Infection associated with the use of central venous catheters can result in serious medical complications and expensive care.¹ In prospective, randomized clinical trials, the use of central venous catheters impregnated with either minocycline and rifampin^...

Severe preeclampsia, abruptio placentae, fetal growth retardation, and stillbirth contribute greatly to maternal and fetal morbidity and mortality. Their causes are unknown, but all of them may be associated with abnormal placental vasculature and ...

High-resolution carotid ultrasonography has been used to obtain measurements of the thickness of the intima and media of the carotid arteries. Previous studies have shown cross-sectional associations between common-carotid-artery intima–media thickness ...

Periodic exacerbations of Pseudomonas aeruginosa endobronchial infection in patients with cystic fibrosis have traditionally been treated with parenteral antipseudomonal antibiotics for 7 to 21 days.¹ Despite frequent intravenous therapy, patients ...

Figure 1. A 50-year-old obese man who sustained a closed traumatic injury to the abdomen in a motor vehicle accident was taken to the operating room, where a splenectomy was performed for a splenic laceration. He was also found to have several contusions ...

Geographic variation in hospital use across the United States is a persistent finding.¹–⁴ Contributory causes that have been explored include differences in practice patterns resulting from physicians' uncertainty about how and in what setting to treat ...

Despite several name changes over the past 50 years, the current diagnosis of attention-deficit–hyperactivity disorder (ADHD) shares the core group of symptoms — impulsivity, inattention, and motor restlessness — with earlier terms such as minimal brain ...

The American health care system is at once the most expensive and the most inadequate system in the developed world, and it is uniquely complicated. In 1997 we spent about $4,000 per person on health care, as compared with the next most expensive country, ...

Imagine the era — only a century ago — when no means of vascular access existed for the life-sustaining support of critically ill patients. In 1832, in the wake of the second cholera pandemic, there were encouraging reports that silver cannulas attached ...

Approximately 1 to 5 percent of pregnant women have serious complications of pregnancy, such as severe preeclampsia, abruptio placentae, intrauterine fetal death, or severe fetal growth retardation. The rates are even higher among older women, those with ...

Geographic variations in health care delivery have been widely documented in the United States, Canada, Europe, and Australia. Most studies have concentrated on cross-sectional variations in the rates of surgical procedures. The study by Ashton et al. in ...

In 1995, the rate of cesarean delivery in the United States was 21 percent.¹ The goal of Healthy People 2000, a project of the Department of Health and Human Services, is to reduce this rate to 15 percent by the year 2000.² The advantages of a safe ...

To the Editor: Narod and colleagues (Aug. 13 issue)¹ suggest that oral-contraceptive therapy reduces the risk of ovarian cancer among women with mutations in the BRCA1 or BRCA2 gene. However, some possible biases should be considered.

First, the ...

To the Editor: In the report on patients undergoing early coronary revascularization (within 72 hours) in the Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial (Aug. 13 issue),¹ the ...

To the Editor: Subcutaneous heparin therapy for atrial fibrillation, deep-vein thrombosis, unstable coronary syndromes, or ischemic cerebral attacks may be an alternative to intravenous treatment, if there are contraindications to oral anticoagulants and ...

To the Editor: Low-molecular-weight heparins such as enoxaparin offer advantages over unfractionated heparin in the treatment of venous thromboembolism.¹ For such indications, enoxaparin is currently approved only as prophylaxis against venous ...

To the Editor: Jones et al. (Aug. 13 issue)¹ are not the first scientists and most likely will not be the last to mistake nuclear pores for viral particles. Probably every beginner in transmission electron microscopy believes that he or she has found a ...

To the Editor: The death of a 32-year-old American traveler from rabies after a dog bite in Nepal, described in Case 21-1998 (July 9 issue),¹ is a sobering reminder that fatal encephalitis can occur when postexposure prophylaxis is not used. Dr. Basgoz, ...

To the Editor: In the past 15 years, the medical community has seen the publication of reports on large, randomized clinical trials that have had a substantial effect on the practice of medicine. The design, execution, and analysis of these trials is the ...

It was probably inevitable, but is nonetheless welcome, that the troubled American conversation about the sexes would one day open up into a thoughtful consideration of what boys are fundamentally like and how they might best thrive. Until just past the ...

Over the years pediatricians have made important contributions to our understanding of such areas as infectious disease, genetics, and immunology, but as a group they seldom acquire the academic and scientific prestige achieved by many other members of ...

The United States operates a health care system that is unique among nations. It is the most expensive of systems, outstripping by over half again the health care expenditures of any other country.¹ The number of people without insurance continues to ...