On May 14, 1993, the New Mexico Office of the Medical Investigator was notified of the unexplained deaths of a couple living in the same household in rural New Mexico: a 21-year-old woman and a 19-year-old man. Both died of acute respiratory failure -- ...

Percutaneous coronary angioplasty is associated with improvement in the symptoms of ischemia and the quality of life,¹,² but acute complications remain a major drawback. The treated vessel closes abruptly during or soon after the procedure in 4 to 9 ...

Diabetes mellitus is one of the most common chronic disorders, affecting as many as 5 to 10 percent of persons in both Japan and Western countries¹. Both types of diabetes mellitus -- insulin-dependent (IDDM) and non-insulin-dependent (NIDDM) -- are ...

The inability to initiate switching from one immunoglobulin isotype to another is the hallmark of the hyper-IgM immunodeficiency syndrome¹. Patients with this primary immune disorder, originally termed “dysgammaglobulinemia type 1,”² usually present with ...

Figure 1. Quitter's Nail.

The tip of the fingernail is discolored in a 68-year-old former cigarette smoker who was unable to smoke after sustaining a head injury. Given the rate of nail growth (0.5 to 1.2 mm per week), the tar-stained portion took ...

Economic Costs of Tobacco Use

The per capita consumption of cigarettes has risen and fallen, depending on particular events (Figure 3)⁶⁹. Deaths from smoking-related illnesses, however, have climbed, possibly reaching a peak or plateau in 1988¹. Studies⁷⁰ ...

The nonsurgical treatment of arteries narrowed by atherosclerosis was introduced in 1964, when Dotter and Judkins performed transluminal angioplasty of femoral arterial stenoses¹. In the 1970s, Gruntzig modified the dilation catheter to allow its use in ...

Stage

During a hospitalization for recurrent pneumonitis, a 40-year-old mildly retarded woman with Down's syndrome, Crohn's disease, a seizure disorder, and chronic renal disease requiring maintenance hemodialysis began to have bilateral eye pain.

...

Presentation of Case

A 54-year-old woman was admitted to the hospital because of intermittent hemoptysis, dyspnea, and a left mediastinal mass.

The patient had been well until seven months earlier, when a cough, fatigue, and hemoptysis developed. She was ...

Like wars and natural disasters, new epidemics of infections occur regularly. Sometimes they skip generations and are perceived as novel and improbable, when in fact they are ageless and routine. Thus, we should not be astonished to read in this issue of ...

Heart attacks and strokes are usually caused by thrombo-occlusive events at sites of atherosclerotic stenosis and plaque rupture¹. These thrombotic processes are generally mediated by thrombin, dependent on the action of platelets, and not completely ...

In the immune response to a foreign protein, the first antibodies to appear are of the IgM class (or isotype). As the response proceeds, other isotypes (IgG, IgA, and IgE) emerge as the result of immunoglobulin-class switching. The isotype switch has ...

To the Editor: On January 8, 1994, a 48-year-old diabetic male teacher from a small town in rural Indiana presented to the hospital with a three-day history of myalgia, weakness, fever, chills, a nonproductive cough, and progressive shortness of breath. ...

To the Editor: In his Sounding Board article (Nov. 18 issue),¹ Dr. Relman warns of the danger that investor-owned health plans will interfere with clinical decisions, particularly through inappropriate financial incentives, and he calls for steps to ...

To the Editor: Dr. Cannistra stated in his review article on cancer of the ovary (Nov. 18 issue)¹ that “the regimen of cisplatin plus cyclophosphamide is just as effective as more complicated and toxic regimens, such as those containing altretamine or ...

To the Editor: Dr. Tynan's editorial (Nov. 18 issue)¹ on the report by Gray et al.² is symptomatic of the growing trend in medicine to advocate new, minimally invasive techniques over surgical procedures that have been proved safe, successful, and ...

To the Editor: We were surprised to see no mention of corticosteroids in Dr. Welch's otherwise informative survey of current migraine therapy (Nov. 11 issue)¹. Corticosteroids have been recommended for the treatment of prolonged migraine²,³ and are ...

To the Editor: We think that the study by Hecht et al. (Nov. 18 issue)¹ does not provide much support for the existing weak epidemiologic evidence that passive smoking increases the risk of lung cancer. The relative risk associated with passive smoking, ...

To the Editor: The article by Marzuk et al. (Nov. 11 issue)¹ on the increase in suicide by asphyxiation in New York City after the publication of Final Exit confirms what many of us who keep statistics already knew. My book has not increased the number ...

In one of the most anticlimactic cases in recent years, the Supreme Court ruled on the last day of its 1992-1993 term that federal judges should admit all relevant scientific testimony and evidence that is “reliable”¹. The result was so uncontroversial ...

The incidence of sports-related ocular injuries treated in hospital emergency departments continues to rise,¹–³ and baseball accounted for the greatest number of sports-related eye injuries in the United States in 1991⁴. Although most injuries occur in ...

Bargaining for Life reminds us that those who fail to remember history are condemned to repeat it. It is a thoroughly researched, well-written book that describes the efforts to control tuberculosis in Philadelphia between 1876 and 1938, with a focus on ...

George Rosen's History of Public Health is a classic. As Elizabeth Fee implies in her thoughtful and perceptive comments, it is a classic because it presents an unclouded vision of the objectives of public health itself, as seen from the mid-20th century (...

When the reader grasps map and compass to begin the exploration of rural medicine promised by this new book, it is not clear what kind of voyage of discovery awaits. The subtitle, Current Issues and Concepts, suggests a book that delves into the ...

For some, the concept of contemporary history is not only an oxymoron, but also a dangerous mistake. A history of the present cannot possibly be based on the perspective provided by the passage of years or a thorough examination of archival material. ...

One of the penalties of working in a field too long is that more and more of what seems important happened over a decade ago. That was when patterns of AIDS transmission were discerned, human immunodeficiency virus types 1 and 2 (HIV-1 and HIV-2) were ...

Postgate's accounts of the weird and wonderful ways of microbes are stories both of sophisticated science and of the extremes in the biologic world. In contrast to plants and animals, single-cell organisms exhibit a wide range of biologic activities and ...