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July 2, 2009  Vol. 361 No. 1

Audio Summary of this Issue

Perspective
1-3

Should the health care reform package include reforms to the medical liability system, which is often blamed for contributing to rising health care costs? Michelle Mello and Dr. Troyen Brennan discuss the pros and cons.

4-5

How can the government finance such a sizeable new expenditure as universal coverage? Jonathan Gruber argues for the elimination or limiting of the income-tax exclusion for expenditures on employer-sponsored insurance.

6-7

Some of the most prominent shortcomings of the U.S. health insurance market are rooted in the fact that the system is a voluntary one. Linda Blumberg and John Holahan argue for bringing all U.S. residents into our health insurance system through an ...

8-9

A Vermont law signed on June 8 bans gifts to physicians from manufacturers of prescription drugs, medical devices, and biologic products, with few exceptions. Dr. Robert Steinbrook reports.)

Original Articles
11-21

In this study of patients with membranous nephropathy, serum samples from 70% of patients with idiopathic, but not secondary, membranous nephropathy were found to have antibodies against a 185-kD glycoprotein in nonreduced glomerular extracts, identified as the M-type phospholipase A2 receptor (PLA2R). PLA2R is present in normal podocytes and in immune deposits in patients with idiopathic membranous nephropathy, indicating that PLA2R is a major antigen in this disease.

22-31

In this longitudinal study of hospitalized Medicare patients, there was no improvement in survival after cardiopulmonary resuscitation (CPR) during the period from 1992 through 2005. The overall rate of survival to discharge of patients who underwent in-hospital CPR was 18.3%. Survival after CPR was lower among black patients than among white patients.

32-39

Combined positron-emission tomography and computed tomography (PET–CT) plus conventional staging was compared with conventional staging alone for preoperative staging of non–small-cell lung cancer (NSCLC). The end point was the number of futile thoracotomies in each group (with futility defined as a result other than potentially curable NSCLC). Preoperative staging of NSCLC with PET–CT was found to reduce the total number of thoracotomies and the number of futile thoracotomies.

40-51

This study aimed to determine whether early administration of drugs that block the renin–angiotensin system slows the progression of change in glomerular mesangial fractional volume and retinopathy progression of two steps or more, according to the retinopathy severity scale. Early blockade of the renin–angiotensin system did not modify nephropathy progression in patients with type 1 diabetes but had important effects in slowing retinopathy.

Special Article
52-61
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This study examined expenditures on drugs and other medical services before and after the implementation of Medicare Part D. For patients who had no drug coverage before Part D, the increase in drug spending after the implementation of Part D was approximately offset by a decrease in other medical spending. Improved access to medications may achieve savings in nonpharmacy costs because of better control of chronic illness.

Review Article
62-72

The causes of acute rhabdomyolysis include trauma, drugs, toxins, and certain infections. Acute kidney injury is a dangerous complication of severe rhabdomyolysis. This review summarizes current views on the pathogenesis of myoglobin-induced kidney injury as well as on its prevention and treatment.

Images in Clinical Medicine
73
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A 56-year-old man presented to the emergency department with a 3-day history of diarrhea and dull epigastric pain. The diarrhea had responded to antidiarrheal agents. However, the epigastric pain had worsened on the day before presentation and had become ...

e1
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A 40-year-old man presented with a 4-month history of intractable pruritus within portions of a tattoo imprinted with red ink. Topical and intralesional corticosteroids had no effect.

Clinical Problem-Solving
74-79

    A 31-year-old man presented to the emergency department with pain in the left shoulder. He had tripped over his backpack shoulder strap earlier in the day and noted immediate severe pain around his left shoulder. Physical examination revealed bony point tenderness over the humeral head and limited range of motion due to pain; crepitus was present. Shoulder radiographs revealed an impacted fracture of the left humerus and evidence of osteopenia.

    Editorials
    81-83

    Just over 50 years ago, the late David Jones1 identified (using the periodic acid–Schiff and methenamine silver stains) the unique glomerular pathologic features of membranous nephropathy, thus distinguishing it from other causes of “nephrotic ...

    83-85

      The hypothesis that inhibition of the renin–angiotensin system may be effective in preventing diabetic nephropathy was based on a large body of evidence.1 Positive findings from studies in animal models and subsequent clinical trials fostered enthusiastic ...

      Clinical Implications of Basic Research
      86-88

        A recent study upends the hypothesis that cardiomyocytes are not renewed after the first weeks of life.

        Correspondence
        89-92

        To the Editor: In the Normoglycemia in Intensive Care Evaluation–Survival Using Glucose Algorithm Regulation (NICE-SUGAR) study (ClinicalTrials.gov number, NCT00220987), reported by Finfer et al. (March 26 issue),1 intensive glucose control increased ...

        92

        To the Editor: It is not known whether concentric hypertrophy is a common precursor to systolic dysfunction in human hypertensive heart disease.13 Bibbins-Domingo et al. (March 19 issue)4 report that increased left ventricular mass was associated with ...

        93-95

        To the Editor: In their article on A Study to Evaluate the Use of Rosuvastatin in Subjects on Regular Hemodialysis: An Assessment of Survival and Cardiovascular Events (AURORA), Fellström et al. (April 2 issue)1 report little benefit for rosuvastatin in ...

        95-97

        To the Editor: As a gastroenterologist who claims to have been the first physician in Connecticut to give fluorouracil to a patient with colon cancer, I was delighted to read in the Conclusions of the Abstract of the article by Van Cutsem et al. (April 2 ...

        97-98

        To the Editor: As the principal investigator of a National Institutes of Health (NIH)–funded natural-history study involving North American adults with moyamoya disease,1 I read with interest the review article on this disease and moyamoya syndrome by ...

        98-99

        To the Editor: We recently found that progression-free survival was shorter among patients with metastatic colorectal cancer treated with chemotherapy, bevacizumab, and cetuximab (CBC regimen) than among patients who received chemotherapy and bevacizumab ...

        Book Reviews
        100-101

        Seeing the three-dimensional world with two-dimensional retinas presents the brain with two problems. To locate an object in space requires depth perception, which can be acquired from one eye alone through size, perspective, and motion parallax. ...

        101-102

        Laboratory medicine has no more urgent role than in the diagnosis and management of infections in immunocompromised patients. For this vulnerable population, clinical algorithms are logically rooted in the need for timely identification, quantification, ...

        Corrections
        102

        Triple-Reassortant Swine Influenza A (H1) in Humans in the United States, 2005–2009 Original Article, N Engl J Med 2009:360;2616-2625. (10.1056/NEJMoa9093812; published on May 7, 2009, at NEJM.org). In the list of authors, the name Susan Vagasky, D.V.M., ...

        102

        Emergence of a Novel Swine-Origin Influenza A (H1N1) Virus in Humans Original Article, N Engl J Med 2009:360;2605-2615. (10.1056/NEJMoa0903810; published on May 7, 2009, at NEJM.org). In the second paragraph of the Demographic and Clinical Features ...

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