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Articles 
Mary Beth Hamel, Roger B. Davis, Joan M. Teno, William A. Knaus, Joanne Lynn, Frank Harrell, Jr., Anthony N. Galanos, Albert W. Wu, Russell S. Phillips for the SUPPORT Investigators This study found a modest association between patient age and short-term survival of serious illness. This age effect was not explained by the current practice of providing less aggressive care to elderly patients.
Drew J. Winston, Anita Pakrasi, and Ronald W. Busuttil Prophylactic fluconazole after liver transplantation decreases fungal colonization, prevents superficial and invasive fungal infections, and is not associated with appreciable hepatotoxicity. Although this therapy is related to fewer deaths from fungal infection compared with placebo, it does not improve overall survival.
H. J. Kolb, Gérard Socié, Thomas Duell, Maria Theresa Van Lint, André Tichelli, Jane F. Apperley, Elke Nekolla, Per Ljungman, Niels Jacobsen, M. van Weel, Roland Wick, Melanie Weiss, H. Grant Prentice for the Late Effects Working Party of the European Cooperative Group for Blood and Marrow Transplantation and the European Late Effect Project Group The spectrum of neoplasms and immunosuppressive treatment with cyclosporine for chronic graft-versus-host disease as dominant risk factors indicate that immunosuppression is the major cause of malignant neoplasms in patients receiving bone marrow transplants.
Kevin Fiscella and Peter Franks Profiles of physician practices that base ratings of physician performance on patients' physical and mental health status are substantially affected by patients' level of education. However, these results do not suggest that physicians who care for less educated patients provide worse care. Physician profiling should account for differences in patients' level of education.
Brief Communications
Jordi Guardiola, Xavier Xiol, Richard Sallie, Joan M. Nolla, Daniel Roig-Escofet, Eduardo Jaurrieta, and Luis Casais Vitamin D receptor gene polymorphism influences bone loss after liver transplantation. Patients with the bb genotype are, to some extent, protected against post-transplantation bone loss.
Eliseo Pascual, Enrique Batlle-Gualda, Agustín Martínez, José Rosas, and Paloma Vela Arthrocentesis of asymptomatic knees and first metatarsophalangeal joints and synovial fluid analysis are simple procedures that facilitate the diagnosis of gout during intercritical periods.
Updates
Theodore Pincus, James R. O'Dell, and Joel M. Kremer This paper discusses the rationale for a rheumatoid arthritis treatment strategy that aims to control inflammation as completely as possible; summarizes evidence from randomized, controlled clinical trials of combination disease-modifying antirheumatic drugs to control inflammation; and describes a contemporary approach to rheumatoid arthritis.
Medicine and Public Issues
Dennis H. Osmond, Andrew B. Bindman, Karen Vranizan, J. Stan Lehman, Frederick M. Hecht, Dennis Keane, Arthur Reingold for the Multistate Evaluation of Surveillance for HIV Study Group* Name-based surveillance of HIV infection is the law in 31 U.S. states, but it remains controversial. The Multistate Evaluation of Surveillance for HIV Study Group surveyed a cross-sectional probability sample of persons with AIDS in 5 states that use name-based surveillance. The results suggest that the potential for negative or positive effects of this surveillance on partner notification and access to health care has been exaggerated.
Editorials
Steven A. Schroeder Few clinical research projects have generated as much public interest or as many published articles as SUPPORT (the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment). The latest of these articles appears in this issue. What accounts for SUPPORT's impact?
On Being a Doctor
Dennis H. Novack She walked to the door. I followed her. I had an eerie sense of predestination: If I had come to the lobby five seconds later, I would have missed her. I was meant to find her, to stop her.
On Being a Patient
Sebastian Fetscher A doctor's failing mitral valve launches a years-long search for some kind of consensus among a series of disagreeing specialists.
Letters Risk Factors for Thromboembolism
Hormone Replacement Therapy in Postmenopausal U.S. Women
Thrombolytic Predictive Instrument
The Park Nicollet Experience
Sigmoidoscopy Reimbursement
Splenectomy-Induced Portal Hypertension and Pulmonary Hypertension
False-Positive HIV Diagnosis by HIV-1 Plasma Viral Load Testing
Nosocomial Transmission of Hepatitis C Virus
Renin-Secreting Adenocarcinoma of the Colon
Famotidine-Induced Erythema Multiforme: Cross-Sensitivity with Cimetidine
Tropheryma whippelii in Synovial Tissue and Fluid
Sudden Jaundice with Isolated Atypical Perinuclear Antineutrophil Cytoplasmic Antibodies
Retroperitoneal Hematoma and Enoxaparin
Long QT Syndrome and Torsade de Pointes in a Patient Receiving Fluconazole
Treatment of Parathyroid Cysts with Fine-Needle Aspiration
"Catastrophic" Diagnosis of the Antiphospholipid Syndrome
Posterior Pituitary Sigma Receptors and Drug-Induced Syndrome of Inappropriate Antidiuretic Hormone Release
Brent A. Bauer
Renslow Sherer
Gail Dutton
George N. Braman
J. M. Cunningham
John C. Ruckdeschel Among the many important topics that currently come under the heading of oncology, this Update focuses on the most common diseases: prostate cancer, breast cancer, and lung cancer. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
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