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Table of contents for

February 5, 2009  Vol. 360 No. 6

Audio Summary of this Issue

Perspective
557-559
Physician–Industry Relations — Will Fewer Gifts Make a Difference?
R. Steinbrook

    Meals and other gifts are an important component of the approximately $7 billion that drug companies spend annually on promotion to medical professionals in the United States. Increasingly, industry giveaways are under attack and subject to a growing ...

    559-561
    The Supreme Court, Preemption, and Malpractice Liability
    A.S. Kesselheim and D.M. Studdert
    • Free Full Text

    The U.S. Supreme Court is considering the case of Wyeth v. Levine, whose central question is whether approval of a pharmaceutical product's label by the FDA should protect the manufacturer from litigation by patients alleging that they were inadequately ...

    Original Articles
    563-572
    Chemotherapy, Bevacizumab, and Cetuximab in Metastatic Colorectal Cancer
    J. Tol and Others
    • Free Full Text

    Capecitabine, oxaliplatin, and bevacizumab are standard treatment for metastatic colorectal cancer. This trial tested whether adding cetuximab to this combination is beneficial. The addition of cetuximab resulted not only in shorter progression-free survival than standard treatment but also in a reduced quality of life.

    573-587
    Breast Cancer after Use of Estrogen plus Progestin in Postmenopausal Women
    R.T. Chlebowski and Others
    • Free Full Text

    The Women's Health Initiative trial of estrogen plus progestin, compared with a placebo, in postmenopausal women was stopped in 2002 because the health risks exceeded the benefits of hormone therapy. Within the first year of follow-up after discontinuation of hormonal therapy, the risk of breast cancer declined sharply.

    588-598
    The Burden of Respiratory Syncytial Virus Infection in Young Children
    C.B. Hall and Others
    • Free Full Text

    In this prospective, population-based survey of children under the age of 5 years, respiratory syncytial virus (RSV) was shown to be associated with 20% of hospitalizations, 18% of emergency department visits, and 15% of office visits for acute respiratory infections during the winter. Only 3% of the outpatient RSV infections were specifically diagnosed.

    599-605
    Brief Report: Mutations in SYNGAP1 in Autosomal Nonsyndromic Mental Retardation
    F.F. Hamdan and Others
    • Free Full Text

    As compared with X-linked mental retardation, little is known about the genetic causes of autosomal nonsyndromic mental retardation. This study implicates variants of SYNGAP1 as a cause of this disorder in approximately 3% of patients who were tested.

    Clinical Practice
    606-614
    Primary Ovarian Insufficiency
    L.M. Nelson
    • Full Text Audio

    A 30-year-old woman presents with a history of no menses since she stopped taking oral contraceptives 6 months ago in order to conceive. She had undergone normal puberty, with menarche at the age of 12. She reports stress at work. Her weight is 59 kg, and her height 1.66 m; her body-mass index (the weight in kilograms divided by the square of the height in meters) is 21.3. The pelvic examination is normal, a pregnancy test is negative, the prolactin level is normal, and the follicle-stimulating hormone level is in the menopausal range. How should she be evaluated and treated?

    Images in Clinical Medicine
    615
    Traumatic Epidural Hematoma
    G.L. Gallia and M.H. Sobotta
    • Free Full Text

    An 18-year-old intoxicated man was assaulted with a glass bottle on the left parietal region of his head and had a 5-minute loss of consciousness. The patient went home, but 2 hours after the injury, he presented to a local emergency department with ...

    e8
    A Smooth, Shiny Tongue
    H.J. Lee and D.Y. Jo
    • Free Full Text

    A 77-year-old woman presented with fatigue and a burning sensation of the tongue on swallowing food. She was pale and had a depapillated, smooth, shiny red tongue. Laboratory testing revealed cytopenia.

    Clinical Problem-Solving
    616-621
    Needle in a Haystack
    R. Kapoor, R.H. Moseley, J.R. Kapoor, L.M. Crapo, and S. Saint

      A 50-year-old woman reported multiple, loose bowel movements associated with mild, cramping abdominal pain. She had been well until 2 months earlier, when her bowel habits changed from one formed stool per day to frequent loose stools of moderate volume.

