NEJM â Collection Updates for Pulmonary Disease

CLINICAL PROBLEM-SOLVING: Under Pressure

Thu, 04Â FebÂ 2010 00:00:00 -05:00

A 25-year-old woman presented to her local hospital with dyspnea. She described a 2-year history of progressive shortness of breath on exertion. One year earlier she was able to walk...

PERSPECTIVE: Tobacco Control and Free Speech â An American Dilemma

Thu, 28Â JanÂ 2010 00:00:00 -05:00

On June 22, 2009, President Barack Obama signed the Family Smoking Prevention and Tobacco Control Act. This landmark legislation, which passed the House by a vote of 307 to 97...

IMAGES IN CLINICAL MEDICINE: Hydropneumothorax

Ping-Hsien Chen, M.D. and Xi-Zhang Lin, M.D. — Thu, 21Â JanÂ 2010 00:00:00 -05:00

A 47-year-old man with a history of cirrhosis associated with alcohol abuse presented with a 2-day history of shortness of breath. Before this symptom developed, he had been treated with...

EDITORIAL: The Shrinking Heart in Chronic Obstructive Pulmonary Disease

Anton Vonk-Noordegraaf, M.D. — Thu, 21Â JanÂ 2010 00:00:00 -05:00

In patients with emphysema, the cardiac silhouette on the radiograph is typically long and narrow. The common explanation for this finding is the altered, more vertical position of the heart...

IMAGES IN CLINICAL MEDICINE: Extramedullary Hematopoiesis Associated with Î²-Thalassemia

Edward Smitaman, M.D. and Ami N. Rubinowitz, M.D. — Thu, 21Â JanÂ 2010 00:00:00 -05:00

A 47-year-old woman of Italian descent with a history of transfusion-dependent Î²-thalassemia intermedia presented to the emergency department with dyspnea that had worsened during the previous several days. The physical...

ORIGINAL ARTICLE: Percent Emphysema, Airflow Obstruction, and Impaired Left Ventricular Filling

Thu, 21Â JanÂ 2010 00:00:00 -05:00

Background: Very severe chronic obstructive pulmonary disease causes cor pulmonale with elevated pulmonary vascular resistance and secondary reductions in left ventricular filling, stroke volume, and cardiac output. We hypothesized that...

IMAGES IN CLINICAL MEDICINE: Postoperative Tracheal Stenosis

Avijit Datta, M.D. and Alex Cale, F.R.C.S. — Thu, 14Â JanÂ 2010 00:00:00 -05:00

A 45-year-old woman presented for an assessment of breathlessness. She had been receiving inhaled bronchodilators and corticosteroids for years without improvement. Her medical history was notable for prolonged endotracheal intubation...

EDITORIAL: Immune Evasion by Chimeric Trachea

Megan Sykes, M.D. — Thu, 14Â JanÂ 2010 00:00:00 -05:00

The types of allogeneic organs and tissues that can be transplanted have expanded considerably in the past three decades. In addition to organs such as liver, heart, lungs, and pancreas,...

ORIGINAL ARTICLE: Tracheal Allotransplantation after Withdrawal of Immunosuppressive Therapy

Thu, 14Â JanÂ 2010 00:00:00 -05:00

Reconstruction of long-segment tracheal defects requires a vascularized allograft. We report successful tracheal allotransplantation after indirect revascularization of the graft in a heterotopic position. Immunosuppressive therapy was administered before the...

IMAGES IN CLINICAL MEDICINE: Radiation Pneumonitis after Radiotherapy for Breast Cancer

Edwin BÃ¶lke, M.D. and Christiane Matuschek, M.D. — Thu, 31Â DecÂ 2009 00:00:00 -05:00

A 58-year-old woman with a history of stage I cancer in the right breast (T1N0M0, according to the tumorânodeâmetastasis classification) presented with a 2-week history of shortness of breath and...

CORRESPONDENCE: Human GM-CSF Autoantibodies and Reproduction of Pulmonary Alveolar Proteinosis

Thu, 31Â DecÂ 2009 00:00:00 -05:00

To the Editor: Idiopathic pulmonary alveolar proteinosis is a rare disease in which surfactant lipids and proteins accumulate in pulmonary alveolar macrophages and alveoli, resulting in respiratory insufficiency and, in...

EDITORIAL: Matrix Metalloproteinase 12, Asthma, and COPD

Guy G. Brusselle, M.D., Ph.D. — Thu, 31Â DecÂ 2009 00:00:00 -05:00

Asthma and chronic obstructive pulmonary disease (COPD) are obstructive airway diseases that involve chronic inflammation of the lower respiratory tract. They differ from each other in the pattern of inflammation,...

IMAGES IN CLINICAL MEDICINE: Vanishing Mediastinal Mass

Marc de Perrot, M.D. and Yaron Shargall, M.D. — Thu, 31Â DecÂ 2009 00:00:00 -05:00

A 39-year-old man with no notable medical history was being examined because of a transient ischemic attack. On a chest radiograph, a mediastinal mass was detected when the patient was...

ORIGINAL ARTICLE: Lung Function, and COPD in High-Risk Populations

Thu, 31Â DecÂ 2009 00:00:00 -05:00

Background: Genetic variants influencing lung function in children and adults may ultimately lead to the development of chronic obstructive pulmonary disease (COPD), particularly in high-risk groups.

Methods: We tested for an...

IMAGES IN CLINICAL MEDICINE: Coughing and Masks

Julian Wei-Tze Tang, M.D. and Gary Settles, Ph.D. — Thu, 24Â DecÂ 2009 00:00:00 -05:00

Coughing can transmit infectious agents, such as influenza virus, and it has been assumed that wearing a mask limits transmission of these agents. Schlieren optics can effectively visualize the dispersion...

CORRESPONDENCE: Holiday Spikes in Pneumococcal Disease among Older Adults

Thu, 24Â DecÂ 2009 00:00:00 -05:00

To the Editor: Rates of invasive pneumococcal disease in the United States increase dramatically, or âspike,â during winter holidays.1 We analyzed population-based surveillance data to determine whether spikes may be...

CORRESPONDENCE: Bacterial Pathogens and Death during the 1918 Influenza Pandemic

Thu, 24Â DecÂ 2009 00:00:00 -05:00

To the Editor: A review of recut lung-tissue specimens and published autopsy series from the 1918 influenza pandemic suggests that secondary bacterial pneumonia1 was an important cause of death, consistent...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 40-2009 â A 29-Year-Old Man with Fever and Respiratory Failure

Thu, 24Â DecÂ 2009 00:00:00 -05:00

Dr. Wilson Tak-Yu Kwong (Medicine): A 29-year-old man was admitted in July 2009 to the critical care unit of this hospital because of fever and respiratory failure.

The patient had been...

IMAGES IN CLINICAL MEDICINE: Intrathoracic Rib

Jonathan H. Chung, M.D. and Sudhakar N. Pipavath, M.D. — Thu, 24Â DecÂ 2009 00:00:00 -05:00

A 67-year-old woman who had a history of breast cancer and who had undergone chemoradiotherapy 10 years earlier underwent routine follow-up chest radiography. The images revealed right axillary surgical clips...

OTHER POINTS OF VIEW: When to Consider the Use of Antibiotics in the Treatment of 2009 H1N1 InfluenzaâAssociated Pneumonia

Thu, 10Â DecÂ 2009 00:00:00 -05:00

We are now facing a pandemic caused by an epidemiologically distinct, novel virus, the 2009 pandemic influenza A (H1N1) virus (swine flu), against which few persons born since 1970 have...

EDITORIAL: Volume CT for Diagnosis of Nodules Found in Lung-Cancer Screening

James L. Mulshine, M.D., and David M. Jablons, M.D. — Thu, 03Â DecÂ 2009 00:00:00 -05:00

Lung cancer, the most lethal type of cancer, accounted for more than 159,000 deaths in 2009 in the United States alone,1 and the annual number of new cases is expected...

IMAGES IN CLINICAL MEDICINE: Tuberculous Abscess Manifesting as Unilateral Gynecomastia

Jansen Koh, M.R.C.P. and Augustine Tee, M.R.C.P. — Thu, 03Â DecÂ 2009 00:00:00 -05:00

A 74-year-old man was admitted to our hospital after presenting with fever, nonproductive cough, and a 2-month history of enlargement of the left breast. Examination showed gynecomastia on the left...

SPECIAL ARTICLE: Forecasting the Effects of Obesity and Smoking on U.S. Life Expectancy

Thu, 03Â DecÂ 2009 00:00:00 -05:00

Background: Although increases in obesity over the past 30 years have adversely affected the health of the U.S. population, there have been concomitant improvements in health because of reductions in...

ORIGINAL ARTICLE: Management of Lung Nodules Detected by Volume CT Scanning

Thu, 03Â DecÂ 2009 00:00:00 -05:00

Background: The use of multidetector computed tomography (CT) in lung-cancer screening trials involving subjects with an increased risk of lung cancer has highlighted the problem for the clinician of deciding...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 36-2009 â A 23-Year-Old Man with Cough, Hoarseness, and Abnormalities on Chest Imaging

Thu, 19Â NovÂ 2009 00:00:00 -05:00

Dr. David T. Ting (Medical Oncology): A 23-year-old man was transferred to this hospital because of cough, hoarseness, fever, and abnormalities on chest imaging.

The patient had been well until 1...

ORIGINAL ARTICLE: Combined Immunodeficiency Associated with Mutations

Thu, 19Â NovÂ 2009 00:00:00 -05:00

Background: Recurrent sinopulmonary and cutaneous viral infections with elevated serum levels of IgE are features of some variants of combined immunodeficiency. The genetic causes of these variants are unknown.

Methods: We...

INTERACTIVE MEDICAL CASE: A Crisis in Late Pregnancy

Thu, 12Â NovÂ 2009 00:00:00 -05:00

A 31-year-old woman in the 37th week of pregnancy presented to the emergency room of another hospital with sudden onset of severe bitemporal headache and shortness of breath. She was...

CLINICAL THERAPEUTICS: Phosphodiesterase Type 5 Inhibitors for Pulmonary Arterial Hypertension

Stephen L. Archer, M.D., and Evangelos D. Michelakis, M.D. — Thu, 05Â NovÂ 2009 00:00:00 -05:00

A 46-year-old woman presents with progressive exertional dyspnea and recurrent exertional syncope. Her jugular venous pressure is 16 cm of water, and moderate peripheral edema is noted. Auscultation reveals a...

IMAGES IN CLINICAL MEDICINE: Bronchial Obstruction after Pneumonectomy

Loren J. Harris, M.D. — Thu, 22Â OctÂ 2009 00:00:00 -05:00

A 42-year-old woman underwent right pneumonectomy because of extensive parenchymal destruction due to tuberculosis. Five years after resection, she reported increasing shortness of breath, wheezing, and dyspnea on exertion. A...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 32-2009 â A 27-Year-Old Man with Progressive Dyspnea

Andrew M. Tager, M.D., Amita Sharma, M.D., and Eugene J. Mark, M.D. — Thu, 15Â OctÂ 2009 00:00:00 -05:00

A 27-year-old man was seen in the outpatient pulmonary division of this hospital because of progressive dyspnea and decreased exercise tolerance.

Approximately 2 years earlier, the patient noted a slight decrease...

ORIGINAL ARTICLE: Screening for Epidermal Growth Factor Receptor Mutations in Lung Cancer

Thu, 03Â SepÂ 2009 00:00:00 -05:00

Background: Activating mutations in the epidermal growth factor receptor gene (EGFR) confer hypersensitivity to the tyrosine kinase inhibitors gefitinib and erlotinib in patients with advanced nonâsmall-cell lung cancer. We evaluated...

ORIGINAL ARTICLE: Gefitinib or CarboplatinâPaclitaxel in Pulmonary Adenocarcinoma

Thu, 03Â SepÂ 2009 00:00:00 -05:00

Background: Previous, uncontrolled studies have suggested that first-line treatment with gefitinib would be efficacious in selected patients with nonâsmall-cell lung cancer.

Methods: In this phase 3, open-label study, we randomly assigned...

EDITORIAL: Personalized Medicine and Inhibition of Signaling in Lung Cancer

Adi F. Gazdar, M.D. — Thu, 03Â SepÂ 2009 00:00:00 -05:00

The concept underlying much of cancer therapy is that patients with specific types and stages of cancer should be treated according to standardized, predetermined protocols. However, recent advances in drug...

CORRESPONDENCE: Codeine, Ultrarapid-Metabolism Genotype, and Postoperative Death

Thu, 20Â AugÂ 2009 00:00:00 -05:00

To the Editor: Obstructive sleep apnea is not rare in children with hypertrophic tonsils, and the common curative procedure is adenotonsillectomy.1 Codeine is commonly prescribed for pain after adenotonsillectomy.2 The...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 26-2009 â A 34-Year-Old Man with Cystic Fibrosis with Abdominal Pain and Distention

Thu, 20Â AugÂ 2009 00:00:00 -05:00

Dr. David M. Dudzinski (Medicine): Fever and abdominal pain and distention developed in a 34-year-old man with cystic fibrosis during an admission to this hospital for pulmonary care.

The patient was...

ORIGINAL ARTICLE: Pneumonia and Respiratory Failure from Swine-Origin Influenza A (H1N1) in Mexico

Thu, 13Â AugÂ 2009 00:00:00 -05:00

Background: In late March 2009, an outbreak of a respiratory illness later proved to be caused by novel swine-origin influenza A (H1N1) virus (S-OIV) was identified in Mexico. We describe...

ORIGINAL ARTICLE: Severe Respiratory Disease Concurrent with the Circulation of H1N1 Influenza

Thu, 13Â AugÂ 2009 00:00:00 -05:00

Background: In the spring of 2009, an outbreak of severe pneumonia was reported in conjunction with the concurrent isolation of a novel swine-origin influenza A (H1N1) virus (S-OIV), widely known...

IMAGES IN CLINICAL MEDICINE: Asymmetric Edema of the Upper Lung Due to Mitral Valvular Dysfunction

Siva Raman, M.D. and Sudhakar Pipavath, M.D. — Thu, 30Â JulÂ 2009 00:00:00 -05:00

An 80-year-old woman with chronic obstructive pulmonary disease and mitral-valve prolapse presented with progressive dyspnea, orthopnea, and dry cough, which she reported having had for the previous 3 days. She...

IMAGES IN CLINICAL MEDICINE: Pneumopericardium and Pneumothorax

Jason Andrade, M.D. and Eve Aymong, M.D. — Thu, 30Â JulÂ 2009 00:00:00 -05:00

A 60-year old man presented with progressive dyspnea 3 months after undergoing uncomplicated aortic-valve replacement and mitral-valve repair for valvular insufficiency related to previous endocarditis. A chest radiograph obtained on...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 22-2009 â A 59-Year-Old Man with Skin and Pulmonary Lesions after Chemotherapy for Leukemia

Thu, 16Â JulÂ 2009 00:00:00 -05:00

Dr. Deborah L. Cummins (Dermatology): A 59-year-old man was seen by consultants in infectious disease and dermatology because of cutaneous and pulmonary lesions that developed after induction chemotherapy for acute...

ORIGINAL ARTICLE: Preoperative Staging of Lung Cancer with Combined PETâCT

Thu, 02Â JulÂ 2009 00:00:00 -05:00

Background: Fast and accurate staging is essential for choosing treatment for nonâsmall-cell lung cancer (NSCLC). The purpose of this randomized study was to evaluate the clinical effect of combined positron-emission...

CLINICAL PRACTICE: Alpha-Antitrypsin Deficiency

Edwin K. Silverman, M.D., Ph.D., and Robert A. Sandhaus, M.D., Ph.D. — Thu, 25Â JunÂ 2009 00:00:00 -05:00

A 60-year-old white man presents for evaluation of progressive dyspnea. He is a former smoker with a 20-pack-year smoking history and a 10-year history of diagnosed chronic obstructive pulmonary disease...

IMAGES IN CLINICAL MEDICINE: Infection 57 Years after Plombage

Shimpei Gotoh, M.D. and Naohiko Chohnabayashi, M.D., Ph.D. — Thu, 04Â JunÂ 2009 00:00:00 -05:00

An 86-year-old man was hospitalized for repeated episodes of septic shock due to methicillin-resistant Staphylococcus aureus (MRSA) pneumonia; he ultimately died of pseudomonal sepsis and pneumonia. In 1948, the patient...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 18-2009 â A 24-Year-Old Woman with AIDS and Tuberculosis with Progressive Cough, Dyspnea, and Wasting

Douglas Wilson, M.B., Ch.B., RocÃo M. Hurtado, M.D., and Subba Digumarthy, M.D. — Thu, 04Â JunÂ 2009 00:00:00 -05:00

Dr. Anne Griffin (Medicine and Pediatrics): A 24-year-old woman with the acquired immunodeficiency syndrome (AIDS) and pulmonary tuberculosis was admitted to a hospital in South Africa that is affiliated with...

IMAGES IN CLINICAL MEDICINE: Plombage Cavities

Ioannis Dimarakis, Ph.D., M.R.C.S. and Jonathan Anderson, F.R.C.S. — Thu, 04Â JunÂ 2009 00:00:00 -05:00

A 73-year-old woman receiving chemotherapy for advanced breast cancer was referred for treatment of a nontuberculous empyema of the thoracic cavity (left side), which had not responded to treatment with...

REVIEW ARTICLE: Immunologic Aspects of Chronic Obstructive Pulmonary Disease

Manuel G. Cosio, M.D., Marina Saetta, M.D., and Alvar Agusti, M.D. — Thu, 04Â JunÂ 2009 00:00:00 -05:00

Chronic obstructive pulmonary disease (COPD) is a major cause of illness and death throughout the world. It affects about 10% of the general population,1 but its prevalence among heavy smokers...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 16-2009 â A 32-Year-Old Pregnant Woman with an Abnormal Fetal Ultrasound Study

Thu, 21Â MayÂ 2009 00:00:00 -05:00

A 32-year-old pregnant woman was admitted to the hospital at 23.1 weeks of gestation, because of an abnormal fetal ultrasound study.

Approximately 15 weeks earlier, a home urine test for human...

EDITORIAL: The Challenge of Managing Wheezing in Infants

Urs Frey, M.D., Ph.D., and Erika von Mutius, M.D., M.Sc. — Thu, 14Â MayÂ 2009 00:00:00 -05:00

Around the world, thousands of times a day, an infant 6 to 8 months old with a runny nose, a cough, and wheezing arrives in a pediatrician's office or an...

ORIGINAL ARTICLE: Antivenom for Critically Ill Children with Neurotoxicity from Scorpion Stings

Thu, 14Â MayÂ 2009 00:00:00 -05:00

Background: Clinically significant scorpion envenomation by Centruroides sculpturatus produces a dramatic neuromotor syndrome and respiratory insufficiency that often necessitate intensive supportive care. We hypothesized that a scorpion-specific F(abâ²)2 antivenom would...

ORIGINAL ARTICLE: Epinephrine and Dexamethasone in Children with Bronchiolitis

Thu, 14Â MayÂ 2009 00:00:00 -05:00

Background: Although numerous studies have explored the benefit of using nebulized epinephrine or corticosteroids alone to treat infants with bronchiolitis, the effectiveness of combining these medications is not well established.

