Premenstrual syndrome is a cyclical disorder characterized by mood-related and somatic symptoms that occur during the luteal phase of the menstrual cycle and disappear at or soon after the onset of menstruation. The pathophysiologic role of the luteal ...

Anal fissure, first recognized as a clinical entity in 1934,¹ is a split extending from the anal verge toward the dentate line. Ninety percent of primary fissures are posterior; the pathogenesis is thought to be related to severe constipation or to ...

At the end of 1996, more than 34,000 patients undergoing dialysis were on the national waiting list for kidney transplants, but only about 8600 cadaveric kidneys were transplanted in that year.¹ The number of patients awaiting cadaveric kidneys has ...

Spontaneous hyperinsulinemic hypoglycemia in adults is most frequently caused by sporadic, solitary pancreatic beta-cell tumors, whereas hyperinsulinemic hypoglycemia in childhood is commonly caused by generalized beta-cell dysfunction.¹ Mutations in the ...

Figure 1. A throbbing headache, diffuse abdominal pain, fever (temperature, 40°C [104°F]), hepatosplenomegaly, and pancytopenia (white-cell count, 3800 per cubic millimeter; hematocrit, 31 percent; and platelet count, 78,000 per cubic millimeter) ...

Faced with an increasing loss of autonomy in the managed care marketplace, physicians often view the debate about the quality of care as simply about finding ways to reward them for doing less for patients and to control costs by the use of arbitrary ...

Hemoglobin is essential for oxygen transport, and the study of its structure and function has led to numerous discoveries that have shaped modern biologic science.¹ This review will examine how hemoglobin actively regulates oxygen transport and will ...

Presentation of Case

A 31-year-old woman was admitted to the hospital because of fever, cough, questionable pneumonia of the left lower lobe with a left pleural effusion, and ascites.

The patient had been well until one month earlier, when she began to ...

During the past decade premenstrual syndrome has become a well-defined entity.¹ The hallmark of the syndrome is the repeated occurrence of behavioral and somatic symptoms severe enough to impair a woman's social and work-related functioning during the ...

It has been said that all patients with anorectal symptoms come to the doctor reporting hemorrhoids or worrying about cancer. Among the myriad other diagnostic possibilities, one of the most common is anal fissure. This small tear in the anal skin just at ...

This issue of the Journal contains a report by Evans and his colleagues at LDS Hospital in Salt Lake City that describes a computer-assisted management program for antiinfective agents.¹ At face value, this program helps physicians to manage infections, ...

To the Editor: Hirschfeld and Russell's algorithm for treating suicidal patients (Sept. 25 issue)¹ does not emphasize the fundamental importance of psychodynamic formulation and brief psychotherapy in clarifying and managing a suicidal crisis. Although ...

To the Editor: In the October 9 issue, Lang et al.¹ report on the effects of posteroventral medial pallidotomy in 40 patients with advanced Parkinson's disease. Despite the conclusion that this is an effective treatment, none of the patients had ...

To the Editor: In the review of the systemic amyloidoses by Falk et al. (Sept. 25 issue),¹ the comments about the treatment of immunoglobulin-light-chain–related (AL) amyloidosis with high-dose chemotherapy and stem-cell infusion may be premature. We and ...

To the Editor: From May 1995, when metformin was introduced in the United States, through June 30, 1996, the Food and Drug Administration (FDA) received reports of lactic acidosis in 66 patients treated with metformin. In 47 patients, the diagnosis was ...

To the Editor: In the December 4 Image in Clinical Medicine my guess is that the twin on the right (Figure 1)¹ has Addison's disease. But that seems too obvious to be correct.

To the Editor: “Do not fear me that I am bronzed, that the sun has tanned me. ...

To the Editor: Rosenheck et al. (Sept. 18 issue)¹ reported a comparison of clozapine and haloperidol in patients hospitalized for refractory schizophrenia. They excluded patients previously treated with clozapine but not those previously treated with ...

To the Editor: The review of Living Downstream, by Berke (Nov. 20 issue),¹ appears to have violated the Journal's policy concerning conflict of interest. Beneath the book review Dr. Berke is identified only by what appears to be a home address, a common ...

Thomas R. Kuhn, in The Structure of Scientific Revolutions (2nd ed. Chicago: University of Chicago Press, 1970), describes scientific progress as a series of revolutions, which he calls paradigm shifts. According to Kuhn, knowledge advances when an ...

Improvements in the surgical and medical care of infants and children with congenital heart disease are one of the most spectacular medical success stories of the past quarter-century. Diseases such as simple D transposition, truncus arteriosus, and ...

Interventional cardiology is such a rapidly progressing discipline that textbooks run the risk of being outdated by the time they are printed. To keep track of all developments requires regular attendance at major meetings. Such a meeting was the Second ...

Despite remarkable progress in the past two decades in preventing myocardial infarction and stroke, the thrombotic complications of the atherosclerotic process are still a leading cause of morbidity and mortality. The demonstration that streptokinase, a ...