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July 16, 2009  Vol. 361 No. 3

Audio Summary of this Issue

Perspective
225-229
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Descendants of the H1N1 influenza A virus that caused the catastrophic and historic pandemic of 1918–1919 continue to contribute their genes to new viruses, causing new pandemics, epidemics, and epizootics. Drs. David Morens, Jeffery Taubenberger, and ...

229-231

As the administration and its congressional allies pursue revenue sources to pay the estimated costs of near-universal coverage ($1.2 trillion over a decade), one potential source is an acceleration of government efforts to pursue waste, fraud, and abuse ...

232-233

Should a patient be permitted to refuse potentially lifesaving care? As a psychiatry resident, Dr. Benjamin Brody is routinely asked to make decisions about whether a patient's judgment is impaired.

Original Articles
235-244

Endoscopic vein-graft harvesting is often used in coronary-artery bypass grafting (CABG) to prevent postoperative wound complications. However, in this study, which had a 3-year follow-up, endoscopic harvesting was associated with a higher rate of graft failure and adverse clinical outcomes. Although this is not a randomized study, it calls into question the use of endoscopic vein-graft harvesting in CABG.

245-254

Adults who had a parent with Alzheimer's disease were randomly assigned either to a group that was informed about their own APOE genotype (a risk variant) or to a group that was not informed. There was no difference in clinically significant psychological distress between subjects who were informed about genotyping results and those who were not informed.

255-263

The APOE ε4 variant confers an increased risk of Alzheimer's disease. Longitudinal modeling of cognitive aging showed that memory decline in subjects with one or two APOE ε4 alleles diverged from that of noncarriers before the age of 60 years.

264-270

This study assessed the ability of a capsule endoscope to detect the colorectal polyps and cancer seen with optical colonoscopy. The sensitivity and specificity of capsule endoscopy for the detection of advanced adenomas were 73% and 79%, respectively. These findings demonstrate the relatively low sensitivity of capsule endoscopy and do not support its use for colorectal-cancer screening at this time.

Clinical Therapeutics
271-278

A sexually active 18-year-old woman presents to her internist for an annual examination and asks whether she should receive the human papillomavirus (HPV) vaccine. HPV causes cervical cancer. Currently available vaccines provide protection against some but not all oncogenic genotypes of the virus if the recipient has not previously been infected. Regular cervical-cancer screening is still required for vaccine recipients.

Review Article
279-285

Twelve key events leading up to the emergence of the current pandemic swine-origin influenza A (H1N1) virus are reviewed.

Images in Clinical Medicine
286
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An 80-year-old man with a history of irritable bowel syndrome presented with a 5-day history of abdominal pain in the left lower quadrant, without aggravating or relieving factors. His last bowel movement had been 3 days before admission, without melena ...

e3
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A 28-year-old woman with systemic lupus erythematosus presented with a 2-day history of periumbilical postprandial abdominal pain with nausea and vomiting. She was afebrile and normotensive, with diffuse abdominal distention and mild rebound pain without ...

Case Records of the Massachusetts General Hospital
287-296

A 59-year-old man was admitted to this hospital for induction chemotherapy for acute myeloid leukemia. On the seventh hospital day, neutropenia, fever, nausea, diarrhea, and abdominal pain developed. Despite the administration of broad-spectrum antimicrobial therapy, tender, erythematous skin lesions developed on the trunk, abdomen, and arms and legs, and bilateral pulmonary nodules were seen on computed tomographic scans of the chest. A diagnostic procedure was performed.

Editorials
298-299

Genetic testing can be considered a complex variant of diagnostic testing. If the results are not actionable, the findings may lead to anxiety or even life-disrupting actions with little offsetting benefit. Even if the results are actionable, the anxiety ...

300-301

In the United States and other countries, colonoscopy has emerged as the primary screening test for colorectal cancer. Colonoscopy is believed to prevent colorectal cancer because polyps are removed during the procedure, but randomized trials have not ...

Clinical Implications of Basic Research
302-303

    Ablating mice of Neto1, a component that stabilizes a postsynaptic glutamate receptor, results in a deficit in memory and learning — a deficit ameliorated by administration of a glutamate-receptor stimulant.

    Correspondence
    304-306

    To the Editor: Sankaranarayanan et al. (April 2 issue)1 report no significant differences in rates of detection of high-risk cervical neoplasia among women who underwent screening by cytologic testing, testing for human papillomavirus (HPV) with the ...

    307-308

    To the Editor: When Tobian et al. (March 26 issue)1 sampled only the glans for human papillomavirus (HPV), they guaranteed a positive finding because the location of HPV on the penis differs according to circumcision status.25 Uncircumcised men with HPV ...

    308-310

    To the Editor: Viel et al. (April 16 issue)1 propose that treatment of hemophilia A with factor VIII that is matched for polymorphic variants may reduce the risk of the development of factor VIII inhibitors. Their study included patients with different ...

    311-312

    To the Editor: In the special article on rehospitalizations among patients in Medicare fee-for-service programs, Jencks et al. (April 2 issue)1 conclude that rehospitalizations among Medicare beneficiaries are prevalent and costly.

    In the recent report, ...

    312-314

    To the Editor: In the Case Record of a man with fever and rash (April 9 issue),1 acute infection with the human immunodeficiency virus (HIV) was the definitive diagnosis. The rash in acute HIV infection is commonly described as maculopapular or ...

    314-316

    Despite the obvious theoretical health benefits of replacing trans fatty acids with other fatty acids in food products, concern has been expressed that this change might increase the intake of saturated fatty acids. The authors examined which types of ...

    Book Reviews
    317-318

    This captivating memoir tells the story of an extraordinary life lived against the backdrop of one of the most cataclysmic events of modern times. Leslie Brent, a world-renowned immunologist and transplantation biologist as well as a codiscoverer (with ...

    318-319

    Pediatric Endocrinology and Inborn Errors of Metabolism was designed for visual learners and features many tables and schematic presentations that are easy to consult. Its structure resembles the central intersection of a Venn diagram. The large circles ...

    319-320

    Research on umbilical-cord blood has revolutionized the field of hematopoietic stem-cell transplantation, and umbilical-cord blood is now used in about 28% of all bone marrow and stem-cell transplants from unrelated donors that are performed each year in ...

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