Several hereditary disorders predispose people to colorectal cancer. Among these the polyposis syndromes have distinctive clinical features,¹ whereas the diagnosis of hereditary nonpolyposis colorectal cancer is based mainly on family history. The lack of ...

Platelet activation and aggregation, with resultant arterial thrombus formation, are pivotal in the pathophysiology of acute coronary syndromes.¹,² The development of inhibitors of fibrinogen binding to the platelet glycoprotein IIb/IIIa receptor has ...

Platelet activation and aggregation are central to the pathophysiology of unstable angina. After plaque fissure or rupture, the activation, adherence, and aggregation of platelets may cause either nonocclusive or occlusive thrombus formation.¹ ...

Many patients with chronic lymphocytic leukemia (CLL) have long lives and die of causes unrelated to the disease.¹,² Rai's classification³–⁵ and Binet's staging system⁶ have improved the identification of the indolent form of the disease (Table 1), and ...

Figure 1. A 50-year-old man with a primary lymphoma of the central nervous system in the left thalamus had a normal, symmetric face at rest (Panel A) and on voluntary movement, showing his teeth (Panel B), but had weakness of the lower right side of the ...

Mother Nature has no mercy. As a consequence, the presence of one disease usually provides no immunity against others. Given the laws of probability, the coincidental occurrence of two unrelated diseases in one patient must happen often in a large ...

The acquired form of diverticular disease is extremely common in Western society, affecting approximately 5 to 10 percent of the population over 45 years old and almost 80 percent of those over 85.¹ It is estimated that symptomatic diverticulitis will ...

Presentation of Case

A 24-year-old man was admitted to the hospital because of the acute respiratory distress syndrome.

The patient had been well until several days earlier, when he began to have nasal congestion with green discharge, myalgia, dry cough, ...

The recent discovery of the genetic basis of certain familial aggregations of colorectal cancer validated 90 years of clinical observation suggesting that such aggregations are hereditary.¹ It also promised the ability to detect asymptomatic carriers of ...

Coronary atherosclerosis develops over decades and then may suddenly lead to an acute coronary event. Often this occurs in an artery with a minor stenosis. The culprit lesion usually has a large lipid core containing tissue factor, and it is covered by a ...

How many medications are optimal for a patient with multiple medical problems? Prescribing too many increases the likelihood of side effects, drug interactions, and poor compliance. Prescribing too few may leave important conditions or symptoms untreated. ...

To the Editor: Malacrida et al. (Jan. 1 issue)¹ describe a hospital-based analysis of the outcome of acute myocardial infarction in women and men. They conclude that, after adjustment for various prognostic factors including age, there is a small ...

To the Editor: The Clinical Problem-Solving case “A Hidden Agenda” (Jan. 1 issue)¹ demonstrates the challenges involved in diagnosing an illness in a patient who denies having risk factors for human immunodeficiency virus (HIV) infection and refuses ...

To the Editor: The article by Bartalena et al. (Jan. 8 issue)¹ on therapy for hyperthyroidism and Graves' ophthalmopathy could be important in establishing practice precedents. Clarification of the following points is needed to define more fully the ...

To the Editor: An epidemic of bilateral optic neuropathy, often with sensorineural hearing loss and symptoms of peripheral neuropathy, is affecting young adults in Dar es Salaam, Tanzania.¹,² The disease is clinically identical to that seen in the recent ...

To the Editor: Sobel states that simple diagnostic criteria are sufficient for the diagnosis of bacterial vaginosis but that few clinicians are trained to use microscopy (Dec. 25 issue).¹ We believe that clinicians can use wet mounts to demonstrate the ...

To the Editor: In his discussion of an 11-year-old boy with a seizure (Jan. 8 issue),¹ Riviello states that in pseudotumor cerebri, pleocytosis is typically present on lumbar puncture. Our experience is that the lumbar puncture is normal. Pseudotumor ...

To the Editor: Many drugs and foods affect the response to oral anticoagulants.¹ We describe a change in the international normalized ratio (INR) that was caused by the consumption of fiddleheads.

A 73-year-old man with atrial fibrillation had an INR of ...

During the first half of the 20th century, the infectious causes of many common childhood diseases became widely understood. The lives of numerous children were saved by improving sanitation, educating parents about hygiene and the communicability of ...

Just about 100 years ago, American medical students were being taught the “germ theory” of infectious disease for the first time as scientific orthodoxy. This theory replaced the older “zymotic theory,” which was based on the concept that the agents of ...

The loss of a baby, whether by miscarriage, stillbirth, or postnatal death, is as profound a loss as anyone could expect to experience. Anyone involved in the care of pregnant women and their families can attest to the intensity of these experiences. For ...

Tobacco Litigation Correspondence, N Engl J Med 1997:336;1832-1834.. In the letter by Rabinoff, on page 1833, the second part of the sentence that begins in the second line of the third paragraph should have read, “the rate of decline in tobacco ...

Prepaid group health care began in the 1940s as an insurgent, even radical form of medicine. At the time, few Americans had health insurance. The early programs would later be called group or staff models — closed systems with salaried doctors and an ...