The blood-coagulation system is regulated by cofactors and anticoagulant proteins in plasma and on the surface of endothelial cells¹–⁸. Under normal physiologic conditions, procoagulant and anticoagulant mechanisms are delicately balanced, but ...

Recent experimental and clinical observations indicate that intracoronary platelet activation at sites of endothelial injury and coronary-artery stenosis may contribute to the development of acute coronary artery disease syndromes, such as unstable angina^...

Type II (tyrosinase-positive) oculocutaneous albinism is an autosomal recessive disorder in which the biosynthesis of melanin pigment is reduced in the skin, hair, and eyes¹–³. Infants with type II oculocutaneous albinism may initially appear to be as ...

The hypereosinophilic syndrome is characterized by persistent eosinophilia of unknown origin often associated with the dysfunction of multiple organs as a result of tissue infiltration by eosinophils and the toxic effects of their products¹. Previous ...

Figure 1. Coronary Atherectomy.

A proximal stenosis of the left anterior descending coronary artery (arrow in Panel A) was found in a 41-year-old man during coronary arteriography for unstable angina. The stenosis improved after atherectomy (Panel B). ...

For more than a decade, health policy analysts have noted -- and some have decried -- the high cost of dying¹–⁷. With the acceleration of pressures on health care costs and calls for reform, considerably more attention has been focused on proposals to ...

Cardiopulmonary resuscitation (CPR) is controversial for patients near death. The appropriateness of CPR depends on three main factors: the outcome, the cost, and the patient's preference. Several recent studies have reported outcomes among elderly ...

In 1927 Harvey Cushing described the outcome for soldiers with spinal cord injuries sustained during World War I: “Fully 80 percent died in the first few weeks in consequence of infection from bedsores and catheterization. . . . Only those cases survived ...

Presentation of Case

An 84-year-old woman was admitted to the hospital because of lymphoma and the recent onset of cough and fever.

The patient had been well until 12 years earlier, when well-differentiated lymphocytic lymphoma and thrombocytopenia were ...

Patients with venous thromboembolism can be divided into two groups. The first includes patients with a disease such as cancer, a predisposing factor such as recent surgery, or an acquired abnormality such as the lupus anticoagulant that is known to ...

The concept of a subdivision of CD4+ helper T cells based on their cytokine profile was first proposed by Mosmann and Coffman in 1987¹. Type 2 helper T cells preferentially transcribe and translate messenger RNA (mRNA) for interleukin-4 and interleukin-5 ...

To the Editor: Ewigman et al. (Sept. 16 issue)¹ attempted to determine the efficacy of ultrasonography in pregnancy, but their methods obscured the issue of routine scanning. Of 55,744 women registering for obstetrical care, the authors excluded 32,317 (...

To the Editor: Genomic imprinting on chromosome 15q11q13 results in two disparate syndromes: Prader-Willi syndrome, in which the paternal 15q11q13 is lacking, and Angelman syndrome, in which the maternal 15q11q13 is lacking¹. Loss of a parental region ...

To the Editor: Owen et al. (Sept. 30 issue)¹ found that lower serum albumin concentrations were associated with an increased risk of death in patients with end-stage renal disease who were undergoing hemodialysis and concluded that poor nutrition was a ...

To the Editor: The model of Shipp et al. for predicting survival in patients with aggressive non-Hodgkin's lymphoma (Sept. 30 issue)¹ may represent an improvement over staging alone, but the approximations that the authors use in simplifying their model ...

To the Editor: In the September 30 issue the Image in Clinical Medicine ¹ was alleged to be that of the superior vena cava syndrome. It showed the torso of a man with dilated superficial veins converging on the superficial inferior epigastric veins at ...

To the Editor: A 28-year-old man with AIDS was hospitalized because of nausea, vomiting, and dizziness. Human immunodeficiency virus (HIV) infection had been diagnosed in 1991. He had had several opportunistic infections, and a recent CD4 cell count was ...

To the Editor: Streptokinase is a commonly used thrombolytic agent. An unusual but well-documented adverse reaction is serum sickness¹. Serum sickness typically develops one to two weeks after exposure to an antigen, with manifestations ranging from ...

To the Editor: Administration of oleic and erucic acids (“Lorenzo's oil”), a widely used therapy for patients with adrenoleukodystrophy or adrenomyeloneuropathy,¹,² is associated with thrombocytopenia³. We studied 15 men with adrenomyeloneuropathy and 3 ...

To the Editor: Patients receiving total parenteral nutrition may undergo routine bedside analysis of urine for glucose and ketones with the use of reagent strips (Ketodiastix, Labstix, or Multistix; Miles, Elkhart, Ind.). Two patients who had undergone ...

To the Editor: The article by Assaf et al. (Sept. 23 issue)¹ discusses many possible theories about the effect of prospective payment systems and diagnosis-related groups (DRGs) in leading to more expensive coding of discharge diagnoses, so that payments ...

Collections of Freud's correspondence with particular people make up a substantial category of the Freud literature. The Letters of Sigmund Freud to Eduard Silberstein, 1871-1881, edited by Walter Boehlich (Cambridge, Mass.: Belknap Press, 1990), was ...

Psychiatry and psychoanalysis, perhaps more than other branches of medicine, have always made their own history a focus of their research. Among the reasons for this, two stand out. First, as new insights into the mind are gained through clinical ...

In this monograph, two policy analysts from the John F. Kennedy School of Government at Harvard University examine the role of the private sector in the provision of mental health care in the United States, from the earliest private asylums to today's ...

Two centuries ago, the medical school at the University of Edinburgh was the finest in the world, and its outstanding physician was William Cullen (1710-1790). To mark the bicentennial of his death, the Royal College of Physicians of Edinburgh mounted an ...

Bearn's biography of Archibald E. Garrod is a joy to read. It portrays the man's character, his defects, and his remarkable scientific insights in the setting of his home, his schools, and his friends and associates. The author provides a family tree ...

This is an interesting book about a physician, George Hatem, also know as Ma Haide, who may well be to medicine in the 20th century what Rudolf Virchow was to medicine in the 19th century and Benjamin Rush in the 18th: the preeminent healer of and through ...

Acute Liver Failure Review Article, N Engl J Med 1993:329;1862-1872.. On page 1863, the first sentence of the “Drugs and Toxins” section should have read, “The chlorinated hydrocarbons trichloroethylene and tetrachloroethane,” not “The fluorinated ...

Declining Incidence of Nephropathy in Insulin-Dependent Diabetes Mellitus Original Article, N Engl J Med 1994:330;15-18.. On page 15, under the heading “Patients,” the sentence that begins in line 15 of the right-hand column should have read, “As multiple ...