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August 16, 2007  Vol. 357 No. 7

Audio Summary of this Issue

Perspective
633-635

The approval, prescribing, and safety surveillance of prescription drugs involve a complicated mix of science, regulatory law, clinical judgment, business, and politics. Dr. Jerry Avorn writes that though the quiet voice of science may often be no match ...

635-637

In June, two car bombs were left outside a nightclub in London; the following day, two men tried to drive a car loaded with gasoline and gas cylinders into the Glasgow airport. Dr. Simon Wessely writes that what has caught the public's attention is that ...

Original Articles
639-647

Genetic analyses of Icelandic and North American subjects with periodic leg movements and restless legs syndrome implicate a genetic susceptibility variant that has a population attributable risk for the combined populations of about 50%.

648-653

Studies have shown that surgical abortion during the first trimester of pregnancy is not associated with increased risks for adverse outcomes in a subsequent pregnancy, but little is known about pregnancy outcomes after medical abortion. This study, using national registry data in Denmark, showed that medical abortion, as compared with surgical abortion, was not associated with an increased risk of ectopic pregnancy, spontaneous abortion, preterm birth, or low birth weight.

654-663

Current techniques for the identification of the infecting organism in prosthetic-joint (e.g., hip or knee) infection remain insensitive. In this study of 331 surgeries involving prosthetic joint replacement, a new technique that sonicates the removed artificial joint is found to be more sensitive in identifying the infecting organism than are standard culture techniques.

664-672

Symptomatic brain metastases are a major clinical problem in small-cell lung cancer. This trial compared prophylactic cranial irradiation with observation in patients with small-cell lung cancer who had had any response to chemotherapy. Prophylactic irradiation reduced the risk of symptomatic brain metastases and was associated with longer overall survival.

Special Article
673-681
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This study of direct-to-consumer advertising by pharmaceutical companies reports a 330% increase in spending from 1996 to 2005. Such advertising campaigns were often initiated within 1 year after Food and Drug Administration (FDA) approval of the drug. Some experts have proposed changing regulations to prohibit such advertising during the first year after FDA approval. These data suggest that such a policy change would lead to a substantial change in the industry's advertising practices.

Clinical Therapeutics
682-690

A 52-year-old man with psoriasis seeks treatment for his skin condition. Treatment with psoralen and ultraviolet A (PUVA) is recommended. PUVA has been used since the 1970s for the treatment of psoriasis, although few randomized studies and clinical trials comparing this treatment with no treatment or with other forms of treatment have been conducted. PUVA therapy increases the risks of both nonmelanoma skin cancer and melanoma.

Images in Clinical Medicine
691
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A 19-year-old man was referred for treatment of multiple papular lesions that had appeared 8 years earlier on the glans of his circumcised penis and had been diagnosed as condyloma accuminatum. The lesions did not respond to treatment with various topical ...

e8
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This 36-year-old woman presented with an abdomen that was tense and distended, with a purplish umbilical mass. She reported having dysmenorrhea, right shoulder pain at the time of menstruation, and umbilical pain.

Case Records of the Massachusetts General Hospital
692-701

    A 60-year-old man was admitted to the hospital because of 5 months of fatigue and weight loss and the recent onset of arthralgias, odynophagia, rash, and fever. On examination, the rash involved the facial cheeks and the upper chest and back. There was palpable cervical, axillary, and inguinal lymphadenopathy. Imaging studies showed focal lung consolidation and intrathoracic and retroperitoneal lymphadenopathy. A diagnostic procedure was performed.

    Editorials
    703-705

    Today, 350 years after its first description, the restless legs syndrome (RLS) is strangely controversial. Experts and patients alike describe RLS both as a miserably impairing disorder and as “the most common disorder you have never heard of.” Critics do ...

    705-706

    The ultrasound system used by bats, dolphins, and whales has developed into a technology that has found numerous applications in diverse fields, including the biomedical domain, where it has been used particularly as an imaging device. Now low-frequency ...

