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September 23, 2010  Vol. 363 No. 13

Audio Summary of this Issue

Perspective
1193-1195
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As the Deepwater Horizon oil disaster enters its next phase, consensus is emerging that among its most profound immediate health effects are those on the emotional and psychosocial health of Gulf Coast communities. State mental health and substance-abuse ...

1196-1198
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Like climate change, the relentless worldwide spread of noncommunicable diseases offers an opportunity for low-, middle-, and high-income countries to join forces in addressing a major global challenge that threatens health and economies alike. A recent ...

1199-1201

At first glance, medicine may seem unrelated to foreign policy, but in reality it is an unappreciated partner of diplomacy. In many parts of the world, poverty, inequity based on ethnicity or sex, shoddy public infrastructure, and environmental ...

Original Articles
1203-1210
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  • CME

Assessment of the effect of breast-cancer screening has been hampered by difficulty in measuring secular trends. In this study, data from a cancer registry were used to determine secular trends and to evaluate the effect of screening on breast-cancer mortality.

1211-1221

This genomewide association study implicates variants of SMAD3 in susceptibility to asthma and confirms previously observed genetic associations. The study implicates molecules that mediate the communication of epithelial damage to the immune system.

1222-1232

Superficial thrombophlebitis in the leg is associated with an increased risk of subsequent thromboembolic events; however, intervention to alter the risk has not been well studied. This study compared fondaparinux with placebo for patients with superficial thrombophlebitis in the leg.

1233-1244

One of the characteristics of severe emphysema is hyperinflation of regions of the lungs. In this trial, valves that prevented air entry but allowed air to escape were placed in lobar airways. Patients receiving endobronchial valves had modest improvements in lung function and exercise performance.

Special Article
1245-1255
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In this evaluation of more than 174,000 adults with selected medical conditions, health care costs were reduced by a telephone intervention that consisted of education by health coaches about shared decision making, self-care, and behavioral change.

Clinical Therapeutics
1256-1264

A 62-year-old man collapses on the street and is found to be in cardiac arrest. He is resuscitated at the scene by emergency medical personnel, but he is comatose. Targeted temperature management, which involves cooling the patient to a core body temperature of 32 to 34°C for 24 hours, is recommended.

Images in Clinical Medicine
1265
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A 58-year-old asymptomatic man with a history of gout presented for a routine physical examination. He was obese (weight, 91 kg; body-mass index [the weight in kilograms divided by the square of the height in meters], 31.1) and had decreased breath sounds ...

e18
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A 30-year-old man presented to our clinic for evaluation of newly diagnosed hypertension. On examination, he had an apical systolic ejection click, a grade 2/6 systolic murmur, and weak femoral pulses. The difference in blood pressure between his arms and ...

Case Records of the Massachusetts General Hospital
1266-1274

A 29-year-old woman with spastic quadriplegia was admitted to this hospital because of fever, nausea, and increasing abdominal pain. The patient had a history of recurrent urinary tract infections and nephrolithiasis. A CT scan of the abdomen showed chronic scarring of the kidney, mild splenomegaly, and possible splenic infarcts.

Editorials
1276-1278

No screening test has ever been more carefully studied than screening mammography. In the past 50 years, more than 600,000 women have participated in 10 randomized trials, each involving approximately 10 years of follow-up. Given this extraordinary ...

1278-1280

In this issue of the Journal, Decousus et al.1 report on the efficacy and safety of fondaparinux for the treatment of superficial-vein thrombosis in the legs. The results of their carefully conducted, placebo-controlled trial show that treatment with ...

1280-1281

Chronic obstructive pulmonary disease (COPD) is characterized by progressive limitation of airflow that results in air trapping and hyperinflation. Some patients with this disease also have irreversible pulmonary emphysema due to the destruction of ...

Clinical Implications of Basic Research
1282-1284

    The thromboemboli in surface arterioles and capillaries of mice are removed through a process of extravasation.

    Correspondence
    1285-1286

    To the Editor: In the Surfactant, Positive Pressure, and Pulse Oximetry Randomized Trial (SUPPORT) (May 27 issue),1 which compared the effects of relatively high (91 to 95%) and low (85 to 89%) levels of oxygenation in extremely preterm infants, the ...

    1286-1287

    To the Editor: The results from the study by van Santvoort et al. (Minimally Invasive Step-up Approach versus Maximal Necrosectomy in Patients with Acute Necrotizing Pancreatitis [PANTER]) (April 22 issue)1 show that percutaneous drainage (PCD) alone is ...

    1288

    To the Editor: To justify routine screening mammography in older women, Muss et al. (May 20 issue)1 cite Badgwell et al.,2 who observed that breast cancer was detected at a lower stage and was associated with a higher rate of survival among women 80 ...

    1289-1290

    To the Editor: Cell therapy is emerging as a realistic treatment for type 1 diabetes, on the basis of the prolonged success of intraportal islet transplantation in selected patients.1 Key improvements include the development of alternative implantation ...

    Corrections
    1290

    Improved Survival with Ipilimumab in Patients with Metastatic Melanoma Original Article, N Engl J Med 2010:363;711-723. The disclosure statement (page 721) should have included the following: “Dr. van den Eertwegh, receiving consulting fees from and ...

    1290

    Implications of a Circulating Vaccine-Derived Poliovirus in Nigeria Original Article, N Engl J Med 2010:362;2360-2369. In the fifth paragraph of the Discussion, beginning “Although we did not account for . . .” (page 2368), the second sentence should have ...

    1290

    A Comparison of Aprotinin and Lysine Analogues in High-Risk Cardiac Surgery Original Article, N Engl J Med 2008:358;2319-2331. In Figure 2 (page 2328), the number at risk given for the tranexamic acid group at 30 days should have been 739, rather than ...