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Table of contents for

June 30, 2011  Vol. 364 No. 26

Audio Summary of this Issue

Perspective
2473-2475
Assessing the Safety of Adding LABAs to Inhaled Corticosteroids for Treating Asthma
B.A. Chowdhury, S.M. Seymour, and M.S. Levenson

    The FDA has issued a requirement for manufacturers of long-acting beta-agonists (LABAs) marketed for asthma to conduct controlled clinical trials to assess the safety of a regimen of LABAs plus inhaled corticosteroids as compared with inhaled corticosteroids alone.

    2476-2478
    A Model Health Care Delivery System for Medicaid
    R.E. Rieselbach and A.L. Kellermann
    • Free Full Text

    Community Health Center (CHC)–Academic Medical Partnerships (CHAMPs) would combine academic medical centers' subspecialist expertise, technology, and inpatient care with CHCs' primary care expertise, creating a distinctive form of accountable care organization.

    2478-2481
    Comparative Effectiveness Research and Patients with Multiple Chronic Conditions
    M.E. Tinetti and S.A. Studenski
    • Free Full Text

    To achieve its goals, comparative-effectiveness research (CER) must address health care's greatest consumers: patients with multiple chronic conditions. The complexity of this population's conditions and treatments makes the necessary studies difficult to conduct.

    Original Articles
    2483-2495
    Mortality after Fluid Bolus in African Children with Severe Infection
    K. Maitland and Others
    • Free Full Text
    • Comments

    In this study from sub-Saharan Africa, children with severe febrile illness and impaired perfusion were randomly assigned to fluid-bolus therapy or no bolus. Albumin or saline boluses significantly increased 48-hour mortality in critically ill children with impaired perfusion.

    2496-2506
    Clinical Effect of Point Mutations in Myelodysplastic Syndromes
    R. Bejar and Others
    • Free Full Text

    About half the patients with a myelodysplastic syndrome have one of several genetic mutations. The authors describe some new genetic lesions and show that the presence of a mutation adversely affects the prognosis, over and above the clinical features.

    2507-2516
    Improved Survival with Vemurafenib in Melanoma with BRAF V600E Mutation
    P.B. Chapman and Others
    • Free Full Text
    • CME

    In patients with advanced melanomas with the BRAF V600E mutation, vemurafenib produced a response in nearly half the patients; secondary skin tumors, arthralgia, rash, and fatigue were side effects. Dacarbazine produced a response in 6%.

    2517-2526
    Ipilimumab plus Dacarbazine for Previously Untreated Metastatic Melanoma
    C. Robert and Others
    • Free Full Text

    Ipilimumab has been shown to improve survival in patients with previously treated metastatic melanoma. In this study, ipilimumab plus dacarbazine improved survival in patients with previously untreated metastatic melanoma.

    Clinical Therapeutics
    2527-2534
    Antitrypanosomal Therapy for Chronic Chagas' Disease
    C. Bern
    • CME

    A 42-year-old woman presents after donating blood and receiving a report that she is positive for Chagas' disease. Chagas' disease is caused by a parasite and is endemic in many parts of Latin America.

    Images in Clinical Medicine
    2535
    Thrombosis of the Inferior Vena Cava and Dilated Veins of the Trunk
    C. Roncato and P.Y. Lefant
    • Free Full Text

    An 82-year-old man presented for evaluation of chronic, progressive edema of the legs. He had a history of deep venous thrombosis of the right leg, pulmonary embolism, and the subsequent insertion, 15 years ago, of an inferior vena cava filter.

    e56
    Dependent Rubor
    G. Uzun and M. Mutluoglu
    • Free Full Text

    A 45-year-old man was referred for evaluation of a painful and erythematous right foot. He had a 12-year history of type 2 diabetes and a 25-pack-year history of smoking. The right foot was deeply erythematous, edematous, and cool to the touch.

    Case Records of the Massachusetts General Hospital
    2536-2541
    Case 20-2011 — A 30-Year-Old Man with Diarrhea after a Trip to the Dominican Republic
    E.T. Ryan, L.C. Madoff, and M.J. Ferraro
    • CME

    A 30-year-old man was seen in the emergency room of this hospital because of the acute onset of diarrhea 2 days after his return from a trip to the Caribbean. He was afebrile, and the diarrhea was watery without blood. A diagnostic test was performed.

