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August 10, 2006  Vol. 355 No. 6

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Perspective
541-543

In May, the United Kingdom's Human Fertilisation and Embryology Authority decided to include susceptibilities to certain cancers among the conditions for which it will allow preimplantation genetic diagnosis. The testing for some specific, highly ...

543-545

Consumers can now order a test for the BRCA1 or BRCA2 gene mutation or any of hundreds of other diagnostic assays, all without involving their physician or health insurance plan. Dr. Adam Wolfberg discusses genetic testing and the concerns about privacy ...

545-546
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With the advent of DNA analysis, there is a growing public impression that the answer to “Who am I?” may be found in our genes. Patricia Roche and George Annas write that we should be alert to the risks as well as the benefits of exploring our DNA and ...

547

Since the firings at the CMAJ in February, there has been passionate public debate about editorial independence and the governance of the publication. In March, the Canadian Medical Association appointed a review panel. Dr. Robert Steinbrook reports on ...

Original Articles
549-559
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In this five-year placebo-controlled trial involving patients who had a recent stroke or transient ischemic attack and baseline low-density lipoprotein cholesterol levels of 100 to 190 mg per deciliter (3 to 5 mmol per liter), atorvastatin (80 mg daily) resulted in an absolute reduction in nonfatal or fatal stroke of 2.2 percent and of major cardiovascular events of 3.5 percent.

560-569

There are now many published examples of gene-expression–based methods to aid in the determination of prognosis, and some of these methods are available to the clinician. This study of five models shows that four of the five classified cancers concordantly, despite minimal overlap in the gene sets used.

570-580

This study showed that a predictor based on gene expression provides prognostic information beyond that provided by traditional clinical predictors. It sets the stage for a prospective trial to determine whether the predictor could be used to guide the treatment of patients with stage IA non–small-cell lung cancer.

581-592

Among patients with neonatal-onset multisystem inflammatory disease — a disorder characterized by fever, urticarial rash, aseptic meningitis, deforming arthropathy, hearing loss, and mental retardation — treatment with the interleukin-1 antagonist anakinra markedly improved clinical and radiologic manifestations of disease (including central nervous system manifestations) and decreased serum markers of inflammation. Anakinra withdrawal resulted in a flare of disease within days; retreatment led to rapid improvement.

Clinical Practice
593-600

A 69-year-old man reports increasing pain in the right leg. Physical examination reveals warmth and anterolateral bowing of the right shin. The serum alkaline phosphatase level is 260 U per liter (normal, 38 to 126 U per liter). A skeletal scintigraphic scan reveals enhanced uptake in only the deformed tibia, where a radiograph shows changes indicative of Paget's disease. His sister, whose alkaline phosphatase level is 160 U per liter, has asymptomatic Paget's disease confined to the left iliac wing. How should their cases be managed?

Images in Clinical Medicine
601
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A 68-year-old man with chronic dysuria and increased urinary frequency presented with three weeks of weakness and fever. Physical examination revealed a man with cachexia who had a large, right-sided inguinal hernia that had been enlarging for more than ...

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This 34-year-old woman reported that the right side of her face was warmer than the left and had a propensity for sweating. She had a left-sided tonic pupil.

Case Records of the Massachusetts General Hospital
602-611

A 40-year-old woman was transferred to the emergency department of this hospital because of hypotension. Seven hours earlier she had ingested 100 sample tablets of amlodipine (10 mg) in a suicide attempt. She was taken to an emergency department, where her blood pressure fell from 100/60 mm Hg to 58/38 mm Hg despite the use of pressors.

Editorials
613-615

Given the disparity in the numbers of cerebrovascular and cardiovascular clinical trials and the similarities in the interventions tested, it seems that stroke neurologists have had to peer at clinical-trial results over the shoulders of their ...

615-617

Breast cancer is classified and managed largely on the basis of anatomy — in contrast with lymphoma, which has been classified and treated according to grade for more than 20 years. Tumor size and the degree of involvement of the axillary nodes are used ...

Sounding Board
618-623

In this Sounding Board, the author examines potential reasons for the limited availability of new drugs and proposes four solutions to this problem.

Correspondence
624-626

To the Editor: Guilbert and colleagues and Bisgaard and colleagues (May 11 issue)1,2 investigated the effect of inhaled corticosteroids in infants and preschool children with wheezing or an increased risk of asthma. The two studies, at best, found a ...

627-629

To the Editor: Berman and colleagues (May 11 issue)1 report their findings regarding the development of hypophosphatemia and associated changes in bone and mineral metabolism in patients with either chronic myelogenous leukemia or gastrointestinal ...

630

To the Editor: In his review of the diagnosis and treatment of thrombotic thrombocytopenic purpura (May 4 issue),1 Dr. George did not mention acetylsalicylic acid, or aspirin. Platelet activation leading to microvascular thrombi is the main pathologic ...

631
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To the Editor: In the video of arthrocentesis of the knee by Thomsen et al. (May 11 issue),1 a folded towel is placed under the patient's knee to keep it semiflexed during the procedure. This intervention is likely to decrease the aspiration success rate ...

631-633

To the Editor: A three-week-old boy was admitted to the hospital because of cardiac failure with diffuse ventricular hypocontractility and normal cardiac anatomy on echocardiography. Coronary and ventricular angiography failed to show any coronary ...

Book Reviews
634-635

On July 12, 1974 — one month before he resigned in response to the Watergate scandal — President Richard Nixon signed the National Research Act, which Congress had passed in response to another scandal that was also linked to a place name: Tuskegee. This ...

635-636

In the preface to this collection of well-written, sometimes elegant essays for medical journals and for magazines such as Commentary, First Things, and The Weekly Standard, Paul McHugh writes, “To avoid an unrelenting stance of criticism against ...

636-637

Behavioral genetics has now entered the molecular era, as indicated by the publication of high-profile reports on the influence of genes on neurotransmitter function and metabolism as well as on brain growth factors. Variations within populations in ...

637-638
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The 1990s, officially dubbed “the decade of the brain,” paved the way for an ever more intense examination of the implications of brain research. An important result is the rise of neuroethics, the subfield of both neuroscience and bioethics that ...

Corrections
638

The Long and Short of Bone Therapy Editorial, N Engl J Med 2006:354;860-863.. On page 860, the sentence that begins on line 3 of the second paragraph should have read, “In this issue of the Journal, from a study that was sponsored, designed, and analyzed ...

638

Effect of ACAT Inhibition on the Progression of Coronary Atherosclerosis Original Article, N Engl J Med 2006:354;1253-1263.. On page 1253, the last line of the Abstract should have read, “(ClinicalTrials.gov number, NCT00185042.),” not “(...

638

Effect of Introduction of the Pneumococcal Conjugate Vaccine on Drug-Resistant Streptococcus pneumoniae Original Article, N Engl J Med 2006:354;1455-1463.. In Table 2 on page 1459, the total number of all nonvaccine serotypes in persons ≥65 years of age ...

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