The availability of improved means to identify women at high risk for breast cancer, such as genetic testing for BRCA1 and BRCA2 mutations, intensifies the need to define the benefits and risks of early detection and protective measures for such women.

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Each year, several million Americans are bitten by animals, resulting in approximately 300,000 visits to emergency departments, 10,000 hospitalizations, and 20 deaths, mostly among young children.¹ Ninety percent of these bites are from dogs and cats, and ...

Sexually transmitted diseases, including the acquired immunodeficiency syndrome (AIDS), are a global problem that causes immense suffering and costs billions of dollars annually.¹–³ Women and children have the most severe symptoms and sequelae.¹–⁴ Women ...

Dietary patterns have repeatedly been associated with the risk of colorectal neoplasia: a diet rich in vegetables and fruits is associated with a lower risk, whereas intake of animal fat and red meat seems to increase risk.¹ The underlying mechanisms are ...

Figure 1. A 17-year-old boy presented with a two-week history of a painful mass on the right side of the neck, fever, malaise, headache, and night sweats. The fever and other systemic symptoms gradually abated during the first 10 days of his illness, but ...

Health insurance paid for by private employers, initially nurtured by wage controls in the World War II era that did not restrict insurance benefits, has become a common fringe benefit of employment.¹ As a result, most Americans obtain health insurance ...

Atherosclerosis is an inflammatory disease. Because high plasma concentrations of cholesterol, in particular those of low-density lipoprotein (LDL) cholesterol, are one of the principal risk factors for atherosclerosis,¹ the process of atherogenesis has ...

Presentation of Case

A 53-year-old right-handed man was admitted to the hospital in December because of fever and an altered mental state.

The patient had been well until two weeks earlier, when a cough and rhinorrhea developed. Three days before ...

Recent progress in understanding the genetic basis of susceptibility to breast cancer has simultaneously allowed the identification of women at increased risk and spawned controversy over their care. Like such contentious issues as the utility of genetic ...

Persons who have been bitten by animals usually seek medical treatment either immediately or at some later time because of concern about local erythema and swelling or, less commonly, fever. In each of these situations, physicians must make a series of ...

Educating the public about the risk of breast cancer promises to contribute to the prevention or early detection of the disease. Data on the risk of breast cancer are widely available to physicians and the public. However, for this information to be ...

The fortunes of managed care have taken a sudden downturn. Consider this: the oldest and largest and one of the most respected health maintenance organizations (HMOs), Kaiser Permanente, posted a loss of about $270 million in 1997, its first deficit in ...

To the Editor: In the February 5 issue, we reported the results of a study designed to determine whether natural disasters affect suicide rates.¹ Previous research on the victims of disasters had reported an increased prevalence of post-traumatic stress ...

To the Editor: Cullen's sign, or periumbilical ecchymosis, is classically associated with hemorrhagic pancreatitis but may also occur with retroperitoneal hemorrhage, splenic rupture, ruptured ectopic pregnancy, and leaking aortic aneurysm.¹–³ In fact, ...

To the Editor: Antonelli et al. (Aug. 13 issue)¹ concluded that noninvasive positive-pressure ventilation was as effective as conventional mechanical ventilation in patients with acute respiratory failure and was associated with fewer serious ...

To the Editor: Hepatic myelopathy is characterized by spastic paraparesis and minimal sensory abnormalities in patients with cirrhosis, particularly those with portosystemic shunts that have been created surgically or have occurred spontaneously.¹,² The ...

To the Editor: The clinical differentiation of a peripheral vestibular lesion from an inferior cerebellar stroke was a main focus of the article by Hotson and Baloh (Sept. 3 issue).¹ The authors did not mention some symptoms and signs that are typical of ...

To the Editor: Cavé et al. (Aug. 27 issue)¹ report that the detection of residual disease in patients with childhood acute lymphoblastic leukemia (ALL) by quantitative polymerase-chain-reaction (PCR) analysis within six months after the completion of ...

To the Editor: Recent studies have suggested that nifedipine is a safer, more effective treatment for preterm labor than the sympathomimetic agents routinely in use.¹,² On the basis of these promising results, calcium-channel antagonists are increasingly ...

To the Editor: In his excellent review, Dr. Gennari (Aug. 13 issue)¹ discusses the principles of potassium replacement in the management of hypokalemia. Although he advises caution in the use of intravenous potassium and makes recommendations about the ...

To the Editor: On September 30, one of us experienced pain at the arch of the right foot. The pain increased, and pressure from the shoe became annoying. In the evening, crepitation was detected on palpation, and a distinct friction rub could be detected ...

In 1957, E. Donnall Thomas, who later won the Nobel prize, reported on the first attempts to use hematopoietic stem cells as rescue therapy for patients with leukemia who had received high-dose myelotoxic treatment. The source was bone marrow. Although ...

Dr. Offit's book on cancer genetics in clinical practice covers most of the essential material in this complex field in a highly effective and readable way. The role of genetics in cancer is put into context by a superb overview of the role of genetics in ...

As the population ages and deaths from preventable causes decline, prostate cancer will more commonly appear on medical-chart “problem lists” and — in the absence of effective therapy — on death certificates. Three facts emphasize the importance of ...

Pancreatic cancer has remained an enigma in an age in which great strides have been made in the management of many forms of cancer. The overall morbidity and mortality associated with pancreatic cancer are nearly the same as those presented in textbooks ...

The most prominent feature of American health insurance coverage is its slow erosion, even as the government seeks to plug the gaps in coverage through such new programs as Medicare+Choice, the Health Insurance Portability and Accountability Act (HIPAA), ...