Methods:...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 14-2009 â A 36-Year-Old Man with Chest Pain, Dysphagia, and Pleural and Mediastinal Calcifications

Henning A. Gaissert, M.D., Nitra Piyavisetpat, M.D., and Eugene J. Mark, M.D. — Thu, 30Â AprÂ 2009 00:00:00 -05:00

A 36-year-old man was admitted to the hospital because of chest pain, dysphagia, dyspnea, and pleural and mediastinal calcifications.

He had been well until approximately 6 years before admission, when a...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 13-2009 â A 54-Year-Old Woman with Respiratory Failure and a Cavitary Lesion in the Lung

Thu, 23Â AprÂ 2009 00:00:00 -05:00

A 54-year-old woman was admitted to the hospital because of respiratory failure, hypotension, and a cavitary lesion in the lung.

She had rheumatoid arthritis but had otherwise been well until approximately...

IMAGES IN CLINICAL MEDICINE: Pulmonary Arteriovenous Fistula

Nils Kraemer, M.D. and Gabriele A. Krombach, M.D. — Thu, 23Â AprÂ 2009 00:00:00 -05:00

A 50-year-old woman presented with mild exercise-induced shortness of breath; she reported being otherwise healthy. Her family history was notable for her mother's having the OslerâWeberâRendu syndrome, also called hereditary...

IMAGES IN CLINICAL MEDICINE: Kerley's A, B, and C Lines

Takeharu Koga, M.D., Ph.D. and Kiminori Fujimoto, M.D., Ph.D. — Thu, 09Â AprÂ 2009 00:00:00 -05:00

A 59-year-old woman with hypertension and diabetic nephropathy presented with a sudden onset of dyspnea after discontinuing her medications. Physical examination revealed hypertension (blood pressure, 225/122 mm Hg), tachycardia (heart...

IMAGES IN CLINICAL MEDICINE: Mediastinal Extension of a Goiter

Giuseppe Mercante, M.D. and Verter Barbieri, M.D. — Thu, 26Â MarÂ 2009 00:00:00 -05:00

A 67-year-old woman presented with a 6-month history of dyspnea and dysphagia. Physical examination revealed a small cervical goiter, but the lower poles of the thyroid were not palpable. The...

CLINICAL THERAPEUTICS: Pulmonary Rehabilitation for Management of Chronic Obstructive Pulmonary Disease

Richard Casaburi, Ph.D., M.D., and Richard ZuWallack, M.D. — Thu, 26Â MarÂ 2009 00:00:00 -05:00

A 61-year-old woman is referred for pulmonary consultation. She smoked one pack of cigarettes a day for 45 years but quit a year ago. For 2 years she has noted...

IMAGES IN CLINICAL MEDICINE: âPopcornâ Calcifications in a Pulmonary Chondroid Hamartoma

Chang Min Park, M.D. and Jin Mo Goo, M.D. — Thu, 19Â MarÂ 2009 00:00:00 -05:00

A 22-year-old man was referred to us for evaluation of an asymptomatic mass in the left upper lung that had been detected on chest radiography (Panel A, arrow) performed during...

CLINICAL PRACTICE: Carbon Monoxide Poisoning

Lindell K. Weaver, M.D. — Thu, 19Â MarÂ 2009 00:00:00 -05:00

A 39-year-old female executive has a several-month history of fatigue, headache, and memory lapse. Multiple specialists have performed evaluations, but no diagnosis has been established. During a period of feeling...

ORIGINAL ARTICLE: Long-Term Ozone Exposure and Mortality

Thu, 12Â MarÂ 2009 00:00:00 -05:00

Background: Although many studies have linked elevations in tropospheric ozone to adverse health outcomes, the effect of long-term exposure to ozone on air pollutionârelated mortality remains uncertain. We examined the...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 6-2009 â A 37-Year-Old Woman with Vertigo, Facial Weakness, and a Generalized Seizure

Didier Cros, M.D., R. Gilberto Gonzalez, M.D., Ph.D., and Eugene J. Mark, M.D. — Thu, 19Â FebÂ 2009 00:00:00 -05:00

Dr. Sang-Woo (Steve) Han (Neurology): A 37-year-old woman was seen in the emergency department of this hospital because of a seizure. Four months earlier, episodes of vertigo began to occur...

IMAGES IN CLINICAL MEDICINE: Achalasia

Chi-Yen Liang, M.D. and Ming-Shian Lin, M.D. — Thu, 19Â FebÂ 2009 00:00:00 -05:00

A 68-year-old woman presented with fever and dull pleuritic pain in the left chest wall. Chest radiography revealed a large mass with an air-fluid level in the right hemithorax (Panel...

SPECIAL ARTICLE: A Randomized, Controlled Trial of Financial Incentives for Smoking Cessation

Thu, 12Â FebÂ 2009 00:00:00 -05:00

Background: Smoking is the leading preventable cause of premature death in the United States. Previous studies of financial incentives for smoking cessation in work settings have not shown that such...

ORIGINAL ARTICLE: The Burden of Respiratory Syncytial Virus Infection in Young Children

Thu, 05Â FebÂ 2009 00:00:00 -05:00

Background: The primary role of respiratory syncytial virus (RSV) in causing infant hospitalizations is well recognized, but the total burden of RSV infection among young children remains poorly defined.

Methods: We...

IMAGES IN CLINICAL MEDICINE: Traumatic Diaphragmatic Rupture with Intrathoracic Liver Herniation

Stephen H. McKellar, M.D. and L. Ray Matthews, M.D. — Thu, 29Â JanÂ 2009 00:00:00 -05:00

A 24-year-old man who had been wearing a seatbelt while driving a car involved in a high-speed motor vehicle crash was taken by ambulance to a local hospital, where his...

EDITORIAL: Evaluating the Effects of Ambient Air Pollution on Life Expectancy

Daniel Krewski, Ph.D. — Thu, 22Â JanÂ 2009 00:00:00 -05:00

Air pollution is an important determinant of population health. In this issue of the Journal, Pope et al.1 provide data that once again reinforce this fundamental concept. In an analysis...

EDITORIAL: Practice Imperfect â Treatment for Wheezing in Preschoolers

Andrew Bush, M.D. — Thu, 22Â JanÂ 2009 00:00:00 -05:00

Nearly one third of preschool children (4 years of age or younger) have intermittent wheezing, a condition that many of them outgrow. The most common early trigger is a respiratory...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery â Constipation

Ioannis Karakis, M.D. and Christos Kosmas, M.D. — Thu, 22Â JanÂ 2009 00:00:00 -05:00

A 56-year-old woman with a medical history notable for epilepsy, scoliosis, and chronic constipation presented with shortness of breath and cough, which she reported having had for the past 10...

SPECIAL ARTICLE: Fine-Particulate Air Pollution and Life Expectancy in the United States

C. Arden Pope III, Ph.D., Majid Ezzati, Ph.D., and Douglas W. Dockery, Sc.D. — Thu, 22Â JanÂ 2009 00:00:00 -05:00

Background: Exposure to fine-particulate air pollution has been associated with increased morbidity and mortality, suggesting that sustained reductions in pollution exposure should result in improved life expectancy. This study directly...

ORIGINAL ARTICLE: Preemptive Use of High-Dose Fluticasone for Virus-Induced Wheezing in Young Children

Thu, 22Â JanÂ 2009 00:00:00 -05:00

Background: Although virus-induced wheezing is common in preschool-age children, optimal management remains elusive. We examined the efficacy and safety of preemptive treatment with high-dose fluticasone in reducing the severity of...

ORIGINAL ARTICLE: Oral Prednisolone for Preschool Children with Acute Virus-Induced Wheezing

Thu, 22Â JanÂ 2009 00:00:00 -05:00

Background: Attacks of wheezing induced by upper respiratory viral infections are common in preschool children between the ages of 10 months and 6 years. A short course of oral prednisolone...

SPECIAL ARTICLE: Mortality Attributable to Smoking in China

Thu, 08Â JanÂ 2009 00:00:00 -05:00

Background: Smoking is a risk factor for many diseases and has been increasingly prevalent in economically developing regions of the world. We aimed to estimate the number of deaths attributable...

ORIGINAL ARTICLE: Arterial Blood Gases and Oxygen Content in Climbers on Mount Everest

Thu, 08Â JanÂ 2009 00:00:00 -05:00

Background: The level of environmental hypobaric hypoxia that affects climbers at the summit of Mount Everest (8848 m [29,029 ft]) is close to the limit of tolerance by humans. We...

CLINICAL PRACTICE: Acute Pulmonary Embolism

Stavros Konstantinides, M.D. — Thu, 25Â DecÂ 2008 00:00:00 -05:00

A 62-year-old man presented with a 5-day history of progressively worsening dyspnea and orthopnea after returning from a 3-day business trip to the Far East. On physical examination, the heart...

ORIGINAL ARTICLE: Azathioprine or Methotrexate Maintenance for ANCA-Associated Vasculitis

Thu, 25Â DecÂ 2008 00:00:00 -05:00

Background: Current standard therapy for Wegener's granulomatosis and microscopic polyangiitis combines corticosteroids and cyclophosphamide to induce remission, followed by a less toxic immunosuppressant such as azathioprine or methotrexate for maintenance...

CORRESPONDENCE: Small-Cell Lung Cancer and Necrolytic Migratory Erythema

Thu, 18Â DecÂ 2008 00:00:00 -05:00

To the Editor: Necrolytic migratory erythema is a rare inflammatory dermatosis, first described by Becker et al.,1 which occurs in 70% of patients with the glucagonoma syndrome.2 Its clinical features...

BOOK REVIEW:

Thu, 04Â DecÂ 2008 00:00:00 -05:00

Lung cancer is the leading cause of cancer-related deaths in North America, with an estimated 213,380 new cases and 160,390 deaths anticipated in 2008. Since the publication of the previous...

IMAGES IN CLINICAL MEDICINE: Ultrasound Imaging of the Thoracic Duct

Marcus Seeger, M.D. and Burkhard Bewig, M.D. — Thu, 27Â NovÂ 2008 00:00:00 -05:00

Recent advances in ultrasound imaging allow visualization of the cervical part of the thoracic duct. In Panel A and Video 1, ultrasound imaging conducted to evaluate the thyroid of a...

CORRESPONDENCE: Emergence of Extensive Drug Resistance during Treatment for Multidrug-Resistant Tuberculosis

Thu, 27Â NovÂ 2008 00:00:00 -05:00

To the Editor: We report the development of fluoroquinolone-resistant tuberculosis and extensively drug-resistant tuberculosis during second-line treatment for multidrug-resistant tuberculosis in Karakalpakstan, Uzbekistan. Eighty-seven patients were treated with a regimen...

REVIEW ARTICLE: Infection in the Pathogenesis and Course of Chronic Obstructive Pulmonary Disease

Sanjay Sethi, M.D., and Timothy F. Murphy, M.D. — Thu, 27Â NovÂ 2008 00:00:00 -05:00

In the 1950s and 1960s, according to a theory known as the British hypothesis, repeated airway infection and hypersecretion of mucus were thought to be the causes of chronic obstructive...

IMAGES IN CLINICAL MEDICINE: Recurrent Aspiration Pneumonia

Maroun M. Tawk, M.D. and Marwan K. Elya, M.D. — Thu, 20Â NovÂ 2008 00:00:00 -05:00

An 84-year-old man with coronary artery disease, atrial fibrillation, chronic obstructive pulmonary disease, and congestive heart failure was admitted to the hospital because of a decrease in mental status. He...

REVIEW ARTICLE: Pulmonary Complications of Sickle Cell Disease

Mark T. Gladwin, M.D., and Elliott Vichinsky, M.D. — Thu, 20Â NovÂ 2008 00:00:00 -05:00

The inheritance of two copies of a mutant Î²-globin gene, one from each parent, is the underlying cause of sickle cell disease. The mutation, GAGâGTG, substitutes valine for glutamic acid...

BOOK REVIEW:

Thu, 13Â NovÂ 2008 00:00:00 -05:00

Pulmonary hypertension and its effects on right heart function have long been an enigma to most clinicians. However, remarkable progress has been made in recent years. We are now able...

EDITORIAL: PEEP Guided by Esophageal Pressure â Any Added Value?

Gordon R. Bernard, M.D. — Thu, 13Â NovÂ 2008 00:00:00 -05:00

Treatment of the acute respiratory distress syndrome (ARDS) with positive end-expiratory pressure (PEEP) was introduced more than 40 years ago.12 Few practitioners question the effects of PEEP on hemoglobin saturation,...

ORIGINAL ARTICLE: Mechanical Ventilation Guided by Esophageal Pressure in Acute Lung Injury

Thu, 13Â NovÂ 2008 00:00:00 -05:00

Background: Survival of patients with acute lung injury or the acute respiratory distress syndrome (ARDS) has been improved by ventilation with small tidal volumes and the use of positive end-expiratory...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Virus Infection, Asthma, and Chronic Obstructive Pulmonary Disease

Ratko DjukanoviÄ, M.D., and Stephan D. Gadola, M.D. — Thu, 06Â NovÂ 2008 00:00:00 -05:00

Both asthma and chronic obstructive pulmonary disease (COPD) are characterized by chronic inflammation of the airways. This inflammation is accompanied by increased mucus production and an excessive propensity of the...

REVIEW ARTICLE: Venous Thromboembolic Disease and Pregnancy

Paul E. Marik, M.D., and Lauren A. Plante, M.D., M.P.H. — Thu, 06Â NovÂ 2008 00:00:00 -05:00

Pulmonary embolism and deep-vein thrombosis are the two components of a single disease called venous thromboembolism. Approximately 30% of apparently isolated episodes of pulmonary embolism are associated with silent deep-vein...

CLINICAL THERAPEUTICS: Varenicline for Tobacco Dependence

J. Taylor Hays, M.D., and Jon O. Ebbert, M.D. — Thu, 06Â NovÂ 2008 00:00:00 -05:00

A 57-year-old man with a 60-pack-year history visits his primary care provider because he wants to quit smoking. He has a history of stable coronary artery disease, peripheral vascular disease,...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 33-2008 â A 63-Year-Old Woman with Dyspnea on Exertion

Charles M. Wiener, M.D., Victorine V. Muse, M.D., and Eugene J. Mark, M.D. — Thu, 23Â OctÂ 2008 00:00:00 -05:00

Dr. Andrew Tinsley (Medicine): A 63-year-old woman was admitted to this hospital because of dyspnea on exertion.

The patient had been in her usual state of health until approximately 3 weeks...

IMAGES IN CLINICAL MEDICINE: What Lies Beneath?

Darren M. Mylotte, M.B. and Anthony O'Regan, M.D. — Thu, 23Â OctÂ 2008 00:00:00 -05:00

A 74-year-old male smoker was hospitalized for a transurethral resection of the prostate. His medical history was notable for the insertion of a dual-chamber pacemaker to treat symptomatic bradycardia 10...

IMAGES IN CLINICAL MEDICINE: Coughing and Aerosols

Julian W. Tang, F.R.C.Path. and Gary S. Settles, Ph.D. — Thu, 09Â OctÂ 2008 00:00:00 -05:00

When a healthy volunteer coughs, he expels a turbulent jet of air with density changes that distort a projected schlieren light beam (Panel A). A velocity map early in the...

BOOK REVIEW:

Thu, 09Â OctÂ 2008 00:00:00 -05:00

Anyone who has had even one poor night of sleep will immediately recognize the substantial impact of sleep disturbance on quality of life. Sleep and Quality of Life in Clinical...

EDITORIAL: COPD and Declining FEV â Time to Divide and Conquer?

John J. Reilly, M.D. — Thu, 09Â OctÂ 2008 00:00:00 -05:00

In 1976, Fletcher et al. published a monograph summarizing the results of an 8-year observational study of the relationship between cigarette smoking, chronic expectoration, and the development of irreversible airflow...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2008 â A 39-Year-Old Man with Chest Pain, Arthralgias, and a Mediastinal Mass

Thu, 09Â OctÂ 2008 00:00:00 -05:00

A 39-year-old man was admitted to this hospital because of chest pain, arthralgias, and a mediastinal mass.

Two months before admission, pain in the middle and right chest developed, which radiated...

ORIGINAL ARTICLE: A 4-Year Trial of Tiotropium in Chronic Obstructive Pulmonary Disease

Thu, 09Â OctÂ 2008 00:00:00 -05:00

Background: Previous studies showing that tiotropium improves multiple end points in patients with chronic obstructive pulmonary disease (COPD) led us to examine the long-term effects of tiotropium therapy.

Methods: In this...

CLINICAL PROBLEM-SOLVING: Variations on a Theme

Thu, 02Â OctÂ 2008 00:00:00 -05:00

A 57-year-old man presented to the emergency department with a 2-week history of progressive dyspnea with exertion, edema of the upper and lower legs, a nonproductive cough, and scant hemoptysis....

IMAGES IN CLINICAL MEDICINE: New-Onset Clubbing Associated with Lung Cancer

Bryan A. Faller, M.D. and John P. Atkinson, M.D. — Thu, 25Â SepÂ 2008 00:00:00 -05:00

A 45-year-old woman with a 27-pack-year history of smoking presented for evaluation of progressive distal finger enlargement and polyarthralgias, which had developed over a period of 18 months. During the...

REVIEW ARTICLE: Lung Cancer

Thu, 25Â SepÂ 2008 00:00:00 -05:00

Lung cancer is the leading cause of cancer deaths in the United States1 and worldwide. The two major forms of lung cancer are nonâsmall-cell lung cancer (about 85% of all...

IMAGES IN CLINICAL MEDICINE: Benign Mediastinal Teratoma

Lisa M. Jones, M.D. and David A. Bradshaw, M.D. — Thu, 21Â AugÂ 2008 00:00:00 -05:00

A 23-year-old male Marine recruit passed out while bending over after a 2.4-km (1.5-mile) run. Chest radiography showed a mass in the anterior mediastinum (Panel A, arrow). His medical history...

IMAGES IN CLINICAL MEDICINE: Allergic Bronchopulmonary Aspergillosis

Ting-hsu Chen, M.D. and Helen Hollingsworth, M.D. — Thu, 07Â AugÂ 2008 00:00:00 -05:00

A 26-year-old man who smoked and had a long history of poorly controlled asthma and severe environmental allergies was admitted for an exacerbation of asthma. He reported no recent hospitalizations...

CLINICAL PROBLEM-SOLVING: Beware of First Impressions

Thu, 07Â AugÂ 2008 00:00:00 -05:00

A 64-year-old Filipino man presented to a Baltimore hospital with a 4-month history of worsening midback pain, progressive leg weakness, and intermittent bladder and bowel incontinence. He had no fever...

BOOK REVIEW:

Thu, 31Â JulÂ 2008 00:00:00 -05:00

Asbestos, a well-known carcinogen, is responsible for the dramatic increase in the incidence of pleural mesothelioma among men in Western countries in the past 40 years. This increase is a...

IMAGES IN CLINICAL MEDICINE: Dynamic Tumor Staging

Chang Min Park, M.D. and Jin Mo Goo, M.D. — Thu, 24Â JulÂ 2008 00:00:00 -05:00

A 54-year-old man with a history of smoking presented with acute chest pain at another hospital, where a chest radiograph was obtained as part of diagnostic testing. A mass in...

