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November 8, 2007  Vol. 357 No. 19

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Perspective
1885-1887

Peter Orszag and Philip Ellis write that a variety of evidence suggests that there are opportunities to constrain health care costs without incurring adverse health consequences. Dr. Peter Orszag discusses the rising cost of health care and the potential ...

1887-1889

Only 14 of 124 U.S. medical school deans are women. Dr. Nancy Andrews writes that if institutions are to accelerate the emergence of more female deans, they will need to consider women who have not stepped on every rung of the traditional academic career ...

1889-1891

Drs. Reshma Jagsi, Nancy Tarbell, and Debra Weinstein write that the issues surrounding parenting during training continue to challenge educators and policymakers, as well as residents and fellows.

Original Articles
1893-1902

A previous report showed that the use of caffeine to treat apnea of prematurity reduces the risk of bronchopulmonary dysplasia, but whether it has long-term effects on neurodevelopment and growth is unknown. In this placebo-controlled, randomized trial, treatment with caffeine significantly improved the rate of survival without neurodevelopmental disability at 18 to 21 months.

1903-1915
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In this study, humoral immunity after vaccination or natural infection was assessed for several common pathogens. Antibodies against varicella–zoster virus, measles, and mumps were long-lived (estimated half-lives, ≥50 years), and antibodies against tetanus and diphtheria were short-lived (estimated half-lives, 11 and 19 years, respectively). Antibody titers were poorly correlated with peripheral-blood memory B cells.

1916-1927

This large trial showed that chemotherapy plus involved-field radiotherapy was superior to subtotal nodal radiotherapy alone in patients with localized stage supradiaphragmatic Hodgkin's disease and risk factors for a good outcome. In patients with early-stage Hodgkin's disease and risk factors for a poor outcome, limited chemotherapy was as effective as a more aggressive course.

1928-1938

Children who survive surgical repair of congenital heart defects often have abnormal neurodevelopment. In this comparison of 41 term newborns with congenital heart disease and 16 controls, abnormalities in brain maturation were present before cardiac surgery.

Clinical Therapeutics
1939-1945

An 82-year-old woman with severe depression, including psychotic symptoms, is referred for consideration of electroconvulsive therapy. She has had four episodes of major depression consisting of crying spells, loss of interest in usual activities, insomnia, loss of appetite and weight, difficulty with concentration, feelings of helplessness and hopelessness, and thoughts of suicide.

Review Article
1946-1955

Bronchopulmonary dysplasia has become the most common chronic lung disease of infancy. This review summarizes the patterns and pathogenesis of chronic lung impairment that may become clinically significant decades after the use of mechanical ventilation and oxygen supplementation in premature newborns.

Videos in Clinical Medicine
e20

    Skin and soft-tissue infections, including cutaneous abscesses, are commonly encountered in primary care and emergency departments. This video covers basic indications and contraindications and demonstrates the technique of incision and drainage of a cutaneous abscess.

    Images in Clinical Medicine
    1956
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    A healthy 25-year-old man presented to the surgical clinic with a hole in the roof of his mouth that allowed nasal regurgitation of food when he ate. The hole had been present for a year, and he requested surgical correction. The patient reported a 5-year ...

    e21
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    A 45-year-old male farmer presented with breathlessness, dry cough, and bilateral alveolar and interstitial opacities, leading to a diagnosis of pulmonary alveolar proteinosis. Bilateral lung lavage was performed with 12 liters of saline. The lavage fluid ...

    Case Records of the Massachusetts General Hospital
    1957-1965

      A 77-year-old man was admitted to the hospital because of difficulty speaking and altered mental status. He had been well until the day before admission, when pain developed in the right side of the face and in the right ear. Several days earlier, he had fallen on the sidewalk and hit his head. On examination, he was lethargic with incomprehensible speech; dried blood was seen in the right ear canal. CT scanning of the head disclosed pneumocephalus and opacification of the right mastoid air cells.

      Editorials
      1967-1968

      It was recognized more than three decades ago1 that methylxanthines can reduce the frequency of apneic episodes in premature infants. Since that time, methylxanthines have become part of the routine clinical management of apnea of prematurity, with ...

      1968-1971

      The history of Hodgkin's disease is one of the most exciting stories in medicine. The disorder accounts for about 1% of all cancers and is curable in 85 to 95% of cases, depending on its stage — whether it is localized or disseminated. Indeed, the article ...

      1971-1973

      During the past 25 years, remarkable progress has been made in the surgical treatment and survival of infants with congenital heart disease.1 Recent data have shown that in-hospital death rates for neonates were less than 10% for the treatment of ...

      Clinical Implications of Basic Research
      1974-1976

      Hepatocellular carcinoma is less prevalent in women than in men. A recent study of a mouse model indicates that estrogen counters a pathway that induces hepatocellular carcinoma and may therefore account for the difference in prevalence between the sexes.

      Correspondence
      1977-1978

      To the Editor: The trial reported by Slotman et al. (Aug. 16 issue)1 showed a reduced incidence of symptomatic brain metastases and an improvement in overall survival with the addition of prophylactic cranial irradiation in patients with extensive-stage ...

      1979-1980

      To the Editor: The review article on prevention of preterm delivery, by Simhan and Caritis (Aug. 2 issue),1 may suggest that oxytocin-receptor antagonists should not be used for the treatment of preterm labor because of a possible excess of fetal and ...

      1980-1982
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      To the Editor: Holick's review of vitamin D deficiency (July 19 issue)1 is timely. We agree2 that the serum concentration of 25-hydroxyvitamin D should exceed 20 ng per milliliter to avoid bone problems. Data supporting much higher levels for bone or ...

      1982-1984

      To the Editor: Assessing responses to treatment on the basis of computed tomographic (CT) measurements in patients with malignant pleural mesothelioma is challenging because of the pattern of growth of this disease.1 There is evidence that 18F-...

      1984-1985

      To the Editor: Unexplained pregnancy loss is a common health problem. Meta-analyses and reviews1 suggest that disorders promoting venous thrombosis, collectively termed “thrombophilias,” contribute to the pathogenesis of fetal loss. The high variability ...

      Book Review
      1986-1988

      I read the four-volume set of Sexual Health just as I was at risk of becoming a bit too smug in my self-proclaimed identity as an “expert” in sexual medicine. I barely made it through the first volume before I was humbled by the extent and diversity of ...

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