    707

    Each year thousands of reviewers contribute their expertise to peer review, a process that contributes critically to the quality of the Journal. The editors and the authors of the papers submitted to the Journal are grateful for the help of all our ...

    Clinical Implications of Basic Research
    708-710

      Invasive E. coli adhere to enterocytes in patients with Crohn's disease before invading the cells. A recent study implicates carcinoembryonic antigen–related cell-adhesion molecule 6 (CEACAM6) in the mediation of this adherence.

      Correspondence
      711-715

      To the Editor: In their report on the Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly (HORIZON) Pivotal Fracture Trial, Black et al. (May 3 issue)1 conclude that a once-yearly infusion of zoledronic acid reduces the risk of ...

      715-717

      To the Editor: We agree with the Perspective article by Hughes and Williams (April 26 issue)1 that a more detailed presentation of data from the well-conducted Data Collection on Adverse Effects of Anti-HIV Drugs (DAD) Study Group collaboration2 may help ...

      717-718

      The medical mystery in the June 21 issue1 involved a 28-year-old woman with a 1-year history of high blood pressure that was diagnosed during her first pregnancy. In addition to an elevated blood pressure, at 200/100 mm Hg, in the left arm, physical ...

      718-719

      To the Editor: With regard to the surgical management of pulmonary-artery dissection in a patient with Eisenmenger's syndrome, described by Westaby et al. (May 17 issue),1 Eisenmenger's syndrome is defined as the reversal of a long-standing left-to-right ...

      719-720

      The authors report on five patients who presented with anaphylactoid reactions after drinking grape juice or newly pressed wines. All had positive skin tests for specific IgE antibodies to Hymenoptera.

      720-722

      To the Editor: Nephrogenic systemic fibrosis is a newly described systemic disorder that occurs in patients with renal insufficiency.1,2 The functional consequences of nephrogenic systemic fibrosis are often devastating and may be fatal. Since ...

      723

      To the Editor: After we submitted our letter about thunderstorms and iPods to the Journal (July 12 issue),1 other authors from our hospital published a separate report about the same case,2 unbeknownst to us when we submitted our letter. Their report was ...

      Book Reviews
      724

      Writing a medical book has always been an act of dedication and a thankless and exhausting task. And with the international body of information expanding daily at a breathtaking pace, a book authored by only one person sounds impossibly daunting, even ...

      725
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      Every year, 10 million people worldwide have strokes. Up to 20% have embolic strokes that originate from the heart. In another 30 to 40%, the source of the brain embolism is a precerebral artery such as the aorta or the carotid or vertebral artery.

      Brain ...

      725-726

      It has been estimated that the number of persons with dementia in the world will increase fourfold during the next four decades because of an increase in the number of elderly persons worldwide. Most cases of dementia will occur in the developing world. ...

      727

      Long before the public fascination with coma began, the state of unconsciousness had a primal appeal to physicians of all stripes. The understanding of coma stretches from Baron Constantin von Economo's observations of brain-stem encephalitis in 1917, to ...

      Corrections
      728

      Chemotherapy with Preoperative Radiotherapy in Rectal Cancer Original Article, N Engl J Med 2006:355;1114-1123.. In Figure 2 (page 1119), the percentage labels for the lines in Panel A were reversed. The solid line should have read 65.8%, and the dashed ...

      728

      Randomized Comparison of Strategies for Reducing Treatment in Mild Persistent Asthma Original Article, N Engl J Med 2007:356;2027-2039.. The second paragraph under Protocol (page 2029) should have read “Inclusion criteria for randomization after the run-...

      728

      The Supreme Court and Abortion Rights Health Law, Ethics, and Human Rights, N Engl J Med 2007:356;2201-2207.. The last sentence before the Discussion section (page 2205) should have read “As described in Casey, stare decisis is a doctrine that obligates ...