EDITORIAL: Noninvasive Monitoring of Tumors

Joan H. Schiller, M.D. — Thu, 24Â JulÂ 2008 00:00:00 -05:00

The treatment of nonâsmall-cell lung cancer has made limited but clinically significant progress during the past two decades of clinical research. Through carefully designed clinical trials, investigators have identified several...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 23-2008 â A 26-Year-Old Man with Back Pain and a Mass in the Lung

Thu, 24Â JulÂ 2008 00:00:00 -05:00

A 26-year-old man was admitted to this hospital because of back pain and a mass in the lung. He had been well until 17 days before admission, when he bent...

ORIGINAL ARTICLE: Detection of Mutations in in Circulating Lung-Cancer Cells

Thu, 24Â JulÂ 2008 00:00:00 -05:00

Background: The use of tyrosine kinase inhibitors to target the epidermal growth factor receptor gene (EGFR) in patients with nonâsmall-cell lung cancer is effective but limited by the emergence of...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 21-2008 â An 11-Month-Old Boy with Fever and Pulmonary Infiltrates

Thu, 10Â JulÂ 2008 00:00:00 -05:00

An 11-month-old boy was admitted to this hospital because of fevers and pulmonary infiltrates. One month before admission, a month after beginning a visit to India with his parents, daily...

ORIGINAL ARTICLE: Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema

Thu, 10Â JulÂ 2008 00:00:00 -05:00

Background: Noninvasive ventilation (continuous positive airway pressure [CPAP] or noninvasive intermittent positive-pressure ventilation [NIPPV]) appears to be of benefit in the immediate treatment of patients with acute cardiogenic pulmonary edema...

IMAGES IN CLINICAL MEDICINE: Severe Kyphosis

Boris Blechacz, M.D. and Ognjen Gajic, M.D. — Thu, 12Â JunÂ 2008 00:00:00 -05:00

An 89-year-old woman was admitted to the hospital with hypercapnic respiratory failure. She had a long history of osteoporosis. Bone densitometry revealed a T score for the lumbar spine of...

VIDEOS IN CLINICAL MEDICINE: Cricothyroidotomy

James Hsiao, M.D., and Victor Pacheco-Fowler, M.D. — Thu, 29Â MayÂ 2008 00:00:00 -05:00

...

REVIEW ARTICLE: Hepatopulmonary Syndrome â A Liver-Induced Lung Vascular Disorder

Roberto RodrÃguez-Roisin, M.D., and Michael J. Krowka, M.D. — Thu, 29Â MayÂ 2008 00:00:00 -05:00

The hepatopulmonary syndrome is characterized by a defect in arterial oxygenation induced by pulmonary vascular dilatation in the setting of liver disease1; patients of all ages can be affected. 08052930.xml...

CLINICAL THERAPEUTICS: Sublingual Immunotherapy

Anthony J. Frew, M.D. — Thu, 22Â MayÂ 2008 00:00:00 -05:00

A busy 28-year-old professional consults his physician for advice on long-standing hay fever. He reports having itchy eyes and an itchy nose, lacrimation, sneezing, rhinorrhea, and nasal congestion during the...

ORIGINAL ARTICLE: Effect of Variation in on Serum YKL-40 Level, Risk of Asthma, and Lung Function

Thu, 17Â AprÂ 2008 00:00:00 -05:00

Background: The chitinase-like protein YKL-40 is involved in inflammation and tissue remodeling. We recently showed that serum YKL-40 levels were elevated in patients with asthma and were correlated with severity,...

CLINICAL PROBLEM-SOLVING: An Unintended Consequence â A 79-year-old man with a 5-month history of fatigue and 20-lb (9-kg) weight loss presented to his local physician

Thu, 03Â AprÂ 2008 00:00:00 -05:00

A 79-year-old man with a 5-month history of fatigue and 20-lb (9-kg) weight loss presented to his local physician. The patient also reported intermittent episodes of high temperature, night sweats,...

EDITORIAL: Effect of Mechanical Ventilation on the Diaphragm

Gary C. Sieck, Ph.D., and Carlos B. Mantilla, M.D., Ph.D. — Thu, 27Â MarÂ 2008 00:00:00 -05:00

It is widely assumed that respiratory-muscle weakness, either intrinsic or due to fatigue, leads to respiratory failure.1 For the past 30 years, attention has been focused on whether the diaphragm...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 10-2008 â A 10-Year-Old Girl with Dyspnea on Exertion

Thu, 27Â MarÂ 2008 00:00:00 -05:00

A 10-year-old girl was seen in the multidisciplinary Airway, Voice, and Swallowing Center for Children at the Massachusetts Eye and Ear Infirmary, associated with this hospital, because of dyspnea and...

ORIGINAL ARTICLE: Rapid Disuse Atrophy of Diaphragm Fibers in Mechanically Ventilated Humans

Thu, 27Â MarÂ 2008 00:00:00 -05:00

Background: The combination of complete diaphragm inactivity and mechanical ventilation (for more than 18 hours) elicits disuse atrophy of myofibers in animals. We hypothesized that the same may also occur...

SPECIAL ARTICLE: A Nationally Representative CaseâControl Study of Smoking and Death in India

Thu, 13Â MarÂ 2008 00:00:00 -05:00

Background: The nationwide effects of smoking on mortality in India have not been assessed reliably.

Methods: In a nationally representative sample of 1.1 million homes, we compared the prevalence of smoking...

ORIGINAL ARTICLE: DNA Methylation Markers and Early Recurrence in Stage I Lung Cancer

Thu, 13Â MarÂ 2008 00:00:00 -05:00

Background: Despite optimal and early surgical treatment of nonâsmall-cell lung cancer (NSCLC), many patients die of recurrent NSCLC. We investigated the association between gene methylation and recurrence of the tumor.

Methods:...

CLINICAL PROBLEM-SOLVING: A Key Miscommunication â An 81-year-old woman presented to the emergency department with increasing abdominal distention, nausea, and vomiting

Thu, 06Â MarÂ 2008 00:00:00 -05:00

An 81-year-old woman presented to the emergency department with increasing abdominal distention, nausea, and vomiting. She also reported increasing shortness of breath and fatigue, which had become worse over the...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery: Epigastric Pain

Rangan Murali, M.D. and Bashar M. Attar, M.D., Ph.D. — Thu, 06Â MarÂ 2008 00:00:00 -05:00

An 82-year-old woman presented with respiratory symptoms, and a chest film was obtained. Six years later, she presented with epigastric pain, nausea, and vomiting. What is the diagnosis?...

REVIEW ARTICLE: Acute Pulmonary Embolism

Victor F. Tapson, M.D. — Thu, 06Â MarÂ 2008 00:00:00 -05:00

Pulmonary embolism, most commonly originating from deep venous thrombosis of the legs, ranges from asymptomatic, incidentally discovered emboli to massive embolism causing immediate death. Chronic sequelae of venous thromboembolism (deep...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 7-2008 â A 17-Year-Old Girl with Chest Pain and Hemoptysis

Thu, 28Â FebÂ 2008 00:00:00 -05:00

Dr. Mary Shannon Fracchia (Pediatrics): A 17-year-old girl was transferred to this hospital because of chest pain and hemoptysis. She had been well except for mild asthma until 4 months...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 6-2008 â A 46-Year-Old Woman with Renal Failure and Stiffness of the Joints and Skin

Thu, 21Â FebÂ 2008 00:00:00 -05:00

Dr. Nancy Cibotti-Granof (Medicine): A 46-year-old woman with end-stage renal disease was seen by a rheumatology consultant because of stiffness of her joints and skin.

The patient had been well except...

IMAGES IN CLINICAL MEDICINE: Sarcoid Arthropathy

Avnit Ahuja, M.D. and Mythili Seetharaman, M.D. — Thu, 14Â FebÂ 2008 00:00:00 -05:00

A 43-year-old woman presented with pain, swelling, and stiffness in the hands and feet; she reported having had the symptoms for the previous 5 years. Possible rheumatoid arthritis had been...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 5-2008 â An 18-Month-Old Girl with an Advanced Neck Contracture after a Burn

Thu, 14Â FebÂ 2008 00:00:00 -05:00

An 18-month-old girl was transferred from a hospital in China to the Shriners Hospital for Children in Boston for management of a life-threatening neck contracture.

The child had been well until...

REVIEW ARTICLE: Acute Lower Respiratory Tract Infection

Joseph P. Mizgerd, Sc.D. — Thu, 14Â FebÂ 2008 00:00:00 -05:00

Acute lower respiratory tract infections are a persistent and pervasive public health problem. They cause a greater burden of disease worldwide than human immunodeficiency virus infection, malaria, cancer, or heart...

ORIGINAL ARTICLE: Nasal CPAP or Intubation at Birth for Very Preterm Infants

Thu, 14Â FebÂ 2008 00:00:00 -05:00

Background: Bronchopulmonary dysplasia is associated with ventilation and oxygen treatment. This randomized trial investigated whether nasal continuous positive airway pressure (CPAP), rather than intubation and ventilation, shortly after birth would...

CLINICAL PROBLEM-SOLVING: What's the Connection? â A 26-year-old white man presented to our referral hospital with a 1-month history of persistent cough productive of white sputum, which was occasionally tinged with blood

Thu, 07Â FebÂ 2008 00:00:00 -05:00

A 26-year-old white man presented to our referral hospital with a 1-month history of persistent cough productive of white sputum, which was occasionally tinged with blood. He reported mild pleuritic...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 4-2008 â A 33-Year-Old Pregnant Woman with Swelling of the Left Breast and Shortness of Breath

Lawrence N. Shulman, M.D., Rachel A. Hitt, M.D., and Judith A. Ferry, M.D. — Thu, 31Â JanÂ 2008 00:00:00 -05:00

A 33-year-old pregnant woman was admitted to the hospital at 30.7 weeks' gestation because of swelling of the left breast, shortness of breath, and tachycardia.

The patient had received prenatal care...

CLINICAL PRACTICE: Croup

James D. Cherry, M.D., M.Sc. — Thu, 24Â JanÂ 2008 00:00:00 -05:00

Crouplike symptoms develop in a previously healthy 2-year-old girl at 11 p.m. She is seen in an emergency department 2 hours later with a barking cough and, when upset, inspiratory...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Guiding Aerosol Deposition in the Lung

Allan L. Coates, M.D., C.M. — Thu, 17Â JanÂ 2008 00:00:00 -05:00

Direct delivery of aerosolized medication to the diseased lung allows therapy to be targeted, albeit with challenges. A study recently reported by Dames et al.1 underscores the magnet as an...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 2-2008 â A 38-Year-Old Woman with Postpartum Visual Loss, Shortness of Breath, and Renal Failure

Thu, 17Â JanÂ 2008 00:00:00 -05:00

Dr. Esperance A. Schaefer (Medicine): A 38-year-old woman was admitted to the hospital, because of blurred vision and shortness of breath, 2 weeks after a cesarean section had been performed...

EDITORIAL: Efficacy of Sirolimus in Treating Tuberous Sclerosis and Lymphangioleiomyomatosis

Elahna Paul, M.D., Ph.D., and Elizabeth Thiele, M.D., Ph.D. — Thu, 10Â JanÂ 2008 00:00:00 -05:00

Owing to their immunosuppressive and antiproliferative effects, sirolimus (also called rapamycin) and related drugs are being evaluated as part of many transplant immunosuppresion regimens, as well as for a plethora...

IMAGES IN CLINICAL MEDICINE: Spontaneous Pneumothorax in Tuberous Sclerosis

Rajeev L. Narayan, M.D. — Thu, 10Â JanÂ 2008 00:00:00 -05:00

A 28-year-old woman with tuberous sclerosis presented with sudden onset of dyspnea and discomfort in the right chest and back. On examination she had tachycardia, tachypnea, and hypoxia, with an...

ORIGINAL ARTICLE: Sirolimus for Angiomyolipoma in Tuberous Sclerosis Complex or Lymphangioleiomyomatosis

Thu, 10Â JanÂ 2008 00:00:00 -05:00

Background: Angiomyolipomas in patients with the tuberous sclerosis complex or sporadic lymphangioleiomyomatosis are associated with mutations in tuberous sclerosis genes resulting in constitutive activation of the mammalian target of rapamycin...

CLINICAL PROBLEM-SOLVING: Failure to Respond â A 52-year-old man presented to his primary care physician with dyspnea and cough

Thu, 03Â JanÂ 2008 00:00:00 -05:00

A 52-year-old man presented to his primary care physician with dyspnea and cough. For the past 15 years, he had recurrent episodes of cough that were relieved only by intermittent...

IMAGES IN CLINICAL MEDICINE: Reversal of Laryngeal Paresis

Jan S. Lewin, Ph.D. and Ralph G. Zinner, M.D. — Thu, 06Â DecÂ 2007 00:00:00 -05:00

A 51-year-old man with stage IV nonâsmall-cell lung cancer, who was receiving chemotherapy, had hoarseness and weak vocal intensity, which developed over a period of 3 days, progressing to near-complete...

EDITORIAL: Health Effects of Airborne Particulate Matter

Morton Lippmann, Ph.D. — Thu, 06Â DecÂ 2007 00:00:00 -05:00

This issue of the Journal includes two multifaceted studies describing significant associations between exposures to particulate matter in ambient air and indexes of health-related responses.12 They are remarkable in their...

ORIGINAL ARTICLE: Reduced Exposure to PM and Attenuated Age-Related Decline in Lung Function

Thu, 06Â DecÂ 2007 00:00:00 -05:00

Background: Air pollution has been associated with impaired health, including reduced lung function in adults. Moving to cleaner areas has been shown to attenuate adverse effects of air pollution on...

EDITORIAL: Lung Transplantation in Cystic Fibrosis â Primum Non Nocere?

Julian Allen, M.D., and Gary Visner, D.O. — Thu, 22Â NovÂ 2007 00:00:00 -05:00

Cystic fibrosis is one of the most common autosomal recessive diseases. It causes intestinal, pancreatic, and progressive lung dysfunction, which is ultimately lethal. In 1989, the first specific cystic fibrosis...

REVIEW ARTICLE: Sarcoidosis

Thu, 22Â NovÂ 2007 00:00:00 -05:00

The modern history of sarcoidosis, an enigmatic multisystem disease, goes back to 1899, when the pioneering Norwegian dermatologist Caesar Boeck coined the term to describe skin nodules characterized by compact,...

ORIGINAL ARTICLE: Lung Transplantation and Survival in Children with Cystic Fibrosis

Thu, 22Â NovÂ 2007 00:00:00 -05:00

Background: The effects of lung transplantation on the survival and quality of life in children with cystic fibrosis are uncertain.

Methods: We used data from the U.S. Cystic Fibrosis Foundation Patient...

IMAGES IN CLINICAL MEDICINE: Pulmonary Alveolar Proteinosis

Zarir F. Udwadia, M.D. and Sushil Jain, M.D. — Thu, 08Â NovÂ 2007 00:00:00 -05:00

A 45-year-old male farmer presented with a 2-month history of increasing breathlessness and dry cough. His arterial oxygen saturation was 82% while he was breathing ambient air, and his chest...

EDITORIAL: On the Caffeination of Prematurity

David K. Stevenson, M.D. — Thu, 08Â NovÂ 2007 00:00:00 -05:00

It was recognized more than three decades ago1 that methylxanthines can reduce the frequency of apneic episodes in premature infants. Since that time, methylxanthines have become part of the routine...

REVIEW ARTICLE: Chronic Lung Disease after Premature Birth

Eugenio Baraldi, M.D., and Marco Filippone, M.D. — Thu, 08Â NovÂ 2007 00:00:00 -05:00

In 1967, Northway et al. first described a new chronic respiratory disease, bronchopulmonary dysplasia, that developed in premature infants exposed to mechanical ventilation and oxygen supplementation.1 Two decades later, the...

ORIGINAL ARTICLE: Long-Term Effects of Caffeine Therapy for Apnea of Prematurity

Thu, 08Â NovÂ 2007 00:00:00 -05:00

Background: Methylxanthine therapy is commonly used for apnea of prematurity but in the absence of adequate data on its efficacy and safety. It is uncertain whether methylxanthines have long-term effects...

IMAGES IN CLINICAL MEDICINE: Herpes Labialis

Julian W. Tang, M.D. and Paul K.S. Chan, M.D. — Thu, 01Â NovÂ 2007 00:00:00 -05:00

A 68-year-old man with a history of asthma and chronic obstructive pulmonary disease was admitted to our hospital with a 1-day history of dyspnea, fever, and epigastric and chest pain....

REVIEW ARTICLE: Leukotrienes

Marc Peters-Golden, M.D., and William R. Henderson, Jr., M.D. — Thu, 01Â NovÂ 2007 00:00:00 -05:00

Leukotrienes (âleuko,â from white blood cells; and âtrienes,â three conjugated double bonds) comprise a family of products of the 5-lipoxygenase pathway of arachidonic acid metabolism. The cysteinyl leukotrienes C4, D4,...

IMAGES IN CLINICAL MEDICINE: Tracheal Bronchus

Baris Bakir, M.D. and Ege Terzibasioglu, M.D. — Thu, 25Â OctÂ 2007 00:00:00 -05:00

A 9-year-old girl with recurrent respiratory infection presented for evaluation for possible active tuberculosis. Multislice computed tomography of the chest showed no evidence of active tuberculosis, but there was an...

VIDEOS IN CLINICAL MEDICINE: Chest-Tube Insertion

Thu, 11Â OctÂ 2007 00:00:00 -05:00

...

CLINICAL PROBLEM-SOLVING: Nothing to Cough At â A 73-year-old man presented to the emergency department with a 4-day history of nonproductive cough that worsened at night

Thu, 04Â OctÂ 2007 00:00:00 -05:00

A 73-year-old man presented to the emergency department with a 4-day history of nonproductive cough that worsened at night. He did not have fever, chills, headache, myalgias, rhinorrhea, nasal congestion,...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 29-2007 â A 51-Year-Old Man with Gastric Cancer and Lung Nodules

Edward T. Ryan, M.D., Suzanne L. Aquino, M.D., and Richard L. Kradin, M.D. — Thu, 20Â SepÂ 2007 00:00:00 -05:00

Dr. Allison L. McDonough (Internal Medicine): A 51-year-old man with a history of gastric cancer was admitted to the hospital because of a new pulmonary lesion.

The patient had been in...

EDITORIAL: Air Pollution, Exercise, and Cardiovascular Risk

Murray A. Mittleman, M.D., Dr.P.H. — Thu, 13Â SepÂ 2007 00:00:00 -05:00

There is mounting evidence that exposure to higher levels of air pollution is associated with adverse cardiovascular consequences. A recent scientific statement from the American Heart Association concluded that transient...

CLINICAL THERAPEUTICS: Low-Tidal-Volume Ventilation in the Acute Respiratory Distress Syndrome

Atul Malhotra, M.D. — Thu, 13Â SepÂ 2007 00:00:00 -05:00

A 55-year-old man who is 178 cm tall and weighs 95 kg is hospitalized with community-acquired pneumonia and progressively severe dyspnea. His arterial oxygen saturation while breathing 100% oxygen through...

ORIGINAL ARTICLE: Ischemic and Thrombotic Effects of Dilute Diesel-Exhaust Inhalation in Men with Coronary Heart Disease

Thu, 13Â SepÂ 2007 00:00:00 -05:00

Background: Exposure to air pollution from traffic is associated with adverse cardiovascular events. The mechanisms for this association are unknown. We conducted a controlled exposure to dilute diesel exhaust in...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 26-2007 â A 61-Year-Old Man with Recurrent Fevers

Thu, 23Â AugÂ 2007 00:00:00 -05:00

Dr. James J. Tolle (Pulmonary and Critical Care Medicine): A 61-year-old man was admitted to this hospital because of recurrent fevers. He had been well until approximately 3.5 months earlier,...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 25-2007 â A 60-Year-Old Man with Fever, Odynophagia, Weight Loss, and Rash

Thu, 16Â AugÂ 2007 00:00:00 -05:00

Dr. Sheila F. Mitsuma (Department of Medicine): A 60-year-old man was admitted to this hospital because of fever, odynophagia, weight loss, and rash.

