Patients with isolated atrial septal defects may have a benign clinical course. Most of them have minimal, if any, functional limitation during childhood and adolescence.¹ Patients often survive to an advanced age.²–⁴ Nevertheless, the life expectancy of ...

Since the first descriptions two decades ago of strains of Streptococcus pneumoniae with a decreased susceptibility to penicillin (minimal inhibitory concentration [MIC] of penicillin G, or the lowest concentration that inhibits pneumococcal growth, >0.12 ...

Streptococcus pneumoniae is a major cause of morbidity and mortality and results in expenditures of over $4 billion yearly in the United States for the treatment of pneumonia, meningitis, bacteremia, sinusitis, and otitis media.¹–³ The emergence of drug-...

Severe congenital neutropenia (Kostmann's syndrome) comprises a heterogeneous group of disorders with variable inheritance whose main features are recurrent bacterial infections and severe neutropenia (fewer than 200 neutrophils per cubic millimeter). The ...

Thrombin (factor IIa) is a serine protease that performs a number of functions in blood coagulation.¹ Among its most important actions is converting fibrinogen into fibrin monomers, which polymerize to form the fibrin clot. Thrombin participates in the ...

Figure 1. A 70-year-old, previously healthy man had had sudden, colicky lower abdominal pain and increased urinary frequency for four days. He had marked suprapubic tenderness but no other abnormal physical findings. There was mild leukocytosis and a ...

Of the three classes of bronchodilators (β₂-adrenergic–receptor agonists, methylxanthines, and anticholinergic agents), the β₂-adrenergic–receptor agonists produce the greatest bronchodilation in patients with bronchial asthma.¹ β₂-Adrenergic agonists are ...

Presentation of Case

A 29-year-old woman was admitted to the hospital because of a pathologic fracture of the right femur.

The patient had been well until 31 days earlier, when she crawled under a machine at work to connect a belt and began to have pain ...

Leonardo da Vinci's description in 1513 of a “perforating channel” in the atrial septum is believed to be the first recorded account of a congenital malformation of the human heart.¹ Atrial septal defects often go unrecognized for decades, because there ...

There is bad news and some good news about the pneumococcus. The study by Hofmann et al. in this issue of the Journal ¹ is a chilling reminder that the United States is no longer safe from the spread of penicillin-resistant and multidrug-resistant ...

Granulocyte colony-stimulating factor (G-CSF) is one of the latest products of molecular biology to permeate clinical practice. The results with this hematopoietic growth factor have been promising, and in one disease, congenital severe neutropenia, they ...

To the Editor: The study by Perriëns et al. (March 23 issue)¹ demonstrates that extending antituberculous treatment from 6 to 12 months reduces the rate of relapse in patients infected with the human immunodeficiency virus (HIV) who have pulmonary ...

To the Editor: Dr. Kreisberg (April 6 issue)¹ makes the ex-cellent clinical point that deciphering liver conditions is difficult in patients with AIDS. I am a little skeptical about viewing trimethoprim–sulfamethoxazole as the sole problem in the case ...

To the Editor: Lipton and Gendelman ascribe a key role to macrophages and reactive oxygen intermediates in the pathogenesis of dementia associated with human immunodeficiency virus (HIV) infection (April 6 issue).¹ Since inhibi-tors of nitric oxide ...

To the Editor: Tsai and Gastfriend (April 13 issue)¹ report the case of a 58-year-old woman with primary pulmonary hypertension and a history of alcohol abuse in whom profound weakness developed after a bilateral lung transplantation. They state, “After ...

To the Editor: I enjoyed the informative article on jumping genes by Dr. Schwartz (April 6 issue).¹ However, there is an error in the introduction. Thomas Hunt Morgan performed the early (1910) work cited not at the California Institute of Technology but ...

To the Editor: Hamilton et al. (March 30 issue)¹ demonstrat-ed frequent mutations of the APC gene in patients with Tur-cot's syndrome and showed that medulloblastoma is the predominant brain tumor in families with that syndrome who have APC mutations. In ...

To the Editor: In his discussion of Case 12-1995 (April 20 issue)¹ on acute renal failure of glomerular origin, Black mentions the possibility of IgA nephropathy as a cause of glomerular hematuria. He cites our study ² of patients with acute renal ...

To the Editor: By injecting sperm into the cytoplasm of an oocyte¹ it is now possible to achieve fertilization and pregnancy in cases of obstructive azoospermia or severe oligozoospermia and asthenospermia after obtaining sperm directly from the ...

To the Editor: Three photographs of patients with relapsing polychondritis were recently published in the Journal's Images in Clinical Medicine series (March 2 issue),¹ including a photograph of a patient with saddle nose. As shown in Figure 1, saddle ...

To the Editor: Solomon et al. state that a “new disease,” formerly called “human adjuvant disease,” is present in many symptomatic patients with silicone breast implants (May 11 issue).¹ They then state, “This disease is included as a nosologic entity in ...

Errors in medicine are common and are at least partly responsible for the deaths of 180,000 patients a year.¹,² There is increasing concern about medical errors and the steps that should be taken to prevent them.¹ Until recently, hospitals have addressed ...

Judith Palfrey has written a well-organized, readable book about children's health as it is affected by forces in the community. Physicians, social workers, and community health workers, as well as politicians and others who shape public policy, would ...

Reflecting increasing interest and the accelerating pace of technical advances in the field, this book arrives in its fourth incarnation five years after the previous edition, after earlier gestations of seven years each. This is not a baby, however, and ...

Screening for fetal Down's syndrome first became possible in the late 1960s, when the positive association between maternal age and the prevalence of Down's syndrome at birth was identified and a diagnostic test (amniocentesis and fetal karyotyping) ...

Post-Polio Syndrome comes at a time when there is a demand for guidelines in diagnosing the post-polio syndrome and caring for patients with the syndrome who have unusual physical problems and medical needs. There is little else on the market for the ...

This multiauthored book about the complications that may occur during the care of children with orthopedic problems is comprehensive. The complications discussed include those the reader might expect (e.g., nonunion, avascular necrosis, and wound ...

This book attempts to address many of the new developments in research on and treatment of cystic fibrosis. It succeeds in some areas but falls short in others. Although the book is not formally divided into sections, the first seven chapters present ...