Many clinicians advocate routine ultrasound screening of the fetus during pregnancy to detect congenital anomalies, multiple-gestation pregnancies, fetal growth disorders, and placental abnormalities and to assess fetal age¹–³. Although the detection of ...

Mycobacterium avium complex was among the first opportunistic pathogens identified in patients with the acquired immunodeficiency syndrome (AIDS)¹. Since 1987, the prevalence of this infection among such patients has steadily increased. This increase has ...

A lack of appropriate autonomic warning symptoms before the development of neuroglycopenia (unawareness of hypoglycemia) occurs frequently in patients with insulin-dependent (type I) diabetes mellitus¹. Although the condition was first reported shortly ...

Marrow transplantation from HLA-identical related donors is an accepted treatment for patients with homozygous beta-thalassemia,¹,² but there remain questions about the selection of patients and the timing of transplantation. A system of classifying ...

Regular erythrocyte transfusions form the cornerstone of treatment for patients with severe β-thalassemia. Despite the use of iron-chelation therapy, fatal iron overload develops in many patients, even when they are under supervision and taking part in ...

Figure 1. Tinea Capitis.

Tinea capitis with kerion formation and cervical adenopathy is shown in an 11-year-old boy who had had the infection for three years. The child had a partial response to a one-month course of griseofulvin and one month of ...

The obstetrical and neonatal complications associated with substance use by pregnant women include low birth weight, prematurity, abruptio placentae, fetal distress, stillbirth, cerebral infarctions, congenital malformations, and neurobehavioral ...

Evaluation of Ventricular Function

Basic Techniques

Cardiac performance, or ventricular function, can be assessed with radionuclide techniques by either of two methods. The first involves analyzing the initial transit of an intravenously administered ...

Presentation of Case

A 48-year-old woman was admitted to the hospital because of a secundum atrial septal defect with severe pulmonary hypertension.

A murmur was first heard when the patient was 11 years of age. At 21 years she began to experience ...

Diagnostic ultrasonography has unquestionably revolutionized the care of obstetrical patients. Before this procedure became available, the uterus of a pregnant woman was a closed space that effectively hid most of its secrets. Since the mid-1970s, however,...

Brain function depends on an adequate supply of glucose from the blood, and the principal danger of an inadequate supply is the loss of cognitive function. Hypoglycemia sufficient to cause cognitive dysfunction does not normally occur, because small ...

The thalassemias are common single-gene disorders and pose an important public health problem in many countries. In recent years there has been great progress in determining the molecular pathology of the different forms of thalassemia and in ...

Managed competition has stormed into Washington. It has been widely endorsed by the lay press and powerful groups, and it forms the core of President Clinton's health reform proposal¹–⁶. Managed competition was designed to address the problems of cost and ...

To the Editor: In the Special Report “The Marketplace in Health Care Reform” (Jan. 14 issue),¹ Kronick et al. suggest that managed competition will not work in smaller metropolitan or rural areas that “would require alternative forms of organization and ...

To the Editor: Dr. Relman's editorial on “managed competition” (Jan. 14 issue)¹ is right on target. I would like to add two more points to bolster his argument.

He is correct in pointing to the “intrusive surveillance and control methods” to reduce costs ...

To the Editor: In their recent paper on early amniotomy and the risk of dystocia in nulliparous women, Fraser et al. (April 22 issue)¹ concluded that early amniotomy was effective in shortening labor and reducing the frequency of dystocia but did not ...

To the Editor: Eisenmenger's syndrome consists of pulmonary hypertension with a reversed or bidirectional shunt at the atrial, ventricular, or aortopulmonary level¹. Pregnancy should ideally be avoided in a woman with Eisenmenger's syndrome, since it ...

To the Editor: The article by Winawer et al. (April 1 issue)¹ comparing surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps was of great interest but dealt only with the issue of colonoscopic discovery and evaluation. ...

To the Editor: In their study of the use of multiple drugs among adolescents who use anabolic steroids, DuRant et al. (April 1 issue)¹ used a questionnaire to determine that 6.5 percent of high-school boys enrolled in compulsory health-science classes ...

To the Editor: In their report in the April 8 issue of the Journal,¹ Heppner et al. discuss malaria and other infectious diseases in Somalia. Although all the antimalarial agents recommended by the authors are preferred, they are frequently not available ...

To the Editor: Journalists who report on health and medicine need full and accurate information if they are to report accurately to the public. The statement on medical journals and the popular media approved by the International Committee of Medical ...

To the Editor: The pharmacologic approaches to the treatment of severe hiccups include the use of chlorpromazine, carbamazepine, nifedipine, baclofen, metoclopramide, haloperidol, ketamine, and phenytoin, each of which has potentially serious side ...

Medicaid fraud is one of the more sordid moral lapses to which physicians have succumbed. Its detection, prosecution, and prevention are in the interests of both the public and the profession. Yet its magnitude, economic impact, and genesis are not as ...

When Hillary Rodham Clinton brought hundreds of prominent academics to Washington to help develop a comprehensive health care reform bill, virtually the first full day involved working through a complex maze of ethical standards for federal government ...

In the rapidly proliferating literature of medical ethics, I found Macklin's new book to be a unique and welcome addition. It is well written, clear, and easy to understand. Her use of a case-based approach seems particularly appropriate to the discussion ...

Stacey claims that medicine is a false religion that is practiced in a crumbling temple. It is false because contemporary health care is often ineffective and almost always expensive. The temple is crumbling because of attacks on medicine that result ...

Melvin Konner, an ethnologist (and former student of the !Kung San, or Bushmen), has written five books about medicine, including one chronicling his own education, Becoming a Doctor (New York: Viking, 1987 [reviewed in the Journal, 1988;318:125-127]). ...

Mycobacterium avium complex causes disseminated disease in as many as 15 to 40 percent of patients with human immunodeficiency virus (HIV) infection in the United States, causing fever, night sweats, weight loss, and anemia¹–⁷. Disseminated M. avium ...