Although interferon is an important advance in the treatment of chronic hepatitis B,¹,² it is effective in fewer than 40 percent of patients,³ must be given by injection, and has potentially dose-limiting side effects. Nucleoside analogues represent an ...

Zidovudine is the recommended initial therapy for human immunodeficiency virus (HIV) infection¹ and is generally tolerated well.² However, clinical studies indicate that its beneficial effects are limited in duration,³ partly because of the development of ...

A series of clinical trials¹–⁷ have examined the effects of angiotensin-converting–enzyme (ACE) inhibitors on survival after acute myocardial infarction. Large studies²–⁴ have shown a moderate benefit of short-term ACE inhibition started early after ...

Figure 1. A 40-year-old woman presented with pulsatile tinnitus in her right ear. In this photograph, a red glomus tumor (T), or paraganglioma, is apparent in the right tympanic membrane. The malleus (M) and annulus tympanicus (A) are labeled. The tumor ...

Under managed care, the financing and delivery of health care are organized by a single entity. Managed-care plans are classified as health maintenance organizations (HMOs), preferred-provider organizations (PPOs), or various mixes of the two.¹ There are ...

In managed-care systems, health care organizations bear the financial risk of operating within a predetermined budget and are responsible for coordinating a full spectrum of clinical services.¹,² In many regions of the United States, health maintenance ...

Testing of thyroid function is common in clinical practice. Many patients who are tested, including those who have or are receiving treatment for thyroid disease, take medications that may affect thyroid function. Therefore, the possible effect of these ...

Presentation of Case

A 72-year-old man was admitted to the hospital because of exertional dyspnea, fatigue, and extensive ecchymoses and purpuric lesions.

During the preceding six months he had been followed as an outpatient because of anorexia, ...

In patients with acute viral infection, therapy with systemic antiviral agents can save lives, as in the case of Lassa fever, or prevent the progression of disease, as in influenza or herpes simplex infection.¹ The challenge is greater when these agents ...

Our own contracts with one health maintenance organization (HMO) state: “Physician shall agree not to take any action or make any communication which undermines or could undermine the confidence of enrollees, potential enrollees, their employers, their ...

To the Editor: Thomas and Lowitt (Aug. 3 issue)¹ describe a 41-year-old female cocaine abuser who presented with an ischemic stroke due to occlusion of the right middle cerebral artery, documented by angiography. As an exercise in clinical problem-...

To the Editor: There is a growing need for an honest analysis of what we do and do not know about emerging infections such as enterohemorrhagic Escherichia coli and for cost-effective incentives to produce a safe food supply. Despite impressive progress ...

To the Editor: Mason and colleagues report the results of a clinical trial of immunosuppressive therapy for myocarditis (Aug. 3 issue).¹ Ventricular function improved to the same extent among the patients randomly assigned to receive conventional therapy ...

To the Editor: O'Neill et al. (Aug. 17 issue)¹ described a radiographic method for the detection of strut separation in Björk–Shiley convexo-concave mitral valves that had a reasonable sensitivity (83 percent) and high specificity (99.7 percent). The ...

To the Editor: In reporting the results of a meta-analysis of the effects of soy protein on serum lipid levels (Aug. 3 issue), Anderson et al.¹ commented on the position of the American Heart Association (AHA) on this issue. The conclusion of the 1993 ...

To the Editor: In their editorial (Aug. 3 issue),¹ Drs. Murphy and Johnson recommend that the causes of a laboratory accident at Yale University in the summer of 1994 should be carefully reviewed. In fact, shortly after the incident Yale requested two ...

In March 1992, the editor of the Journal inaugurated the Images in Clinical Medicine section with an editorial pointing out the enormous variety of visual images that doctors use in their daily work. Noting how crucial these images are to clinical ...

Before getting down to the business of examining representations of illness and health in a variety of visual media, Sander Gilman takes the reader on an instructive tour of the use of illustrations in histories of medicine. The most common use of the ...

In 1938, Surgeon General Thomas Parran reported on the status of the campaign against syphilis: “The hampering, ostrich-like attitude toward these diseases is gradually being overcome. When they are brought out into the open, freed from the medieval ...

This is the story of the International Task Force on Hepatitis B Immunization and the four men who founded it and led its efforts to introduce immunization against hepatitis B to developing countries where hepatitis B virus is most endemic. As such, the ...