      Editorial
      623-625
      Targeted Therapy for Advanced Colorectal Cancer — More Is Not Always Better
      R.J. Mayer

        During the past few years, the outlook for patients with colorectal cancer has brightened considerably. Fluorouracil, an inhibitor of thymidylate synthase (and therefore DNA synthesis), was until recently the only effective systemic treatment for this ...

        Health Policy Report
        626-633
        Limits on Medicare's Ability to Control Rising Spending on Cancer Drugs
        P.B. Bach
        • Free Full Text
        • Interactive/Multimedia

        During the past decade, the price of cancer drugs and the spending for cancer treatments by Medicare have increased dramatically. The author outlines the usual tools Medicare uses to control its spending on drugs and discusses the policies that make cancer drugs a special case and prohibit the regulation of their prices and utilization.

        Correspondence
        634-636
        Toll-like Receptor 4 Polymorphisms and Aspergillosis
        • Free Full Text

        To the Editor: Bochud et al. (Oct. 23 issue)1 present data suggesting an association between toll-like receptor 4 (TLR4) haplotypes in unrelated donors and an increased risk of invasive aspergillosis among recipients of allogeneic hematopoietic-cell ...

        636-638
        Clostridium difficile
        • Free Full Text

        To the Editor: I would add two comments to Kelly and LaMont's review of the management of Clostridium difficile infection (Oct. 30 issue).1 First, in the diagnosis of C. difficile infection, it is important to note that the positive predictive value of ...

        638-640
        Venous Thromboembolic Disease and Pregnancy
        • Free Full Text

        To the Editor: In their review article on venous thromboembolic disease during pregnancy, Marik and Plante (Nov. 6 issue)1 recommend the use of compression ultrasonography as the initial test for pulmonary embolism. However, in nonpregnant patients, ...

        640-642
        Prevalence of Mitochondrial 1555A→G Mutation in European Children
        • Free Full Text

        To the Editor: Aminoglycoside antibiotics are used worldwide to treat gram-negative sepsis. Since these drugs are ototoxic and nephrotoxic, drug levels are closely monitored. However, their effect on patients with the mitochondrial DNA mutation m.1555A→G ...

        642-644
        Prevalence of Mitochondrial 1555A→G Mutation in Adults of European Descent
        • Free Full Text

        To the Editor: Sensorineural hearing loss is the most common type of sensory impairment worldwide.1 We have found that pathogenic mitochondrial DNA (mtDNA) mutations, such as the m.3243A→G mutation associated with mitochondrial encephalopathy, lactic ...

        Book Reviews
        645-646
        The Fertility Doctor: John Rock and the Reproductive Revolution
        • Free Full Text

        In his book, Outliers: The Story of Success (New York: Little, Brown, 2008), Malcolm Gladwell asks, Why do some people succeed, living remarkably productive and impactful lives, while so many more never reach their potential? Gladwell would squarely place ...

        646-647
        The Placebo Response and the Power of Unconscious Healing
        • Free Full Text

        Richard Kradin, as he explains in the acknowledgements section of his book, sets out to develop “an explanatory model for the placebo response,” with a particular interest in mind–body physiology and the possible mechanisms of the response — meaning ...

        647-648
        Dermatologic Immunity
        • Free Full Text

        In this latest addition to the Current Directions in Autoimmunity series from Karger, a broad spectrum of immune-mediated cutaneous diseases, including most of the major disorders that are known to arise from alterations in cellular and humoral immunity, ...

        Corrections
        648
        Effectiveness of Maternal Influenza Immunization in Mothers and Infants
        • Free Full Text

        Effectiveness of Maternal Influenza Immunization in Mothers and Infants Original Article, N Engl J Med 2008:359;1555-1564.. In the author list, Robert Breiman's middle initial should have been F., and in the affiliations, R.E.B. should have been R.F.B. ...

        648
        Genotype Score in Addition to Common Risk Factors for Prediction of Type 2 Diabetes
        • Free Full Text

        Genotype Score in Addition to Common Risk Factors for Prediction of Type 2 Diabetes Original Article, N Engl J Med 2008:359;2208-2219.. In Table 2, the footnote symbol next to the P Value column head should be deleted, and in the data for rs864745, the ...

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