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March 4, 1999  Vol. 340 No. 9

Original Articles
669-676

Delirium, also known as acute confusional state, is a common, serious, and potentially preventable source of morbidity and mortality among hospitalized older patients.13 Delirium has particular importance because patients over 65 years of age account for ...

677-684

Cardiovascular disease is the leading cause of morbidity and mortality among patients with diabetes mellitus.1 Calcium-channel blockers have been found to be safe and effective for the treatment of various cardiovascular disorders, as well as for the ...

685-691

Each year, approximately 20 million of the 50 million smokers in the United States try to quit smoking, but only about 6 percent of those who try succeed in quitting in the long term.1 Nicotine-replacement therapies, such as the nicotine patch and ...

692-702

The hyper-IgE syndrome (numbers 147060 and 243700 in the Mendelian Inheritance in Man, a catalogue of inherited diseases)1 is characterized by recurrent staphylococcal skin abscesses, pneumonia with pneumatocele formation, and extreme elevations of serum ...

703-707
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Mosaicism is the phenomenon in which a fraction of, rather than all, germ-line and somatic cells contain a mutation or chromosomal abnormality. It occurs in all genetic disorders in which spontaneous mutations occur and has important clinical consequences ...

Images in Clinical Medicine
708
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Figure 1. A 71-year-old woman who had had a basal-cell carcinoma presented with a six-week history of an enlarging lesion on the upper part of her right arm (Panel A). The well-circumscribed crateriform nodule, which had a keratotic core and measured 2 by ...

Review Article
709-718

Fertility in women is regulated by a series of highly coordinated and synchronized interactions in the hypothalamic–pituitary–ovarian axis (Figure 1A). The central regulator of the axis is the group of neurons that secrete gonadotropin-releasing hormone (...

Editorial
720-721

Geriatric medicine has focused primarily on the management of acute and chronic diseases in frail older persons, with much less emphasis on the promotion of health and the prevention of disease than there is in health care for children or middle-aged ...

Sounding Board
722-728

The demise of both the Medicare Catastrophic Coverage Act of 19881 and the 1993 Clinton plan for health care reform2,3 resulted in missed opportunities to correct a glaring defect in the American health care system — inadequate coverage for costly ...

Correspondence
730-732

To the Editor: Levy and Thom (Sept. 24 issue),1 in their editorial on rates of death from coronary heart disease (CHD), note an apparent paradox in the declining prevalence of causal risk factors for myocardial infarction and the lack of change or slight ...

732-735

To the Editor: In their study of dilated cardiomyopathy in patients with human immunodeficiency virus (HIV) infection, Barbaro et al. (Oct. 15 issue)1 did not ascertain whether nutritional abnormalities were present, as Lipshultz notes in his ...

735

To the Editor: Skin necrosis is a rare complication of warfarin therapy.1 The necrotic lesions usually appear in a distinct pattern, with a predilection for fatty tissues such as the breasts, buttocks, and thighs, three to six days after the initiation ...

735-737

To the Editor: In his review of hemodialysis, Ifudu (Oct. 8 issue)1 points out the high annual mortality rate of 22 to 24 percent among patients undergoing hemodialysis in the United States and calls for an increase in the dialysis dose. This is at odds ...

737-738

To the Editor: Bisphosphonates are widely used to inhibit osteoclastic bone resorption. As analogues of pyrophosphate they share several structural homologies with recently identified non-peptide γ/δ T-cell ligands, such as isopentenyl pyrophosphate, ...

738

To the Editor: The patient described in Case Record 31-1998 (Oct. 15 issue),1 an eight-year-old boy with bronchiectasis, was born in El Salvador. Examination of stool specimens showed ova of Ascaris lumbricoides and cysts of Entamoeba coli. Ent. coli ...

738-739

To the Editor: It is unknown why monozygotic twins are more frequent in conceptions brought about by assisted-reproduction techniques.14 One hypothesis is that the exposure of the zona pellucida to biochemical or mechanical trauma leads to herniation of ...

Book Reviews
740

The sudden death of an athlete from cardiac causes, although extremely rare, is always perceived by the public as particularly tragic, because the victims are young and seemingly the healthiest people in our society. In this book, 47 authors give up-to-...

740-741

The disappointing results of pharmacologic therapy in the treatment of cardiac arrhythmias have been an important stimulus for the development of nonpharmacologic approaches to the management of rhythm disturbances. This book presents these approaches in ...

741

Despite the wealth of data immortalized in the Framingham Study and other flagship observational studies, the implications of the prevention of cardiovascular diseases did not influence clinical practice until a series of well-designed randomized trials ...

742

Cardiovascular disease remains the leading cause of death in the United States, accounting for approximately 40 percent of deaths annually. Although advances in the control of cardiovascular risk factors and improved treatments for acute myocardial ...

Correction
744

Unruptured Intracranial Aneurysms — Risk of Rupture and Risks of Surgical Intervention Original Article, N Engl J Med 1998:339;1725-1733.. On page 1729, in Figure 2B, the curves were mislabeled. The upper curve, with the square symbols, should have been ...