Lyme disease, which is caused by the tick-borne spirochete Borrelia burgdorferi, is now the most common vector-borne disease in the United States.¹ Since the initial descriptions of Lyme disease in 1977,²,³ the number of cases has increased dramatically, ...

Lyme disease is a multisystem inflammatory disease caused by Borrelia burgdorferi, transmitted by the bite of infected ixodes ticks. B. burgdorferi elicits an antibody response to a repertoire of borrelial proteins, including outer-surface protein C (OspC)...

Dissemination to locoregional lymph nodes is an important prognostic factor in colorectal cancer. Five-year survival rates drop from 80 percent in patients with tumor–node–metastasis (TNM) stage II disease (who have no lymph-node metastases) to 45 to 50 ...

Diabetes is associated with a marked increase (by a factor of two to four) in the risk of coronary heart disease.¹–⁴ Clinically established coronary heart disease itself is associated with an increase in mortality from coronary heart disease by a factor ...

Figure 1. A 27-year-old man had had a pruritic and eczematous rash for three days. One week earlier, he had peeled a mango, become distracted by a telephone call, and rested his left hand on his right leg. Three days later, contact dermatitis became ...

The human immunodeficiency virus (HIV) has infected nearly 900,000 persons in North America and more than 30 million worldwide.¹,² Since the initial description of eye abnormalities in HIV-positive patients more than 15 years ago,³ numerous reports have ...

When bleeding is the consequence of a specific defect of hemostasis, the goal of treatment is to correct the defect. A typical example is the replacement of factor VIII by transfusion in patients with hemophilia. Specific treatment may be impossible, ...

Presentation of Case

A 74-year-old man was admitted to the hospital because of recurrent lymphoma, with paraplegia.

Nine and a half years earlier, a computed tomographic (CT) scan of the head had shown a mass in the base of the tongue, with left cervical ...

Lyme disease is an inflammatory disorder that can involve the skin and the musculoskeletal, neurologic, and cardiovascular systems.¹ The etiologic agent, Borrelia burgdorferi, was isolated from tick vectors in 1982² and subsequently from patients in 1983.^...

Successful treatment is available for many neoplasms, but patients with cancer often die despite therapy because of a disseminated tumor that was not detected at the time of diagnosis. Surgery alone is sometimes enough to cure a patient with a solid tumor,...

To the Editor: Cook et al. (March 19 issue)¹ found that among critically ill patients requiring mechanical ventilation, those receiving ranitidine had a significantly lower rate of clinically important gastrointestinal bleeding than those treated with ...

To the Editor: The cardiovascular collapse and death of a healthy 38-year-old woman considered an “excellent candidate” for vaginal delivery after cesarean section (March 19 issue)¹ should raise some doubt in the minds of those who fervently promote this ...

To the Editor: Hemochromatosis is an autosomal recessive disorder of iron overload caused by a mutation of the HFE gene on the short arm of chromosome 6. The principal clinical features are diabetes mellitus, cirrhosis, hypogonadism, and cardiac failure,^...

To the Editor: Chang et al. (March 12 issue)¹ describe an outbreak of Malassezia pachydermatis in a neonatal intensive care unit. Several prior studies have reported similar infections in neonates,²,³ and there is a report of an adult with canaliculitis ...

To the Editor: The images of tinea barbae in a man, provided by Glaser and Riordan (March 12 issue),¹ are accompanied by a picture of the man's dog, which at first glance appears to have the canine counterpart of his master's skin condition. The lesion ...

To the Editor: The Americans with Disabilities Act requires equal access to services, including health care, and it applies not only to those with physical needs, such as wheelchair access, but also to those with disabilities affecting communication. We ...

The Institute of Medicine (IOM) study of end-of-life care was initiated by a request to develop guidelines for limiting futile treatments, but it was soon determined that such a task might itself prove futile. Instead, the IOM embarked on a large-scale ...

This book, written entirely by academic psychologists, is a dose of strong medicine. A critical review of the psychoactive-drug literature, it asserts essentially that there is inadequate scientific information to conclude that psychoactive drugs are ...

My favorite medical textbook is Where There Is No Doctor (edited by D. Werner et al. Berkeley, Calif.: Hesperion Foundation, 1992), written originally as a medical bible for paramedics in South American villages. It is short and cheap, but above all, it ...

The political debate over abortion during the past 25 years has shifted among various dichotomous views of the world: life versus choice, fetus versus woman, fetus versus baby, constitutional right versus states' rights, government versus physician, ...