Childbirth may be accompanied by mechanical or neurologic injury to the anal sphincter. Overt sphincter damage due to a third-degree or fourth-degree tear¹ occurs in approximately 0.7 percent of women undergoing vaginal delivery in centers where ...

Hypertension is an important contributor to the morbidity and mortality of cardiovascular disease¹. There is compelling evidence that systolic blood pressure is at least as important a determinant of the risk of cardiovascular disease as diastolic blood ...

Active compression-decompression cardiopulmonary resuscitation (CPR) is a novel method of resuscitation in which the passive relaxation phase of CPR is converted into an active phase by means of a hand-held suction device (Ambu CardioPump, Ambu ...

Early in the epidemic of the acquired immunodeficiency syndrome (AIDS), Pneumocystis carinii pneumonia occurred in 75 percent of patients with the syndrome¹,². The incidence of P. carinii pneumonia declined after 1988,³–⁶ however, as the use of primary ...

Alcohol abuse may result in a wide range of electrolyte and acid-base disorders, including hypophosphatemia, hypomagnesemia, hypocalcemia, hypokalemia, metabolic acidosis, and respiratory alkalosis¹. The severity and clinical importance of these disorders ...

Figure 1. Coccidioides immitis.

A specimen of bronchoalveolar-lavage fluid was obtained from a 33-year-old patient with the acquired immunodeficiency syndrome who had been admitted to the hospital with anorexia, weakness, dyspnea, cough, and fever. A ...

Sexual harassment in the workplace has been the focus of much media attention, litigation, and legislation. Substantial numbers of women (25 to 75 percent) in work settings ranging from the traditional (for example, nursing) to the nontraditional (for ...

Irritable bowel syndrome is one of a group of disorders that includes chest pain of unexplained origin, nonulcer dyspepsia, and biliary dyskinesia. These chronic disorders are frequently considered functional, because no specific structural or biochemical ...

Presentation of Case

A 36-year-old man was admitted to the hospital with the recent onset of fever spikes and an increase in chronic diarrhea.

The patient was known to have the acquired immunodeficiency syndrome (AIDS), with the first demonstration of a ...

Since the beginning of recorded medical history, vaginal delivery has been known to damage the pelvic floor. Vesicovaginal fistulae, fecal incontinence, and uterine prolapse were often the dreaded price of bearing children. In the past few centuries, ...

About two fifths of two-year-old children in the United States have not received recommended immunizations on schedule¹. These children, and a smaller number of older children, are susceptible to potentially devastating illnesses that can be prevented by ...

To the Editor: Antiretroviral therapy and chemoprophylaxis are changing the natural history of infection with the human immunodeficiency virus (HIV), with a change in the pattern of initial AIDS-defining illnesses¹,² [see Hoover et al. elsewhere in this ...

To the Editor: Bunin et al. (Aug. 19 issue),¹ in their article on the relation between maternal diet and subsequent primitive neuroectodermal brain tumors, noted that in multivariant analyses, folate, early vitamin use, and iron supplements remained ...

To the Editor: The treatment of infants with malignant brain tumors by maximal resection and chemotherapy, with radiation treatment delayed to the age of 24 to 48 months (June 17 issue),¹ is an important new strategy with the objective of decreasing ...

To the Editor: CD44 is a cell-surface glycoprotein involved in cell-cell and cell-matrix interactions¹. CD44 isoforms are expressed during progression and metastasis in colon and breast cancer and in non-Hodgkin's lymphoma²–⁴. We investigated the ...

To the Editor: Cardiac output during standard manual cardiopulmonary resuscitation (CPR) is 30 to 60 percent of the normal value¹. A study in animals² demonstrated improved systemic blood flow and increased coronary perfusion pressure during active ...

To the Editor: The Images in Clinical Medicine in the July 1 issue¹ intrigued me. I am uncertain whether the hemodynamic reaction shown represents syncope mediated by the neurocardiogenic (Bezold-Jarisch) reflex or carotid-sinus hypersensitivity with ...

To the Editor: Giaid et al. recently reported (June 17 issue)¹ increased expression of endothelin-1 in vascular endothelial cells of patients with pulmonary hypertension. We have previously reported that patients with pulmonary hypertension have ...

To the Editor: The case of vaccine-associated paralytic poliomyelitis reported by Mermel et al. (Sept. 9 issue)¹ raises important questions for public health policy. At current rates, some 80 cases of vaccine-associated paralytic poliomyelitis may be ...

To the Editor: Hurowitz (July 8 issue)¹ argues for a social policy for health whereby the medical care system focuses on responding to unavoidable diseases, and social problems are resolved through other means. We believe that the solutions he proposes ...

To the Editor: Trans fatty acids, which are created by the partial hydrogenation of liquid vegetable oils in the manufacturing of margarine and vegetable shortening, increase serum levels of low-density lipoprotein cholesterol and decrease those of high-...

Physicians are usually careful to explain the purpose and format of a teaching session when asking a patient to take part. Failure to do so when the patient is poorly educated or of a different cultural background may seriously disturb the patient and ...

As these psychoanalysts -- all from Boston, New Haven, and New York -- make clear, a child at play is a child, ironically, working quite hard -- anxious to explore and fathom the world, to test its possibilities, to give expression to all sorts of wishes, ...

Scientific truths are rarely learned instantaneously except in the movies. Nowhere is this lesson more evident than in Alzheimer's disease. Like many other neuropsychiatric disorders, it has defied attempts to unravel its biologic basis despite increasing ...

This brief but important book fills a gap between clinical psychiatry and the rapidly evolving field of molecular neuroscience. Conceived neither as a textbook nor as a monograph, it is an overview of the molecular mechanisms of synaptic transmission, ...

New Applications of Interpersonal Psychotherapy is really two things. It is a discussion of psychotherapy and research in psychotherapy, but perhaps more important, it is a legacy of the late Gerald L. Klerman. Dr. Klerman was a distinguished American ...

Medical Issues and the Eating Disorders nicely fills a niche in the medical literature by lucidly and comprehensively presenting the most common medical problems associated with anorexia nervosa and bulimia nervosa. Anorexia nervosa, first described at ...

The Eating Disorders, written and edited, for the most part, by nonresearchers (and in several cases nonacademics), is well written overall and useful, albeit uneven. It suffers most from the lack of a coherent design, which results in both omissions and ...