Join the 200th Anniversary Celebration

Issue IndexA searchable index of tables of contents

Find An Issue

By Volume and Issue
By Date

Table of contents for

July 26, 2007  Vol. 357 No. 4

Audio Summary of this Issue

Perspective
321-324

Dr. Gail Gazelle writes that hospice care is now considered part of mainstream medicine, as evidenced by growing patient enrollment and Medicare expenditures. But despite its increased use, many aspects of hospice care are still misunderstood by both ...

324-327

More Americans are choosing hospice for end-of-life care, but ironically, hospice patients increasingly are forced to give up effective palliative treatments along with aggressive medical intervention. Drs. Alexi Wright and Ingrid Katz discuss open-access ...

328-329
  • Free Full Text

Since he was adopted by nursing home staff members as a kitten, Oscar the Cat has had an uncanny ability to predict when residents are about to die. Dr. David Dosa describes a day in the life of Oscar.

Original Articles
331-339

Infants with a first episode of wheezing diagnosed as bronchiolitis are often treated with oral dexamethasone. In this trial, children with bronchiolitis and no history of asthma received oral dexamethasone or placebo. There were no clinically significant differences in outcomes between the two groups.

340-348

This article summarizes the experience of a single institution in treating patients with metastatic testicular tumors that did not respond to cisplatin-based chemotherapy. High-dose chemotherapy with hematopoietic stem-cell rescue was potentially curative in such cases.

349-359

A cohort of 201 patients with type B acute aortic dissection was classified according to whether the false lumen of the aorta was patent, partially thrombosed, or completely thrombosed. Patients with partial thrombosis had a significantly higher mortality rate at 3 years.

360-369

In this clinical trial, rofecoxib (25 mg per day) was studied in the prevention of recurrent colorectal cancer. Although the median duration of study treatment was only 7.4 months, rofecoxib therapy was associated with an increased risk of cardiovascular adverse events (relative risk as compared with placebo, 2.66; P=0.04). The results indicate that even short-term treatment with rofecoxib may result in cardiovascular toxicity.

Special Article
370-379
  • Free Full Text
  • Interactive/Multimedia

This article, which describes the person-to-person spread of obesity as a potential contributing factor in the U.S. obesity epidemic, analyzes a densely interconnected social network, using repeated assessments performed from 1971 to 2003 as part of the Framingham Heart Study. Social-network phenomena seem relevant to obesity, which appears to spread through social ties.

Clinical Practice
380-390

A 37-year-old man presents with localized swelling and tenderness of the left leg just below the knee; he suspects a spider bite. Examination shows a 5-by-7-cm area of erythema and warmth. A small area of necrotic skin covers a central, fluctuant 2-by-2-cm area. The temperature is 38.3°C, the pulse rate 115 beats per minute, and the blood pressure 116/78 mm Hg.

Videos in Clinical Medicine
e4

Providing positive-pressure ventilation with a face mask and a bag-valve device can be a lifesaving maneuver. Although seemingly simple, the technique requires an understanding of the airway anatomy, the equipment, and the indications. This video demonstrates the equipment and technique used to provide positive-pressure ventilation with a face mask and a bag-valve device.

Images in Clinical Medicine
391
  • Free Full Text

A 60-year-old man presented with progressive swelling of the right side of the scrotum. He reported no history of trauma to this area and no sexually transmitted infections. The alpha-fetoprotein level was elevated at 3100 μg per liter (normal value, <8), ...

e5
  • Free Full Text

This man presented with chest pain of 2 days' duration. The pain was heavy, intermittent, and worse when he was lying flat.

Case Records of the Massachusetts General Hospital
392-400

A 9-year-old boy with autism was admitted to the hospital because of pain in the hip, rash, and swelling of the gingiva. Three months earlier, pain in his right hip developed, and he eventually refused to walk. Physical examination disclosed no joint swelling, and radiographs of the pelvis and spine were normal. Indomethacin was prescribed; the pain improved, but a petechial rash on the legs and gingival swelling developed.

Editorials
402-404

In past centuries, infant mortality in the first year of life was described as the greatest plague.1 Infants in the 21st century continue to be plagued by high rates of hospitalization, and bronchiolitis is the number one cause.2,3 Despite therapeutic ...

404-407

A recent study reported that among people who carried a single copy of the high-risk allele for the FTO gene, which is associated with fat mass and obesity, the risk of obesity increased by 30%. The risk of obesity increased by 67% among people who ...

Health Law, Ethics, and Human Rights
408-413

The Abigail Alliance for Better Access to Developmental Drugs sued the FDA, objecting to its policy prohibiting the sale of unapproved drugs and arguing that terminally ill patients with cancer should have access to experimental treatments after phase 1 studies. The author discusses this case and explains why he thinks a ruling in favor of the Abigail Alliance is unlikely.

Correspondence
414-418

To the Editor: On the basis of the report by Boden et al. on the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial (April 12 issue),1 we updated our meta-analysis of percutaneous coronary intervention (PCI) ...

418-420

To the Editor: In his review of diabetic gastroparesis, Camilleri (Feb. 22 issue)1 states that in our clinical trial of exenatide,2 nausea and vomiting led to the “cessation of treatment in about one third of patients.” This information is incorrect. Of ...

420-421

To the Editor: In the Case Record presented by Wechsler et al. (May 17 issue),1 many possible causes of death in a patient with asthma are considered. However, the discussants do not sufficiently emphasize that lung mechanics and hemodynamic effects ...

421-422

To the Editor: Several reports have indicated that elevated plasma levels of the amino acid homocysteine are associated with, or are a primary risk factor for, coronary and vascular disease and Alzheimer's disease. However, a number of additional studies ...

422-424

To the Editor: Oncogenic osteomalacia is a rare syndrome that is usually driven by small, mesenchymal tumors that express phosphatonins, proteins that decrease the abundance of sodium–phosphate cotransporters in the proximal renal tubule. This decrease ...

Book Reviews
425-426

A flask or dish containing nutrient medium and living cells is such a usual sight in a biologic or medical laboratory that we hardly notice it. Hannah Landecker's fascinating, beautifully written account of the history of cell culture restores the sense ...

426-427
  • Free Full Text

Throughout its nearly 40-year history, modern bioethics has been intimately connected with law. The establishment of U.S. regulations governing human subjects research and the judicial recognition of patients' rights to consent to or refuse treatment are ...

427

This book, intended for general readers, reviews recent research on a major question at the intersection of evolutionary biology and medicine: Why does evolution, which, as Moalem and Prince write in their introduction, “is supposed to weed out harmful ...

Corrections
427

Diabetic Gastroparesis Clinical Practice, N Engl J Med 2007:356;820-829.. The last sentence of the second paragraph under Impaired Gastric Emptying in Patients with Diabetes (page 821) should have read “In a clinical trial of exenatide, nausea occurred in ...

428

Posaconazole or Fluconazole for Prophylaxis in Severe Graft-versus-Host Disease Original Article, N Engl J Med 2007:356;335-347.. The second sentence of the third paragraph under Efficacy (page 341) should have read “In other analyses, posaconazole was ...

Trends: Most Viewed (Last Week)

More Trends