He had been well until 5 months earlier,...

ORIGINAL ARTICLE: Prophylactic Cranial Irradiation in Extensive Small-Cell Lung Cancer

Thu, 16Â AugÂ 2007 00:00:00 -05:00

Background: We conducted a randomized trial of prophylactic cranial irradiation in patients with extensive small-cell lung cancer who had had a response to chemotherapy.

Methods: Patients between the ages of 18...

CLINICAL PROBLEM-SOLVING: A Growing Problem â A 36-year-old pregnant woman at 21 weeks of gestation presented with a 4-week history of a dry, nonproductive cough

Wendy W. Yeh, M.D., Sanjay Saint, M.D., M.P.H., and Steven E. Weinberger, M.D. — Thu, 02Â AugÂ 2007 00:00:00 -05:00

A 36-year-old pregnant woman at 21 weeks of gestation presented with a 4-week history of a dry, nonproductive cough. The patient said she had no fever, chills, dyspnea, chest pain,...

EDITORIAL: Therapy for Bronchiolitis: When Some Become None

Caroline Breese Hall, M.D. — Thu, 26Â JulÂ 2007 00:00:00 -05:00

In past centuries, infant mortality in the first year of life was described as the greatest plague.1 Infants in the 21st century continue to be plagued by high rates of...

ORIGINAL ARTICLE: A Multicenter, Randomized, Controlled Trial of Dexamethasone for Bronchiolitis

Thu, 26Â JulÂ 2007 00:00:00 -05:00

Background: Bronchiolitis, the most common infection of the lower respiratory tract in infants, is a leading cause of hospitalization in childhood. Corticosteroids are commonly used to treat bronchiolitis, but evidence...

ORIGINAL ARTICLE: Effect of Aircraft-Cabin Altitude on Passenger Discomfort

Thu, 05Â JulÂ 2007 00:00:00 -05:00

Background: Acute mountain sickness occurs in some unacclimatized persons who travel to terrestrial altitudes at which barometric pressures are the same as those in commercial aircraft during flight. Whether the...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery â High Blood Pressure

Raul Quiros-Lopez, M.D. and Javier Garcia-Alegria, M.D. — Thu, 21Â JunÂ 2007 00:00:00 -05:00

A healthy 28-year-old woman presented with a 1-year history of high blood pressure, which had been diagnosed during her first pregnancy and treated with amiloride and hydrochlorothiazide. Physical examination revealed...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 17-2007 â A 25-Year-Old Woman with Relapsing Fevers and Recent Onset of Dyspnea

Thu, 31Â MayÂ 2007 00:00:00 -05:00

Dr. Surajit Nundy (Department of Medicine): A 25-year-old woman was admitted to this hospital because of a 5-month history of relapsing fevers and a 3-day history of dyspnea. She had...

IMAGES IN CLINICAL MEDICINE: âStagingâ Pneumothorax

Robert C. Hoch, M.D. — Thu, 31Â MayÂ 2007 00:00:00 -05:00

A 63-year-old man was found to have a new mass in the right lung on chest radiography. Computed tomography (CT) showed a soft-tissue density in the medial aspect of the...

PERSPECTIVE: The Legacy of World Trade Center Dust

Thu, 31Â MayÂ 2007 00:00:00 -05:00

More than 5 years after the World Trade Center disaster on September 11, 2001, uncertainty and controversy remain about the health risks posed by inhaling the dust from the collapse...

IMAGES IN CLINICAL MEDICINE: A Complication of Central Venous Catheterization

Sudip Nanda, M.D. and Laurie Strockoz-Scaff, P.A.C. — Thu, 24Â MayÂ 2007 00:00:00 -05:00

A 65-year-old man with a history of hypertension, diabetes mellitus, coronary artery disease with angioplasty and bypass grafting, and deep-vein thrombosis (with placement of an inferior vena cava filter several...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 16-2007 â A 61-Year-Old Man with a Mediastinal Mass

Thu, 24Â MayÂ 2007 00:00:00 -05:00

A 61-year-old man was referred to the thoracic oncology service of this hospital for management of a thymoma. He had been well until 6 weeks earlier, when he experienced the...

ORIGINAL ARTICLE: Advanced Life Support for Out-of-Hospital Respiratory Distress

Thu, 24Â MayÂ 2007 00:00:00 -05:00

Background: Respiratory distress is a common symptom of patients transported to hospitals by emergency medical services (EMS) personnel. The benefit of advanced life support for such patients has not been...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 15-2007 â A 20-Year-Old Woman with Asthma and Cardiorespiratory Arrest

Thu, 17Â MayÂ 2007 00:00:00 -05:00

A 20-year-old woman with asthma was taken to the emergency room of another hospital because of cardiorespiratory arrest. The patient had had severe asthma since childhood. She was born after...

IMAGES IN CLINICAL MEDICINE: Azygous Lobe

Shinjiro Hirose, M.D. and Robert A. Cowles, M.D. — Thu, 17Â MayÂ 2007 00:00:00 -05:00

A 15-year-old boy was receiving chemotherapy for osteogenic sarcoma of the left femur. A routine chest radiograph incidentally showed an azygous lobe of the lung (Panel A) with a thin...

CLINICAL PROBLEM-SOLVING: The Drenched Doctor â A 55-year-old male physician was seen in August because of a 1-week history of fever and night sweats

Thu, 03Â MayÂ 2007 00:00:00 -05:00

A 55-year-old male physician was seen in August because of a 1-week history of fever and night sweats. The night sweats required at least one nightly change of his pajamas...

CLINICAL PRACTICE: Superior Vena Cava Syndrome with Malignant Causes

Thu, 03Â MayÂ 2007 00:00:00 -05:00

A 58-year-old man presents with a 2-week history of progressive dyspnea on exertion, neck swelling, decreased appetite, and fatigue. There is no history of syncope or dysphagia. He smoked cigarettes...

IMAGES IN CLINICAL MEDICINE: Pulmonary and Peritoneal Ossification

Phillip H. Kuo, M.D., Ph.D. and Myung Soo Shin, M.D., D.Sc. — Thu, 26Â AprÂ 2007 00:00:00 -05:00

A 20-year-old man, who had long-standing end-stage renal disease and was receiving peritoneal dialysis, presented with fever and abdominal pain. The patient began peritoneal dialysis at the age of 4...

CLINICAL THERAPEUTICS: Continuous Positive Airway Pressure for Obstructive Sleep Apnea

Robert C. Basner, M.D. — Thu, 26Â AprÂ 2007 00:00:00 -05:00

During an evaluation by his internist, a 48-year-old man reports that his wife tells him that he snores loudly. Further questioning reveals that he has been falling asleep whenever sedentary....

PERSPECTIVE: Tobacco Tightrope â Balancing Disease Prevention and Economic Development in China

Thu, 12Â AprÂ 2007 00:00:00 -05:00

During the past 20 years, as smoking rates have fallen in high-income countries, the tobacco industry has found new and bigger markets in the developing world. One third of current...

EDITORIAL: Natural Killer T Cells in Asthma â Toward Increased Understanding

Ling-Pei Ho, M.D., Ph.D. — Thu, 05Â AprÂ 2007 00:00:00 -05:00

This issue of the Journal contains the second report within about a year on the presence of natural killer T cells in the lungs of patients with asthma. The two...

CLINICAL PROBLEM-SOLVING: Building a Diagnosis from the Ground Up â A 49-year-old man came to the clinic with a 1-week history of suprapubic pain and fever

Thu, 05Â AprÂ 2007 00:00:00 -05:00

A 49-year-old man came to the clinic with a 1-week history of suprapubic pain and fever. On examination, he had a temperature of 38.1Â°C but appeared well. A urinalysis revealed...

ORIGINAL ARTICLE: Invariant Natural Killer T Cells in Asthma and Chronic Obstructive Pulmonary Disease

Thu, 05Â AprÂ 2007 00:00:00 -05:00

Background: The number of type 2 helper CD4+ T cells is increased in the airways of persons with asthma. Whether the majority of these cells are class II major-histocompatibility-complexârestricted cells...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Idiopathic Pulmonary Fibrosis â New Insights

Subodh Verma, M.D., Ph.D., and Arthur S. Slutsky, M.D. — Thu, 29Â MarÂ 2007 00:00:00 -05:00

âDeath occurred about three months and a half after the onset of the acute disease and the lung was two thirds of the normal size, grayish in color, and hard...

REVIEW ARTICLE: Withdrawal of Albuterol Inhalers Containing Chlorofluorocarbon Propellants

Leslie Hendeles, Pharm.D., Gene L. Colice, M.D., and Robert J. Meyer, M.D. — Thu, 29Â MarÂ 2007 00:00:00 -05:00

Inhaled short-acting Î²2-agonists are indicated for short-term relief of symptoms related to bronchospasm in patients with asthma and chronic obstructive pulmonary disease (COPD). Albuterol (called salbutamol outside the United States)...

ORIGINAL ARTICLE: Telomerase Mutations in Families with Idiopathic Pulmonary Fibrosis

Thu, 29Â MarÂ 2007 00:00:00 -05:00

Background: Idiopathic pulmonary fibrosis is progressive and often fatal; causes of familial clustering of the disease are unknown. Germ-line mutations in the genes hTERT and hTR, encoding telomerase reverse transcriptase...

CLINICAL PROBLEM-SOLVING: Into the Woods

Nasia Safdar, M.D., Daniel R. Kaul, M.D., and Sanjay Saint, M.D., M.P.H. — Thu, 01Â MarÂ 2007 00:00:00 -05:00

A 79-year-old woman presented with a 1-month history of dyspnea and a cough productive of yellow sputum. She reported no chest pain, hemoptysis, night sweats, or fever. Three months earlier,...

EDITORIAL: Treating COPD â The TORCH Trial, P Values, and the Dodo

Klaus F. Rabe, M.D., Ph.D. — Thu, 22Â FebÂ 2007 00:00:00 -05:00

In the United States, the overall, age-standardized death rate decreased from 1242 deaths per 100,000 population in 1970 to 845 deaths per 100,000 in 2002. This good news must be...

ORIGINAL ARTICLE: Salmeterol and Fluticasone Propionate and Survival in Chronic Obstructive Pulmonary Disease

Thu, 22Â FebÂ 2007 00:00:00 -05:00

Background: Long-acting beta-agonists and inhaled corticosteroids are used to treat chronic obstructive pulmonary disease (COPD), but their effect on survival is unknown.

Methods: We conducted a randomized, double-blind trial comparing salmeterol...

ORIGINAL ARTICLE: GM-CSF Autoantibodies and Neutrophil Dysfunction in Pulmonary Alveolar Proteinosis

Thu, 08Â FebÂ 2007 00:00:00 -05:00

Background: Increased mortality from infection in patients with pulmonary alveolar proteinosis occurs in association with high levels of autoantibodies against granulocyteâmacrophage colony-stimulating factor (GM-CSF). We tested the hypothesis that neutrophil...

PERSPECTIVE: Pulmonary Alveolar Proteinosis â Is Host Defense Awry?

Thu, 08Â FebÂ 2007 00:00:00 -05:00

Pulmonary alveolar proteinosis is a rare disorder caused by abundant accumulation of surfactant-derived components in the lungs. The incidence is estimated to be 0.36 case per million population, and the...

EDITORIAL: Cardiovascular Risks from Fine Particulate Air Pollution

Douglas W. Dockery, Sc.D., and Peter H. Stone, M.D. — Thu, 01Â FebÂ 2007 00:00:00 -05:00

More than a decade ago, prospective epidemiologic studies showed that mortality was increased among people living in communities with elevated concentrations of fine particulate air pollution.12 Subsequent research has shown...

CLINICAL PROBLEM-SOLVING: Anchors Away

Thu, 01Â FebÂ 2007 00:00:00 -05:00

A 50-year-old Asian woman presented with a papulonodular, erythematous rash on her legs below the knees. The skin lesions were nontender and nonpruritic and were accompanied by paresthesias. She had...

ORIGINAL ARTICLE: Long-Term Exposure to Air Pollution and Incidence of Cardiovascular Events in Women

Thu, 01Â FebÂ 2007 00:00:00 -05:00

Background: Fine particulate air pollution has been linked to cardiovascular disease, but previous studies have assessed only mortality and differences in exposure between cities. We examined the association of long-term...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 3-2007 â A 3-Year-Old Boy with Recurrent Episodes of Respiratory Insufficiency

Thu, 25Â JanÂ 2007 00:00:00 -05:00

A 3-year-old boy was admitted to the hospital because of recurrent episodes of respiratory insufficiency, pulmonary infiltrates, and anemia. He was treated with antibiotics and levalbuterol and budesonide by inhalation...

IMAGES IN CLINICAL MEDICINE: Prevertebral Emphysema after a Dental Procedure

Kumar Sujeet, M.D. and Stuti Shankar, M.D. — Thu, 11Â JanÂ 2007 00:00:00 -05:00

A 47-year-old woman with diabetes was seen in the emergency room with difficulty swallowing, bilateral chest pain, and a foreign-body sensation in her throat. Earlier that day, she had undergone...

IMAGES IN CLINICAL MEDICINE: Multiple Pulmonary Bacterial Abscesses

Ju-Yi Chen, M.D. and Yi-Heng Li, M.D., Ph.D. — Thu, 21Â DecÂ 2006 00:00:00 -05:00

A 21-year-old woman with human immunodeficiency virus infection and a CD4 count of 400 cells per cubic millimeter who was not receiving antiretroviral therapy presented with a 1-week history of...

EDITORIAL: Diagnosis of Ventilator-Associated Pneumonia

Marin H. Kollef, M.D. — Thu, 21Â DecÂ 2006 00:00:00 -05:00

In this issue of the Journal, Heyland et al., writing for the Canadian Critical Care Trials Group, report the results of a multicenter, randomized trial comparing the use of bronchoalveolar...

ORIGINAL ARTICLE: A Randomized Trial of Diagnostic Techniques for Ventilator-Associated Pneumonia

The Canadian Critical Care Trials Group — Thu, 21Â DecÂ 2006 00:00:00 -05:00

Background: Critically ill patients who require mechanical ventilation are at risk for ventilator-associated pneumonia. Current data are conflicting as to the optimal diagnostic approach in patients who have suspected ventilator-associated...

CLINICAL PROBLEM-SOLVING: Sum of the Parts

Thu, 07Â DecÂ 2006 00:00:00 -05:00

A 36-year-old Pakistani woman presented to the emergency room with a 10-day history of a nonproductive cough, dyspnea, and fever. She reported having no night sweats and no contact with...

IMAGES IN CLINICAL MEDICINE: Squamous-Cell Carcinoma with Pericardial Metastases

Pierre Boukhalil, M.D. and Ali Debek, M.D. — Thu, 23Â NovÂ 2006 00:00:00 -05:00

A 78-year-old woman presented with dyspnea, cough, and a pleural effusion on the left side. She had fractured a hip 3 years earlier, and a chronic decubitus ulcer developed while...

CLINICAL PRACTICE: Acute Bronchitis

Richard P. Wenzel, M.D., and Alpha A. Fowler III, M.D. — Thu, 16Â NovÂ 2006 00:00:00 -05:00

A 40-year-old man with no underlying lung disease has a 7-day history of mild shortness of breath with exertion, as well as cough that is now productive of purulent sputum....

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 34-2006 â A 72-Year-Old Woman with Nausea Followed by Hypotension and Respiratory Failure

Thu, 09Â NovÂ 2006 00:00:00 -05:00

Dr. David S. Frankel (Medicine): A 72-year-old woman was admitted to this hospital because of respiratory failure and hypotension.

During the week before admission, the patient and other members of her...

CLINICAL PROBLEM-SOLVING: The Missing Piece

Thu, 02Â NovÂ 2006 00:00:00 -05:00

A 21-year-old man presented to the emergency department after a 2-day history of increasing pain in the right lower quadrant. The pain was dull and nonradiating, was not exacerbated by...

EDITORIAL: A Pause, Progress, and Reassessment in Lung Cancer Screening

Michael Unger, M.D. — Thu, 26Â OctÂ 2006 00:00:00 -05:00

We are all well acquainted with the frightfully high incidence of lung cancer and the short survival of patients after the diagnosis has been made. The extremely low survival rate...

IMAGES IN CLINICAL MEDICINE: Intrathoracic Splenosis after Remote Trauma

Leah M. Backhus, M.D. and Ross M. Bremner, M.D., Ph.D. — Thu, 26Â OctÂ 2006 00:00:00 -05:00

A healthy 39-year-old man with persistent influenza-like symptoms underwent chest radiography, which showed two pericardial masses (Panels A and B, arrows). Computed tomography (CT) showed that the masses (one 3.3...

ORIGINAL ARTICLE: Survival of Patients with Stage I Lung Cancer Detected on CT Screening

The International Early Lung Cancer Action Program Investigators — Thu, 26Â OctÂ 2006 00:00:00 -05:00

Background: The outcome among patients with clinical stage I cancer that is detected on annual screening using spiral computed tomography (CT) is unknown.

Methods: In a large collaborative study, we screened...

IMAGES IN CLINICAL MEDICINE: Rasmussen's Aneurysm

Michel M. van den Heuvel, M.D., Ph.D. and Jacques J. van Rensburg, M.D. — Thu, 19Â OctÂ 2006 00:00:00 -05:00

A 54-year-old man presented with a 3-month history of hemoptysis of approximately 50 ml per day. He had a remote history of pulmonary tuberculosis. On the second hospital day, he...

VIDEOS IN CLINICAL MEDICINE: Thoracentesis

Todd W. Thomsen, M.D., Jennifer DeLaPena, M.D., and Gary S. Setnik, M.D. — Thu, 12Â OctÂ 2006 00:00:00 -05:00

...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2006 â A 15-Year-Old Girl with Severe Obesity

Thu, 12Â OctÂ 2006 00:00:00 -05:00

A 15 1/2-year-old girl was seen in the outpatient Weight Center of this hospital for the evaluation of severe obesity. She had had a normal gestation without complications and had...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 30-2006 â A 41-Year-Old Man with Dyspnea, Fever, and Lymphadenopathy

David T. Scadden, M.D., Victorine V. Muse, M.D., and Robert P. Hasserjian, M.D. — Thu, 28Â SepÂ 2006 00:00:00 -05:00

A 41-year-old man was admitted to the hospital because of shortness of breath and fever. He had been well until 7 months earlier, when a rash and wheezing developed after...

IMAGES IN CLINICAL MEDICINE: Intratracheal Melanoma Metastases

Aditya Bardia, M.D., M.P.H. and Ravi D. Rao, M.D. — Thu, 28Â SepÂ 2006 00:00:00 -05:00

A 42-year-old woman with metastatic melanoma presented with a 1-month history of dyspnea and wheezing. The diagnosis of malignant melanoma had been made 6 years earlier on the basis of...

