OPIOID anesthetic agents in high doses can blunt endocrine and metabolic responses to cardiac or noncardiac operations in adults, as demonstrated by perioperative changes in the levels of cortisol,^{1 , 2} catecholamines,³ vasopressin,⁴ and growth hormone.¹ ...

PERCUTANEOUS transluminal coronary angioplasty (PTCA) is an increasingly popular treatment for coronary-artery stenosis. An estimated 200,000 procedures were performed in the United States and another 100,000 in Europe during 1990.¹ The growth in the use ...

ALTHOUGH nasopharyngeal carcinoma accounts for only 3 percent of all head and neck tumors in North America, it is the most common tumor in China and is also frequent in Greenland, Alaska, and Mediterranean countries. Largely unidentified environmental ...

IMPAIRED insulin secretion and insulin resistance are prominent features of non-insulin-dependent diabetes mellitus (NIDDM).^{1 , 2} Despite extensive investigation, the role of these abnormalities in the pathogenesis of NIDDM remains controversial.^{1 2 3} A ...

FIBRILLARY glomerulonephritis is an unusual kidney disease characterized by infiltration of the mesangium and glomerular basement membrane by fibrillary deposits that are negative on Congo-red staining but are reactive for polyclonal immunoglobulins.^{1 2 3} ...

THE underwater environment, with its rapidly changing ambient pressures, presents pathophysiologic challenges that may lead to a variety of unusual diseases for which rapid diagnosis and treatment are critical. In the United States there are more than 5 ...

The step-by-step process of clinical problem-solving is the subject of this new Journal feature. Information about a real patient is presented to an expert clinician in stages (boldface type), to simulate the way such information emerges in everyday ...

Presentation of Case

First admission. A 34-year-old woman was admitted to the hospital because of a pruritic rash, cough, myalgia, and low-grade fever.

The patient was well until one month earlier, when she began to experience an "ache" in the ...

ONE hundred fifty years ago, surgery was performed under brutal conditions. Without benefit of anesthesia, patients endured excruciating pain; indeed, the belief was widespread that they could die from the "shock" of surgery. With the advent of anesthesia,...

GIVEN the prevalence of coronary artery disease and its considerable cost to society, selecting the optimal approach to treatment for each patient is an important health care issue. During the 1970s, several large clinical trials compared medical therapy ...

IN this issue of the Journal, Feinmesser et al.¹ report on the use of fine-needle aspiration or open biopsy followed by the polymerase chain reaction (PCR) to detect viral genomes of the Epstein–Barr virus (EBV) in cervical lymph nodes containing ...

IN this issue of the Journal we begin a new series, "Clinical Problem-Solving," which focuses on the difficult diagnostic, therapeutic, and ethical challenges that physicians face every day. Each installment will consist of a description of a clinical ...

ALTERNATIVE medicine has long played an important part in the care of people with health problems in this country. Although there has been no comprehensive assessment of its use, there are good reasons to believe that alternative medicine has many ...

To the Editor: Farci et al. (July 11 issue) ¹ reported longitudinal data on the levels of hepatitis C virus (HCV) RNA in patients with post-transfusion non-A, non-B hepatitis and in experimentally infected chimpanzees. They drew several interesting ...

To the Editor: We agree with the observations of Stark et al. (June 20 issue)¹ that chest pain can occur with myocardial ischemia in some cardiac-transplant recipients. The case we report emphasizes that in transplant recipients myocardial ischemia may ...

To the Editor: In his article on oral anticoagulant drugs (June 27 issue),¹ Hirsh gives an excellent review of this important subject. We disagree, however, with his interpretation of the literature on oral anticoagulant treatment in patients with tissue ...

To the Editor: Familial hypercholesterolemia is an autosomal dominant disorder due to mutations in the low-density-lipoprotein (LDL)—receptor gene. In the French Canadian population, 60 percent of patients with familial hypercholesterolemia have the same ...

To the Editor: Intrauterine growth retardation is associated with atheroma-like lesions in the arteries of the placental bed.¹ The finding of increased resistance to uterine-artery blood flow is predictive of both preeclampsia and intrauterine growth ...

To the Editor: The Health Policy Report by Iglehart regarding the Food and Drug Administration (July 18 issue)¹ provided a very useful summary of the agency's current problems. No mention was made, however, of a regulatory "window" that permits the sale ...

To the Editor: Thousands of U.S. military personnel have been treated with radium applicators. Beginning in World War II, the Navy recognized aerotitis media as a problem for trainees in the submarine service practicing underwater escapes. Otic ...

To the Editor: During the past 12 months there have been at least four known cases of Lyme disease in Truro, Massachusetts. Of the four patients, three also had tularemia, and two had Rocky Mountain spotted fever, fatal in one. Although I knew none of ...

The five books under review have relatively little in common beyond the fact that each deals with one facet or another of health care and economics. In fact, only two — those by Jacobs and Gray — are books in the conventional sense that they are the work ...

The receipt of these books is acknowledged, and this listing must be regarded as sufficient return for the courtesy of the sender. Books that appear to be of particular interest will be reviewed as space permits. The Journal does not publish unsolicited ...

Notices submitted for publication should contain a mailing address and phone number of a contact person or department. We regret we are unable to publish all Notices received.

FRUCTOSE AND FRUCTOSE CONTAINING FOODS

The international congress, subtitled "...

These guidelines are in accordance with the "Uniform Requirements for Manuscripts Submitted to Biomedical Journals." (The complete document appears in the February 9, 1991, issue of the British Medical Journal and the February 7, 1991, issue of the New ...