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November 4, 2010  Vol. 363 No. 19

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Perspective
1781-1784

Multidrug-resistant (MDR) tuberculosis is a treatable, airborne infectious disease that killed an estimated 1.5 million people between 2000 and 2009 — an annual rate 10 times that of the H1N1 influenza virus.1,2 During this period, barely 0.5% of the ...

1784-1786

U.S. academic medical centers (AMCs) are facing new challenges to their financial well-being. As payers seek to control health care costs, teaching hospitals and their medical staffs can anticipate continued payment reductions. Under the fee-for-service ...

1786-1789

    The patient looks better than I expected. Investigations for a septic episode revealed a liver replaced by tumor, the primary obscure. He cuts a handsome figure at 70. His handshake is brisk, his expression open and warm.

    “Hello,” I greet him. “I'm the ...

    Original Articles
    1791-1800
    • Free Full Text
    • CME

    The authors examined the incidence of thromboembolic events associated with off-label use of rFVIIa in patients with bleeding problems. Coronary arterial thrombotic events and abnormal clotting among older patients were more common with rFVIIa than with placebo.

    1801-1811

    Neurosurgical resection is standard for subependymal giant-cell astrocytomas (SEGAs) in tuberous sclerosis. Treatment with everolimus, which inhibits the mammalian target of rapamycin, a protein regulated by gene products involved in tuberous sclerosis, resulted in reduced SEGA volume and seizures.

    1812-1821

    Brentuximab vedotin is a drug immunoconjugate with an antibody targeting CD30, an antigen expressed mainly on Hodgkin's and anaplastic large-cell lymphomas, linked to a potent microtubule inhibitor. In a study involving 45 patients after relapse, 11 complete remissions were observed.

    Special Article
    1822-1832
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    In the 1990s, administration of GnRH agonists for prostate cancer was profitable for physicians, and the use of these drugs increased substantially. After Medicare reduced reimbursement in 2004, the use of GnRH agonists decreased.

    Review Article
    1833-1845
    • CME

    The expansion of dialysis into a form of long-term renal-replacement therapy has transformed nephrology and created a new area of science: the physiology of the artificial kidney. This review describes the medical, social, and economic evolution of hemodialysis therapy.

    Images in Clinical Medicine
    1846
    • Free Full Text

    A 60-year-old woman underwent multislice whole-body computed tomography for staging of a high-risk melanoma of the anus. The examination revealed no metastases but did reveal a round, calcified structure in the mid-maxilla (Panel A, arrow). In the ...

    e29
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    • Video

    An otherwise healthy 40-year-old man presented with a 3-week history of paresthesia and inability to control his hands. Physical examination revealed generalized areflexia, marked loss of position sense, loss of feeling in a glove-and-stocking ...

    Clinical Problem-Solving
    1847-1851
    • CME

    A 60-year-old man presented with a report of increasing frequency of urination, nighttime urination, and increasing thirst. He reported no dysuria, urgency, incomplete bladder emptying, straining to initiate urination, fevers, chills, arthralgias, or rash.

    Editorial
    1853-1854

    The seminal discovery that a recombinant activated factor VII (rFVIIa) could be produced led to new treatments in hemophilia. The initial licensure of this product was to produce hemostasis in patients with hemophilia who had factor VIII and IX ...

    Health Law, Ethics, and Human Rights
    1855-1862

    Several federal laws have encouraged the development of new drugs by offering longer market exclusivity. The author discusses unintended consequences of these policies and the need for more carefully designed regulations to encourage pharmaceutical innovation.

    Clinical Implications of Basic Research
    1863-1864

      The Z deficiency allele (PI*Z) of SERPINA1, which encodes the serine protease inhibitor (PI) alpha1-antitrypsin, results in the formation of intrahepatic inclusions that cause cirrhosis. The only curative therapy for patients with severe liver disease is ...

      Correspondence
      1865-1867

      To the Editor: In their study involving elderly men with impaired mobility, Basaria et al. (July 8 issue)1 found that men who received testosterone treatment, as compared with those who received placebo, had a higher rate of cardiovascular adverse ...

      1867-1869

      To the Editor: Wu et al. (July 8 issue)1 propose a new definition of late-onset hypogonadism in men that is based on a symptom score in combination with a testosterone threshold. In his editorial, Bremner concludes that their findings will be of value in ...

      1870-1871

      To the Editor: The Perspective article by Modlin1 and the articles on polio immunization by Mohammed et al.2 and Jenkins et al.3 (June 24 issue) reflect the dilemma of eradication: it cannot be accomplished without discontinuing the use of the oral ...

      1871-1873

      To the Editor: In their article on treating acute tears in the anterior cruciate ligament (ACL), Frobell et al. (July 22 issue)1 conclude that early ACL reconstruction is not superior to a strategy of initial rehabilitation with delayed reconstruction. ...

      1873-1874

      To the Editor: Arana and colleagues (Aug. 5 issue)1 report an increased incidence of attempted and completed suicides among nonepileptic patients with depression who received antiepileptic drugs, as compared with such patients who did not receive drugs ...

      1874-1875

      To the Editor: In the Case Record (July 29 issue)1 involving a patient with renal lymphangiectasis, secondary polycythemia, and monoclonal gammopathy of undetermined significance (MGUS), Sykes states that “we recommended that the patient begin a course ...

      1875-1876

      To the Editor: We wish to update our article about the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial (Sept. 17, 2009, issue).1 After the database was locked on August 15, 2009, we identified several additional primary efficacy ...

      Corrections
      1877

      Use of Diuretics in Patients with Hypertension Review Article, N Engl J Med 2009;361:2153-2164. In Table 3 (page 2161), under “Possible Solution,” the parenthetical information in the entry beginning, “Sulfa antibiotic allergy . . .” should have read, “a ...

      1877

      Dicer, Drosha, and Outcomes in Patients with Ovarian Cancer Original Article, N Engl J Med 2008;359:2641-2650. In the Validation subsection of Methods (page 2643), the final sentence should have begun, “Probe sets 212888_at and 218269_at were used . . .,” ...