Pneumococcal disease accounts for more deaths than any other vaccine-preventable bacterial disease.¹ Among the elderly, the case fatality rates for bacteremia approach 40 percent.²,³ Most cases are sporadic, and during the antibiotic era outbreaks caused ...

Epilepsy is among the most common neurologic disorders, affecting approximately two million people in the United States.¹ Epileptic-seizure recurrences sometimes follow a distinctive temporal pattern.²,³ Some patients periodically have repetitive seizures,...

Polycystic ovary syndrome, which affects approximately 6 percent of women of reproductive age and is characterized by chronic anovulation and hyperandrogenism,¹ is the most common cause of infertility in women in the United States. Insulin resistance with ...

Misoprostol is a synthetic prostaglandin E₁ analogue with greater antisecretory and mucosal-protective activity than natural prostaglandins. It is used to prevent and treat gastrointestinal lesions induced by nonsteroidal antiinflammatory drugs and upper ...

Figure 1. A 16-year-old girl presented with right-sided loin pain, anemia, and severe hypotension. Ultrasonographic scanning revealed multiple highly reflective lesions of various sizes consistent with the presence of angiomyolipomas (arrows in Panel A) ...

Figure 1. The skin of a two-year-old boy with mental retardation appears unspotted in a photograph taken in normal daylight (left-hand panel). A photograph taken under Wood's light shows a hypopigmented spot in the shape of a leaf from the mountain ash ...

The appropriateness of health procedures has commanded considerable attention recently.¹–³ Escalating health care costs and identification of inappropriate care have led to the critical examination of possible overuse and underuse of many medical and ...

Evaluations of the appropriateness of medical care have become more common in recent years. Investigators at RAND have developed a formal method for clinical experts to rate the appropriateness of medical care,¹–³ and they have applied this method in ...

Presentation of Case

A 53-year-old man with cardiac amyloidosis was admitted to the hospital because of hemoptysis and a pulmonary lesion.

The patient had first been seen at this hospital four years earlier because of atrial fibrillation, congestive heart ...

Last winter, the Texas Department of Health called me about an outbreak of pneumococcal pneumonia at a nursing home. When I mentioned the outbreak to my daughter, a third-year medical student, she asked, “How is that possible? Hadn't all the residents of ...

Three articles in this and the June 11 issue of the Journal give us an opportunity to reexamine issues that are critical to how we perceive and respond to seizures in children.¹–³ Seizures are frightening; they are unpredictable and can result in ...

In virtually all industrialized nations, the past decade has brought unprecedented scrutiny of the processes and outcomes of medical care, even as private and public payers press for further cost containment. An old management-consulting adage reads: “...

To the Editor: We would like to take issue with the call for the demise of the slow code (Feb. 12 issue).¹ Decisions concerning the intensity, duration, and appropriateness of the procedures performed during a code are made all the time. When the family ...

To the Editor: The article by Rösler and Witztum (Feb. 12 issue)¹ reporting the beneficial effects of the inhibition of gonadotropin secretion in men with paraphilia is an important contribution, but several problems will have to be solved before this ...

To the Editor: Primary hyperoxaluria type I is an autosomal recessive disorder characterized by a deficiency of liver-specific peroxisomal alanine–glyoxylate aminotransferase (EC 2.6.1.44). The disease leads to increased urinary excretion of oxalate, ...

To the Editor: Early diagnosis is paramount in the successful treatment of gastric cancer.¹ We have found that empirical treatment with a proton-pump inhibitor can delay the diagnosis as occurred in the first patient described below, and we have also ...

To the Editor: There is an error in Table 3 of Case 5-1998 (Feb. 12 issue),¹ which concerns a 51-year-old man with myelodysplasia and a pulmonary infiltrate. The percentage of blasts in the bone marrow of patients with chronic myelomonocytic leukemia ...

To the Editor: The Clinical Problem-Solving exercise by Saint et al. (Feb. 5 issue)¹ was a useful discussion of several important topics. However, the statement that “the diagnosis of iron deficiency is virtually ruled out by the normal ferritin ...

To the Editor: In his review of Dermatology in Emergency Care (Feb. 12 issue),¹ Dr. Greaves incorrectly uses the generic name ephedrine for a 2 percent phenylephrine spray used to treat a localized mucosal reaction. Phenylephrine hydrochloride is an α-...

To the Editor: The letter by Spingarn and Benjamin and the reply by Meissner (March 5 issue)¹,² highlight problems with the discussion about the merits of universal varicella immunization. All parties agree that the vaccine is safe and effective and that ...

At the end of the 12th century, King Richard the Lion-Hearted (ruled 1189 to 1199) lay on his deathbed, attended by both physicians and surgeons. This is the first European reference we have to a division between the fields of medical and surgical ...

Sushruta said more than 2000 years ago that to be a fit physician, one must have multiple virtues and be “fully equipped with supplies of medicine, surgical instruments and appliances.” The two books reviewed here describe surgical instruments and will ...

Emergency Medicine: Concepts and Clinical Practice has gained the reputation of being the standard reference textbook for the young specialty of emergency medicine. The 1998 fourth edition offers an extensive treatment of emergency medicine, with several ...