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October 21, 2010  Vol. 363 No. 17

Audio Summary of this Issue

Perspective
1589-1591

On September 28, the Accreditation Council for Graduate Medical Education (ACGME) released new standards to which residency programs must adhere or risk losing their accreditation. Recognizing societal demands for improved patient safety, the task force ...

1591-1593

The federal system for protecting research subjects was designed decades ago, when most research studies took place at a single institution. These days, if a study is conducted at multiple sites, an ethics review by an institutional review board (IRB) may ...

1593-1595

On September 7, 2010, Consumers Union (publisher of Consumer Reports) reported the results of coronary-artery bypass grafting (CABG) procedures at 221 U.S. cardiac surgery programs.1 The voluntary reporting of risk-adjusted outcomes in approximately 20% ...

Original Articles
1597-1607

Patients with aortic stenosis underwent transfemoral transcatheter implantation of a balloon-expandable bovine pericardial aortic valve. One-year mortality was lower with the balloon-expandable valve than with standard therapy, but the risk of stroke was higher.

1608-1620

Weekly home monitoring of warfarin anticoagulation was not superior to monthly clinic testing in reducing the time to first stroke, major bleeding, or death, but it was associated with improved time within the target INR range, satisfaction with therapy, and quality-of-life scores.

1621-1630

This study showed near-universal expression of FSH receptors on a subgroup of tumor-vessel endothelial cells in a band near the outer edge of tumors where they interface with normal tissue. FSH receptors may be exploitable clinically for imaging and treatment delivery.

1631-1637

CHUK encodes a subunit of a protein complex that influences cell proliferation and survival. The authors describe severe malformations in two fetuses with an autosomal recessive deficiency in CHUK.

Review Article
1638-1647

This review traces the development of the embryonic heart from a simple midline tube to the four-chambered structure of the adult heart. Recent research has uncovered findings that will influence the classification and management of congenital heart disease.

Clinical Therapeutics
1648-1655

A 66-year-old man presents with a 2-week history of blurred and distorted vision in his right eye. A retinal specialist diagnoses neovascular age-related macular degeneration (AMD) and recommends treatment with ranibizumab.

Images in Clinical Medicine
1656
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A 61-year-old man with mild cognitive impairment and a seizure disorder from traumatic brain injury sustained 3 years earlier presented to the emergency department while having a cluster of complex partial seizures. He had been receiving levetiracetam ...

e27
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A 37-year-old man with insulin-dependent diabetes who had undergone kidney transplantation 7 years earlier presented with delirium caused by diabetic ketoacidosis. His calculated serum osmolarity peaked at 304 mOsm per liter, and the serum glucose level ...

Case Records of the Massachusetts General Hospital
1657-1665

A woman at 34 weeks of gestation presented with sudden abdominal pain, most severe in the right lower quadrant. Imaging revealed peritoneal fluid. After delivery, pain decreased but recurred suddenly the next day, with hypotension. A procedure was performed.

Editorial
1667-1668

Aortic-valve replacement is the most effective treatment to alleviate symptoms and improve survival in patients with critical aortic stenosis. The incidence of aortic stenosis multiplies with age, and as the life span of our population increases, a larger ...

Clinical Implications of Basic Research
1669-1671

    A study involving mouse models of retinitis pigmentosa examines one of four possible approaches to its treatment in humans.

    Correspondence
    1672-1675

    To the Editor: For patients with newly diagnosed chronic myeloid leukemia (CML) in the chronic phase, a complete cytogenetic response at 12 months is widely accepted as an optimal response.1 This response was used as a primary end point in the trial of ...

    1675-1677

    To the Editor: Khor et al. (June 3 issue)1 show that variants of the cytokine-inducible SRC homology 2 (SH2) domain protein (CISH) gene are associated with susceptibility to diverse infections and suggest that negative regulators of cytokine signaling ...

    1677-1679

    To the Editor: Zuckerman et al. (July 1 issue)1 support the status quo regarding geographic differences in Medicare payment, asking policymakers to “resist the appeal of simple solutions.” Yet they, themselves, take the easy road by simply relying upon ...

    1679

    To the Editor: Reproductive medicine continually confronts new ethical frontiers, as illustrated by a recently published case (July 15 issue).1 Although similar cases with men and sperm retrieval have been observed, posthumous oocyte retrieval is new.

    ...

    1679-1680

    To the Editor: The Accreditation Council for Graduate Medical Education (ACGME) is to be applauded for its response to the 2008 Institute of Medicine (IOM) report and the process of soliciting input from stakeholder organizations to prepare the new ...

    1680-1681

    To the Editor: Vincenzi et al. (July 22 issue)1 report on the off-label use of the antiemetic agent aprepitant in the management of pruritus in patients with cancer who are receiving erlotinib. Erlotinib is an oral drug that is incompletely absorbed (...

    1681-1682

    To the Editor: Over the past year, we have observed three instances in which patients with advanced cancer received blood products solely for the purpose of altering a laboratory value to satisfy eligibility criteria for clinical trials of new ...

    Corrections
    1682

    The Disclosure Dilemma — Large-Scale Adverse Events Health Law, Ethics, and Human Rights, N Engl J Med 2010;363:978-986. In Table 1 (page 980), in the Event and Location column, the location of the Fremont Cancer Center should have been “Fremont, NE,” ...

    1682

    Prosthetic-Valve Dehiscence Images in Clinical Medicine, N Engl J Med 2010;362:e20. In the second sentence (page e20), the parenthetical information should have read “Bjork–Shiley and ATS Medical, respectively,” rather than “Medtronic Hall and ATS Medical,...

    1682

    Emergence of Extensive Drug Resistance during Treatment for Multidrug-Resistant Tuberculosis Correspondence, N Engl J Med 2008;359:2398-2400. The penultimate paragraph (page 2399) should have ended with, “These data point to the risk of nosocomial ...