Join the 200th Anniversary Celebration

Issue IndexA searchable index of tables of contents

Find An Issue

By Volume and Issue
By Date

Table of contents for

April 8, 2010  Vol. 362 No. 14

Audio Summary of this Issue

Perspective
1253-1255

One might imagine that medical educators have attempted to incorporate cost consciousness into their teaching, but such efforts have been remarkably few. Dr. Molly Cooke discusses how medical education can address the urgent issue of cost.

1255-1258

New Medical Schools in the United States For more than two decades, no new allopathic medical schools were established in the United States. Dr. Michael Whitcomb describes the recent exploration, planning, and implementation of new medical schools.

1259-1261
  • Free Full Text

The War Isn't Over Henry Aaron and Robert Reischauer write that passage of health care reform is a cause for celebration, but supporters must prepare to meet the serious challenges that remain.

e48
  • Free Full Text

President Barack Obama, sealing a hard-fought and historic victory, has signed into law the Democrats' comprehensive health care reform bill, the Patient Protection and Affordable Care Act, a sweeping measure that would expand coverage to 32 million ...

Original Articles
1263-1272

Lung function was measured in firefighters and emergency-medical-service workers who responded to the collapse of the World Trade Center towers in New York on September 11, 2001. There was initial marked loss in lung-function measures without substantial recovery during the following 7 years.

1273-1281

In this randomized trial comparing cisplatin plus gemcitabine with gemcitabine alone for the treatment of biliary tract cancer, overall survival and progression-free survival were improved with the use of cisplatin plus gemcitabine. Adverse events were similar in the two groups.

1282-1291

It has been hypothesized that oxidative stress may underlie the development of preeclampsia. In this large, multicenter, randomized, double-blind trial involving low-risk, nulliparous women, supplementation with 1000 mg of vitamin C and 400 IU of vitamin E, beginning in the 9th to 16th week of pregnancy, did not reduce the rates of adverse maternal or perinatal outcomes related to pregnancy-associated hypertension.

1292-1303
  • Free Full Text

In this randomized trial of patients infected with hepatitis C virus genotype 1 in whom a sustained virologic response was not achieved after initial therapy, patients retreated with peginterferon alfa-2a and ribavirin combined with telaprevir were more likely to have a sustained response than patients retreated with peginterferon alfa-2a and ribavirin alone.

Special Article
1304-1311
  • Free Full Text

In this demonstration experiment on the structure of an internal-medicine teaching service, the investigators found that a model with two attending physicians and limited patient-staff census resulted in greater satisfaction on the part of trainees and attending physicians than the approach used on the standard teaching services.

Review Article
1312-1324

Hyperphosphatemia, which is nearly universal in kidney failure, is accompanied by low serum levels of vitamin D and hypocalcemia. Without treatment, severe secondary hyperparathyroidism occurs, which may result in painful fractures, brown tumors, and generalized osteopenia. This article reviews the rationale for treatment with oral phosphate binders, discusses evidence supporting the use of available agents, and suggests an approach for clinical practice.

Images in Clinical Medicine
1325
  • Free Full Text

A 21-year-old woman presented for a routine eye examination. Her visual acuity was 20/25 in the right eye and 20/40 in the left eye, and her pupils were reactive. The slit-lamp examination showed persistent pupillary strands and membranes in both eyes (...

e49
  • Free Full Text

A 4-year-old boy presented with a 5-day history of mild fever and malaise and a 3-day history of a vesicular rash involving his hands, feet, tongue, and buttocks.

Goksugur N., Goksugur S.

N Engl J Med 2010;362:e49, April 8, 2010

Case Records of the Massachusetts General Hospital
1326-1333

Three days before admission to this hospital, a 37-year-old, right-handed woman had vertigo, weakness and numbness of the left side, and shaking of the left leg. Magnetic resonance imaging (MRI) at another hospital revealed a mass in the right parietal lobe of the brain. She had had an endometrial biopsy 2 weeks before admission and a dental procedure 1.5 weeks before admission. On transfer to this hospital, she did not have fever, chills, or pain. Examination revealed decreased sensation to touch on the left. Repeat MRI showed enlargement of the brain lesion. A diagnostic procedure was performed.

Editorials
1335-1337

The term “biliary tract cancer” refers primarily to cancers that develop in the gallbladder and bile ducts, although periampullary tumors are often considered part of this group as well. Bile-duct tumors that develop within the liver and the distal ...

1337-1338

Since the Libby Zion case in 1984, the medical profession and the public have been preoccupied with the subject of residents' work hours. However, this narrow focus on work hours has diverted attention from a more fundamental development affecting the ...

Clinical Implications of Basic Research
1339-1340

Drug interactions may be explained by the extent to which a combination of drugs balances or offsets the balance of the metabolism of different cellular components.

Correspondence
1341-1342

To the Editor: As medical providers currently deployed in Iraq, we read the article by Holbrook et al. (Jan. 14 issue)1 with great interest. If confirmed, the association of morphine use with reductions in post-traumatic stress disorder (PTSD) would ...

1342-1346

To the Editor: The study by van der Gaag et al. (Jan. 14 issue)1 comparing preoperative biliary drainage with surgery alone in patients with pancreatic cancer has some noteworthy limitations.

First, the trial design mandates a preoperative delay of 4 to ...

1346-1348

To the Editor: In their review of nosocomial bacterial meningitis, van de Beek et al. (Jan. 14 issue)1 advocate for cerebrospinal fluid analysis as part of the diagnostic approach. We certainly agree that investigative study and empiric antimicrobial ...

1348-1350

To the Editor: Rare, naturally occurring gene mutations provide important insights into normal human physiology. We report on a young girl with severe neonatal hypoglycemia due to a novel glucokinase mutation (V91L). Her father had a similar clinical ...

Points of View
e50

Anesthesiologists have a unique view of humanitarian disasters, as I discovered when I spent 21 days volunteering on the U.S.N.S. Comfort after the January earthquake in Haiti. Based in operating rooms, anesthesiologists see close up the entire grotesque ...

Corrections
1350

Sudden Death in Myotonic Dystrophy , N Engl J Med 2008:359;. In Panel B of Figure 1 (page 1627), under the Controls heading, the value for N should have been 14 rather than 7. We regret the error. The article has been corrected at NEJM.org.

1350

Case 13-2009: A 54-Year-Old Woman with Respiratory Failure and a Cavitary Lesion in the Lung Case Records of the Massachusetts General Hospital, N Engl J Med 2009:360;1770-1779. In the fourth sentence of the Summary subsection under Differential Diagnosis ...