Endogenous gonadal hormones have an important role in causing breast cancer. Early age at menarche and late menopause increase the risk of breast cancer.¹,² The number and timing of deliveries also affect this risk.³ Furthermore, among postmenopausal ...

Congenital osteopetrosis is a group of disorders resulting in decreased osteoclastic function and hence decreased bone resorption. The accumulation of sclerotic bone compromises marrow space and cranial-nerve foramina and predisposes patients to ...

Severe fecal incontinence is a problem that may substantially diminish a person's quality of life.¹,² The prevalence of persistent fecal incontinence in the United States has been reported to be 2.3 percent.³ Treatment methods such as a change of diet, ...

Enhanced production of fetal hemoglobin (α₂γ₂) lessens the severity of the two major β-hemoglobinopathies, β-thalassemia and sickle cell disease. In homozygous β-thalassemia, reduced or absent production of β chains results in an excess of unpaired α-...

Figure 1. The legs of a 46-year-old man with scurvy are shown. The man had a mild mental disorder, and his diet consisted only of bread, pasta, packaged cookies, and water. Large ecchymotic areas extended over the backs of the legs (Panel A). A close-up (...

Controlling expenditures for drugs is an important part of cost containment in the Medicaid program. In the 10 years from 1984 through 1993, these expenditures increased fourfold, from $1.97 billion to $7.97 billion,¹ as a result of increases in ...

The childhood leukemias are a study in contrasts. Acute lymphoblastic leukemia (ALL) is diagnosed in approximately 2000 children in the United States each year, whereas acute myeloid leukemia (AML) is diagnosed in only about 500 children, and chronic ...

Presentation of Case

A 59-year-old woman was admitted to the hospital because of increasing constipation, abdominal pain, and a rectosigmoid mass.

The patient had been well until three months earlier, when pain in the right lower quadrant and constipation ...

Thanks to many public health advances, in the developed countries the average woman will be postmenopausal for about one third of her life. As a consequence, she and her physician will ultimately need to make a decision about postmenopausal estrogen-...

Osteopetrosis (marble-bone disease) results from diminished skeletal resorption.¹ We are certain of this pathogenesis because histologic studies of bone show that primary spongiosa — the scaffolding synthesized by chondrocytes in growth plates for ...

On October 28, 1990, with little debate, Congress passed the Omnibus Budget Reconciliation Act, requiring the states to provide claims-based drug-utilization review to approximately 34 million Medicaid enrollees.¹,² The provisions of the program were ...

To the Editor: The recent papers by Cao et al.¹ and Pantaleo et al.² (Jan. 26 issue) focus on characteristics of long-term survivors of human immunodeficiency virus type 1 (HIV-1) infection. The authors quantitated HIV-1 in plasma with a modification of ...

To the Editor: With respect to the review article on the acute respiratory distress syndrome (ARDS) by Kollef and Schuster (Jan. 5 issue),¹ only two randomized studies of extracorporeal gas exchange have been published,²,³ and neither could establish ...

To the Editor: Mackall et al. (Jan. 19 issue)¹ clearly demonstrate an inverse relation between age and the ability to regenerate CD4+ populations of T lymphocytes after intensive chemotherapy. They suggest that involution of the thymus (which occurs ...

To the Editor: The article on the use of granisetron and dexamethasone to prevent chemotherapy-induced nausea and vomiting (Jan. 5 issue)¹ does not appear to be relevant to current practice in the United States. The study group used 3 mg of granisetron, ...

To the Editor: Harry Schwartz's review of my book (coauthored with Laurel Hixon Illston and Raymond J. Hanley), Sharing the Burden: Strategies for Public and Private Long-Term Care Insurance (Jan. 19 issue),¹ was disappointing to me and to anyone ...

The term “multidisciplinary” has become the buzzword for cancer care in the 1990s. Hepatobiliary cancers, although not particularly common in the United States, are very common worldwide. And no set of diseases requires more dexterity by clinicians, who ...

Tamoxifen is an extraordinary drug. Even those mesmerized by rational drug design will marvel at its usefulness. Originally identified for one purpose for which it turned out to be totally ineffective in humans (as a “morning after” pill), tamoxifen ...

Dear Uncle,

Thank you very much for the wonderful book on elephants you sent me for my birthday. It told me more than I ever wanted to know about elephants.

Your niece

While settling down on many occasions to the task of reviewing this large book on ...

Fully one fifth of patients with cancer experience neurologic difficulties. In addition to the 100,000 patients whose systemic neoplasms invade the brain, the spinal cord, or their coverings, an equal number experience the neurologic toxic effects of ...

Functional gastrointestinal disorders are frequent but poorly understood and often prove frustrating to patients and physicians. Amid the uncertainty stemming from limited clinical trials in this area, patients are often subjected to extensive (and ...

Brain Tumors in Children Correspondence, N Engl J Med 1995:332;1238-1239.. On page 1239, in reference 8 in the left-hand column and reference 1 in the right-hand column, the first author's last name should have been Kleihues, not Kleihaus, as printed.