Join the 200th Anniversary Celebration

Issue IndexA searchable index of tables of contents

Find An Issue

By Volume and Issue
By Date

Table of contents for

October 16, 2008  Vol. 359 No. 16

Audio Summary of this Issue

Perspective
1645-1647

Dr. David Blumenthal argues that the central purpose of John McCain's health policy is to reduce the role of insurance and make Americans pay a larger part of their health care bills out of pocket. This plan would risk the viability of employer-sponsored ...

1648-1650

Barack Obama has laid out a vision for reform that promises health insurance for (nearly) everyone, with coverage as good as that enjoyed by members of Congress. Joseph Antos argues that the Obama plan offers a host of policy proposals that address the ...

1650-1653

Dr. Lisa Rosenbaum writes that there is little room for diagnostic uncertainty in the hospital systems where physicians train. But diagnosis for the sake of diagnosis can be an ill in its own right.

Original Articles
1655-1665
  • Free Full Text

One potential tool in the quest for global eradication of poliomyelitis is a newly developed monovalent type 1 oral poliovirus vaccine. In this study involving 421 infants in Egypt who were given either monovalent type 1 or trivalent vaccine at birth, significantly more infants given the monovalent vaccine underwent seroconversion to type 1 poliovirus (55%, vs. 32% of those given trivalent vaccine). In addition, the monovalent vaccine more effectively reduced shedding of type 1 poliovirus after challenge.

1666-1674

Control of poliovirus in Nigeria has been a considerable challenge, and incomplete control remains a threat to the goal of global eradication of poliomyelitis. The traditional approach to poliovirus control has relied largely on the use of the trivalent oral polio vaccine. Recently the monovalent oral vaccine for serotype 1 has been used to improve protective immunity to this specific serotype. In this case–control study of poliomyelitis in Nigeria, the estimated per-dose efficacies of monovalent and trivalent vaccine for serotype 1 were 67% and 16%, respectively. The estimated efficacy of trivalent vaccine for serotype 3 was 18%.

1675-1684

This large trial of methods used for the evaluation of screening mammograms compared the rate of detection of breast cancer achieved by the use of two readers for each mammogram with that of a single reader using computer-aided detection. The detection rates were virtually the same for both methods, but the recall rate was slightly but significantly higher for mammograms read by a single reader with computer-aided detection than for those read by two readers.

1685-1699

This study shows an association between a broad range of phenotypes and either deletion or duplication of a genomic segment at chromosome 1q21.1, suggesting a fundamental role of the deletion or duplication in early development and challenging the notion that a specific mutation disposes toward a specific disorder or syndrome.

Clinical Practice
1700-1707
  • Full Text Audio

A 53-year-old man, who is otherwise healthy and has a 20-year history of occasional heartburn, reports having had worsening heartburn for the past 12 months, with daily symptoms that disturb his sleep. He reports having had no dysphagia, gastrointestinal bleeding, or weight loss and in fact has recently gained 20 lb (9 kg). What would you advise regarding his evaluation and treatment?

Review Article
1708-1716

    Blunt aortic injury occurs after sudden deceleration, and it is second only to head injury as the leading cause of death after automobile crashes. Helical computed tomography of the thorax is more sensitive than angiography for detection. Although immediate operative repair was once the rule, endovascular repair is now an alternative for many patients, including those with multiple major injuries. The endovascular approach can improve survival as well as reduce the risk of paraplegia.

    Images in Clinical Medicine
    1717
    • Free Full Text

    A 45-year-old man presented with a kerotic nodule of the second right toe that had been increasing in size for 4 months. There was no history of trauma and no relevant medical history, and there was no family history of skin cancer. Examination revealed a ...

    e21
    • Free Full Text

    An otherwise healthy 46-year-old woman who was not taking any medications presented with anemia and gingival hypertrophy. The white-cell count was 10,300 per cubic millimeter, the hematocrit was 26%, and the platelet count was 81,000 per cubic millimeter.

    Case Records of the Massachusetts General Hospital
    1718-1724

    A 10.8-year-old girl was seen in the pediatric dermatology clinic because of recurrent oral ulcers and cutaneous bullae since 2 years of age. White lesions in the mouth and vesicles and bullae on the dorsal and plantar surfaces of the feet, the knees, and the hands that ulcerated and became painful occurred at intervals of 3 to 4 months, lasted 4 days to 2 weeks, and resolved without scarring. Biopsy of a lesion 2 years earlier was reported to show features of epidermolysis bullosa. A diagnostic procedure was performed.

    Editorials
    1726-1727

    The polio eradication campaign initiated in 1988 by the World Health Organization (WHO) led to an impressive decline in cases of paralytic poliomyelitis around the world. The eradication strategy involved highly organized mass immunization campaigns, ...

    1728-1730

    In this issue of the Journal, Mefford et al.1 describe an association between a microdeletion at 1q21.1 and a diverse range of impairments: mental retardation associated with microcephaly, cardiac abnormalities, or cataracts. A microdeletion at 16p11.2, ...

    Correspondence
    1731-1732

    To the Editor: In their article on desensitization during renal transplantation (July 17 issue), Vo et al.1 report very encouraging results of desensitization with a rather simple and short protocol that combines two doses of intravenous immune globulin ...

    1732-1734

    To the Editor: Brooke et al. (June 26 issue),1 report a reduced rate of aortic-root dilation among pediatric patients with Marfan's syndrome after treatment with angiotensin II–receptor blockers (ARBs) as compared with previous medical therapy alone. ...

    1734-1735
    • Free Full Text

    To the Editor: Lynch et al. (July 10 issue)1 report on a family in which members had multiple myeloma or other tumors. Using the Utah Population Database, a resource including 2.5 million persons with genealogic data linked to the Utah Surveillance, ...

    1735-1736

    To the Editor: The review of age-related macular degeneration by Jager et al. (June 12 issue)1 does not refer to an editorial accompanying the report of the Age-Related Eye Disease Study (AREDS) in the Archives of Ophthalmology in 2001 and two subsequent ...

    1736-1738

    To the Editor: In our recently reported prospective, randomized, international clinical trial comparing rabbit antithymocyte globulin and basiliximab in renal transplantation (ClinicalTrials.gov number, NCT00235300),1 we observed that induction treatment ...

    1738-1739

    To the Editor: Juweid et al. (September 18 issue)1 describe the administration of thyrotropin alfa (Thyrogen) to a patient with thyroid cancer who still has a thyroid gland. Genzyme, the manufacturer of Thyrogen, wants to point out that all regulatory ...

    Book Reviews
    1740-1741
    • Free Full Text

    Lawrence Henderson's simple equation, H+=K×HA/A−, which describes the dynamic equilibrium that occurs when weak acids are in solution, was a revolutionary breakthrough that changed forever the way clinicians evaluate and manage acid–base disorders. This ...

    1741

    Adolescent Health Care is a comprehensive book that will be of considerable value to clinicians working with teenagers and young adults. This useful book begins with a solid overview of general considerations that are required to adequately understand, ...

    1741-1742

    Headache, one of the most common disorders, is a considerable burden to the individual and to society. The word “comprehensive” in the title of this book may put off some readers, but the book is easy to read and covers all the main topics in headache ...