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Table of contents for

June 19, 2008  Vol. 358 No. 25

Audio Summary of this Issue

Perspective
2661-2663
Keeping Pace with the Times — The Genetic Information Nondiscrimination Act of 2008
K.L. Hudson, M.K. Holohan, and F.S. Collins
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  • Video

On May 21, President George Bush signed the Genetic Information Nondiscrimination Act (GINA). Kathy Hudson, M.K. Holohan, and Dr. Francis Collins write that at last, the United States has a federal law that protects consumers from discrimination by health ...

2664-2665
Focus on Research: Cancer Immunotherapy — The Endgame Begins
L.M. Weiner

    Every clinical investigator who has witnessed remarkable tumor regressions in some patients treated with immunotherapy has been intrigued and tormented by the idea that immunotherapy can trigger powerful and durable cancer control. Dr. Louis Weiner ...

    Original Articles
    2667-2677
    Rhythm Control versus Rate Control for Atrial Fibrillation and Heart Failure
    D. Roy and Others
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    In this clinical trial involving patients with atrial fibrillation and congestive heart failure, rhythm control (to maintain sinus rhythm) and rate control (to control the ventricular rate in atrial fibrillation) were compared. The two strategies were nearly identical with respect to all clinical outcomes. Thus, the simpler approach, rate control, should be considered the treatment of choice in such patients.

    2678-2687
    Increased Mortality after Dronedarone Therapy for Severe Heart Failure
    L. Køber and Others
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    Dronedarone is a class III antiarrhythmic drug that has efficacy as a treatment for atrial fibrillation and ventricular arrhythmias. In this clinical trial involving patients with severe heart failure, however, dronedarone was found to increase overall mortality, raising serious concern about the safety of this drug in patients with advanced heart failure.

    2688-2697
    Electrocardiographic Abnormalities and Sudden Death in Myotonic Dystrophy Type 1
    W.J. Groh and Others
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    In a study of 406 patients with myotonic dystrophy type 1, 96 had severe electrocardiographic (ECG) abnormalities when first evaluated. During an average of 5.7 years of follow-up, there were 81 deaths, of which 27 were sudden. The presence of a severe ECG abnormality at baseline was an independent predictor of sudden death (relative risk, 3.3).

    2698-2703
    Brief Report: Treatment of Metastatic Melanoma with Autologous CD4+ T Cells against NY-ESO-1
    N.N. Hunder and Others
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    A patient with refractory metastatic melanoma had a complete remission after an infusion of cells from an in vitro–generated clone of autologous CD4+ T cells with specificity for the melanoma-associated NY-ESO-1 antigen.

    Review Article
    2704-2715
    Molecular Origins of Cancer: Cancer Immunology
    O.J. Finn

      This review is a comprehensive account of the current status of tumor immunology, beginning with the identification of human tumor antigens and ending with a summary of clinical applications of what we know about the immunology of tumors.

      Images in Clinical Medicine
      2716
      Central Hemiretinal Arterial Occlusion
      K.C. Mathys and S. Garg
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      A 65-year-old woman with a history of hypertension and cigarette smoking presented with complete loss of vision in the inferior field of the left eye, which she had noticed an hour before presentation. She reported having had two transient episodes of ...

      e29
      Bladder Foreign Body
      W.E. Corcoran and N. Phifer
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      This 35-year-old woman with bipolar disorder was found wandering with disorganized speech. The patient said that she had a nail in her uterus.

      Case Records of the Massachusetts General Hospital
      2717-2723
      Case 19-2008 — A 63-Year-Old HIV-Positive Man with Cutaneous Merkel-Cell Carcinoma
      P.M. Busse, J.R. Clark, V.V. Muse, and V. Liu

        A 63-year-old HIV-positive man was referred to this hospital for management of a cutaneous Merkel-cell carcinoma on the forehead that metastasized to the ipsilateral preauricular and cervical lymph nodes. A treatment plan was established.

        Editorial
        2725-2727
        Rhythm Control in Atrial Fibrillation — One Setback after Another
        M.E. Cain and A.B. Curtis

          Atrial fibrillation, the most common sustained arrhythmia observed in hospitalized patients, is associated with substantial morbidity, and its occurrence approximately doubles the rate of death as compared with that of patients in whom sinus rhythm is ...

          Sounding Board
          2728-2732
          Over-the-Counter Sales of Statins and Other Drugs for Asymptomatic Conditions
          M.E. Tinetti
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          Two Food and Drug Administration advisory committees recently voted not to recommend approval of over-the-counter sales of lovastatin. This article reviews the rationale behind the committees' recommendations and discusses the risks and benefits of nonprescription sales of statins and other medications for asymptomatic conditions.

          Clinical Implications of Basic Research
          2733-2734
          Tumor Necrosis Factor α and Colitis-Associated Colon Cancer
          J.A.P. Wilson

            Mice that undergo ablation of a gene encoding a receptor of tumor necrosis factor α (TNF-α) or treatment with an antibody that binds TNF-α are partially protected against induced colitis and colitis-associated colon cancer.

            Correspondence
            2735-2736
            Cetuximab-Induced Anaphylaxis and IgE Specific for Galactose-α-1,3-Galactose
            • Free Full Text

            To the Editor: Chung and colleagues (March 13 issue)1 found IgE antibodies to galactose-α-1,3-galactose in pretreatment serum samples from 17 of 25 patients who had hypersensitivity reactions to cetuximab, whereas IgE antibodies were found in only 1 of ...

            2736-2738
            Vasopressin in Septic Shock
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            To the Editor: The results of the Vasopressin and Septic Shock Trial (VASST), reported by Russell et al. (Feb. 28 issue),1 do not fully support the conclusion that “low-dose vasopressin did not reduce mortality.” The secondary hypothesis that “the ...

            2738-2741
            Five Genetic Variants Associated with Prostate Cancer
            • Free Full Text

            To the Editor: We agree with Zheng et al. (Feb. 28 issue)1 that additional research is needed to assess the value of their finding of genetic variants associated with the risk of prostate cancer. Unfortunately, the planned marketing of a test based on ...

            2741-2744
            Genetics of Warfarin Response
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            To the Editor: In the study reported by Schwarz et al. (March 6 issue),1 specific genetic variants related to warfarin metabolism reduced the time to the first therapeutic and supratherapeutic international normalized ratio (INR) tests. A pharmacogenetic-...

            2744-2746
            Acute Pulmonary Embolism
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            To the Editor: We were surprised that the nephrotic syndrome was omitted from the list of underlying prothrombotic conditions in the review of acute pulmonary embolism by Tapson (March 6 issue).1 The nephrotic syndrome is relatively common in comparison ...

            2746-2747
            Imatinib as a Possible Cause of Severe Rhabdomyolysis
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            To the Editor: Imatinib mesylate (Gleevec [Glivec], Novartis), a protein kinase inhibitor of c-kit receptor tyrosine kinase (KIT) and platelet-derived growth factor receptor α (PGFR-α), is widely used for the treatment of chronic myeloid leukemia and ...

            Book Review
            2748-2750
            Handbook of PTSD: Science and Practice
            Haunted by Combat: Understanding PTSD in War Veterans Including Women, Reservists, and Those Coming Back from Iraq
            • Free Full Text

            Drs. Eugene Kim and Charles Hoge review two recent books on post-traumatic stress disorder (PTSD). One book consolidates the immense body of knowledge on PTSD in a single textbook, and the other shows that for individual veterans the complexity of combat ...

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