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Table of contents for

August 7, 2008  Vol. 359 No. 6

Audio Summary of this Issue

Perspective
553-555
The President's Emergency Plan for AIDS Relief — Is the Emergency Over?
W.M. El-Sadr and D. Hoos
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On July 16, the Senate approved legislation that would increase the funding for the President's Emergency Plan for AIDS Relief (PEPFAR) to $48 billion for the next 5 years. Drs. Wafaa El-Sadr and David Hoos examine PEPFAR's achievements, limitations, and ...

556-558
Medicare Showdown
J.K. Iglehart
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In a stunning rebuke of President George W. Bush, the House and Senate voted July 15 in a strong bipartisan fashion to override his veto, erasing a scheduled reduction of 10.6% in the fees that Medicare pays physicians. John Iglehart reports.

559-561
Disclosure of Industry Payments to Physicians
R. Steinbrook

    Within the next several years, the manufacturers of drugs, medical devices, and medical supplies that are paid for by Medicare, Medicaid, or the State Children's Health Insurance Program may be required to report publicly many of these gifts and payments; ...

    Original Articles
    563-574
    Comprehensive Treatment of Extensively Drug-Resistant Tuberculosis
    C.D. Mitnick and Others
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    Important questions exist regarding the ability to treat extensively drug-resistant tuberculosis. In this study involving 48 patients in Peru who had extensively drug-resistant tuberculosis but were not infected with the human immunodeficiency virus, treatment with a structured, comprehensive, community-based approach and aggressive antituberculosis medications (an average of five or six medications per patient) achieved a cure in 29 patients (60%).

    575-583
    Monoclonal B-Cell Lymphocytosis and Chronic Lymphocytic Leukemia
    A.C. Rawstron and Others
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    Small numbers of monoclonal B cells with the phenotype of chronic lymphocytic leukemia (CLL) were detected by means of high-sensitivity flow cytometry in about 5% of adults with a normal blood count and about 14% of subjects with lymphocytosis. In the latter group, frank CLL ultimately developed in 15%. The principal features of these monoclonal B cells and the B cells of CLL were similar.

    584-592
    Fibroblast Growth Factor 23 and Mortality among Patients Undergoing Hemodialysis
    O.M. Gutiérrez and Others
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    This study involving patients in whom hemodialysis was being initiated shows that increased levels of fibroblast growth factor 23 (FGF-23), a hormone that enhances the renal excretion of phosphate, appear to be independently associated with mortality. Whether FGF-23 is a potential biomarker that could guide strategies to reduce phosphorus levels in patients with chronic kidney disease remains to be established.

    593-602
    Brief Report: HHV-6A in Syncytial Giant-Cell Hepatitis
    L. Potenza and Others
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    Syncytial giant-cell hepatitis is a rare, severe form of hepatitis. Human herpesvirus 6A (HHV-6A) from a liver donor was found to be the cause of disease in the organ recipient.

    Clinical Practice
    603-612
    Malaria Prevention in Short-Term Travelers
    D.O. Freedman
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    A family is planning a safari that includes 3 days in Cape Town, 3 days in Kruger National Park, South Africa, and 3 days in Victoria Falls, Zambia. The 31-year-old husband takes no medications, but recently he discontinued fluoxetine for depression. His 29-year-old wife is healthy and 15 weeks pregnant. Their 7-year-old child is in good health. How should the risk and prevention of malaria be managed in this family?

    Review Article
    613-626
    Drug Therapy: Monoclonal Antibody Therapy for B-Cell Non-Hodgkin's Lymphoma
    B.D. Cheson and J.P. Leonard

      Treatment of B-cell non-Hodgkin's lymphoma has become more successful, largely owing to the availability of therapeutic monoclonal antibodies, which may avoid the toxic effects of chemotherapy, improve the outcomes when combined with chemotherapy, and provide options for patients with refractory disease. This article reviews the current uses of monoclonal antibodies in B-cell non-Hodgkin's lymphoma.

      Images in Clinical Medicine
      627
      Allergic Contact Dermatitis from a Henna Tattoo
      C.C. Evans and J.D. Fleming
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      A 19-year-old otherwise healthy Kuwaiti woman presented 8 days after the brush application of a temporary henna tattoo while in Kuwait for a wedding. Burning and itching at the site of application began 6 days after the application, indicating that the ...

      e7
      Allergic Bronchopulmonary Aspergillosis
      T.-h. Chen and H. Hollingsworth
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      This 26-year-old man who had a long history of poorly controlled asthma was admitted for an exacerbation. His IgE level was 21,494 IU per milliliter.

