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Articles 
Robert E. Eckart, Stephanie L. Scoville, Charles L. Campbell, Eric A. Shry, Karl C. Stajduhar, Robert N. Potter, Lisa A. Pearse, and Renu Virmani Anomalous origin of the left coronary artery and myocarditis are the leading identifiable causes of sudden death among military recruits. More than one third of sudden deaths remain unexplained after detailed medical investigation and autopsy.
Nathan E. Goldstein, Rachel Lampert, Elizabeth Bradley, Joanne Lynn, and Harlan M. Krumholz Implantable cardioverter defibrillators (ICDs) may discharge as an inevitable death draws near and make the act of dying more distressing. In this study, deceased patients' next of kin reported that clinicians seldom discussed deactivating ICDs. Individuals with an ICD should have the opportunity to turn it off as death approaches.
Suman W. Rathbun, Thomas L. Whitsett, and Gary E. Raskob A negative D-dimer test result can obviate the need for further testing or anticoagulation in many patients with a suspected first episode of deep venous thrombosis. This management trial extends this concept to patients with suspected recurrent venous thrombosis by showing a very low rate of deep venous thrombosis after a negative D-dimer test result in up to two thirds of such patients.
Karine Spiegel, Esra Tasali, Plamen Penev, and Eve Van Cauter Sleep-deprived healthy persons experience increased hunger. They also have increased blood levels of leptin and decreased levels of ghrelin (hormones that regulate satiety and hunger). These hormonal effects could be the cause of their increased hunger.
Improving Patient Care
Kathlyn E. Fletcher, Steven Q. Davis, Willie Underwood, Rajesh S. Mangrulkar, Laurence F. McMahon, Jr., and Sanjay Saint Studies of interventions to decrease housestaff work hours, fatigue, and sleep deprivation are few; taken together, they make a relatively weak body of evidence. As educators struggle to improve working conditions for housestaff, they cannot rely on past research.
Updates
Bennett Lorber This year's Update in Infectious Diseases incorporates articles on common infections, HIV medicine, therapeutics, bioterrorism, and emerging infections.
Reviews
Kevin A. Bybee, Tomas Kara, Abhiram Prasad, Amir Lerman, Greg W. Barsness, R. Scott Wright, and Charanjit S. Rihal Some people who do not have coronary artery obstruction experience transient wall-motion abnormalities involving the left ventricular apex and mid-ventricle. They have transient left ventricular apical ballooning syndrome. The authors review case series of patients with this syndrome.
Lisa K. Moores, William L. Jackson, Jr., Andrew F. Shorr, and Jeffrey L. Jackson Patients with suspected pulmonary embolism seldom have subsequent venous thromboembolism after negative results on computed tomographic pulmonary angiography (CTPA). Withholding anticoagulation after negative CTPA results seems to be safe.
Editorials
Gary J. Balady In this issue, Eckart and colleagues show that cardiovascular conditions account for most sudden deaths in basic military training. These conditions are very difficult to detect with noninvasive tests in a low-risk population. A history of chest pain, syncope, or unusual dyspnea before or during basic training should alert physicians to military recruits at relatively high risk.
Jeffrey S. Flier and Joel K. Elmquist In this issue, Spiegel and colleagues raise much food for thought (so to speak). If their findings on changes in leptin and ghrelin during sleep deprivation are reproducible and generalizable, and if these hormonal changes cause changes in food intake over time, we may add inadequate sleep to the environmental factors that contribute to weight gain and obesity.
On Being a Doctor
Michael J. Schott One day after my lecture during morning report, Dr. Martin approached me. She said, "I'm going to teach you how to read an EKG." I was shocked that she would take time out of her busy day to teach me. It seemed almost sacrilegious to me, like a master magician sharing her art with a member of the audience.
Letters Obstetricians Still Wanted: Mothers Should Read the Fine Print
Single Complete Compression Ultrasonography for Suspected Deep Venous Thrombosis: Ideal in Routine Clinical Practice?
Aerobic Physical Exercise and Atherosclerosis in Men
Exercise and Atherosclerosis
Foreign Medicine
Management of the Acute Radiation Syndrome
Dose Effects of Steroids on Survival in Sepsis
Angiotensin-Converting Enzyme Inhibitors and Diuretics: Optimal Combination Therapy
Barry R. Davis, Curt D. Furberg, Jackson T. Wright, Jr., Jeffrey A. Cutler, and Paul Whelton—RESPONSE Ginseng and Warfarin Interactions
B-Type Natriuretic Peptide Is Effective Therapy before Care
Multiple Pseudotumors in IgG4-Associated Multifocal Systemic Fibrosis
The Health Insurance Portability and Accountability Act and the Informed Consent Process
Gastrointestinal Beriberi: A Previously Unrecognized Syndrome
Ann Klassen
Geno J. Merli
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