The milk sugar lactose must be hydrolyzed by a lactase at the intestinal brush border before it can be absorbed. After weaning, there is a genetically programmed reduction in lactase activity in many people that cannot be altered by the ingestion of milk.^...

The efficacy of oral anticoagulant therapy in reducing the risk of stroke and systemic embolism has been demonstrated for both primary and secondary prevention in patients with nonrheumatic atrial fibrillation. Reductions in the risk of thromboembolic ...

Patients with mechanical heart-valve prostheses receive lifelong, high-intensity oral anticoagulant therapy to prevent thromboembolic complications, but this treatment is associated with an increased risk of bleeding.¹ The risks of thromboembolism and ...

The polycystic kidney diseases are a group of disorders characterized by the presence of numerous cysts throughout grossly enlarged kidneys. In humans, they are inherited as autosomal dominant or autosomal recessive disorders. Autosomal dominant ...

In the 1970s, during an intensive search for natural substances with anthelmintic properties, over 40,000 cultures of actinomycetes were screened in a collaboration between the Kitasato Institute in Japan and the Merck Institute for Therapeutic Research ...

Figure 1. Polycystic Liver and Kidney Disease.

An asymptomatic 63-year-old man was found on routine physical examination to have palpable hepatic nodules and ballotable kidneys. Contrast-enhanced abdominal computed tomography showed many hepatic masses of ...

Despite a marked decline in the incidence of gastric carcinoma in many industrialized nations, cancer of the stomach remains the second most common cause of cancer-related deaths in the world.¹ In 1995, 22,800 Americans will be given a diagnosis of ...

Multiple myeloma begins when one B cell of approximately 10 billion in the body undergoes mutations that enable it to outgrow most other cells in the bone marrow. When the neoplastic clone consists of 10¹¹ B cells, serum electrophoresis barely detects the ...

Stage

A 59-year-old building contractor reported facial flushing while working at a physician's home. His blood pressure was 185/120 mm Hg.

Response

Facial flushing is fairly nonspecific, although the carcinoid syndrome comes to mind. The blood pressure ...

Whether health care should be subjected to the values of the marketplace is a fundamental question facing us today. A powerful trend in this direction is upon us, with enormous, well-financed companies already dominating the delivery of health care in ...

Although abdominal symptoms are quite common, a specific cause is rarely found. Under some circumstances, healthy people perceive abdominal sensations arising from the digestive tract. Although it is unusual to be able to perceive physiologic intestinal ...

Since its discovery more than 50 years ago, warfarin has endured as a remarkable drug and is now the 14th-largest-selling medication in the United States. The efficacy of oral anticoagulant therapy in treating and providing prophylaxis against venous ...

Renal cysts look innocent enough. When they occur alone, as they commonly do in adults over the age of 50 years, they do no harm. The handiwork of the aging process, some would have you believe. But when they appear in the kidneys in large numbers, as in ...

In recent years, it seemed that regular performance reports on the quality of health care would soon be de facto if not de jure national policy. Several states established statewide reporting systems for hospitals. Voluntary coalitions of employers and ...

To the Editor: The report by Strebel et al. (Feb. 23 issue)¹ provides support for our ongoing work on the role of the muscle and the participation of the poliovirus receptor in the transport of the poliovirus from the muscle to the motor neurons. The ...

To the Editor: From their study of Hodgkin's disease in monozygotic and dizygotic twins, Mack et al. (Feb. 16 issue)¹ concluded that genetic susceptibility underlies certain subtypes of Hodgkin's disease. We have studied the familial aggregation of ...

To the Editor: It is generally accepted that Hodgkin's disease in patients infected with the human immunodeficiency virus (HIV) tends to present at an advanced stage and ultimately has a poorer prognosis than in patients not infected with HIV. However, ...

To the Editor: The Images in Clinical Medicine in the February 16 issue¹ presents a temperature chart of cyclic fever in Hodgkin's disease, which the authors identify as Pel-Ebstein fever.

In his essay ``Making Sense,''² Richard Asher refers specifically ...

To the Editor: The editorial by Dr. Gale (Feb. 9 issue)¹ highlights potential benefits and theoretical obstacles associated with the use of cryopreserved umbilical-cord blood as a source of hematopoietic stem cells. Dr. Gale asks the valid, though ...

To the Editor: We describe two cases of corticosteroid-resistant, life-endangering hemangioma treated with vincristine: a benign hemangioendothelioma in a patient with Kasabach-Merritt syndrome and a liver hemangioendothelioma. Mortality rates among ...

To the Editor: In his otherwise superb discussion of Case 5-1995 (Feb. 16 issue),¹ Dr. Caplan was inaccurate in stating that ``lymphomatoid granulomatosis does not involve the peripheral nerves.'' In addition to causing intraparenchymal brain masses, ...

To the Editor: The review of abuse of elderly persons by Lachs and Pillemer (Feb. 16 issue)¹ was timely, accurate, and comprehensive. We think, however, that it runs the risk of excessively portraying elderly patients as victims of malign outside ...

“Everybody talks about the weather, but nobody does anything about it,” said Charles Warner, and this has been true of stroke -- until recently. As Dr. Caplan points out, however, in his preface to this interesting book, times have changed. With a newly ...

With the rapid spread of managed care, we have entered a critical period in which the very concept of medicine as a profession is being questioned. Faced with the increasing demands of the medical marketplace, many physicians have forgotten how and why ...

Of those with bipolar disorder (formerly known as manic-depressive illness), only half have a good response to lithium carbonate, the first and best-known mood stabilizer, available in the United States since the early 1970s. Thus, the discovery that ...

The objective of this monograph is to inform the reader of recent anatomical and physiologic information that has radically altered our conception of infantile spasms. Clusters of axial spasms accompanied by at least transient developmental regression ...

In his foreword to this new book about muscle diseases, Lewis P. Rowland asks the obvious embarrassing question: ``There is already a plethora of books on neuromuscular diseases. Why yet one more?'' The only satisfactory answer (one that Rowland does not ...

Intrasphincteric Botulinum Toxin for the Treatment of Achalasia Original Article, N Engl J Med 1995:332;774-778.. On page 776, in Table 2, the first P value in the last column should have been 0.02, not 0.2, as printed.

Paclitaxel (Taxol) Review Article, N Engl J Med 1995:332;1004-1014.. On page 1005, in line 22 of the right-hand column, the premedication dose of ranitidine should have been 50 mg, not 150 mg, as printed.