X-linked adrenoleukodystrophy is a peroxisomal disease caused by a gene located in Xq28 and coding for an ATP-binding transporter¹. One of the phenotypes, the cerebral form, occurs in young boys and is characterized by brain demyelination, with rapid ...

An estimated 10 to 15 percent of women over 60 years of age have frequent urinary tract infections¹. Hormonally induced changes in the vaginal flora associated with menopause are thought to play an important part in the pathogenesis of urinary tract ...

In many patients with leukemia or myelodysplastic syndromes, the underlying disease recurs after allogeneic bone marrow transplantation¹. Attempts to reinduce durable remissions with chemotherapeutic agents or a second bone marrow transplant are usually ...

There are more than 300,000 victims of cardiac arrest each year, and attempts to resuscitate them are usually unsuccessful. Both laboratory studies¹–³ and clinical studies⁴ have shown that the restoration of cardiac function after cardiac arrest is ...

Cyclosporine has many side effects, the most important being nephrotoxicity¹,². The drug causes a dose-dependent, initially reversible decrease in the glomerular filtration rate and the effective renal plasma flow,³–⁵ often accompanied by an increase in ...

Figure 1. Peutz-Jeghers Syndrome.

Striking examples of facial (Panel A) and lip (Panel B) pigmentation are shown in an eight-year-old boy with Peutz-Jeghers syndrome, an inherited disorder characterized by mucocutaneous pigmentation, gastrointestinal ...

Over the past two decades there has been substantial growth in the applications of nuclear cardiology to both clinical practice and research. The use of nuclear imaging techniques in the noninvasive study of cardiovascular disease is well established. ...

The era of modern, predictably effective tuberculosis chemotherapy began in 1952. Since then, strains of Mycobacterium tuberculosis have acquired resistance to various drugs, thus compromising both treatment and control programs. Most ominously, the ...

Presentation of Case

A 28-year-old man was evaluated at the hospital because of the acquired immunodeficiency syndrome (AIDS), pancytopenia, and lymphoma.

The patient had been well until 38 months earlier, when he was first examined at this hospital ...

The rational development of therapy for a disease depends critically on knowledge about its pathogenesis. In the absence of such insight, physicians are vulnerable to the prevailing winds of opinion and practice, each liable to shift from one moment to ...

The healthy urinary tract is usually able to resist bacterial infection. However, urinary tract infections may occur in all age groups. The frequency is greater in women than in men, who are predominantly affected as children and in old age. A certain ...

Although the New England Journal of Medicine is owned, published, and copyrighted by the Massachusetts Medical Society, the editorial by its executive editor, Dr. Marcia Angell, “How Much Will Health Care Reform Cost”¹? should dispel doubts, if any exist, ...

To the Editor: Why doesn't Dr. Angell (June 17 issue)¹ come out and say that we are going to have to deny care? It is acceptable, perhaps, to deny care when it is not needed, but the discussion of this should be public and not hidden under criticisms of ...

To the Editor: Hsiao et al. (April 1 issue) assess the implementation of physician-payment reform and conclude that the “misallocation of practice expenses in the Medicare fee schedule results in serious underpayment for medical services”¹. As a general ...

To the Editor: Poliomyelitis was a major health problem in the United States until the introduction of inactivated poliovirus vaccine and attenuated oral poliovirus vaccine (OPV) in 1955 and 1961, respectively. Since 1963, trivalent OPV has been used ...

To the Editor: In their report in the April 22 issue, Small et al.¹ showed that exogenous reinfection with multidrug-resistant Mycobacterium tuberculosis can occur either during therapy for the original infection or after therapy has been completed. They ...

To the Editor: A favorable long-term effect of large doses of nifedipine or diltiazem has been reported in patients with primary pulmonary hypertension when the therapy was guided by invasive testing¹. We had an unfortunate experience after such testing.

To the Editor: Case 8-1993 (Feb. 25 issue)¹ describes a patient with subarachnoid cysticercosis who was treated with praziquantel without the simultaneous administration of glucocorticoids. This approach contrasts with that currently recommended for the ...

To the Editor: Cluttering is a form of speech disfluency characterized by an excessive rate and irregular rhythm of speech, often with condensation of sounds and collapsing of words. It ranges in severity from a form with somewhat annoying but generally ...

Clinicians regularly share with patients bad news ranging from the catastrophic (“You have a terminal illness” or “There has been a death in the family”) or serious (“You have an ulcer” or “You should take medicine regularly for your blood pressure”) to ...

It is no longer possible to escape the growing public demand that the medical profession pay more attention to end-of-life care. Public-opinion surveys show that increasing numbers of people support measures that give more control to patients at the end ...

This book, written from the heart, is compassionate and empathic. It makes a compelling argument for legalizing physician-assisted suicide, by discussing cases in which comfort or palliative care proved inadequate. Dr. Quill first described a case in the ...

Who, indeed, survives cancer? We know a great deal at a rough descriptive level. The clinical stage at the time of diagnosis matters a lot; the anatomical stage matters more. The histologic type matters, and so do many microscopical features of cells and ...

The contributors to Cancer Pain are well known and have added substantially to the science of pain management. The book provides a methodical, multidisciplinary approach to managing pain, while stressing respect for each specialty involved in the care of ...