Although many advances have been made in the design and construction of prosthetic heart valves since the first successful human valve replacements were performed by Starr and Edwards¹ and Harken et al.² in 1960, none of the currently available prosthetic ...

The clinical manifestations of hypogonadism in men depend on the timing of the testicular failure. If it occurs in the first several months of fetal life, the external genitalia do not develop normally, resulting in male pseudohermaphroditism. If it ...

Mastocytosis is a heterogeneous group of diseases characterized by increased numbers of mast cells in various organs¹. In individual patients, mastocytosis is usually confined to one organ or tissue, most often the skin.

Cutaneous mastocytosis may consist ...

Spherical organisms that are 8 to 10 micrometers in diameter and have variable characteristics on acid-fast staining are being identified with increasing frequency in feces from both immunocompetent visitors to developing countries and immunocompromised ...

Familial adenomatous polyposis is an autosomal dominant disorder characterized by the formation of hundreds of colorectal adenomas in young adults¹,². This condition is due to a germline alteration of the adenomatous polyposis coli gene on the long arm of ...

An increased risk of lymphoproliferative disorders has been well documented in patients who are treated with immunosuppressive agents after organ transplantation¹ and in patients with the acquired immunodeficiency syndrome². The lymphomas that develop in ...

Figure 1. Candida albicans.

A scanning electron micrograph shows a pure culture of Candida albicans (x6030).

The importance of neutropenia in the risk of serious infection in patients with cancer who are receiving cytotoxic chemotherapy was first recognized nearly 30 years ago¹. Since then, considerable progress has been made in the management of fever and ...

Stage

A 47-year-old executive experienced several episodes of brief, exertion-related precordial chest pain in the six weeks before his initial evaluation. A single episode of midsternal vise-like pain that began after he lifted his child lasted 20 ...

Presentation of Case

A 57-year-old man was admitted to the hospital because of reddish-purple lesions on the right lower extremity.

The patient had been well until the age of 38 years, when he felt a mass in the right inguinal region. Two years later the ...

“Whatever you say, you say nothing.” When I was asked to write an editorial on my personal experiences with heart-valve surgery, that pithy phrase of Seamus Heaney, succinctly expressing the Catholic code of silent speech in Northern Ireland, came to ...

The practice of medicine has come under increasingly intense public examination during the past several years. Two reasons for this scrutiny are rapidly rising health care costs and the increasing proportion of the population with limited access to health ...

To the Editor: Truog et al. (Dec. 3 issue)¹ think that physicians should be willing to accept the risk of using barbiturate-induced general anesthesia to relieve suffering in certain terminally ill patients. This and similar well-meaning recommendations²,...

To the Editor: In their analysis of risk factors for infection with the human immunodeficiency virus (HIV) in pregnant women in rural Florida, Ellerbrock and colleagues (Dec. 10 issue)¹ do not mention anal intercourse. I assume, from the information ...

To the Editor: Further clarification of the methods and recognition of potential biases would assist in interpretation of the report of patients with central nervous system toxoplasmosis by Porter and Sande (Dec. 3 issue).¹ In their study, “a patient was ...

To the Editor: Although it is well known that various birds carry cryptococci, the degree of human exposure to birds that is required for the emergence of clinical cryptococcal disease is not known. Two patients with cryptococcal meningitis had unusually ...

To the Editor: Despite the growth of laparoscopic surgery, its complications must not be underestimated. We describe a retrospective (1987 to 1989) and prospective (1990 to 1991) study of the complications of laparoscopic gynecologic surgery at seven ...

To the Editor: I was rather confused by the article by Smith et al. (Dec. 10 issue)¹ and the related editorial by Rowland². The authors suggest that high-titer antibodies to human motor-neuron voltage-gated calcium channels (VGCCs) present in patients ...

To the Editor: Nasal continuous positive airways pressure (CPAP) is a standard treatment for the sleep apnea syndrome¹. The reported side effects are not major: nasal dryness, epistaxis, extension of respiratory infections to the middle ear or sinuses, ...

To the Editor: Ascherio et al. (Sept. 24 issue)¹ determined the increase in the mortality rate after January 1, 1991, in a sample of more than 16,000 Iraqi children under five years of age, according to age, mother's education, and region of residence.

...

As the health care-delivery system is reshaped in an age of limits, the issue of allocation sharpens. What is the most efficient and the most just distribution of scarce health care resources? One way to address this question is to rank the benefits and ...

Given the high priority assigned to health care reform in the recent presidential and congressional elections, one would expect to see a growing market for books dealing with the pros and cons of various reform proposals. Into this category fall the two ...

This book collects 19 articles written by a prominent American bioethicist over the past 10 years. Seventeen of the articles appeared elsewhere, 12 in journals and 5 in other book collections. The other two, one on the human genome project and the other ...

A major contributor to escalating health care costs is the proliferation and use of expensive forms of medical technology. Without control of these “medical arms,” it is unlikely that the steady increase in health care expenditures will be attenuated. ...

There is a perception among medical scientists that clinical investigation is being threatened from all quarters. Fewer investigators are engaged in patient-oriented research, research funding has become increasingly difficult to obtain, and spectacular ...