Electronic fetal monitoring during labor was developed to detect fetal-heart-rate patterns thought to indicate hypoxia. The early recognition of hypoxia would, it was reasoned, alert clinicians to potential problems and enable them to intervene quickly to ...

Some patients with inflammatory bowel disease have anemia that is refractory to treatment with iron and vitamins. A lack of erythropoietin may be important in the pathophysiology of anemia associated with inflammation,¹,² if deficiencies in iron, ...

High-altitude pulmonary edema is a life-threatening condition¹ characterized by marked pulmonary vasoconstriction.²–⁶ Even though the exact underlying mechanisms of high-altitude pulmonary edema are incompletely understood, pulmonary hypertension is ...

Autoimmunity is often implicated in pure red-cell aplasia. Approximately 10 to 15 percent of patients with pure red-cell aplasia have thymomas,¹ and remission of the anemia occurs in 25 to 30 percent of these patients after the thymoma is removed.² In ...

Figure 1. Electroencephalography in a 13-year-old boy with fever, altered sensorium, and sudden onset of seizures reveals complex repetitive discharges composed of spiky elements mixed with slower waveforms (Panel A). They are seen diffusely in the left (...

Using emergency departments for nonemergency care contributes to overcrowding¹ and is costly.² Such use is common in urban public hospitals,³,⁴ where a lack of accessible primary care often makes the emergency department a last resort. However, ...

The costs of services provided by hospital emergency departments have become a major concern. Patients complain about the high costs of health care. President Bill Clinton has referred to emergency departments as “the most expensive place of all.”¹ It is ...

Of the approximately 2 million Americans with a diagnosis of epilepsy who are treated with antiepileptic drugs, 20 percent continue to have seizures¹; this group of patients accounts for over 75 percent of the cost of epilepsy in the United States.² For ...

The photograph of a giant transgenic mouse created by the overexpression of growth hormone, which appeared on the cover of Nature in 1982, represented a landmark in molecular biology. The technology for producing transgenic animals was made possible by ...

Emergency department care for patients whose problems are not true emergencies has become a fashionable scapegoat for the ills of the health care system in the United States. Such care is considered wasteful and expensive and is therefore a prime target ...

Laënnec's invention of the stethoscope in 1806 was soon followed by auscultation of the fetal heart, which was pioneered by Kergaradec. Hoping to hear the fetus crying and splashing about in the womb, Kergaradec heard “beats occurring 143 to 148 times per ...

The main function of red cells is to transport oxygen from the lungs to the peripheral tissues. Erythropoietin controls red-cell production by stimulating the differentiation of erythroid progenitor cells in the bone marrow. The hormone originates mainly ...

High-altitude pulmonary edema occurs in mountaineers who ascend rapidly to heights of more than 2500 m. It is at the severe end of the spectrum of symptoms of acute mountain sickness, which include headache, insomnia, anorexia, lethargy, vomiting, ...

To the Editor: I am deeply concerned that the report by Shaner et al. (Sept. 21 issue)¹ and the accompanying editorial by Satel² may further fuel an already acrimonious discussion about the “appropriate use” of publicly derived funds. Have the authors ...

To the Editor: In their study of annual in-home comprehensive geriatric assessments for elderly people living at home (Nov. 2 issue),¹ Dr. Stuck and colleagues use multiple imputation to address problems arising from missing data. Multiple imputation is ...

To the Editor: Woolf's review (Nov. 23 issue)¹ of screening for cancer with prostate-specific antigen (PSA) omits important findings. He states that PSA testing could cost billions of dollars but does not mention that treating advanced prostate cancer is ...

To the Editor: Franks (Sept. 28 issue)¹ cites a prevalence of hyperprolactinemia of up to 30 percent in women with polycystic ovaries, yet he does not address the treatment of women with the polycystic ovary syndrome and hyperprolactinemia. Carefully ...

To the Editor: Treatment with unopposed estrogen is known to increase the risk of endometrial hyperplasia, atypia, and carcinoma, and therefore the administration of a progestogen during hormone-replacement therapy is recommended.¹,² The addition of a ...

Succinctly put, Matthews's book chronicles some of the pivotal events in the evolution of the art of medicine into the science of medicine. Starting with the debates surrounding Pierre Louis's numerical method in the 1800s, we traverse a series of ...

Because the epistemologic basis of medicine is probabilistic, it is difficult for patients to give truly informed consent for a treatment. The patient seeks a factual answer to questions: “Will I get better?” “Will I have a complication?” The clinician ...

There is a cartoon by Sidney Harris that is sufficiently well known as to have made its way onto T-shirts sold in mail-order catalogues of the Public Broadcasting System. It depicts two scientists standing at a blackboard covered with equations both to ...

Platelet Glycoprotein IIb/IIIa Receptors in Cardiovascular Medicine Review Article, N Engl J Med 1995:332;1553-1559.. On page 1556, the chemical structures shown in Figure 3 are incorrect. The correct figure and legend appear below.