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December 4, 2008  Vol. 359 No. 23

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Perspective
2409-2412

As baby boomers enter their 60s, their increasing medical needs and a worsening shortage of primary care doctors are expected to fuel a crisis in health care for the elderly. Dr. Susan Okie reports that meeting their medical needs will most likely require ...

2412-2415

Drs. Ingrid Katz and Alexi Wright report that, in a radical departure from earlier strategies, public health officials are now arguing that circumcision of men should be a key weapon in the fight against infection with HIV in Africa. Skeptics argue that ...

Original Articles
2417-2428

The optimal combination drug therapy for treatment of hypertension is not established, although current U.S. guidelines recommend inclusion of a diuretic. This double-blind trial, in which high-risk patients with hypertension were randomly assigned to treatment with benazepril plus either amlodipine or hydrochlorothiazide, showed that benazepril plus amlodipine was superior to benazepril plus hydrochlorothiazide in reducing cardiovascular events in this population.

2429-2441

Patients with chronic hepatitis C who did not have a sustained viral response to peginterferon and ribavirin were randomly assigned to receive low-dose peginterferon or no treatment for 3.5 years. The clinical and histologic outcomes were not better in patients treated with peginterferon. These findings do not support the use of long-term peginterferon in patients who do not have a sustained virologic response to initial therapy.

2442-2455

In this randomized comparison of treatment with tenofovir disoproxil fumarate or adefovir dipivoxil for 48 weeks in patients with chronic hepatitis B, tenofovir was more likely to result in viral suppression. The follow-up period was not long enough to assess the resistance patterns, risks, and benefits of long-term treatment.

2456-2467

In a multicenter trial, 4128 patients who had heart failure with a preserved ejection fraction were randomly assigned to receive irbesartan or placebo and were followed for a mean of 49.5 months. There were no significant differences between the two study groups in the rate of the primary outcome (death or hospitalization for heart failure).

Clinical Therapeutics
2468-2476

A 62-year-old man presents with Parkinson's disease, and treatment with levodopa is recommended. Levodopa, a naturally occurring amino acid that is metabolized to dopamine in the brain, is considered the most effective drug available for Parkinson's disease. However, after several years of therapy, serious side effects, including motor fluctuations and dyskinesias, may occur.

Images in Clinical Medicine
2477
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A 56-year-old woman presented to the emergency department with a 3-day history of severe pain in and loss of movement of her right index finger. She reported that for the previous 2 months, she had noted a small, tender lump, with no progression in size, ...

e29
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A 26-year-old man with a history of chronic alcohol abuse presented with dysarthria, lethargy, and horizontal nystagmus. Results of a clinical examination and blood tests were otherwise normal. Spastic quadriparesis developed.

Clinical Problem-Solving
2478-2482

    A 25-year-old woman with a history of depression, mitral-valve prolapse, and migraine headaches presented to a hospital emergency department with a 3-day history of subjective fever, diffuse arthralgia, and a severe generalized headache that was not characteristic of her previous migraines.

    Editorials
    2484-2485
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    In the November elections, the citizens of three states resoundingly defeated initiatives aimed at curtailing reproductive rights. In Colorado, a proposed amendment to the state's Constitution would have given the same legal rights to fertilized eggs as ...

    2485-2488

    Hypertension is one of the most important risk factors for cardiovascular and renal diseases. Currently, approximately 73 million adults in the United States and approximately 1 billion adults worldwide have hypertension, and the prevalence is increasing....

    2488-2491
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    The hepatitis B virus (HBV) causes chronic infection in approximately 400 million people in the world. Most carriers of chronic HBV, including Asians, Africans, and a proportion of persons in Mediterranean countries, acquire the infection at birth or ...

    Clinical Implications of Basic Research
    2492-2494

    A direct effect on the podocyte, rather than on the lymphocyte, may underlie the therapeutic effect of cyclosporine in some nephropathies.

    Correspondence
    2495-2497

    To the Editor: Lovell et al. (Aug. 21 issue)1 report that adalimumab seems to be effective in the treatment of children with juvenile rheumatoid arthritis. However, interpretation of their results is difficult, given the medication-withdrawal design of ...

    2497-2499

    To the Editor: Llovet et al. (July 24 issue)1 report that their study of sorafenib therapy in patients with hepatocellular carcinoma showed a higher overall incidence of treatment-related adverse events with sorafenib than with placebo (80% vs. 52%), ...

    2499-2500

    To the Editor: With regard to the article on the initial management of epilepsy, by French and Pedley (July 10 issue),1 there are about 1 million women of reproductive age who have epilepsy in the United States. Guidelines recommend highly effective ...

    2501

    To the Editor: In the Case Record of a 64-year-old man with abdominal pain and an elevated level of serum creatinine (Aug. 28 issue),1 a kidney-biopsy specimen revealed findings that were diagnostic of acute phosphate nephropathy. Severe abdominal pain ...

    2501-2502

    To the Editor: Clatworthy et al. (Aug. 14 issue)1 report on two patients (one with multiple sclerosis and the other with antineutrophil cytoplasmic antibody–associated vasculitis) in whom anti–glomerular basement membrane nephritis developed after ...

    2502-2504

    To the Editor: There have been few reports of osteosarcoma after allogeneic bone marrow transplantation.1 We report the development of osteosarcoma in a recipient 17 years after stem-cell transplantation.

    A 23-month-old boy with β-thalassemia received a ...

    Book Reviews
    2505
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    Lung cancer is the leading cause of cancer-related deaths in North America, with an estimated 213,380 new cases and 160,390 deaths anticipated in 2008. Since the publication of the previous edition of Lung Cancer 10 years ago, there have been important ...

    2505-2506

    In 1969, the young surgeon Judah Folkman made a clinical observation that elevated the study of angiogenesis to a scientific discipline and led to new therapies for cancer, eye diseases, and chronic wounds, as well as therapies that are still under ...

    2506-2507

    Approximately 10% of men are affected by the enigmatic condition known as chronic prostatitis–chronic pelvic pain syndrome. Traditionally, the prostate has been implicated, but emerging evidence implicates other organs and sites within the pelvis that can ...

    2507-2508

    William Carlos Williams (1883–1963) was a pediatrician who made house calls from Rutherford to Paterson, New Jersey. Despite the daily grind of working as a physician, he was posthumously awarded the Pulitzer Prize for his poetry.

    Williams received his ...