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The New England Journal of Medicine Downloaded from nejm.org at QUEENS UNIV on April 30, 2013. For personal use only. No other uses without permission. From the NEJM Archive. Copyright © 2010 Massachusetts Medical Society. All rights reserved.

Case 14-1967

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The New England Journal of Medicine Downloaded from nejm.org at QUEENS UNIV on April 30, 2013. For personal use only. No other uses without permission.

From the NEJM Archive. Copyright © 2010 Massachusetts Medical Society. All rights reserved.

The New England Journal of Medicine Downloaded from nejm.org at QUEENS UNIV on April 30, 2013. For personal use only. No other uses without permission.

From the NEJM Archive. Copyright © 2010 Massachusetts Medical Society. All rights reserved.

The New England Journal of Medicine Downloaded from nejm.org at QUEENS UNIV on April 30, 2013. For personal use only. No other uses without permission.

From the NEJM Archive. Copyright © 2010 Massachusetts Medical Society. All rights reserved.

The New England Journal of Medicine Downloaded from nejm.org at QUEENS UNIV on April 30, 2013. For personal use only. No other uses without permission.

From the NEJM Archive. Copyright © 2010 Massachusetts Medical Society. All rights reserved.

The New England Journal of Medicine Downloaded from nejm.org at QUEENS UNIV on April 30, 2013. For personal use only. No other uses without permission.

From the NEJM Archive. Copyright © 2010 Massachusetts Medical Society. All rights reserved.

The New England Journal of Medicine Downloaded from nejm.org at QUEENS UNIV on April 30, 2013. For personal use only. No other uses without permission.

From the NEJM Archive. Copyright © 2010 Massachusetts Medical Society. All rights reserved.

The New England Journal of Medicine Downloaded from nejm.org at QUEENS UNIV on April 30, 2013. For personal use only. No other uses without permission.

From the NEJM Archive. Copyright © 2010 Massachusetts Medical Society. All rights reserved.

The New England Journal of Medicine Downloaded from nejm.org at QUEENS UNIV on April 30, 2013. For personal use only. No other uses without permission.

From the NEJM Archive. Copyright © 2010 Massachusetts Medical Society. All rights reserved.

The New England Journal of Medicine Downloaded from nejm.org at QUEENS UNIV on April 30, 2013. For personal use only. No other uses without permission.

From the NEJM Archive. Copyright © 2010 Massachusetts Medical Society. All rights reserved.

The New England Journal of Medicine Downloaded from nejm.org at QUEENS UNIV on April 30, 2013. For personal use only. No other uses without permission.

From the NEJM Archive. Copyright © 2010 Massachusetts Medical Society. All rights reserved.