Women with intraductal breast cancer (ductal carcinoma in situ) have been treated in many different ways, ranging from local excision of the tumor with or without breast irradiation to unilateral or bilateral mastectomy. Because there is little ...

Twelve years ago we observed in a randomized trial that the results of Halsted radical mastectomy might be equaled by those of more conservative treatment, such as quadrantectomy with axillary dissection and radiotherapy¹. These results were subsequently ...

Hepatic veno-occlusive disease is a serious consequence of high-dose chemotherapy or radiotherapy combined with bone marrow transplantation for neoplasia; it occurs in 15 to 50 percent of patients, with a mortality rate of up to 50 percent¹–⁷. The ...

Chronic urticaria is a common skin disorder characterized by recurrent, transitory, itchy wheals. It is known that the binding of antigen (allergen) to antigen-specific IgE on mast cells and basophils causes the cells to degranulate, resulting in the ...

The hypoplastic left-heart syndrome is a complex congenital cardiac malformation¹–³ that accounts for 7 to 8 percent of all cardiac lesions presenting in the first year of life; in addition, it is known to be the most common cause of death due to cardiac ...

Figure 1. Nonpalpable Breast Carcinoma Detected by Screening Mammography.

Breast cancer was identified on a routine screening mammogram (oblique view) in a 69-year-old woman. The mass, which measured 4 mm (arrow), was not palpable. Histologic examination ...

One of the distinguishing characteristics of American society, noted long ago by Alexis de Tocqueville, has been optimism and a belief, bordering on faith, in progress. That characteristic is evident in our popular culture and in our politics. We recall --...

In the United States the average daily intake of dietary iron ranges from 10 to 30 mg, but only about 1 mg is absorbed, to balance precisely the loss due to the sloughing of intact cells containing iron. Iron absorption can be increased if iron stores are ...

Stage

A 71-year-old man consulted his doctor because he had had stiffness and swelling of his hands and feet, especially in the morning, for the previous six weeks.

Response

Swelling of the hands and feet suggests arthritis or an edematous state, perhaps ...

Presentation of Case

A 22-year-old man was admitted to the hospital because of increasing swelling of the face.

The patient had been well until 20 months earlier, when a swelling developed on the inner aspect of the right upper lip, with firm, slightly ...

The two articles in this issue of the Journal¹,² about the treatment of women with ductal carcinoma in situ or small invasive breast cancers (<2.5 cm) contain valuable information for all clinicians. The reported incidence of these two tumors has ...

Congressman John Dingell's Shattuck Lecture on misconduct in medical research, delivered in May 1992 to the Massachusetts Medical Society, appears in this issue of the Journal¹. In his lecture, Mr. Dingell is critical of scientists, officials of research ...

To the Editor: The paper by Nienaber et al.¹ and the review article by Cigarroa et al.² (Jan. 7 issue) on diagnosing thoracic aortic dissection demonstrate the problems of evaluating rapidly developing imaging techniques. Progress in computed tomographic ...

To the Editor: The article by Niemann on cardiopulmonary resuscitation (Oct. 8 issue)¹ should have stated clearly that the review concerns the treatment of adults and not children, since the doses of drugs and the countershock energy settings given in ...

To the Editor: In their comprehensive review of asthma, McFadden and Gilbert (Dec. 31 issue)¹ appropriately question published epidemiologic data suggesting that all asthma is related to atopy. There is increasing evidence of immunologic differences ...

To the Editor: The modest decrease in the numbers of parent-reported seizures in children receiving felbamate (Jan. 7 issue)¹ is encouraging, but the results were disappointing in several respects.

The frequency of seizures during the base-line period ...

To the Editor: The vitamin supplement used in the study by Czeizel and Dudas of the prevention of first occurrences of neural-tube defects (Dec. 24 issue)¹ contained calcium pantothenate. Pantothenate supplementation may be particularly important for ...

To the Editor: I should like to call attention to an error in Case 46-1992 (Nov. 19 issue)¹. The patient, a middle-aged woman with severe tracheal distortion, was described as having undergone placement of “a 6-French pediatric cuffed endotracheal tube” ...

To the Editor: On behalf of the National Leadership Coalition for Health Care Reform, Simmons et al. (Nov. 19 issue)¹ call for a new payroll tax to fund their national health insurance scheme. They fail, however, to note the many drawbacks and ...

To the Editor: Pasic et al. (Feb. 4 issue)¹ report the successful reuse of a transplanted heart. In our hospital, Moreno et al.² reused a liver graft with a favorable result. Recently, we reused a transplanted kidney with a beneficial outcome.

The kidney ...

Sharing hot dogs slathered in ballpark mustard with my former chairman at the 1992 Spring Meetings made me wonder if this rite of spring had lost more than its flavor.

Since 1917, the Association of American Physicians (AAP) has held its annual meeting on ...

Like a priest betraying a confession, a journalist revealing his or her source, or a doctor killing a patient, a scientist who commits fraud violates a central principle of the perpetrator's profession. Despite the intellectual enormity of the crime, ...

The thyroid gland has been in the news in the past few years, with both former President George Bush and Barbara Bush given a diagnosis of Graves' disease. Although conjugal thyrotoxicosis (perhaps now dignified with the eponym “Bush disease”) has no ...

This book is dedicated, appropriately, to Dr. Fuller Albright, a pioneer endocrinologist whose observations on the cause and physiology of metabolic bone disease earlier this century opened the field to intensive research for the next 40 years. The ...

As a reviewer, my first question is, Does the title accurately reflect the contents? If “nutritional” is taken in its broadest sense -- that is, including the biochemistry of foodstuffs -- then the answer must be, not really; a more precise title would ...

For many years, iron metabolism languished in the backwaters of biomedical research and teaching, slowly corroding like an old Chevy abandoned near the levee. The prevailing view was that everything of importance about this metal was known, leaving only a ...

Based on extensive archival research, this book provides valuable insight into the intellectual and institutional origins of pharmacology in America. Rather than reviewing theories, methods, or discoveries, Parascandola describes the professionalization ...

This is a massive work, with monographs written by more than 500 contributors from all over the world. About 40 percent of the contributors are from the United Kingdom, and the remainder are from the United States, most of the European countries, the ...

Biologic Modifiers and Chemoprevention of Cancer of the Oral Cavity Editorial, N Engl J Med 1993:328;58-59.. On page 58, in the right-hand column, the second line of the first full paragraph should have read, “. . . routine examinations by physicians and ...

A New Therapy for the Adult Respiratory Distress Syndrome Editorial, N Engl J Med 1993:328;431-432.. On page 432, in the left-hand column, the sentence beginning in the ninth line should have read, “Seven patients received long-term treatment with nitric ...