In approximately 8 percent of women with pregnancies at term, the fetal membranes rupture before labor begins.¹ If labor is not induced, over 60 percent of these women begin labor spontaneously within 24 hours and over 95 percent begin labor spontaneously ...

Antiretroviral therapy is associated with delayed progression of disease and prolonged survival in patients with advanced human immunodeficiency virus (HIV) type 1 infection, but the duration of both clinical benefit and viral suppression is limited, and ...

Helicobacter pylori causes chronic gastritis in virtually all infected people. In many of them, this persistent inflammation ultimately leads to loss of the normal architecture of the gastric mucosa, with disappearance of the gastric glands and ...

Left ventricular hypertrophy is recognized as a major independent risk factor for morbidity and mortality from cardiovascular causes.¹–⁴ Blood pressure, obesity, and age are important determinants of left ventricular mass²; however, they account only for ...

Figure 1. Acute, severe odynophagia developed in a 52-year-old man known to be positive for the human immunodeficiency virus (HIV). A double-contrast esophagogram (Panel A) shows two giant, ovoid ulcers (arrows) measuring 3 cm and 6 cm in length in the ...

Invasive cervical cancer is uncommon in the United States, with an incidence of 15,800 cases and 4800 deaths in 1995.¹ This relatively low incidence is largely due to the effectiveness of screening programs that assess cervical cytology by Pap smear. On a ...

Although sudden death in a young person is rare, it can have a great impact on both the lay and the medical communities. Such unanticipated deaths sometimes occur in dramatic circumstances and often have medical and legal ramifications. Some of these ...

Presentation of Case

An 18-year-old woman was admitted to the hospital because of hepatomegaly and ascites.

The patient had been in excellent health until four weeks earlier, when she started taking norethindrone–ethinyl estradiol tablets. Four days later,...

Premature rupture of the membranes, which is defined as rupture before the onset of labor, complicates 5 to 10 percent of all pregnancies. Preterm rupture of the membranes has received considerable attention in the obstetrical literature and deservedly so,...

The health care delivery system in America is undergoing a series of revolutionary changes. What was once a system of retrospective, cost-based reimbursement is rapidly becoming a market-based system of focused, coordinated care. It is my contention that ...

In any business, money coming in must equal or exceed money going out. This most basic of all fiscal laws means that no business venture can survive for long if it continually spends more than it makes. That is as true for not-for-profit organizations as ...

To the Editor: In response to the editorial by Drs. Woolhandler and Himmelstein (Dec. 21 issue),¹ we would like to point out that financial incentives have always been a part of fee-for-service medicine — a reality that seems to have been ignored until ...

To the Editor: The report by the Cuba Neuropathy Field Investigation Team (Nov. 2 issue)¹ describes an excellent retrospective case–control study to determine the proximal causes of the epidemic of optic neuropathy in Cuba from 1991 through 1993. The ...

To the Editor: Drs. Mangano and Goldman (Dec. 28 issue)¹ recommend that all patients with known coronary disease undergo routine postoperative electrocardiography on day 1 and again before discharge from the hospital, to rule out myocardial infarction. ...

To the Editor: In his discussion of Case 39-1995 (Dec. 21 issue),¹ involving a nutritional disorder, scurvy, that developed in a 72-year-old man admitted to the hospital because of exertional dyspnea, fatigue, and extensive ecchymoses and purpuric ...

To the Editor: Much interest has been focused on long-term survivors of human immunodeficiency virus type 1 (HIV-1) infection,¹,² but little information is available about the progression of the disease in these patients. We present the results of a four-...

In 1925 Thomas Cooley and Pearl Lee described five children in Detroit as having what was then called von Jacsch's anemia, as well as a “peculiar mongoloid appearance, caused by enlargement of the cranial and facial bones, combined with the skin ...

Why We Get Sick is the result of a collaboration between a practicing physician and an evolutionary biologist. A model of scientific popularization, it acquaints readers with some fundamental ideas of evolutionary theory and suggests ways to apply this ...

At a time when the “war on drugs” is still a losing battle, powerful lobbies and legislative forces resist the classification of nicotine-delivery systems (cigarettes) as drugs, and melatonin can escape the scrutiny of the Food and Drug Administration by ...

The word “drug,” in its double sense of therapeutic agent and substance of abuse, has an ancient and tortuous heritage stemming from social attitudes and scientific knowledge in other eras and places. The demarcation between use and abuse has been debated ...

The long debate over the future of Medicare grinds on, but the Republican-controlled Congress and the Clinton administration have agreed on the general thrust of reforms that, if enacted, would reshape this massive health insurance program in fundamental ...

Cyclophosphamide and Cisplatin Compared with Paclitaxel and Cisplatin in Patients with Stage III and Stage IV Ovarian Cancer Original Article, N Engl J Med 1996:334;1-6.. On page 1, in the Results paragraph of the Abstract, the fourth sentence should have ...

Case Records of the Massachusetts General Hospital (Case 2-1996) Case Records of the Massachusetts General Hospital, N Engl J Med 1996:334;176-183.. On page 181, in the left-hand column, the sentence beginning in line 20 should have read, “Low-molecular-...