The incidence of adenocarcinomas of the esophagus and gastric cardia has risen rapidly in the United States and western Europe, including Sweden, in recent decades.¹–⁴ The increase has been more pronounced for adenocarcinoma of the esophagus than for ...

Ethylene glycol poisoning may cause severe morbidity and death.¹ Though not toxic itself, ethylene glycol is converted by alcohol dehydrogenase to active metabolites¹,² (Figure 1) that cause metabolic acidosis, renal failure, hypocalcemia, oxaluria, ...

Atrial flutter and atrial fibrillation are well-documented sequelae of atrial septal defects, associated with substantial morbidity and, occasionally, death.¹–³ The prevention of atrial flutter or fibrillation or the restoration of sinus rhythm in ...

In Spain, the annual cost of traffic accidents is equivalent to 1 to 2 percent of the gross national product.¹ Obstructive sleep apnea syndrome is estimated to affect 4 percent of men and 2 percent of women in middle age.² It is characterized by repeated ...

Hypoglycemia stimulates rapid increases in the secretion of several hormones, including catecholamines, glucagon, cortisol, and growth hormone, that act in concert to increase the plasma glucose concentration. The chief role of the central nervous system ...

Figure 1. A 45-year-old woman with pulmonary hypertension and polycythemia presented with increasing cyanosis, edema of the legs, and dyspnea on exertion. She had a partial pressure of arterial oxygen of 35 mm Hg (pH, 7.35). The chest radiograph (lower ...

Carcinoid tumors were first described over 100 years ago by Lubarsch, who found multiple tumors in the distal ileum of two patients at autopsy.¹ The term karzinoide was used by Oberndorfer in 1907 to describe similar tumors that appeared to behave in a ...

Presentation of Case

A 28-year-old man was admitted to the hospital because of gram-negative sepsis.

The patient had been in excellent health until three weeks earlier, when malaise developed. Ten days before admission, he attended a wedding. The next day ...

Heartburn is a serious symptom that merits more attention from patients and physicians. It is the hallmark of gastroesophageal reflux, a disorder that may lead to esophagitis, progressing in some patients to the metaplastic columnar mucosal changes known ...

Ethylene glycol poisoning has it all. It is a medical emergency with well-defined clinical stages resulting from an intriguing pathophysiologic process that can be explained by applied biochemistry.¹ The morbidity and mortality associated with untreated ...

Snoring used to be a laughing matter. We now know that it can be a sign of obstructive sleep apnea, a serious condition characterized by repeated collapse of the pharynx during sleep, leading to periods in which breathing stops (apnea) or hypoventilation ...

The U.S. Postal Service recently unveiled prostate-cancer and breast-cancer stamps with strikingly different messages (Figure 1). The stamp pertaining to prostate-cancer awareness advocates screening and reads, “Prostate Cancer Awareness: Annual Checkups ...

To the Editor: We — physicians and Medicare — have a shared responsibility for the nearly $20 billion that will be spent in 1999 for evaluation and management services. The article by Brett (Dec. 3 issue)¹ on new guidelines for coding physicians' ...

To the Editor: Iacono et al. (Oct. 15 issue)¹ report that in young children, chronic constipation can be a manifestation of intolerance of cow's milk. They suggested the link between constipation and hypersensitivity to cow's milk on the basis of ...

To the Editor: Hokama and Kinjo (Oct. 22 issue)¹ show us a clear endoscopic view of biliary sludge extruding from the papilla of a patient with cholangitis. The authors, however, have failed to mention whether they attempted endoscopic sphincterotomy or ...

To the Editor: Slightly elevated bluish-gray nodules developed on the lower legs of a 16-year-old boy in April 1997. The nodules were asymptomatic, and the boy was otherwise in good health. Examinations by various physicians yielded no diagnosis. The boy ...

To the Editor: A 1995 study found that treatment with tissue plasminogen activator (t-PA) was efficacious for intravenous thrombolysis if given within three hours after the onset of ischemic stroke.¹ The drug most likely improves the outcome by inducing ...

To the Editor: I read with increasing unease the article by Overpeck and colleagues, and the accompanying editorial by Wissow (Oct. 22 issue).¹,² Infant homicide is a horrific crime, and emotions on the part of readers can make an objective review of ...

To the Editor: A 37-year-old nonsmoking man who worked as a special-effects coordinator in the moviemaking industry was referred to the allergy clinic at my institution because of a chronic cough and allergic rhinitis. He had been coughing for 11 weeks ...

There are few diseases as easy to recognize as classic gouty podagra (from the Greek word meaning “foot seizure”). A gluttonous, bibulous, upper-class man suddenly notices a severely painful, swollen great toe. The attack passes after several days to ...

McCarthy, a pathologist, and Frassica, an orthopedic surgeon, both at the Johns Hopkins School of Medicine, have collaborated to produce an eminently readable and informative book. In the introduction they state that the book is designed to be an ...

Psoriasis is a common chronic, inflammatory skin disease that affects approximately 6 million people in the United States, crossing the boundaries of sex, age, and race. For most patients, the diagnosis of psoriasis marks the beginning of a lifelong ...