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Table of contents for

January 13, 2011  Vol. 364 No. 2

Audio Summary of this Issue

Perspective
97-99
The Age-Old Struggle against the Antivaccinationists
G.A. Poland and R.M. Jacobson
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Today, the most recent in a long line of antivaccinationists are using modern media to sway public opinion and distract attention from scientific evidence. But there are steps we can take to avert the ill effects of these campaigns.

99-101
ACOs and the Enforcement of Fraud, Abuse, and Antitrust Laws
R.F. Leibenluft
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Hospitals and physicians eagerly await regulations for accountable care organizations (ACOs), which can share in Medicare's savings if they furnish efficient, high-quality care. But many worry that in creating ACOs they risk violating fraud, abuse, and antitrust laws.

102-103
Educating Physicians to Prevent Fraud, Waste, and Abuse
J.K. Taitsman
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To help fund expanded access to care, lawmakers propose to redouble the government's efforts to reduce health care fraud, waste, and abuse. Educating physicians about the relevant laws would help them to become partners in this mission.

Original Articles
105-115
Treatment of Acute Otitis Media in Children under 2 Years of Age
A. Hoberman and Others
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  • CME
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In this trial involving children with carefully diagnosed acute otitis media, treatment with amoxicillin–clavulanate for 10 days had a modest but measurable benefit with respect to the time to resolution of symptoms but was associated with an increased frequency of diarrhea and diaper-area dermatitis.

116-126
A Placebo-Controlled Trial of Antimicrobial Treatment for Acute Otitis Media
P.A. Tähtinen and Others
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  • Comments

In this study of stringently defined acute otitis media in children in Finland, amoxicillin–clavulanate was shown to significantly reduce the rate of treatment failure and the need for rescue treatment but was associated with more diarrhea and rash.

127-135
Cholesterol Efflux Capacity, High-Density Lipoprotein Function, and Atherosclerosis
A.V. Khera and Others
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In a cohort of healthy volunteers, cholesterol efflux capacity was correlated with carotid intima–media thickness. In a cohort of patients with or without angiographically confirmed coronary disease, cholesterol efflux capacity predicted coronary disease status.

136-145
Genetic Variant of the Scavenger Receptor BI in Humans
M. Vergeer and Others
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In a family with high HDL, a genetic mutation was identified. In addition to higher HDL levels, carriers had reduced cholesterol efflux from macrophages, impaired platelet function, and attenuated adrenal steroidogenesis. No significant difference was seen in the carotid artery intima–media thickness.

Clinical Therapeutics
146-156
Iron-Chelating Therapy for Transfusional Iron Overload
G.M. Brittenham
  • CME
  • Interactive/Multimedia

A 16-year-old boy with sickle cell anemia requires long-term red-cell transfusion. Prophylactic iron-chelating therapy is recommended. Iron chelators bind to plasma and intracellular iron and cause its excretion into urine or bile.

Images in Clinical Medicine
157
Auricular Cartilage Calcification and Adrenal Insufficiency
H. Uthoff and P. Wiesli
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A healthy 60-year-old man presented to the emergency department with profound hypotension 1 day after sustaining a minor hand laceration with minimal blood loss. Physical examination revealed stiffness in both ears, and calcification of the ears was ...

e3
Fungal Infection from Sweeping in the Wrong Place
T.H.C. Tang and O.T.Y. Tsang
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A 43-year-old man presented with fever, malaise, a nonproductive cough, and skin lesions near the left eyelid and eyebrow (Panel A) and left antecubital fossa (Panel B). The symptoms had developed during the course of several weeks. The patient underwent ...

Case Records of the Massachusetts General Hospital
158-166
Case 1-2011 — A 35-Year-Old Man with Fever, Bacteremia, and a Mass in the Left Atrium
A.W. Karchmer, T.E. MacGillivray, T.T. Healey, and J.R. Stone
  • CME

A 35-year-old man was admitted to the hospital because of fever, bacteremia, and a mass in the left atrium. Two weeks before admission, fever and shaking chills developed. A transesophageal echocardiogram showed a mass that was attached to the nonseptal side of the left atrium.

