Until recently, it was unusual to isolate drug-resistant Mycobacterium tuberculosis in the United States. Tuberculosis caused by such organisms occurred sporadically, and only rarely could epidemiologic connections be demonstrated between cases¹,². During ...

Artificial rupture of the amniotic membranes (amniotomy) with the intention of accelerating the progress of labor is among the most commonly performed procedures in obstetrics. Early amniotomy has recently been advocated to prevent dystocia in women in ...

Many studies have established beyond reasonable doubt that serum lipid levels influence the risk of coronary heart disease¹. Although efforts at prevention have focused on the modifiability of lipid levels by factors such as diet,² genetic factors also ...

Nephropathic cystinosis is an autosomal recessive disease of impaired cystine transport across lysosomal membranes¹–³. Lysosomal storage of cystine causes crystal formation in many tissues, which sustain damage according to a relatively predictable ...

Strains of human immunodeficiency virus type 1 (HIV-1) with reduced sensitivity to zidovudine have been isolated from patients treated with this drug for six months or more¹. Resistance to zidovudine is associated with late-stage disease, low CD4 ...

Figure 1. Aortoenteric Fistula.

A 1.5-cm mucosal defect with the classic appearance of an aortoduodenal fistula was detected by endoscopy in the third portion of the duodenum (Panel A). The patient had a Dacron aortic graft and presented with hematemesis. ...

Modern treatment of abdominal aortic aneurysms began in Paris on March 29, 1951, when Dubost performed the first successful aortic resection for aneurysm¹. The following year American vascular surgeons duplicated Dubost's feat and established aortic ...

Although retroviruses were among the earliest viruses discovered,¹,² they were linked to human disease only in the early 1980s,³–⁵ with the study of T-cell lines from patients with the lymphoproliferative disorder adult T-cell leukemia⁶. T cells from ...

Presentation of Case

A 13-year-old girl was admitted to the hospital because of fever, cough, and hematuria.

As a young child she had had recurrent pneumonia, with one episode of gross hematuria ascribed to urinary tract infection. At the age of nine ...

The primary infection of a host with the human immunodeficiency virus (HIV) is characterized by fever, pharyngitis, myalgia, lymphadenopathy, maculopapular rash, oral ulcers, and less frequently, aseptic meningitis¹. About three to six weeks after a ...

It would seem that a relatively simple question -- “Does amniotomy have an important effect on the course of labor at term?” -- should be relatively easy to answer, but this has not proved to be the case. The routine use of amniotomy to hasten labor has ...

To the Editor: The Coalition of Healthcare Communicators takes exception to the article by Bero et al (Oct. 15 issue).¹ Their research seems to be centered on the supposition of some in academia today that if industry is involved it must be a bad thing. ...

To the Editor: Plehn et al. (Nov. 26 issue)¹ present a case of primary (AL [amyloid light chain]) amyloid heart disease with atrial systolic failure. The authors provide no evidence of AL amyloidosis: they report neither plasma-cell dyscrasia nor ...

To the Editor: In their review article “Nonmelanoma Cancers of the Skin” (Dec. 3 issue),¹ Drs. Preston and Stern should have pointed out that radiation therapy properly delivered by competent radiation oncologists results in a tumor recurrence rate of 5 ...

To the Editor: In a recent piece in the Journal's Clinical Problem-Solving series (Dec. 3 issue),¹ a patient is presented who initially appears to have alcoholic hepatitis, but is ultimately given a diagnosis of hepatoma. Although the discussion is ...

To the Editor: With regard to the article by Menikoff et al. on health care surrogate laws (Oct. 15 issue)¹: I am the clinical ethicist at a 400-bed, university-affiliated, urban hospital in Illinois. In the 12 months after the state's Health Care ...

To the Editor: We have two major reservations about the article by Ginzberg entitled “Health Care Reform -- Where Are We and Where Should We Be Going?” (Oct. 29 issue).¹ The American Medical Association is a leading proponent of major reform of the ...

To the Editor: It is estimated that U.S. health care expenditures for 1992 totaled $838.5 billion, or 14 percent of our gross domestic product (GDP). On January 6, 1993, the day this information was presented in a front-page story in The New York Times, ...

To the Editor: On November 29, 1992, Dennis Byrd, a football player with the New York Jets, suffered a serious spinal cord injury when he collided with a teammate during a game. According to reports by the news media, Byrd was treated at Lenox Hill ...

In 1960, kidney doctors lost their innocence. Prioritizing, rationing, and exclusion, before 1960, were words alien to the lexicon of renal medicine. Before that year, except for patients treated by Alwall in Lund, Sweden, and Merrill in Boston, who ...

Clinical nephrology has important roots in Europe and in the work of European scholars such as Addis, Bywaters, Black, and Hamburger. The newest and most massive addition to nephrology's crowded libraries comes from this tradition. Its editorial goal is ...

The authors of this reasonably brief book attempt to cover virtually the entire scope of topics that define clinical nephrology. The 35 short chapters succinctly touch on the major points of these subjects, avoiding discussion of research and therapeutic ...

This book, one of a series on current therapy, can be read over a reasonable period of time. The chapters are brief (usually five or six pages), with succinct and valuable tables and suggested readings. The material is geared to the clinician, who will ...

In the preface to this book, the editor makes three important points. First, the percentage of people over the age of 65 in Western countries will rise by 8 to 10 percent by the year 2010 and hypertension may affect 50 percent of this population. This ...

As was stated in the preface to the first edition of Pediatric Kidney Disease, published in 1978, the purpose of the book was “to provide as complete a compendium as possible of all aspects of nephrology that related to infants and children.” The goal was ...

This book on the hemolytic-uremic syndrome and thrombotic thrombocytopenic purpura will have broad appeal to the medical community, especially because of physicians' fascination with these two related disorders. The scope and breadth of the book are ...

What is “managed competition,” the blueprint for reforming the health care system that has been endorsed by President Bill Clinton and key elements of which former president George Bush incorporated into the scheme he introduced last year? As applied to ...

Case Records of the Massachusetts General Hospital (Case 1-1993) Case Records of the Massachusetts General Hospital, N Engl J Med 1993:328;48-55.. On page 48, in the left-hand column, line 10 of the second paragraph, the Apgar scores should have been ...

Hypothalamic-Pituitary Dysfunction after Radiation for Brain Tumors Original Article, N Engl J Med 1993:328;87-94.. On page 92, in 3, the reference ranges for basal serum corticotropin and peak serum corticotropin after CRH should have been <79 and 16-225,...