IMAGES IN CLINICAL MEDICINE: Elevated Jugular Venous Pressure

SÃ¡ndor GyÃ¶rik, M.D. and Andrea Menafoglio, M.D. — Thu, 14Â SepÂ 2006 00:00:00 -05:00

A 43-year-old man presented to the emergency room in respiratory distress after a 3-week illness. He had a history of alcoholism but no other serious illness. He had a respiratory...

IMAGES IN CLINICAL MEDICINE: Catamenial Pneumothorax

Christoph M. Kronauer, M.D. — Thu, 07Â SepÂ 2006 00:00:00 -05:00

A 38-year-old female smoker reported having had intermittent, recurrent right-sided chest pain for several months. Pelvic endometriosis had been diagnosed during laparoscopy for in vitro fertilization 6 years earlier. Six...

CLINICAL PROBLEM-SOLVING: More Than Meets the Eye

Thu, 07Â SepÂ 2006 00:00:00 -05:00

A 61-year-old woman was hospitalized with a two-day history of palpitations and dyspnea. She was found to be in atrial fibrillation with a rapid ventricular response, and intravenous diltiazem and...

EDITORIAL: Inhaled NO for Preterm Infants â Getting to Yes?

Ann R. Stark, M.D. — Thu, 27Â JulÂ 2006 00:00:00 -05:00

Preterm birth, especially at an extremely low gestational age, is often perilous. Despite improved survival associated with contemporary neonatal intensive care, more than one third of survivors with a birth...

ORIGINAL ARTICLE: Early Inhaled Nitric Oxide Therapy in Premature Newborns with Respiratory Failure

Thu, 27Â JulÂ 2006 00:00:00 -05:00

Background: The safety and efficacy of early, low-dose, prolonged therapy with inhaled nitric oxide in premature newborns with respiratory failure are uncertain.

Methods: We performed a multicenter, randomized trial involving 793...

ORIGINAL ARTICLE: Inhaled Nitric Oxide in Preterm Infants Undergoing Mechanical Ventilation

Thu, 27Â JulÂ 2006 00:00:00 -05:00

Background: Bronchopulmonary dysplasia in premature infants is associated with prolonged hospitalization, as well as abnormal pulmonary and neurodevelopmental outcome. In animal models, inhaled nitric oxide improves both gas exchange and...

REVIEW ARTICLE: Intensive Care of Patients with HIV Infection

Thu, 13Â JulÂ 2006 00:00:00 -05:00

Antiretroviral therapy has increased the life expectancy of patients who are infected with the human immunodeficiency virus (HIV) and has reduced the incidence of illnesses associated with the acquired immunodeficiency...

EDITORIAL: Influenza Control

W. Paul Glezen, M.D. — Thu, 06Â JulÂ 2006 00:00:00 -05:00

Influenza is an uncontrolled epidemic disease that occurs every winter. Epidemics, which vary in severity, are measured by excess mortality, but influenza is always the leading cause of acute respiratory...

EDITORIAL: Air Pollution and Children â An Unhealthy Mix

W. James Gauderman, Ph.D. — Thu, 06Â JulÂ 2006 00:00:00 -05:00

Residents in urban areas may be worried about the air they breathe. In recent reports, air pollution has been linked to increased mortality, an increased risk of asthma, and decreased...

SPECIAL ARTICLE: Hospital Volume and the Outcomes of Mechanical Ventilation

Thu, 06Â JulÂ 2006 00:00:00 -05:00

Background: An increased volume of patients is associated with improved survival in numerous high-risk medical and surgical conditions. The relationship between the number of patients admitted (hospital volume) and outcome...

ORIGINAL ARTICLE: The Underrecognized Burden of Influenza in Young Children

Thu, 06Â JulÂ 2006 00:00:00 -05:00

Background: The disease burden of influenza infection among children is not well established. We conducted a population-based surveillance of medical visits associated with laboratory-confirmed influenza.

Methods: Eligible children were younger than...

ORIGINAL ARTICLE: Carbon in Airway Macrophages and Lung Function in Children

Thu, 06Â JulÂ 2006 00:00:00 -05:00

Background: Epidemiologic studies indirectly suggest that the inhalation of carbonaceous particulate matter impairs lung function in children. Using the carbon content of airway macrophages as a marker of individual exposure...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 20-2006 â An 84-Year-Old Man with Staphylococcal Bacteremia and Renal Failure

Thu, 29Â JunÂ 2006 00:00:00 -05:00

Dr. Alec D. Weisberg (Medicine): An 84-year-old man was transferred to this hospital because of staphylococcal bacteremia and renal failure. Two weeks before admission, fever, chills, nausea, vomiting, shortness of...

IMAGES IN CLINICAL MEDICINE: Venous Air Embolism

Antoine Cuvelier, M.D., Ph.D. and Jean-Francois Muir, M.D. — Thu, 22Â JunÂ 2006 00:00:00 -05:00

An 82-year-old man was transferred to our hospital for the treatment of respiratory distress after computed tomography (CT) of the thorax. He had undergone a follow-up evaluation seven years after...

EDITORIAL: Cyclophosphamide for Scleroderma Lung Disease

Fernando J. Martinez, M.D., and W. Joseph McCune, M.D. — Thu, 22Â JunÂ 2006 00:00:00 -05:00

Clinically significant interstitial lung disease affects patients with systemic sclerosis (scleroderma) and is a cause of morbidity and mortality in approximately 40 percent of these patients.1 Management of this condition...

ORIGINAL ARTICLE: Cyclophosphamide versus Placebo in Scleroderma Lung Disease

Thu, 22Â JunÂ 2006 00:00:00 -05:00

Background: We conducted a double-blind, randomized, placebo-controlled trial to determine the effects of oral cyclophosphamide on lung function and health-related symptoms in patients with evidence of active alveolitis and scleroderma-related...

IMAGES IN CLINICAL MEDICINE: Tooth Aspiration

Yevgeniy Ostrinsky, M.D. and Zaza Cohen, M.D. — Thu, 15Â JunÂ 2006 00:00:00 -05:00

A 77-year-old man with a history of hypertension was found on the sidewalk, face down and unresponsive. He had tonicâclonic movements and was brought to the hospital. The initial chest...

EDITORIAL: Fluid-Management Strategies in Acute Lung Injury â Liberal, Conservative, or Both?

Emanuel P. Rivers, M.D., M.P.H. — Thu, 15Â JunÂ 2006 00:00:00 -05:00

One of the factorial assessments carried out in the Fluids and Catheters Treatment Trial (FACTT) conducted by the National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical...

IMAGES IN CLINICAL MEDICINE: Cutaneous Metastases of Small-Cell Lung Cancer

Manuel Haro Estarriol, M.D. and Manuel Rubio Goday, M.D. — Thu, 15Â JunÂ 2006 00:00:00 -05:00

A 70-year-old former smoker presented with a history of several weeks of multiple painless cutaneous nodules on his chest wall. He also reported fatigue, weight loss, and cough with blood-tinged...

ORIGINAL ARTICLE: Comparison of Two Fluid-Management Strategies in Acute Lung Injury

Thu, 15Â JunÂ 2006 00:00:00 -05:00

Background: Optimal fluid management in patients with acute lung injury is unknown. Diuresis or fluid restriction may improve lung function but could jeopardize extrapulmonary-organ perfusion.

Methods: In a randomized study, we...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 17-2006 â A 34-Year-Old Man with Cavitary Lung Lesions

Thu, 08Â JunÂ 2006 00:00:00 -05:00

Dr. Anna Kagan (Department of Medicine): A 34-year-old man was admitted to this hospital because of cough, dyspnea, and cavitary lung lesions. Over a period of several days three months...

EDITORIAL: Pulmonary-Artery Catheters â Peace at Last?

Deborah Shure, M.D. — Thu, 25Â MayÂ 2006 00:00:00 -05:00

The history of the use of the pulmonary-artery catheter (PAC) illustrates a great deal about physicians' often uncritical acceptance of technology in clinical applications. In 1956, Forssmann, Cournand, and Richards...

ORIGINAL ARTICLE: Pulmonary-Artery versus Central Venous Catheter to Guide Treatment of Acute Lung Injury

Thu, 25Â MayÂ 2006 00:00:00 -05:00

Background: The balance between the benefits and the risks of pulmonary-artery catheters (PACs) has not been established.

Methods: We evaluated the relationship of benefits and risks of PACs in 1000 patients...

EDITORIAL: Caffeine for Apnea of Prematurity

Eduardo Bancalari, M.D. — Thu, 18Â MayÂ 2006 00:00:00 -05:00

Caffeine is one of the most commonly prescribed drugs among premature infants. It is a potent respiratory stimulant indicated primarily to reduce the incidence of episodes of apnea associated with...

ORIGINAL ARTICLE: Caffeine Therapy for Apnea of Prematurity

Thu, 18Â MayÂ 2006 00:00:00 -05:00

Background: Methylxanthines reduce the frequency of apnea of prematurity and the need for mechanical ventilation during the first seven days of therapy. It is uncertain whether methylxanthines have other short-...

IMAGES IN CLINICAL MEDICINE: Reexpansion Pulmonary Edema after Treatment of Pneumothorax

Syed Mohammad Tariq, F.R.C.P. and Tabinda Sadaf, M.B., B.S. — Thu, 11Â MayÂ 2006 00:00:00 -05:00

A 50-year-old smoker presented with acute-onset breathlessness and right-sided chest pain of four days' duration. There was no history of chest trauma. A posteroanterior chest radiograph (Panel A) demonstrated a...

EDITORIAL: PEEP or No PEEP â Lung Recruitment May Be the Solution

Arthur S. Slutsky, M.D., and Leonard D. Hudson, M.D. — Thu, 27Â AprÂ 2006 00:00:00 -05:00

The acute respiratory distress syndrome (ARDS) is characterized by inflammatory lung injury with alveolar flooding and abnormalities in surfactant function. ARDS (a subcategory of acute lung injury) is associated with...

ORIGINAL ARTICLE: Lung Recruitment in Patients with the Acute Respiratory Distress Syndrome

Thu, 27Â AprÂ 2006 00:00:00 -05:00

Background: In the acute respiratory distress syndrome (ARDS), positive end-expiratory pressure (PEEP) may decrease ventilator-induced lung injury by keeping lung regions open that otherwise would be collapsed. Since the effects...

EDITORIAL: Lung Inflammation in ARDS â Friend or Foe?

Peter M. Suter, M.D. — Thu, 20Â AprÂ 2006 00:00:00 -05:00

There is good reason that treatment of the acute respiratory distress syndrome (ARDS) with corticosteroids has been a much-studied subject. In response to a number of serious underlying events, such...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 12-2006 â A 37-Year-Old Man with Hemoptysis and a Pulmonary Infiltrate

Fiona K. Gibbons, M.D., John A. Branda, M.D., and Jo-Anne O. Shepard, M.D. — Thu, 20Â AprÂ 2006 00:00:00 -05:00

Dr. Michael D. Howell (Pulmonary and Critical Care Unit): A 37-year-old man was seen in the pulmonary clinic of this hospital because of blood-streaked sputum and an abnormal result on...

ORIGINAL ARTICLE: Efficacy and Safety of Corticosteroids for Persistent Acute Respiratory Distress Syndrome

Thu, 20Â AprÂ 2006 00:00:00 -05:00

Background: Persistent acute respiratory distress syndrome (ARDS) is characterized by excessive fibroproliferation, ongoing inflammation, prolonged mechanical ventilation, and a substantial risk of death. Because previous reports suggested that corticosteroids may...

IMAGES IN CLINICAL MEDICINE: Pneumomediastinum

Kuo-Hsien Chiang, M.D. and Andy Shau-Bin Chou, M.D. — Thu, 16Â MarÂ 2006 00:00:00 -05:00

A 15-year-old boy had the sudden onset of sharp, piercing, centralized chest pain while at rest. He had no important medical history. He also reported a sore throat and said...

IMAGES IN CLINICAL MEDICINE: Nebulizer-Associated Anisocoria

Neil Iosson, M.R.C.P., M.B., B.Chir. — Thu, 02Â MarÂ 2006 00:00:00 -05:00

A 42-year-old intravenous drug user was transferred to the ward for noninvasive respiratory support after discharge from the intensive care unit, where she had been treated for fungal pneumonia and...

CLINICAL PROBLEM-SOLVING: Search for the Complication

Thu, 02Â MarÂ 2006 00:00:00 -05:00

A 58-year-old woman was hospitalized for the evaluation of prolonged fever and hemoptysis. She reported an eight-month history of intermittent fevers, a productive cough, shortness of breath, and hemoptysis, which...

EDITORIAL: Depressing Observations on the Use of Selective Serotonin-Reuptake Inhibitors during Pregnancy

James L. Mills, M.D. — Thu, 09Â FebÂ 2006 00:00:00 -05:00

Persistent pulmonary hypertension of the newborn (PPHN) is a serious condition that typically occurs in full-term or near-term infants. Before birth, the fetus receives oxygenated blood from the placenta; a...

ORIGINAL ARTICLE: Selective Serotonin-Reuptake Inhibitors and Risk of Persistent Pulmonary Hypertension of the Newborn

Thu, 09Â FebÂ 2006 00:00:00 -05:00

Background: Persistent pulmonary hypertension of the newborn (PPHN) is associated with substantial infant mortality and morbidity. A previous cohort study suggested a possible association between maternal use of the selective...

IMAGES IN CLINICAL MEDICINE: Radiographic Evidence Linking Tobacco Use and Lung Cancer

David Michael McMullan, M.D. and Gordon Alan Cohen, M.D., Ph.D. — Thu, 26Â JanÂ 2006 00:00:00 -05:00

A 72-year-old man presented for evaluation of progressive dyspnea and cough. He reported smoking one to two packs of cigarettes a day since the age of 15 years. Standard chest...

ORIGINAL ARTICLE: Ethnic and Racial Differences in the Smoking-Related Risk of Lung Cancer

Thu, 26Â JanÂ 2006 00:00:00 -05:00

Background: There is remarkable variation in the incidence of lung cancer among ethnic and racial groups in the United States.

Methods: We investigated differences in the risk of lung cancer associated...

EDITORIAL: Restoring Airway Surface Liquid in Cystic Fibrosis

Felix Ratjen, M.D., Ph.D. — Thu, 19Â JanÂ 2006 00:00:00 -05:00

The current pathophysiological model of cystic fibrosis lung disease assumes that defective expression, trafficking, or function of the cystic fibrosis transmembrane regulator (CFTR) protein leads to impaired epithelial chloride secretion...

ORIGINAL ARTICLE: Mucus Clearance and Lung Function in Cystic Fibrosis with Hypertonic Saline

Thu, 19Â JanÂ 2006 00:00:00 -05:00

Background: Abnormal homeostasis of the volume of airway surface liquid in patients with cystic fibrosis is thought to produce defects in mucus clearance and airway defense. Through osmotic forces, hypertonic...

ORIGINAL ARTICLE: A Controlled Trial of Long-Term Inhaled Hypertonic Saline in Patients with Cystic Fibrosis

Thu, 19Â JanÂ 2006 00:00:00 -05:00

Background: Inhaled hypertonic saline acutely increases mucociliary clearance and, in short-term trials, improves lung function in people with cystic fibrosis. We tested the safety and efficacy of inhaled hypertonic saline...

EDITORIAL: Inhaled Cyclosporine â A Breath of Fresh Air?

Malcolm M. DeCamp, Jr., M.D. — Thu, 12Â JanÂ 2006 00:00:00 -05:00

During the past two decades, lung transplantation has evolved from a new investigational intervention performed in fewer than 20 patients per year at one institution to an accepted, albeit complex,...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 1-2006 â A 64-Year-Old Male Lung-Transplant Recipient with Fever, Cough, Hemoptysis, and Abdominal Pain

Robert H. Rubin, M.D., Matthew D. Gilman, M.D., and Richard L. Kradin, M.D. — Thu, 12Â JanÂ 2006 00:00:00 -05:00

A 64-year-old man with emphysema who had received a double-lung allograft six months previously was admitted to the hospital because of cough, hemoptysis, and abdominal pain.

Three days before admission, abdominal...

ORIGINAL ARTICLE: A Randomized Trial of Inhaled Cyclosporine in Lung-Transplant Recipients

Thu, 12Â JanÂ 2006 00:00:00 -05:00

Background: Conventional regimens of immunosuppressive drugs often do not prevent chronic rejection after lung transplantation. Topical delivery of cyclosporine in addition to conventional systemic immunosuppression might help prevent acute and...

CLINICAL PROBLEM-SOLVING: Needle in a Haystack

Krishna R. Polu, M.D., and Myles Wolf, M.D., M.M.Sc. — Thu, 05Â JanÂ 2006 00:00:00 -05:00

A 63-year-old man presented to the emergency department because of shortness of breath that had begun the evening before, after he had gone to bed, and worsened progressively during the...

CLINICAL PRACTICE: Acute Pulmonary Edema

Lorraine B. Ware, M.D., and Michael A. Matthay, M.D. — Thu, 29Â DecÂ 2005 00:00:00 -05:00

A 62-year-old man presents with a three-day history of progressive dyspnea, nonproductive cough, and low-grade fever. He had been hospitalized two years earlier for congestive heart failure. His blood pressure...

REVIEW ARTICLE: Inhaled Nitric Oxide Therapy in Adults

Mark J.D. Griffiths, M.R.C.P., Ph.D., and Timothy W. Evans, M.D., Ph.D. — Thu, 22Â DecÂ 2005 00:00:00 -05:00

Nitric oxide was largely regarded as a toxic pollutant until 1987, when its biologic similarities to endothelium-derived relaxing factor were demonstrated.1 Subsequently, nitric oxide and endothelium-derived relaxing factor were considered...

PERSPECTIVE: Safety of Long-Acting Beta-Agonists â An Urgent Need to Clear the Air

Thu, 22Â DecÂ 2005 00:00:00 -05:00

Eleven years after the first long-acting beta-agonist, salmeterol, was approved for sale in the United States, the Food and Drug Administration (FDA) has issued a stern public health advisory alerting...

EDITORIAL: Can Sleep Apnea Be Treated without Modifying Anatomy?

Daniel J. Gottlieb, M.D., M.P.H. — Thu, 15Â DecÂ 2005 00:00:00 -05:00

The obstructive sleep apnea syndrome is a common chronic disease of adults. It is estimated to afflict 2 percent of middle-aged women and 4 percent of middle-aged men, based on...

ORIGINAL ARTICLE: Atrial Overdrive Pacing for the Obstructive Sleep ApneaâHypopnea Syndrome

Thu, 15Â DecÂ 2005 00:00:00 -05:00

Background: The role of atrial overdrive pacing (AOP) in sleep apnea remains uncertain. We prospectively evaluated the effect of AOP after 24 hours and after one month in patients with...

EDITORIAL: Antioxidant Therapy for Idiopathic Pulmonary Fibrosis

Gary W. Hunninghake, M.D. — Thu, 24Â NovÂ 2005 00:00:00 -05:00

Idiopathic pulmonary fibrosis (IPF) is a progressive disease characterized by fibrosis and remodeling of the lung parenchyma. The median survival of patients with the disease is about three years after...

ORIGINAL ARTICLE: High-Dose Acetylcysteine in Idiopathic Pulmonary Fibrosis

Thu, 24Â NovÂ 2005 00:00:00 -05:00

Background: Idiopathic pulmonary fibrosis is a chronic progressive disorder with a poor prognosis.

Methods: We conducted a double-blind, randomized, placebo-controlled multicenter study that assessed the effectiveness over one year of a...

