The decline in muscle strength and mass during aging¹,² has been linked to physical frailty, falls, functional decline, and impaired mobility in very elderly people³–⁵. Although many factors, including chronic illness, a sedentary lifestyle, nutritional ...

The skeleton is a reservoir of labile calcium that is responsive to humoral mechanisms that maintain the concentration of ionic calcium in extracellular fluid within narrow limits. The skeleton is also a reservoir of labile base (in the form of alkaline ...

Studies in animals have shown that the coronary vasodilator reserve (defined as the ratio of maximal to basal coronary blood flow) can be used as a functional index of the severity of coronary-artery stenosis¹,². Additional studies have demonstrated that ...

Hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease) is characterized by telangiectatic lesions of the nose, lips, and visceral organs including the liver, spleen, gastrointestinal tract, lungs, brain, and spinal cord¹–⁵. It is inherited as ...

Figure 1. Lucite-Ball Plombage.

Chest discomfort and negative U waves in precordial leads V, V, and V of the electrocardiogram (black arrows) with T-wave inversion occurred after the infusion of dipyridamole in a patient with severe stenosis of the ...

Over the past 20 years, computer-based systems designed to support clinical decision making have evolved from prototypes to commercially available systems¹–¹⁰. Although many of these systems address narrow areas of subject matter, such as electrolyte and ...

Twenty years ago, the discovery of a deficit of acetylcholine receptors at the neuromuscular junctions of patients with myasthenia gravis¹ and the development of an animal model of the disease² shed new light on a disorder that was first described ...

Presentation of Case

A 58-year-old woman was admitted to the hospital because of intractable diarrhea after chemotherapy for carcinoma of the tongue.

Five months before admission, the patient had received radiation therapy for a stage T4N2cM0 squamous-...

In the United States, as well as in other developed countries, the elderly population is getting older. From 1960 to 1990, the number of Americans 85 years of age or older increased by 232 percent, whereas the number 65 years of age or older increased by ...

“Life is a struggle, not against sin, not against the Money Power, not against malicious animal magnetism, but against hydrogen ions”¹. These words, written by H.L. Mencken about the meaning of life and death, may also apply to the struggle of the healthy ...

Hereditary hemorrhagic telangiectasia, also known as Rendu-Osler-Weber syndrome, is a familial disease in which telangiectases occur in the skin, mucosal surfaces, and solid organs¹,². Small telangiectases are a mild cosmetic problem, but larger lesions ...

This issue of the Journal contains a comparison of four commercially available computer programs designed to diagnose diseases that internists might encounter¹. All the programs performed equally well. When they were presented with information on known ...

To the Editor: Gwaltney and his colleagues obtained 45 computed tomographic (CT) scans in 31 volunteers (Jan. 6 issue)¹ and conclude that “the common cold is actually a viral rhinosinusitis.” Well done, guys!

To justify their study and its results, ...

To the Editor: In his review of the care of patients with ascites (Feb. 3 issue),¹ Runyon downplays surgical treatments, such as peritoneovenous shunting. One option not mentioned is formal surgical portosystemic shunting, usually with an end-to-side ...

To the Editor: O'Brien et al. (Feb. 3 issue)¹ reported a low rate of remission after 2-chlorodeoxyadenosine therapy among patients with chronic lymphocytic leukemia refractory to fludarabine. However, 57 percent of the patients had a decrease in the ...

To the Editor: Treatment of hematologic cancers has recently focused on the use of tretinoin (retinoic acid), the vitamin A derivative, and similar retinoids to induce differentiation of immature neoplastic cells¹. Unfortunately, severe side effects have ...

To the Editor: Chodak et al. (Jan. 27 issue)¹ conclude that conservative management is an appropriate choice for some patients with clinically localized prostate cancer -- that is, those with a life expectancy of 10 years or less. However, because they ...

To the Editor: Gamma-glutamyltransferase (GGT) is a glycoprotein enzyme that catalyzes the transfer of the gamma-glutamyl group from gamma-glutamyl peptides to other peptides and to l-amino acids. The activity of GGT in the kidney is very high; there is ...

To the Editor: In their thought-provoking article, Hutson et al. (Feb. 3 issue)¹ state that “perpetrators of drive-by shootings . . . tend to shoot others . . . within their own ethnic group.” Nonetheless, in addition to “stressed families, poverty, lack ...

To the Editor: Like many Americans, I am afraid that waiting periods and background checks would delay but not prevent the purchase of handguns by criminals. It would be difficult to confiscate all the guns: 67 million handguns are owned by private ...

Grave illness (with its consequences) is a natural subject for a writer of fiction -- a chance to explore dramatically, psychologically, and morally a situation that will escape no one and therefore will potentially appeal to everyone. Reynolds Price, one ...

Early in the 19th century, Fanny Burney, one of the most noted novelists of her day, felt a lump in her breast. It persisted. Eventually, she underwent a mastectomy, with all the travail that the medical care of the period involved. She received little ...

As Fred Plum rightly states in his foreward, this is more than just another book about headache; it is an encyclopedia on the subject. It consists of 125 chapters, divided into six sections and written by 121 authors. Most chapters are written by ...

This book is about a highly specialized treatment, the excision of the epileptogenic focus in patients with epilepsy intractable to management with drugs. About 5000 patients in the United States are candidates for this operation each year.

During the ...

More than any other disorder in the modern history of medicine, schizophrenia has been an ideological battleground. Early neurologic explanations yielded to psychobiology and psychoanalysis. The 1960s and 1970s brought sociological and political ...

The editors of this book (which I reviewed in collaboration with the faculty and residents of the Department of Neurology, Boston University School of Medicine) identified an enthusiastic group of young neurologists, “a new breed of clinicians,” to ...