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December 24, 2009  Vol. 361 No. 26

Audio Summary of this Issue

Perspective
2497-2499

Jonathan Gruber argues that the primary criticisms of the health care reform bills are largely unwarranted.

2499-2501

Updated breast-cancer screening recommendations have sparked substantial controversy and have had a polarizing effect in the breast-cancer community. Drs. Ann Partridge and Eric Winer write that the intensity of the controversy is unfortunate, because ...

2501-2503

New recommendations on screening for breast cancer have raised concerns about access to potentially lifesaving care. Dr. Robert Truog believes that for health care reform to progress with clarity, transparency, and honesty, we must discuss how, not ...

2503-2505

Dr. George Sawaya discusses three major changes that are designed to minimize screening harms while preserving high benefit.

e60

The Democrats' ambitious health care reform measure escaped its first week of Senate debate unscathed, with the defeat of Republican amendments that would have eliminated Medicare spending cuts and killed a new program for long-term care championed by the ...

Original Articles
2507-2517

The first case of 2009 pandemic influenza A (H1N1) infection in China was identified on May 10, 2009. An initial policy of quarantine was instituted, and the early cases were systematically monitored. In these early 426 cases, the incubation period (2 days), spectrum of illness (67.4% with fever), and duration of viral shedding by PCR (6 days) were determined.

2518-2528

Using a novel gene chip, investigators identified single-nucleotide polymorphisms (SNPs) from three chromosomal regions, including the LPA locus, that were associated with the risk of coronary disease. Two SNPs in LPA were strongly associated with both the level of Lp(a) lipoprotein and the risk of coronary disease. After adjustment for the Lp(a) lipoprotein level, the association with the risk of coronary disease was abolished. These findings support a causal role of an increased Lp(a) lipoprotein level in the risk of coronary disease.

2529-2537

Early-repolarization patterns on electrocardiography are generally considered to be benign. However, this study with 30 years of follow-up in a Finnish population indicates that early-repolarization patterns in the inferior and lateral leads are associated with an increased risk of death from cardiac causes and from arrhythmia.

2538-2547

In a retrospective analysis from a randomized trial, stored serum samples from patients with stable coronary artery disease were analyzed with the use of a new, highly sensitive assay for cardiac troponin T. At levels well below the limit of detection of the conventional assay, troponin T concentrations correlated significantly with the subsequent risk of cardiovascular death and heart failure but not with the risk of myocardial infarction.

Clinical Practice
2548-2556
  • Full Text Audio

A 56-year-old obese man with long-standing gastroesophageal reflux who recently received a diagnosis of Barrett's esophagus presents for a follow-up visit. He has been taking omeprazole at a dose of 20 mg twice daily and currently has no symptoms of reflux. He has no dysphagia or weight loss. Endoscopic and histopathological examinations show a 4-cm segment of Barrett's esophagus without dysplasia. How should Barrett's esophagus be managed?

Videos in Clinical Medicine
e61

Endometrial biopsy is an office-based method for evaluating the tissue lining of the uterus. The many indications for endometrial biopsy include abnormal uterine bleeding, postmenopausal bleeding, amenorrhea for a year or longer, evaluation of infertility, evaluation of uterine response to hormone therapy, and follow-up for a Papanicolaou smear that has shown atypical glandular cells. The video demonstrates the technique of endometrial biopsy.

Images in Clinical Medicine
2557
  • Free Full Text

A 67-year-old woman who had a history of breast cancer and who had undergone chemoradiotherapy 10 years earlier underwent routine follow-up chest radiography. The images revealed right axillary surgical clips from previous breast-cancer surgery (Panels A ...

e62
  • Free Full Text
  • Video

It has been assumed that wearing a mask limits transmission of infectious agents during coughing. Schlieren optics demonstrate that both standard and N95 surgical masks help to halt the forward momentum of the cough plume.

Case Records of the Massachusetts General Hospital
2558-2569
  • Free Full Text

A 29-year-old man was transferred to this hospital because of fever and respiratory distress. Nine days earlier, fever, a nonproductive cough, and myalgias developed. On admission to this hospital, he was hypoxemic. Computed tomography of the chest revealed diffuse infiltrates. Respiratory failure, renal failure, and hypotension developed. On the sixth hospital day, a diagnostic test result was received.

Editorials
2571-2572

When H5N1 avian influenza emerged in 1997, much of the world began planning for an eventual pandemic. Most planners expected the pandemic to begin in Asia and believed the virus would be highly lethal. In the United States, planning efforts for pandemic ...

2573-2574

Lp(a) lipoprotein, which was initially described in 1963,1 is a circulating macromolecule consisting of a low-density lipoprotein (LDL) particle that is covalently linked to a protein called apolipoprotein(a). Plasma Lp(a) lipoprotein has been proposed as ...

Correspondence
2575-2577

To the Editor: Keller et al.1 and Reichlin et al.2 (Aug. 27 issue) unequivocally report the superiority of new sensitive troponin assays over standard assays in the diagnosis of acute myocardial infarction. In both studies, statements of superiority were ...

2578

To the Editor: Fernandez et al. (Sept. 24 issue)1 conclude that high-dose anthracycline may be given safely to patients with favorable-risk or intermediate-risk acute myeloid leukemia (AML). In clinical practice, there is a delay in obtaining cytogenetic ...

2578-2580

To the Editor: Hurst et al. (Sept. 3 issue)1 report on the significant therapeutic effect of injectable collagenase clostridium histolyticum in patients with Dupuytren's contracture. They also report two cases of tendon rupture. We are concerned about ...

2580-2582

To the Editor: Kinney and Thach (Aug. 20 issue)1 review the putative terminal respiratory pathway associated with the sudden infant death syndrome (SIDS), and they indicate a life-threatening event and failure of arousal as the first steps in the ...

2582-2583

To the Editor: A review of recut lung-tissue specimens and published autopsy series from the 1918 influenza pandemic suggests that secondary bacterial pneumonia1 was an important cause of death, consistent with our preliminary analysis of antemortem ...

2584-2585

Rates of invasive pneumococcal disease in the United States increase dramatically during winter holidays. The authors analyzed population-based surveillance data to determine whether spikes may be caused by increased transmission from children to older ...

Other Points of View
e116
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Health care reform seems to be a two-act play. We are moving toward the conclusion of the first act, universal coverage. The second act will consist of controlling the cost of health care, or “bending the cost curve.”

A recent article by Atul Gawande ...