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Table of contents for

January 17, 2008  Vol. 358 No. 3

Audio Summary of this Issue

Perspective
213-216
“Westernizing” Women's Risks? Breast Cancer in Lower-Income Countries
P. Porter
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Some 45% of the new cases of breast cancer diagnosed each year, and more than 55% of breast-cancer–related deaths, occur in low- and middle-income countries. Dr. Peggy Porter writes that the most widely cited reason for the global increase in breast ...

216-219
A Bridge to Nowhere — The Troubled Trek of Foreign Medical Graduates
R. Srivastava
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Dr. Ranjana Srivastava writes about her experience as a tutor to foreign-trained doctors taking a “bridging” course to earn medical credentials in Australia. These foreign doctors are driven by the dream of becoming doctors again, but the reality can be a ...

Original Articles
221-230
Iron-Overload–Related Disease in HFE Hereditary Hemochromatosis
K.J. Allen and Others
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In this large, prospective study of persons of northern European ancestry living in Australia, 1 in 146 was homozygous for a mutation (C282Y) in the HFE gene that is associated with hereditary hemochromatosis. Disease related to iron overload developed in 28% of male homozygotes but in only 1% of female homozygotes.

231-240
A Citywide Protocol for Primary PCI in ST-Segment Elevation Myocardial Infarction
M.R. Le May and Others
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To minimize door-to-balloon times, Ottawa developed a program in which patients with ST-elevation myocardial infarction were taken directly from the field to a cardiac care center for primary coronary angioplasty. The median door-to-balloon time (69 minutes) was approximately half that of patients who were transferred from emergency departments (123 minutes). Respective in-hospital mortality rates were 3.0% and 5.7% (P=0.30).

241-251
Etanercept Treatment for Children and Adolescents with Plaque Psoriasis
A.S. Paller and Others
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In this randomized trial of 211 children and adolescents with moderate-to-severe psoriasis, response rates at 12 weeks were higher among patients treated with etanercept than among those receiving placebo (57% vs. 11%, P<0.001). Response was maintained during 24 weeks of open-label treatment. Three serious infections occurred in patients treated with etanercept.

Special Article
252-260
Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy
E.H. Turner, A.M. Matthews, E. Linardatos, R.A. Tell, and R. Rosenthal
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This study compares the published data on a dozen antidepressant drugs with analyses of the same drugs by the Food and Drug Administration. The results of studies in the entire database were less likely to be favorable to the drug than those in the published literature.

Review Article
261-273
Current Concepts: Update on Avian Influenza A (H5N1) Virus Infection in Humans
Writing Committee of the Second World Health Organization Consultation on Clinical Aspects of Human Infection with Avian Influenza A (H5N1) Virus
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Avian influenza A (H5N1) viruses are entrenched among poultry in parts of Asia and Africa and continue to cause disease with high mortality in humans. This update summarizes recent information including research on the transmission and pathogenesis of the infection and on the current strategies for treatment and prevention.

Videos in Clinical Medicine
e2
Examination of the Larynx and Pharynx
F.C. Holsinger and Others

    This video demonstrates examination of the larynx and pharynx using indirect laryngoscopy, with either a simple dental mirror or a flexible fiberoptic endoscope.

    Images in Clinical Medicine
    274
    Leukemic Gingival Infiltration
    A. Mani and D.A. Lee
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    An otherwise healthy 36-year-old man presented with a 6-day history of bleeding gums and abdominal pain in the left upper quadrant. He reported having had fevers, fatigue, decreased appetite, and unintentional weight loss of 10 lb (4.5 kg) during the ...

    e3
    Penetrating Orbital Trauma
    H.S. Reddy and E. Chang
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    This 15-year-old boy presented with an inability to open his left eye after being assaulted with a pencil. A small laceration was noted.

    Case Records of the Massachusetts General Hospital
    275-289
    Case 2-2008 — A 38-Year-Old Woman with Postpartum Visual Loss, Shortness of Breath, and Renal Failure
    C.C. Magee, M.P. Coggins, C.S. Foster, V.V. Muse, and R.B. Colvin
    • Video

    A 38-year-old woman was admitted to the hospital 2 weeks after delivery because of loss of vision, shortness of breath, and renal failure. Preeclampsia had developed during pregnancy, and cesarean section was performed at 25 weeks' gestation. The day after delivery, blurred vision and scotomata developed and persisted. Intravenous corticosteroid therapy was begun, but shortness of breath developed, and the patient was admitted to the hospital.

