Lyme disease is caused by the tick-borne spirochete Borrelia burgdorferi¹. Weeks to months after the onset of disease, approximately 60 percent of untreated patients begin to have brief, intermittent attacks of arthritis that may recur for several years². ...

Although electrical alternans (alternating amplitude from beat to beat on the electrocardiogram) has remained an electrocardiographic curiosity for more than three quarters of a century,¹–⁴ we have only recently recognized that it can be a harbinger of ...

Prostate cancer is now the most common cancer and the second most common cause of death from cancer among men in the United States¹. Both the incidence and the mortality rate have continued to rise, with no reduction projected over the next several years²...

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired disorder of blood cells in which the affected cells originate from an abnormal hematopoietic stem cell; the condition is characterized by nocturnal hemoglobinuria, chronic hemolytic anemia, and ...

Figure 1. Clostridium difficile.

The use of antibiotics may allow Clostridium difficile, an anaerobic bacterium sometimes isolated as part of the normal fecal flora, to overgrow in the gut; the toxins it produces may cause pseudomembranous colitis. (...

Clostridium difficile, the agent that causes pseudomembranous colitis associated with antibiotic therapy, has been identified in recent years as a common nosocomial pathogen. First described in 1935 by Hall and O'Toole, this gram-positive anaerobic ...

Amphotericin B was the treatment of choice for patients with systemic fungal disease from the time of its introduction in the late 1950s until recently¹. However, since the introduction of ketoconazole in 1981, fluconazole in 1990, and itraconazole in ...

Presentation of Case

A 38-year-old man was admitted to the hospital because of bloody diarrhea, weakness, and dyspnea.

There was a history of intravenous drug abuse and bisexual activity. Ten months before admission the patient was first seen at this ...

Our understanding of Lyme disease relies primarily on clinical observations. The diagnosis is typically made with clinical criteria, and the effectiveness of antibiotic therapy is determined by clinical end points. Although this approach has served both ...

A rare disease merits general attention if it is associated with extraordinary clinical manifestations, unusual laboratory findings, or an instructive molecular defect. Paroxysmal nocturnal hemoglobinuria (PNH) has all three. Its clinical hallmark, black ...

To the Editor: The recent two-part review article “Progress in Psychiatry” by Michels and Marzuk (Aug. 19 and 26 issues)¹ should be balanced by pointing out regressive developments in psychiatry during the past two to three decades. Michels and Marzuk ...

To the Editor: Mason and his colleagues are to be commended for undertaking the first large, randomized study to compare the roles of electrophysiologic testing and ambulatory monitoring in predicting the efficacy of antiarrhythmic drugs (Aug. 12 issue)¹–...

To the Editor: Adenosine is the treatment of choice for tachycardia with narrow QRS complexes involving the atrioventricular node as part of its reentrant circuit¹. It has also been recommended as a diagnostic aid in determining the mechanism of other ...

To the Editor: Every et al. (Aug. 19 issue)¹ are to be complimented on their article on the association between the availability of cardiac catheterization facilities and the use of coronary angiography and in-hospital mortality among patients admitted ...

To the Editor: The study of prehospital thrombolytic therapy by the European Myocardial Infarction Project (EMIP) Group, published in the August 5 issue of the Journal,¹ showed a nonsignificant reduction in mortality among patients treated before ...

To the Editor: In their review article “Thrombolysis in Acute Myocardial Infarction” (Sept. 2 issue),¹ Anderson and Willerson state that “urokinase is a true enzyme . . . [that] exists in both double-chain and single-chain forms.” This statement obscures ...

To the Editor: In their excellent review of tick-borne diseases (Sept. 23 issue),¹ Spach et al. recommended tetracyclines for most adults with Rocky Mountain spotted fever and chloramphenicol for those with “prominent central nervous system ...

To the Editor: Human ehrlichiosis, a tick-borne rickettsialike infection marked by fever, leukopenia, and thrombocytopenia, has not been reported in New England. Here we describe an elderly man who acquired ehrlichiosis on Cape Cod, Massachusetts.

A 67-...

To the Editor: We are writing to follow up on the article by Berkel et al. concerning breast implants and the risk of cancer (June 18, 1992, issue).¹ The study was a population-based, noncurrent cohort-linkage study, which was performed under the ...

The growing complexity of the process of dying in an age of sophisticated medical technology has been very good for business recently -- the publishing business, that is. A tremendous spate of books, not to mention journal articles, has been issued in the ...

One's first reaction to this unusual book is to reflect on the tragic loss, early in her career, of Dr. Marianne Paget. Medicine, social sciences, and the law had much to gain from her insights. Hers was a short but unique career. As a sociologist, she ...

During the past two decades, George Annas has ranked among this country's leading scholars of health law. He has been a prolific contributor to the literature, and his work has offered valuable guidance to bioethicists, physicians, and jurists. Standard ...

Most physicians strongly dislike medical-malpractice litigation. The idea that they or their colleagues might be sued for injuring someone because of substandard care is repugnant. The litigation process is time-consuming and, more important, emotionally ...

This collection of 15 essays, almost exclusively by physicians, explores the nature of empathy, how it affects the lives of physicians and patients, and (especially) how it can be taught and nurtured as a part of medical education.

Empathy has been so ...

Among the many bizarre and incredible conditions that can develop in human beings, factitious illnesses (of which Munchausen syndrome is the ultimate form) are unequaled. The very mind-set of a physician -- caring, trusting, and eager to help -- is ...

Interferon Alfa-2b Therapy for Life-Threatening Hemangiomas of Infancy (N Engl J Med 1992:326:1456-1463). Table 1 contained several errors; the authors have therefore submitted a corrected Table 1, shown here.