent on a basic scientific relationship was challenged, and the case (LabCorp v. Metabolite) was appealed to the Supreme Court.

    Clinical Implications of Basic Research
    2042-2044

    A new, searchable repository of gene-expression data reveals new candidate drugs and drug targets.

    Correspondence
    2045-2046

    To the Editor: In his Sounding Board article calling for changes in the drug-approval process, Wood (Aug. 10 issue)1 does not consider a very important concept. What if basic research points toward a simpler and cheaper way to treat, control, or cure one ...

    2046-2048

    To the Editor: In reviewing the pathophysiological process of rheumatoid arthritis, Scott and Kingsley (Aug. 17 issue)1 focus almost exclusively on dendritic cells and T cells. However, in mice, the maintenance of T-cell activation and tumor necrosis ...

    2048

    To the Editor: In his Perspective article on preimplantation diagnosis for genetic susceptibility (Aug. 10 issue),1 an English colleague, Braude, asserts that assisted reproductive technology is unregulated in the United States. There are profound ...

    2048-2050

    To the Editor: Bisphosphonates are the most widely used agents to prevent and treat osteoporosis.1 Although their safety has been tested in randomized trials (for up to 10 years),2 reports of previously unnoticed complications, such as severe suppression ...

    Book Reviews
    2051

    As recent examples attest, managing an environmental or infectious crisis, real or perceived, requires understanding more than the science. The Great Stink of Paris and the Nineteenth-Century Struggle against Filth and Germs, by historian of science David ...

    2051-2052

    In Pneumonia before Antibiotics, Scott H. Podolsky demonstrates remarkable scholarship as he examines the philosophical and sociologic implications of the introduction of serotherapy and the sulfa drugs for treating pneumonia in the first part of the 20th ...

    2053-2054
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    From his vantage point as both surgeon and historian, Ira Rutkow brilliantly navigates that narrow space that contains both the political history and the medical facts concerning the untimely death of President James A. Garfield. This book is the 33rd in ...

    Correction
    2054

    AMG 531, a Thrombopoiesis-Stimulating Protein, for Chronic ITP Original Article, N Engl J Med 2006:355;1672-1681.. On page 1672, the ninth line of the Results section of the Abstract should have read “3, 6, and 10 μg of AMG 531 per kilogram,” rather than “...