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Table of contents for

January 21, 2010  Vol. 362 No. 3

Audio Summary of this Issue

Perspective
189-192
Erythropoiesis-Stimulating Agents — Time for a Reevaluation
E.F. Unger, A.M. Thompson, M.J. Blank, and R. Temple
  • Free Full Text

Randomized trials have endeavored to show that using ESAs to raise hemoglobin concentrations to higher targets improves clinical outcomes in patients with anemia associated with chronic kidney disease. Dr. Ellis Unger and FDA colleagues describe the trial ...

192-195
Accelerating the Use of Electronic Health Records in Physician Practices
S. Shea and G. Hripcsak
  • Free Full Text

North Shore Hospital System in New York recently announced that it will pay an incentive of up to $40,000 to each physician in its network who adopts its electronic health record. Drs. Steven Shea and George Hripcsak write that the decision by North Shore ...

e6
Health Care Reform and the Need for Comparative-Effectiveness Research
A.I. Mushlin and H. Ghomrawi
  • Free Full Text

Health care reform will eventually pit the goal of expanding health insurance coverage against strong pressure to reduce the growth in health care costs. If left to measures in the proposed reform legislation, cost containment will be driven primarily by ...

e7
Patient-Centered Medical Homes in Ontario
W.W. Rosser, J.M. Colwill, J. Kasperski, and L. Wilson
  • Free Full Text

As the United States debates health care reform, the concept of “patient-centered medical homes” is receiving increasing attention.1 Many experts believe that medical homes with multidisciplinary teams and financial incentives for providing comprehensive ...

e8
Nearing Negotiations — Reconciling Key Differences between House and Senate Reform Measures
J.K. Iglehart
  • Free Full Text

With Republicans unanimously opposed to the Democrats' health care reform, the challenge of melding the House and Senate reform bills has fallen to House Speaker Nancy Pelosi (D-CA) and Senate Majority Leader Harry Reid (D-NV). To broker a deal by the end ...

Original Articles
197-205
Treatment with Monoclonal Antibodies against Clostridium difficile Toxins
I. Lowy and Others
  • Free Full Text

In this randomized trial involving patients with Clostridium difficile infection, treatment with monoclonal antibodies against C. difficile toxins A and B, in addition to metronidazole or vancomycin, reduced the rate of recurrence of infection, as compared with placebo (7% vs. 25%).

206-216
Lethal Skeletal Dysplasia in Mice and Humans Lacking the Golgin GMAP-210
P. Smits and Others
  • Free Full Text

A form of skeletal dysplasia in mice is caused by a mutation in a gene that is critical for the functioning of the Golgi apparatus. A mutation in the orthologous gene in humans results in a similar phenotype: achondrogenesis type 1A.

217-227
Percent Emphysema, Airflow Obstruction, and Impaired Left Ventricular Filling
R.G. Barr and Others
  • Free Full Text

In a population-based study, emphysema was quantified by computed tomography, pulmonary function was assessed by spirometry, and cardiac volumes and function were measured by magnetic resonance imaging. Both percent emphysema and the severity of airflow obstruction were linearly related to reductions in left ventricular end-diastolic volume, stroke volume, and cardiac output. These effects were more pronounced among smokers.

Clinical Practice
228-238
Systolic Heart Failure
J.J.V. McMurray
  • Full Text Audio

A 74-year-old man with a history of hypertension and myocardial infarction that had occurred in the remote past presents with breathlessness on exertion. On examination, his pulse is 76 beats per minute and his blood pressure is 121/74 mm Hg. There is jugular venous distention and edema in the lower limbs; the lungs are clear. An echocardiogram shows left ventricular dilatation and an ejection fraction of 33%. How should his case be managed?

Review Article
239-252
Medical Progress: Williams–Beuren Syndrome
B.R. Pober

    Williams–Beuren syndrome, a multisystem disorder caused by the deletion of a chromosome region of 1.5 million to 1.8 million base pairs containing 26 to 28 genes, is a disorder of microdeletion or contiguous gene deletion. This review covers current understanding of the biology of this disorder.

