As women pursue educational and career goals, they are more likely to delay childbearing. In the United States from 1976 to 1986, the rate of first births among women 40 years of age or older has doubled,¹ but the effect of advanced maternal age or of ...

Since the early 1970s corticosteroids, often in combination with azathioprine, have been standard therapy for autoimmune hepatitis.¹–⁴ Most patients can be maintained in remission for long periods, but a true cure is rare. Since the majority of patients ...

Thyroid dysfunction and cigarette smoking are both common in the general population, with prevalences of about 10 percent¹ and 30 percent,² respectively. The influence of cigarette smoking on thyroid function is controversial. Both decreased and increased ...

A low-molecular-weight protein, p16INK4, inhibits the activity of the cyclin D1–cyclin-dependent kinase 4 complex.¹ This complex phosphorylates the retinoblastoma protein, allowing the cell to pass through the G1 cell-cycle checkpoint. Thus, p16INK4 ...

The distinguishing characteristics of familial cancer syndromes are an inherited predisposition to one or more characteristic types of tumors, early age at onset, and multiple synchronous or asynchronous tumors. Recently, the genes responsible for a ...

Figure 1. The elbow (Panel A) of a 33-year-old woman who had had dermatomyositis since childhood shows subcutaneous calcifications extruding through the skin. A focus of purulent inflammation within a calcium deposit is evident (arrow).

An x-ray film of ...

The growth of managed care presents a particular challenge for academic medical centers, because demand for the services of specialists is likely to continue to decrease.¹ In addition, managed-care plans often send patients to community hospitals at ...

The recognition of gastritis due to Helicobacter pylori as a factor of major importance has revolutionized the therapeutic approach to peptic ulcer disease.¹,² The recurrence of ulcers can be more effectively prevented by a single course of antimicrobial ...

Presentation of Case

A 43-year-old man was admitted to the hospital because of increasing leg pain and bladder and bowel incontinence, with confusion.

Sixteen years earlier the patient fell from a bicycle and began to have intermittent tingling of the ...

Smoking is associated with so many abnormalities of thyroid function that it is unlikely it has a single action on the thyroid gland. In this regard, it is like at least one substance that occurs naturally in the body — iodine — and several drugs.

The ...

During the past decade, the proportion of American women giving birth over the age of 35 has increased. In 1991, there were approximately 513,000 pregnancies in women 35 to 39 years of age and another 92,000 in women 40 or older,¹ as older and often well-...

Although autoimmune hepatitis has been recognized for more than 40 years, only the advent of diagnostic tests for infections with hepatitis B and C viruses has permitted it to be reliably identified. Even so, up to 5 percent of patients with autoimmune ...

To the Editor: We disagree that the study by Warkentin et al. (May 18 issue)¹ identified a difference in outcome favoring the use of low-molecular-weight heparin. Their initial study of the identical patient population found no statistically significant ...

To the Editor: Charache et al. (May 18 issue)¹ reported on the efficacy of hydroxyurea in ameliorating some of the complications of sickle cell anemia. In a randomized, double-blind setting, hydroxyurea treatment was associated with a reduced frequency ...

To the Editor: The conclusion by Mark et al. in their analysis of the cost effectiveness of thrombolytic therapy for acute myocardial infarction (May 25 issue)¹ that the routine use of accelerated tissue plasminogen activator (t-PA) in patients with ...

To the Editor: The study by Taplin and colleagues (May 25 issue)¹ provides strong evidence supporting the role of mutant androgen receptors in the emergence of prostate cancer refractory to hormone treatment. We were surprised, however, that these ...

To the Editor: Marsh et al. (May 25 issue)¹ identified impaired consciousness, respiratory distress, hypoglycemia, and jaundice as ominous prognostic indicators in African children with a primary diagnosis of malaria. Our findings, made in a different ...

To the Editor: In his review of child abuse and neglect (May 25 issue),¹ Wissow defines child maltreatment as “intentional harm or a threat of harm to a child by someone acting in the role of caretaker, for even a short time.” Intent is not generally ...

To the Editor: Secondary localization of intrathoracic tumors in the heart is often due to metastatic spread or neoplastic infiltration of veins. Renal, adrenal, and hepatic carcinomas as well as leiomyomas of the uterus can also reach the heart through ...

You've heard about the information superhighway? The Internet? You've heard the terms “bits,” “pixels,” “bandwidth,” “fiber optics,” and “virtual reality”? Are you dismayed that you know little or nothing about all this new stuff? Take comfort: you are ...

The AIDS epidemic, since its inception in the early 1980s, has presented American society with a series of complex and often tragic ethical dilemmas. Debates on these issues have exposed raw nerves in our moral life. Often we have been faced with choices ...

Infections are a major problem for immunosuppressed patients, a group whose numbers are increasing dramatically as a result of chemotherapy, organ transplantation, autoimmune diseases, and the spread of AIDS. Skin lesions may be the first clue that an ...

This timely and comprehensive work critically analyzes the history of AIDS, virologic and molecular aspects of the human immunodeficiency virus (HIV), and mechanisms of HIV infection. This work was originally written for Microbiological Reviews but has ...

Fear is a great motivator, as exemplified by the reactions to the Ebola virus and the human immunodeficiency virus. Among the most dreaded bacteria, the foremost is the meningococcus, which can kill a healthy adolescent in a matter of hours. In today's ...

When health care costs were of little concern and ready access was the only issue, the 6 medical schools, 80 teaching and community hospitals, and 14,000 doctors in Greater Philadelphia were a prized local asset. But now, many of these providers are ...

Nicotine Addiction in Young People Sounding Board, N Engl J Med 1995:333;186-189.. On page 187, the last sentence of the second full paragraph in the right-hand column should have read, “By the age of six, children in the study were able to identify Joe ...

Case Records of the Massachusetts General Hospital (Case 25-1995) Case Records of the Massachusetts General Hospital, N Engl J Med 1995:333;441-447.. On page 443, 10 lines from the bottom of the left-hand column, the phrase “the alpha subunit of prolactin ...