    Editorial
    291-292
    Clinical Penetrance of Hereditary Hemochromatosis
    B.R. Bacon and R.S. Britton

      In 1996, Feder and colleagues1 showed that homozygosity for a mutation (C282Y) in the HFE gene is responsible for the majority of cases of typical phenotypic hereditary hemochromatosis. At that time, it was commonly believed that most C282Y homozygotes ...

      Clinical Decisions
      293-297
      Management of Type 2 Diabetes
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      This interactive Journal feature presents the case of a 55-year-old woman with type 2 diabetes, obesity, and hypertension. Three possible treatment options, any of which could be considered correct, are presented. Which option do you recommend?

      Health Law, Ethics, and Human Rights
      298-303
      Rules for Donations to Tissue Banks — What Next?
      L. Glantz, P. Roche, and G.J. Annas

        The authors discuss two legal cases involving patients claiming property rights to human tissue used for research after the tissue was surgically removed or donated and a third involving a dispute between a researcher and a university over the ownership of tissue samples.

        Clinical Implications of Basic Research
        304-305
        Guiding Aerosol Deposition in the Lung
        A.L. Coates

          A model of targeted drug delivery to the lung uses magnetized droplets and a magnetic field.

          Correspondence
          306-307
          Prednisolone or Acyclovir in Bell's Palsy
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          To the Editor: Sullivan et al. (Oct. 18 issue)1 report that early treatment with prednisolone significantly improves the chances of complete recovery in patients with Bell's palsy, whereas no evidence of a benefit of acyclovir could be found. Idiopathic ...

          308-309
          CTGF Polymorphism Associated with Systemic Sclerosis
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          To the Editor: In the study reported by Fonseca et al. (Sept. 20 issue),1 the G−945C substitution in the promotor region of the connective-tissue growth factor (CTGF) gene was clearly demonstrated to be associated with susceptibility to systemic ...

          310-311
          Hypertriglyceridemia
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          To the Editor: Brunzell's Clinical Practice article on hypertriglyceridemia (Sept. 6 issue)1 does not give n−3 fatty acid supplementation fair representation. Clinical evidence, similar to or better than evidence in support of niacin, supports the use of ...

          311
          Taenia in the Gastrointestinal Tract
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          To the Editor: Liao and Bair (Sept. 6 issue)1 describe a tapeworm in a 60-year-old woman from a community where pork and pork liver are eaten, especially at festivals, and suggest infection with Taenia solium (the pork tapeworm) rather than T. saginata (...

          312-313
          Case 31-2007: A Man with Abdominal Pain and Elevated Creatinine
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          To the Editor: In the Case Record of a 41-year old man with acute renal failure, discussed by Rabb and Colvin (Oct. 11 issue),1 kidney biopsy revealed lesions that the discussants ascribe to nonsteroidal antiinflammatory drugs in association with ...

          313-315
          Indian Mucosal Leishmaniasis Due to Leishmania donovani Infection
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          To the Editor: A 62-year-old man from Chamoli District of Uttaranchal, north India, had a 2-year history of a fleshy, polypoid swelling with superficial ulceration on the mucosal aspect of the lower lip, lower gum, floor of the mouth, and palate, without ...

          Book Reviews
          316-317
          The Legacy of Harvey Cushing: Profiles of Patient Care
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          Harvey Cushing has been called the father of neurosurgery, and as a testament to his singular importance, the American Association of Neurological Surgery was founded in 1931 as the Harvey Cushing Society. Not surprisingly, several biographies of Cushing ...

          317-318
          Hodgkin Lymphoma
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          In the second edition of this important book, published 8 years after the first edition, the title has been changed from Hodgkin's Disease to Hodgkin Lymphoma, in accordance with the World Health Organization's system of classification for lymphoma. But ...

          318-319
          Building Genetic Medicine: Breast Cancer, Technology, and the Comparative Politics of Health Care
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          Clinical testing for BRCA mutations became available in 1996 as a means for the identification of women with a high lifetime risk of breast and ovarian cancer. This innovation was widely viewed as a medical breakthrough. Shobita Parthasarathy's intriguing ...

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