HEADACHE, lethargy, and other symptoms are known to follow the discontinuation of caffeine administration (caffeine withdrawal),¹ but the relevance of these observations to the general population is unclear. The incidence and severity of caffeine ...

IN patients who receive radiotherapy alone for advanced, inoperable squamous-cell carcinoma of the head and neck, the expected five-year survival is lower than 25 percent,¹ and in patients with local invasive and massive nodal involvement, it may be as ...

FEBRILE seizures are the most common type of seizure and occur in 2 to 4 percent of all children.^{1 2 3 4} Approximately one third of children who have a febrile seizure have a recurrence.^{2 , 4 5 6} Only the age at the time of the first febrile seizure is a ...

SINCE the initial observation by Trousseau in 1868 relating thrombotic phenomena to cancer,¹ numerous studies have addressed the relation between malignant disease and venous thromboembolism. An increased incidence of venous thromboembolism in patients ...

A larva of Trichinella spiralis is coiled in a still-living skeletal-muscle cell. The patient contracted trichinosis by eating raw pork in which similar viable larvae were undoubtedly encysted (×828).

AN increasing proportion of marketing expenses of the pharmaceutical industry has gone to funding symposiums, with funding rising from $6 million in 1975 (adjusted for inflation to 1988 dollars) to $86 million in 1988.¹ Although the number of sponsored ...

ABOUT three fourths of all kidney stones are composed of calcium oxalate¹; most calcium oxalate stones also contain a small amount of hydroxyapatite, and 10 to 12 percent contain some uric acid.² Ten to 20 percent of stones contain struvite (magnesium ...

Presentation of Case

A three-year-old boy was referred to the hospital for cardiac evaluation because of a murmur that was increasing in volume.

He was born of a full-term second pregnancy to a mother 28 years of age. His birth weight was 4.0 kg. The ...

Cessation of the use of products containing caffeine can cause a withdrawal syndrome of headaches, drowsiness, fatigue, decreased performance, and in some instances, nausea and vomiting.¹ These symptoms begin within 12 to 24 hours after the last use, peak ...

Observing a seizure may be one of life's most frightening experiences. Many parents who witness a child's first seizure think the child is dying. Their lack of knowledge and sense of helplessness may be compounded by misconceptions about the risks of ...

A relation between hypercoagulability and cancer has been recognized for more than 125 years. Trousseau,¹ lecturing on phlegmasia alba dolens in 1872, noted that deep-vein thrombosis of the extremities often accompanied visceral cancer and concluded that "...

Encouraging patients to execute advance directives is a worthy goal. Although such documents are certainly not perfect and may in many instances be difficult to interpret,¹ it is usually much easier to determine and respect a patient's wishes when there ...

To the Editor: . . . Berenguer et al. report (March 5 issue)¹ that 59 percent of all cases of tuberculous meningitis during the study period occurred in patients infected with the human immunodeficiency virus (HIV); however, there must be an error, ...

To the Editor: Edlin et al. (June 4 issue)* ascribe the transmission of multidrug-resistant tuberculosis to patient-to-patient spread, on the basis of their epidemiologic study. In their discussion, they note that tuberculin-skin-test conversions ...

To the Editor: The recent review of childhood asthma by Dr. Larsen (June 4 issue)¹ was thorough, but we were disappointed by his interpretation of the role of immunotherapy. Dr. Larsen refers extensively to recommendations by the Expert Panel of the ...

To the Editor: The Journal recently published two papers by a group of investigators reporting their molecular genetic studies of familial hypertrophic obstructive cardiomyopathy (Dec. 19 and April 23 issues).^{1 , 2} Mutations in the cardiac myosin heavy-...

To the Editor: Lai et al. (June 11 issue)* report decreased morbidity and mortality after drainage of the common bile duct by endoscopic means as compared with surgical decompression, but the differences could be explained by the different timing of the ...

To the Editor: I believe that Blumenthal and Epstein made a serious error in their analysis of the attempts to make the Medicare physician-payment plan rational and equitable (May 14 issue).* They state that "perhaps the primary goal of the Medicare fee ...

To the Editor: We would like to correct statements in our recent letter about the hazard of lead in infant formula (May 14 issue)* that are incorrect and may be misleading. The phrase "formulas stored in lead and lead-soldered cans" should read "formulas ...

The second edition of Intensive Care Medicine represents an exhaustive attempt to cover the multidisciplinary problems encountered in the modern intensive care unit. The book is almost twice the size of its predecessor and has new sections on shock and ...

The first edition of this book, published in 1983, was distinctly European. In the new edition, American specialists in intensive care account for over a third of the contributors, with unusual juxtapositions of eclectic writing styles the result. This ...

The recognition of emergency medicine as an established medical specialty has brought with it a spate of textbooks, some already in second and third editions. Early in the growth of the field, these books were often compilations of chapters from various ...

It is commonly agreed that medical school and postgraduate educational curriculums have been largely devoid of organized discussions of pain and its management. This is a paradox, given the almost universal nature of pain as a presenting symptom. At the ...

In the second edition of this book, Dr. Ozonoff has succeeded nicely in providing a comprehensive overview of the field of pediatric orthopedic radiology. The writing is clear and concise, and the book is well illustrated. It is organized according to ...

Biomedical Science

Advances in Understanding Genetic Changes in Cancer: Impact on diagnosis and treatment decisions in the 1990s. By the Division of Health Sciences Policy, Institute of Medicine. 84 pp., illustrated. Washington, D.C., National Academy ...

TULANE UNIVERSITY MEDICAL CENTER

The following will be offered in New Orleans: "Pathology Update" (Oct. 30 and 31) and "New Dimensions in Mental Health Administration — 1992" (Nov. 5–8).

Contact TUMC, Office of Cont. Educ., 1440 Canal St., Box 55, Suite ...

Corticosteroids in the Treatment of Optic Neuritis (July 23, 1992;327:281–2). The next-to-last sentence in the left-hand column should have read, "On the basis of our results, both intravenous methylprednisolone followed by oral prednisone and no ...

The Prevention of Heart Failure — A New Agenda (September 3, 1992; 327:725–7). A change just before publication altered the author's intended message on page 726, in the right-hand column, second-to-last line. The phrase "an ACE inhibitor" should have ...