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June 3, 2010  Vol. 362 No. 22

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Perspective
2045-2047
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Drs. Aaron Kesselheim and Daniel Solomon write that it came as a surprise to many patients and physicians that the FDA not only approved the new version of colchicine but also granted the manufacturer 3 years of market exclusivity for this ancient drug.

2047-2050

The Patient Protection and Affordable Care Act enables community health centers to serve nearly 20 million new patients while adding an estimated 15,000 providers to their staffs by 2015. Dr. Eli Adashi and colleagues describe the “new” community health ...

2050-2051

Jonathan Gruber argues that by the second decade, the Patient Protection and Affordable Care Act will have reduced national health care spending.

e65
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In April 2009, a novel influenza A (H1N1) virus emerged in the United States with the key characteristics of a pandemic virus, and within weeks it had spread to every region in the country.1 Ultimately, the rate of death was lower than was initially ...

Original Articles
2053-2065

In node-positive breast cancer, adjuvant doxorubicin plus cyclophosphamide followed by docetaxel was associated with significantly better disease-free survival than the three drugs together or doxorubicin–docetaxel. Premenopausal women who became amenorrheic as a consequence of treatment had significantly improved overall and disease-free survival, regardless of their treatment or the hormone-receptor status of their tumor.

2066-2076

This randomized trial comparing retropubic and transobturator slings for the treatment of stress urinary incontinence showed equivalent rates of treatment success according to objective criteria; the rates of treatment success in the two groups according to subjective criteria were similar but did not meet the criteria for equivalence. Complications differed in the two groups, with more voiding dysfunction requiring surgery in the retropubic-sling group and more neurologic symptoms in the transobturator-sling group.

2077-2091

In this randomized trial of deep-brain stimulation targeted to either the globus pallidus interna or the subthalamic nucleus in patients with advanced Parkinson's disease, the patients assigned to pallidal stimulation and those assigned to subthalamic stimulation had a similar improvement in motor function.

2092-2101
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Interleukin-2 is a proinflammatory interleukin with a pleiotropic effect on different cell types of the immune system. Cytokine-inducible SRC homology 2 (SH2) domain protein (CISH) is up-regulated by interleukin-2 and suppresses interleukin-2 signaling. This study shows that variants of the CISH gene are associated with susceptibility to bacteremia, malaria, and tuberculosis.

Clinical Therapeutics
2102-2112
  • CME

A 57-year-old woman is seen in an outpatient clinic, where her blood pressure reading is 155/95 mm Hg. Dietary therapy is recommended. Dietary changes that have been shown to reduce blood pressure include reduced sodium intake, reduced caloric intake (for weight loss), and diets high in fruits, vegetables, low-fat dairy products, whole grains, poultry, fish, nuts, and unsaturated vegetable oils.

Images in Clinical Medicine
2113
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A 19-year-old healthy man with a history of allergic rhinitis presented with a 6-month history of snoring and a sensation of having a foreign body in his mouth. The symptoms were associated with difficulty swallowing and foul-smelling breath. For 2 years ...

e66
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A 50-year-old woman presented with pulsatile tinnitus in the right ear without any hearing loss. Examination revealed a pulsating reddish mass at the posterior segment of the tympanic membrane.

Clinical Problem-Solving
2114-2120
  • CME
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A 34-year-old woman presented to a community hospital with aphasia. Her husband reported that her condition had been normal until 2 hours earlier, when her arms and legs suddenly shook for several seconds. Immediately afterward, she was unable to speak or to move her limbs on the right side.

Editorials
2122-2124

Over the past several decades, taxane-based chemotherapy regimens for breast cancer have evolved through a large number of randomized studies designed to detect modest improvements in patient outcome with changes in the dose, schedule, and agent or ...

2124-2125

A participant in a recent postgraduate course on urinary incontinence said to a panel of surgical experts: “Just tell us what surgery works well, without complications, so that we can take better care of our patients.” Like most surgeons, the course ...

Health Law, Ethics, and Human Rights
2126-2131

After 9/11, policy analysts speculated that clinicians may be reluctant to provide care during disasters because of fear of medical liability and proposed policies to create different standards of care for emergencies. In the context of the Haitian earthquake, the author argues that redefining the standard of care in disasters is neither necessary nor justified.

Clinical Implications of Basic Research
2132-2134

Sterile inflammation, which occurs in the post-traumatic systemic inflammatory response and other conditions such as myocardial infarction, may be spurred by mitochondria released from dying cells.

Correspondence
2135-2136

To the Editor: Steidl et al. (March 11 issue)1 report that an increased number of CD68+ cells was a significant prognostic factor in patients with classic Hodgkin's disease, especially in those with limited disease. Age is a well-known prognostic factor ...

2137-2139

To the Editor: In the Starting Antiretroviral Therapy at Three Points in Tuberculosis (SAPIT) study (Feb. 25 issue),1 the sequential-therapy group included patients with CD4+ counts of <200 cells per cubic millimeter. In this group, patients started ...

2139-2140

To the Editor: Cain et al. (Feb. 25 issue)1 conclude that screening for tuberculosis in people with human immunodeficiency virus (HIV) infection should include questions about a combination of symptoms rather than just chronic cough. They suggest that ...

2140-2142

To the Editor: Slichter et al. (Feb. 18 issue)1 report on the results of the platelet-dose (PLADO) trial (ClinicalTrials.gov number, NCT00128713). To interpret the results of this study accurately, it would be very important to know the ABO compatibility ...

Corrections
2142

Williams–Beuren Syndrome Review Article, N Engl J Med 2010:362;239-252. In the legend for Figure 3 (page 246), the following sentence should appear after the first sentence: “Of the genes labeled in the WBSCR, the ELN gene is the only unique sequence gene ...

2142
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Prolactinomas Clinical Practice, N Engl J Med 2010:362;1219-1226. The last sentence of the Evaluation subsection (page 1220) should not have included the phrase “but such occurrences are rare.” The article has been corrected at NEJM.org.