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Articles 
Kin Wing Choi, Tai Nin Chau, Owen Tsang, Eugene Tso, Ming Chee Chiu, Wing Lok Tong, Po Oi Lee, Tak Keung Ng, Wai Fu Ng, Kam Cheong Lee, William Lam, Wai Cho Yu, Jak Yiu Lai, Sik To Lai the Princess Margaret Hospital SARS Study Group* This study suggests that some patients with severe acute respiratory syndrome do not present with respiratory symptoms even though they have lung infiltrates. Advanced age and high initial serum lactate dehydrogenase level predict mortality.
Andreas Michalsen, Stefanie Klotz, Rainer Lüdtke, Susanne Moebus, Günther Spahn, and Gustav J. Dobos Patients with osteoarthritis of the knee have reduced symptoms for at least 1 week after application of leeches. The pharmacologic properties of leech saliva that are responsible for this effect are not known.
Roberto Pastor-Barriuso, José R. Banegas, Javier Damián, Lawrence J. Appel, and Eliseo Guallar Increasing systolic blood pressure increases all-cause and cardiovascular mortality over a wide range of blood pressure. In older people, the relationship of diastolic blood pressure to mortality is J-shaped. Therefore, the association of pulse pressure with mortality is complex, which makes it less useful as a guide to treatment or prognosis.
Improving Patient Care
Neil S. Wenger, David H. Solomon, Carol P. Roth, Catherine H. MacLean, Debra Saliba, Caren J. Kamberg, Laurence Z. Rubenstein, Roy T. Young, Elizabeth M. Sloss, Rachel Louie, John Adams, John T. Chang, Patricia J. Venus, John F. Schnelle, and Paul G. Shekelle Vulnerable older people do not receive adequate care for many conditions. Care for geriatric conditions is much less likely to be optimal than care for general medical conditions.
Reviews
Paul Khairy, Clare P. O'Donnell, and Michael J. Landzberg Paradoxical thromboembolism through a patent foramen ovale may be an important mechanism of cryptogenic stroke. This review shows that transcatheter closure of a patent foramen ovale is associated with a lower rate of recurrent stroke than treatment with antiplatelet agents or warfarin anticoagulation.
Suzanne Oparil, M. Amin Zaman, and David A. Calhoun Increased recognition of specific causes of hypertension may lead to therapies that address specific pathophysiologic mechanisms and cause fewer adverse effects. Research to identify such therapies will use powerful new techniques of genetics, genomics, and proteomics in conjunction with systems physiology and population studies.
Perspectives
Franz H. Messerli In the recent Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), the incidence of the primary end point was identical in the chlorthalidone, lisinopril, and amlodipine groups. The authors based their widely publicized major conclusion—that thiazide diuretics are the preferred first-line antihypertensive therapy—solely on secondary end points and cost.
Editorials
Marc C. Hochberg Although future studies might show that leech therapy is a practical, effective therapy for osteoarthritis of the knee, the work by Michalsen and colleagues in this issue is most exciting precisely because it raises the possibility of a novel, analgesic agent that could be safely administered without the need for a leech bite.
Linda P. Fried In this issue, Wenger and colleagues found that preventive care, chronic care, and care of geriatric conditions in U.S. vulnerable elders are often suboptimal. We need to focus much more attention on medical care for the most vulnerable third of the older population. Reimbursement practices must change so that they support practice patterns necessary to provide such care.
J. P. Mohr and Shunichi Homma Khairy and colleagues' review of uncontrolled studies suggests that closure of a patent foramen ovale is associated with a lower rate of recurrent stroke than treatment with antiplatelet agents or warfarin anticoagulation. Proving this point will require a prospective controlled clinical trial.
On Being a Doctor
Michael L. Willoughby He didn't feel very likable when he was on call. He must have made his family just as miserable as he made himself, since they seemed to dread his call days almost as much as he did. This call day was unexpected, and he was grateful that he hadn't had time to dread it.
Letters Fungal Endocarditis due to Scopulariopsis
Providing Free Care to the Uninsured: How Much Should Physicians Give?
Distinct Responses of Membranoproliferative Glomerulonephritis–Related Proteinuria to Spironolactone with and without Angiotensin II Blockade
Paradoxical Lowering of High-Density Lipoprotein Cholesterol Level in 2 Patients Receiving Fenofibrate and a Thiazolidinedione
Delayed-Onset Heparin-Induced Thrombocytopenia
Laboratory Monitoring of High-Dose Factor VIIa Therapy
Hope for the Best, and Prepare for the Worst
Atorvastatin-Induced Polyneuropathy
Charles F. von Gunten
Howard J. Eisen
John M. Luce This Update discusses cardiac arrest, pulmonary embolism, the acute respiratory distress syndrome, aspergillosis, sepsis and septic shock, bacterial meningitis, carbon monoxide poisoning, and methanol poisoning. | |||||||||||||||||||||||||||||||||||||||||||||||
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