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October 11, 2007  Vol. 357 No. 15

Audio Summary of this Issue

Perspective
1465-1469

Studies show that obese, physically inactive employees with diabetes are likely to get sicker and rack up high medical bills. Dr. Susan Okie writes that a growing number of big U.S. companies are tackling high medical costs by promoting wellness in their ...

1469-1472
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Deciphering the molecular basis of pluripotency will facilitate the development of procedures for efficiently deriving patient-specific stem cells. Dr. John Gearhart, Evanthia Pashos, and Megana Prasad discuss the latest research on human embryonic stem ...

1472-1475
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September 12 marked the 50th anniversary of E. Donnall Thomas's initial report of a radical new approach to cancer treatment: radiation and chemotherapy followed by the intravenous infusion of bone marrow. Dr. Frederick Appelbaum writes that Thomas's ...

Original Articles
1477-1486

The West of Scotland Coronary Prevention Study demonstrated a significant reduction in coronary events after 5 years of treatment with pravastatin as compared with placebo. Participants were followed for an additional 10 years; approximately one third used statins. The rate of coronary events was reduced by 27% over the entire follow-up interval.

1487-1495

In this cohort study of Danish children at high risk for asthma, colonization of the airway at the age of 1 month with Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae, or a combination of these organisms, but not with Staphylococcus aureus, was associated with the development of asthma by the age of 5 years.

1496-1506

The tissue blocks from a large group of women who had participated in a randomized trial of the treatment of node-positive breast cancer were analyzed for the expression of HER2 and the estrogen receptor. A significant interaction was found between HER2 positivity and a benefit from the addition of paclitaxel after adjuvant treatment with doxorubicin plus cyclophosphamide.

1507-1514

This report describes three siblings with stop mutations in the muscle glycogen synthase gene, resulting in a severe reduction or complete absence of muscle and heart glycogen. One brother died suddenly; another had muscle fatigue, hypertrophic cardiomyopathy, and an abnormal exercise response.

Special Article
1515-1523

This study assessed the extent to which recommended pediatric outpatient care is delivered and documented. On average, children received 46.5% of the overall indicated care, 67.6% of the indicated care for acute medical problems, 53.4% of the indicated care for chronic conditions, and 40.7% of the indicated preventive care.

Clinical Therapeutics
1524-1529

A 52-year-old woman receives a diagnosis of primary biliary cirrhosis. Treatment with ursodeoxycholic acid is recommended. Therapy with this drug appears to prolong transplantation-free survival, although the mechanism of benefit is unclear.

Videos in Clinical Medicine
e15

    Chest-tube insertion can be lifesaving. The technique requires an understanding of the chest anatomy, equipment, indications, and complications. This video demonstrates a common technique used to insert a chest tube.

    Images in Clinical Medicine
    1530
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    A 19-year-old man presented with painful burns on his posterior scalp after exposure to an incendiary agent. Smoke emanated from the wounds on removal of the dressing that had been applied during prehospital treatment. The wounds appeared waxy and yellow ...

    e16
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    This 50-year-old man had a 30-year history of end-stage renal disease. After a second renal transplant failed, he began to undergo dialysis. The left brachiocephalic arteriovenous fistula became severely aneurysmal over the next 6 years.

    Case Records of the Massachusetts General Hospital
    1531-1541

    A 41-year-old man was admitted to the hospital because of abdominal pain, nausea, and an elevated serum creatinine level. Six days earlier, he had had chills and malaise and had taken ibuprofen. Symptoms persisted, and weakness, abdominal pain, nausea, and anorexia developed. He went to an emergency room, where elevated serum creatinine and urea nitrogen levels were noted. The urinary sediment contained granular casts.

    Editorials
    1543-1545

    The development and progression of atherosclerosis is an intricate inflammatory process dependent on intimal entry of low-density lipoprotein (LDL) cholesterol. Although myriad genetic and environmental factors modulate this process, the centrality of LDL ...

    1545-1547

    In the first half of the past century, it was thought that asthma was precipitated or prolonged by infection and that infection with several bacteria, including Streptococcus pneumoniae and Haemophilus influenzae, had a role in asthma.1 Some investigators ...

    1547-1549

    Adjuvant therapy for breast cancer — treatment after surgical removal of the tumor — is a major therapeutic advance that has had a considerable effect on prolonging disease-free and overall survival. Not all patients benefit from adjuvant therapy, however,...

    1549-1551

    High-quality health care matters for all children — and is critically important for some. In many ways, health care for children serves the same function as health care for adults. For example, the incidence of chronic illness in children is increasing, ...

    Clinical Implications of Basic Research
    1552-1554

    In rats with myocardial infarction, the boosting of levels of cardiac periostin — a matrix molecule derived from fibroblasts — was associated with increased DNA synthesis by cardiomyocytes, enhanced angiogenesis, and improved cardiac function.

    Correspondence
    1555-1556

    To the Editor: Rennert et al. (July 12 issue)1 report that a BRCA1 or BRCA2 mutation was not a significant predictor of mortality from breast cancer in an Israeli population-based cohort. However, 43% of potential cases were not included because tumor ...

    1556-1558

    To the Editor: Schiffer (July 19 issue)1 discusses some of the adverse events associated with the use of BCR-ABL tyrosine kinase inhibitors for chronic myelogenous leukemia (CML). We would add hypothyroidism to the list of events presented in Table 1 of ...

    1558-1559

    To the Editor: As a physician and clinical ethicist involved in the development and use of the Texas Advance Directives Act, I believe Truog's Perspective article (July 5 issue)1 requires corrective focus. Most futility cases involve adults who can never ...

    1559-1561

    To the Editor: In their letter to the editor, Niedernhofer et al. (June 14 issue)1 have doubts about the specificity of the monoclonal mouse antibody 8F1, which is used to detect the excision repair cross-complementation group 1 (ERCC1) protein. These ...

    1561-1562

    To the Editor: Hypercholesterolemia in patients with primary biliary cirrhosis is not consistently associated with preclinical carotid atherosclerosis.1 Although hypercholesterolemia has been documented worldwide as a major risk factor for illness and ...

    Book Reviews
    1563-1564

    The concept that emotional, cognitive, sensory, and motor functions reside in the brain dates from antiquity. It was not until the mid-19th century, however, that localization of specific functions in the human brain was demonstrated when consistent ...

    1564-1565

    Older adults with bipolar disorder constitute a growing population of people with serious mental illness and considerable need for treatment. In the past few years, we have become increasingly aware that the notion that bipolar disorder in late life “...

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