Amyotrophic lateral sclerosis is a progressive and fatal neurodegenerative disorder¹ associated with survival ranging from a few months to decades (median, 37 to 49 months)²–⁵. Known prognostic factors include age at onset, site of onset, duration of ...

Pain is the most persistent and incapacitating symptom of recurrent or metastatic cancer. A large proportion of patients with metastatic cancer have pain long before the terminal stage of their illness¹–⁵. Pain, even when treated, is often severe enough ...

Proteins encoded by the RAS family of proto-oncogenes regulate cellular growth and differentiation by cycling between an active state in which they are bound to guanosine triphosphate (Ras-GTP) and an inactive state in which they are bound to guanosine ...

Castleman's disease (angiofollicular lymphoid hyperplasia) is a heterogeneous group of lymphoproliferative disorders of uncertain cause¹. Two pathologic types, hyaline vascular and plasma-cell disease, have been recognized. The plasma-cell variant of ...

Figure 1. Situs Inversus.

A chest film was obtained in an 11-year-old girl who presented with pain and tenderness of the left iliac fossa. Chest auscultation revealed right-sided heart sounds. The position of the heart suggested situs inversus totalis. ...

As health care costs continue to escalate, U.S. physicians are becoming increasingly aware of the need to set limits on the services they deliver. Two types of review could be used to set limits: assessing the appropriateness of specific decisions, and ...

In many neurologic disorders, injury to neurons may be caused at least in part by overstimulation of receptors for excitatory amino acids, including glutamate and aspartate. These neurologic conditions range from acute insults such as stroke, hypoglycemia,...

Stage

A 64-year-old man presented to the emergency room with fever, chills, nausea, malaise, and left-leg pain that had lasted for four days. For the past two days he had been unable to lift his left leg.

Response

I assume he has been unable to lift his ...

Presentation of Case

An 80-year-old woman was admitted to the hospital because of persistent gastrointestinal bleeding after a right colectomy.

The patient had been in stable health until five months earlier, when chronic gastrointestinal bleeding began, ...

Once upon a time doctors had nearly complete professional autonomy. If they completed their training, were licensed by the state, and were certified by a professional board, they were assured the respect and trust of the public, and virtually no one kept ...

When it comes to announcing an effective treatment for a currently untreatable disease, investigators have a grave responsibility. Bensimon et al.¹ report in this issue of the Journal that riluzole, a glutamate antagonist, increased survival in one group ...

Molecular investigations of cancer cells have identified genes, proteins, and biochemical pathways that may be useful for diagnosing and classifying cancer, formulating a prognosis, or identifying people who are predisposed to cancer. These studies have ...

To the Editor: Emanuel and Brett (Sept. 16 issue)¹ describe a number of mechanisms by which managed competition may disrupt patient-physician relationships. Prominent among these is involuntary disruption of continuity of care as patients are forced to ...

To the Editor: The report of the Diabetes Control and Complications Trial (Sept. 30 issue)¹ provided much information about the importance of achieving strict control of blood glucose levels through intensive treatment in diabetic patients. Patients with ...

To the Editor: Pell and colleagues (Sept. 23 issue)¹ used transesophageal echocardiography to visualize echogenic masses in a patient undergoing fixation of a femoral fracture with an intramedullary nail. They assumed these masses were embolic fat on the ...

To the Editor: In his review, Calne (Sept. 30 issue)¹ mentioned the use of electroconvulsive therapy in the treatment of drug-induced psychosis in patients with Parkinson's disease, but he did not discuss its use in treating the manifestations of the ...

To the Editor: In their Clinical Problem-Solving article “A Rewarding Pursuit of Certainty” (Oct. 7 issue),¹ Drs. Pauker and Kopelman discuss the treatment of a patient brought into the emergency room in status epilepticus. Evaluation with computed ...

To the Editor: The prognosis of patients with a relapse of leukemia within the first year after allogeneic bone marrow transplantation is dismal. Giralt et al. (Sept. 9 issue)¹ described seven patients whose leukemia had relapsed after allogeneic bone ...

To the Editor: Transplantation of solid-organ allografts can induce long-term donor-type microchimerism¹ by migration of passenger mononuclear cells²,³. So far, microchimerism has been described only in immunologically stable patients after liver or ...

To the Editor: Gortmaker et al. (Sept. 30 issue)¹ found that obese young women were less likely to marry, had lower incomes, and had completed less schooling than nonobese women and that obese young men were less likely to marry than nonobese men. Two ...

“If we take a survey of ages and of countries, we shall find the women, almost -- without exception at all times and in all places, adored and oppressed. . . . Society, instead of alleviating their condition, is to them the source of new miseries.” Thomas ...

The December 5, 1993, Sunday New York Times Magazine had an exceedingly disturbing picture on page 63: a woman, obviously in an advanced state of pregnancy, smoking crack cocaine. It was a picture calculated to drive a few to pity, some to horror, others ...

There may be no more divisive dispute in our society than that about the morality of abortion, because of the fundamental disagreement about the moral status of human life from fertilization through conception and gestation to birth. The present state of ...

In 1968 President Lyndon B. Johnson described it as shocking that in saving the lives of babies, America ranked 15th among the nations of the world. The high infant mortality rate at that time was related to the high incidence of prematurity in the United ...

A constant problem for obstetricians in practice, as well as those responsible for educating residents who will practice general obstetrics and gynecology, is how to keep abreast of the rapidly changing field of genetics. Since most completed medical ...

Cancer is newly diagnosed in more than 1 million Americans annually, and 1 of 5 deaths in the United States -- about 1400 per day -- results from cancer¹. Cancer is increasingly prevalent in the United States, yet unfortunately, the pain associated with ...

Informed Consent, Cancer, and Truth in Prognosis Legal Issues in Medicine, N Engl J Med 1994:330;223-225.. On page 224, in the left-hand column, under the heading “The California Supreme Court,” the first sentence should have read, “The California Supreme ...