IMAGES IN CLINICAL MEDICINE: Pulmonary Sequestration

Alexandra Platon, M.D. and Pierre-Alexandre Poletti, M.D. — Thu, 17Â NovÂ 2005 00:00:00 -05:00

A healthy 48-year-old man without prior pulmonary symptoms underwent routine chest radiography for minor thoracic pain. The frontal and lateral images (Panels A and B) showed a well-defined, lobulated mass...

ORIGINAL ARTICLE: Sildenafil Citrate Therapy for Pulmonary Arterial Hypertension

Thu, 17Â NovÂ 2005 00:00:00 -05:00

Background: 05111727.xml 05111727.xml 05111727.xml Sildenafil inhibits phosphodiesterase type 5, an enzyme that metabolizes cyclic guanosine monophosphate, thereby enhancing the cyclic guanosine monophosphateâmediated relaxation and growth inhibition of vascular smooth-muscle cells,...

EDITORIAL: Sleep â A New Cardiovascular Frontier

Virend K. Somers, M.D., Ph.D. — Thu, 10Â NovÂ 2005 00:00:00 -05:00

Sleep occupies a third of our lives. The cardiovascular implications of normal and disturbed sleep, and of sleep apnea1 in particular, have only recently gained prominence. Central sleep apnea is...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 34-2005 â A 10-Year-Old Girl with a Bullous Skin Eruption and Acute Respiratory Failure

Robert L. Sheridan, M.D., Vincent Liu, M.D., and Sudha Anupindi, M.D. — Thu, 10Â NovÂ 2005 00:00:00 -05:00

A 10-year-old girl was transferred to the Shriners Hospital for Children because of a bullous skin eruption, with sloughing of the skin and respiratory failure.

The patient had been well until...

REVIEW ARTICLE: Acute Oxygen-Sensing Mechanisms

Thu, 10Â NovÂ 2005 00:00:00 -05:00

Joseph Priestley, one of the three scientists credited with the discovery of oxygen, described the death of mice that were deprived of oxygen. However, he was also well aware of...

ORIGINAL ARTICLE: Obstructive Sleep Apnea as a Risk Factor for Stroke and Death

Thu, 10Â NovÂ 2005 00:00:00 -05:00

Background: Previous studies have suggested that the obstructive sleep apnea syndrome may be an important risk factor for stroke. It has not been determined, however, whether the syndrome is independently...

ORIGINAL ARTICLE: Continuous Positive Airway Pressure for Central Sleep Apnea and Heart Failure

Thu, 10Â NovÂ 2005 00:00:00 -05:00

Background: The Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnea and Heart Failure trial tested the hypothesis that continuous positive airway pressure (CPAP) would improve the survival...

CLINICAL PROBLEM-SOLVING: A Perfect Storm

Thu, 03Â NovÂ 2005 00:00:00 -05:00

A 21-year-old male college student presented to the student health center after two days of extreme fatigue. Over the course of the previous two months, frequent headaches, difficulty concentrating, and...

EDITORIAL: Acute Lung Injury â Affecting Many Lives

Margaret S. Herridge, M.D., M.P.H., and Derek C. Angus, M.D., M.P.H. — Thu, 20Â OctÂ 2005 00:00:00 -05:00

Acute lung injury is the clinical syndrome of rapid-onset bilateral pulmonary infiltrates and hypoxemia of noncardiac origin. When the hypoxemia is severe, the condition is termed the acute respiratory distress...

ORIGINAL ARTICLE: Incidence and Outcomes of Acute Lung Injury

Thu, 20Â OctÂ 2005 00:00:00 -05:00

Background: Acute lung injury is a critical illness syndrome consisting of acute hypoxemic respiratory failure with bilateral pulmonary infiltrates that are not attributed to left atrial hypertension. Despite recent advances...

EDITORIAL: Serum Osteopontin Levels â Is It Time to Screen Asbestos-Exposed Workers for Pleural Mesothelioma?

Mark R. Cullen, M.D. — Thu, 13Â OctÂ 2005 00:00:00 -05:00

In this issue of the Journal, Pass et al.1 remind us yet again that the fallout from the once uncontrolled use of asbestos will remain with us for years to...

REVIEW ARTICLE: Advances in Malignant Mesothelioma

Bruce W.S. Robinson, M.D., and Richard A. Lake, Ph.D. — Thu, 13Â OctÂ 2005 00:00:00 -05:00

Malignant mesothelioma is an aggressive tumor of serosal surfaces, such as the pleura and the peritoneum.1 This tumor was once rare, but its incidence is increasing worldwide, probably as a...

ORIGINAL ARTICLE: Asbestos Exposure, Pleural Mesothelioma, and Serum Osteopontin Levels

Thu, 13Â OctÂ 2005 00:00:00 -05:00

Background: We investigated the presence of osteopontin in pleural mesothelioma and determined serum osteopontin levels in three populations: subjects without cancer who were exposed to asbestos, subjects without cancer who...

EDITORIAL: Finding Genetic Modifiers of Cystic Fibrosis

Christina K. Haston, Ph.D., and Thomas J. Hudson, M.D. — Thu, 06Â OctÂ 2005 00:00:00 -05:00

Susceptibility genes and modifier genes are two biologic phenomena that few clinicians should ignore in the genome era. Susceptibility genes, which are genes with functional variants that affect the causes...

ORIGINAL ARTICLE: Genetic Modifiers of Lung Disease in Cystic Fibrosis

Thu, 06Â OctÂ 2005 00:00:00 -05:00

Background: Polymorphisms in genes other than the cystic fibrosis transmembrane conductance regulator (CFTR) gene may modify the severity of pulmonary disease in patients with cystic fibrosis.

Methods: We performed two studies...

IMAGES IN CLINICAL MEDICINE: Chylothorax and Chyloperitoneum

Thai Yen Ly, M.D. and Robert A. Fowler, M.D. — Thu, 11Â AugÂ 2005 00:00:00 -05:00

A 76-year-old man underwent elective repair of an abdominal aortic aneurysm, and in the subsequent eight weeks, exertional dyspnea, orthopnea, and abdominal pain developed. On physical examination, the patient was...

EDITORIAL: Shift-Work Sleep Disorder â The Glass Is More Than Half Empty

Robert C. Basner, M.D. — Thu, 04Â AugÂ 2005 00:00:00 -05:00

As many as 20 percent of workers in industrialized nations are shift workers â in other words, people who work either at night or on rotating shifts.1 Shift-work sleep disorder,...

ORIGINAL ARTICLE: Modafinil for Excessive Sleepiness Associated with Shift-Work Sleep Disorder

Thu, 04Â AugÂ 2005 00:00:00 -05:00

Background: Patients with shift-work sleep disorder chronically have excessive sleepiness during night work and insomnia when attempting to sleep during the day. We evaluated the use of modafinil for treating...

IMAGES IN CLINICAL MEDICINE: Bilateral Pulmonary-Artery Aneurysms in BehÃ§et's Syndrome

Sudhir Lohani, M.D. and Robert Niven, M.D. — Thu, 28Â JulÂ 2005 00:00:00 -05:00

A 28-year-old Asian woman presented with pyrexia of unknown origin, oral and genital ulcers, and hemoptysis. A chest radiograph showed bilateral central hilar opacities (Panel A, arrows). A computed tomographic...

SPECIAL ARTICLE: Care in U.S. Hospitals â The Hospital Quality Alliance Program

Thu, 21Â JulÂ 2005 00:00:00 -05:00

Background: The Hospital Quality Alliance (HQA) is the first initiative that routinely reports data on hospitals' performance nationally. Heretofore, such data have been unavailable.

Methods: We used data collected by the...

SPECIAL ARTICLE: Quality of Care in U.S. Hospitals as Reflected by Standardized Measures, 2002â2004

Thu, 21Â JulÂ 2005 00:00:00 -05:00

Background: In July 2002, the Joint Commission on Accreditation of Healthcare Organizations implemented standardized performance measures that were designed to track the performance of accredited hospitals and encourage improvement in...

EDITORIAL: Inhaled Nitric Oxide for Preterm Infants â Who Benefits?

Richard J. Martin, M.B., F.R.A.C.P., and Michele C. Walsh, M.D. — Thu, 07Â JulÂ 2005 00:00:00 -05:00

Endogenously released nitric oxide is widely recognized to play a key role in multiple vertebrate organ systems, and its deficiency disrupts pulmonary parenchymal and vascular development. These observations have suggested...

ORIGINAL ARTICLE: Neurodevelopmental Outcomes of Premature Infants Treated with Inhaled Nitric Oxide

Thu, 07Â JulÂ 2005 00:00:00 -05:00

Background: Chronic lung disease and severe intraventricular hemorrhage or periventricular leukomalacia in premature infants are associated with abnormal neurodevelopmental outcomes. In a previous randomized, controlled, single-center trial of premature infants...

ORIGINAL ARTICLE: Inhaled Nitric Oxide for Premature Infants with Severe Respiratory Failure

Thu, 07Â JulÂ 2005 00:00:00 -05:00

Background: Inhaled nitric oxide is a controversial treatment for premature infants with severe respiratory failure. We conducted a multicenter, randomized, blinded, controlled trial to determine whether inhaled nitric oxide reduced...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 19-2005 â A 17-Year-Old Girl with Respiratory Distress and Hemiparesis after Surviving a Tsunami

Thu, 23Â JunÂ 2005 00:00:00 -05:00

Editor's note: After the earthquake and tsunami in the Indian Ocean on December 26, 2004, the Massachusetts General Hospital formed a clinical-response team to work with Project HOPE (Health Opportunities...

IMAGES IN CLINICAL MEDICINE: Recurrent Respiratory Papillomatosis with Lung Involvement

Daniel Glikman, M.D. and Fuad M. Baroody, M.D. — Thu, 16Â JunÂ 2005 00:00:00 -05:00

A five-year-old girl received the diagnosis of respiratory papillomatosis after an episode of respiratory distress in which the collapse of the right lung required intubation. During bronchoscopy, a single laryngeal...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 17-2005 â A 22-Year-Old Woman with Back and Leg Pain and Respiratory Failure

Thu, 09Â JunÂ 2005 00:00:00 -05:00

A 22-year-old black woman was transferred to this hospital because of respiratory failure.

A diagnosis of sickle cell anemia had been made when the patient was a child, at six years...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 15-2005 â An 80-Year-Old Man with Shortness of Breath, Edema, and Proteinuria

Thu, 19Â MayÂ 2005 00:00:00 -05:00

An 80-year-old man was admitted to the hospital because of shortness of breath, pleural effusions, and edema of the legs.

Atrial fibrillation had developed seven years earlier, with bradycardia and syncope,...

IMAGES IN CLINICAL MEDICINE: Asphyxia Due to an Inhaled Foreign Body

Neda Zarrin-Khameh, M.D., M.P.H. and Robert E. Lyon, D.O. — Thu, 19Â MayÂ 2005 00:00:00 -05:00

A three-year-old boy was playing with a small plastic ball while riding in the backseat of a motor vehicle driven by his father. The father heard a gasp, saw that...

REVIEW ARTICLE: Cystic Fibrosis

Steven M. Rowe, M.D., Stacey Miller, B.S., and Eric J. Sorscher, M.D. — Thu, 12Â MayÂ 2005 00:00:00 -05:00

Advances in the care of patients with cystic fibrosis have improved survival, and as a result, patients with the disease now often live beyond the third decade.1 In addition, developments...

ORIGINAL ARTICLE: Decreased Histone Deacetylase Activity in Chronic Obstructive Pulmonary Disease

Thu, 12Â MayÂ 2005 00:00:00 -05:00

Background: Chronic obstructive pulmonary disease (COPD) is characterized by chronic airway inflammation that is greater in patients with advanced disease. We asked whether there is a link between the severity...

EDITORIAL: Multislice Computed Tomography for Pulmonary Embolism â A Technological Marvel

Samuel Z. Goldhaber, M.D. — Thu, 28Â AprÂ 2005 00:00:00 -05:00

Rapid and accurate diagnosis of pulmonary embolism will improve survival and quality of life because treatment decreases mortality and the likelihood that thromboembolic pulmonary hypertension or the post-thrombotic syndrome will...

EDITORIAL: RSV Infection â Not for Kids Only

Sanjay Sethi, M.D., and Timothy F. Murphy, M.D. — Thu, 28Â AprÂ 2005 00:00:00 -05:00

It is ironic that respiratory syncytial virus (RSV) infection in adults, though recognized for several decades, has been overlooked, at least in part, because of the importance of RSV in...

ORIGINAL ARTICLE: Multidetector-Row Computed Tomography in Suspected Pulmonary Embolism

Thu, 28Â AprÂ 2005 00:00:00 -05:00

Background: Single-detectorârow computed tomography (CT) has a low sensitivity for pulmonary embolism and must be combined with venous-compression ultrasonography of the lower limbs. We evaluated whether the use of D-dimer...

ORIGINAL ARTICLE: Respiratory Syncytial Virus Infection in Elderly and High-Risk Adults

Thu, 28Â AprÂ 2005 00:00:00 -05:00

Background: Respiratory syncytial virus (RSV) is an increasingly recognized cause of illness in adults. Data on the epidemiology and clinical effects in community-dwelling elderly persons and high-risk adults can help...

IMAGES IN CLINICAL MEDICINE: An Unusual Case of Pulmonary Embolism

Tom Routledge, M.R.C.S. and David Jenkins, F.R.C.S. — Thu, 14Â AprÂ 2005 00:00:00 -05:00

A 33-year-old woman had dyspnea for six months, with intermittent fever. She was admitted to the hospital with worsening dyspnea, hypoxia, and patchy bilateral pulmonary consolidations. Computed tomography showed large,...

IMAGES IN CLINICAL MEDICINE: Uremic Frost

Stephen R. Walsh, M.D.C.M. and Nereida A. Parada, M.D. — Thu, 31Â MarÂ 2005 00:00:00 -05:00

A 57-year-old woman with hypertension and chronic renal insufficiency who had refused dialysis for two years was found in respiratory distress after one week of upper respiratory symptoms due to...

IMAGES IN CLINICAL MEDICINE: Benign Subcutaneous Emphysema of the Upper Extremity

James S. Winshall, M.D. and Barbara N. Weissman, M.D. — Thu, 31Â MarÂ 2005 00:00:00 -05:00

A 59-year-old woman fell from a horse and injured her left elbow. Four days later she sought evaluation for persistent swelling of her arm. On examination, the patient had a...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 9-2005 â A 67-Year-Old Man with Acute Respiratory Failure

David M. Systrom, M.D., and Conrad Wittram, M.B., Ch.B. — Thu, 24Â MarÂ 2005 00:00:00 -05:00

A 67-year-old man was transferred to this hospital with acute respiratory failure.

Four days before admission, the patient had visited his primary care physician because of a three-month history of chest...

ORIGINAL ARTICLE: DayâNight Pattern of Sudden Death in Obstructive Sleep Apnea

Thu, 24Â MarÂ 2005 00:00:00 -05:00

Background: The risk of sudden death from cardiac causes in the general population peaks from 6 a.m. to noon and has a nadir from midnight to 6 a.m. Obstructive sleep...

IMAGES IN CLINICAL MEDICINE: Tuberculosis Empyema Necessitatis

Kongkrit Chaiyasate, M.D. and John Hramiec, M.D. — Thu, 03Â MarÂ 2005 00:00:00 -05:00

An 18-year-old man with no clinically significant medical history presented with a six-month history of an increasing mass on the left side of his back (Panel A). About three days...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Toward a New Therapy for Tuberculosis

Eric J. Rubin, M.D., Ph.D. — Thu, 03Â MarÂ 2005 00:00:00 -05:00

It is often tempting to abandon old ways for glamorous new ones. Such is certainly the case for antibiotic development. However, a recent study by Andries and colleagues1 shows that...

EDITORIAL: Multicenter Trials of Treatment for Empyema â After All These Years

John E. Heffner, M.D. — Thu, 03Â MarÂ 2005 00:00:00 -05:00

It is paradoxical that Hippocrates established in ancient times the clinical importance of pleural infections, yet only a few high-quality trials have studied this common condition during the intervening 2400...

ORIGINAL ARTICLE: U.K. Controlled Trial of Intrapleural Streptokinase for Pleural Infection

Thu, 03Â MarÂ 2005 00:00:00 -05:00

Background: Intrapleural fibrinolytic agents are used in the drainage of infected pleural-fluid collections. This use is based on small trials that did not have the statistical power to evaluate accurately...

IMAGES IN CLINICAL MEDICINE: Malposition of a SengstakenâBlakemore Tube

Jung-Yien Chien, M.D. and Chong-Jen Yu, M.D., Ph.D. — Thu, 24Â FebÂ 2005 00:00:00 -05:00

An 86-year-old woman had a history of cirrhosis associated with chronic hepatitis B infection lasting more than 16 years; she had had five episodes of esophageal variceal bleeding that had...

EDITORIAL: Chasing Mutations in the Epidermal Growth Factor in Lung Cancer

Jonathan E. Dowell, M.D., and John D. Minna, M.D. — Thu, 24Â FebÂ 2005 00:00:00 -05:00

Nonâsmall-cell lung cancer is the leading cause of death from cancer in men and women in the United States, and worldwide it kills more than 1 million people annually. Approximately...

IMAGES IN CLINICAL MEDICINE: Corkscrew Esophagus

Giovanni Cammarota, M.D. and Maria Certo, M.D., Ph.D. — Thu, 24Â FebÂ 2005 00:00:00 -05:00

An 81-year-old man was admitted to the hospital because of a six-month history of intermittent dysphagia, regurgitation, and vomiting during meals. Upper gastrointestinal endoscopy revealed an abnormal appearance of the...

ORIGINAL ARTICLE: Mutation and Resistance of NonâSmall-Cell Lung Cancer to Gefitinib

Thu, 24Â FebÂ 2005 00:00:00 -05:00

Mutations of the epidermal growth factor receptor (EGFR) gene have been identified in specimens from patients with nonâsmall-cell lung cancer who have a response to anilinoquinazoline EGFR inhibitors. Despite the...

ORIGINAL ARTICLE: Etanercept plus Standard Therapy for Wegener's Granulomatosis

The Wegener's Granulomatosis Etanercept Trial (WGET) Research Group — Thu, 27Â JanÂ 2005 00:00:00 -05:00

Background: The majority of patients with Wegener's granulomatosis have disease flares after conventional medications are tapered. There is no consistently safe, effective treatment for the maintenance of remission.

Methods: We conducted...

PERSPECTIVE: The Spectrum of Wegener's Granulomatosis and Disease Relapse

Paul A. Bacon, M.D. — Thu, 27Â JanÂ 2005 00:00:00 -05:00

Wegener's syndrome (Wegener's granulomatosis) is a rare systemic disorder, and because it involves multiple organs, affected patients may seek help from physicians in many specialties. It is classified as a...

CLINICAL PROBLEM-SOLVING: Unfashionably Late

Thu, 06Â JanÂ 2005 00:00:00 -05:00

An 18-year-old man presented with shortness of breath, a cough that was productive of clear sputum, and a two-week history of pleuritic chest pain. He also reported night sweats, fever,...

