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Articles 
S. Claiborne Johnston, Ellen S. O'Meara, Teri A. Manolio, David Lefkowitz, Daniel H. O'Leary, Steven Goldstein, Michelle C. Carlson, Linda P. Fried, and W. T. Longstreth, Jr. Cognitive impairment and decline are associated with asymptomatic high-grade stenosis of the left internal carotid artery but not the right carotid artery. The lack of association with right-sided stenosis indicates that the association is specific and not due to generalized atherosclerosis.
Tien Yin Wong, Ronald Klein, A. Richey Sharrett, Bruce B. Duncan, David J. Couper, Barbara E.K. Klein, Larry D. Hubbard, F. Javier Nieto for the Atherosclerosis Risk in Communities Study Researchers have speculated that narrowing of the small arterioles contributes to the pathogenesis of hypertension. In this prospective study, patients who were normotensive at baseline but had narrowed retinal arterioles were more likely to develop hypertension later in life. Arteriolar narrowing may be an early stage of hypertension.
Kathryn Anastos, Yolanda Barrón, Mardge H. Cohen, Ruth M. Greenblatt, Howard Minkoff, Alexandra Levine, Mary Young, and Stephen J. Gange The CD4+ cell count and HIV-1 RNA level after highly active antiretroviral therapy predict death and new AIDS-defining illness. Pretreatment values of these markers do not predict clinical outcomes if post-treatment values are taken into account. Highly active antiretroviral therapy can overcome even advanced immunesuppression if treatment results in CD4+ cell counts of greater than 0.200 x 109 cells/L and RNA levels of less than 10 000 copies/mL.
Brief Communications
Sean C. Halligan, Bernard J. Gersh, Robert D. Brown, Jr., A. Gabriela Rosales, Thomas M. Munger, Win-Kuang Shen, Stephen C. Hammill, and Paul A. Friedman Lone atrial flutter has a stroke risk at least as high as lone atrial fibrillation. The risk for atrial fibrillation is higher in patients with lone atrial flutter than in the general population. Physicians should consider long-term anticoagulation for all patients with atrial flutter who are older than 65 years of age.
Improving Patient Care
Diane E. Campbell, Joanne Lynn, Tom A. Louis, and Lisa R. Shugarman Hospice enrollment correlates with slightly lower Medicare expenditures among people dying of cancer, especially lung cancer and other aggressive types of cancer. Medicare expenditures are higher for hospice patients dying of other diseases, such as heart failure and dementia. Overall, Medicare expenditures are higher for dying patients enrolled in hospice than for dying patients who do not enroll in hospice.
Academia and Clinic
Karna Gendo and Eric B. Larson This paper reviews the use of the history, skin tests, and in vitro tests in diagnosing allergic rhinitis. In patients whose history strongly suggests allergic rhinitis, tests are not helpful except in patients who do not respond to standard treatment and must consider immunotherapy or allergen avoidance. Tests are more likely to change management if the pretest probability of allergic rhinitis is relatively low.
Medicine and Public Issues
William H. Maisel This article describes the rules that govern the approved and unapproved use of medical devices. It also describes the federal government's processes for premarket evaluation and approval and postmarket surveillance of medical devices.
Editorials
H.J.M. Barnett In this issue, Johnston and colleagues report on cognition at baseline and subsequent cognitive decline in 4006 patients who were free of symptomatic vascular disease. They found an association between stenosis of the carotid artery that supplies the dominant hemisphere and cognitive impairment and decline. Although their evidence is important, we need larger, more inclusive studies before deciding that carotid stenosis causes functionally important cognitive impairment.
Robert T. Schooley In this issue, Anastos and colleagues analyzed the predictors of successful outcomes of antiretroviral chemotherapy in women participating in the Women's Interagency Health Study. Even persons with advanced HIV disease benefited from antiretroviral chemotherapy, and a patient's response to therapy was more predictive of death and AIDS than baseline markers of disease activity.
On Being a Doctor
Yishai Ofran and Shaden Salameh Giryes In 1948, when the state of Israel was established, Jerusalem was divided between Israel and Jordan. Consequently, Mount Scopus, the location of the Hebrew University campus and Hadassah University hospital, became an Israeli enclave in the midst of an Arab population. This article reflects our daily experience as doctors in Hadassah Mount Scopus Hospital. We are 2 residents, one Jewish, one Arab, working together in the internal medicine ward.
Letters Duration of Antibiotic Therapy for Lyme Disease
Dark Rounds
The Symbol of Modern Medicine
High-Dose and Low-Dose Cosyntropin Stimulation Tests for Diagnosis of Adrenal Insufficiency
Responsiveness of Thrombotic Thrombocytopenic Purpura to Rituximab and Cyclophosphamide
Fadi Fakhouri, Luis Teixeira, Richard Delarue, Jean-Pierre Grünfeld, and Agnès Veyradier Correction: Diagnosis of Adrenal Insufficiency
Correction: Gatifloxacin-Induced Hepatotoxicity and Acute Pancreatitis
Andrew G. Plaut
Joel D. Howell
Jennifer Fisher Wilson
Merle A. Sande and Allan R. Ronald This year's Update in Infectious Diseases focuses on the severe acute respiratory syndrome (SARS), hepatitis B, respiratory viruses, antibiotic resistance, and vaccination. In the past year, we heard both alarming findings about emerging infectious diseases and drug-resistant bacteria and exciting findings about new vaccines and more effective therapy for infectious diseases. | ||||||||||||||||||||||||||||||||||||||||||||||||||
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