In 1975 the case of Karen Ann Quinlan dramatized the moral and legal debate over life-sustaining treatment after the irreversible loss of all meaningful cognitive functions¹–³. After a cardiopulmonary arrest and coma, Quinlan was in a persistent ...

The neonatal respiratory distress syndrome was first associated with prematurity-related deficiency of surfactant in the 1950s¹. Since then, eight surfactant compounds have been developed and tested in clinical trials. That surfactant therapy results in ...

The initial experience with radiofrequency ablation in the treatment of supraventricular tachyarrhythmias has shown excellent success with low complication rates in large numbers of adult patients¹–⁶. These early reports of safety and efficacy led to the ...

X-Linked Agammaglobulinemia is the prototypical humoral immunodeficiency first described by Bruton in 1952¹. It is characterized by a paucity of circulating B cells and a drastic reduction in the serum concentrations of immunoglobulins²,³. Studies ...

Figure 1. Struck by Lightning.

A 41-year-old woman in her 26th week of pregnancy was struck by lightning while standing under a tree during a thunderstorm. The lightning entered her body on the right side of the neck through a necklace, went toward the ...

In 1940, President Franklin Roosevelt, a polio victim who understood well the suffering and devastation caused by chronic illness, made what was then a long drive out to Bethesda, Maryland, to dedicate the campus of the new National Institutes of Health (...

The term “persistent vegetative state” was coined by Jennett and Plum in 1972 to describe the condition of patients with severe brain damage in whom coma has progressed to a state of wakefulness without detectable awareness¹. Such patients have sleep-wake ...

In 1982 a 32-year-old married bricklayer was admitted to a hospital in Rochester, New York, because of fever and subcutaneous nodules. The nodules were firm, 2 to 6 cm in diameter, and nontender and had appeared in the three weeks before admission. The ...

Presentation of Case

A 20-year-old man was admitted to the hospital because of recurrent hemoptysis and a pulmonary cavity.

The patient had been well until 20 months earlier, when he was admitted to another hospital because of a spontaneous left ...

In 1968 an ad hoc committee of Harvard Medical School recommended that death be defined as cessation of all brain function¹. Before that time, a patient was not pronounced dead until heart and lung function had ceased. One by one, the states accepted ...

In the 42 years since Ogden Bruton discovered agammaglobulinemia,¹ more than 50 additional immunodeficiency syndromes have been described². Until recently, there was little insight into the fundamental problems underlying most of these conditions. Within ...

The President has proposed a budget for the 1995 fiscal year that reduces discretionary spending but increases support for the National Institutes of Health (NIH) to $11 billion -- an increase that exceeds the rate of inflation and an amount that is more ...

There is probably no question that plagues investigators, especially young investigators, more than how to pick a research project. This decision is not one that must be faced only once in a lifetime; rather, it must be continually revisited. Although it ...

To the Editor: In his article “Screening for Colorectal Cancer by Nurse Endoscopists,” Dr. Maule (Jan. 20 issue)¹ concludes that “nurses can carry out screening . . . sigmoidoscopy as accurately and safely as experienced gastroenterologists,” since “...

To the Editor: I am writing in response to the Sounding Board article by Mundinger on advanced-practice nursing (Jan. 20 issue)¹. As a family practitioner and the director of a family-practice residency program, I am very much aware of the skills that a ...

To the Editor: In response to your editorial on the role of nurse practitioners in primary care (Jan. 20 issue),¹ the scope of practice for nurse practitioners and nurse-midwives is defined by a program's competency standards and by state requirements ...

To the Editor: Pruritus is a common, often distressing symptom in patients with cholestatic disease of various malignant and nonmalignant origins. Its exact cause is poorly understood, and treatment is often unsatisfactory¹. In August and September 1993, ...

To the Editor: Fludarabine monophosphate is a synthetic purine antimetabolite that has been used almost exclusively in the treatment of chronic lymphoid cancers¹. The medication may cause dose-related myelosuppression. Recently, CD4+ T-lymphocytopenia ...

To the Editor: In addition to the well-established systemic, dermatologic, pulmonary, and vascular damage caused by cigarette smoking, smoking poses an additional hazard for patients with psoriasis who are treated with flammable tar preparations.

A 46-...

Almost two decades ago, Dr. Franz J. Ingelfinger predicted that if physicians kept turning to the courts “to resolve essentially medical matters,” the medical profession's unfortunate “dependence on the lawyer in reaching essentially medical decisions ...

The applicability to modern medicine of Newton's comment about “standing upon the shoulders of Giants” is vividly brought home to the reader of Barbara Kaplan's book on Robert Boyle. By repeatedly presenting information about the great natural scientist ...

Anthropology is training its sights on physicians. The ethnographer, no longer content with studying preliterate cultures and the Gururumba, Bunyoro, Tiwi, or Cheyenne, is subjecting us to critical examination. Be prepared to be startled. There is an ...

This is a history of conscientious objectors during World War II, the vicissitudes of their experiences from 1940 to 1946, and their lasting effect on the American mental health system. The author was one of these conscientious objectors.

In September ...