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April 5, 2007  Vol. 356 No. 14

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Perspective
1393-1395

In January, President George W. Bush announced a major two-part health initiative. Robert Reischauer writes that if adopted as proposed, the initiative would take half a step toward a more equitable system, but it would have an uncertain effect on the ...

1395-1397
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This year marks the 20th anniversary of the Safe Motherhood Conference in Nairobi, an event that launched a global initiative to reduce maternal mortality in developing countries. Dr. Allan Rosenfield, Caroline Min, and Lynn Freedman ask, how far have we ...

Original Articles
1399-1409

Since its approval by the Food and Drug Administration, computer-aided detection has come into use for screening mammography at many facilities. The authors of this observational study of almost 430,000 mammograms found that the use of computer-aided detection reduced the accuracy of mammography and that its systemwide use would increase the annual cost of mammography by an estimated $550 million in the United States.

1410-1422

Although airway inflammation is an established component of disease pathology in asthma and chronic obstructive pulmonary disease (COPD), the nature of this inflammation is not clear. In this study, in which airway specimens from subjects with asthma or COPD were examined for the presence of invariant natural killer cells, very few of these immunoregulatory T lymphocytes, restricted by the antigen-presenting molecule CD1d, were identified.

1423-1431

In this large, randomized trial in Tanzania, daily multivitamin supplementation in HIV-negative pregnant women reduced the incidence of low birth weight (<2500 g) and small-for-gestational-age infants, although it did not significantly reduce the risk of prematurity or fetal death. Given their potential benefits and low cost, multivitamins should be considered for all pregnant women in developing countries.

1432-1437

Despite the frequency of neural-tube defects, little is known about their cause. In this study, the authors implicate the gene VANGL1 in three children with the disease, two of them with familial types of disease — a finding that points to the need for further study of this gene and others that lie in the same pathway.

Clinical Practice
1438-1444

A 62-year-old man is admitted with fever, cough, and dyspnea. He is weak, appears to be dehydrated, and has purulent sputum. His temperature is 39.2°C, respirations 22, and blood pressure 128/69 mm Hg. There are crackles over the left lower lung field, and chest radiography shows a density in the left lower lobe that is consistent with pneumonia. Should thromboprophylaxis be provided? If so, in what form?

Review Article
1445-1454

Liver disease due to chronic HBV or HCV infection is becoming a leading cause of death among persons with HIV infection. Both the risk of hepatocellular carcinoma and the risk of hepatotoxicity due to antiretroviral drugs increase in patients with coinfection. This review presents an approach to the use of newer treatments for both HCV and HBV infections in patients with HIV infection, and it provides an update on optimal management to prevent complications of advanced liver disease.

Images in Clinical Medicine
1455

A healthy 34-year-old bank employee presented with black discolorations on all her fingers. She was unable to remove the spots. The same symptoms had developed in some of her colleagues.

Clinical Problem-Solving
1456-1462

    A 49-year-old man came to the clinic with a 1-week history of suprapubic pain and fever. On examination, he had a temperature of 38.1°C but appeared well.

    Editorials
    1464-1466

    Breast imaging is the newest, and according to most criteria the weakest, of all radiology subspecialties. Screening mammography in particular often loses money and is subsidized by other sections of the radiology department and occasionally, as in my own ...

    1466-1468

    This issue of the Journal contains the second report within about a year on the presence of natural killer T cells in the lungs of patients with asthma. The two reports represent an intersection of two complex entities — asthma, because its pathogenesis ...

    Correspondence
    1469-1471

    To the Editor: Heyland and colleagues, on behalf of the Canadian Critical Care Trials Group (Dec. 21 issue),1 report on the comparison between bronchoalveolar lavage and endotracheal aspiration for the diagnosis of ventilator-associated pneumonia. The ...

    1471-1472

    To the Editor: In the trial reported by Geyer et al. (Dec. 28 issue),1 which compared capecitabine alone with a combination of lapatinib and capecitabine in women with HER2-positive advanced breast cancer, approximately 60% of patients had received ...

    1472-1475

    To the Editor: Wang et al. (Dec. 21 issue)1 suggest that novel biomarkers in aggregate have little influence on the prediction of first cardiovascular events or death. We wonder whether there were sufficient analyses to warrant this conclusion. As ...

    1475-1479

    To the Editor: Bradley et al. (Nov. 30 issue)1 have analyzed strategies to reduce the interval between arrival at the hospital and intracoronary balloon inflation (door-to-balloon time) in primary angioplasty in a large multicenter series. However, use ...

    1479-1481
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    To the Editor: In their Medical Progress article on Whipple's disease, Fenollar and colleagues (Jan. 4 issue)1 raise important issues regarding culture-negative endocarditis. We report on a 38-year-old-man with a 6-month history of polyarthralgia. He had ...

    1481

    To the Editor: A letter that I submitted to the Journal was published in the January 25 issue.1 Because there has been concern about the provenance and authorship of that letter, I request that it be retracted.

    1481-1483

    To the Editor: The use of voriconazole has become common for the management of invasive aspergillosis. However, therapy with voriconazole still sometimes fails, more often because of unresponsive underlying disease than because of resistance of the ...

    Book Reviews
    1484-1485

    The “pursuit of scientific truth, detached from the practical interests of everyday life, ought to be treated as sacred by every government, and it is in the highest interests of all that honest servants of truth should be left in peace.” Albert Einstein'...

    1485-1486

    For reasons not entirely clear, medical historians writing in the first half of the 20th century seemed driven to write sweeping histories, describing developments from antiquity to their own time. The fact-filled tomes of Fielding Garrison (1913), ...

    1486

    In this book, a distinguished group of historians and social scientists have written 13 chapters organized around the idea that history can, and should, inform contemporary decisions on health policy. In the introduction, Rosemary Stevens underscores the ...

    Corrections
    1487

    Lapatinib plus Capecitabine for HER2-Positive Advanced Breast Cancer Original Article, N Engl J Med 2006:355;2733-2743.. Table 3 (page 2741) should have included a footnote for Grade 4 adverse events: “A total of 13 grade 4 adverse events occurred among ...

    1487

    Synergistic Copathogens — HIV-1 and HSV-2 Editorial, N Engl J Med 2007:356;854-856.. The fourth sentence of the fourth paragraph (page 855) should have read “As Nagot et al. show with sampling every 2 weeks, 50% of patients who are coinfected with HSV-2 ...

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