Dyspepsia affects 20 to 40 percent of the population of the Western world.¹–⁴ Upper gastrointestinal endoscopy of patients with dyspepsia reveals no abnormality in the majority; such patients are considered to have nonulcer, or functional, dyspepsia.⁵ The ...

Approximately one third of people in industrialized nations have recurrent dyspeptic symptoms, or dyspepsia, many of whom have no evidence of chronic peptic ulceration, reflux esophagitis, a malignant condition, or other defined organic disease.¹–⁴ The ...

In the United States, approximately 5 million people annually undergo evaluation in the emergency department for acute chest pain, at a cost of more than $6 billion.¹,² Most of these patients are admitted to the hospital; their average length of stay is ...

The prevention of Pneumocystis carinii pneumonia has had a substantial influence on the course of human immunodeficiency virus (HIV) disease.¹,² Although trimethoprim–sulfamethoxazole is the treatment of choice for prophylaxis against P. carinii pneumonia,...

Figure 1. A photomicrograph of a bronchoalveolar-lavage specimen shows an alveolar macrophage with a segmented nucleus (Giemsa stain, ×400).

Although much has been learned about the care of persons with human immunodeficiency virus (HIV) infection, there are persistent questions about the population under care, how much care they receive, where they get it, what it costs, and who pays for it. ...

Survival in a hostile environment requires the ability to mount a protective immune response while avoiding a reaction of the immune system against the self. We propose that the migration and localization of antigen are the governing factors in ...

Presentation of Case

A 13-year-old right-handed girl was admitted to the hospital because of a relapsing–remitting neurologic disorder.

She had had a normal childhood, although she was awkward at running, bicycle riding, and gymnastics. Twenty-six months ...

Federal officials were taken off guard recently by the announcement that nearly 100 managed-care plans had decided either to withdraw from the Medicare managed-care program or to end their participation in some regions of the country. More than 400,000 ...

The good news continues in the battle against AIDS. In the United States, the age-adjusted death rate among people with human immunodeficiency virus (HIV) in 1997 was less than 40 percent of what it was in 1995.¹,² The 16,685 deaths in 1997 represent the ...

Dyspepsia encompasses a variety of upper abdominal symptoms — pain and discomfort, bloating, fullness, early satiety, nausea, anorexia, heartburn, regurgitation, and belching — that are experienced regularly by 25 to 40 percent of the population of the ...

For much of this decade, managed care has led a private, market-driven “reform” of the U.S. health care system. The introduction of late-20th-century business practices into the cottage industry of medicine has not always been pleasant or productive. It ...

The 1997 Balanced Budget Act (Public Law 105-33) not only balanced the federal budget for the first time in decades but also mandated major changes in Medicare. One important goal of these changes was to expand the choice of health plans for Medicare ...

To the Editor: In their interesting study, Diel et al. (Aug. 6 issue)¹ demonstrate the efficacy of clodronate therapy when it is used in addition to standard systemic therapy in high-risk patients with early-stage breast cancer. However, it is unclear ...

To the Editor: In their article on perinatal transmission of the agent of human granulocytic ehrlichiosis, Horowitz et al. (Aug. 6 issue)¹ state that “in the general (nonpregnant) population, prophylactic antibiotics should not be prescribed routinely ...

To the Editor: Wright and Weinstein's article (Aug. 6 issue)¹ on the gains in life expectancy from medical interventions allows physicians to compare the value of different medical interventions in various at-risk populations. We have used similar data ...

To the Editor: Masters (Aug. 6 issue)¹ provides a fascinating pictorial account of the progression of a lesion caused by the bite of a brown recluse spider, from the initial stages to healing. He reported that the patient was treated with dapsone. ...

To the Editor: Even low doses of mastic gum — 1 mg per day for two weeks — can cure peptic ulcers very rapidly, but the mechanism responsible has not been clear. We have found that mastic is active against Helicobacter pylori, which could explain its ...

To the Editor: An upper-body distribution of fat, especially with increased visceral fat, is more predictive of the metabolic complications of obesity than is the degree of overweight.¹ Insulin resistance, type 2 diabetes mellitus, dyslipidemia, and ...

To the Editor: Irrespective of physicians' preferences, mineral oil is still very much in use, portending the uncommon risk of lipoid pneumonia, which was the subject of the February 19 Images in Clinical Medicine by Berg and Saenger.¹ In an assessment ...

The development of extracorporeal circulation and the ability to perform surgery on the human heart is one of the greatest achievements of medical science in the 20th century. The extraordinary efforts related to the development of these highest forms of ...

Cardiovascular disease is still the chief cause of death in our society. It is therefore not surprising that the field of cardiovascular science continues to expand rapidly, particularly at the cellular and subcellular levels. This expansion can cause ...

In the early 1970s, silent myocardial ischemia was defined as a condition in which the myocardium is underperfused, causing transient electrocardiographic (ECG) abnormalities that are not associated with the usual symptoms of a myocardial infarction (...

For a cardiologist, reviewing Cardiac Markers, written predominantly by and for clinical biochemists, feels uncomfortably like reading someone else's diary. However, the nature of this book's subject will encourage prying eyes. The inadequacy of clinical ...

Risk adjustment refers to the adjustment of payments to health plans (or to doctors) to reflect more accurately the actual health status or recent medical experience of patients. Risk adjustment has become an issue because payments by governments, ...