In patients with type IV glycogen storage disease, deficiency of the branching enzyme α-1,4-glucan:α-1,4-glucan 6-glucosyltransferase is responsible for the accumulation in the liver and elsewhere of an insoluble and irritating amylopectin-like ...

Atrial fibrillation is one of the most common types of arrhythmia, occurring in up to 4 percent of patients over 60 years of age¹–³. This arrhythmia is characterized by a lack of organized atrial electrical and mechanical activity, and the resulting blood ...

Escalation of the dose of many antineoplastic drugs is limited by granulocytopenia and thrombocytopenia. Although colony-stimulating factors¹,² and the transplantation of bone marrow or peripheral-blood progenitor cells³–⁶ have had an effect on this ...

Graft-versus-host disease (GVHD) has been well documented in several recipients of liver transplants¹–⁸. In this syndrome alloreactive cells from the donor attack the recipient's skin, gastrointestinal tissue, and hematopoietic tissue. Severe ...

Graft-versus-host disease (GVHD) is a well-known complication of allogeneic bone marrow transplantation and is increasingly being recognized after solid-organ transplantation and transfusion¹–³. Like GVHD occurring after bone marrow transplantation, ...

Figure 1. Large Left Atrial Thrombus.

This four-chamber view of the heart (Panel A) was obtained by transesophageal echocardiography in a 75-year-old man with longstanding nonvalvular atrial fibrillation who had recently had a transient ischemic attack. A ...

Expenditures for hospital care were substantially higher in the United States than in Canada in 1985 after adjustment for population size and the difference in currencies. Hospital costs, along with physicians' services¹ and the cost of administering ...

Medical training is very similar in Canada and the United States, in that undergraduate and postgraduate training are both organized along the same lines and are considered equivalent in the two countries¹–³. Not surprisingly, studies comparing the ...

Musculoskeletal System

MRI is widely used to assist in the diagnosis of joint injuries, bone marrow disorders, soft-tissue tumors, and other musculoskeletal abnormalities. Fibrocartilage and ligaments normally appear dark because of a paucity of mobile ...

Presentation of Case

A 52-year-old man with cardiomyopathy and interstitial lung disease was admitted to the hospital in extremis.

Asthma began at the age of 10 years. A coarctation of the aorta was repaired at the age of 22 years. At the age of 36 years ...

Type IV glycogen storage disease results in progressive destruction of the liver and other vital organs, including the heart. This disease, caused by a deficiency of the branching enzyme α-1,4-glucan-1,4-glucan 6-transferase, results in the accumulation ...

Atrial fibrillation occurs in 0.3 to 0.4 percent of the adult population,¹ and its prevalence increases with age. It is found in 2 to 4 percent of people over 60 years of age,² and in those over 75 years, a prevalence of 11.6 percent has been reported³. ...

This issue of the Journal contains two papers that are likely to fuel the debate over the appropriateness of Canada's universal single-payer health insurance system as a model for Americans. Redelmeier and Fuchs¹ show that American acute care hospitals ...

To the Editor: In his accompanying editorial (Oct. 29 issue),¹ Dr. Growdon cites the minimally positive results with tacrine in the multicenter study by Davis et al.² to argue for the abandonment of “simple replacement” cholinomimetic therapies in favor ...

To the Editor: The Current Concepts article by Donegan (Sept. 24 issue)¹ on the management of palpable breast masses raises several important issues that should be clarified. Although the term “diagnostic mammography” is commonly used, mammography is ...

To the Editor: Juliusson et al. (Oct. 8 issue)¹ describe four patients with chronic lymphocytic leukemia (CLL) who responded well to 2-chlorodeoxyadenosine (one with a complete response and three with partial responses), although their disorder was ...

To the Editor: Infections caused by Listeria monocytogenes have been described in patients with chronic lymphocytic leukemia (CLL). Cases have also occurred after treatment with prednisone combined with the purine analogue fludarabine¹. We have been ...

To the Editor: Burgard et al. (Oct. 22 issue)¹ are to be congratulated on their use of very sensitive assays to detect infection with human immunodeficiency virus type 1 (HIV-1) in neonates and infants. However, in their Discussion the authors state that ...

To the Editor: Anaphylactic reactions in patients receiving pulsatile gonadotropin-releasing hormone (GnRH) are rare.¹ We describe a patient who had such a reaction when given GnRH intravenously after having received pulsatile subcutaneous GnRH therapy ...

To the Editor: A 40-year-old recreational athlete recovering from a low back injury had acute scrotal swelling and pain several hours after performing stretching exercises for the lower back. There was no history of acute scrotal trauma during the ...

Hardly a year has passed since the centennial of the Origin of Species in 1959 in which one or two books on Charles Darwin have not appeared. Fortunately, there is not much overlap among them, and each fills a somewhat different niche. The new Darwin ...

Thomas Willis (Figure 1) became famous in 1650 at the age of 29 because of his involvement in an unusual case of resuscitation from near-death. Ann Green, a servant, was evidently seduced by the son of her employer. She became pregnant and delivered a ...

“. . . For the secret of the care of the patient is in caring for the patient.”

These words, burned indelibly into the minds of generations of medical students, closed a lecture given by Francis W. Peabody to Harvard students on October 21, 1925, and the ...

Peter Medawar, the late doyen of transplantation biology, once noted that the lives of scientists usually make dull reading. But books about the struggles of clinicians (particularly surgeons) to cure disease, or at least to keep it at bay, captivate the ...

Those who take on the task of writing a synthetic historical work, in this case a textbook for college students, seldom please everybody. Given the dramatic expansion in recent decades of scholarship about our medical past, prospective authors face ...

The past two decades have seen something of a revolution in the study of the history of medicine. Traditionally regarded as a byway of history, the preserve of physicians who focused on “the history of great doctors, great discoveries and great ideas,” ...

In colonial New England, formally trained physicians were few and congregated in urban areas. Harvard College, founded in 1636, was of no help in remedying this dearth of practitioners, since it concentrated on turning out classical scholars whose main ...