After Hibbard and Smithells suggested a possible association between low folic acid levels and congenital neural-tube defects,¹ seven subsequent epidemiologic studies supported the proposition that periconceptional folic acid supplementation may reduce ...

Osteoporosis is a common disorder characterized by reduced bone mineral density, deterioration of the microarchitecture of bone tissue, and increased risk of fracture.¹ Evidence from twin and family studies suggests that genetic factors have a major role ...

Glaucoma is a disorder of the optic nerves that is characterized by cupping of the optic-nerve head and loss of peripheral vision. Occasionally, there is also loss of central vision. Intraocular pressure is elevated in the majority of cases and is thought ...

Port-wine stains are congenital vascular malformations that occur in an estimated 3 children per 1000 births.¹ The stigma of a disfiguring facial birthmark may have a substantial effect on a child's social and psychosocial adjustment.²–⁵ Many methods have ...

Figure 1. A 53-year-old man with a family history of premature atherosclerosis, borderline hypercholesterolemia, and a 15-pack-year history of cigarette smoking was seen for intermittent claudication, which had been present for six months. On auscultation,...

The compression-of-morbidity hypothesis¹–³ suggests that it may be possible to reduce cumulative lifetime morbidity. Since chronic illness and disability usually occur late in life, cumulative lifetime disability could be reduced if primary-prevention ...

In 1969, McCully made the clinical observation linking elevated plasma homocyst(e)ine concentrations with vascular disease.¹ He reported autopsy evidence of extensive arterial thrombosis and atherosclerosis in two children with elevated plasma homocyst(e)...

Presentation of Case

A 35-year-old woman was admitted to the hospital because of obstructive pulmonary disease with cystic changes on computed tomographic (CT) examination of the chest.

The patient had been well until the age of 14 years, when she had the ...

Since the mid-1970s, 25 percent of American adults have regularly consumed a multivitamin containing 400 μg of folic acid. The current evidence suggests that people who take such supplements and their children are healthier. This evidence raises the ...

Over the past decade, we have applied the power of molecular biology to the study of human diseases, and we have identified genetic defects causing over 100 different diseases. Evidence of genetic causes of osteoporosis has been with us for some time. Yet ...

Glaucoma is the second leading cause of blindness in the world after cataract, affecting approximately 70 million people, about half of whom are estimated to have open-angle glaucoma.¹ Nearly as many people have angle-closure glaucoma, a disorder that is ...

Eighteen years ago, the Journal published an article entitled “Aging, Natural Death, and the Compression of Morbidity,” which has been widely cited and hotly debated ever since.¹ The author, James Fries, challenged the assumption that the aging of a ...

The phrase “quality improvement in health care” has come into widespread use since the early 1990s. As physicians, we are expected to heed the advice of the experts to strive continuously to improve the quality of care given to our patients. The concept ...

To the Editor: As occupational and environmental physicians, we disagree with Menzies and Bourbeau's assessment of building-related illnesses with respect to fungal and bacterial contamination (Nov. 20 issue).¹ In a growing number of investigations we ...

To the Editor: Pauwels et al. (Nov. 13 issue)¹ found that in patients with persistent symptoms of asthma despite treatment with inhaled glucocorticoids, the addition of formoterol to budesonide therapy or the use of a higher dose of budesonide may be ...

To the Editor: The hyper-IgE recurrent-infection syndrome (Online Mendelian Inheritance in Man no. 243700), also called Job's syndrome, is a rare immunodeficiency disorder that is characterized by recurrent staphylococcal skin abscesses, pneumonia, and ...

To the Editor: A major goal of antiretroviral therapy for human immunodeficiency virus (HIV) infection should be to keep the viral load undetectable or at least suppressed as fully as possible.¹,² For patients with detectable viral loads, changes in ...

To the Editor: Light-microscopical examination of blood smears is the cornerstone of the diagnosis of malaria. Recently, two rapid immunodiagnostic tests, the ParaSight F test (Becton Dickinson, Cockeysville, Md.)¹ and the ICT Malaria Pf test (ICT ...

To the Editor: In his Sounding Board article (Nov. 13 issue),¹ Melton ignores the very reasons he lists for why many people support legislation that requires specific consent on the part of patients for access to medical records by medical researchers. ...

To the Editor: An estimated 1 million serious accidental poisonings and 2 million suicide attempts involving organophosphorus compounds occur each year worldwide.¹ India ranks second in Asia in annual pesticide consumption.²

We prospectively studied 164 ...

Menopause is often of the utmost importance in a woman's life. Years before the last menstrual period, the transition from fertility to sterility can leave its mark. For many women this time of life is one of blood (disorders of the menstrual cycle), ...

Recent years have seen a surge in publications of all sorts in the field of cerebrovascular disease: research papers, reviews, and textbooks. Driving this activity is the burst of new information about the mechanisms underlying ischemic or hemorrhagic ...

The future of diagnostic sonography in today's era of cost containment is unclear. As compared with magnetic resonance imaging (MRI) and computed tomography (CT), sonography has the disadvantages of a limited field of view, poorer resolution, operator ...

Clinical follow-up is a neglected field in oncology. Although attention is focused on detecting and treating primary cancers and cancer recurrence, follow-up strategies all too frequently do not receive the same attention. Many of these strategies are ...

Part 1 of this article described three cost-saving health care strategies embraced by large employers: channeling employees into managed-care plans, increasing the negotiating power of employers by aggregating them into regional purchasing coalitions, and ...