Approximately 5 percent of all pregnancies are complicated by gestational diabetes mellitus, which increases both maternal and perinatal morbidity.¹ In treating women with this condition, many have advocated minimizing fluctuations in blood glucose ...

Apolipoprotein E, a major component of circulating lipoproteins and an important regulator of lipid metabolism, exists in three major isoforms (E2, E3, and E4) encoded by three alleles (ε2, ε3, and ε4) of the apolipoprotein E gene.¹,² The ε4 allele has ...

Reduced oxygen availability at high altitude is associated with increased neonatal and infant mortality. Two groups of people have lived at high altitude (3000 to 4500 m) in the Tibet Autonomous Region, People's Republic of China, for different lengths of ...

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired disorder of hematopoiesis characterized by intravascular hemolysis and manifested by episodes of hemoglobinuria and life-threatening venous thromboses.¹ The cellular abnormality in this disorder is ...

Figure 1. A 30-year-old alcoholic woman presented with confusion and disorientation after a grand mal seizure. The patient's serum sodium concentration on admission was 99 mmol per liter. Treatment was initiated with a slow infusion of normal saline, ...

Maintenance of a constant volume in the face of extracellular and intracellular osmotic perturbations is a critical problem faced by all cells. Most cells respond to swelling or shrinkage by activating specific metabolic or membrane-transport processes ...

The use of cocaine has reached epidemic proportions. Over 30 percent of men and 20 percent of women between the ages of 26 and 34 have used cocaine at least once.¹ Moreover, 23 million Americans have used cocaine at some time,¹ and 5 million use it ...

Presentation of Case

A 77-year-old woman was admitted to the hospital because of chronic gastrointestinal bleeding with increasing weakness and dyspnea.

There was a 17-year history of gastrointestinal bleeding with an undetermined source, despite ...

Glucose intolerance that is first diagnosed during pregnancy is termed gestational diabetes mellitus. The definition is ambiguous, and the treatment controversial. Most important, the threshold at which glucose intolerance adversely affects the course of ...

The apolipoprotein E gene is present in the general population in three alleles, ε2, ε3, and ε4, with ε3 being common and ε2 and ε4 relatively less common. Genetic-linkage and association studies have shown that the ε4 allele is overrepresented¹ and the ...

To the Editor: Gill et al. (June 29 issue)¹ report the encouraging results of a trial in which interferon alfa and zidovudine were combined for the treatment of adult T-cell leukemia–lymphoma. The response to this treatment was impressive, and the ...

To the Editor: The successful treatment of leukemia is one of the great triumphs of modern pediatrics. Twenty-five years ago, a diagnosis of childhood leukemia was a virtual death sentence. Today, as lucidly described by Pui (June 15 issue),¹ the ...

To the Editor: Sher et al. (June 15 issue)¹ may have drawn premature conclusions about the potential efficacy of butyrate in treating the β-hemoglobinopathies, for several reasons. The patients in the study did not receive any iron supplements, according ...

To the Editor: The well-designed and well-executed study by Schulman et al. (June 22 issue)¹ contributes a great deal to our understanding of the course and treatment of venous thromboembolism. Neither the excellent discussion in this article nor the ...

To the Editor: Smalley et al. (June 15 issue)¹ effectively demonstrate that prior-authorization requirements are cost effective with regard to expenditures for nonsteroidal antiinflammatory drugs (NSAIDs). They correctly state that NSAIDs are similar in ...

To the Editor: Much of the concern voiced about drug-utilization review by Drs. Soumerai and Lipton (June 15 issue)¹ — about the lack of proof that this process is cost effective, the lack of attention paid to the underuse of effective medications, and ...

To the Editor: Those who prescribe medications may be unaware that they may contain substantial amounts of sodium. References such as package inserts, the Physicians' Desk Reference, and Drug Information ¹ do not always provide information about sodium, ...

Arthur Kornberg, professor emeritus of biochemistry at Stanford University School of Medicine, has written a deeply disturbing book. It is hard to understand what motivated him to write The Golden Helix. The book is nothing more than a puff piece for a ...

The fact that the title is metaphorical rather than literal should not dissuade physicians from reading, enjoying, and profiting from this book. Certainly, anyone concerned about the old stereotypes of “the drunken Indian” and the special metabolic ...

We live in a sea of electromagnetic fields. But the sea is shallow, and the fields are so minute that they are detectable only with sophisticated technology and are arguably undetectable by biologic systems and, hence, harmless. But a host of biologic ...

In the early 1950s, when poliomyelitis was again epidemic in northern Europe and the United States, an anesthesiologist in Copenhagen, Denmark, named Ibsen did something that was routine for him in the operating room but had never before been done on a ...

The Japanese health care system presents a tantalizing puzzle. On the positive side, universal health insurance has been achieved at relatively low cost and the health indexes of infant mortality and life expectancy at birth are among the best in the ...