For the past two decades the preoperative approach to hypotensive patients with trauma in North America has included prompt intravenous infusion of isotonic fluids¹–³. The rationale for this treatment has been to sustain tissue perfusion and vital organ ...

Over 3000 orthotopic liver transplantations are performed each year in the United States¹. The success of this procedure is related in large part to the availability of potent immunosuppressive agents for preventing and treating acute rejection²,³. The ...

Vasoactive Intestinal Peptide (VIP) is a 28-amino-acid neuroendocrine mediator with a broad range of activities in diverse cells and tissues. The peptide is a major regulator of water and electrolyte secretion in the gut¹ and causes the watery-diarrhea ...

Patients with cirrhosis have an increased incidence of bacterial infection¹. Although immunologic abnormalities have been observed in such patients, the precise mechanisms responsible for the increased frequency of infection are uncertain. Macrophage Fcγ ...

Figure 1. Bleeding Esophageal Varices.

In an endoscopic photograph of the esophagus of a 56-year-old alcoholic man with massive hematemesis, blood can be seen spurting from a ruptured varix (arrow, Panel A). After injection sclerotherapy of the variceal ...

Many studies have compared the structure and process of health care in the United States with those in Canada, but few have examined medical outcomes and almost none have compared quality of life¹. Recently, Rouleau and colleagues compared U.S. and ...

The appropriate role of generalist and specialist physicians is a major issue in the debate about the health care system of the United States¹–³. Over two thirds of physicians in the United States are specialists,⁴ but managed-care plans use considerably ...

Presentation of Case

A 69-year-old woman was admitted to the hospital because of a right orbital mass with chronic conjunctivitis.

One month before admission she had noticed that her right eye was bloodshot. An ophthalmologist found a mass beneath the ...

Despite complaints that the care provided by specialists is discontinuous and fragmented, Americans have traditionally valued their unrestrained access to care by cardiologists, dermatologists, urologists, and other specialists. But now the rapid spread ...

The resuscitation of hypotensive patients with hypovolemia who have sustained penetrating injuries traditionally follows the management principles outlined in the American College of Surgeons Advanced Trauma Life Support course.¹ These principles consist ...

The introduction of cyclosporine as an immunosuppressive agent improved the results of all types of organ transplantations¹ and allowed liver transplantation to become the treatment of choice for many patients with end-stage liver disease.² The rejection ...

To the Editor: Sox's article questioning the value of screening and treatment for localized prostate cancer (June 2 issue)¹ provides a limited view. He incorrectly states that studies have not measured the accuracy of screening with the prostate-specific-...

To the Editor: Senator Gramm's grocery analogy is flawed (June 16 issue).¹ In his view, American health care consumers will greedily consume as much health care as they can get unless financial disincentives are applied. Clearly, health care is a ...

To the Editor: Sempos and coworkers report data from the National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study (NHEFS) and conclude that “higher transferrin-saturation levels were not associated with an increased risk ...

To the Editor: The study by Hayes et al. (June 16 issue)¹ demonstrates that excessive doses of adrenergic agents (dobutamine alone or in combination with norepinephrine) may result in altered tissue function and increased mortality rates among critically ...

To the Editor: Utrophin is an autosomally inherited protein encoded by chromosome 6 that is homologous to dystrophin and localized in normal adult muscle exclusively at neuromuscular junctions.¹ No clinical disorder is recognized that relates to altered ...

To the Editor: I would like to report on two medications with similar names and dosages, which may be a source of errors by pharmacists. A 54-year-old woman with hypothyroidism due to total thyroidectomy for thyroid carcinoma had been prescribed ...

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) is the most comprehensive and authoritative book devoted to the classification of psychiatric illness. There have been four major revisions since 1950. The ...

Many physicians, torn between their fidelity to fee-for-service medicine and the realities of a more competitive health insurance market, are taking a reluctant professional step: they are becoming involved in the rapidly growing phenomenon known as ...