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May 10, 2012  Vol. 366 No. 19

Audio Summary of this Issue

Perspective
1749-1752
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Human immunodeficiency virus and hepatitis B virus exact a high toll worldwide. Both can lead to chronic disease, cancer, and death, and neither can be eradicated with the use of current therapies. Coinfection with the two viruses represents a major global health problem.

1752-1755

The Food and Drug Administration has added information to statin labels regarding an effect on diabetes, noting reported increases in glycated hemoglobin and fasting serum glucose levels but adding that it believes that the cardiovascular benefits outweigh the risks.

1755-1757
  • Interactive/Multimedia

Between 2000 and 2008, measles control improved markedly worldwide, but with poorer countries focused on polio eradication and some richer countries falling prey to opposition to vaccination, the measles genie seems to have slipped out of the bottle in recent years.

e29
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Since the spending targets in Medicare's new accountable care organization (ACO) programs are being set on the basis of national, rather than local, rates of spending growth, ACOs could gain or lose financially without altering their delivery of care.

Original Articles
1759-1769

Patients treated with an induction regimen of melphalan, prednisone, and lenalidomide followed by lenalidomide maintenance therapy had longer progression-free survival than those who did not receive maintenance therapy.

1770-1781

In patients who had undergone stem-cell transplantation, lenalidomide maintenance therapy improved progression-free and overall survival, though at the expense of some increased hematologic toxicity and second malignant tumors.

1782-1791

Lenalidomide maintenance after stem-cell transplantation significantly prolonged progression-free and event-free survival in patients with multiple myeloma. At 4 years, overall survival was similar in the lenalidomide-treated and placebo-treated groups.

1792-1802

In a randomized trial, performance of percutaneous coronary intervention (PCI) at hospitals without cardiac surgery on site was noninferior to PCI performed at hospitals with cardiac surgery on site with respect to mortality at 6 weeks and major adverse cardiac events at 9 months.

1803-1813

In this study, the risk of birth defects was increased with IVF but was no longer significant after adjustment for maternal factors. The risk of birth defects associated with intracytoplasmic sperm injection remained higher after multivariate adjustment. Residual confounding cannot be ruled out.

Review Article
1814-1823
  • CME

PCIs for acute coronary disease are increasingly being performed at centers without on-site surgical backup. This review summarizes the safety and the efficacy of this practice, along with the policy implications, including those for patients undergoing elective procedures.

Images in Clinical Medicine
1824

A 62-year-old man with chronic renal insufficiency reported having reduced exercise tolerance for the previous week. The physical examination was unremarkable, but oxygen saturation was diminished.

e30
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A 3-year-old girl presented with a 3-week history of low back pain. Physical examination revealed mild tenderness over the upper lumbar spine.

Case Records of the Massachusetts General Hospital
1825-1834
  • CME

A 43-year-old woman with a history of atopic dermatitis was admitted to the hospital because of fever and a generalized painful, pruritic rash involving the entire body. Examination revealed vesicles, pustules, and erosions with scalloped borders. A diagnostic test result was received.

Editorial
1836-1838

With the introduction of high-dose therapy and new agents, outcomes of treatment have improved considerably for patients with myeloma.1 As therapy has become more effective, the goals of therapy have wavered between fixed-duration therapy aimed at ...

Correspondence
1839-1840

To the Editor: In their article on the results of the SAVE-ONCO study (ClinicalTrials.gov number, NCT00694382), which showed that semuloparin reduced the risks of deep-vein thrombosis in the lower or upper limbs and pulmonary embolism among patients ...

1840

To the Editor: The mean platelet volume (MPV), analogous to the calculation of the mean corpuscular volume, is calculated as the plateletcrit divided by the total number of platelets. Although the MPV is readily available on a routine blood count, many ...

1841-1842

To the Editor: The results of facial transplantation presented by Pomahac et al. (Feb. 23 issue)1 are encouraging. Nevertheless, in this article (and in others by the same authors and other groups), we would have liked to see a detailed, preoperative ...

1842-1843

To the Editor: Donohue et al. (Feb. 9 issue)1 report regional variation in Medicare Part D drug spending resulting largely from differences in the cost of drugs. It is important to note, however, that this study may not have captured in full the ...

1843-1845

Telangiectasias, erythrocytosis, monoclonal gammopathy, perinephric-fluid collection, and intrapulmonary shunting are characteristic of the TEMPI syndrome. A case report documents improvement with bortezomib, a drug used in the treatment of myeloma.

1845-1846

A patient with chronic weakness, muscle cramps, paresthesia, gait disturbance, somnolence, and cognitive impairment was found to be magnesium deficient. However, no source of magnesium loss could be identified. Her symptoms resolved with magnesium repletion.