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December 16, 1993  Vol. 329 No. 25

Original Articles
1829-1834

The effects of alcohol consumption on cardiovascular disease are complex. Although heavy alcohol intake increases overall mortality14 and mortality due to cardiovascular diseases,36 moderate intake appears to exert a protective effect against coronary ...

1835-1841

Human immunodeficiency virus type 1 (HIV-1) is transmitted most often by one of three routes: sexual, percutaneous (through intravenous drug use and formerly through blood transfusion or the administration of clotting factors), and perinatal1. Although ...

1842-1847

Liver transplantation is an established treatment for life-threatening liver disease, and patients with chronic or acute liver failure due to hepatitis B virus (HBV) infection represent a large pool of candidates for liver transplantation1,2. However, ...

1848-1852

Among patients with limited small-cell lung cancer, long-term survival does not exceed 15 percent1. The early emergence of chemoresistant tumor cells is the main cause of treatment failure. A possible strategy to improve survival is to administer higher ...

1853-1858

A chronic mononuclear-cell infiltration of pancreatic islets is the pathological hallmark of insulin-dependent diabetes mellitus (IDDM). The lesion is composed predominantly of T lymphocytes, which are thought to have a pivotal role in the pathogenesis of ...

1859-1860
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Herpes simplex virus (HSV) infections in an immunocompromised host may be atypical in location and morphology. We describe five immunocompromised patients in whom HSV type 1 infection presented as linear fissures on the dorsum of the tongue. The tongue ...

Images in Clinical Medicine
1861
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Figure 1. Clubbing and Hypertrophic Osteoarthropathy.

On examination the hands of a 70-year-old woman with worsening cough and pretibial pain show digital clubbing (Panel A). The terminal phalanges are enlarged, and there is loss of the normal nail-to-...

Review Article
1862-1872

Few conditions in medicine are more dramatic or more devastating than acute liver failure. Severe liver-cell dysfunction strikes previously well people suddenly, and many of them die. Acute liver failure embraces a number of conditions whose common thread ...

Case Records of the Massachusetts General Hospital
1873-1880

Presentation of Case

A 46-year-old man was admitted to the hospital because of a mass in the lower lobe of the left lung.

The patient had been in excellent health until 15 weeks earlier, when he was in Florida visiting his father, who had an upper ...

Editorials
1882-1883

    In speaking about the role of alcohol in society, Abraham Lincoln observed, “None seemed to think the injury arose from the use of a bad thing but from the abuse of a very good thing.” The article by Gaziano et al.1 in this issue of the Journal again ...

    1883-1885

    An important goal of epidemiologic and laboratory research on the human immunodeficiency virus (HIV) has been to determine how HIV transmission occurs, so that effective prevention strategies can be developed. Early in the epidemic, epidemiologic studies ...

    1885-1887

    The health problems associated with hepatitis B virus (HBV) infection are immense. Roughly 5 percent of the world's population is chronically infected with HBV, and this is often said to be the chief cause of cirrhosis and hepatocellular carcinoma. Even ...

    Sounding Board
    1887-1890

    Until the beginning of the 20th century, the organization of medical schools and hospitals was simple. There were usually four clinical departments representing the traditional disciplines -- medicine, surgery, obstetrics and gynecology, and pathology. As ...

    Correspondence
    1891-1893

    To the Editor: Two important randomized studies comparing directional atherectomy with balloon angioplasty were recently published in the Journal (July 22 issue), and both suggested that there was little or no difference in the rate of restenosis1,2. ...

    1893-1895

    To the Editor: In their study of the relation between the number of pregnancies and the risk of cardiovascular disease (May 27 issue), Ness et al. found that having six or more pregnancies was associated with a small but consistent increase in the risk ...

    1895-1896

    To the Editor: Cooper et al. (July 29 issue)1 conclude that zidovudine confers benefits that last “more than 2 1/2 years” in asymptomatic patients with HIV infection and more than 400 CD4+ cells per cubic millimeter.

    The authors use an “on-treatment” ...

    1896

    To the Editor: We report a community-acquired methicillin-resistant Staphylococcus aureus infection in a 65-year-old woman who did not use intravenous drugs and was not a nursing home resident. The patient was hospitalized with endocarditis due to ...

    1896-1898

    To the Editor: In the report by Tsukuma et al. (June 24 issue)1 on the risk factors for hepatocellular carcinoma in patients with chronic liver disease, the study group was composed of patients with cirrhosis of the liver or chronic hepatitis. It is not ...

    1898

    To the Editor: We were interested in the report by D'Angelo et al. of autoimmune protein S deficiency in a boy with severe thromboembolic disease (June 17 issue)1 and believe that the transient presence of anticardiolipin antibodies warrants more ...

    1899

    To the Editor: The modified Blalock-Taussig operation, now performed by inserting a polytetrafluoroethylene graft between the subclavian and pulmonary arteries, is considered to be the palliative procedure of choice in infants with cyanosis who are less ...

    Book Reviews
    1899-1900

    Here is the most recent project of the remarkably prolific Ira Rutkow. Among his recent books are the two volumes of his History of Surgery in the United States (1775-1900): Textbooks, Monographs and Treatises (San Francisco: Norman, 1988) and Periodicals ...

    1900

    Books on the physiology and pathophysiology underlying surgery constitute a distinct genre of surgical textbooks. They are devoted to the basic biomedical science that should be a part of the surgeon's education. They include, for example, Ian Aird's ...

    1900-1901

    As its title implies, Minimally Invasive Surgery is intended to be a panoramic review of “high-tech” surgery. The book is not limited to laparoscopic procedures, although recent developments in laparoscopic surgery are certainly given ample treatment.

    The ...

    1901

    This book is one of several comprehensive reviews of the diagnosis and management of prostate cancer that have appeared recently. Still, it was a pleasure to read this compilation of timely, adequate, and precisely formatted review chapters. The book is ...

    1901-1902

    This book reflects Kricun's lifetime interest in bone tumors. It is divided into three unequal sections; all the chapters in the first section were written by Kricun himself and reflect his experience in bone-tumor radiology. There is an excellent ...

    Corrections
    1904

    Case Records of the Massachusetts General Hospital (Case 40-1993) Case Records of the Massachusetts General Hospital, N Engl J Med 1993:329;1108-1115.. On page 1111, in the right-hand column, line 11, the sentence beginning “Ninety percent of patients ...

    1904

    Vitamin E and the Risk of Coronary Disease Correspondence, N Engl J Med 1993:329;1424-1426.. On page 1426, in line 9 of Dr. Steinberg's reply, the sentence should have read, “There is also epidemiologic evidence correlating a high intake of vitamin E with ...