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January 15, 2009  Vol. 360 No. 3

Audio Summary of this Issue

Perspective
205-207

Recognizing the blunders that doomed the reform effort of President Bill Clinton 16 years ago, the new administration is working closely with Congress to craft a bill that will attract sufficient support to ensure enactment. John Iglehart reports.

208-209

Victor Fuchs writes that, in pursuing comprehensive health care reform, President-elect Obama should be aware of four major reasons why, in the past, we heard so much talk and saw so little action.

209-211

Dr. Perri Klass discusses the moments when doctors give — or think of giving — money to patients. Klass asks, if sending someone out of the office with a $20 bill will well and truly meet some small immediate need, what do you do?

Original Articles
213-224

Fractional flow reserve (FFR) is a measure of the functional significance of a coronary stenosis. In this study, the use of FFR, as compared with angiography alone, in guiding the placement of coronary stents resulted in the use of fewer stents and better clinical outcomes.

225-235
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It is known that the use of typical antipsychotic agents (e.g., haloperidol) is associated with an increased risk of sudden cardiac death. This study shows that the same association applies to the newer atypical antipsychotic agents (e.g., risperidone) and is dose-related.

236-243
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Among couples undergoing up to six cycles of in vitro fertilization (IVF) at one large infertility center, the overall live-birth rate was 72% with an optimistic analysis (assuming that women lost to follow-up had the same chance of pregnancy as women who continued treatment) and 51% with a conservative analysis (assuming that there were no live births among women lost to follow-up). These rates decreased significantly with increasing maternal age.

244-256

Streptococcus pneumoniae is an important cause of bacterial meningitis. Since the introduction of the heptavalent pneumococcal conjugate vaccine PCV7, rates of pneumococcal meningitis have decreased substantially in the United States, from 1.13 cases to 0.79 case per 100,000 persons between 1998–1999 and 2004–2005; rates of disease from serotypes covered by the vaccine decreased the most, and rates from those not covered increased.

257-267

In this open-label, nonrandomized trial, Latino and non-Latino white patients with chronic hepatitis C (genotype 1) were treated with peginterferon alfa-2a and ribavirin for 48 weeks. The sustained virologic response rate was lower among Latino patients than among non-Latino patients (33% vs. 49%). The difference in response was not explained by differences in adherence to treatment or in baseline characteristics of the patients.

Review Article
268-279

This review emphasizes the participation of estrogen and inflammation in the development of endometriosis. A feedback cycle in which prostaglandins and aromatase activity are prominent allows for the persistence of endometriotic tissue. Knowledge of this cycle has important implications for the treatment of endometriosis.

Images in Clinical Medicine
280
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A 55-year-old man with end-stage liver disease associated with alcohol abuse was evaluated for liver transplantation. He had a history of refractory ascites and hepatic encephalopathy. On physical examination, we noted muscle atrophy, jaundice, ascites, ...

e3
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An imprint of a health care worker's ungloved hand was obtained for culture after the worker had performed an abdominal examination of a 24-year-old man colonized with methicillin-resistant Staphylococcus aureus(MRSA).

Case Records of the Massachusetts General Hospital
281-290

    A 25-year-old man was transferred to the emergency department of this hospital because of pain and swelling of the right hand and hypotension. His hand was mottled and swollen, with a black eschar on the dorsum, and soft-tissue swelling extended up the proximal forearm. Vigorous fluid resuscitation and norepinephrine were required for hemodynamic support.

    Editorials
    292-294

    The broad goals of treatment for patients with coronary artery disease are improvement in survival and a reduction in the risk of myocardial infarction and symptoms of coronary disease. The circumstances under which revascularization with the use of ...

    294-296

    Antipsychotic medications are commonly used across the entire age spectrum, both within and outside their labeled (and evidence-based) indications.1,2 Three atypical antipsychotic medications, olanzapine (Zyprexa, Eli Lilly), risperidone (Risperdal, ...

    Clinical Decisions
    e4
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    This interactive feature presented the case 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. Readers were invited to vote for one of three possible treatment ...

    Clinical Implications of Basic Research
    297-299

    Molecules that are involved in the epithelial-to-mesenchymal transition and that are known to promote metastasis also have a role in oncogenesis.

    Correspondence
    300-302

    To the Editor: Mauri et al. (Sept. 25 issue)1 report lower 2-year mortality rates among patients presenting in 2003–2004 with acute myocardial infarction who were selected for treatment with drug-eluting stents than among those selected for treatment ...

    302-303

    To the Editor: We have eagerly awaited the results of the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) Study (Sept. 18 issue),1 since a significant benefit of angiotensin-receptor blockers (ARBs) was anticipated based on the ...

    304

    To the Editor: Investigators in the Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine (SEARCH) Collaborative Group found one single-nucleotide polymorphism (SNP) in the SLCO1B1 gene that was significantly associated with ...

    304-306

    To the Editor: In his review article on drug therapy for hepatitis B virus (HBV) infection, Dienstag (Oct. 2 issue)1 does not mention the use of prophylactic antiviral drugs in patients treated with chemotherapy, stem-cell transplantation, or ...

    306-307

    To the Editor: Patients with erythropoietic protoporphyria, a rare inherited disease, accumulate photosensitizing protoporphyrin in the dermis, which results in severe dermal pain and incapacitating phototoxic reactions when the skin is exposed to ...

    308-309

    A 31-year-old woman was admitted to the emergency department because of a seizure-like attack after a single 3.5-g dose of ibogaine. ECG showed a severe prolonged-QT interval of 548 msec and ventricular tachyarrhythmias during prolonged monitoring.

    Book Reviews
    310-311

    The previous edition of this book was an attempt to collate the science of the endometrium into one comprehensive volume. This current edition is an even more ambitious undertaking, and the editors have gathered the foremost authorities to cover all areas ...

    311-312

    The appropriate treatment of prostate cancer continues to challenge researchers and clinicians. During the past decade, intensive screening for prostate-specific antigen has resulted in a dramatic rise in the number of cases that are diagnosed in the ...

    312-313

    Viruses are responsible for 20% of malignant conditions in humans, including some of the most common cancers worldwide, and are especially common in immunosuppressed patients. The identification of viruses associated with cancers may provide prognostic ...

    313

    Research on the biologic basis of leukemias and lymphomas has revealed new molecular entities with distinctive genetic and epigenetic abnormalities. Correct diagnosis of these disorders affects their clinical management because they involve genetic ...

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