Since its introduction into endoscopic retrograde cholangiopancreatography (ERCP) in 1974,¹,² endoscopic biliary sphincterotomy has become a common procedure; approximately 150,000 such procedures are performed annually in the United States. ...

Endoscopic retrograde cholangiopancreatography (ERCP) is used to diagnose and treat diseases affecting the biliary and pancreatic tracts. Manipulation of the papilla of Vater, however, is associated with serum pancreatic-enzyme elevations in up to 70 ...

The transmissible spongiform encephalopathies constitute a group of uniformly fatal neurodegenerative diseases. These diseases include Creutzfeldt–Jakob disease and kuru, among others, in humans,¹,² scrapie in sheep and goats, and spongiform ...

Among people in the United States who smoked in 1991, 71 percent reported that they tried their first cigarette before the age of 19 years.¹ In the 1950s many more boys than girls smoked, but adolescent girls now take up smoking at least as frequently as ...

Ethanol is a strong myocardial depressant, and its short-term hemodynamic effects have been studied in normal subjects¹–⁶ and in persons with a history of excessive intake.⁷ The vasodilatation associated with the intake of ethanol may improve left ...

Figure 1. Seven days before admission, nausea and crampy abdominal pain developed in a 65-year-old woman with a history of cholecystitis and cholelithiasis. Two days before admission, the pain became more intense, and she vomited, had no bowel movements, ...

Recent years have brought major advances in our understanding of the molecular genetic basis of both types of multiple endocrine neoplasia (MEN), an autosomal dominant cancer syndrome. MEN type 1 (MEN-1 [designated “MEN 1” by the Second International MEN ...

Presentation of Case

An 81-year-old, right-handed man was admitted to the hospital because of progressive disorientation and repeated falls.

The patient had been well until six weeks earlier, when he was believed to have been in an unwitnessed automobile ...

Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy for gallstone removal and the insertion of biliary and pancreatic stents is the most difficult gastrointestinal endoscopic procedure. Success rates depend on the proper ...

The transmissible spongiform encephalopathies, or prion diseases, are neurodegenerative conditions that affect both humans and animals. They are transmissible experimentally both within and between mammalian species by inoculation with infected tissues ...

Until recently, we relied primarily on professional judgment to ensure that patients received high-quality medical care. Hospitals routinely monitored poor outcomes, such as deaths or infections, to identify ways to improve the quality of care. In rare ...

To the Editor: As a clinical nurse specialist and cochairperson of the Hospital of the University of Pennsylvania's ethics committee, I am compelled to respond to Asch's study (May 23 issue)¹ by stating that this research has unnecessarily induced public ...

To the Editor: The article by den Heijer et al. (March 21 issue)¹ supports our finding that hyperhomocysteinemia is a risk factor for deep-vein thrombosis that is independent of coexisting abnormalities of naturally occurring anticoagulants.² This ...

To the Editor: The article by Després et al. (April 11 issue)¹ purports to demonstrate an association between hyperinsulinemia and ischemic heart disease that is independent of other known risk factors, including diabetes mellitus. However, the criteria ...

To the Editor: The expression of major-histocompatibility-complex (MHC) class II genes (HLA-DR, DP, and DQ) is tightly regulated at the transcriptional level.¹ The complete absence of MHC class II molecules on all the cells of patients with MHC class II ...

To the Editor: My initial response to the “new” New England Journal of Medicine that lay on my desk that fateful Friday morning of July 5, 1996, was to turn as white as the cover while murmuring, “Et tu, Brute?” As a faithful 12-year reader of the ...

Kluger's newest work, about Camel, Chesterfield, Lucky Strike, Old Gold, Pall Mall, and Marlboro cigarettes, is the definitive history of the cigarette in this country. It tells how Buck Duke and Dick Reynolds created the foundations of empires with ...

Extensive research links tobacco use with addiction, lung cancer, and heart disease. Yet, among recent lawsuits against tobacco companies brought by families of persons who died from lung cancer, only two have demonstrated liability. Why is the tobacco ...

Family Violence: A Clinical and Legal Guide examines the psychological sequelae for victims of family violence and provides important information about therapeutic interventions. It addresses the physical abuse, neglect, and maltreatment of children and ...

Hobbs and Wynne state that this photographic atlas represents a unique way of recording some of their accumulated experience. Of the 140 pages in the book, 9 contain text and tables. A total of nine references are cited, of which three are the authors' ...

On August 23, the Food and Drug Administration (FDA) issued a regulation restricting the sale and distribution of cigarettes and smokeless tobacco to children and adolescents.¹ This regulation, known as a rule, is the most far-reaching measure ever ...

The quality of medical care provided by managed-care plans is an increasingly complicated and controversial topic.¹–⁷ Traditionally, the quality of care has been measured by professional judgment, often rendered subjectively in individual cases.⁸ Now, as ...