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December 14, 2006  Vol. 355 No. 24

Audio Summary of this Issue

Perspective
2505-2508

On December 19, a Libyan court is scheduled to announce its verdict in the trial of five Bulgarian nurses and one Palestinian doctor who have languished in prison for 8 years on charges that they intentionally injected more than 400 Libyan children with ...

2508-2511
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Mark Pallansch and Dr. Hardeep Sandhu write that six years after the original 2000 target date for the global eradication of polio, public health workers are encountering several stumbling blocks.

Original Articles
2513-2522

This randomized, placebo-controlled trial of inactivated and live attenuated influenza vaccines was performed in the winter of 2004–2005. During that season, in which most circulating viruses were dissimilar to those in the vaccines, the absolute efficacies of the inactivated vaccine and the live attenuated vaccine were 67 to 77% and 30 to 57%, respectively.

2523-2532
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Children are important vectors of the influenza virus. In this study, investigators vaccinated children in several intervention schools and compared the occurrence of influenza-like illness in their households with that in households of children in control schools. Intervention-school households had significantly fewer outcomes related to influenza-like illness than did control-school households, including household members with any influenza-like symptoms, fever plus cough or sore throat, medical visits for children, absenteeism among elementary and high school students, and workdays lost by adults during the recall week.

2533-2541
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In this study of 12 experienced gastroenterologists who performed colonoscopic screening, the duration of withdrawal of the colonoscope varied widely among physicians. Rates of detection of polyps were higher among endoscopists who took more time. These findings suggest that the effectiveness of colonoscopy in preventing colon cancer may be influenced by procedure times.

2542-2550

It now appears that most cancers acquire the nourishment that feeds their growth by sprouting new blood vessels under the influence of vascular endothelial growth factor (VEGF). Monoclonal antibodies against VEGF are coming on line in clinical trials. In this article, the authors report on a large clinical trial of one such agent, bevacizumab, in advanced non–small-cell lung cancer. The results are modest but encouraging.

Clinical Practice
2551-2557
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A 52-year-old man with no personal or family history of colon cancer, colonic polyps, or inflammatory bowel disease underwent a screening colonoscopy that showed no abnormalities except for a 1.5-cm pedunculated polyp at the hepatic flexure that was removed by means of a snare with cautery. The polyp was a tubulovillous adenoma without high-grade dysplasia. How should his care be managed?

Review Article
2558-2573

Pituitary tumors account for about 15% of primary intracranial neoplasms. Proliferation of pituitary cells, which secrete hormones, may result in a spectrum of endocrine symptoms. Tumors that originate from pituitary somatotroph cells lead to aberrant secretion of growth hormone and the distinctive features of acromegaly. This review discusses advances in the understanding and treatment of acromegaly.

Images in Clinical Medicine
2574
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A 19-year-old man presented with a 10-month history of Raynaud's phenomenon, fever, abdominal pain, and hypertension. On examination, he had multiple subcutaneous nodules on his forehead, and his blood pressure was 150/100 mm Hg. Laboratory findings ...

e26

Acute unilateral loss of peripheral vestibular function causes spontaneous nystagmus. Initially, nystagmus is present during visual fixation.

Case Records of the Massachusetts General Hospital
2575-2584

A 5-year-old boy was admitted to the hospital because of headaches, abdominal pain, increasing abdominal girth, and a rash. Five months earlier, intermittent severe headaches and abdominal pain had developed, and papilledema was found. MRI disclosed bilateral subdural hygromas, which required placement of a subdural–peritoneal shunt, at which time ascites was noted. Headaches, abdominal pain, and ascites gradually worsened, and a rash developed. Diagnostic procedures were performed.

Editorials
2586-2587
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In this issue of the Journal, two important and timely studies address basic questions related to the use and performance of influenza vaccines.1,2 The findings are also informative because both studies were conducted in the 2004–2005 influenza season ...

2588-2589

Several years ago I visited the Ming Tombs near Beijing. The Ming emperors were buried in elaborate structures, hidden away in the hills to prevent looting. Bricks were embedded with the signature of the brick maker. My guide told me that if the brick ...

Correspondence
2590-2591

To the Editor: Olaussen and colleagues (Sept. 7 issue)1 report a survival benefit associated with the absence of the excision repair cross-complementation group 1 (ERCC1) protein in patients with completely resected non–small-cell lung cancer who ...

2591-2594

To the Editor: The events of the phase 1 trial of TGN1412, as detailed by Suntharalingam et al. (Sept. 7 issue),1 are a sobering reminder of the risks that research volunteers take when they participate in trials, but the article did not contain any ...

2594-2595
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To the Editor: In their Perspective article, Sharpe and Abbas (Sept. 7 issue)1 discuss possible explanations for the adverse events associated with a phase 1 trial of the anti-CD28 monoclonal antibody TGN1412, as reported by Suntharalingam et al.2 Sharpe ...

2595-2598

To the Editor: In his Perspective article (Aug. 31 issue),1 Bodenheimer accurately describes the assault on primary care medicine. Insurers deny payment and bureaucrats add onerous record keeping, while the needs of patients increase. We persist only ...

2598-2599

To the Editor: Arepally and Ortel (Aug. 24 issue)1 review the role of bivalirudin as one of the therapeutic options in the management of heparin-induced thrombocytopenia. In Table 2 of their article, the activated clotting time is listed as a means of ...

2599-2600

To the Editor: Turner's syndrome is characterized by estrogen deficiency due to nonfunctioning bilateral streaks of fibrous stroma.1 The benefit of hormone-replacement therapy in patients with this disorder has been well demonstrated. An increased risk ...

Book Review
2601-2603

The effect of disease on voice and persona underscores the need for a reliable source of information on the science of voice production and the art of clinical medicine. Voice Science, Clinical Assessment of Voice, and Treatment of Voice Disorders are ...