ORIGINAL ARTICLE: Codeine Intoxication Associated with Ultrarapid CYP2D6 Metabolism

Thu, 30Â DecÂ 2004 00:00:00 -05:00

Life-threatening opioid intoxication developed in a patient after he was given small doses of codeine for the treatment of a cough associated with bilateral pneumonia. Codeine is bioactivated by CYP2D6...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 39-2004 â A 52-Year-Old Woman with Recurrent Episodes of Atypical Pneumonia

Thu, 23Â DecÂ 2004 00:00:00 -05:00

A 52-year-old woman was admitted to the hospital because of cough and dyspnea.

She had smoked two to three packs of cigarettes daily for 35 years. During the two decades before...

IMAGES IN CLINICAL MEDICINE: Diaphragmatic Hernia

Reiko Fukamizu, M.D. and Seiji Hayashi, M.D., Ph.D. — Thu, 09Â DecÂ 2004 00:00:00 -05:00

A 76-year-old man was referred to our hospital because of hemoptysis. He had had pulmonary tuberculosis six years before his current admission, and he had had an abnormal chest radiograph...

IMAGES IN CLINICAL MEDICINE: Double Aortic Arch Diagnosed by Magnetic Resonance Imaging

Joachim Lotz, M.D. and Paolo Macchiarini, M.D. — Thu, 25Â NovÂ 2004 00:00:00 -05:00

A six-month-old boy who had recurrent respiratory difficulties was admitted to the hospital with acute respiratory failure that required mechanical ventilation. Echocardiography suggested the presence of a double aortic arch....

EDITORIAL: Dynamic Mitral Regurgitation â More Than Meets the Eye

Robert A. Levine, M.D. — Thu, 14Â OctÂ 2004 00:00:00 -05:00

Recollections of early medical training conjure up images of the master clinician standing beside the exercising patient, keenly observing the effects of disease. Exercise stress testing is a cornerstone of...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2004 â A Four-Year-Old Boy with Hypoxemia

T. Bernard Kinane, M.D., and Sjirk J. Westra, M.D. — Thu, 14Â OctÂ 2004 00:00:00 -05:00

A four-year-old boy was transferred to this hospital because of hypoxemia of unknown origin. Five days before admission, he had been taken to the emergency room of another hospital with...

REVIEW ARTICLE: Pulmonary Arterial Hypertension

Harrison W. Farber, M.D., and Joseph Loscalzo, M.D., Ph.D. — Thu, 14Â OctÂ 2004 00:00:00 -05:00

Pulmonary hypertension is usually classified as primary (idiopathic) or secondary.1 It is now clear, however, that there are conditions within the category of secondary pulmonary hypertension that resemble primary pulmonary...

ORIGINAL ARTICLE: The Role of Ischemic Mitral Regurgitation in the Pathogenesis of Acute Pulmonary Edema

Luc A. PiÃ©rard, M.D., Ph.D., and Patrizio Lancellotti, M.D. — Thu, 14Â OctÂ 2004 00:00:00 -05:00

Background: Acute mitral regurgitation may cause pulmonary edema, but the pathogenetic role of chronic ischemic mitral regurgitation, a dynamic condition, has not yet been characterized.

Methods: We prospectively studied 28 patients...

REVIEW ARTICLE: Treatment of Pulmonary Arterial Hypertension

Marc Humbert, M.D., Ph.D., Olivier Sitbon, M.D., and GÃ©rald Simonneau, M.D. — Thu, 30Â SepÂ 2004 00:00:00 -05:00

Pulmonary arterial hypertension is a disease of the small pulmonary arteries that is characterized by vascular proliferation and remodeling.12 It results in a progressive increase in pulmonary vascular resistance and,...

IMAGES IN CLINICAL MEDICINE: Morgagni's Hernia

Henning Schubert, M.D. and Patrick Haage, M.D. — Thu, 23Â SepÂ 2004 00:00:00 -05:00

A 64-year-old woman without symptoms underwent routine chest radiography, which revealed a well-circumscribed, low-density mass that measured 8 cm in diameter and rendered the right cardiophrenic angle opaque (Panel A,...

ORIGINAL ARTICLE: A Randomized Trial of a Single Dose of Oral Dexamethasone for Mild Croup

Thu, 23Â SepÂ 2004 00:00:00 -05:00

Background: The benefits of dexamethasone treatment for moderate-to-severe croup are well established. However, most children with croup have mild symptoms, and it is unknown whether they would derive the same...

PERSPECTIVE: Croup â The Bark Is Worse Than the Bite

Perri Klass, M.D. — Thu, 23Â SepÂ 2004 00:00:00 -05:00

It is a clichÃ© of primary care pediatrics: on call in the winter, you find yourself on the telephone with a worried parent who is anxiously trying to describe a...

EDITORIAL: Air Pollution and Health â Good News and Bad

C. Arden Pope III, Ph.D. — Thu, 09Â SepÂ 2004 00:00:00 -05:00

Early concerns regarding the health-related effects of air pollution originated from severe episodes in Meuse Valley, Belgium, in 1930; Donora, Pennsylvania, in 1948; and London, in 1952. Although the overall...

ORIGINAL ARTICLE: The Effect of Air Pollution on Lung Development from 10 to 18 Years of Age

Thu, 09Â SepÂ 2004 00:00:00 -05:00

Background: Whether exposure to air pollution adversely affects the growth of lung function during the period of rapid lung development that occurs between the ages of 10 and 18 years...

CLINICAL PROBLEM-SOLVING: Undercover and Overlooked

Andrew Wang, M.D., and Thomas M. Bashore, M.D. — Thu, 02Â SepÂ 2004 00:00:00 -05:00

A 67-year-old overweight man was seen by his physician because of a two-month history of shortness of breath, a nonproductive cough, and bilateral swelling of the lower extremities. He also...

IMAGES IN CLINICAL MEDICINE: Inhaled Foreign Body

Syed Mohammad Tariq, M.R.C.P. and Jojy George, M.R.C.P. — Thu, 26Â AugÂ 2004 00:00:00 -05:00

Many Arab women wear a head scarf, termed the lahaaf or hejaab. It is usually secured around the head and neck with one or two pins. A 20-year-old Arab woman...

PERSPECTIVE: Exogenous Surfactant Replacement in ARDS â One Day, Someday, or Never?

Simon V. Baudouin, M.D. — Thu, 26Â AugÂ 2004 00:00:00 -05:00

Most therapies that fail to show benefit in well-conducted, randomized, controlled trials are abandoned by both clinical investigators and pharmaceutical companies. Treatment with exogenous surfactant for the acute respiratory distress...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 26-2004 â A 56-Year-Old Woman with Cough and a Lung Nodule

Thu, 19Â AugÂ 2004 00:00:00 -05:00

Dr. Jennifer Temel (Medical Oncology): A 56-year-old woman was evaluated in the thoracic oncology clinic for treatment of nonâsmall-cell lung cancer.

The patient had been in her usual state of...

IMAGES IN CLINICAL MEDICINE: Gastrothorax Simulating Acute Tension Pneumothorax

Cornelis P.C. de Jager, M.D. and Ronald J. Trof, M.D. — Thu, 05Â AugÂ 2004 00:00:00 -05:00

A 27-year-old man was admitted to the emergency department because of respiratory failure. Three years earlier, he had undergone surgery to repair a traumatic rupture of the left side of...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Can Curcumin Cure Cystic Fibrosis?

Pamela Zeitlin, M.D., Ph.D. — Thu, 05Â AugÂ 2004 00:00:00 -05:00

Cystic fibrosis, a progressive and ultimately fatal inherited disorder caused by a mutant cystic fibrosis transmembrane conductance regulator (CFTR) gene, has mobilized the government, charitable foundations, the biotechnology industry, and...

EDITORIAL: PEEP in ARDS â How Much Is Enough?

Mitchell M. Levy, M.D. — Thu, 22Â JulÂ 2004 00:00:00 -05:00

In 1967, Ashbaugh et al.1 introduced the use of positive end-expiratory pressure (PEEP) during mechanical ventilation to treat refractory hypoxemia in patients with the acute respiratory distress syndrome (ARDS). Almost...

ORIGINAL ARTICLE: Higher versus Lower Positive End-Expiratory Pressures in Patients with the Acute Respiratory Distress Syndrome

The National Heart, Lung, and Blood Institute ARDS Clinical Trials Network — Thu, 22Â JulÂ 2004 00:00:00 -05:00

Background: Most patients requiring mechanical ventilation for acute lung injury and the acute respiratory distress syndrome (ARDS) receive positive end-expiratory pressure (PEEP) of 5 to 12 cm of water. Higher...

IMAGES IN CLINICAL MEDICINE: Massive Subcutaneous Emphysema after Tracheal Perforation

Kenzo Hirose, M.D. and Brendan C. Visser, M.D. — Thu, 15Â JulÂ 2004 00:00:00 -05:00

A 77-year-old woman underwent laminectomy and posterior spinal fusion from T12 to S1, an operation that was performed while she was in the prone position. At the conclusion of the...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 22-2004 â A 30-Year-Old Woman with a Pericardial Effusion

Thu, 15Â JulÂ 2004 00:00:00 -05:00

A 30-year-old woman was admitted to the hospital because of fever, cough, shortness of breath, and a pericardial effusion.

Approximately one month earlier, the woman had noticed an increased heart rate...

REVIEW ARTICLE: Management of Chronic Obstructive Pulmonary Disease

E. Rand Sutherland, M.D., M.P.H., and Reuben M. Cherniack, M.D. — Thu, 24Â JunÂ 2004 00:00:00 -05:00

Chronic obstructive pulmonary disease (COPD) is a syndrome of progressive airflow limitation caused by chronic inflammation of the airways and lung parenchyma.1 The primary physiological abnormality in COPD is an...

ORIGINAL ARTICLE: The Nature of Small-Airway Obstruction in Chronic Obstructive Pulmonary Disease

Thu, 24Â JunÂ 2004 00:00:00 -05:00

Background: Chronic obstructive pulmonary disease (COPD) is a major public health problem associated with long-term exposure to toxic gases and particles. We examined the evolution of the pathological effects of...

PERSPECTIVE: Small Airways in COPD

Peter J. Barnes, D.M., D.Sc. — Thu, 24Â JunÂ 2004 00:00:00 -05:00

Chronic obstructive pulmonary disease (COPD) is a major and growing global health problem. It ranked as the sixth most common cause of death worldwide in 1990, and the Global Burden...

EDITORIAL: Noninvasive Ventilation â Don't Push Too Hard

Jonathon Dean Truwit, M.D., and Gordon R. Bernard, M.D. — Thu, 10Â JunÂ 2004 00:00:00 -05:00

Noninvasive mechanical ventilation has been used increasingly over the past decade in an effort to avoid endotracheal intubation and to accelerate the discontinuation of mechanical ventilation. Noninvasive ventilation as adjunctive...

REVIEW ARTICLE: Pneumocystis Pneumonia

Charles F. Thomas, Jr., M.D., and Andrew H. Limper, M.D. — Thu, 10Â JunÂ 2004 00:00:00 -05:00

Pneumocystis pneumonia remains the most prevalent opportunistic infection in patients infected with the human immunodeficiency virus (HIV).12 First identified as a protozoan nearly 100 years ago and reclassified as a...

ORIGINAL ARTICLE: Noninvasive Positive-Pressure Ventilation for Respiratory Failure after Extubation

Thu, 10Â JunÂ 2004 00:00:00 -05:00

Background: The need for reintubation after extubation and discontinuation of mechanical ventilation is not uncommon and is associated with increased mortality. Noninvasive positive-pressure ventilation has been suggested as a promising...

ORIGINAL ARTICLE: Public Health Measures to Control the Spread of the Severe Acute Respiratory Syndrome during the Outbreak in Toronto

Thu, 03Â JunÂ 2004 00:00:00 -05:00

Background: Toronto was the site of North America's largest outbreak of the severe acute respiratory syndrome (SARS). An understanding of the patterns of transmission and the effects on public health...

ORIGINAL ARTICLE: Incidence of Chronic Thromboembolic Pulmonary Hypertension after Pulmonary Embolism

Thu, 27Â MayÂ 2004 00:00:00 -05:00

Background: Chronic thromboembolic pulmonary hypertension (CTPH) is associated with considerable morbidity and mortality. Its incidence after pulmonary embolism and associated risk factors are not well documented.

Methods: We conducted a prospective,...

PERSPECTIVE: Chronic Thromboembolic Pulmonary Hypertension â Not So Rare after All

Irene M. Lang, M.D. — Thu, 27Â MayÂ 2004 00:00:00 -05:00

Chronic thromboembolic pulmonary hypertension (CTPH) is believed to result from single or recurrent pulmonary thromboemboli arising from sites of venous thrombosis. The occurrence of CTPH after a diagnosis of acute...

PERSPECTIVE: Smoking Ban â Made in Ireland, for Home Use and for Export

N. Gerry McElvaney, M.D. — Thu, 27Â MayÂ 2004 00:00:00 -05:00

On March 29, 2004, the Irish government implemented a law banning smoking in the workplace. This was the first law of its kind in Europe and represented the culmination of...

ORIGINAL ARTICLE: Activating Mutations in the Epidermal Growth Factor Receptor Underlying Responsiveness of NonâSmall-Cell Lung Cancer to Gefitinib

Thu, 20Â MayÂ 2004 00:00:00 -05:00

Background: Most patients with nonâsmall-cell lung cancer have no response to the tyrosine kinase inhibitor gefitinib, which targets the epidermal growth factor receptor (EGFR). However, about 10 percent of patients...

IMAGES IN CLINICAL MEDICINE: Air Embolism after the Insertion of a Central Venous Catheter

Ulf K.M. TeichgrÃ¤ber, M.D. and Thomas Benter, M.D. — Thu, 06Â MayÂ 2004 00:00:00 -05:00

A 17-year-old girl was involved in a car accident as a passenger. Before she was transported by helicopter to a hospital, a central venous catheter was inserted. She was admitted...

IMAGES IN CLINICAL MEDICINE: Pneumoperitoneum

Jolanda H.M. van Steijn, M.D. and Peter H.J. van der Voort, M.D., Ph.D. — Thu, 29Â AprÂ 2004 00:00:00 -05:00

A 47-year-old man was admitted to the intensive care unit with respiratory failure complicating pneumonia due to legionella infection. Mechanical ventilation with positive end-expiratory pressure was initiated. Radiographs of the...

EDITORIAL: Adjuvant Chemotherapy for Adenocarcinoma of the Lung â Is the Standard of Care Ready for Change?

Robert B. Diasio, M.D. — Thu, 22Â AprÂ 2004 00:00:00 -05:00

The treatment for stage I nonâsmall-cell lung cancer, regardless of cell type, is wide surgical resection (lobectomy or pneumonectomy) of the involved area.1 Although the propensity of nonâsmall-cell lung cancer...

ORIGINAL ARTICLE: Laboratory-Acquired Severe Acute Respiratory Syndrome

Thu, 22Â AprÂ 2004 00:00:00 -05:00

The outbreak of severe acute respiratory syndrome (SARS) in Singapore ended in late May 2003.1 The Centers for Disease Control and Prevention (CDC) removed its travel alerts for Toronto, Hong...

ORIGINAL ARTICLE: Evidence of Airborne Transmission of the Severe Acute Respiratory Syndrome Virus

Thu, 22Â AprÂ 2004 00:00:00 -05:00

Background: There is uncertainty about the mode of transmission of the severe acute respiratory syndrome (SARS) virus. We analyzed the temporal and spatial distributions of cases in a large community...

ORIGINAL ARTICLE: A Randomized Trial of Adjuvant Chemotherapy with UracilâTegafur for Adenocarcinoma of the Lung

Thu, 22Â AprÂ 2004 00:00:00 -05:00

Background: In a previous phase 3 trial of adjuvant chemotherapy after resection of nonâsmall-cell lung cancer, a combination of uracil and tegafur (often referred to as UFT) taken orally was...

CLINICAL PROBLEM-SOLVING: Red Snapper or Crab?

Thu, 01Â AprÂ 2004 00:00:00 -05:00

A 68-year-old man originally from the Philippines presented with a three-month history of increasing dyspnea on exertion and orthopnea. He also reported an unintentional weight loss of 7 kg (15...

EDITORIAL: Postnatal Corticosteroids for Preterm Infants â Do What We Say, Not What We Do

Alan H. Jobe, Ph.D. — Thu, 25Â MarÂ 2004 00:00:00 -05:00

Physicians caring for pregnant women and their preterm infants have used corticosteroids since Liggins and Howie reported in 1972 that prenatal betamethasone decreased the incidence of the respiratory distress syndrome...

ORIGINAL ARTICLE: Outcomes at School Age after Postnatal Dexamethasone Therapy for Lung Disease of Prematurity

Thu, 25Â MarÂ 2004 00:00:00 -05:00

Background: We studied the outcomes at school age in children who had participated in a double-blind, placebo-controlled trial of early postnatal dexamethasone therapy (initiated within 12 hours after birth) for...

ORIGINAL ARTICLE: Gene Mutations in Newborns with Fatal Surfactant Deficiency

Thu, 25Â MarÂ 2004 00:00:00 -05:00

Background: Pulmonary surfactant forms a lipid-rich monolayer that coats the airways of the lung and is essential for proper inflation and function of the lung. Surfactant is produced by alveolar...

PERSPECTIVE: Lung Surfactant, Respiratory Failure, and Genes

Mikko Hallman, M.D., Ph.D. — Thu, 25Â MarÂ 2004 00:00:00 -05:00

After the first observation of surfactant deficiency in infants who were dying of the respiratory distress syndrome (also known as hyaline membrane disease), a series of investigations led to effective...

PERSPECTIVE: Looking at the Patient â Approaching the Problem of COPD

Stephen I. Rennard, M.D. — Thu, 04Â MarÂ 2004 00:00:00 -05:00

Chronic obstructive pulmonary disease (COPD) is currently the fourth leading cause of death in the United States and is expected to become the third leading cause of death by 2020....

CLINICAL PROBLEM-SOLVING: A Pain in the Neck

Sandra J. Bliss, M.D., Scott A. Flanders, M.D., and Sanjay Saint, M.D., M.P.H. — Thu, 04Â MarÂ 2004 00:00:00 -05:00

A previously healthy 16-year-old girl presented to her physician because of a two-day history of sore throat, fatigue, fever, headache, and vomiting; she had not had rhinorrhea or a cough....

IMAGES IN CLINICAL MEDICINE: Dynamic Airway Narrowing

Hajime Kurosawa, M.D. and Masahiro Kohzuki, M.D. — Thu, 04Â MarÂ 2004 00:00:00 -05:00

A 61-year-old man who reported progressive exertional dyspnea of 12 years' duration received a diagnosis of chronic obstructive pulmonary disease on the basis of a 150-pack-year history of smoking, emphysema...

ORIGINAL ARTICLE: The Body-Mass Index, Airflow Obstruction, Dyspnea, and Exercise Capacity Index in Chronic Obstructive Pulmonary Disease

Thu, 04Â MarÂ 2004 00:00:00 -05:00

Background: Chronic obstructive pulmonary disease (COPD) is characterized by an incompletely reversible limitation in airflow. A physiological variable â the forced expiratory volume in one second (FEV1) â is often...

ORIGINAL ARTICLE: Pulmonary Hypertension as a Risk Factor for Death in Patients with Sickle Cell Disease

Thu, 26Â FebÂ 2004 00:00:00 -05:00

Background: The prevalence of pulmonary hypertension in adults with sickle cell disease, the mechanism of its development, and its prospective prognostic significance are unknown.

Methods: We performed Doppler echocardiographic assessments of...

