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April 17, 2008  Vol. 358 No. 16

Audio Summary of this Issue

Perspective
1653-1656

Online repositories will allow patients to store, retrieve, manage, and share their health data. Dr. Robert Steinbrook writes that it remains uncertain whether the long-term result will be improved health care and decreased costs or simply the creation of ...

1656-1658

The ultimate goal of the electronic medical record is to make all patient information immediately accessible and easily transferable and to allow its essential elements to be held by both physician and patient. Drs. Pamela Hartzband and Jerome Groopman ...

1658-1661
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The Association of American Medical Colleges has responded to the concern about a physician workforce crisis with calls for a 30% expansion of U.S. medical schools and a lifting of the current cap on Medicare funding for graduate medical education. Drs. ...

Original Articles
1663-1671

This randomized trial of adjuvant chemotherapy in women with axillary lymph node–positive or high-risk, lymph node–negative breast cancer showed that weekly paclitaxel improved disease-free and overall survival as compared with docetaxel, when either was given after standard adjuvant chemotherapy.

1672-1681
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The decision to give intensive care to very preterm infants is often guided by gestational age alone. In this multicenter, prospective study of infants who received such care, female sex, singleton birth, higher birth weight, and antenatal corticosteroids were associated with reduced risks similar in magnitude to those associated with a 1-week increase in gestational age.

1682-1691

The chitinase-like protein YKL-40 is known to be involved in inflammation and tissue remodeling and is a biomarker of asthma severity and pulmonary function. This study shows an association between markers in the gene encoding YKL-40 and asthma, indicating that YKL-40 levels not only serve as a biomarker but also contribute to disease susceptibility.

Clinical Practice
1692-1699
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A 28-year-old woman presents with a 7-month history of recurrent, crampy pain in the left lower quadrant, bloating with abdominal distention, and frequent, loose stools. She reports having had similar but milder symptoms since childhood. Physical examination is unremarkable except for tenderness over the left lower quadrant. How should her case be evaluated and treated?

Review Article
1700-1711

With increasing numbers of extremely premature infants surviving, the outcome for these infants has generated much interest and controversy. This article reviews recent progress in the management and outcomes of some of the most common conditions affecting infants with very low birth weight (1500 g or less) and extremely low birth weight (1000 g or less).

Images in Clinical Medicine
1712
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A healthy girl, 4 1/2 years of age, was brought to our clinic for an assessment of her growth. A general physical examination was normal except for an incidental mass noted at the base of her tongue (arrow). Her height and weight were at the 25th ...

e18
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This 62-year-old Korean man had fever, abdominal pain, and abnormal liver-function tests. Computed tomographic scan showed dilatation of the common bile duct. After cannulation of the common bile duct, numerous worms popped out.

Case Records of the Massachusetts General Hospital
1713-1723

A 1-day-old female infant was admitted to the neonatal intensive care unit because of intermittent apnea and cyanosis. She was delivered by cesarean section after a 44-hour labor, 17 hours after rupture of membranes. On the second day of life, multiple episodes of apnea occurred. A 24-hour electroencephalogram showed evidence of seizure activity.

Editorial
1725-1726

    Asthma is a complex and heterogeneous syndrome in which the airway mucosa is abnormal and inflamed. Although its causes are unknown, there are strong clues: it runs in families, and many, but by no means all, patients with asthma have signs and symptoms ...

    Sounding Board
    1727-1732

    Legal restrictions on off-label promotion of drugs are being challenged in the courts as a violation of First Amendment protection of “commercial speech.” The authors argue that public health concerns make pharmaceutical promotion different from other commercial speech and that more stringent regulation should be permitted.

    1732-1737

    As patients store their personal health information in online repositories, the entities holding this information may be able to use it for a variety of purposes. This article explains the challenges and problems associated with a small number of companies holding large numbers of individual health records.

    1738-1740

      As medical records and research data are increasingly stored electronically, data standards permitting the integration and analysis of such information have become necessary. Progress is being made in developing and disseminating a common data format.

      Health Policy Report
      1741-1749

      In this Health Policy Report, the author discusses the supply of physicians in the United States and the growing consensus that there will be a shortage of physicians in the future. Medical and osteopathic schools are expanding, and the Association of American Medical Colleges believes graduate medical education (residency) positions also should be increased.

      Correspondence
      1750-1751

      To the Editor: To preserve language function during glioma resection in or near language areas, Sanai and colleagues, including Berger (Jan. 3 issue),1 advocate negative mapping through intraoperative cortical stimulation (negative cortical stimulation) ...

      1751-1753

      To the Editor: Le May et al. (Jan. 17 issue)1 achieved guideline-recommended door-to-balloon times of less than 90 minutes for 79.7% of patients with ST-segment elevation myocardial infarction when paramedics interpreted the electrocardiograms (ECGs) and ...

      1753-1755

      To the Editor: The analysis by Liou et al. (Nov. 22 issue)1 is a step toward a better understanding of the risk–benefit ratio of lung transplantation in cystic fibrosis. The study, however, has several limitations.

      First, the authors have neither ...

      1755-1758

      To the Editor: The article by Lindenauer and colleagues (Dec. 20 issue)1 compares the outcomes of care by hospitalists with the outcomes of traditional models of care. As physicians who have practiced both as hospitalists and as primary care physicians, ...

      1758

      To the Editor: Three cheers for the Journal for recognizing the importance of the Supreme Court's upcoming rulings on “FDA [Food and Drug Administration] preemption” cases: whether the fact that a drug or medical device is in compliance with FDA ...

      1758-1760

      To the Editor: In their video and accompanying article, Braner et al. (Dec. 13 issue)1 omit an important and common complication of subclavian central-venous-catheter placement — misplacement of the catheter tip in the internal jugular vein. This occurs ...

      1760-1761

      To the Editor: Over the past two decades, testing for eosinophiluria has gained widespread acceptance as a means of screening for acute interstitial nephritis. The frequent use of this test may be explained, in part, by the subtle clinical presentation ...

      Book Reviews
      1762-1763

      How did the very personal and private experience of sleep and dreaming become such a highly public scientific object with public policy and socioeconomic implications — and at what cost? The fascinating metamorphosis of the field of sleep medicine is ...

      1763-1764

      Many people believe that the cause of essential hypertension remains unknown. In Essential Hypertension and Its Causes, Paul Korner aims to identify the pathogenesis of essential hypertension by bringing together a considerable amount of knowledge in a ...

      1764-1765

      The successful manipulation of a cancer-directed immune response has long been a goal of cancer immunologists. Occasionally, spectacular successes have reinforced the enthusiasm of some investigators for this goal, but the more common failed attempts to ...

      1765-1766

      Retinal vascular diseases are leading causes of impaired vision and blindness worldwide. Consider that diabetes mellitus, an important cause of vision impairment, afflicts millions of people in the United States and is on the rise in developing countries. ...