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November 6, 2008  Vol. 359 No. 19

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Perspective
1977-1981

Britain's National Institute for Health and Clinical Excellence, known as NICE, is an independent, government-funded organization that advises the British National Health Service. Dr. Robert Steinbrook writes that NICE can be viewed as either a heartless ...

1981-1983

A new federal program will give the sponsor of a drug for a tropical disease a “voucher” entitling the company to expedited FDA review of a new drug application for any other product it makes. Dr. Aaron Kesselheim writes that as enacted, however, priority-...

Original Articles
1985-1994

A locus on chromosome 17 has previously been shown to be associated with susceptibility to asthma. This study shows that the association is specific to early-onset asthma (occurring at the age of 4 years or younger) in those exposed to environmental tobacco smoke in early life. The study implicates markers regulating at least two genes — ORMDL3 and GSDML — in determining susceptibility.

1995-2004

The authors have established a method for the analysis of gene expression in tissue specimens preserved in formaldehyde. The expression profile of tissue adjacent to primary hepatocellular carcinoma, rather than the cancer itself, is associated with late recurrence. This finding, together with other data, suggests that the late recurrences are actually second primary tumors.

2005-2017

In this double-blind, placebo-controlled, 52-week trial among postmenopausal women not receiving estrogen therapy, treatment with a patch delivering 300 μg of testosterone per day resulted in a significant although modest increase in the 4-week frequency of satisfying sexual episodes (1.4 more episodes per month), but the women were also subject to more adverse events, including androgenic side effects.

Clinical Therapeutics
2018-2024

    A 57-year-old man presents to his primary care provider because he would like to quit smoking. A trial of varenicline, a partial agonist of the nicotinic acetylcholine receptor that has been shown to increase rates of smoking abstinence as compared with placebo, is recommended. In light of reports of neuropsychiatric side effects, including suicidal behavior, patients treated with varenicline should be closely monitored for behavioral symptoms.

    Review Article
    2025-2033

    The incidence of venous thromboembolic disease increases by a factor of four with pregnancy, and in developed countries pulmonary embolus is the leading cause of maternal death. This review provides guidance on the diagnosis and management of thromboembolic disease in pregnant women, including guidelines for the prophylactic use of anticoagulant agents in women at high risk during pregnancy and the puerperium.

    Images in Clinical Medicine
    2034
    • Free Full Text

    A 40-year-old man presented with a 3-day history of increasing abdominal pain. On physical examination, rebound tenderness was present, and both hip joints were fixed in flexion state with no range of motion. Plain abdominal radiography showed ileus, as ...

    e23
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    This 81-year-old man presented with gradual, painless swelling of both eyes. He reported blurred vision and weight loss of 10 kg.

    Clinical Problem-Solving
    2035-2041

      A 20-year-old man presented to the emergency department after a syncopal episode. During the previous 2 weeks, he had had persistent low-grade fever, anorexia, rhinorrhea, and headache. On the morning of admission, he felt weak and then collapsed while walking into a room; he had no other antecedent symptoms.

      Editorials
      2043-2045

      It has long been established that many common diseases are the result of interactions between genetic susceptibility and environmental exposure. The identification of genetic variants that underlie susceptibility to diseases and alter the expression or ...

      2045-2047

      Although the treatment of hepatocellular carcinoma is evolving, hepatic resection remains the treatment of choice for many patients. Resection is associated with a 5-year survival rate of 50% but also a 70% recurrence rate.13 Thus, for most patients, ...

      2047-2049

      Decreased or low sexual desire is commonly reported by women from late adolescence through the seventh decade across a number of cultures. Estimates of prevalence range from 25 to 53%.13 Low desire is not always a “problem” causing distress for women,4,5 ...

      Special Report
      2050-2061

      Voters view health care as an important issue in the 2008 U.S. presidential election. Most voters favor major changes in our health care system. Registered voters who planned to vote for Senator Obama placed higher priority on increasing coverage for the uninsured, and Senator McCain's supporters gave higher priority to health care reforms that would not raise taxes.

      Clinical Implications of Basic Research
      2062-2064

      A mouse model of chronic obstructive airway disease suggests that viral infection leads to changes in the airways seen in human asthma and chronic obstructive pulmonary disease by activating invariant natural killer cells.

      Correspondence
      2065-2066

      To the Editor: The key issue regarding monoclonal B-cell lymphocytosis (MBL) and early chronic lymphocytic leukemia (CLL) is whether there is a fundamental biologic difference that influences the risk of progression and clinical management. Rawstron et ...

      2066-2068

      To the Editor: The results of the trial of cellulose sulfate as a vaginal gel for the prevention of human immunodeficiency virus (HIV) infection, reported by Van Damme et al. (July 31 issue),1 indicated that cellulose sulfate did not prevent sexual ...

      2068-2069

      To the Editor: Gray et al. (July 10 issue)1 report that the Three Interventions in Cardiogenic Pulmonary Oedema (3CPO) trial showed no benefit from noninvasive ventilation for reducing the intubation rate or short-term mortality. These findings are of ...

      2070

      To the Editor: Pell et al. (July 31 issue)1 report that smoke-free legislation in Scotland was strongly associated with a decreased risk of the acute coronary syndrome. Nested within their study is a critical and remarkable observation: smokers are also ...

      2070-2071

      To the Editor: In 1998, Mark Berlind, chief legislative counsel of Philip Morris, drafted specifications for regulation of tobacco products by the Food and Drug Administration (FDA) that would ensure the continuing profitability of the Marlboro brand, ...

      2071-2073

      To the Editor: Recognition of characteristic changes in an electrocardiogram (ECG) that are associated with acute occlusion of a coronary artery guides decisions regarding immediate reperfusion therapy.13 Working from our primary database of ...

      Book Reviews
      2074

      In the developed world, the Internet has become a given, and it is changing how people communicate, think, and understand the world. It is certainly changing medical practice. Patients consult Web sites before seeing physicians, and subsequent visits to ...

      2074-2076

      Psychotherapists endeavor to help people bear the burdens of their lives and become more fulfilled in their relationships and societal roles. Modern approaches to psychotherapy take many forms and use many different techniques, ranging from motivational ...

      2076-2077

      The authors of this book state in their introduction: “Our mission is to reveal the truth about the potions, lotions, pills, needles, pummeling and energizing that lie beyond the realms of conventional medicine.” Their goal is to answer the question of ...

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