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January 8, 2009  Vol. 360 No. 2

Audio Summary of this Issue

Perspective
101-103

    Drs. Pamela Hartzband and Jerome Groopman argue that assigning a monetary value to every aspect of a physician's time and effort may actually reduce productivity, impair the quality of performance, and thereby even increase costs.

    103-106

    Recently, lawsuits alleging damages from illegal marketing of gabapentin (Neurontin) have yielded remarkable discoveries about the structure and function of pharmaceutical marketing. Drs. Seth Landefeld and Michael Steinman write that Neurontin's most ...

    106-109
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    Schistosomiasis remains one of the world's most prevalent diseases. Dr. Charles King discusses how we can break the cycle of transmission.

    Original Articles
    111-120

    Among a large cohort of women with viable singleton pregnancies who underwent elective repeat cesarean sections, more than a third of deliveries were performed before 39 weeks of gestation. As compared with deliveries at or after 39 weeks, deliveries before 39 weeks of gestation — even those during the last 3 days before week 39 — were associated with an increased risk of a composite primary outcome that included neonatal death, respiratory complications, need for mechanical ventilation, treated hypoglycemia, newborn sepsis, and admission to the neonatal intensive care unit.

    121-128

    Schistosoma japonicum has been successfully controlled in villages along Poyang Lake, the largest freshwater lake in China. In addition to synchronous chemotherapy for humans and cattle, successful interventions have included the removal of cattle from snail-infested grasslands, improvements in sanitation, and intensive health education. The use of such interventions has now been adopted as the national control strategy for China.

    129-139

    In this study, 1791 military veterans with poorly controlled type 2 diabetes were randomly assigned to receive either standard or intensive glucose control. Other cardiovascular risk factors were treated uniformly. The glycated hemoglobin goal was an absolute reduction of 1.5 percentage points in the intensive-therapy group. There was no significant difference between the two groups for the rates of major cardiovascular events, death, or microvascular complications.

    140-149

    Ambient oxygen tension falls with decreasing barometric pressure, limiting the ability of oxygen to diffuse into the blood. In this field study, the authors measured arterial oxygen tension in climbers on their ascent to and descent from the peak of Mount Everest. The oxygen tensions recorded are quite low and indicate that humans can function, when acclimatized, in environments with very low ambient oxygen tension.

    Special Article
    150-159
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    In this large, prospective cohort study of Chinese adults in 2005, tobacco smoking was associated with increased mortality. The authors estimate that 673,000 deaths in China in 2005 were caused by smoking. The leading causes of smoking-related deaths were cancer, cardiovascular disease, and respiratory diseases.

    Clinical Practice
    160-169
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    A healthy 25-year-old brunette woman reports a 12-month history of skin depigmentation. She first noticed patches of skin whitening on her hips, followed by additional depigmented patches on her elbows, shins, upper eyelids, and lower chin. A dermatologist recently made a diagnosis of vitiligo and recommended a sunscreen but offered little hope for treatment. How should she be evaluated and treated?

    Images in Clinical Medicine
    170
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    A 34-year-old woman with seven previous cesarean deliveries and a history of scant prenatal care presented at 32 weeks' gestation with constant, vague lower abdominal pain that had worsened over the past day. Her vital signs were normal, and the ...

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    This 30-year-old man with epilepsy presented with firm, polypoid, erythematous nodules on the upper and lower gingivae. He had been taking phenytoin for more than 20 years.

    Case Records of the Massachusetts General Hospital
    171-181

      A 57-year-old man was transferred to this hospital because of progressive cognitive decline. Before admission, he had a generalized seizure, after which he was confused, incoherent, and intermittently agitated; he was admitted to another hospital and transferred 5 days later. His wife reported that he had had episodes of confusion for the past 5 years and worsening memory loss and performance problems for the preceding 2 months. He had a history of cutaneous melanoma, alcohol and drug abuse, and occupational exposure to organic solvents. Magnetic resonance imaging of the brain revealed diffuse signal abnormalities in the white matter. A diagnostic procedure was performed.

      Editorial
      183-184

      Cesarean sections performed without antecedent labor are associated with a higher risk of respiratory distress than those performed after the onset of labor, despite the fact that they may have been done at full term (at least 37 weeks of gestation).1 ...

      Correspondence
      185-187

      To the Editor: The Understanding Potential Long-Term Impacts on Function with Tiotropium (UPLIFT) study by Tashkin et al. (Oct. 9 issue)1 was expected to provide data on the effectiveness and safety of tiotropium in 5993 patients with chronic obstructive ...

      187-189

      To the Editor: Mark et al. (Sept. 4 issue)1 report data on quality of life from the well-designed Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). These data call for a repeat cost-effectiveness analysis of the use of implantable cardioverter–...

      189-190

      To the Editor: In their article on the use of magnesium sulfate before preterm birth to prevent cerebral palsy, Rouse et al. (Aug. 28 issue)1 refer to a study, the Magnesium and Neurologic Endpoints Trial (MagNET), a cerebral-palsy prevention study we ...

      190-192

      To the Editor: The Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group (Oct. 2 issue)1 concluded that “continuous glucose monitoring can be associated with improved glycemic control in adults with type 1 diabetes.” The authors ...

      192-193

      To the Editor: In their review of monoclonal antibody therapy for B-cell non-Hodgkin's lymphoma (Aug. 7 issue),1 Cheson and Leonard did not mention a potential cause of resistance to this treatment. Statins, by depleting cholesterol in the cell membrane, ...

      194-195

      To the Editor: Infantile Pompe's disease is due to a deficiency of lysosomal acid alpha glucosidase (GAA). In patients in whom GAA is not produced, a status called cross-reacting immunologic material (CRIM)–negative, enzyme-replacement therapy with ...

      195-197

      To the Editor: Management of refractory hypoglycemia due to malignant insulinoma is challenging. Currently available treatments include dietary modification, diazoxide, and, in patients with resistant disease, the use of intravenous dextrose infusion or ...

      Book Reviews
      198-199

      This concise, lively, and sometimes humorous history will interest women and men of all ages. Author Toni Martin includes the experiences of herself and four others in her book — all from the class of 1977 of the medical school of the University of ...

      199-200
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      Asperger's Disorder is a fascinating compilation of scientific papers that concern a condition about which few people know anything. The book is a page turner — I could hardly put it down. The case histories could have been written by Sigmund Freud or ...

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