Gastrointestinal bleeding due to stress ulceration is an important complication in critically ill patients¹,². Prophylactic measures such as neutralization of gastric acid, reduction of gastric acid secretion, or cytoprotection are commonly recommended, ...

Although hemorrhage is the most common complication of duodenal ulcer disease, there are few controlled trials of maintenance therapy in patients with documented hemorrhage¹,². We and others have found no previous randomized, controlled, double-blind ...

Osteoporosis is an increase in bone fragility that accompanies aging¹. Bone density is an important determinant of bone strength and a predictor of fractures²,³. Effective methods of minimizing loss of bone during adulthood will help prevent osteoporosis.

In dissections of the extracranial internal carotid or vertebral arteries, blood penetrates through an intimal tear, splits off the media, and extends along the artery, usually distally¹. Spontaneous cervical-artery dissection typically occurs in young ...

Post-transfusion graft-versus-host disease (GVHD) is generally thought to result from the engraftment of lymphocytes in blood products¹,². If circumstances permit, the donor's T lymphocytes mount an immune attack against the recipient's tissues. The ...

Figure 1. Porcelain Gallbladder.

The entire wall of the gallbladder is calcified in an 86-year-old woman with anemia probably caused by a slowly bleeding hiatal hernia. The patient had no abdominal symptoms. The border of the gallbladder is evident on a ...

Surgical treatment of gallstone disease has changed dramatically because of the introduction of laparoscopic cholecystectomy¹,². In some populations as many as 80 percent of cholecystectomies are now performed laparoscopically²,³.

The rapid and widespread ...

Over the past five years, a revolution has taken place in general surgery requiring the retraining of tens of thousands of surgeons and the retooling of their operating rooms. This startling change has come about because of the rapid acceptance of ...

Presentation of Case

A 31-month-old girl was admitted to the hospital because of fever and diarrhea.

Her early growth and development had been normal, except that her weight was consistently at or just below the 5th percentile. She had been well until two ...

Although there are exciting new techniques to treat acute episodes of gastrointestinal bleeding, prevention is certainly preferable. In this issue of the Journal, Jensen and his colleagues present evidence that long-term maintenance therapy with histamine ...

In this issue of the Journal Hopper and Seeman examine the effect of tobacco use on bone density by comparing female twins discordant for cigarette smoking¹. The bone density of the women who smoked or who smoked more heavily was significantly lower than ...

To the Editor: Phelps is correct to warn of the methodologic limitations of consensus-based definitions of appropriateness (Oct. 21 issue)¹. His suggestion that a panel's decisions can be affected by the composition of its membership is true. We found ...

To the Editor: The article by Tanenbaum (Oct. 21 issue)¹ criticizing outcomes research troubled me deeply. Her thesis is that outcomes research attempts to replace subjective professional judgment with micromanagement by insurance companies and ...

To the Editor: In the recent Sounding Board article by Greco and Eisenberg (Oct. 21 issue),¹ an increasingly important mechanism of changing physicians' behavior was not discussed -- that of educating patients in order to change their physicians' ...

To the Editor: The article on rifabutin prophylaxis against Mycobacterium avium complex disease by Nightingale et al. (Sept. 16 issue)¹ provides important information. We are perplexed by one point, however. How, in a randomized trial of 1146 patients, ...

To the Editor: We report the occurrence of uveitis and pseudojaundice in patients with AIDS who were receiving the combination of clarithromycin, rifabutin, and ethambutol for the treatment of Mycobacterium avium complex bacteremia.

We are conducting a ...

To the Editor: While I was a passenger on a recent transatlantic flight, an elderly woman became ill and required assistance. Six or seven physicians responded promptly to the flight crew's request for help. The emergency medical kit offered by the crew ...

“A well person is a patient who has not been completely worked up.” -- a resident's answer to the question, “What is a well person?” (Freymann J: personal communication).

“There must be something the matter with someone who goes to see a doctor when there ...

Cancer Factories traces the effect of our government's conscious policy decision to promote nuclear self-sufficiency at the expense of U.S. uranium miners immediately after World War II and throughout the 1950s and 1960s. The Atomic Energy Commission was ...

This book's goal is to provide lay readers with a discussion of “two intersecting themes: the problems of assessing subtle environmental or occupational risks, and the havoc this creates in the courtroom.” In two introductory chapters, the editors give an ...

The title of this book is bound to stimulate the interest of a diverse spectrum of readers. All of us take an interest in the quality of food fed to our children and its potential risks. Most of us have assumed that our food is free of risks posed by ...

One of the attractions of occupational and environmental medicine is that it is directly involved with important social and public health issues. The practice of occupational and environmental medicine affects not only the health of individual patients ...

The tapestry of American society is woven from many interdependent yet distinct cultural threads. Each cultural perspective is characterized by beliefs and values that influence the interpretation of events. Given the broad spectrum of values and beliefs ...

Cancer of the Ovary Review Article, N Engl J Med 1993:329;1550-1559.. On page 1552, in Table 2, the footnote should have stated “FIGO denotes International Federation of Gynecology and Obstetrics,” not “International Federation of Gynecologic Oncologists.”...

Case Records of the Massachusetts General Hospital (Case 46-1993) Case Records of the Massachusetts General Hospital, N Engl J Med 1993:329;1560-1567.. On page 1561, in the left-hand column, line 15, the phrase “intravenous injection of 99mTc” should have ...