PERSPECTIVE: Pulmonary Hypertension in Sickle Cell Disease

Elliott P. Vichinsky, M.D. — Thu, 26Â FebÂ 2004 00:00:00 -05:00

Sickle cell disease was first described in 1910 by Herrick and Irons. The irregularly shaped blood cells observed by Irons were those of Walter Clement Noel, a dental student with...

REVIEW ARTICLE: Acute Chemical Emergencies

Stefanos N. Kales, M.D., M.P.H., and David C. Christiani, M.D., M.P.H. — Thu, 19Â FebÂ 2004 00:00:00 -05:00

Acute chemical emergencies can occur as a result of an industrial disaster,12 occupational exposure,34 recreational mishap,5 natural catastrophe,6 chemical warfare,78 and acts of terrorism.910 This article reviews the health effects...

EDITORIAL: B-Type Natriuretic Peptide â A Biomarker for All Seasons?

Daniel B. Mark, M.D., M.P.H., and G. Michael Felker, M.D. — Thu, 12Â FebÂ 2004 00:00:00 -05:00

Despite more than two decades of research that has shown the value and cost effectiveness of information from the medical history and physical examination for management decisions, physicians are increasingly...

ORIGINAL ARTICLE: Use of B-Type Natriuretic Peptide in the Evaluation and Management of Acute Dyspnea

Thu, 12Â FebÂ 2004 00:00:00 -05:00

Background: B-type natriuretic peptide levels are higher in patients with congestive heart failure than in patients with dyspnea from other causes.

Methods: We conducted a prospective, randomized, controlled study of 452...

EDITORIAL: Fatty Acid Metabolism in Cystic Fibrosis

Birgitta Strandvik, M.D., Ph.D. — Thu, 05Â FebÂ 2004 00:00:00 -05:00

In 1989, when the gene locus for cystic fibrosis was identified, expectations were great for rapid progress in understanding and effectively treating the disease. It was generally believed that cystic...

CLINICAL PROBLEM-SOLVING: Occam's Razor versus Saint's Triad

Thu, 05Â FebÂ 2004 00:00:00 -05:00

A 60-year-old woman with a history of radiologically confirmed seronegative rheumatoid arthritis presented to the emergency department with a 10-day history of worsening dyspnea on exertion, nonproductive cough, and subjective...

ORIGINAL ARTICLE: Association of Cystic Fibrosis with Abnormalities in Fatty Acid Metabolism

Thu, 05Â FebÂ 2004 00:00:00 -05:00

Background: Patients with cystic fibrosis have altered levels of plasma fatty acids. We previously demonstrated that arachidonic acid levels are increased and docosahexaenoic acid levels are decreased in affected tissues...

ORIGINAL ARTICLE: Soluble Triggering Receptor Expressed on Myeloid Cells and the Diagnosis of Pneumonia

Thu, 29Â JanÂ 2004 00:00:00 -05:00

Background: The diagnosis and treatment of bacterial pneumonia in patients who are receiving mechanical ventilation remain a difficult challenge. The triggering receptor expressed on myeloid cells (TREM-1) is a member...

PERSPECTIVE: Diagnosing Ventilator-Associated Pneumonia

Antoni Torres, M.D., and Santiago Ewig, M.D. — Thu, 29Â JanÂ 2004 00:00:00 -05:00

The establishment of an appropriate diagnosis of ventilator-associated pneumonia is one of the most crucial and difficult issues in the care of critically ill patients. Established clinical criteria alone, such...

PERSPECTIVE: Human Metapneumovirus â An Important New Respiratory Virus

Kenneth McIntosh, M.D., and Alexander J. McAdam, M.D., Ph.D. — Thu, 29Â JanÂ 2004 00:00:00 -05:00

Physicians who have an interest in infectious diseases know well that many infections cannot be assigned a microbial cause. This gap between what we observe and what we can explain...

EDITORIAL: Adjuvant Chemotherapy for Lung Cancer â A New Standard of Care

Ronald H. Blum, M.D. — Thu, 22Â JanÂ 2004 00:00:00 -05:00

In patients with cancer who undergo surgery with curative intent but who are known to be at risk for a recurrence, postoperative chemotherapy increases the chance of a cure. The...

REVIEW ARTICLE: Multidisciplinary Management of Lung Cancer

Alexander Spira, M.D., Ph.D., and David S. Ettinger, M.D. — Thu, 22Â JanÂ 2004 00:00:00 -05:00

In 2004, an estimated 173,700 Americans will receive a diagnosis of lung cancer, and 164,440 of them will die of the disease. Despite years of research, the prognosis for patients...

ORIGINAL ARTICLE: Cisplatin-Based Adjuvant Chemotherapy in Patients with Completely Resected NonâSmall-Cell Lung Cancer

The International Adjuvant Lung Cancer Trial Collaborative Group — Thu, 22Â JanÂ 2004 00:00:00 -05:00

Background: On the basis of a previous meta-analysis, the International Adjuvant Lung Cancer Trial was designed to evaluate the effect of cisplatin-based adjuvant chemotherapy on survival after complete resection of...

EDITORIAL: The Elusive Goal of Therapy for Usual Interstitial Pneumonia

Alvin S. Teirstein, M.D. — Thu, 08Â JanÂ 2004 00:00:00 -05:00

Idiopathic pulmonary fibrosis, defined pathologically as usual interstitial pneumonia, is a fatal disease that occurs most commonly among persons who are 60 years of age or older and in otherwise...

IMAGES IN CLINICAL MEDICINE: Progression of Idiopathic Pulmonary Fibrosis

Rony M. Abou Jawde, M.D. and Feyrouz Al-Ashkar, M.D. — Thu, 08Â JanÂ 2004 00:00:00 -05:00

A 75-year-old man with idiopathic pulmonary fibrosis was admitted because of progressive shortness of breath. He stated that he had not had new cough, fever, chest pain, palpitations, orthopnea, or...

ORIGINAL ARTICLE: A Placebo-Controlled Trial of Interferon Gamma-1b in Patients with Idiopathic Pulmonary Fibrosis

Thu, 08Â JanÂ 2004 00:00:00 -05:00

Background: Idiopathic pulmonary fibrosis is a progressive, fatal disease with no known efficacious therapy.

Methods: In a double-blind, multinational trial, we randomly assigned 330 patients with idiopathic pulmonary fibrosis that was...

CLINICAL PROBLEM-SOLVING: True, True, and Related

Thu, 01Â JanÂ 2004 00:00:00 -05:00

A 51-year-old woman was admitted to a community hospital with a six-week history of progressive shortness of breath. She had initially noted dyspnea when climbing stairs at work, and by...

REVIEW ARTICLE: Pulmonary Alveolar Proteinosis

Bruce C. Trapnell, M.D., Jeffrey A. Whitsett, M.D., and Koh Nakata, M.D., Ph.D. — Thu, 25Â DecÂ 2003 00:00:00 -05:00

Pulmonary alveolar proteinosis is a rare disorder in which lipoproteinaceous material accumulates within alveoli.1 The clinical course of the disease is variable, ranging from respiratory failure to spontaneous resolution. An...

IMAGES IN CLINICAL MEDICINE: Congenital Pulmonary Lymphangiectasia

Cornelia Hagmann, M.D. and Thomas M. Berger, M.D. — Thu, 27Â NovÂ 2003 00:00:00 -05:00

A female infant was born at 40 weeks and 3 days of gestation, weighing 2970 g. The Apgar scores were 8, 10, and 10 at 1, 5, and 10 minutes,...

EDITORIAL: Nitric Oxide for Preemies â Not So Fast

Richard J. Martin, M.B., F.R.A.C.P. — Thu, 27Â NovÂ 2003 00:00:00 -05:00

The past three decades have seen the emergence of neonatology as a vibrant subspecialty of pediatrics, highlighted by advances in the management of the respiratory distress syndrome in preterm infants....

ORIGINAL ARTICLE: Inhaled Nitric Oxide in Premature Infants with the Respiratory Distress Syndrome

Thu, 27Â NovÂ 2003 00:00:00 -05:00

Background: Inhaled nitric oxide improves gas exchange, decreases pulmonary vascular lability, and reduces pulmonary inflammation. We hypothesized that the use of inhaled nitric oxide would decrease the incidence of chronic...

ORIGINAL ARTICLE: A Randomized Trial of Fetal Endoscopic Tracheal Occlusion for Severe Fetal Congenital Diaphragmatic Hernia

Thu, 13Â NovÂ 2003 00:00:00 -05:00

Background: Experimental and clinical data suggest that fetal endoscopic tracheal occlusion to induce lung growth may improve the outcome of severe congenital diaphragmatic hernia. We performed a randomized, controlled trial...

PERSPECTIVE: Fetal Surgery for Congenital Diaphragmatic Hernia

Katharine D. Wenstrom, M.D. — Thu, 13Â NovÂ 2003 00:00:00 -05:00

Diaphragmatic hernia occurs when any of the four separate structures making up the diaphragm (the septum transversum, pleuroperitoneal membranes, dorsal mesentery of the esophagus, and body wall) fail to grow...

IMAGES IN CLINICAL MEDICINE: Buffalo Chest

Kurt W. Grathwohl, M.D. and Stephen Derdak, D.O. — Thu, 06Â NovÂ 2003 00:00:00 -05:00

A 66-year-old man was admitted to the hospital with a two-day history of left-sided pleuritic chest pain and progressive shortness of breath. A right pneumonectomy had been performed 17 years...

ORIGINAL ARTICLE: Subcutaneous Fondaparinux versus Intravenous Unfractionated Heparin in the Initial Treatment of Pulmonary Embolism

The Matisse Investigators — Thu, 30Â OctÂ 2003 00:00:00 -05:00

Background: The standard initial treatment of hemodynamically stable patients with pulmonary embolism is intravenous unfractionated heparin, requiring laboratory monitoring and hospitalization.

Methods: We conducted a randomized, open-label trial involving 2213 patients...

IMAGES IN CLINICAL MEDICINE: Spindle-Cell Thymoma

Oz M. Shapira, M.D. and John M. Kasznica, M.D. — Thu, 09Â OctÂ 2003 00:00:00 -05:00

A 77-year-old Chinese woman presented with an abnormality on a chest film obtained as part of her screening for immigration to the United States. A posteroanterior film showed a well-circumscribed...

ORIGINAL ARTICLE: Gentamicin-Induced Correction of CFTR Function in Patients with Cystic Fibrosis and Stop Mutations

Thu, 09Â OctÂ 2003 00:00:00 -05:00

Background: Mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene containing a premature termination signal cause a deficiency or absence of functional chloride-channel activity. Aminoglycoside antibiotics can suppress premature...

PERSPECTIVE: Pharmacologic Approaches to Correcting the Basic Defect in Cystic Fibrosis

Gergely L. Lukacs, M.D., Ph.D., and Peter R. Durie, M.D. — Thu, 09Â OctÂ 2003 00:00:00 -05:00

Cystic fibrosis is a heterogeneous condition caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene.1 The gene product, a regulated chloride channel, is expressed in the apical...

CLINICAL PRACTICE: The Evaluation of Suspected Pulmonary Embolism

Peter F. Fedullo, M.D., and Victor F. Tapson, M.D. — Thu, 25Â SepÂ 2003 00:00:00 -05:00

An otherwise healthy 51-year-old woman presents to her physician with pleuritic right posterior chest pain, without dyspnea or hemoptysis. Her temperature is 38.2Â°C, and her pulse is 102 beats per...

IMAGES IN CLINICAL MEDICINE: Gigantic Pulmonary Arteries

F. Reichenberger, Dr.Med. and Jonathan Brant, M.D. — Thu, 18Â SepÂ 2003 00:00:00 -05:00

A 49-year-old woman presented with a 12-month history of progressive exertional dyspnea and hoarseness. She had received a diagnosis of primary pulmonary hypertension after an uneventful pregnancy and delivery 22...

ORIGINAL ARTICLE: Expression of Human Herpesvirus 8 in Primary Pulmonary Hypertension

Thu, 18Â SepÂ 2003 00:00:00 -05:00

Background: Severe pulmonary hypertension constitutes a group of diseases characterized by complex, lumen-occluding vascular lesions that develop in genetically susceptible persons. The only viral infection associated with severe pulmonary hypertension...

CLINICAL PROBLEM-SOLVING: Anatomy of a Diagnosis

Thu, 04Â SepÂ 2003 00:00:00 -05:00

A 33-year-old man presented for evaluation of hemoptysis. He had been in his usual state of health until the day of presentation, when he had a transient cough productive of...

REVIEW ARTICLE: Genomics as a Probe for Disease Biology

Wylie Burke, M.D., Ph.D. — Thu, 04Â SepÂ 2003 00:00:00 -05:00

Although our understanding of pathology has grown rapidly in recent decades, the underlying mechanisms of many diseases remain obscure. Genomic research offers a new opportunity for determining how diseases occur,...

IMAGES IN CLINICAL MEDICINE: The Harlequin Color Change

Jaggi Rao, M.D. and Alfons Krol, M.D. — Thu, 04Â SepÂ 2003 00:00:00 -05:00

On the third day of life, balloon dilatation of the pulmonary valve was performed in a full-term newborn with pulmonary atresia. Eight days later, asymptomatic, macular, blanchable erythema developed, involving...

PERSPECTIVE: Trial Design and Patient Safety â The Debate Continues

Robert Steinbrook, M.D. — Thu, 14Â AugÂ 2003 00:00:00 -05:00

On July 3, 2003, nearly a year after it first became involved, the Office for Human Research Protections (OHRP) of the Department of Health and Human Services released its decision...

EDITORIAL: Treatment of Acute Bronchiolitis

Mary Ellen B. Wohl, M.D., and Victor Chernick, M.D. — Thu, 03Â JulÂ 2003 00:00:00 -05:00

In this issue of the Journal, Wainwright et al.1 provide data from a clinical trial in which 194 infants hospitalized with bronchiolitis were treated with inhaled epinephrine or placebo. In...

ORIGINAL ARTICLE: A Multicenter, Randomized, Double-Blind, Controlled Trial of Nebulized Epinephrine in Infants with Acute Bronchiolitis

Thu, 03Â JulÂ 2003 00:00:00 -05:00

Background: The treatment of infants with bronchiolitis is largely supportive. The role of bronchodilators is controversial. Most studies of the use of bronchodilators have enrolled small numbers of subjects and...

EDITORIAL: Systemic Corticosteroids for Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Richard S. Irwin, M.D., and J. Mark Madison, M.D. — Thu, 26Â JunÂ 2003 00:00:00 -05:00

Chronic obstructive pulmonary disease (COPD) is a common disease that affects up to 24 million people in the United States and leads to substantial disability and death.1 Patients with COPD...

ORIGINAL ARTICLE: Outpatient Oral Prednisone after Emergency Treatment of Chronic Obstructive Pulmonary Disease

Thu, 26Â JunÂ 2003 00:00:00 -05:00

Background: In this randomized, double-blind, placebo-controlled trial, we studied the effectiveness of prednisone in reducing the risk of relapse after outpatient exacerbations of chronic obstructive pulmonary disease (COPD).

Methods: We enrolled...

CLINICAL PRACTICE: The Solitary Pulmonary Nodule

David Ost, M.D., Alan M. Fein, M.D., and Steven H. Feinsilver, M.D. — Thu, 19Â JunÂ 2003 00:00:00 -05:00

A 60-year-old man undergoes chest radiography during an evaluation for pneumonia, and a nodule 1.5 cm in diameter is discovered. He is a heavy smoker but has no history of...

ORIGINAL ARTICLE: Staging of NonâSmall-Cell Lung Cancer with Integrated Positron-Emission Tomography and Computed Tomography

Thu, 19Â JunÂ 2003 00:00:00 -05:00

Background: We compared the diagnostic accuracy of integrated positron-emission tomography (PET) and computed tomography (CT) with that of CT alone, that of PET alone, and that of conventional visual correlation...

EDITORIAL: Expression of Concern: Schiffl H, et al. Daily Hemodialysis and the Outcome of Acute Renal Failure. N Engl J Med 2002;346:305-10.

Thu, 22Â MayÂ 2003 00:00:00 -05:00

In the issue of January 31, 2002, we published a study by Helmut Schiffl, M.D., Susanne M. Lang, M.D., and Rainald Fischer, M.D.1 It has come to our attention, through...

SPECIAL ARTICLE: Cost Effectiveness of Lung-VolumeâReduction Surgery for Patients with Severe Emphysema

National Emphysema Treatment Trial Research Group — Thu, 22Â MayÂ 2003 00:00:00 -05:00

Background: The National Emphysema Treatment Trial, a randomized clinical trial comparing lung-volumeâreduction surgery with medical therapy for severe emphysema, included a prospective economic analysis.

Methods: After pulmonary rehabilitation, 1218 patients at...

IMAGES IN CLINICAL MEDICINE: Centrilobular Emphysema with Predominantly Upper-Lobe Involvement

Andetta R. Hunsaker, M.D. and John J. Reilly, M.D. — Thu, 22Â MayÂ 2003 00:00:00 -05:00

A 57-year-old man with severe, disabling end-stage emphysema presented for enrollment in the National Emphysema Treatment Trial. After the completion of pulmonary rehabilitation, he was randomly assigned to the surgery...

ORIGINAL ARTICLE: A Randomized Trial Comparing Lung-VolumeâReduction Surgery with Medical Therapy for Severe Emphysema

National Emphysema Treatment Trial Research Group — Thu, 22Â MayÂ 2003 00:00:00 -05:00

Background: Lung-volumeâreduction surgery has been proposed as a palliative treatment for severe emphysema. Effects on mortality, the magnitude and durability of benefits, and criteria for the selection of patients have...

PERSPECTIVE: The National Emphysema Treatment Trial â How Strong Is the Evidence?

James H. Ware, Ph.D. — Thu, 22Â MayÂ 2003 00:00:00 -05:00

The National Emphysema Treatment Trial (NETT), reported in this issue of the Journal (pages 2059â2073) raises interesting questions about the interpretation of secondary analyses of data collected in clinical trials....

EDITORIAL: Case Clusters of the Severe Acute Respiratory Syndrome

Jeffrey M. Drazen, M.D. — Thu, 15Â MayÂ 2003 00:00:00 -05:00

Just over three weeks ago, the World Health Organization (WHO) issued a worldwide notice about the severe acute respiratory syndrome (SARS). It described a rapidly progressive, sometimes fatal pneumonia that...

EDITORIAL: Faster . . . but Fast Enough? Responding to the Epidemic of Severe Acute Respiratory Syndrome

Julie Louise Gerberding, M.D., M.P.H. — Thu, 15Â MayÂ 2003 00:00:00 -05:00

Severe acute respiratory syndrome (SARS) was diagnosed in more than 1800 patients in 17 countries (including the United States and Canada) between February 1 and March 31, 2003. During this...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 15-2003 â A 47-Year-Old Man with Waxing and Waning Pulmonary Nodules Five Years after Treatment for Testicular Seminoma

Carolyn M. Fleming, M.D., Jo-Anne O. Shepard, M.D., and Eugene J. Mark, M.D. — Thu, 15Â MayÂ 2003 00:00:00 -05:00

A 47-year-old man was evaluated in the pulmonary clinic because of waxing and waning pulmonary lesions several years after treatment for seminoma.

The patient had been well until five years earlier,...

IMAGES IN CLINICAL MEDICINE: Radiologic Manifestations of Severe Acute Respiratory Syndrome