Editorials
168-169
Is Acute Otitis Media a Treatable Disease?
J.O. Klein
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In this issue of the Journal, investigators in Pittsburgh and in Turku, Finland, respond to the question of whether infants and young children with acute otitis media benefit from amoxicillin–clavulanate therapy initiated at the time of diagnosis.1,2 ...

170-171
HDL and Cardiovascular-Disease Risk — Time for a New Approach?
J. Heinecke

    Clinical and epidemiologic studies have consistently shown that low levels of high-density lipoprotein (HDL) cholesterol are strongly associated with an increase in the risk of coronary artery disease.1 Moreover, hypercholesterolemic mice with genetic ...

    Health Policy Report
    172-176
    Rapidly Evolving Physician-Payment Policy — More Than the SGR
    P.B. Ginsburg
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    Since 2002, the physician-payment policy that has been closest to home for practicing physicians has involved repeated down-to-the-wire congressional interventions to avert large Medicare payment rate cuts specified by the sustainable growth rate (SGR) ...

    Clinical Implications of Basic Research
    177-178
    Reprogramming Fibroblasts into Cardiomyocytes
    C.E. Murry and W.T. Pu

      The transdifferentiation of one differentiated cell type into another is the focus of much research activity. A recent study shows that mouse fibroblasts can be transdifferentiated, albeit with low efficiency, into cardiomyocytes.

      Correspondence
      179-181
      Transcatheter Aortic-Valve Implantation for Aortic Stenosis
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      To the Editor: Although Leon et al. (Oct. 21 issue)1 report that transcatheter aortic-valve implantation (TAVI) is better than standard therapy, a look at the Placement of Aortic Transcatheter Valves (PARTNER) trial shows that this conclusion is ...

      181-182
      Induced Pluripotent Stem Cells in Long-QT Syndrome
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      To the Editor: Moretti et al. (Oct. 7 issue)1 report that patient-derived pluripotent stem cells recapitulated features of a cardiac disorder through reprogramming. The authors clearly show the directed differentiation of such stem cells into functional ...

      182-185
      Rapid Molecular Detection of Tuberculosis
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      To the Editor: Boehme et al. (Sept. 9 issue)1 report encouraging results on the use of an automated molecular test for Mycobacterium tuberculosis and resistance to rifampin (Xpert MTB/RIF). However, the population of patients with clinical tuberculosis ...

      185-188
      Therapeutic Hypothermia after Cardiac Arrest
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      To the Editor: The midazolam dose of 0.15 mg per kilogram of body weight per hour described in the article by Holzer (Sept. 23 issue)1 and in other articles on therapeutic hypothermia2 is very similar to the recommended dose of midazolam used to adapt ...

      188-189
      Update of the ACCORD Eye Study
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      To the Editor: We wish to update our report on the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Eye study (July 15, 2010, issue).1 We made a mistake in the calculation of vision loss that also affected another article.2 Our intent was to ...

      189-190
      A Controlled Trial of a Prostacyclin and rt-PA in the Treatment of Severe Frostbite
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      To the Editor: Many alternatives have been proposed for the treatment of frostbite: hemodilution, platelet-aggregation inhibitors, low-molecular-weight heparin, alpha-adrenergic vasodilators, calcium-channel inhibitors, nonsteroidal antiinflammatory ...

      Videos in Clinical Medicine
      e4
      Tympanocentesis in Children with Acute Otitis Media
      N. Shaikh, A. Hoberman, D.H. Kearney, and R. Yellon

        Tympanocentesis involves needle aspiration of fluid from the middle ear. The technique permits drainage of pus from the middle ear, identification of pathogens, and pressure relief. This video demonstrates tympanocentesis.

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