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July 10, 2008  Vol. 359 No. 2

Audio Summary of this Issue

Perspective
113-115

Today, treatment of mental disorders is increasingly part of the medical mainstream. But Sherry Glied and Richard Frank write that some glaring exceptions remain.

115-117

Dr. Robert Steinbrook writes that the prescription pad, as familiar a medical emblem as the stethoscope or the white coat, is on its way to becoming a historical curiosity.

Original Articles
119-129

The prevention of mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) during breast-feeding is a unique opportunity to curtail the AIDS epidemic. In this trial in Malawi, 3016 infants without HIV-1 infection who were born to infected mothers were randomly assigned to receive a single dose of nevirapine plus 1 week of zidovudine (control regimen) or the control regimen plus extended daily prophylaxis with nevirapine or with nevirapine plus zidovudine until the age of 14 weeks. Extended prophylaxis significantly decreased the rate of HIV-1 transmission (10.6%, 5.2%, and 6.4%, respectively) at 9 months.

130-141

Minimizing the risk of maternal-to-child transmission of the human immunodeficiency virus (HIV) is a high priority. In this trial in Zambia, 958 HIV-infected women were randomly assigned to breast-feeding according to the standard practice or to abrupt weaning at 4 months. There was no significant difference in HIV-free survival between the study groups at 24 months.

142-151

Noninvasive ventilation (either continuous positive airway pressure or noninvasive intermittent positive-pressure ventilation) had no effect on 7-day or 30-day mortality in patients with cardiogenic pulmonary edema, as compared with standard oxygen therapy. Noninvasive ventilation should be used only to relieve symptoms and correct metabolic disturbances.

152-157
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This report describes three generations of a family that included five cases of multiple myeloma, three cases of monoclonal gammopathy of undetermined significance (MGUS), and five cases of prostate cancer. The putative progenitor had progeny with prostate cancer, multiple myeloma, and MGUS with two female partners.

158-165

In a family with hereditary atrial fibrillation, linkage analysis and candidate-gene sequencing identified a frameshift mutation in the atrial natriuretic peptide gene. This mutation segregated with atrial fibrillation in the family and generated a fusion protein that was detected by radioimmunoassay in the plasma of affected family members. The mutant protein caused shortening of the atrial monophasic action potential and the effective refractory period in isolated perfused hearts.

Clinical Practice
166-176
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A 29-year-old woman reports that the previous evening, her husband (who was in the next room) heard unusual sounds and found her lying on the bed looking dazed. She was confused for a few minutes but quickly returned to normal. She recalls an unwitnessed event about 1 month previously when she awoke feeling mildly confused and had sore muscles. How should she be evaluated and treated?

Images in Clinical Medicine
177
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A 34-year-old woman underwent renal transplantation for chronic idiopathic glomerulonephritis, and 4 years later small verrucae developed on her distal fingertips. Over the course of 11 years after transplantation, during which time she was on a stable ...

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This 24-year-old man had a family history of aortic disease. The triad of craniofacial abnormalities, aortic aneurysm, and bifid uvula suggested a diagnosis of Loeys–Dietz syndrome.

Case Records of the Massachusetts General Hospital
178-187

    An 11-month-old boy was admitted to this hospital after returning from a trip to India, during which fever and pulmonary infiltrates had developed and had recurred despite treatment with broad-spectrum antimicrobial therapy. On admission, the patient had fever and an erythematous nodule on his right forearm. Imaging studies disclosed bilateral nodular pulmonary infiltrates with calcification. Diagnostic tests were performed.

    Editorial
    189-191
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    More than 200,000 of the 500,000 new human immunodeficiency virus (HIV) infections that occur each year in children are the result of transmission of the virus through the mother's breast milk.1 In resource-constrained environments, how do we continue to ...

    Health Law, Ethics, and Human Rights
    192-199

    Many health plans and employers offer wellness programs and incentives for participation. In this article, the authors examine the legal issues employers and health plans must consider as they develop programs to reward healthy behaviors and discourage unhealthy ones.

    Correspondence
    200-202

    To the Editor: The quality of life is an important consideration in treatment for prostate cancer. The study by Sanda et al. (March 20 issue)1 provides valuable information regarding this aspect of treatment. Unfortunately, the abstract highlights two of ...

    202-204

    To the Editor: In their report on coronary calcium and coronary events in four ethnic groups, Detrano et al. (March 27 issue)1 grouped persons by ethnicity but did not provide any proof that these persons were ethnically similar or offer an operational ...

    205-207

    To the Editor: The article by Eremina et al. (March 13 issue)1 suggests that the survival of glomerular endothelial cells depends on vascular endothelial growth factor (VEGF) from podocytes. The authors propose that VEGF might be transported across the ...

    207-209

    To the Editor: We would like to make two points about the case of disseminated cryptococcosis in a liver-transplant recipient, discussed in the Case Records by Fishman et al. (April 10 issue).1 The first point concerns delayed diagnosis of this infection ...

    209-210

    To the Editor: In their Sounding Board article on shifts in health information, Mandl and Kohane (April 17 issue)1 observe that “companies providing PCHRs [personally controlled health records] are not covered entities under the Health Insurance ...

    210-212

    To the Editor: Two years ago, we reported that the incorporation of thalidomide into high-dose therapy for myeloma increased the frequency of complete remission but not the duration of remission and extended event-free survival but not overall survival.1 ...

    Book Reviews
    213-214

    The relentless “scientification” of medical training during the past century has laudably taken medicine far from its roots in hucksterism. Each generation of physicians is steeped in an ever-expanding universe of medical facts. Evidence-based medicine, ...

    214-215

    Aristotle famously asked, “Why is it that all men who have become outstanding in philosophy, statesmanship, poetry, and the arts are melancholic?” The question persists today, as investigators in the humanities and the health sciences attempt to ...

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