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May 1, 2008  Vol. 358 No. 18

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Perspective
1881-1883

Lawrence Jacobs writes that the current moment in U.S. health care reform is eerily reminiscent of the lead-up to the 1992 election. Despite unusually broad agreement that health care arrangements need reform, there is no convergence on proposals for ...

1883-1885
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Next fall, the Court will hear a case about preemption and FDA-approved drugs. The pharmaceutical industry is arguing that once the FDA approves a drug, the preemption doctrine implicitly deprives injured persons of the opportunity to prove it was ...

Original Articles
1887-1898

In this study, patients 80 years of age or older with sustained systolic hypertension were randomly assigned to receive either the diuretic indapamide, with or without the angiotensin-converting–enzyme inhibitor perindopril, or matching placebos, for a target blood pressure of 150/80 mm Hg. Active treatment resulted in a nearly significant reduction of the risks of fatal or nonfatal stroke and death from cardiovascular causes and a significant reduction in the rates of death from stroke and death from any cause, suggesting that antihypertensive treatment in these persons may be beneficial.

1899-1908

This study shows that mutations in genes previously implicated in adult-onset cardiomyopathy cause 49% of presumed sporadic cases and 64% of familial cases of childhood-onset cardiac hypertrophy. These findings indicate that genetic analyses and family evaluations are warranted when childhood-onset hypertrophy is diagnosed.

1909-1918

Almost half of patients with acute myeloid leukemia (AML) do not have detectable cytogenetic abnormalities. This study of more than 870 such patients determined the frequencies of mutations of the NPM1, FLT3, CEBPA, and MLL genes that affect the growth and differentiation of hematopoietic stem cells and showed that these mutations are associated with the treatment outcome. The authors propose that these mutations constitute a new basis for refining the risk classification of AML.

1919-1928

This study outlines the development of a microRNA signature in patients with cytogenetically normal acute myeloid leukemia (AML) with high-risk molecular features. This type of AML constitutes approximately 65% of cases of cytogenetically normal AML and one third of all AML cases involving patients under the age of 60 years. The microRNA signature correlated not only with the clinical outcome but also with the expression of genes encoding proteins of the innate immune system.

Special Article
1929-1940

In this randomized trial of a multifaceted intervention to improve obstetrical care in 19 hospitals in Argentina and Uruguay, the rate of prophylactic use of oxytocin in the third stage of labor increased from 2% at baseline to 84% after intervention at hospitals that underwent intervention and from 3% to 12% at control hospitals. The rate of episiotomy decreased from 41% to 30% at intervention hospitals but remained stable at control hospitals.

Clinical Practice
1941-1950

A 44-year-old woman desires weight reduction. She has a history of hypertension, daytime somnolence, and osteoarthritis. Her weight is 215 lb (98 kg), her waist circumference is 40 in. (102 cm), and her body-mass index is 32.7. Her blood pressure is 140/92 mm Hg. What would you advise?

Images in Clinical Medicine
1951

A 53-year-old man presented with a 4-week history of bilateral retrobulbar headache and blurred vision. His blood pressure was 220/135 mm Hg; his neurologic examination was unremarkable. He had no history of hypertension and was not taking any medication ...

e20
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This 14-year-old girl noticed that a small birthmark on her scalp had started growing rapidly. It was pruritic and caused considerable emotional distress.

Clinical Problem-Solving
1952-1956

    A 41-year-old woman was brought by her husband to the emergency department with a history of 72 hours of epigastric pain, nausea, repeated vomiting, and altered mental status. Her blood calcium was found to be 18.9 mg per deciliter (4.7 mmol per liter).

    Editorials
    1958-1960

    Hypertension is prevalent and accounts for a large proportion of cardiovascular morbidity and mortality worldwide.1 There is a continuous, approximately linear, increase in systolic blood pressure with increasing age in developed and developing nations in ...

    1960-1962

    The days when the microscope was the principal tool for classifying the various forms of acute myeloid leukemia (AML) and predicting the outcome of affected patients seem long past. The discovery, during the past 15 years, of acquired mutations and ...

    Correspondence
    1963-1964

    To the Editor: Bissler et al. and Davies et al. (Jan. 10 issue)1,2 report the beneficial effects of sirolimus on renal angiolipoma in patients with lymphangioleiomyomatosis (LAM). In contrast to the findings of Bissler et al., Davies et al. observed no ...

    1965

    To the Editor: Cunningham et al. (Jan. 3 issue)1 state that capecitabine and oxaliplatin are equivalent to fluorouracil and cisplatin in esophagogastric cancer. One disadvantage of their study is that patients with squamous-cell carcinoma were not ...

    1965-1967

    To the Editor: Percy et al. (Jan. 10 issue)1 uncovered a mutation within the hypoxia-inducible factor 2α (HIF2A) gene as a cause of attenuated HIF-2α degradation and increased erythropoietin production in patients with familial erythrocytosis. This is an ...

    1967-1968
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    To the Editor: In his discussion of the Clinical Practice vignette involving a fatal arrhythmic event in a child with the long-QT syndrome, Roden (Jan. 10 issue)1 emphasizes the importance of rigorously screening family members in order to provide an ...

    1968-1969

    To the Editor: The medical mystery in the March 6 issue1 involved an 82-year-old woman who presented with respiratory symptoms and then, 6 years later, presented with epigastric pain, nausea, and vomiting. During her first visit, an intrathoracic stomach ...

    1969-1972

    To the Editor: Seven years after receiving a kidney transplant, a 44-year old woman with a 31-year history of type 1 diabetes mellitus and long-term complications (retinopathy, neuropathy, and end-stage renal disease) underwent an allogeneic islet-after-...

    Book Reviews
    1973-1974

    This altogether splendid book provides an incisive critique of the politics and economics of health care — the major determinants of who gets what kind of care and how much of it. What makes this book unique is that none of “the usual suspects” (...

    1974-1975

    Since 1996, the Brazilian AIDS Control Program (BACP) has provided free access to highly active antiretroviral therapy (HAART) for all symptomatic patients and for asymptomatic people who have fewer than 200 CD4+ cells per cubic millimeter. HAART is also ...

    1975-1976

    Given the tremendous growth of the prison population in the United States over the past 30 years, Robert Greifinger's comprehensive book on health and the criminal justice system is overdue. Public Health Behind Bars is a compilation of cross-disciplinary ...

    1976-1977

    Alcohol is one of the most widely enjoyed — and abused — drugs in the United States. It is a part of the mainstream U.S. culture. What could be more American than having a beer and a hot dog at a baseball game? Moreover, of all drugs of abuse, alcohol ...

    Corrections
    1977

    Clinical Decisions: Management of Type 2 DiabetesClinical Decisions, N Engl J Med 2008:358;293-297.. The third sentence of the second paragraph (page 296) should have read “These drugs also appear to inhibit gastric emptying and enhance satiety, leading ...

    1977

    Simvastatin with or without Ezetimibe in Familial Hypercholesterolemia Original Article, N Engl J Med 2008:358;1431-1443.. In the list of authors' affiliations (p. 1431), the affiliation for Daniel Gaudet should have read “Department of Medicine, Montreal ...

    1977

    Adjuvant Chemotherapy for Gastric Cancer with S-1, an Oral Fluoropyrimidine Original Article, N Engl J Med 2007:357;1810-1820.. In Figure 1A (page 1816), the third entry for S-1 should have been 370 rather than 270. The figure has been corrected on the ...