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May 22, 2008  Vol. 358 No. 21

Audio Summary of this Issue

Perspective
2197-2200

On November 22, 2007, television viewers witnessed the launch of the first direct-to-consumer advertising campaign for percutaneous transluminal coronary angioplasty with a drug-eluting coronary stent. Drs. William Boden and George Diamond ask, has ...

2201-2203

Anita Raj, Charlemagne Gomez, and Jay Silverman write that there is increasing recognition of tragedy among Afghan girls and women: self-immolation. The predominant causes or precipitating events of self-immolation identified by survivors or contacts were ...

Original Articles
2205-2217

Immediate percutaneous coronary intervention (PCI) is the treatment of choice for acute ST-segment elevation myocardial infarction. In this study, PCI that was “facilitated” by pretreatment with reteplase plus abciximab or abciximab alone did not improve clinical outcomes and increased bleeding, calling into question the use of facilitated PCI for the treatment of acute myocardial infarction.

2218-2230

Bivalirudin is a direct thrombin inhibitor. As compared with a combination of heparin and a glycoprotein IIb/IIIa inhibitor, bivalirudin use resulted in less bleeding and lower 30-day mortality among patients undergoing PCI for acute myocardial infarction. However, bivalirudin was associated with a higher rate of acute stent thrombosis within 24 hours.

2231-2239

A form of Leber's congenital amaurosis is caused by mutant RPE65, a critical component of the visual cycle. Two early clinical trials to assess subretinal injection of a viral vector containing RPE65 in young adults with advanced retinal degeneration show that this approach is generally safe in the short term, although one group reported an adverse event: macular hole. The authors observed improvement in some measures of visual function.

2240-2248

Leber's congenital amaurosis (LCA) is a group of inherited disorders involving retinal degeneration with severe vision loss noted in early infancy. The condition is usually identified through behaviors, including abnormal roving-eye movements (nystagmus). ...

Special Article
2249-2258
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The prevalence of smoking has decreased substantially in the United States over the past 30 years. This article examines the extent of person-to-person spread of smoking behavior and the extent to which groups of widely connected people quit together. Smoking behavior spreads through close and distant social ties, groups of interconnected people quit in concert, and smokers are increasingly marginalized socially.

Clinical Therapeutics
2259-2264

A 28-year-old man presents with allergic rhinitis, primarily due to grass pollen, that has not previously responded to antihistamines and nasal sprays. A trial of sublingual immunotherapy is recommended. Sublingual immunotherapy is more convenient than injection immunotherapy. However, only one agent, which is specific for grass-pollen allergies, has been approved for clinical use in some European countries. The Food and Drug Administration has not approved any agent for sublingual immunotherapy.

Images in Clinical Medicine
2265
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A 14-year-old girl presented with a traumatic injury to the right eye from a water-bottle cap, caused by the increasingly popular adolescent activity of twisting and crushing an empty plastic water bottle, with the cap loosened, until the cap flies off ...

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This 67-year-old woman presented with dyspnea and severe tricuspid regurgitation. The mitral and aortic valves from 38 years earlier were functioning normally.

Case Records of the Massachusetts General Hospital
2266-2274

    A 46-year-old woman was evaluated at this hospital because of pain in the right hip and leg of several months' duration. The patient had a history of celiac disease but was otherwise well. Imaging studies disclosed multiple bone lesions in the pelvis and long bones, with a diffuse abnormality in the bone marrow. Laboratory tests showed low serum calcium and elevated alkaline phosphatase levels. A diagnostic procedure was performed.

    Editorials
    2276-2277
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    For many years, the editors of the Journal have relied on peer review to ensure the scientific quality of the articles that we publish. Of the thousands of manuscripts submitted to the Journal each year, we publish about 1 in 20. To aid us in selecting ...

    2277-2279

    Sir Winston Churchill once said, “It's not enough that we do our best; sometimes we have to do what is required.” Such a sentiment underlies the premise of facilitated percutaneous coronary intervention (PCI), a therapeutic strategy of pharmacologic ...

    2280-2282

    The goals of the initial management of ST-segment elevation myocardial infarction include swift restoration of flow within the occluded coronary artery, prevention of early reinfarction, and avoidance of complications of reperfusion therapy.1,2 The ...

    2282-2284

    In this issue of the Journal, two groups of investigators — Bainbridge et al.1 and Maguire et al.2 — describe the first results of separate clinical trials investigating the short-term safety and preliminary efficacy of gene therapy for Leber's congenital ...

    2284-2286

    One of the greatest health advances in the past three decades has been the continuing decline in the prevalence of smoking, which recently hit a modern age-adjusted low of 19% of adults in the United States, down from a high of 57% of men in 1955 and 34% ...

    Clinical Implications of Basic Research
    2287-2289

    The human immunodeficiency virus (HIV) binds an integrin receptor on CD4+ T cells in the gut.

    Correspondence
    2290-2291

    To the Editor: Calis et al. (Feb. 28 issue)1 report a significant association of bacteremia with severe anemia in Malawi. Bacteremia in case patients and control patients was mainly due to nontyphoid salmonella. The study showed that nontyphoid ...

    2292-2293

    To the Editor: In their article on aggressive multiagent treatment of risk factors for diabetic complications, Gæde et al. (Feb. 7 issue)1 comment that there were no differences in smoking status between the intensive-therapy and conventional-therapy ...

    2293-2295

    To the Editor: The report by Allen et al. (Jan. 17 issue)1 on iron-overload–related disease in patients with HFE hereditary hemochromatosis states that among men, the clinical penetrance among HFE C282Y homozygotes was 28.4%. Our study showed that only ...

    2295-2296

    To the Editor: We strongly support the rationale for ablation of ventricular tachycardia to reduce implantable cardioverter–defibrillator (ICD) therapy, described by Reddy et al. (Dec. 27 issue),1 but would caution that risk stratification is essential ...

    2296-2298

    To the Editor: Pelliccia et al. (Jan. 10 issue)1 report long-term follow-up data on 81 athletes with deeply inverted T waves on electrocardiograms (ECGs), who had no apparent cardiac disease, selected from a cohort of 12,550 trained athletes. Among these ...

    2298

    To the Editor: In his Clinical Practice article on neurogenic orthostatic hypotension, Freeman (Feb. 7 issue)1 notes that the definition of orthostatic hypotension encompasses a drop in blood pressure during the first 3 minutes of standing. He states ...

    2299-2300

    To the Editor: Cohen et al. (March 23, 2006, issue)1 describe a missense variant in the proprotein convertase subtilisin/kexin type 9 (PCSK9) gene that was associated with reductions in low-density lipoprotein (LDL) cholesterol levels and in the risk of ...

    Book Reviews
    2301-2302

    More than 20,000 doctors currently identify themselves as hospitalists — physicians whose practices center on inpatient services and who focus on organizing and coordinating care; on communicating with patients, their families, and staff; and on educating ...

    2302-2303

    A more exact title for this book might be “Short Illustrated Histories of 21 Proprietary Medicines Popular in Great Britain, 1600–2005.” The actual, concise title promises potential readers coverage of a bit more ground than any book could deliver in so ...

    2303-2304

    The emerging interdisciplinary field of narrative medicine has benefited in recent years from media attention and from formal institutional support. Psychoanalysis and Narrative Medicine is a collection of recent scholarly research in the field by ...

    2304-2305

    When I was an infant, my father set up a little record player near my crib. He was a man of few words, and his love of music was out of proportion to everything else about him. His ambitions had been curtailed by the Great Depression, and he wanted to ...

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