MAINTAINING the quality of care in an increasingly cost-conscious environment is a goal of many health policy decision makers. The ability to achieve this goal may depend on the ability to determine the medical appropriateness of care. We define a ...

OF the estimated 60 million Americans with hypertension, less than 1 percent will ever have a hypertensive crisis.¹ The infrequency of such events can be attributed to improvements in the management of hypertension over the past 10 years. When patients do ...

IN VITRO fertilization has become a routine procedure for the treatment of infertility, with a pregnancy success rate in many centers of 20 to 25 percent per egg collection. Considerable effort has been invested in improving laboratory procedures, methods ...

FERTILITY in women over the age of 40 is generally acknowledged to be decreased. In analyzing a large series of women, Leridon suggested that fecundity in women actually begins to decline by 30 years of age.¹ Fertility rates peak by the age of 25 and fall ...

THE hemolytic uremic syndrome is a leading cause of acute renal failure in childhood.¹ The classic triad of microangiopathic hemolytic anemia, thrombocytopenia, and renal failure was first reported in 1955,² and subsequently progress has been made in ...

THAT insulin-dependent diabetes mellitus (IDDM) is an autoimmune disorder is now generally accepted. Autoantibodies to cytoplasmic antigens in the pancreatic islet cells were originally described nearly 15 years ago in patients with the autoimmune ...

PAROXYSMAL nocturnal hemoglobinuria is a rare acquired disease caused by an unusual susceptibility of erythrocytes to the lytic action of complement. The abnormal erythrocytes are thought to originate from the clonal proliferation of bone marrow ...

Presentation of Case

A 3 1/2-year-old boy was admitted to the hospital because of pharyngitis, fever, rash, and cervical lymphadenopathy.

The child was born to a 21-year-old woman by spontaneous vaginal delivery after a full-term second pregnancy; the ...

Last month, newspapers reported two legal disputes involving new reproductive methods. The first (Davis v. Davis)¹ was a battle for custody of seven frozen embryos, conceived by in vitro fertilization two years ago. A lower court had referred to them as "...

Expectations are high for the Agency for Health Care Policy and Research, established by the 101st Congress to promote research on medical outcomes and develop guidelines for practice. Physicians and patients expect that such research will make it ...

To the Editor: The Sounding Board articles by Schoen¹ and Poland² (May 3 issue) are impressive summaries of the medical evidence for and against routine neonatal circumcision. It appears that the risks of circumcision are minimal, whereas the benefits ...

To the Editor: After reading the recent article by Bracken et al. (May 17 issue),¹ we have several questions regarding data not discussed that would facilitate our analysis of this very important work. First, we understand from the description of the ...

To the Editor: I would like to express several concerns about the study by Storm et al. (May 3 issue).¹ On review of the results of this three-year study, I am unable to come to the same conclusions as the authors, because of an omission of critical ...

To the Editor: With reference to the article by Carbonari and colleagues (Jan. 11 issue) describing a relative increase in γ/δ T cells in patients with ataxia—telangiectasia,¹ recent work by me and my collaborators has demonstrated a similar relative ...

To the Editor: In his excellent discussion (Dec. 21, 1989, issue)¹ of a 72-year-old woman who was treated four years previously for node-positive, estrogen-receptor—positive breast cancer, Dr. Beamis remarked that "the therapeutic approach chosen four ...

To the Editor: We report a case of Military tuberculosis that developed after extracorporeal shock-wave lithotripsy.

A 60-year-old man with a history of recurrent urolithiasis was admitted to the hospital because of repeated ureteric colic caused by ...

To the Editor: Many households in the United States currently use microwave ovens to cook and prepare a variety of foods. These units can superheat food products in a relatively short time. The makers of microwaveable popcorn sell their products in ...

When the first edition of this book was published in 1977, the area of pediatric and adolescent gynecology was just beginning to be recognized as a discipline unto itself. With the third edition of this book, it is clear that pediatric and adolescent ...

This book addresses an important aspect of adolescent health care in a format primarily intended for pediatricians, family practitioners, and others offering primary care to teenagers and young adults. The reader is given a good overall view of ...

Textbooks on pediatric cardiology have usually reflected the practice of the specialty as it has evolved from descriptive pathology through clinical cardiology to an in-depth knowledge of experimental embryology, molecular biology, myocardial energetics ...

This is the third edition of a book that has become an important standard for all who care for the fetus or newborn (and the mother) with an infectious disease. It is the most complete and authoritative work on the subject in this country, and may well be ...

This book exhibits both the advantages and the disadvantages of multiauthored comprehensive textbooks. Many distinguished contributors from pediatric urology and pediatric surgery have been drawn into collaboration. Every chapter is adequate, and several ...

As a special field, pediatric pathology is in relative infancy. In fact, the first qualifying examination is being offered by the American Board of Pathology this year. Consequently, the majority of practicing surgical pathologists are self-taught in this ...

This is the second edition of this color atlas, first published in 1981. It serves as a guide to physical diagnosis, with 702 color photographs, many more than appeared in the original atlas. There is an accompanying text, adapted by Roger F. Soll.

The ...

UPDATE IN CLINICAL MEDICINE

The course will be offered in Steamboat Springs, Colo., Feb. 24—March 1.

Contact Karen Kirsch Jacobsen, George Washington Univ. Medical Ctr., Office of CME, 2300 K St., NW, Washington, DC 20037; or call (202) 994–4285.

MANAGING ...

Currently, about 33 million people in the United States lack health insurance.¹ They include the self-employed, those employed part time, seasonal workers, the unemployed, and full-time workers whose employers offer unaffordable insurance or none at all. ...