Sickling of red cells in patients with sickle cell anemia is caused by the polymerization of molecules of deoxygenated hemoglobin S (α₂β₂s) into rigid, rod-like polymers. Fetal hemoglobin (α₂γ₂), which lacks β-globin chains, inhibits sickling in vitro by ...

Birth defects are the leading cause of infant mortality in the United States,¹ and heart malformations are present in at least half of infants with such defects.² Reports of familial malformation syndromes, such as those involving an atrial septal defect,^...

Thrombocytopenia induced by heparin typically appears five or more days after the start of heparin therapy.¹–³ The thrombocytopenia is caused by heparin-dependent IgG antibodies that activate platelets through their Fc receptors.⁴–⁶ Recently, several ...

Figure 1. The electrocardiogram of a 42-year-old woman with the ostium secundum type of atrial septal defect shows normal sinus rhythm with incomplete right bundle-branch block (RBBB), indicated by the rSR' pattern in leads V₁ and V₂ and the terminal S ...

Figure 1. Transesophageal echocardiography was performed in a 23-year-old patient who presented with exertional dyspnea, fatigue, and palpitations. Cardiac auscultation revealed fixed splitting of the second heart sound and a short mid-diastolic murmur (...

There is heightened interest today in improving the outcomes in a variety of groups of patients.¹–³ Most recent efforts to improve patients' outcomes, however, have focused on specific diseases,⁴,⁵ treatments,⁶–⁸ or behavior of physicians.⁹,¹⁰ We ...

The usefulness of comprehensive geriatric assessment as a method of improving the health care of frail elderly persons is still in question. Although a number of studies¹ have demonstrated benefits of the approach — improved health status, conservation of ...

Celsus described four of the five cardinal signs of inflammation 2000 years ago, and Eustachio discovered the adrenal glands almost 500 years ago, but not until 1936 did Selye note that in rats exposed to stressors, the adrenal glands were enlarged, and ...

Presentation of Case

A 70-year-old woman was admitted to the hospital because of obtundation, aphasia, and a right hemiparesis.

She had a five-year history of treated hypertension. Four months before admission a lumpectomy was performed because of breast ...

Fifty years ago this spring, a conversation between an eminent clinical investigator and an extraordinarily imaginative physical chemist led to the insight that introduced the era of molecular medicine. Although their recollections of the encounter ...

Heparin-induced thrombocytopenia and associated thrombotic events, relatively common side effects of heparin therapy, can cause substantial morbidity and mortality. Typically, these conditions occur after about five days of therapy, but they can appear ...

For vulnerable elderly patients, hospitalization can be hazardous.¹–³ Too often their treatment is complicated by delirium, depression, adverse drug reactions, poor nutrition, and loss of precious physical strength. Too often their pneumonia is cured or ...

To the Editor: The long-term studies of morbidity from asthma by Silverstein et al.¹ and Lang and Polansky² (Dec. 8 issue) do not provide evidence of a history of either active or passive smoking that is based on explicit criteria. Silverstein et al. ...

To the Editor: Greengard et al. (Dec. 8 issue)¹ describe siblings, from a symptomatic family, who were homozygous for the arginine → glutamine mutation at position 506 in the factor V gene. On the basis of this report and others,²–⁴ one can estimate that ...

To the Editor: Dec and Fuster (Dec. 8 issue)¹ categorized the use of beta-blockers in patients with idiopathic dilated cardiomyopathy as investigational. There is now sufficient evidence to support their use as adjunctive therapy. Numerous clinical ...

To the Editor: Naiman's magnificent photograph of Digitalis purpurea (Dec. 8 issue)¹ illustrates the derivation of its common name: because of its color and resemblance to fingers, it was called foxglove by the botanist Leonhard Fuchs in 1542. William ...

“Well, have you actually tried what you're proposing?” I sheepishly admitted I had not. The setting was the 1993 International Congress on Peer Review in Biomedical Publication, and I had just spoken on book reviews as a form of peer review. I had ...

Women dominate the health care industry. As providers they make up more than 80 percent of the health care work force, and as consumers they average one third more visits to physicians than men. Moreover, almost all home health care, including the care of ...

Women account for about half the adults infected with the human immunodeficiency virus (HIV) throughout the world. In addition, women are affected by the HIV epidemic, as mothers, wives, companions, and providers of care to those infected by the virus. ...

The determinants and consequences of the human immunodeficiency virus (HIV) go beyond virology. The AIDS epidemic has challenged contemporary notions of infectious disease and immunology, health and health care, sex, and science. Like all chronic ...