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May 20, 2010  Vol. 362 No. 20

Audio Summary of this Issue

Perspective
1853-1855

    One of the most talked-about features of the draft revisions for the DSM-V is a new diagnostic category for children: temper dysregulation disorder with dysphoria (TDD). Erik Parens and colleagues argue that this new diagnosis may not help troubled ...

    1855-1858

    Are human genes and the process of comparing DNA sequences patentable? Dr. Aaron Kesselheim and Michelle Mello describe a recent federal district court decision that reignites a long-simmering debate about the patentability of genes.

    1858-1861

    Dr. Dominique Bayard worked in a makeshift hospital in Tabarre, a northeast section of Port-au-Prince, where the hospital staff treated more than 800 patients a day for infections, disabilities, complications from delayed treatment, respiratory illness, ...

    Original Articles
    1863-1871
    • Free Full Text

    Patients with large abdominal aortic aneurysms were assigned to undergo endovascular repair or open surgical repair. Operative mortality was lower with endovascular repair, but at a median of 6 years, there was no significant difference between groups in total mortality or aneurysm-related mortality. There were more graft-related complications and reinterventions with endovascular repair.

    1872-1880

    Patients with large abdominal aortic aneurysms who were physically ineligible for open surgical repair were assigned to undergo endovascular repair or to receive no intervention. At a median of 3 years, aneurysm-related mortality was significantly lower with endovascular repair, but there was no difference in total mortality.

    1881-1889

    Patients with large abdominal aortic aneurysms were assigned to undergo open surgical repair or endovascular repair. At 6 years, the cumulative survival rates did not differ significantly between groups. The rate of secondary intervention was significantly higher with endovascular repair.

    1890-1900

    Patients were assigned to monitoring for rejection after cardiac transplantation either according to the standard practice of endomyocardial biopsies or with gene-expression profiling. At 19 months, the rates of rejection with hemodynamic compromise, graft dysfunction, death, or retransplantation were similar in the two groups, although the power of the trial was limited.

    1901-1908
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    Susceptibility to Tourette's syndrome is known to have a genetic influence. This study, of a nonconsanguineous family in which the father and his eight children are affected by the disorder, implicates a deficit in L-histidine decarboxylase activity as one potential cause of the disorder.

    Review Article
    1909-1919

    Fanconi's anemia is a rare disorder that arises from defective repair of damaged DNA. Of the 13 Fanconi's anemia genes, 3 are breast-cancer–susceptibility genes. One is identical to BRCA2. Cells from patients with the D1 subtype of Fanconi's anemia and their family members carry biallelic mutations in BRCA2, and heterozygote members of kindreds with the D1 subtype have an increased risk of breast and ovarian cancer. Studies of a rare disorder can thus illuminate a common disorder.

    Videos in Clinical Medicine
    e62

      Middle-ear inflammation may be classified clinically as either acute otitis media or otitis media with effusion. Mastery of otoscopic examination techniques is necessary for accurately diagnosing otitis media and differentiating its forms. This video demonstrates how to perform an otoscopic examination and how to remove cerumen from the external auditory canal.

      Images in Clinical Medicine
      1920
      • Free Full Text

      A 22-year-old man presented with a 10-day history of torticollis. Two months before presentation, he had fallen from standing height but did not report subsequent cervical pain, weakness, or paresthesia. On examination, there was a reduced range of ...

      e63
      • Free Full Text

      A 69-year-old man was referred for the evaluation of changes to his fingernails after the initiation of chemotherapy for gastric cancer.

      Case Records of the Massachusetts General Hospital
      1921-1928

      An 85-year-old woman had poorly differentiated invasive ductal cancer (positive for estrogen and progesterone receptors and HER2) with no clinical evidence of lymph-node or distant metastases. She had hypercholesterolemia, hypertension, chronic obstructive pulmonary disease, hypothyroidism, arthritis, and a history of pleural and pericardial effusions of unknown cause. She lived with a daughter and performed all activities of daily living. A management decision was made.

      Editorials
      1930-1931

      Abdominal aortic aneurysm is a lethal condition associated with an 85% risk of death after rupture. Optimal treatment relies on early detection followed by prophylactic surgical intervention. Although aneurysms are traditionally treated with open surgery, ...

      1932-1933

      Among patients undergoing heart transplantation, a fundamental clinical concern is the risk of rejection of the new organ. Although modern immunosuppressive regimens have reduced the incidence of rejection substantially, about one quarter of recipients ...

      Clinical Implications of Basic Research
      1934-1935

      The transition from quiescence of the sperm in the epididymis to capacitation in the female reproductive tract depends on alkalinization of the intracellular milieu. A recent study underscores the role of a particular proton channel in the process of alkalinization.

      Correspondence
      1936-1938

      To the Editor: The report by Monti et al. (Feb. 18 issue)1 has raised concern worldwide among relatives of patients in a persistent vegetative state. Could their loved ones be conscious after all?

      However, in addressing such concerns, perhaps the ...

      1938-1940

      To the Editor: Haskal et al. (Feb. 11 issue)1 report prolonged vascular access with the use of a stent graft among patients undergoing balloon angioplasty for failing dialysis-access grafts. Despite the impressive results, some aspects of the work need ...

      1940-1942

      To the Editor: Barnes et al. (Feb. 11 issue)1 describe a family with mutations in the gene encoding peptidyl-prolyl isomerase B (PPIB), which causes moderate osteogenesis imperfecta, with normal collagen helical modification and normal P986 3-...

      1942-1943

      To the Editor: In the review of stage IV chronic kidney disease by Abboud and Henrich (Jan. 7 issue),1 there is an omission that, as a practicing physician and kidney-transplant recipient, I would like to point out.

      The authors suggest that patients be “...

      1943-1945

      To the Editor: Isselbacher et al. (Jan. 21 issue)1 report the case of a 47-year-old Latin-American immigrant with Chagas' cardiomyopathy and a left ventricular apical aneurysm with thrombus who had abdominal and flank pain because of a renal embolism. In ...

      1945-1946

      To the Editor: An 88-year-old Chinese woman was brought to the emergency department by her family, who reported that she had been lethargic and unable to walk or swallow for 3 days. She had been eating an estimated 1.0 to 1.5 kg of raw bok choy daily for ...