During the past three decades, several reports have suggested that the quality of semen in normal men is declining.¹–⁴ Recently, in a meta-analysis of 61 studies worldwide, Carlsen et al. found a trend toward decreasing sperm count and volume of seminal ...

McCully made the initial observation linking plasma homocysteine concentrations and arteriosclerotic vascular disease more than 25 years ago.¹ He reported that an infant with homocystinuria who died as a result of a rare inborn error of cobalamin ...

Crohn's disease is an inflammatory disorder that commonly involves the small bowel and colon. Although corticosteroids are highly effective in improving symptoms,¹,² attempts to discontinue therapy are unsuccessful in approximately 20 percent of patients.^...

The genus babesia comprises approximately 100 species of tick-transmitted protozoa (family Piroplasmorida) that infect a wide variety of wild and domestic animals.¹,² Babesial parasites, together with members of the genus theileria, are referred to as ...

Figure 1. Posteroanterior and lateral chest radiographs of a 42-year-old Japanese man reveal fine metallic opacities in the soft tissues of the back. The opacities represent indwelling gold acupuncture needles aligned along vertical “meridians” of the ...

Bone is remodeled continuously during adulthood through the resorption of old bone by osteoclasts and the subsequent formation of new bone by osteoblasts. These two closely coupled events are responsible for renewing the skeleton while maintaining its ...

Fifteen percent of couples are subfertile — that is, they have less-than-normal fertility. In approximately 30 percent of the cases, an important abnormality is identified in only the man, and in another 20 percent abnormalities are detected in both ...

One of the most important tools underlying the revolution in medical genetics is the ability to visualize sequence differences directly in DNA. When studied in the context of a population, these differences in DNA sequences are called polymorphisms; they ...

Stage

A 72-year-old man came to the emergency room with recurrent shortness of breath and dizziness.

Response

The combination of shortness of breath and dizziness makes me think about a cardiac event, and the shortness of breath raises the possibility of ...

Several studies over the past 20 years have suggested that the quality of semen is declining in industrialized countries throughout the world, arousing concern about male fertility in the future. The study reported by Auger et al.¹ in this issue of the ...

High serum cholesterol levels are an important risk factor for coronary disease, but most patients with myocardial infarction have normal cholesterol levels. Despite considerable advances in our understanding of the causes of cardiovascular disease, the ...

More than 40 years after the initial report¹ of a beneficial effect of aminopterin, the parent compound of methotrexate, in rheumatoid arthritis and psoriasis, there is a resurgence of interest in the use of methotrexate in autoimmune and inflammatory ...

To the Editor: In the medical conundrum presented by Ben-Chetrit and Putterman (Oct. 6 issue),¹ despite a 21-year search for a diagnosis, the patient's illness remains hazy. The diagnosis is most obviously hereditary coproporphyria. The patient and her ...

To the Editor: Mayer et al. (Oct. 6 issue)¹ conclude that adults with acute myeloid leukemia (AML) in remission who are 60 years of age or younger benefit from high-dose cytarabine therapy. It should be noted that the population these authors treated was ...

To the Editor: Although the term “leukemic infiltrates” accurately describes the pertinent funduscopic findings in retinopathy in leukemia, which are strikingly pictured in the image by Perazella and Magaldi (Oct. 6 issue),¹ the legend fails to indicate ...

To the Editor: Dr. Catalona's article on the management of cancer of the prostate (Oct. 13 issue)¹ was informative and thorough, except for two omissions concerning the treatment of patients with end-stage disease.

First, patients with extensive, painful ...

To the Editor: The letter “Discordant Occurrence of Primary Biliary Cirrhosis in Monozygotic Twins” (October 6 issue)¹ reflects a common misconception regarding the determination of zygosity. Although the sisters described in the report are twins, ...

To the Editor: Directly observed therapy for tuberculosis has been advocated as a way to improve compliance and control the emergence of drug resistance.¹,² We recently cared for two patients with human immunodeficiency virus (HIV) infection who were ...

To the Editor: The report of a fatal case of hantavirus pulmonary syndrome in a Rhode Island resident (Aug. 25 issue)¹ prompted us to examine whether hantaviruses are enzootic in New England. Because deer mice (Peromyscus maniculatus) serve as the main ...

To the Editor: Numerous infectious diseases can be transmitted from pets to their owners.¹ The zoonotic spread of mycobacterial infections, however, is extremely uncommon.² We report a case of Mycobacterium chelonae infection of soft tissue, which was ...

To the Editor: Pasteurella multocida is part of the normal flora of many domestic animals and can produce infection in humans. Although the infection is often acquired through a bite, we describe a patient with P. multocida bacteremia acquired in an ...

The hypothesis that several diseases that are frequent in North America, northern Europe, and most of Oceania, but rather infrequent in the rest of the world, may have common etiologic components in the diets of the various populations was advanced by ...

For centuries wine has been assigned health-giving attributes. Sometimes just drops of particular wines were recommended for specific ailments. The Chinese, in particular, invented daunting concoctions — mixtures of wines with snakes, frogs, and the like, ...

Ten years ago a friend and colleague observed that the field of occupational medicine was then at the same stage of sophistication as internal medicine in the 1920s. The problems we were encountering in occupational medicine had very little precedent. The ...

In the wake of the recent electoral results in the state of Oregon — where voters approved a referendum that decriminalized physician-assisted suicide under specific circumstances — Deathright is a timely addition to the debate on the ethics and politics ...

Physicians might assume that Emergency Care of the Compromised Patient is a book about the care of immunocompromised patients. Though it does include such patients, the scope of the book is far more comprehensive. This textbook describes the evaluation ...

Fluoxetine Review Article, N Engl J Med 1994:331;1354-1361.. On page 1357, in Table 1, the total Hamilton score for the imipramine group should have been 16.3, not 14.8, as printed. Also, in the placebo group the mean Hamilton score of the Stark and ...

Books Received (November 17, 1994;331:1388-90). On page 1389, under the heading “Medicine,” the book listed as Essentials of Cardiovascular Medicine should have been listed as two books, as follows:

Essentials of Cardiovascular Medicine. Edited by Mark ...