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January 29, 2009  Vol. 360 No. 5

Audio Summary of this Issue

Perspective
437-439

Some argue that universal coverage is a luxury that we must do without in order to make way for other programs that will stimulate the economy. Jonathan Gruber writes that this argument presents a false choice.

439-443

Drs. Cesar Arias and Barbara Murray write that we have arrived at a point as frightening as the preantibiotic era: for patients infected with multidrug-resistant bacteria, there is no magic bullet.

444-445
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Conflicting wishes and demands regarding end-of-life care are a common problem, but one with no clear solution. Drs. Jeffrey Drazen, Nihar Desai, and Philip Green write that those of us on the front lines can't help but wonder: for whom do we “fight on,” ...

Original Articles
447-458

Deficiency of adenosine deaminase (ADA) causes a form of severe combined immunodeficiency disease. This study shows that gene therapy in the form of hematopoietic stem cells transduced with a viral vector containing the human ADA gene can restore immune function in patients with this disease.

459-469
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This study examined the vital status and lifetime risk of end-stage renal disease in 3698 persons who donated a kidney between 1963 and 2007. The results indicate that survival and the risk of end-stage renal disease among carefully screened kidney donors appear to be similar to those in the general population. Most donors who were studied had a preserved glomerular filtration rate, normal albumin excretion, and an excellent quality of life.

470-480

About 20% of children with acute lymphoblastic leukemia (ALL) that arises from a B-cell progenitor have a relapse after induction chemotherapy. This study investigated genetic abnormalities in high-risk and low-risk ALL. Copy-number variations and mutations of IKZF1 were reproducibly found in high-risk ALL. The evidence suggests that the loss of function of IKZF1 has a role in resistance to chemotherapy in ALL.

481-490

Obesity is a modifiable risk factor for urinary incontinence. This study randomly assigned overweight and obese women with urinary incontinence to an intensive 6-month weight-loss program or to a structured education program. More intervention-group participants had clinically relevant reductions in the frequency of episodes of any incontinence, stress incontinence, and urge incontinence.

Special Article
491-499

In eight hospitals throughout the world, implementation of a 19-item surgical safety checklist was associated with improved outcomes. Use of the checklist may improve the safety of surgical procedures in hospitals in various economic circumstances.

Clinical Therapeutics
500-506

A 23-year-old woman with anorexia nervosa visits her internist to discuss possible admission to an inpatient behavioral-treatment program. Behavioral therapy for anorexia nervosa includes direct supervision of eating, establishment of weight-gain goals, and implementation of contingencies if goals are not achieved. The most important adverse effect of such programs is the risk of the refeeding syndrome, a rare but potentially life-threatening metabolic disorder.

Videos in Clinical Medicine
e6

    Evaluation of blood pressure is used in assessing cardiovascular health, in screening for hypertension, and in monitoring the effectiveness of treatment. This video demonstrates the appropriate technique for the indirect measurement of blood pressure in adults.

    Images in Clinical Medicine
    507
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    Severe pain developed in the left hand of a 46-year-old woman after open heart surgery was performed to repair an atrial septal defect. It was initially thought that this pain was due to a thrombosis associated with a pressure-monitoring device in her ...

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    A 24-year-old male seat-belted driver involved in a high-speed motor vehicle crash was taken to the operating room for repair of a partial aortic transection. After resolution of the right hemopneumothorax, an elevated right hemidiaphragm was seen on a ...

    Case Records of the Massachusetts General Hospital
    508-516

    A 39-year-old woman in the first trimester of her first pregnancy was seen in the obstetrics and gynecology clinic of this hospital at 14 weeks of gestation because of persistent fevers. She had recently traveled to Africa to adopt a child. In the interval between returning home and becoming ill, she became pregnant. On examination, there was a maculopapular rash over the trunk, arms, and legs, as well as a slightly enlarged liver. Sequential ultrasound examinations showed an apparently normal fetus.

    Editorials
    518-521

      From its earliest conception, gene therapy held the promise of correcting inherited diseases by inserting a normal copy of the relevant gene into somatic cells.1 Common monogenic diseases of blood cells, such as sickle cell disease or β-thalassemia, were ...

      522-523

      Kidney transplantation remains the preferred therapeutic option for patients with end-stage renal disease (ESRD), since survival and health-related quality of life are better after kidney transplantation than after dialysis therapy. The incidence of ESRD ...

      524-526

      Acute lymphoblastic leukemia (ALL) with an immature B-cell immunophenotype (B-cell–progenitor ALL) is a common cancer in children and adolescents, and it also occurs in adults. Cure rates of B-cell–progenitor ALL among children are very high, but they are ...

      Clinical Decisions
      527-531
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      Case Vignette

      A 56-year-old homeless man was found having a seizure and was transported to the hospital. He was found to have a subarachnoid hemorrhage and acute hydrocephalus. He underwent intubation, and mechanical ventilation was started. A shunt was ...

      Clinical Implications of Basic Research
      532-534

      Proteomic analysis of heart tissue in animal models of myocardial infarction shows that phosphorylation of an aldehyde dehydrogenase protects against ischemic insults.

      Correspondence
      535-537

      To the Editor: Beardsall et al. (Oct. 30 issue)1 report the results of the Neonatal Insulin Replacement Therapy in Europe (NIRTURE) trial, which investigated the effects of a fixed-dose insulin (0.05 U per kilogram of body weight per hour) and glucose (...

      537-538

      To the Editor: In their article on maternal influenza vaccination, Zaman et al. (Oct. 9 issue)1 address a very important preventive health intervention that had substantial benefits to both mothers and infants. However, the potential effect of breast-...

      538-541

      To the Editor: In their review of uric acid and cardiovascular disease, Feig and colleagues (Oct. 23 issue)1 state that “it is worth noting that humans and apes have higher uric acid levels than most other mammals, since they lack the hepatic enzyme ...

      541-542

      To the Editor: In his Perspective article, Steinberg (Oct. 2 issue)1 cites the largest meta-analysis to date of the statin class of pharmaceutical agents.2 The range he cites as the relative risk reduction for all-cause mortality, 20 to 30%, is ...

      542-544

      To the Editor: Atypical hemolytic–uremic syndrome is a disease of uncontrolled complement activation associated with a high mortality rate, and most cases progress to end-stage renal disease.1 About 50% of patients with this syndrome carry mutations in ...

      544-546

      To the Editor: Atypical hemolytic–uremic syndrome of infancy is a rare disorder that is associated with thrombotic microangiopathy and acute renal failure. It often involves complement dysregulation.1,2 Plasma infusions have variable efficacy, and end-...

      Book Reviews
      547-548

      The widespread conviction that a defining moment is at hand has led many to hope that the goal of providing universal access to health care in the United States may soon be realized. President Barack Obama has set forth his own plan and has stated that he ...

      548-549

      How health risks are investigated, perceived, and discussed is hardly objective and dispassionate. Rather, a variety of cultural, political, personal, and other factors influence which potential hazards are studied, how they are studied, and how the ...

      549

      Changes in lifestyle that promote obesity and physical inactivity have led to a global increase in the prevalence of type 2 diabetes and its coexisting diseases among people of all ages. Given the numerous articles that have been published about diabetes, ...

      550-551

      The antimicrobial era began about 75 years ago. Although it is far from over, it is being increasingly challenged by the emergence of resistant microorganisms. Antimicrobial resistance is the inevitable result of Darwinian evolution — natural selection ...

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