Percutaneous balloon mitral commissurotomy (valvuloplasty), first described in 1984,¹ has had good short- and intermediate-term results²–⁶. In a randomized trial in patients with favorable anatomical features,⁷ we reported that the outcome of balloon ...

Hirsutism can be an early sign, and even the only sign, of a virilizing adrenal carcinoma or adenoma, as well as of adrenal hyperplasia and ovarian disorders, and hirsutism of neoplastic origin cannot be excluded on the basis of the history or physical ...

Cystic fibrosis is an autosomal recessive genetic disorder that reflects mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene,¹–³ which codes for a cyclic AMP (cAMP)-regulated chloride channel⁴,⁵. The disorder has a broad range ...

Infection with Pseudomonas (Burkholderia) cepacia in patients with cystic fibrosis greatly increases morbidity. For a substantial percentage of those who acquire the organism, there is a markedly accelerated course ending in death. The rapid increase in ...

Figure 1. Porphyria cutanea tarda.

Water-soluble porphyrins from a liver-biopsy specimen from a patient with porphyria cutanea tarda show pink fluorescence under a Wood's light (405 nm). The biopsy specimen (short arrow) was preserved in saline solution ...

Geographic variations in the use of hospital services are associated with differences in the availability of hospital beds. There would be substantial savings if areas of the United States with high rates of hospital admission adopted the hospitalization ...

Prostate cancer is the second leading cause of death from cancer among men; 25 percent of men with prostate cancer die of the disease¹. Moreover, many patients who do not die of prostate cancer require treatment to ameliorate symptoms such as pain, ...

Presentation of Case

A newborn boy was admitted to the hospital because of petechiae and massive splenomegaly.

The infant was born in the 39th week of the sixth pregnancy of a woman 35 years old. The pregnancy was complicated only by a febrile illness ...

Mitral stenosis is a progressive disease that is usually fatal unless mechanical intervention enlarges the mitral-valve orifice enough to permit adequate cardiac output at a tolerable left atrial pressure. Although some medical therapies, including the ...

Approximately 5 percent of women have hirsutism,¹ and 40 to 60 percent of hirsute women have elevated serum androgen concentrations.² More than 95 percent of women with hirsutism have the relatively benign conditions of idiopathic hirsutism or the ...

Fifty years of scholarship have established the existence and importance of the variation phenomenon in modern medicine -- the observation of differences in the way apparently similar patients are treated from one health care setting to another. Recent ...

To the Editor: In their fine review of histamine H₁-receptor-antagonist drugs (June 9 issue),¹ Simons and Simons do not mention doxepin, a potent and useful H₁-receptor antagonist. Although it is not typically placed in this pharmacologic group, doxepin ...

To the Editor: In their article on cerebral vascular anatomy as a risk factor for ischemic infarction (June 2 issue),¹ Schomer et al. incorrectly imply that unilateral “watershed” infarcts can occur in juxtaventricular white matter. We wish to correct ...

To the Editor: The serotonin syndrome consists of behavioral, neuromuscular, and autonomic changes that result from increased activity of serotonin (5-hydroxytryptamine) in the central nervous system.¹ Its symptoms and signs include confusion, fever, ...

To the Editor: The article by Platt et al. (June 9 issue)¹ described the risk factors associated with early death in patients with sickle cell disease -- specifically, they found that, of the 69 “healthy” patients with sickle cell anemia who died, ...

To the Editor: In their report on a patient with oncogenic osteomalacia, Cai et al. (June 9 issue)¹ noted that the patient had first become symptomatic more than 20 years earlier, had been evaluated at the Mayo Clinic in 1974, and had complete remission ...

To the Editor: In their report on the performance of four commercially available computer-based diagnostic systems in internal medicine (June 23 issue),¹ Berner and colleagues conclude that “the programs should be used by physicians who can identify and ...

To the Editor: The Sounding Board article by Elias and Annas (June 2 issue)¹ calling for enforceable regulation of genetic screening champions ignorance over knowledge and demonstrates incredible arrogance.

The current problem with genetic screening is ...

To the Editor: Policies proposed by the Health Care Financing Administration (HCFA) are threatening the process by which a primary care physician admits a Medicare patient with multiple illnesses to the hospital and uses knowledge of the patient's ...

To the Editor: Bergman's proposal (June 2 issue)¹ that institutions declare an all-out war on meetings, task forces, and retreats has made a real stir at my university. A committee has been formed to study the problem. Alas, its first meeting is next ...

In the national debate about who should have health insurance, surprisingly little attention has been focused on what medical services health insurance itself should cover. Historically, discussions of this topic have centered on concepts such as basic ...

In 1970, a girl who had been literally imprisoned in a 10-ft-by-14-ft room from the age of 2 years to the age of 13 came to the attention of Southern California authorities. The reasons for her cruel treatment are unclear. Her father committed suicide the ...

In 1828 Kaspar Hauser, a foundling, physically and intellectually stunted by abuse and neglect, was abandoned at the Haller Gate of the wall of the city of Nuremberg. The facts of his story tore a hole through another wall, the wall of denial of the ...

Every Man for Himself and God against All: The Enigma of Kaspar Hauser is Werner Herzog's film about Kaspar Hauser, the famous foundling. The film presents Hauser's story as the passage of an absolute outsider through 19th-century German culture. At the ...

Robertson charts an ethical and legal course through the questions and concern posed by the reproductive techniques that are now available rather than merely material for science-fiction novels. These questions confront us professionally as physicians or ...

Several recent reviews in professional journals have begun with the author's expressed hope that the book under review would merit a positive report, only to continue “But alas....” There is no “but alas” in my response to this two-volume series on ...

A Massive Outbreak in Milwaukee of Cryptosporidium Infection Transmitted through the Public Water Supply Original Article, N Engl J Med 1994:331;161-167.. On page 166, in the sentence beginning on line 22 of the right-hand column, the phrase “the ...

Thyroxine Therapy Review Article, N Engl J Med 1994:331;174-180.. On page 176, line 11 of the right-hand column should have read, “six months later to determine,” not “six months after the start of therapy to determine,” as printed. We regret the error.