Acute painful episodes, often called vaso-occlusive crises, are the most frequent complication of sickle cell disease and are a common reason for visits to the emergency room and admission to the hospital¹–³. In some patients, painful events account for a ...

Infection with the human immunodeficiency virus (HIV) is chronic and results in progressive deterioration of the immune system and, eventually, death. Previous studies have shown that zidovudine delays the progression of disease in both mildly symptomatic ...

Mother-to-baby transmission is well documented for hepatitis B virus (HBV) and the human immunodeficiency virus (HIV). This mode of transmission has a key role in the survival of HBV over many generations. Hepatitis C virus (HCV)¹ infection is ...

Essential mixed cryoglobulinemia is a systemic disorder in which cutaneous vasculitis, arthralgia, weakness, and frequently glomerulonephritis are associated with cryoprecipitable serum immune complexes¹–³. The circulating cryoglobulins usually include a ...

Parathyroid carcinomas are malignant neoplasms that are an uncommon but often devastating cause of hyperparathyroidism¹–³. These malignant tumors are usually associated with more profound clinical manifestations of hyperparathyroidism than are parathyroid ...

Figure 1. Uric Acid Crystals.

Typical uric acid crystals from fresh, centrifuged urinary sediment are shown through polarized light (x400).

Since the approval in 1987 of zidovudine, the first clinically effective form of antiretroviral therapy,¹ a number of prophylactic and therapeutic drugs have been introduced for the treatment of patients with human immunodeficiency virus (HIV) disease²–¹²...

Perhaps no disease is more painful than acute polyarthritis. The inability to change the posture without agonizing pain, the drenching sweats, the prostration, utter helplessness, combine to make it one of the most distressing of febrile afflictions. A ...

Presentation of Case

A 35-year-old man, a native of Ethiopia, was admitted to the hospital because of fever, chills, and splenomegaly.

Twelve years before admission he had immigrated to the Sudan, where he remained for 10 years, employed as a tailor. ...

Pain is such a regular feature of sickle cell anemia that in some African languages the disease is referred to as “a state of suffering.” Biopsies in patients with severe acute bone pain reveal that the underlying lesion is marrow necrosis with ...

Hepatitis C virus (HCV) is a blood-borne virus that generally circulates in low titers in infected serum. Epidemiologic studies show that the most efficient transmission of HCV is through the transfusion of blood or blood products or the transplantation ...

The retinoblastoma gene (RB) was identified because of germ-line mutations that strongly predisposed infants with the mutant gene to a rare cancer of the retina. However, the RB protein turned out to be a regulator of transcription in all cells of adults. ...

Each year thousands of reviewers contribute their expertise to peer review, a process that contributes critically to the quality of the Journal. The editors and the authors of the papers submitted to the Journal are grateful for the help of all our ...

To the Editor: Age-specific data on the seroincidence of the human immunodeficiency virus (HIV) are difficult to obtain. Although several studies in special populations have shown relatively high seroprevalence and seroincidence in younger people, trends ...

To the Editor: On the basis of reduced procedure-related mortality and the absence of stent migration, Knyrim et al. (Oct. 28 issue)¹ conclude that expansile metal stents are superior to conventional plastic endoprostheses in the treatment of esophageal ...

To the Editor: The Brief Report by Freeman and Kwan (Oct. 28 issue)¹ describes presumed osteonecrosis in two patients with inflammatory bowel disease who had not received glucocorticoid therapy. We believe that the radiographic diagnosis is in error. In ...

To the Editor: In their excellent review of the management of urinary tract infections in adults (Oct. 28 issue),¹ Stamm and Hooton comment that pyuria is “usually” present in patients with cystitis. Our experience is that pyuria is always present in ...

To the Editor: In their Brief Report on pseudoxanthoma elasticum in patients with premature cardiovascular disease, Lebwohl et al. (Oct. 21 issue)¹ provide no data to support one of their conclusions. Their Patient 1 had recurrent angina several months ...

To the Editor: In Case 43-1993 (Oct. 28 issue),¹ I believe that the two computed tomograms of the head have been reversed. Figure 1 is said to be the preoperative scan, but it clearly shows a bur hole containing air in the parietal bone, whereas Figure 2,...

To the Editor: In the Special Article “Prevalence and Magnitude of Perinatal Substance Exposures in California” (Sept. 16 issue), Vega et al. report an unusually high prevalence of illicit drug and alcohol use among black women as compared with women of ...

To the Editor: In the report by Sibai et al. (Oct. 21 issue)¹ on the use of low-dose aspirin to prevent preeclampsia, the overall perinatal mortality was similar in the aspirin and placebo groups (aspirin: 22 deaths among a total of 1545 fetuses, or 14.2 ...

To the Editor: In the August 26 issue of the Journal, Bennett and colleagues describe the application of the polymerase chain reaction to determine the RhD genotype of fetuses by using DNA derived from chorionic villi and amniocytes¹. The first set of ...

To the Editor: Egg donation to help an infertile woman achieve pregnancy is now an accepted procedure world-wide. Yet there is a shortage of available eggs, even if compensation is provided to donors for time, risk, and inconvenience¹. This has been most ...

It all began about 20 years ago, in early 1994, when somebody joked with Hillary Rodham Clinton that “an apple a day keeps the doctor away,” noting that this would provide the best cost control imaginable. The idea took root as if both Johnny and Joanie ...

Over the past year, the great national debate on health care reform has not produced as many new books on the subject as one might have expected. Most of the recent discussion has been conducted in the popular media, which have done a pretty good job of ...

As we ponder as a society and a profession whether we should undertake changes in our health care system, it is helpful to be reminded of why we are facing this decision. Two new books, one from the point of view of health care experts and the other from ...