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September 30, 2010  Vol. 363 No. 14

Audio Summary of this Issue

Perspective
1293-1296
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In late July, the National Football League introduced a new poster to be hung in league locker rooms, warning players of possible long-term health effects of concussions. Public awareness of the pathological consequences of traumatic brain injury has been ...

1296-1299
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Too many people in our country are not reaching their full potential for health because of preventable conditions. Moreover, Americans receive only about half of the preventive services that are recommended1 — a finding that highlights the national need ...

1300-1301
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Having been outmaneuvered in Congress with the passage of the Patient Protection and Affordable Care Act (“Affordable Care Act,” or ACA), Republicans have taken their case to federal court, arguing that the law's key provision, the individual mandate to ...

Original Articles
1303-1312

Spleen tyrosine kinase (Syk) is an important modulator of immune signaling. In this randomized trial involving patients with active rheumatoid arthritis, there was a higher ACR 20 response rate with R788, an oral inhibitor of Syk, than with placebo at 6 months.

1313-1323

The treatment of neuroblastoma has produced remarkable results with intensive combination chemotherapy. The authors attempted to reduce the duration of treatment in patients with intermediate-risk disease while maintaining a 3-year overall survival rate of more than 90%.

1324-1334

This study evaluated whether the addition of a monoclonal antibody against the tumor-associated disialoganglioside GD2, in combination with GM-CSF and interleukin-2, to standard therapy consisting of isotretinoin alone improved outcomes in children with high-risk neuroblastoma.

1335-1340

This study of monozygous twins, in which one twin has Dravet's syndrome and the other does not, suggests that the mutation occurred in the early morula that gave rise to the affected twin.

Review Article
1341-1350

Growing evidence suggests that nonalcoholic fatty liver disease is associated with an increased risk of cardiovascular disease beyond that conferred by established risk factors.

Videos in Clinical Medicine
e19

    Urethral catheterization may be needed in a child for diagnostic purposes or for performing voiding cystourethrography or monitoring urine output in very ill or postoperative patients. This video demonstrates a diagnostic urethral catheterization in a male infant.

    Images in Clinical Medicine
    1351
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    A 15-year-old boy presented with lifelong neck swellings that had been gradually increasing in size. He was otherwise asymptomatic. Physical examination was notable for a larger nodule in the infrahyoid area (Panel A, white arrow) and a smaller nodule in ...

    e20
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    A 72-year-old man presented with a 3-week history of gradually worsening pain and bluish discoloration in his right index, middle, and ring fingers. He was a nonsmoker and reported having had no history of Raynaud's phenomenon, trauma, atrial fibrillation,...

    Case Records of the Massachusetts General Hospital
    1352-1360
    • CME

    A 15-year-old boy was seen in the outpatient cancer center because of a skin lesion that had recurred 13 months after excision. The recurrent lesion was excised, and a diagnosis of an atypical melanocytic lesion with features of melanoma was made.

    Editorial
    1362-1364

    Rheumatoid arthritis is a chronic, systemic inflammatory disease that affects close to 1% of the population. It is manifested principally as an attack on peripheral joints and may lead to marked destruction and deformity of joints, with considerable ...

    Sounding Board
    1365-1367

    The authors suggest that placebo-controlled trials in osteoporosis can, with appropriate safeguards, benefit some patients with osteoporosis and can be informative, provided that appropriate guidelines are used to exclude high-risk patients.

    1367-1370

    The authors suggest that placebo-controlled trials in osteoporosis are nearly always unethical, since several drugs that materially decrease the risk of fractures in such patients are currently available.

    Correspondence
    1371-1373

    To the Editor: We compliment the work of Kaminski et al. (May 13 issue)1 on quality indicators for colonoscopy. Given the enormity of colorectal cancer worldwide (more than 1 million cases annually), the quality of colonoscopy is a major public health ...

    1374

    To the Editor: Pham et al.1 reported that in a select population, a strategy of monitoring for cardiac allograft rejection that involved gene-expression profiling, as compared with routine biopsies, “was not associated with an increased risk of serious ...

    1375-1376

    To the Editor: In their article on the use of the transjugular intrahepatic portosystemic shunt (TIPS), García-Pagán et al.1 do not explain how cirrhosis was diagnosed in their study. Since a majority of patients had alcoholic cirrhosis, some of them may ...

    1377-1378

    To the Editor: In reference to the article by Loder (July 1 issue)1 on the use of triptans for the treatment of migraine, we would like to add acute and chronic ischemic colitis to the author's list of potential adverse effects of triptans25 (Figure 1). ...

    1378-1380

    To the Editor: Annas (June 3 issue)1 critiques national, consensus-driven efforts to define and craft crisis standards of care for catastrophic health emergencies involving scarce resources. He concludes that the movement supporting altered standards of ...

    1381-1382

    To the Editor: Since the outbreak of influenza A (H1N1) virus pandemic, almost 300 cases of infection with an oseltamivir-resistant influenza virus have been reported to the World Health Organization as of June 2010.1 These strains typically contain a ...

    1382-1383

    To the Editor: Clostridial toxic shock is a rare and largely fatal syndrome among reproductive-age women. Six cases were reported after medical abortions between 2000 and 2007.1,2 We report two additional cases, bringing the current U.S. rate of fatal ...

    Points of View
    e21

    We agree with some of the points made by Stein and Ray but disagree about their conclusions. As clinicians, we recognize that fractures reduce the quality of life of patients with osteoporosis and increase the risk of coexisting conditions. Hence, we ...

    e22

    Rosen and Khosla review the arguments that are often advanced to provide support for placebo-controlled fracture trials in osteoporosis, which we discuss in our article. The undeniable crux of these arguments is that such trials are the most direct and ...

    Corrections
    1383

    Bone Marrow Transplantation for Recessive Dystrophic Epidermolysis Bullosa Original Article, N Engl J Med 2010:363;629-639. The author list and affiliations (page 629) were incorrect as published: two additional authors (David T. Woodley, M.D., and Mei ...

    1383-1384

    Case 18-2010: A 7-Year-Old Boy with Elevated HIV RNA Levels despite Antiretroviral Medications Case Records of the Massachusetts General Hospital, N Engl J Med 2010:362;2305-2312. In Table 2 (page 2310), the first mutation detected for protease inhibitors ...

    1384

    Increased Mortality after Dronedarone Therapy for Severe Heart Failure Original Article, N Engl J Med 2008:358;2678-2687. In Table 1 (pages 2680 and 2681), the “Mean duration of heart failure — mo” for the placebo group should have been 23, rather than ...