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January 4, 2007  Vol. 356 No. 1

Audio Summary of this Issue

Perspective
1-4

Democratic legislators, energized by their new (if slim) majorities in the 110th Congress, now face the daunting challenge of enacting an ambitious policy agenda while fulfilling their pledge to restore “pay-as-you-go” rules to new legislation. John ...

4-6

Dialysis facilities can make more money from administering epoetin than from dialysis and related routine services, which Medicare has reimbursed at a composite rate since 1983. Dr. Robert Steinbrook writes that in 2007, Congress may consider whether to ...

6-9

Several findings have implicated activation of 5-HT2B receptors as a key step in initiating drug-induced valvular heart disease. Dr. Bryan Roth describes molecular mechanisms by which 5-HT2B agonists induce valvular heart disease.

Original Articles
11-20

The authors show that a five-gene signature is closely associated with outcome among patients who have undergone surgical resection of early-stage non–small-cell lung cancer. This investigation represents the final phase of work to devise molecular methods for staging tumors and formulating a prognosis. For the findings to be clinically directive, these kinds of signatures will need to be incorporated into prospective clinical trials of cancer treatment.

21-28

An estimated 1.4 million salmonella infections occur annually in the United States, typically acquired from tainted food. This report describes a 10-state outbreak of infection with Salmonella enterica serotype Typhimurium associated with commercially distributed pet rodents that was identified by the molecular fingerprint of this resistant strain.

29-38
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The association between antiparkinsonian drugs and cardiac-valve regurgitation was assessed in a nested case–control study from a large general-practice database in the United Kingdom. The rate of cardiac-valve regurgitation was increased with current use of pergolide (incidence-rate ratio, 7.1) or cabergoline (incidence-rate ratio, 4.9) but not with current use of other dopamine agonists. Clinicians should consider the risk of valvular heart disease when prescribing these agents.

39-46

A cohort of patients with Parkinson's disease treated with either ergot-derived or non–ergot-derived dopamine agonists underwent echocardiographic evaluation. As compared with a group of normal control subjects, patients taking pergolide or cabergoline had a higher frequency of clinically important valve regurgitation and more evidence of stiffening and displacement of the mitral leaflet, as measured by the tenting area of the mitral valve.

Clinical Therapeutics
47-54
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A 58-year-old man has chest pain at 9:30 a.m.; 3 hours later, he calls for an ambulance. Paramedics arrive, provide standard treatment, and transport him to the nearest emergency department. On his arrival at a small hospital at 1 p.m., the findings are diagnostic of a myocardial infarction with ST-segment elevation. The emergency department physician recommends immediate transfer to a hospital 1 hour away for primary percutaneous coronary intervention (PCI).

Review Article
55-66

    In 2000, Tropheryma whipplei was finally identified as the cause of Whipple's disease, a chronic condition with protean manifestations that was first described in 1907. This review discusses the epidemiology, pathogenesis, diagnosis, and treatment of this rare and elusive chronic disease.

    Images in Clinical Medicine
    67
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    A 59-year-old nonobese man presented with a 7-year history of gradually progressive swelling over the left eye. He had no other clinically significant medical history or history of trauma. There was a soft, yellowish mass in the outer temporal ...

    e1
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    This 74-year-old man underwent an ultrasonographic examination as part of an evaluation for a hepatoma. A tumor in the pulmonary artery was noted.

    Clinical Problem-Solving
    68-74
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    A 45-year-old woman from northern Ontario presented to her local hospital with a 2-year history of asymmetric migratory arthralgias involving the left knee, ankles, elbows, and fingers. She also had morning stiffness, increasing fatigue, an erythematous, nonpruritic rash after sun exposure, and a 3-month history of chest pain that was relieved when she was in an upright position.

    Editorial
    76-78

    Lung cancer is the deadliest cancer in the world. Relapses are frequent after primary and adjuvant therapy and often evolve into lethal metastatic disease. Currently, lung-cancer staging rests on histopathological and clinical criteria that have only ...

    Clinical Implications of Basic Research
    79-81

    A p53-mediated response to tissue damage caused by ionizing radiation does not invoke protection against tumorigenesis in two mouse models.

    Correspondence
    86-87

    To the Editor: Creticos et al. (Oct. 5 issue)1 describe the results of a study comparing a vaccine — consisting of an immunostimulatory DNA sequence conjugated to Amb a 1, a ragweed-pollen antigen — with saline placebo. The study showed improvement of ...

    87-89

    To the Editor: Hladik and colleagues (Sept. 28 issue)1 provide evidence of human herpesvirus 8 (HHV-8) transmission by blood transfusion. They suggest that HHV-8 blood screening for immunocompromised patients may be warranted. However, their statement ...

    90-91

    To the Editor: Cooke and colleagues (Sept. 28 issue)1 trace the changes in medical education that have occurred since the Flexner report was issued a century ago and outline the current challenges. A recent international Web-based survey of 806 of the ...

    92-94

    To the Editor: We wish to reframe the discussion regarding the neurodevelopmental manifestations of the tuberous sclerosis complex (TSC) in the overview of TSC by Crino et al. (Sept. 28 issue).1 First, the authors state, “Epilepsy may be the most ...

    94-95

    To the Editor: There are numerous reports of hyponatremia associated with selective serotonin-reuptake inhibitors (SSRIs),1 with at least 35 reports involving citalopram (Celexar, Forest).2 However, there have been few reported cases of hyponatremia ...

    Book Reviews
    96-97

    For readers who are unaware of the marvels of the placenta — as a diagnostic tool, as a predictor of neonatal and adult morbidity, as an elegant and powerful system for studying the biology of cancer and immune tolerance, and simply as a fascinatingly ...

    97-98

    Shall the littlest of children lead? Neonatology is a relatively young field, but its history is unquestionably remarkable in many dimensions. In the past 50 years, both neonatology and the care of the sickest and smallest babies have evolved ...

    98-99

    Pregnancy presents substantial challenges with complications, argue the authors of The Diabetes in Pregnancy Dilemma, a well-developed, comprehensive, and clearly written contribution to the literature and a “must have” reference for clinicians who care ...