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February 26, 2009  Vol. 360 No. 9

Audio Summary of this Issue

Perspective
849-852
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Most observers see rising health care costs as an inexorable force. Dr. Elliott Fisher, Dr. Julie Bynum, and Jonathan Skinner write that by learning from regions that have attained sustainable growth rates and building on successful models of delivery-...

852-855

Enactment of comprehensive health care reform is likely to hinge on the development of a plan that is affordable to families, employers, and taxpayers. Karen Davis describes a set of health care policies that would produce savings for the system.

855-857

In the first demonstration of Democratic dominance on health care issues, the new Congress quickly reauthorized the State Children's Health Insurance Program (SCHIP) and President Obama signed it into law on February 4. John Iglehart writes that the newly ...

Original Articles
859-873

This randomized trial compared the effect of reduced-calorie diets with various compositions of fat, protein, and carbohydrates on weight loss over a 2-year period. Compliance with the diets was not high. No significant differences in weight loss were observed among the various diets. Reduced-calorie diets appear to have similar effects on weight loss regardless of their particular compositions.

874-880
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The role of complement component 3 (C3) allotypes C3F (fast) and C3S (slow) in the long-term outcomes of renal allografts remains controversial. This study does not confirm the hypothesis that the transplantation of donor kidneys of allotype FS or FF in recipients with the SS allotype is advantageous, possibly because chronic allograft nephropathy is a multifaceted disease involving the interplay of many biologic pathways.

881-885

The azoospermia factor region A (AZFA) on chromosome Y contains two genes, one of which is USP9Y. Deletions in this region have been associated with male infertility. However, a man and his father and brother, all of whom carry a deletion that encompasses USP9Y, are normospermic, providing definitive evidence that USP9Y is not required for spermatogenesis.

886-892

Meningococcal disease is associated with significant morbidity. Three cases of ciprofloxacin-resistant Neisseria meningitidis disease caused by the same serogroup B strain were detected in North Dakota and Minnesota. Recommendations for the antimicrobial agents to be used as secondary chemoprophylaxis have been modified in these areas.

Clinical Therapeutics
893-901

A 45-year-old man presents with extensive burns after a house fire. Excision and grafting are recommended for management of his burns. Depending on the depth and extent of the burn, early excision and grafting promote wound healing, reduce the risk of infection, and shorten hospitalization but increase the need for blood transfusion, as compared with conservative management.

Review Article
902-911

The increasing number of young survivors of cancer who have favorable outcomes necessitates planning for the preservation of fertility, which may mean modifying the strategy for oncologic treatment. In addition to in vitro fertilization in women and sperm banking in men, new methods on the horizon include in vitro follicle maturation and techniques for tissue transplantation.

Images in Clinical Medicine
912
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A 56-year-old man with diabetes presented with a several-month history of decreased vision in the left eye. There was no history of trauma, flashes of light, or floaters. Visual acuity was 20/20 in the right eye and 20/200 in the left. Examination of the ...

e12

A 50-year-old woman had an acute pontine hemorrhage which resulted in quadriplegia. Thirty months later, she reported having difficulty reading because of oscillopsia.

Case Records of the Massachusetts General Hospital
913-921

A 29-year-old woman was transferred to this hospital at 38 weeks 4 days of gestation because of a large cystic structure that had been detected by ultrasonography in the fetal oral cavity and appeared to obstruct the airway. The placenta was anterior, and a uterine fibroid was seen. A management decision was made.

Editorials
923-925

No medical condition has generated as many dietary remedies as obesity. All diets have their followers, but hard data on the efficacy of the diets are scarce. In this issue of the Journal, Sacks et al.1 report the results of a large, long-term trial that ...

925-927

It has been known for decades that the Y chromosome carries genes required for spermatogenesis and male fertility. But it has been frustratingly difficult to pin down the relevant genes, to such an extent that a finding reported by Luddi et al.1 in this ...

Clinical Implications of Basic Research
928-930

Eradication of acute promyelocytic leukemia (APL) in mice depends on two events: derepressing the differentiation pathway and ridding the APL cell of the fusion oncoprotein that sustains it.

Correspondence
931-932

To the Editor: The study of subthalamic nucleus stimulation for the treatment of severe obsessive–compulsive disorder (OCD), reported by Mallet and colleagues (Nov. 13 issue),1 appears to be problematic for several reasons. First, on the basis of the ...

933-935

To the Editor: Zacho and colleagues (Oct. 30 issue)1 provide considerable support for other studies2 that suggest that since polymorphisms in the C-reactive protein (CRP) gene are not associated with ischemic heart disease, CRP itself is not causally ...

935-936

To the Editor: In his Clinical Therapeutics article, LeWitt (Dec. 4 issue)1 emphasizes that levodopa is still the pivotal treatment in Parkinson's disease, despite the disabling motor complications caused by the intermittent, pulsatile supply of ...

937-938

To the Editor: In his article on implantable cardioverter–defibrillators (ICDs) after myocardial infarction, Myerburg (Nov. 20 issue)1 summarizes the major ICD trials and makes recommendations regarding primary prevention. Unfortunately, he does not ...

939-940

To the Editor: Normal thyroid function in fetuses and breast-fed infants, which is dependent on sufficient maternal dietary intake of iodine, is crucial for normal neurocognitive development.1 Children of mothers with severe iodine deficiency may have ...

Book Reviews
941-942

In the 1930s, Tracy Putnam and Houston Merritt codiscovered the antiepileptic properties of phenytoin (Dilantin). Their triumph is among the first translational partnerships between academia and pharmaceutical companies in which a chemical “library” that ...

942-943

It is estimated that more than 1.4 million people in the United States will receive a diagnosis of cancer in 2009 (excluding in situ carcinoma and nonmelanotic skin cancer), and that approximately 500,000 will die from the disease. Most patients who die ...

943-944

Joel Paris, an academic psychiatrist with a special interest in personality disorders, was chair of the McGill University department of psychiatry from 1997 through 2007 and is editor-in-chief of the Canadian Journal of Psychiatry. He looks back — and ...

Correction
944

Limits on Medicare's Ability to Control Rising Spending on Cancer Drugs Health Policy Report, N Engl J Med 2009:360;626-633.. In Figure 1, some of the data points for drug approvals occurring after the year 2003 were incorrect, and they affected the data ...

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