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August 20, 2009  Vol. 361 No. 8

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Perspective
737-740

The FDA receives thousands of complaints about prescription medications annually but lacks resources to investigate or respond individually to most of them. Ensuring the quality of prescription drugs has become a tougher job than ever before, now that the ...

741-743

In 2008, the proportion of the world's population living in urban areas crossed the 50% mark. Drs. Ronak Patel and Thomas Burke write that urbanization is a health hazard for certain vulnerable populations, and this demographic shift threatens to create a ...

Original Articles
745-755

Men receiving androgen-deprivation therapy for nonmetastatic prostate cancer are at high risk for bone loss and fractures. This placebo-controlled study investigated the effects of denosumab, a fully human monoclonal antibody against the receptor activator of nuclear factor-κB ligand, on bone mineral density and fractures in such men. Use of denosumab was associated with increased bone mineral density at all sites and reduction in the incidence of new vertebral fractures.

756-765

In this trial, women between the ages of 60 and 90 with low bone mineral density received twice-yearly subcutaneous injections of denosumab, a fully human monoclonal antibody against the receptor activator of nuclear factor-κB ligand, which inhibits the development and activity of osteoclasts, or placebo. Denosumab was associated with a reduced risk of vertebral, nonvertebral, and hip fractures.

766-776

This study of adjuvant hormonal therapy in postmenopausal women with hormone-receptor–positive early breast cancer showed that disease-free survival was similar after 5 years of treatment with letrozole alone, 2 years of treatment with letrozole followed by 3 years with tamoxifen, or 2 years of treatment with tamoxifen followed by 3 years with letrozole. Five years of letrozole monotherapy may be superior to 5 years of tamoxifen monotherapy.

777-786

In this 12-month randomized trial involving 251 long-term heroin users, injectable diacetylmorphine (the active ingredient in heroin) was more effective than oral methadone in achieving retention in treatment for addiction and in reducing illicit-drug use and other illegal activity. As compared with methadone, injectable diacetylmorphine was associated with more serious adverse events, including seizures and drug overdoses.

Clinical Practice
787-794
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A 62-year-old woman with osteoarthritis presents with a 7-month history of progressively worsening left hip pain radiating to the groin, 8 months after undergoing total left-hip arthroplasty. Physical examination reveals a sinus tract overlying her left hip. A radiograph shows loosening of the prosthesis at the bone–cement interface. How should her case be managed?

Review Article
795-805

Recent years have seen major advances in our understanding of the sudden infant death syndrome (SIDS), including the discovery that the prone sleep position more than triples the risk of SIDS. This finding has led to a worldwide campaign advocating the supine sleep position for infants, which has been associated with a decrease of 50 to 90% in the SIDS rate. This review considers demographic and pathophysiological factors and current concepts about SIDS.

Images in Clinical Medicine
806
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An 84-year-old man presented with a foreign body hanging from his rectum. Eleven years earlier, he had undergone a radical prostatectomy for prostate cancer. One week before presentation, he underwent incision and dilation of a urethral stricture, at ...

e12
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A 25-year-old woman presented with recurrent abdominal pain that had first developed 10 years earlier. She had mild tenderness in the left upper quadrant. Laboratory tests showed no significant abnormalities.

Case Records of the Massachusetts General Hospital
807-816

A 34-year-old man with cystic fibrosis was admitted to this hospital because of cough, increased dyspnea, and sputum production. Broad-spectrum antimicrobial therapy was initiated. On the fifth hospital day, fever developed, and on the eighth day, nausea, vomiting, leukocytosis, and acidosis developed. The next day, a diagnostic procedure was performed.

Editorials
818-820

More than a decade ago, receptor activator of nuclear factor-κB ligand (RANKL) was identified as the key molecule mediating osteoclast development, activity, and survival.1 Since osteoporosis results, in part, from increased osteoclastic bone resorption, ...

820-821

In this issue of the Journal, Oviedo-Joekes et al.1 report on the results of the North American Opiate Medication Initiative (NAOMI) trial comparing methadone with injectable diacetylmorphine (the active ingredient in heroin) for the treatment of heroin ...

Correspondence
822-824

To the Editor: Kitahata et al. (April 30 issue)1 addressed the question of whether persons who received antiretroviral therapy during their study lived longer if that treatment was initiated early rather than deferred. Through careful selection and ...

824-825

To the Editor: The review of predisposing factors for adrenal insufficiency by Bornstein (May 28 issue)1 includes a welcome discussion of the limitations of current tests that measure plasma cortisol levels in critically ill patients. However, in the ...

826-827
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To the Editor: In their review article on scleroderma, Gabrielli et al. (May 7 issue)1 incorporate their earlier observations that all patients with this disease have activating antibodies to platelet-derived growth factor (PDGF) receptors (PDGFRs).2 ...

827-828

To the Editor: Obstructive sleep apnea is not rare in children with hypertrophic tonsils, and the common curative procedure is adenotonsillectomy.1 Codeine is commonly prescribed for pain after adenotonsillectomy.2 The respiratory depressant effects of ...

828-829

This report documents the long-term sustainability of antiretroviral-therapy programs in resource-poor countries, with excellent rates of retention and adherence and a survival rate of 75% at 5 years.

Book Reviews
830-831

The study of the relation between infectious diseases and national security is hardly a new endeavor. In this book, Andrew Price-Smith reminds us that Thucydides, in his 5th-century publication The History of the Peloponnesian War, mused about the ...

831-832

Many fields in medicine intersect, thereby promoting clinical and research collaborations. Nephrology and endocrinology encompass a number of common topics; indeed, some departments and practices are joint ventures that include researchers and clinicians ...

832-833

The publication of this book, just months after the death of Alvin Goldfarb — one of the founders of the North American Society for Pediatric and Adolescent Gynecology — prompts reflection upon the progress that was made toward clinical, scientific, and ...

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