      Clinical Problem-Solving
      628-634
      Beware of First Impressions
      O.O. Falade, E.S. Antonarakis, D.R. Kaul, S. Saint, and P.A. Murphy

        A 64-year-old Filipino man presented to a Baltimore hospital with a 4-month history of worsening midback pain, progressive leg weakness, and intermittent bladder and bowel incontinence. He had no fever or pulmonary symptoms.

        Editorials
        636-638
        Facing Extensively Drug-Resistant Tuberculosis — A Hope and a Challenge
        M.C. Raviglione
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        As of June 2008, a total of 49 countries worldwide reported to the World Health Organization (WHO) at least one case of extensively drug-resistant tuberculosis. Since its first description in March 2006,1 this disease has become the most alarming issue in ...

        638-640
        Monoclonal B-Cell Lymphocytosis — A Frequent Premalignant Condition
        G. Dighiero

          Chronic lymphocytic leukemia (CLL), a lymphoproliferative disorder of B cells, is the commonest form of leukemia in Western countries, with an incidence of 6 cases per 100,000 persons in North America1; since most cases are discovered through an ...

          640-642
          FGF-23 and Outcomes Research — When Physiology Meets Epidemiology
          C.-y. Hsu

            In this issue of the Journal, Gutiérrez and colleagues report the results of a study, conducted with an efficient nested case–cohort design, that showed that among patients who were beginning hemodialysis treatment, higher serum levels of fibroblast ...

            Health Policy Report
            643-650
            Medicare, Graduate Medical Education, and New Policy Directions
            J.K. Iglehart
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            In the context of the concerns of many experts about a looming shortage of physicians, the author discusses policy proposals to increase federal support for graduate medical education and to expand the supply of primary care physicians.

            Correspondence
            651-653
            Cytogenetically Normal Acute Myeloid Leukemia
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            To the Editor: Schlenk and colleagues (May 1 issue)1 found that patients who have cytogenetically normal acute myeloid leukemia (AML) with a genotype other than mutant NPM1 (nucleophosmin gene) without FLT3-ITDs (fms-related tyrosine kinase 3 gene ...

            653-654
            MicroRNA in Acute Myeloid Leukemia
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            To the Editor: Marcucci et al. (May 1 issue)1 highlight a possible association between the microRNA-181 family and innate-immunity genes. Of the 452 genes that correlated strongly with their microRNA summary value, 32 were predicted to be targets of the ...

            654-655
            Mumps in the United States
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            To the Editor: The article by Dayan et al. (April 10 issue)1 on the resurgence of mumps in 2006 raises a number of issues. First, the resurgence may be partly explained by the switch in 1992 in the United States from the Urabe vaccine strain to the Jeryl ...

            655-656
            Vaccines and Autism Revisited
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            To the Editor: In his Perspective article on a possible connection between vaccines and autism, Offit (May 15 issue)1 speculates about my daughter, Hannah, and repeats inaccuracies from a March New York Times opinion piece that was officially corrected ...

            656-657
            More on Microembolism and Foam Sclerotherapy
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            To the Editor: Ceulen et al. (April 3 issue)1 found intracardiac gas emboli in all patients treated with polidocanol foam (air-to-liquid ratio, 4:1), noting the potential for microembolism. We corroborate this observation in a series of 45 patients ...

            657
            Retraction: Gong Z et al. Injuries after a Typhoon in China. N Engl J Med 2007;356:196-7.
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            To the Editor: I request that our letter to the editor, “Injuries after a Typhoon in China,”1 be retracted because much of it was previously published in Chinese journals.2,3

            657-659
            Treatment Outcomes in Extensively Resistant Tuberculosis
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            The authors retrospectively analyzed 205 cases of multidrug-resistant tuberculosis to determine what percentage met the definition of extensively drug-resistant tuberculosis and compared the treatment outcomes. Odds ratios for treatment success in the ...

            Book Review
            660-661
            Human Dignity and Bioethics: Essays Commissioned by the President's Council on Bioethics
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            In 2001, President George W. Bush established the President's Council on Bioethics and appointed Leon Kass as its chair. Under Kass's direction, the council issued reports on caregiving, stem-cell research, cloning, assisted reproduction, and biomedical ...

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