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December 11, 2008  Vol. 359 No. 24

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Perspective
2513-2515

In November, residents of the state of Washington voted 58% to 42% to allow physician-assisted suicide. Dr. Robert Steinbrook reports.

2515-2516

Prostate-cancer screening with the prostate-specific antigen (PSA) test remains one of the most controversial issues in modern medicine. Dr. Michael Barry discusses the revised recommendations from the U.S. Preventive Services Task Force regarding ...

2517-2519

Soon, the three major ICD manufacturers will introduce a new ICD technology: a novel four-pole connector. Drs. Robert Hauser and Adrian Almquist write that in their opinion, the decision by the FDA and industry to forgo premarket clinical testing of the ...

Original Articles
2521-2532

Plasmodium falciparum malaria is the cause of considerable morbidity and mortality worldwide; no effective vaccine is available. In this phase 2 randomized, double-blind study of 894 children in Kenya and Tanzania, the RTS,S malaria vaccine given with the AS01E adjuvant was found to have an adjusted rate of efficacy in preventing clinical malaria of 52.9%.

2533-2544

In this double-blind study of 340 infants in Tanzania, the candidate malaria vaccine RTS,S/AS02D was compared with the hepatitis B vaccine and coadministered with the standard infant vaccines. No safety concerns were identified, and the immune responses to the coadministered vaccine antigens (diphtheria, tetanus, pertussis, and Haemophilus influenzae type b) were noninferior.

2545-2557

In this open-label study of four regimens (chloroquine–sulfadoxine–pyrimethamine, artesunate–sulfadoxine–pyrimethamine, dihydroartemisinin–piperaquine, and artemether–lumefantrine) to treat children with malaria in Papua New Guinea, artemether–lumefantrine was found to be the most efficacious for treating falciparum malaria, and dihydroartemisinin–piperaquine the most efficacious for vivax malaria.

2558-2566
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This study genotyped children for an obesity-associated variant of the FTO gene and measured adiposity, energy expenditure, and food intake in a subsample. This variant does not appear to be involved in the regulation of energy expenditure but may play a role in the control of food intake and food choice.

2567-2578

This trial tested the influence of aspirin or resistant starch on the incidence of colorectal cancer or colonic adenomas in patients with the Lynch syndrome (hereditary nonpolyposis colon cancer). Neither intervention influenced the incidence of colorectal neoplasms in the Lynch syndrome.

Clinical Practice
2579-2585
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Fever developed in a previously healthy 15-year-old girl, with a peak temperature of 102°F (38.9°C) and mild upper respiratory congestion. Oseltamivir therapy was initiated, but the fever persisted, and she began to vomit. She was taken to an emergency room, where she was found to be hypotensive. Despite intensive resuscitative efforts, she died 12 hours later. A viral culture confirmed influenza A (H1N1) infection.

Images in Clinical Medicine
2586

A 58-year-old woman presented with a cavitating left breast lesion and increasing pain in the left arm. For over a year she had noticed an enlarging breast mass but did not seek medical advice. Imaging showed metastatic disease in the chest and brain. ...

e30
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A healthy 35-year-old man presented with small eggs and a brownish lesion on the medial edge of his right big toe. Two weeks before, he had been on a trip to Brazil.

Case Records of the Massachusetts General Hospital
2587-2597

A 58-year-old man was admitted to this hospital because of hepatitis C infection, hepatocellular carcinoma, and recurrent bleeding. Hemophilia had caused multiple hemarthroses, for which he had received blood products since infancy. Hepatocellular carcinoma was detected 8 months before admission; attempts at radiofrequency ablation had been complicated by hemorrhage and the failure to correct coagulation-test results with factor VIII. A surgical procedure was performed.

Editorials
2599-2601
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An effective human malaria vaccine has been sought for over 70 years, with little success.1 A successful malaria vaccine used in conjunction with other control interventions would help reduce and eventually eliminate the considerable global disease burden ...

2601-2603

Wellems and Miller1 wrote of two worlds of malaria: one, of the residents of rural tropical areas in which the disease is endemic, and the other, of travelers to those areas, who typically have greater resources. The distinction is sharp, valid, and ...

2603-2604

More than 100 genes have been implicated in the determination of body weight. These genes, acting primarily in or through the central nervous system (primarily the hypothalamus and brain stem), affect conscious and unconscious aspects of food intake and ...

Clinical Decisions
2605-2609

This interactive Journal feature presents the case of a 63-year-old man with a normal digital rectal examination but a prostate-specific antigen level that has been increasing over a 3-year period. Three possible treatment options, any of which could be considered correct, are presented.

Correspondence
2610

To the Editor: In their Perspective article in this issue of the Journal, Hauser and Almquist1 discuss issues involved in the testing of implantable cardioverter–defibrillators (ICDs). The authors contend that “the decision by the FDA [Food and Drug ...

2611-2612

To the Editor: The rate of 1.3% for advanced adenoma detected approximately 5 years after a negative colonoscopy, is indeed low, as Imperiale et al. report (Sept. 18 issue).1 The rate for detection of any adenoma was 16.0%. What is striking is the low ...

2613-2614

To the Editor: San Miguel et al. (Aug. 28 issue)1 state that the standard treatment for patients with multiple myeloma who are not candidates for high-dose therapy is melphalan and prednisone. In the light of recent studies,2,3 we do not think this ...

2615

To the Editor: Contrary to the statement by Kim et al. (Sept. 4 issue)1 in their article on the prognostic effect of hyponatremia on the survival of patients on the liver-transplant waiting list, organ allocation should not be decided solely on the basis ...

2615-2617

To the Editor: Karim et al. (Sept. 11 issue)1 report on three nonsynonymous nucleotide changes in NHERF1 (also called SLC9A3R1) — at p.L110V, p.R153Q, and p.E225K — which were found in 4 of 92 unrelated patients with nephrolithiasis or osteopenia. The ...

2617-2618

This case demonstrates the potential for using whole-ovary transplantation between monozygotic twins who are discordant for premature ovarian failure, in order to restore fertility in the affected twin.

2619-2620

To the Editor: Although artemisinins are potent and rapidly acting antimalarial drugs, their widespread use for treating patients with Plasmodium falciparum malaria raises the question of emerging drug resistance.1,2 Artemisinin monotherapy should not be ...

Book Reviews
2621-2622

This slim book contains 134 pages of text and 57 pages of notes and bibliographic references. Many of the references will not be readily available to most readers. The work is not a comprehensive intellectual history of the science of multiple sclerosis. ...

2622

This book is about the great drug discoveries that were made by the legendary Albert Sjoerdsma and his team beginning in the 1950s. The first discoveries were made at the Experimental Therapeutics Branch of the National Heart Institute in Bethesda, ...

2622-2623

The focus of this book is not limited to sleep difficulties in children and adolescents with psychiatric disorders. About half of the 28 chapters deal with such problems as autism, anxiety disorders, and attention deficit–hyperactivity disorder (ADHD); ...