When Ashbaugh et al.¹ described the acute respiratory distress syndrome (ARDS) in 1967, they suggested that the clinical and pathological findings in patients with this condition were in part due to abnormalities in the alveolar wall. Petty et al.²,³ ...

Chronic hepatitis B is associated with high morbidity and mortality. Several randomized clinical trials have reported that therapy with recombinant interferon alfa increases the rate of elimination of hepatitis B e antigen (HBeAg), from a low rate of ...

Chemotherapy can induce a remission in up to 85 percent of children with acute myeloid leukemia (AML).¹–⁷ However, most patients relapse, and the long-term event-free survival ranges from 29 to 45 percent.¹–⁷

The high rates of relapse in these children ...

Gastroduodenal damage can be seen on endoscopy in 20 to 40 percent of people who take nonsteroidal antiinflammatory drugs (NSAIDs). In epidemiologic studies, the risks of peptic ulcer and death are three to six times higher among people who take these ...

Figure 1. A kidney biopsy in a 34-year-old man with IgA nephropathy showed mesangial-cell proliferation and predominant mesangial IgA deposition. At the time of the biopsy, the patient's serum creatinine and blood urea nitrogen levels were 1.3 mg per ...

Despite strategies such as prospective payment and required approval for hospitalization before admission, costs of inpatient care in 1993 accounted for $327 billion, or 42 percent of national spending for medical care.¹ Readmissions account for up to ...

Acute renal failure is characterized by a deterioration of renal function over a period of hours to days, resulting in the failure of the kidney to excrete nitrogenous waste products and to maintain fluid and electrolyte homeostasis. In the past five ...

Presentation of Case

A 48-year-old man with the acquired immunodeficiency syndrome (AIDS) was admitted to the hospital because of bloody diarrhea and severe abdominal pain.

Two years earlier, the patient had been found to have advanced AIDS and ...

Acute respiratory distress syndrome (ARDS) continues to be a major cause of morbidity and mortality in critically ill patients. In this issue of the Journal, Anzueto et al.¹ report the results of a large, multicenter, randomized trial that was carried out ...

Interferon alfa was approved as therapy for chronic hepatitis C in the United States in 1991 and for chronic hepatitis B in 1992. These approvals were based on the results of randomized, controlled trials showing that four-to-six-month courses of ...

Imagine you are watching a sunset with friends in the early 16th century. Imagine the difficulty you have in challenging their conclusion that the sun revolves around the earth because it does not fit with your latest observations of planetary motion. ...

To the Editor: In their excellent commentary in the Clinical Problem-Solving article “A Broken Heart” (Feb. 1 issue),¹ Drs. Zahger and Milgalter describe the difficulties in diagnosing subacute ventricular-wall rupture after myocardial infarction. ...

To the Editor: According to the World Health Organization and the American College of Cardiology, type II second-degree atrioventricular block is defined as a single nonconducted P wave associated with constant PR intervals before and after the blocked ...

To the Editor: Barst et al. (Feb. 1 issue)¹ report better clinical improvement and survival in 41 patients with primary pulmonary hypertension treated with a 12-week continuous intravenous infusion of epoprostenol (no deaths) than in 40 patients ...

To the Editor: In their review article on group A streptococcal infections of skin and soft tissues (Jan. 25 issue),¹ Bisno and Stevens point out that it may be difficult to differentiate necrotizing fasciitis from cellulitis. The distinction is critical,...

To the Editor: The Case Records in the January 18 issue of the Journal ¹ reflects the difficulties in distinguishing focal nodular hyperplasia from the fibrolamellar variant of hepatocellular carcinoma. Polysomies of chromosome 1, detected by ...

To the Editor: The hepatitis C virus (HCV) has been shown to cause progressive and chronic liver damage.¹ Interferon therapy apparently eradicates HCV in 20 to 30 percent of patients, but the follow-up in published studies is generally short (6 to 18 ...

To the Editor: Skelton and Fried recently coined the phrase “headphone neuralgia” (Dec. 28 issue).¹ The external ear, unlike its middle and internal counterparts, is a major neurologic crossroads. Its canal and the outer surface of the tympanic membrane ...

This book is as bold and ambitious in scope as its title promises. It includes contributions from former president Jimmy Carter, former surgeon general C. Everett Koop, and 41 other world leaders, representing medical associations, the World Health ...

For the first time, the most recent dietary guidelines for Americans focus on the interactive roles of exercise and diet in health promotion and disease prevention. The Joint Commission on Accreditation of Healthcare Organizations now requires health ...

If we Americans were as committed to the bottom line as we are reputed to be, we would long since have arranged for every child's vaccinations. Nothing offers a better return on the dollar than measles inoculations, as editors Howard S. Frazier and ...

In 1898, Dr. Patrick Manson wrote that “A manual on the diseases of warm climates, of handy size, and yet giving adequate information, has long been a want; for the exigencies of travel and tropical life are, as a rule, incompatible with big volumes.” The ...