Institutionalized populations may be affected disproportionately by outbreaks of certain respiratory infections.¹–⁹ Transmission to surrounding communities is frequently a matter of concern, although quantitative assessments of the risk in the community ...

Asthma affects 5 to 7 percent of the population of North America and Europe; about 60 to 70 percent of patients with asthma have mild disease and are treated with inhaled β-agonists.¹–⁴ Before 1990, a number of standard reference works recommended the use ...

The role of triglycerides in atherosclerosis¹ is controversial. We investigated the role of triglyceride-rich particles in atherosclerosis by studying patients with an inherited disorder of triglyceride metabolism, deficiency of lipoprotein lipase.

...

Ornithine transcarbamylase (ornithine carbamoyltransferase) deficiency is an X-linked disorder in which the synthesis of citrulline, and hence urea, from carbamoyl phosphate and ornithine is impaired. The consequences include hyperammonemia, ...

Insulin-dependent diabetes mellitus is an autoimmune disease in which the beta cells of the islets of Langerhans are selectively destroyed.¹ In a patient with this disease, a transplanted pancreas should be as susceptible to the autoimmune process as the ...

Figure 1. A computed tomographic scan of a 73-year-old man with acute epigastric pain and abdominal distention shows gas in the portal venous system (arrows). A plain film of the abdomen did not reveal the gas within the liver. The patient was taken to ...

Renal-cell carcinoma is characterized by a lack of early-warning signs (which results in a high proportion of patients with metastases), diverse clinical manifestations, and resistance to radiotherapy and chemotherapy, and there is a potential role for ...

Presentation of Case

A 59-year-old man was admitted to the hospital because of a painful preauricular mass.

He had been well until five months earlier, when he noticed a mild hearing impairment in the right ear. Several weeks later, the hearing loss ...

Suddenly, “quality” has become the watchword among those who care about the American health care system, and attempts to measure it are giving rise to a whole new industry. Just three short years ago, during the debate about the Clinton plan for reforming ...

On the binding of an old book on the shelf in my office is imprinted “Common Contagious Diseases — Stimson.”¹ Fifty years ago, when it was published, medical and nonmedical people alike could have told you, without even checking the table of contents, ...

The introduction of selective, potent inhaled β₂-agonists more than 30 years ago revolutionized the treatment of asthma. Until that time, nonselective sympathomimetic agents, such as ephedrine and epinephrine, which stimulate both α- and β-adrenergic ...

Given the autoimmune cause of insulin-dependent diabetes mellitus,¹ the theoretical barriers to successful pancreatic and islet transplantation are autoimmunity (destruction of beta cells due to recurrent autoimmunity) and alloimmunity (rejection of ...

Of the many issues now confronting medical professionals, none seems more perplexing than the debate about the quality of care. Just a few years ago, physicians could be confident that they alone had a social mandate to judge and manage the quality of ...

To the Editor: The elderly patients studied by Weinberger and colleagues (May 30 issue)¹ may have had additional access to physicians and nurses during the six-month period after their discharge from the hospital, but the question remains: Did they ...

To the Editor: Methotrexate is effective in the treatment of a number of chronic diseases, such as Crohn's disease,¹ but concern about long-term hepatotoxicity has limited its widespread use. Although elevated serum aminotransferase concentrations are ...

To the Editor: Dr. Woodward (April 25 issue)¹ points to Maryland's Medical care Data Base, established by the Health Care Access and Cost Commission, as one example of how patients' privacy is being eroded. Dr. Woodward is misinformed.

The data base ...

To the Editor: Herron provides striking photographs of a patient with smallpox in the May 16 issue.¹ Of course, 1996 is the 200th anniversary of Edward Jenner's first use of vaccination against smallpox, in Berkeley, England. Jenner's courageous act was ...

I'll lead you about a round,/Through bog, through bush, through brake, through brier:/Sometime a horse I'll be, sometime a hound,/A hog, a headless bear, sometime a fire.” The confusion about identity that the magical Puck inspires in A Midsummer Night's ...

Several large books on clinical neurology have been published over the past few years, so the need for yet another one merits consideration. As indicated in the preface, two specific aims justify this book: it is intended for clinicians seeing outpatients ...

Surgical correction of lesions of the extracranial arterial circulation, after evolving over a period of four decades, has been refined until it is now a safe and effective approach for the prevention of stroke. Although controversial for several years, ...

Pain Management: Theory and Practice is an ambitious attempt to integrate recent advances in pain research and therapy within and across disciplines, with particular emphasis on clinical management. The editors are aware of their daunting task and have ...

Images in Clinical Medicine: Placental Malaria Images in Clinical Medicine, N Engl J Med 1996:335;98.. In the second paragraph of the legend, the “blue-staining chromatin of the parasite” is said to be indicated by a “long arrow.” In fact, as the result ...