Stroke, the third leading cause of death in the United States, will continue to be a challenging problem as the population ages. Patients who undergo myocardial revascularization procedures, now more than 800,000 a year throughout the world, are ...

For over two decades, physicians have attempted to define the best methods of discontinuing mechanical ventilation in patients recovering from respiratory failure. An early study of weaning¹ noted that the clinical decision to discontinue mechanical ...

Patients with congenital lipoid adrenal hyperplasia, the most severe genetic disorder of steroid hormone biosynthesis, have a severe defect in the conversion of cholesterol to pregnenolone, the first step in adrenal and gonadal steroidogenesis. Deficient ...

Figure 1. A 47-year-old woman presented with dyspnea on exertion and a history of having awoken at night with a sensation of choking twice in the previous week. She had been discharged from the hospital three weeks earlier, after an episode of severe ...

A common strategy of health care organizations in the United States to reduce use of medical services is to increase the use of primary care physicians and limit access to specialists.¹,² Because primary care physicians have been found to provide care ...

There is considerable geographic variation in the use of coronary angiography and revascularization within the United States and internationally, both in general populations¹–³ and among patients who have had myocardial infarctions.⁴–⁸ It is less clear ...

All proteins in mammalian cells are continually being degraded and replaced. In the cytosol, nucleus, and organelles, individual proteins are degraded at widely differing rates; some cytosolic enzymes have half-lives as short as 10 minutes, whereas others ...

Presentation of Case

A 30-year-old right-handed man was admitted to the hospital because of a generalized tonic–clonic seizure and a left temporal-lobe mass.

The patient had been well until three months earlier, when a pruritic eruption developed on his ...

Mechanical ventilation is used primarily to support patients whose respiratory function is so compromised by drugs, disease, or other conditions that they cannot adequately breathe without assistance. Mechanical ventilation is also used in some patients ...

It seems just yesterday that the value of specialty training was unchallenged and the health benefits associated with the care and procedures provided by subspecialists were unquestioned. In cardiology, for example, the extra two or three years of ...

To the Editor: Mr. Kuttner has written an illuminating two-part report on the for-profit hospital business, highlighting the dominant player in the game, Columbia/HCA (Aug. 1 and Aug. 8 issues).¹ He correctly points out that not-for-profit hospitals, ...

To the Editor: Boele van Hensbroek et al. and Hien et al. (July 11 issue)¹,² conclude that artemether is a safe and effective alternative to quinine in the treatment of severe malaria. Curiously, the data in the two reports do not fully support this ...

To the Editor: Acquired alveolar proteinosis is a rare lung disease of adults characterized by excessive accumulation of surfactant.¹ Standard therapy is whole-lung lavage, which usually provides temporary symptomatic benefit.¹ In mice lacking the ...

To the Editor: In the Clinical Problem-Solving article entitled “The Domino Principle” (Aug. 1 issue),¹ Jaffe and Zahger describe an assumed anaphylactic reaction that produced shock and subsequent myocardial ischemia. What is unusual in this case is the ...

To the Editor: In their analysis of hospice enrollment patterns, Drs. Christakis and Escarce (July 18 issue)¹ analyzed Medicare-certified hospice providers as independent agencies, without recognizing their relation to other providers of home care. In ...

To the Editor: The recent analysis of Columbia/HCA Healthcare and its view of medicine as a business venture (Aug. 1 and Aug. 8 issues)¹ is complemented nicely by an advertisement² in the promotional magazine sent to all households in the area of our ...

Gynecologic Oncology: Current Diagnosis and Treatment is, in the words of the editors, “targeted at the postgraduate textbook level.” It comprehensively reviews the current management of gynecologic cancer, with special chapters on techniques important to ...

For years, gynecologists have been the sole providers of health care for many women, especially those of reproductive age. Often office visits have focused on contraceptive issues, breast and pelvic examinations, and Pap smears. With the arrival of ...

When one first picks up this monograph and reads the introductory statement concerning its uniqueness, expectations are raised that this may be a concise compilation of the adverse effects of medications on fertility and sexual function. However, what one ...

The ovary is one of the most interesting organs in women. Besides its physiologic role — to produce steroid hormones and eggs — it gives rise to a wide array of neoplasms, benign and malignant. The editors of this book attempt to discuss in a single ...

This book is a collection of papers dealing with obstetrical anesthesia. It will appeal primarily to anesthesiologists. The material is heavily weighted toward the management of labor pain with regional anesthesia and the management of cesarean section. ...