Prompt, complete restoration of coronary flow is the principal mechanism by which reperfusion therapy improves survival and other clinical outcomes in patients with acute myocardial infarction in whom there is electrocardiographic evidence of ST-segment ...

Sudden out-of-hospital cardiac arrest remains a clinical problem. Despite community-based interventions, overall survival is still low.¹,² The frequency of acute coronary occlusion in survivors of out-of-hospital cardiac arrest ranges from 36 percent in ...

Sciatica due to a herniated nucleus pulposus is an important medical and socioeconomic problem.¹ Although the majority of patients recover with conservative management, 10 to 15 percent need surgery.² Epidural corticosteroid injections were first used to ...

The human immunodeficiency virus (HIV) increases the risk of aggressive B-cell lymphoma,¹,² which often presents at an advanced stage and frequently involves extranodal sites, such as the central nervous system and bone marrow.³–⁷ In HIV-infected patients,...

Figure 1. The black widow spider, of the genus latrodectus, is found predominantly in the southern and western United States but inhabits every state except Alaska. The mature female has a leg span of up to 5 cm (including the body) and a body length of ...

Since 1991, some of the over 690,000 U.S. veterans of the Persian Gulf War have conceived children born with birth defects, and these children have been the object of much speculation. There have been allegations that the Gulf War veterans had unusual ...

Multiple myeloma is a disorder in which malignant plasma cells accumulate in the bone marrow and produce an immunoglobulin, usually monoclonal IgG or IgA. Common complications of overt multiple myeloma include recurrent bacterial infections, anemia, ...

In this issue of the Journal, Asch and Ubel call our attention to a common problem for physicians — namely, whether to choose the “best” test or treatment for their patients or a second-best, cheaper one.¹ They illustrate the problem with several ...

Although many clinicians and health policy makers are comfortable with the notion that some beneficial health care services are simply too expensive to provide, fewer are comfortable using the word “rationing” to describe these compromises. The word is so ...

On January 8, 1997, the U.S. Supreme Court heard oral arguments in Vacco v. Quill ¹ and Washington v. Glucksberg, ² the two cases concerning whether a state may prohibit persons in the terminal stage of an illness from obtaining the assistance of their ...

To the Editor: In their report on intraperitoneal versus intravenous cisplatin for stage III ovarian cancer, Alberts et al. (Dec. 26 issue)¹ suggest that among the patients with microscopical disease (no gross residual disease), the rates of complete ...

To the Editor: Dr. Sinaiko's review of hypertension in children (Dec. 26 issue)¹ includes a recommendation to use oral nifedipine capsules for urgent or emergency treatment of hypertension. Dr. Sinaiko states, “For rapid absorption the drug must first be ...

To the Editor: In their report on the Multicenter Automatic Defibrillator Implantation Trial (MADIT), Moss et al. (Dec. 26 issue)¹ note the lower mortality in a group of patients receiving implantable defibrillators for unsustained ventricular ...

To the Editor: Nonbacterial thrombotic endocarditis is a rare clinical entity whose cause is poorly understood.¹–⁴ We describe a father and his two daughters who had this disorder and associated cerebral embolic strokes.

A 34-year-old, previously healthy ...

To the Editor: Hammoudeh and Haft (Dec. 26 issue)¹ report on 15 patients in whom acute coronary syndromes developed during or immediately after shoveling snow. They suggest that evidence of rupture of coronary plaque and acute thrombosis associated with ...

To the Editor: Dr. Loxterkamp's essay “Hearing Voices,” on the anguish and rewards of general practice (Dec. 26 issue),¹ calls on physicians to respond to the needs of patients, using their experience as a moral guide. However, the brief sketch of the ...

To the Editor: The Harvard Medical Practice Study is responsible for the widely cited extrapolation implying that America's doctors “kill 80,000 patients a year,”¹,² and the study authors have previously asserted that there are, if anything, too few ...

Hypertension was once considered almost exclusively the province of internists. However, an extensive body of clinical and epidemiologic research now clearly points to the antecedents of essential hypertension in childhood. With this realization, ...

For a rare disease such as pheochromocytoma, general physicians will find most of the information they need in the regularly updated editions of standard general textbooks of medicine. It may be thought that with instant access to specialist literature in ...

The editors of Diabetes Mellitus: A Fundamental and Clinical Text have endeavored to bring together the latest information on the cellular, molecular, and therapeutic developments in the field. The result of their efforts is a comprehensive book in which ...

The antiphospholipid-antibody syndrome is enigmatic for several reasons. Until recently, there was no standardized definition of the syndrome. The associated antibodies (lupus anticoagulant and anticardiolipin antibody) can come and go in a given patient, ...