    Images in Clinical Medicine
    253
    Extramedullary Hematopoiesis Associated with β-Thalassemia
    E. Smitaman and A.N. Rubinowitz
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    A 47-year-old woman of Italian descent with a history of transfusion-dependent β-thalassemia intermedia presented to the emergency department with dyspnea that had worsened during the previous several days. The physical examination revealed 28 ...

    e9
    Hydropneumothorax
    P.-H. Chen and X.-Z. Lin
    • Free Full Text

    A 47-year-old man with a history of cirrhosis presented with a 2-day history of shortness of breath. On pulmonary examination, breath sounds were absent on the right side, and a succussion splash was audible in the right upper chest when the patient was ...

    Case Records of the Massachusetts General Hospital
    254-262
    Case 2-2010 — A 47-Year-Old Man with Abdominal and Flank Pain
    E.M. Isselbacher, S.J. Kligerman, K.M. Lam, and R.M. Hurtado
    • Video

    A 47-year-old man was admitted to this hospital because of abdominal pain of 5 weeks' duration, which radiated to the flank. He had had intermittent abdominal pain and constipation for 15 years. He was born in Central America and lived in rural and urban areas until immigrating to the United States more than 25 years before admission. Computed tomography of the abdomen revealed renal abnormalities consistent with infarcts. Echocardiography revealed a left ventricular aneurysm with thrombus. A diagnostic test was performed.

    Editorials
    264-265
    Clostridium difficile — Beyond Antibiotics
    L. Kyne

      In this decade, the prevention and control of Clostridium difficile infection in health care settings has become a global public health challenge. Infection rates have increased dramatically, and several large outbreaks associated with toxinotype III BI/...

      266-267
      Achondrogenesis Type 1A — From Mouse to Human
      H.H. Freeze

        In this issue of the Journal, Smits et al.1 describe how they identified the cause of a rare human skeletal dysplasia, achondrogenesis type 1A. In so doing, they have provided an excellent example of the interdependence between clinical medicine and basic ...

        267-268
        The Shrinking Heart in Chronic Obstructive Pulmonary Disease
        A. Vonk-Noordegraaf

          In patients with emphysema, the cardiac silhouette on the radiograph is typically long and narrow. The common explanation for this finding is the altered, more vertical position of the heart in the thoracic cavity. The study by Barr et al. in this issue ...

          Correspondence
          269-270
          Defibrillator Implantation Early after Myocardial Infarction
          • Free Full Text

          To the Editor: Steinbeck et al. (Oct. 8 issue)1 conclude that prophylactic therapy with the use of an implantable cardioverter–defibrillator (ICD) early after a myocardial infarction did not reduce overall mortality among patients with clinical features ...

          270-271
          Interleukin-2 Therapy in Patients with HIV Infection
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          To the Editor: Abrams and other members of the writing committee (Oct. 15 issue)1 describe two trials of recombinant interleukin-2 therapy in combination with antiretroviral therapy: the Subcutaneous Recombinant, Human Interleukin-2 in HIV-Infected ...

          272-273
          Doxycycline for Mansonella perstans Infection
          • Free Full Text

          To the Editor: The article by Coulibaly et al. (Oct. 8 issue)1 and the corresponding editorial by Hoerauf2 point out the role of wolbachia as an endosymbiont in mansonella, and they report on doxycycline as an effective therapy for filariasis. The ...

          273-274
          Case 33-2009: A Woman with Fever after Cesarean Section
          • Free Full Text

          To the Editor: In the Case Record, de Moya and colleagues (Oct. 22 issue)1 describe a patient who received cefazolin after clamping of the umbilical cord, and a discussant states “the patient received appropriate prophylactic antibiotic coverage.” ...

          274
          Contaminated Dietary Supplements
          • Free Full Text

          To the Editor: With regard to the Perspective article by Cohen (Oct. 15 issue)1: I would argue that the challenge posed by the inclusion of undeclared drug ingredients in supplements bears no relation to any purported shortcomings of the Dietary ...

          275-276
          Balancing “No Blame” with Accountability in Patient Safety
          • Free Full Text

          To the Editor: Wachter and Pronovost (Oct. 1 issue)1 question the “no-blame” paradigm in patient-safety improvement and suggest the adoption of explicit punitive approaches to poorly performing physicians. We counsel caution. In a longitudinal study over ...

          276-277
          Lovastatin in X-Linked Adrenoleukodystrophy
          • Free Full Text

          To the Editor: As reported previously in the Journal, lovastatin lowers levels of very-long-chain fatty acids in plasma in patients with X-linked adrenoleukodystrophy (X-ALD).1 Further studies did not reproduce this finding with the use of simvastatin in ...

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