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February 2, 2012 Vol. 366 No. 5

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Perspective

389-391

Assessing Supplement Safety — The FDA's Controversial Proposal

P.A. Cohen

Audio
Comments

By law, dietary supplements whose ingredients were not sold in the United States before 1994 require demonstration of a “reasonable expectation of safety” — a currently unenforced requirement. Will the FDA's proposed new guidance in this area be adequate?

391-393

Improving Childhood Vaccination Rates

D.S. Diekema

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U.S. parents who decline or delay selected vaccinations or refuse to vaccinate their children are a diverse group. Vaccine coverage can be increased by focusing on parents who encounter barriers to obtaining vaccines or hesitate because of fears about safety.

393-395

Keeping Score under a Global Payment System

B.E. Landon

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Global payment could change the perverse incentives inherent in the fee-for-service system. But accountable care organizations that track their member physicians' earnings according to standard fees for service will undermine the purpose of the approach.

395-397

Opportunity in Austerity — A Common Agenda for Medicine and Public Health

N.W. Stine and D.A. Chokshi

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Government austerity is likely to hit public health programs hard, as these programs compete for funds against the health care delivery juggernaut. But such an approach seems likely to hamper efforts to improve population health and reduce medical spending.

Original Articles

399-408

ABVD Alone versus Radiation-Based Therapy in Limited-Stage Hodgkin's Lymphoma

R.M. Meyer and Others

CME
Comments

In patients with limited-stage Hodgkin's disease, ABVD chemotherapy alone resulted in a higher rate of long-term (12-year) survival than either radiation therapy alone or radiation therapy plus ABVD chemotherapy, with significantly fewer late treatment-related deaths.

409-420

Ulipristal Acetate versus Placebo for Fibroid Treatment before Surgery

J. Donnez and Others

In this trial involving women with symptomatic fibroids who were planning to undergo surgery, treatment with the selective progesterone-receptor modulator ulipristal acetate was effective in controlling excessive bleeding and reducing fibroid size at 13 weeks.

421-432

Ulipristal Acetate versus Leuprolide Acetate for Uterine Fibroids

J. Donnez and Others

In this trial comparing oral ulipristal acetate (5 mg or 10 mg daily) with once-monthly leuprolide acetate in women with symptomatic uterine fibroids before planned surgery, both doses of ulipristal acetate were noninferior to leuprolide acetate in controlling uterine bleeding.

433-442

GAD65 Antigen Therapy in Recently Diagnosed Type 1 Diabetes Mellitus

J. Ludvigsson and Others

This trial assessed alum-formulated glutamic acid decarboxylase, the 65-kD isoform (GAD65), a major autoantigen in type 1 diabetes. In patients with recent-onset disease; the compound did not significantly alter the loss of C peptide or improve clinical outcomes.

Clinical Practice

443-453

Delayed Puberty

M.R. Palmert and L. Dunkel

CME
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Puberty is considered delayed when it has not yet occurred at an age that is 2 to 2.5 SD later than average (traditionally, 14 years in boys and 13 years in girls). Constitutional delay of growth and puberty (CDGP) is the most common cause. Management of CDGP is discussed.

Review Article

454-461

200th Anniversary Article: The Perpetual Challenge of Infectious Diseases

A.S. Fauci and D.M. Morens

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Interactive/Multimedia
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During the past 200 years, our understanding of infectious diseases has radically evolved from the identification of microbes, to defining their genetic structure, to the development of focused antimicrobial therapies, to the realization of vector biology. This article highlights the tremendous advances that have been made in the field.

Images in Clinical Medicine

462

Post-Traumatic Herniated Cervical Disk

S. Diabira and X. Morandi

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An 18-year-old man with no notable medical history had sudden transient tetraplegia after heading a soccer ball. Ten minutes later, he had recovered normal strength. On examination, he had intense cervical pain, paresthesias on his shoulders and arms, and no other neurologic deficits.

Insulin-Induced Lipohypertrophy

S. Landau

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A 55-year-old man with a 31-year history of type 1 diabetes mellitus presented for a routine clinical evaluation, his first in two decades. His insulin regimen consisted of a combination of neutral protamine Hagedorn (NPH) and rapid-acting insulin. In the ...

Clinical Problem-Solving

463-468

Worth a Second Look

T.M. Berzin, N.J. Greenberger, B.D. Levy, and J. Loscalzo

Comments

A 72-year-old man presented to his physician for evaluation of fatigue and weight loss. Over the previous 8 months, the patient had lost 16 kg (35 lb) and had begun having up to 10 loose stools per day. There was no history of blood in the stool, fever, chills, or rash.

Editorials

470-471

Chemotherapy Alone for Early-Stage Hodgkin's Lymphoma

D.J. Straus

Extensive radiation therapy was the first therapeutic advance in the treatment of early-stage Hodgkin's lymphoma. More recently, less extensive radiation therapy in combination with chemotherapy has resulted in the lowest reported rates of early relapse. ...

471-473

Uterine Fibroids and Evidence-Based Medicine — Not an Oxymoron

E.A. Stewart

The 2011 report from the Agency for Healthcare Research and Quality on comparative management of uterine fibroids noted, “Despite the prevalence and possible complications of uterine fibroids, few published studies examining the effectiveness of treatment ...

Correspondence

474-476

Timing of Antiretroviral Therapy for HIV-1–Associated Tuberculosis

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To the Editor: Three randomized trials reported by Blanc et al.,¹ Havlir et al.,² and Abdool Karim et al.³ (Oct. 20 issue) consolidate the evidence base underpinning recommendations on when to start antiretroviral therapy (ART) in patients with human ...

476-477

Glucocorticoids plus N-Acetylcysteine in Alcoholic Hepatitis

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To the Editor: The study by Nguyen-Khac et al. (Nov. 10 issue)¹ sidesteps old contentious issues regarding the use of glucocorticoid therapy in alcoholic hepatitis. Among the 8 references cited in support of glucocorticoid treatment, 2 in fact concluded ...

477-479

Early Liver Transplantation for Severe Alcoholic Hepatitis

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To the Editor: The study reported by Mathurin et al. (Nov. 10 issue)¹ could have a strong impact on living-donor liver transplantation.

Mandatory alcohol abstinence before deceased-donor liver transplantation serves two purposes: evaluation of compliance,...

480-481

Ultraviolet A and Photosensitivity during Vemurafenib Therapy

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The BRAF inhibitor, vemurafenib, is associated with photosensitivity. This small study identifies ultraviolet A (UVA) as the active agent. UVA blockers may be effective in preventing photosensitivity among patients taking vemurafenib.

481-482

Staphylococcus aureus Reactivation Osteomyelitis after 75 Years

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In this case report, Staphylococcus aureus was found to persist in an 85-year-old woman 75 years after the successful treatment of osteomyelitis during her childhood.

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February 2, 2012 Vol. 366 No. 5

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