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Articles 
Susan L. Hogan, Ronald J. Falk, Hyunsook Chin, Jianwen Cai, Caroline E. Jennette, J. Charles Jennette, and Patrick H. Nachman The authors aimed to identify predictors of relapse and resistance to treatment in 350 patients with antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis. Patients had Wegener granulomatosis, microscopic polyangiitis, and vasculitis confined to the kidney. Treatment resistance was associated with female sex, black ethnicity, and severe kidney disease at presentation. Relapse was associated with antiproteinase-3 antibodies and disease of the lung or upper respiratory tract.
Régis Sablé-Fourtassou, Pascal Cohen, Alfred Mahr, Christian Pagnoux, Luc Mouthon, David Jayne, Daniel Blockmans, Jean-François Cordier, Philippe Delaval, Xavier Puechal, Dominique Lauque, Jean-François Viallard, Abdelkader Zoulim, Loïc Guillevin the French Vasculitis Study Group* Of 112 patients with a new diagnosis of the Churg–Strauss syndrome, 43 (38%) were positive for antineutrophil cytoplasmic antibody (ANCA). Positive ANCA status was associated with renal involvement, peripheral neuropathy, and biopsy-proven vasculitis. Negative ANCA status was associated with heart disease and fever. The presenting clinical features of the Churg–Strauss syndrome appear to be related to ANCA status.
Kirsten K. Ness, Ann C. Mertens, Melissa M. Hudson, Melanie M. Wall, Wendy M. Leisenring, Kevin C. Oeffinger, Charles A. Sklar, Leslie L. Robison, and James G. Gurney This study compared 11 481 long-term survivors of childhood cancer with 3839 unaffected siblings. Survivors were more likely to report limitations on performance, including personal care skills and attendance at work or school. Survivors of brain and bone cancer were most at risk.
Barna D. Tugwell, Priti R. Patel, Ian T. Williams, Katrina Hedberg, Feng Chai, Omana V. Nainan, Ann R. Thomas, Judith E. Woll, Beth P. Bell, and Paul R. Cieslak The authors used molecular techniques to prove that an organ and tissue donor who was negative for antibody to hepatitis C virus (HCV) transmitted HCV infection to 8 transplant recipients. Although this occurrence is probably uncommon, it may provoke discussion of the value of testing potential transplant donors for HCV RNA.
Improving Patient Care
Charles F. von Gunten and True Ryndes Hospice has 3 forms in the United States. Traditional hospice provides palliative care for the dying. Community hospice provides multifaceted programs, including palliative care, for patients with eventually fatal disease. Academic hospice has a more complex mission that includes patient care, public health, and education and research.
Updates
Leonard Wartofsky This Update is a critical examination of articles selected from more than 25 peer-reviewed journals from the fields of endocrinology and general internal medicine. The importance of the observations and their applicability to clinical practice were the criteria for selecting articles. The topics include diabetes mellitus, thyroid disease, lipid-lowering therapy, and adrenal function.
Reviews
Alexander M. Clark, Lisa Hartling, Ben Vandermeer, and Finlay A. McAlister The authors reviewed 63 randomized trials that measured the effect of adding an exercise program to secondary cardiac prevention programs. Programs that promoted exercise reduced all-cause mortality (summary risk ratio, 0.85 [95% CI, 0.77 to 0.94]) relative to programs that did not promote exercise. Exercise-promoting programs had no added benefit 1 year after patients began them but reduced mortality substantially after 2 years.
Editorials
Gary S. Hoffman and Carol A. Langford For some autoimmune diseases, autoantibodies and their target antigen specificity can provide information about pathogenic mechanisms and disease phenotypes. What do antineutrophil cytoplasmic antibodies (ANCAs) tell us about a patient with vasculitis? Do ANCAs or their antigen specificity identify patients whose vasculitis differs in its clinical expression and relapse potential? If so, could this information guide treatment? Two articles in this issue address these questions.
On Being a Doctor
Y. Pritham Raj Transitional objects are ubiquitous in childhood. They may take the form of a favorite blanket or, in my 18-month-old son's case, a stuffed bear named Bo. Mine was, oddly enough, a label maker. Once I could spell, the "click, click-click" of the label maker became standard household din. Upon matriculation to medical school, I was introduced to a new, more sophisticated form of labeling. More rooted in science than in the imagination, it was the art of creating medical diagnostic labels.
Alex Zusman I am writing to apologize for all the confusion and to explain what has happened to you. I believe you did not receive the best care possible, and I would have expected more for my grandparent. There is more information regarding that clot in your left leg. You might justifiably ask, "Why was I initially told that the clot had disappeared only to find out, after leaving the hospital in good faith, that it was still there?" You are probably pondering this question on your way to have a filter placed in one of your large blood vessels.
Letters Deactivating Implantable Cardioverter Defibrillators
Acupuncture for Low Back Pain
The Future of Generalism in Medicine
Cimetidine and Acute Intermittent Porphyria
Correction: Acupuncture for Low Back Pain
Correction: Comparison of Rosiglitazone and Metformin for Treating HIV Lipodystrophy
Karen J. Sherman
Edgar R. Miller, III
Davey Smith
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