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November 22, 2007  Vol. 357 No. 21

Audio Summary of this Issue

Perspective
2101-2104

Health care reform is back in vogue as the 2008 election approaches. Jonathan Oberlander writes that the issue is playing out very differently in the parties' presidential primaries. Jonathan Oberlander discusses the health care plans of the presidential ...

2104-2107

On October 18, the House failed to override President Bush's veto of the reauthorization of SCHIP. John Iglehart discusses the implications for health care coverage for uninsured children. Senator Charles Grassley discusses compromises that were made in ...

Original Articles
2109-2122

Torcetrapib, a cholesteryl ester transfer protein inhibitor, markedly raises levels of high-density lipoprotein cholesterol. Unexpectedly, in the ILLUMINATE trial, torcetrapib therapy in combination with atorvastatin, as compared with atorvastatin alone, increased the risk of death from both cardiovascular and noncardiovascular causes. The drug also raised blood pressure.

2123-2132

Thalidomide has activity in multiple myeloma, but its use is limited by a constellation of adverse effects, most notably peripheral neuropathy. Lenalidomide, an analogue of thalidomide, does not have the toxicity profile of thalidomide. This study compared lenalidomide plus dexamethasone with placebo plus dexamethasone in the treatment of relapsed multiple myeloma. Lenalidomide plus dexamethasone was superior in all end points, including overall survival.

2133-2142

This randomized trial compared lenalidomide plus dexamethasone with a placebo plus dexamethasone in patients in the United States and Canada who had multiple myeloma that was resistant to one or more other treatments. The addition of lenalidomide improved the time to progression and overall survival in these patients. Important adverse events were severe neutropenia and venous thromboembolism.

2143-2152
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Lung transplantation is a treatment used for patients with cystic fibrosis. In this epidemiologic study examining survival among patients with cystic fibrosis who were younger than 18 years of age at the time of placement on the waiting list for a lung transplant, no significant survival benefit was associated with the procedure. There were insufficient data to determine whether the procedure improved the patients' quality of life.

Review Article
2153-2165
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Sarcoidosis affects people of all racial and ethnic groups and occurs at any age, although usually before the age of 50 years. The incidence of sarcoidosis varies widely throughout the world, probably because of differences in environmental exposures, case-surveillance methods, and predisposing HLA alleles, along with other genetic factors. This article summarizes advances in our understanding of sarcoidosis and addresses pitfalls in its diagnosis and treatment.

Images in Clinical Medicine
2166
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A 29-year-old homeless man was admitted to the hospital after being stabbed in the chest. A hemothorax was diagnosed, and a chest tube was placed. One day after admission, he had a generalized tonic–clonic seizure. He was afebrile and had no meningeal ...

e23
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This 18-year-old woman presented with pain, weight loss, and a firm epigastric mass. She had a habit of eating her hair.

Case Records of the Massachusetts General Hospital
2167-2178

A 31-year-old woman was admitted to this hospital because of rash, fever, and facial swelling that developed after the administration of modafinil for the treatment of fatigue associated with multiple sclerosis. Several hours after admission, chest discomfort and hypotension developed, ST-segment elevation was present on the electrocardiogram, and biomarkers of cardiac necrosis were elevated. Echocardiography disclosed a pericardial effusion and left ventricular dysfunction. A diagnostic procedure was performed.

Editorials
2180-2183

Raising plasma levels of high-density lipoprotein (HDL) cholesterol has been a therapeutic goal ever since the strong inverse association between HDL levels and the risk of coronary heart disease was first observed.1 Nearly two decades ago, the discovery ...

2183-2186

Perhaps the darkest memory in modern pharmaceutical history is that of the devastating effects of thalidomide exposure on fetal development. More than four decades later, thalidomide reemerged from the ashes as the prototype for a new proprietary class of ...

2186-2188

Cystic fibrosis is one of the most common autosomal recessive diseases. It causes intestinal, pancreatic, and progressive lung dysfunction, which is ultimately lethal. In 1989, the first specific cystic fibrosis gene defect on chromosome 7 was described, ...

Special Report
2189-2194
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The analysis of subgroups is often used as a way to glean additional information from data sets. The strengths and weaknesses of this approach and new Journal policies concerning the reporting of subgroup analyses are discussed in this article.

Clinical Implications of Basic Research
2195-2197

Atherosclerosis can be prevented in mice by treating them with a ligand of the liver X receptor β, a protein expressed by macrophages.

Correspondence
2198-2199

To the Editor: Shuaib et al. (Aug. 9 issue)1 report that in the Stroke–Acute Ischemic NXY Treatment II (SAINT II) trial, NXY-059 did not improve the outcome for patients with acute stroke. The authors state that NXY-059 met all the Stroke Therapy ...

2199-2201

To the Editor: Hafler et al. of the International Multiple Sclerosis Genetics Consortium (Aug. 30 issue)1 provide support for the previously tentative association between multiple sclerosis and alleles of the interleukin-2 receptor α gene (IL2RA) and the ...

2201-2203

To the Editor: The study by Bonner et al. (Feb. 9, 2006, issue)1 reports a survival advantage with the addition of concurrent cetuximab to radiotherapy in patients with advanced head and neck cancer. In addition, cetuximab improved locoregional control ...

2203-2204
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To the Editor: In the Clinical Practice article by van der Worp and van Gijn (Aug. 9 issue),1 the question of the age at which a patient could be selected for treatment with intravenous thrombolysis warrants further attention. According to the Safe ...

2204-2206

To the Editor: In his review of normotensive ischemic acute renal failure (Aug. 23 issue),1 Abuelo mainly emphasizes altered glomerular hemodynamics and a reduced glomerular filtration rate in the pathogenesis of normotensive ischemic acute renal ...

2206-2207

The authors conducted a trial of mirror therapy versus imagery therapy in patients with phantom limb pain after the amputation of a leg or foot. Pain intensity decreased with mirror treatment, as did the number and duration of pain episodes.

Book Reviews
2208

When I started my clinical training in hematology around 1970, the outcome of patients with acute myeloid (or myelogenous) leukemia (AML) was invariably poor. The diagnosis was based solely on morphology. As a result, it was not always possible to ...

2209-2210

During the past decade, reporting of the health problems and health care needs of cancer survivors has grown considerably. The number of peer-reviewed articles published in this area in the past 5 years is more than double the number published in the ...

2210

The prevalence, morbidity, and mortality of chronic obstructive pulmonary disease (COPD) have increased to the extent that the World Health Organization estimates that COPD is now the fourth leading cause of death worldwide. Approximately 3 million deaths ...