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Articles 
Jeffrey A. DesJardin, Matthew E. Falagas, Robin Ruthazer, John Griffith, Dorothy Wawrose, David Schenkein, Kenneth Miller, and David R. Snydman In hospitalized hematology–oncology patients, culture of blood drawn through a central catheter or peripheral vein has excellent negative predictive value. Culture of blood drawn through an indwelling central venous catheter has a low positive predictive value, apparently less than seen with peripheral venipuncture. Thus, a positive result from a catheter needs clinical interpretation and may require confirmation. However, use of a catheter to obtain blood for culture may be acceptable for ruling out bloodstream infections.
Harlan M. Krumholz, Martha J. Radford, Yun Wang, Jersey Chen, and Thomas A. Marciniak In this study, early ß-blocker therapy was not used for 51% of elderly patients who were hospitalized with an acute myocardial infarction and did not have a contraindication to this therapy. Increasing ß-blocker use for these patients would provide an excellent opportunity to improve their care and outcomes.
Johan Askling, Per Sørensen, Anders Ekbom, Morten Frisch, Mads Melbye, Bengt Glimelius, and Henrik Hjalgrim Patients with a history of squamous-cell skin cancer have a worse prognosis after diagnosis of subsequent cancer than patients without prior skin cancer, and they warrant careful medical attention.
Lubor Golan, John D. Birkmeyer, and H. Gilbert Welch Treating all middle-aged diabetic patients with angiotensin-converting enzyme inhibitors is a simple strategy that provides additional benefit at modest additional cost. The strategy assumes that patients meet the older diagnostic criteria for diabetes and makes sense only for patients who are not bothered by the treatment.
Brief Communications
Bruno Annibale, Massimo Marignani, Bruno Monarca, Giorgio Antonelli, Adriana Marcheggiano, Gina Martino, Franco Mandelli, Renzo Caprilli, and Gianfranco Delle Fave Cure of Helicobacter pylori infection is associated with reversal of iron dependence and recovery from iron deficiency anemia.
Academia and Clinic
Maria G.M. Hunink, Karen M. Kuntz, Kirsten E. Fleischmann, and Thomas J. Brady New imaging techniques, such as magnetic resonance imaging and electron-beam computed tomography, must be relatively inexpensive and have excellent sensitivity and specificity to be cost-effective compared with other techniques that are already available for the diagnosis of coronary artery disease.
Updates
Robert G. Hart and Jonathan L. Halperin The remarkable pace of development has revolutionized management of nonvalvular atrial fibrillation and makes detection of this long-neglected dysrhythmia an important opportunity for stroke prevention. This paper presents recent advances, discusses controversies, and explores new ideas about stroke and its prevention in patients with nonvalvular atrial fibrillation.
Perspectives
Vicky Baffis, Ian Shrier, Averell H. Sherker, and Andrew Szilagyi This paper discusses the pathogenesis of hepatocellular carcinoma in patients with cirrhosis related to hepatitis B or C and reviews clinical studies of interferon therapy to prevent or delay hepatocellular carcinoma in these patients.
History of Medicine
Theodore B. Schwartz In the mid- to late 19th century, the schism between academicians and medical practitioners was nowhere greater than in the field of endocrinology. Henry Harrower was a leading proponent of organotherapeutics—the idea that extracts from glands were effective for treating most human ailments. This school of thought went unchallenged for years until Harvey Cushing launched an attack on its purveyors.
Editorials
Deborah J. Cook and Gordon H. Guyatt Golan and colleagues' decision analysis in this issue focuses on the prevention of diabetic neuropathy under three scenarios. This study highlights the reality that clinicians and patients with different perspectives and resources might come to different conclusions when presented with the same evidence about a screening procedure.
On Being a Doctor
Leslie G. Cohen A trumpet-playing 13-year-old patient evokes memories of a doctor's own musical—and medical—ambitions.
Letters Famciclovir and Postherpetic Neuralgia
Theophylline Therapy for Near-Fatal Cheyne-Stokes Respiration
Improving Preventive Care Guidelines
Elevated Estradiol and Testosterone Levels and Risk for Breast Cancer
Delayed Treatment of Bacterial Meningitis
Impaired Glucose Tolerance in HIV-Infected Patients
Treatment of Chronic Lead Intoxication
Hepatitis B Virus Genotypic Resistance to Lamivudine
Left Coronary Ostial Stenosis Caused by Focal Intimal Fibrosis
Correction: Nathan Smith and Early American Education
Faith McLellan The Pulitzer Prize–winning play W;t captures some hard truths about the experience of illness, while at the same time reflecting a long and sometimes distinguished tradition of illness narratives, or pathographies.
Tony M. Balistreri and William F. Balistreri
William W. Stead
John J. Keveney
Richard M. Berlin
Laurence H. Beck and Seema Pania Kumar Many of the studies published in 1998 that dealt with prevention are concentrated in three areas: cardiovascular disease, breast and other cancers, and osteoporosis. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
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