Among the disease-modifying drugs used to treat rheumatoid arthritis, methotrexate is increasingly regarded as the agent of first choice, because of its early onset of action and superior efficacy and tolerability.¹ Clinical benefit with methotrexate may ...

Acute otitis media is the most common bacterial infection among children and the most frequent reason for outpatient antibiotic therapy.¹ Despite proper antibiotic treatment, middle-ear effusion may persist for weeks or months,²,³ often resulting in ...

Of the approximately 170,000 cases of lung cancer diagnosed each year in the United States, 20 percent are small-cell cancers.¹ Staging systems divide small-cell lung cancer into two categories: limited and extensive. The former is clinically confined to ...

Although physical exercise has become an important part of standard therapy for patients who have had acute myocardial infarction and cardiac surgery, its role after heart transplantation has not been well defined.¹,² Patients undergoing heart ...

Killer-cell inhibitory receptors inhibit cytolysis when natural killer cells encounter cells bearing HLA class I molecules.¹,² This phenomenon explains the preferential killing by natural killer cells of tumor cells with reduced expression of HLA class I ...

Figure 1. A 21-year-old man presented with a stab wound of the left side of the neck (Panel A). Neurologic examination revealed right-sided Horner's syndrome, right hemiplegia, and complete loss of discriminatory, proprioceptive, and vibratory sensation ...

The list entitled “America's Best Hospitals,” published annually by U.S. News & World Report since 1990, is one of the longest-running and most influential “report cards” on the quality of hospitals. The survey has been described as a public-relations ...

The cost of care is generally higher in teaching hospitals than in nonteaching hospitals.¹–⁵ The higher cost of care in teaching hospitals has been attributed to a more complex case mix; the location of teaching hospitals in urban areas, where costs for ...

Presentation of Case

A 41-year-old woman was admitted to the hospital because of muscle weakness, painful paresthesias, and transient visual problems.

The patient had been well until four months earlier, when a rash developed on her thighs, and lumbar ...

Teaching hospitals are beset by a litany of now familiar complaints. They are often described as large and impersonal. Their expert clinician-professors are said to be aloof and uncaring. House staff rotate off services just when patients are beginning to ...

With the clinical availability of two different approaches to decrease the activity of tumor necrosis factor (TNF), a new era in the treatment of rheumatoid arthritis has begun. In this issue of the Journal, Weinblatt and colleagues report significant ...

Acute otitis media is a common disease whose cause is complex. Recent estimates suggest that more than 12 million episodes of acute otitis media are treated annually in the United States. Three bacteria — Streptococcus pneumoniae, nontypable Haemophilus ...

The immune system can summon a variety of defenses against invaders from the outside. Among these deterrents are three types of killer lymphocytes that attack and lyse cellular targets. One type consists of cytotoxic, or CD8, T cells with α/β antigen ...

To the Editor: Krag et al. (Oct. 1 issue)¹ present interesting data on the use of probe-guided resection of radioactive sentinel nodes in patients with breast cancer, but they conclude that “the procedure can be technically challenging, and the success ...

To the Editor: In his review of the treatment of breast cancer (Oct. 1 issue),¹ Dr. Hortobagyi discusses the indications for adjuvant treatment. Table 4 of his article shows the selection of adjuvant systemic therapy according to the patient's age, ...

To the Editor: Thapa et al. (Sept. 24 issue)¹ performed an important retrospective study of the risk of falls among nursing home residents receiving antidepressants. The increased risk of falls with the use of tricyclic antidepressants is not surprising, ...

To the Editor: Several studies have shown that oats are not toxic in patients with celiac disease and dermatitis herpetiformis.¹–⁴ Avenin is a protein in oats and has similarities to wheat gliadin. Both are prolamins and are rich in glutamine and ...

To the Editor: Pearson et al. (Sept. 3 issue)¹ correctly warn that all methods of payment to physicians influence physicians' clinical judgment. But they wrongly portray current risk-sharing capitation arrangements as a mere inversion of fee-for-service ...

To the Editor: The beautiful photograph on page 1439 of the November 12 issue, labeled St. Basil's, Moscow, is in fact the Church of the Resurrection (or Church of Our Savior on the Spilled Blood) in St. Petersburg. The Church of the Resurrection, now a ...

(After extra time)

Years of getting it together, fretted, gone,

skills turned to dust, retrieval system spent;

the fabric of his life beyond repair.

With no there, there, his here and now's a blank,

a game of dice — with all the dots rubbed off.

Where ...

We reviewed this book from two perspectives; one of us is a senior neuropathologist working in experimental neurobiology, and the other is a recently trained neurologist-neuropathologist who examines and treats patients, performs diagnostic ...

Worldwide, 33 million adults and 2 million children are infected with human immunodeficiency virus type 1 (HIV-1). Despite preventive efforts, the epidemic of the acquired immunodeficiency syndrome (AIDS) continues to spread rapidly. Every day 16,000 ...

For much of their length, peripheral nerves are protected against the immune system by tight capillary endothelial junctions and perineurium. However, this protection is only relative. Lymphocytes, immunoglobulins, complement components, viruses, and ...

When Medicare was enacted in 1965 as the health care linchpin of President Lyndon Johnson's Great Society, its architects considered this insurance program for the elderly only an interim step toward the broader goal of universal health care coverage.¹ ...