A standard therapy for women with advanced epithelial ovarian cancer in the United States is an alkylating agent plus cisplatin. Cisplatin-based combination therapy has been found to be more effective than alkylating agents alone¹ or combinations without ...

Recent studies indicate that patients with myocardial infarction preceded by angina have smaller infarcts and a better in-hospital outcome after thrombolytic therapy than patients without preinfarction angina.¹,² The reason for this finding is unclear, ...

In 1991, about 190,000 persons in the United States either underwent dialysis or received a renal transplant for end-stage renal disease.¹ Hypertension was judged to be the underlying cause of the condition in 29 percent of these patients, second only to ...

In the spring of 1993, a waterborne outbreak of cryptosporidiosis occurred in Milwaukee. The municipal water supply became contaminated with cryptosporidium, affecting more than 400,000 people.¹ Immunocompromised patients are susceptible to biliary ...

The vegetative state is a cognitively unresponsive state in which the patient's eyes are open.¹ The diagnosis is made clinically in patients who are awake but have no behavioral evidence of awareness of self or the environment. The absence of ...

Figure 1. A cross-sectional computed tomographic scan of the abdomen of an 85-year-old man shows an aneurysm (arrow) of the infrarenal aorta measuring 10 cm in diameter. The initial diagnosis was made on physical examination by palpation of a pulsatile ...

Figure 1. An 85-year-old man was brought to the emergency room after two hours of excruciating abdominal pain, nausea, and vomiting. He was hypotensive on admission. Physical examination revealed a pulsatile midabdominal mass. Emergency computed ...

Correct regulation of gene expression, so that specific proteins are made by the appropriate organs at the appropriate times or in response to specific signals, is essential both to normal development and to the correct functioning of the adult organism. ...

Schizophrenia is an often severe and disabling disorder that usually begins in late adolescence or early adulthood. The essential features of this illness are a variable array of symptoms, such as delusions, hallucinations, disorganized or impoverished ...

The feasibility of using DNA as a treatment has been demonstrated in animal models, but clinical applications of this form of technology remain elusive. When gene therapy does come into wide medical use, it may be as a vaccine. Difficulties in developing ...

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A 15-year-old white girl has been unable to attend school for three months because of excessive fatigue. For the past seven months she had been short of breath during exercise but had no wheezing or cough. During that time she had lost 6.8 kg in ...

Cancer of the ovarian epithelium is the fourth most common cause of death from cancer in women and the leading cause of death from gynecologic cancer. At the time of diagnosis, the majority of women with the disease have involvement of one or both ovaries,...

According to Herrick's description in 1912,¹ and for several decades thereafter, acute myocardial infarction was considered to be an unheralded event — in lay parlance, the sudden “heart attack.” By the middle of the century, it was recognized that this ...

To the Editor: Since the first description of infection caused by β-lactam–resistant Streptococcus pneumoniae, the optimal empirical antibiotic therapy for patients with suspected meningitis caused by this microorganism has remained unknown. Hofmann et ...

To the Editor: We are troubled by the strong conclusion of Drew et al. (Sept. 7 issue)¹ that “oral ganciclovir is safe and effective as maintenance therapy for cytomegalovirus retinitis.” This statement implies equivalence between intravenous and oral ...

To the Editor: In the August 24 issue of the Journal, ¹ Konstantinides et al. describe a nonrandomized study of two treatment strategies for adults with atrial septal defect. The authors conclude that the surgical closure of atrial septal defects in ...

To the Editor: In his excellent commentary (Clinical Problem-Solving, Sept. 7 issue),¹ Dr. Thibault is rightfully surprised that the “mitral stenosis [was] masquerading as pneumonia!” A diagnosis of mitral stenosis could have been made in the emergency ...

To the Editor: The data on neonatal diabetes mellitus reported by von Mühlendahl and Herkenhoff (Sept. 14 issue)¹ indicate that the causes of this rare condition are heterogeneous. Among the 57 infants, only 7 were known to have HLA haplotypes associated ...

To the Editor: Attitudes toward analgesic therapy were strongly influenced by efforts in the 1930s to “solve the problem of drug addiction.” An influential paper published in 1941 stated, “The use of narcotics in terminal cancer is to be condemned if it ...

Few physicians, whether male or female, identify themselves as feminists, and many perceive feminism as an angry critique of men that few of their patients support. If family physician Lucy M. Candib is correct, however, doctors should be feminists, and ...

To be honest, as I began reading this large book, I had a bias as a male gynecologist. The preface, foreword, and contributions, most of which have been written by women, suggested a feminist critique of my current practice — that I do not address the ...

About the debate over futility, not a few have commented that the debate itself is futile. We will never establish an objective, uniform definition, so we should not try. Schneiderman and Jecker do not agree with this stance. In their book they issue a ...

It is now generally agreed, though Americans do not usually celebrate the point, that we cannot have it all: universal access to high-quality health care at moderate and stable costs. Joseph White, a research associate at the Brookings Institution (which ...