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August 23, 2007  Vol. 357 No. 8

Audio Summary of this Issue

Perspective
733-735
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In his controversial new film about U.S. health care, Michael Moore heads abroad to show us that a single public insurer is the only hope for health care reform. Jacob Hacker argues that one need not travel to see the virtues of combining universality ...

736-739

Between January and June 2007, the presidential candidates raised more than $265 million, representing the fastest start to presidential fund-raising ever. Dr. Robert Steinbrook writes that, so far, only a small percentage of the contributions has come ...

Original Articles
741-752

The prospective, controlled Swedish Obese Subjects study enrolled 4047 subjects who either underwent bariatric surgery or received conventional treatment. The results of follow-up for up to 15 years suggest that bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality.

753-761
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This study examined long-term total mortality after gastric bypass surgery in severely obese subjects, as compared with severely obese controls who did not have surgery. Mortality was significantly reduced in subjects in the surgery group, particularly death from diabetes, heart disease, and cancer. However, the risk of non–disease-related death (including accidents and suicide) was higher in the surgery group than in the control group. Gastric bypass surgery appears to reduce long-term mortality in severely obese patients.

762-774

This survey of a large population of adults 57 to 85 years of age showed that rates of sexual activity decline with age but that many older adults are sexually active. Women were less likely than men to report having a partner and being sexually active. Many older adults reported sexual problems; few had discussed sexuality with a physician. These cross-sectional data inform our understanding of sexual activity and problems in older adults.

775-788

A genomewide analysis of sporadic ALS suggests that a variant of FLJ10986, a gene of unknown function expressed in the spinal cord and other tissues, may confer susceptibility to the disease. This study also provides provisional identification of other candidate genes, variants of which may underlie susceptibility.

Clinical Practice
789-796

A 68-year-old accountant visits his physician. A year earlier he was told that his blood pressure was somewhat elevated and was advised to reduce salt intake and increase activity. Otherwise, he has been in good health and has no history or signs of cardiovascular or renal disease. On physical examination, his blood pressure is 178/72 mm Hg, and his body-mass index is 28.4. How should he be further evaluated and treated?

Review Article
797-805

Prerenal azotemia and acute tubular necrosis, the two forms of ischemic acute renal failure, account for more than half the cases of renal failure in hospitalized patients. Yet the contribution of ischemia is initially unrecognized in many patients with acute renal failure. This article reviews the renal response to ischemia and the clinical features of and risk factors for normotensive ischemic acute renal failure.

Images in Clinical Medicine
806
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A 66-year-old man presented with edema, which had developed over the previous month. The urinary sediment showed fatty casts (Panel A), with typical “Maltese crosses” under polarized light (Panel B), and was otherwise unremarkable, with no sign of ...

e9
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This 12-year-old boy presented with abdominal pain, vomiting, and abdominal distention. CT scan showed proximal jejunojejunal and ileocolic intussusceptions.

Case Records of the Massachusetts General Hospital
807-816

    A 61-year-old man was admitted to this hospital because of recurrent fevers and pulmonary infiltrates. He had been well until approximately 3.5 months earlier, when chills, fevers, and fatigue developed, followed by dyspnea, all of which persisted despite antimicrobial therapy. On admission, the patient had daily fever, with temperatures up to 38.9° C; the erythrocyte sedimentation rate was 94 mm per hour. Computed tomography of the chest showed interlobular septal thickening and hilar and subcarinal lymphadenopathy. Positron-emission tomography showed diffuse uptake in the lungs. A diagnostic procedure was performed.

    Editorials
    818-820

    In this issue of the Journal, two articles — by Sjöström et al.1 and Adams et al.2 — may provide the missing link between intentional weight loss and lives saved for obese patients. For the past two decades, we have been living through an epidemic of ...

    820-822

      Human beings are living longer, women more so than men. Among people 85 years of age and older, there are 4 men for every 10 women.1 What happens to sexuality in older age?

      In this issue of the Journal, Lindau et al.2 report the results of a community-...

      822-823

      Amyotrophic lateral sclerosis (ALS) is a human disease resulting from the degeneration of motor neurons in the brain, spinal cord, and peripheral nervous system. The resultant clinical features include weakness of the arms, legs, and face and difficulties ...

      Correspondence
      824-825

      To the Editor: Chan et al. (May 24 issue)1 evaluated the influence of aspirin on the risk of colorectal cancer according to the expression of cyclooxygenase-2 (COX-2) in the resected tumors and found a significantly reduced risk of colorectal cancers ...

      825-827

      To the Editor: Pettersson and colleagues (May 3 issue)1 report that treatment for undescended testis before puberty as compared with treatment after puberty halves the risk of testicular cancer associated with undescended testicles. In a Danish cohort ...

      827-829

      To the Editor: In their review of the roles of sodium and potassium in the pathogenesis of hypertension, Adrogué and Madias (May 10 issue)1 appropriately emphasize the central roles of an excess of sodium, the expansion of extracellular fluid volume, the ...

      829-830

      To the Editor: Recent studies have shown a poor prognosis for patients with heart failure who have a normal ejection fraction,1 a finding that differs markedly from the results of randomized, controlled trials.2,3 This discrepancy requires an ...

      830-831

      This study evaluated 210 U.S. soldiers after blast injury in Iraq. There was a significant association between tympanic-membrane perforation and concussive brain injury.

      Book Reviews
      832

      In this book, a group of distinguished European medical researchers has nicely orchestrated a multiauthored text that is an update of knowledge about the prevention of cardiovascular disease and the rehabilitation of patients with such disease. The ...

      832-833

      The ancients recognized the effect of emotions on the pulse, but it wasn't until centuries later that the connection between emotions and heart disease was made. John Hunter, the eminent 18th-century surgeon who had angina pectoris, noted, “My life is in ...

      833-834

      Almost 30 years ago, Andreas Gruentzig performed the first balloon angioplasty in Zurich, Switzerland. If he were alive today, a book written by him would be the bible of interventional cardiology. It therefore deserves our attention when Spencer King — ...

      834-835
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      Sudden death from cardiac causes accounts for nearly 20% of all deaths in developed countries. According to the Centers for Disease Control and Prevention, 456,076 sudden deaths from cardiac causes occurred in the United States in 1998, two thirds of ...

      Corrections
      835

      China and HIV — A Window of OpportunityPerspective, N Engl J Med 2007:356;1801-1805.. In the fourth paragraph from the end of the Perspective (page 1805), the first sentence should have read “Relying almost entirely on generic drugs produced in China, the ...

      835

      Effect of Torcetrapib on the Progression of Coronary Atherosclerosis Original Article, N Engl J Med 2007:356;1304-1316.. In the list of authors (page 1304), Dr. Lasala should have been listed as Gabriel P. Lasala rather than Gregory P. Lasala. The text ...