It is well recognized that heavy physical exertion sometimes immediately precedes, and indeed appears to trigger, the onset of acute myocardial infarction¹–³. Descriptive studies have established that in approximately 5 percent of patients with myocardial ...

Throughout this century, the possible association of external stimuli with the onset of acute myocardial infarction has been debated¹–¹⁰. Among the factors that have been suggested as precipitating myocardial infarction are strenuous physical activity and ...

Occult bleeding from the gastrointestinal tract is widely believed to be the most common cause of iron-deficiency anemia in patients without an obvious source of blood loss. A thorough examination of the gastrointestinal tract, particularly the colon, has ...

The World Health Organization estimates that in 1992 90 percent of the 1 million children with the acquired immunodeficiency syndrome (AIDS) worldwide lived in sub-Saharan Africa¹. Approximately 80 percent of these children will die by the age of five ...

Corticosteroids are potent antiinflammatory agents, and administering them by aerosol has been recommended as the treatment of choice for patients with severe persistent asthma¹. The use of inhaled corticosteroids in young children has been limited, ...

Figure 1. Polyp of the Appendix.

An asymptomatic filling defect of the appendix was discovered during a barium enema (arrow, Panel A) in a 72-year-old woman during an evaluation for persistently guaiac-positive stools. After laparoscopic appendectomy, a 5-...

Most adults have life plans that include children. When those who desire children find their efforts unsuccessful, frustration, despair, and helplessness are common and debilitating consequences. In this article we survey the scope of the problem of ...

Stage

A 25-year-old, previously healthy white man consulted his physician because of a two-month history of progressive diffuse joint pain. Initially, the patient noticed pain in his left elbow on awakening. The pain soon involved both knees and ankles ...

Presentation of Case

A 27-year-old woman was admitted to the hospital because of pulmonary hypertension with increasing right-sided heart failure.

The patient had been well and active until nine months earlier, when she first experienced mild dyspnea ...

At one time or another, most physicians have encountered a patient -- perhaps even a friend or family member -- who suffered a heart attack during strenuous physical exertion. Some familiar examples include shoveling snow, recreational jogging, and sexual ...

Administration of a glucocorticoid by inhalation has assumed a prominent role in the treatment of asthma in both children and adults. The reasons are that asthma is now viewed as a disease with an important inflammatory component and that there are ...

Without much doubt, sometime in the not-too-distant future, this country is going to undertake some sort of reform of the health care system through federal legislation. Although the nature of that reform remains uncertain, some areas of general agreement ...

A tired old lawyer's joke retitles almost any complex reform statute the “Lawyers' and Expert Witnesses' Relief Act of 199 .” To avoid this fate, a statute instituting comprehensive health care reform will have to address a host of difficult legal issues ...

To the Editor: The Sounding Board article by Dr. Maron (July 1 issue)¹ is an excellent example of the type of flawed thinking that results in “a lengthy and convoluted judicial process.” Hank Gathers -- not the team physician, the coach, Gathers's ...

To the Editor: Previous studies have demonstrated an increased incidence of sudden cardiac death associated with exercise¹. However, few data are available regarding the risk of sudden cardiac death during participation in mountain sports. We therefore ...

To the Editor: Egashira et al. (June 10 issue)¹ described blunted coronary vasodilation in response to acetylcholine infusion in a group of patients with angina pectoris, positive exercise tests, angiographically normal coronary arteries, no coronary-...

To the Editor: Endothelin, a newly isolated, endothelium-derived peptide, has contractile and proliferative effects on vascular smooth-muscle cells¹,². Plasma endothelin concentrations are elevated in patients with pulmonary hypertension³. Pulmonary-...

To the Editor: In an excellent discussion of iron deficiency, Oski (July 15 issue)¹ did not mention the existence of the serious yet reversible complication of increased intracranial pressure leading to pseudotumor cerebri. As early as the 1880s and ...

To the Editor: Figueroa-Quintanilla et al. (June 10 issue)¹ state that bismuth subsalicylate could be a useful, safe, and cost-effective adjunct to oral rehydration and nutritional therapy in children with acute watery diarrhea. We are surprised that ...

To the Editor: In the April 1 issue,¹ your experts recommended and implemented an extensive, unnecessary cardiologic diagnostic and surgical course of treatment for a hopelessly ill 87-year-old woman; and in the June 3 issue,² your experts put a 71-year-...

To the Editor: In May 1993, a new hantavirus-associated acute respiratory illness was recognized in the southwestern United States. Laboratory evidence of the infection has been confirmed in 30 patients, of whom 20 have died. All three Colorado patients ...

To all appearances, the 20th century will end in Europe much as it began. Ethnic tensions fuel wars; traditional power axes create their own logic of alliances and struggles. For the past 32 months, the former Yugoslavia has been making seismic ...

This book is the 44th volume in the series “Philosophy and Medicine” begun by Tristram Engelhardt and Stuart Spicker in 1975, a comprehensive collection of contemporary thought on philosophical issues pertinent to medicine. To name a series “Philosophy ...

If the unexamined life is not worth living, it would seem to follow that the unexamined practice is not worth carrying out. In this engaging book, Paul McNeill, an Australian teacher of medical law and ethics, examines the examiners: the committee process ...

It is not an overstatement to say that the American health care system is driven by technology. Physicians are procedure-oriented, patients demand the latest in technological advances, the industries that manufacture health care devices and drugs are ...

During the past 30 years, the public perception of the relations between the environment and health has changed considerably. There is a greater awareness that human beings are but one part of a complicated ecologic system that society can influence in ...

It is unusual for a book to be timely and innovative when published. This book concerning boundaries and territoriality in the health professions is both. In these times of budget cuts, cross-training, restructuring, seamless systems, and health care ...

Case Records of the Massachusetts General Hospital (Case 43-1993) Case Records of the Massachusetts General Hospital, N Engl J Med 1993:329;1335-1341.. The photographs in Figure 1 and Figure 2 are transposed. The image in Figure 1 should be Figure 2 and ...