    Editorials
    2543-2544
    Fluid Resuscitation in Acute Illness — Time to Reappraise the Basics
    J.A. Myburgh

      Fluid resuscitation is a fundamental intervention in the treatment of critically ill patients. However, there is little conclusive evidence to guide clinicians about the best type of resuscitation fluid; the appropriate timing, volume, and rate of fluid ...

      2545-2546
      The Dawn of the Molecular Era of the Myelodysplastic Syndromes
      O. Odenike and M.M. Le Beau

        The myelodysplastic syndromes are a heterogeneous group of clonal hematopoietic stem-cell diseases characterized by cytopenias, dysplasia in one or more of the myeloid cell lines, ineffective hematopoiesis, and an increased risk of acute myeloid leukemia....

        2547-2548
        Been There, Not Done That — Melanoma in the Age of Molecular Therapy
        M.S. Ernstoff

          In 1976, the detection of estrogen-receptor expression in melanomas ushered in the era of targeted therapy in melanoma, although we did not use that term back then.1 In 1992, Cocconi et al. found that dacarbazine plus tamoxifen provided a higher response ...

          Clinical Implications of Basic Research
          2549-2551
          Lessons from Sickle Cell Disease in the Treatment and Control of Malaria
          P.J. Rosenthal

            Persons with sickle cell disease and carriers of the trait are protected against malaria. A study of mice infected with a plasmodium species similar to Plasmodium falciparum provides insight into how the severity of infection in humans may be modulated.

            Correspondence
            2552-2554
            Tiotropium versus Salmeterol in COPD
            • Free Full Text

            To the Editor: The article on the Prevention of Exacerbations with Tiotropium in COPD (POET-COPD) trial (ClinicalTrials.gov number, NCT00563381) by Vogelmeier et al. (March 24 issue)1 provides valuable information on choosing between inhaled therapies to ...

            2554-2556
            Prenatal versus Postnatal Repair of Myelomeningocele
            • Free Full Text

            To the Editor: In the report on the results of the Management of Myelomeningocele Study (MOMS) (March 17 issue),1 a randomized trial comparing the efficacy of prenatal repair of myelomeningocele with that of postnatal repair, Adzick et al. state that ...

            2556-2558
            Anti-IgE for Asthma in Inner-City Children
            • Free Full Text

            To the Editor: As Busse et al. report (March 17 issue),1 inner-city children, adolescents, and young adults with atopic asthma who were treated with omalizumab had reductions in asthmatic episodes, particularly if the patients were sensitized to ...

            2558-2559
            Adolescent BMI and Risk of Diabetes versus Coronary Disease
            • Free Full Text

            To the Editor: Tirosh et al. (April 7 issue)1 do not emphasize two crucial points. First, the metabolic syndrome is an inflammatory, prothrombotic, prehypertensive, atherogenic dyslipidemic, and prediabetic state.2,3 Insulin resistance and excess weight ...

            2559-2560
            Care of Transsexual Persons
            • Free Full Text

            To the Editor: In his article in which guidelines and supporting evidence are presented for the treatment of gender dysphoria, Gooren (March 31 issue)1 says, “Hormonal treatment should . . .be preceded and accompanied by an extended period (at least 1 ...

            2560-2561
            Teaching Clinicians about Drugs
            • Free Full Text

            To the Editor: In his Perspective article (March 31 issue),1 Avorn highlights the need for high-quality, unbiased physician education regarding drug therapies. Although public policy is important, pharmacists already serve as knowledgeable and accessible ...

            2561-2563
            Eculizumab in Severe Shiga-Toxin–Associated HUS
            • Free Full Text

            This letter reports treatment of three children with severe, dialysis-requiring Shiga-toxin–induced hemolytic–uremic syndrome (HUS) with eculizumab, a monoclonal anti-C5 antibody. The condition of all three children improved rapidly.

            2563-2564
            Investigation of a Researcher's Death Due to Septicemic Plague
            • Free Full Text

            This letter identifies the death of a researcher from infection with disseminated Yersinia pestis, which he was working with in the lab. It was subsequently determined that he had hemochromatosis, a condition that may have increased his susceptibility to this infection.

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