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September 11, 2008  Vol. 359 No. 11

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Perspective
1085-1087

The expert adviser must both “speak truth to power” and aid in the exercise of power. Jacob Hacker questions whether the adviser's talents can really be used, or be useful, in the bare-knuckles world of American politics.

1087-1090

The global war on terror has brought renewed attention to the question of whether physicians in the U.S. military are physicians first, soldiers first, or physician–soldiers. George Annas writes that it is not surprising that wars have produced ...

1090-1092

Jonathan Marks and Dr. M. Gregg Bloche write that the AMA and APA firmly oppose physicians' helping to devise interrogation plans for individual detainees. Yet documents recently provided by the U.S. Army make clear that the Department of Defense still ...

1092-1095

Lately, concerns have been raised that some antidiabetes agents may impart greater cardiovascular risk than was previously appreciated. Dr. Allison Goldfine writes that both macrovascular effects of antidiabetes agents and the optimal glycemic goals ...

Original Articles
1097-1107

This randomized trial showed no benefit of the addition of arthroscopic treatment to optimized physical and medical therapy and provided evidence that arthroscopic surgery is not indicated for the treatment of osteoarthritis of the knee.

1108-1115

In this cross-sectional study involving magnetic resonance imaging (MRI) of the right knee in middle-aged and older men and women, more than a third of the participants had a meniscal tear or meniscal destruction or resection; many of these persons reported having had no knee pain or stiffness in the previous month. Meniscal damage was particularly common in persons with radiographic evidence of osteoarthritis. Clinicians should take into consideration the high prevalence of incidental meniscal findings when ordering or interpreting this test in older patients with knee pain.

1116-1127

This randomized trial of the treatment of advanced head and neck cancer tested the efficacy of adding cetuximab, an antibody against the epidermal growth factor receptor, to standard therapy (platinum-based chemotherapy). As compared with standard chemotherapy alone, cetuximab plus chemotherapy prolonged median overall survival by almost 3 months.

1128-1135

Impaired reabsorption of phosphate by renal tubules increases the risks of nephrolithiasis and bone demineralization. On the basis of data from animals, the sodium–hydrogen exchanger regulatory factor 1 (NHERF1) appears to control renal phosphate transport. The authors sequenced NHERF1 in people with nephrolithiasis or bone demineralization and identified three mutations, suggesting a previously unrecognized cause of renal phosphate loss in humans.

Clinical Therapeutics
1136-1142

A 36-year-old woman with a presumptive diagnosis of endometriosis presents with long-standing pelvic pain that is not relieved by means of oral contraceptives or medroxyprogesterone. Treatment with a gonadotropin-releasing hormone agonist is recommended. Gonadotropin-releasing hormone agonists profoundly suppress gonadotropin secretion and sex-steroid production. Side effects include loss of bone mineral density and memory impairment.

Review Article
1143-1154

There are more than half a million incident cases of squamous-cell carcinoma of the head and neck worldwide each year, primarily affecting the oropharynx, oral cavity, hypopharynx, and larynx. This review considers the biologic features of these tumors, including the role of human papillomavirus as a risk factor for cancer of the oropharynx. New therapies are considered, along with management approaches.

Images in Clinical Medicine
1155
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A healthy 34-year-old woman presented with an acute, painful swelling and bluish discoloration of the anterior neck with no associated trauma. She reported having fatigue, anorexia, and depression during the past few weeks. On examination, she had ...

e12
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A 46-year-old man from Cambodia presented with myalgias and an elevated creatine kinase. After 4 weeks of empirical therapy with oral corticosteroids, pulmonary hemorrhage, hypoxemic respiratory failure, and septic shock occurred.

Case Records of the Massachusetts General Hospital
1156-1167

An 8-day-old boy was admitted to this hospital because of weakness and lethargy. He had been hospitalized briefly after birth because of respiratory distress, and sensorineural deafness was noted, but his postnatal course had been otherwise normal. On the day before admission, he became lethargic and hypothermic, with grunting respirations; lumbar puncture at another facility disclosed blood in the cerebrospinal fluid, and he was transferred to this hospital. Imaging studies disclosed intracerebral hemorrhage and edema. Coma developed, and the infant died on the fifth hospital day. An autopsy was performed.

Editorials
1169-1170

Orthopedic surgeons perform arthroscopic surgery in many joints of the extremities, most commonly the knee. Two or three incisions are routinely made, each measuring approximately 7 mm. The knee is inflated with fluid under pressure, with the assistance ...

1171-1173

Nephrolithiasis is a common disorder, and idiopathic hypercalciuria is the most frequent metabolic disorder associated with nephrolithiasis.1 Several studies have shown that subjects with idiopathic hypercalciuria have phosphaturia or renal phosphate ...

1174

Each year thousands of reviewers contribute their expertise to peer review, a process that contributes critically to the quality of the Journal. The editors and the authors of the papers submitted to the Journal are grateful for the help of all our ...

Clinical Implications of Basic Research
1175-1177

Two monkeys have been trained to control a robotic arm to feed themselves by means of electrodes implanted into their motor cortexes.

Correspondence
1178-1180

To the Editor: Hutchison et al. (June 5 issue)1 report that hypothermia therapy that was initiated within 8 hours after traumatic brain injury and continued for 24 hours did not improve the neurologic outcome in children in their study. However, five ...

1181-1182

To the Editor: Fergusson et al. (May 29 issue)1 report the findings of the Blood Conservation Using Antifibrinolytics in a Randomized Trial (BART) study. They found a negative mortality trend associated with aprotinin as compared with lysine analogues ...

1182-1183

To the Editor: In discussing informed consent for organ transplantation, Halpern et al. (June 26 issue)1 blend two important but independent concerns — the quality of organs from various groups of deceased donors and the risk of transmission of ...

1183-1184

To the Editor: The diagnosis of secondary hyperparathyroidism in the case discussed by Demay and colleagues (May 22 issue)1 is doubtful. Primary hyperparathyroidism with coexisting vitamin D deficiency presents with normocalcemia and hypophosphatemia.2 ...

1184-1186

To the Editor: We describe a case of hypercalcemia associated with the secretion of an abnormally truncated parathyroid hormone (PTH) from a parathyroid adenoma. A 59-year-old postmenopausal woman presenting with back pain had an elevated serum calcium ...

Book Reviews
1187

We take for granted that on average, women in the United States live longer than men, even though they are subject to more chronic disease during their lifetimes. Research findings inform us as to how we can reduce our risk of various diseases and ...

1188-1189

Stroke is the third leading cause of death worldwide. In industrialized countries it accounts for 10 to 12% of all deaths, but two thirds of deaths from stroke now occur in nonindustrialized countries. About half of stroke survivors must depend on others ...

1189-1190
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Acute heart failure is a major health issue, accounting for a large proportion of patients admitted to hospitals. Patients with recent hospitalizations for acute heart failure are at high risk for future cardiovascular events and death. In contrast to ...

1190-1191

Atrial fibrillation has become the focus of intense investigation over the past several years, owing to its clinical importance, an increased understanding of its pathophysiology, and the development of new therapies. Andrea Natale and José Jalife, ...