The role of carotid endarterectomy in both symptomatic and asymptomatic carotid occlusive disease is an important topic for prospective clinical research. The recent publication of data from three clinical trials has confirmed the benefits of carotid ...

That acute biliary pancreatitis is initiated by obstruction of the ampulla of Vater by migratory gallstones¹ is supported by the findings of a high incidence of stones of the common bile duct²–⁴ and impacted ampullary stones (62 to 75 percent)²,³ at ...

Hearing impairment affects at least 28 million Americans, more than 250,000 of whom have profound deafness. Cochlear implants are electronic devices designed to stimulate surviving neuronal elements in the inner ears of patients with profound hearing ...

Hyperinsulinemia, which reflects the impaired sensitivity of tissue to the action of insulin (insulin resistance), is a risk factor for several common disorders¹,². Insulin resistance is a characteristic finding in patients with non-insulin-dependent ...

Figure 1. Impacted Stone in the Ampulla of Vater.

An impacted common-duct stone is visible in the ampulla of Vater in a patient with suppurative cholangitis. White or tan pus can be seen draining around the margin of the calculus.

Unconventional, alternative, or unorthodox therapies are difficult to define, because they encompass a broad spectrum of practices and beliefs. As Murray and Rubel have written, “Many are well known, others are exotic or mysterious, and some are dangerous”...

Drowning is an unexpected tragedy, in which previously healthy persons are exposed to severe cerebral hypoxia leading to death or, if they survive near-drowning, to brain damage in some cases. If survival with normal brain function is to occur, a thorough ...

Most physicians and immunologists, if they think of the mast cell at all, regard it as something of a pariah. Other cells of hematopoietic origin, such as neutrophils, macrophages, and platelets, are clearly important in host defense, hemostasis, or both. ...

Presentation of Case

First admission. A 73-year-old man was admitted to the hospital because of worsening right upper facial pain and decreasing visual acuity in the right eye.

There was a history of Hodgkin's disease localized to the right groin 27 years ...

Ischemic stroke remains one of the most common devastating illnesses in developed countries, ranking third as the cause of death and extracting a huge socioeconomic toll because of the permanence of the disability experienced by many of those who survive. ...

If the lodging of a gallstone at the duodenal papilla can precipitate an attack of acute pancreatitis, it is logical to suppose that the sooner the stone is removed the better the outcome will be. One of the first to explore this hypothesis was the ...

Some of the earliest human records evidence an interest in the recognition and treatment of deafness. Even the most ancient and primitive tribes placed minerals and plant extracts in the ear, with empirical or magical intent¹. However, only in the past ...

The careful national survey reported by Eisenberg et al. in this issue of the Journal¹ tells us that in a given year about a third of all American adults use unconventional medical treatments, such as relaxation techniques, chiropractic, therapeutic ...

To the Editor: The study by Rowland et al. (Oct. 1 issue)¹ clearly demonstrated reduced fertility among female dental assistants exposed to high levels of unscavenged nitrous oxide. The authors also reported, but did not comment on, a higher rate of ...

To the Editor: Dr. Kempe and her associates have presented a thoughtful analysis of infants with very low birth weight (Oct. 1 issue)¹. Their study design failed to consider three important factors crucial to an analysis of intrauterine growth.

First, ...

To the Editor: Gursoy et al. (Sept. 10 issue)¹ should have defined “pounding in the neck” in their article on its hemodynamic mechanism. Nowhere in their article is an explanation of the apparently subjective sensation given, in spite of the fact that ...

To the Editor: Vincent and colleagues (Sept. 17 issue)¹ ably describe the spectrum of symptoms and QT intervals related to the long-QT syndrome. It is not surprising that the QT interval corrected for heart rate (QT_c) was not always adequate for an ...

To the Editor: Vascular endothelium converts L-arginine to nitric oxide. An increase in blood pressure after the inhibition of nitric oxide synthase suggests that a deficiency of nitric oxide may contribute to the pathogenesis of hypertension¹. Indeed, ...

To the Editor: Acute immunosuppression with opportunistic infection immediately after human immunodeficiency virus (HIV) seroconversion is believed not to occur. Here is one such case.

On September 16, 1991, a 31-year-old, heterosexual white man without ...

To the Editor: Standard practice for collecting a urine specimen from women for bacterial culture includes cleansing of the perineum and urethral meatus before collection. To determine whether such cleansing affects the rate of bacterial contamination of ...

To the Editor: The pheochromocytoma-imitating condition described in the recent Clinical Problem-Solving article by Pauker and Kopelman (Oct. 1 issue)¹ is a very frequent one². The authors correctly analyzed the methodologic pitfalls of determinations of ...

The diagnosis and treatment of cardiac arrhythmias have evolved into a full-fledged subdiscipline of cardiovascular medicine; in recognition, the American Board of Internal Medicine has administered the first subspecialty certifying examination in ...

The purpose of this book, as stated in the preface, is to provide those who treat patients with acute myocardial infarction with a summary of the latest information on the subject. The editor hopes that the book will serve as a resource for the broad ...

This package of four videocassettes and a book attempts to address practitioners of coronary angioplasty. The book combines 13 traditional chapters that cover a variety of clinical topics (134 pages) with 32 case summaries (130 pages). The video-tutorial ...

The technique of coronary angioplasty has had a spectacular evolution since Gruentzig performed the first percutaneous coronary balloon dilation more than 15 years ago. Since then, the search for the Holy Grail has centered on alternative catheter methods,...

Despite the increasing reliance of clinical medicine on technology, the clinical examination remains the cornerstone of diagnosis and therapy, and the physician-patient encounter remains pivotal in the patient's satisfaction with health care. Thus, ...