Humans and some other primates are unique in having adrenal glands that secrete large amounts of dehydroepiandrosterone and its sulfate ester.¹ In normal subjects there is an age-related decline in dehydroepiandrosterone secretion,²–⁴ but whether this ...

In the 1950s, Goldman and associates¹ and Massimo and Boffi² proposed that natural or artificial conduits could be implanted in the subendocardium to direct left ventricular blood through the coronary sinusoids and into ischemic areas of the myocardium. ...

Despite the success of current medical and surgical management of ischemic heart disease, a growing number of patients have diffuse obstructive coronary artery disease that is not amenable to coronary-artery bypass grafting or catheter-based ...

Exercise intolerance is a common symptom of the encephalomyopathies that are associated with mutations in mitochondrial DNA (mtDNA).¹,² These usually multisystemic disorders include several distinct syndromes: the Kearns–Sayre syndrome; mitochondrial ...

Figure 1. A 65-year-old man with a five-year history of uncontrolled hypertension was admitted to the emergency department with pulmonary edema. On admission his blood pressure was 180/110 mm Hg. A chest film showed bilateral pleural effusions as well as ...

Humankind has been besieged through-out its evolution by microorganisms that pose a continual challenge to the survival of the species.¹ Although such ancient killers as tuberculosis and malaria persistently take a toll of millions of lives per year, ...

Acute myeloid leukemia (AML) is characterized by an increase in the number of myeloid cells in the marrow and an arrest in their maturation, frequently resulting in hematopoietic insufficiency (granulocytopenia, thrombocytopenia, or anemia), with or ...

Presentation of Case

An 86-year-old man was admitted to the hospital because of gastrointestinal bleeding with abdominal pain.

The gastrointestinal bleeding had begun a year and a half earlier. The patient was hospitalized at that time because of several ...

The human adrenal cortex secretes not only the essential hormones cortisol and aldosterone, but also dehydroepiandrosterone and large amounts of dehydroepiandrosterone sulfate. The serum concentration of dehydroepiandrosterone sulfate is 20 times that of ...

To perform transmyocardial laser revascularization, the surgeon exposes the beating heart through a lateral thoracotomy, places a laser (carbon dioxide or holmium) on the epicardial surface of the left ventricle, and applies sufficient energy to create ...

Muscle pain and fatigue affect nearly half of patients who seek medical care.¹ One of the paradoxes of medicine is that patients with these symptoms seldom have a recognizable disorder of muscle that can be identified by objective diagnostic tests such as ...

To the Editor: In his editorial (June 10 issue),¹ Dr. Relman recommended a cautious approach to the proposal for sponsorship by the National Institutes of Health (NIH) of a Web site for the publication of all new biomedical-research reports. However, the ...

To the Editor: Guinan et al. (June 3 issue)¹ reported an interesting method for preventing graft-versus-host disease after bone marrow transplantation. CTLA-4–Ig was added to a culture of a mixture of irradiated mononuclear cells from the recipient and ...

To the Editor: About a third of patients with dilated cardiomyopathies have left ventricular thrombi.¹ Mobile thrombi have a high rate of systemic embolization. Definitive treatment of these thrombi has yet to be established. Oral anticoagulation has had ...

To the Editor: Acute myocardial infarction due to coronary thromboembolism from a left ventricular thrombus has been suspected in patients with dilated or aneurysmal left ventricles, but it has rarely been documented. In previous reports of acute ...

To the Editor: The accuracy of measurements of troponin T and creatine kinase MB fraction (CK-MB) is central to the results of the c7E3 Fab Antiplatelet Therapy in Unstable Angina (CAPTURE) study reported by Hamm et al. (May 27 issue).¹ The authors state ...

To the Editor: The analysis by Thiemann et al. (May 27 issue)¹ of data from the Health Care Financing Administration's Cooperative Cardiovascular Project demonstrates a well-recognized inverse association between the number of patients treated at a ...

We've all heard that you can't judge a book by its cover, and that is certainly true of Trichotillomania. The Medusa-like figure on the jacket suggests that patients with trichotillomania are evil, mythical creatures, rather than real people with a ...

In 1885, the French neurologist Georges Gilles de la Tourette, describing the first nine patients with Gilles de la Tourette syndrome, stated, “Everything is extraordinary in this disease: the name is ridiculous, its symptoms peculiar, its character ...

The past decade has seen a startling drop in the provision of insurance benefits for psychiatric care. Whereas the real value of employer-provided insurance for general medical treatment decreased 7.2 percent from 1988 to 1997, benefits for the treatment ...

After a quarter century of relative plenty, academic medical centers find themselves in a serious financial squeeze that is beginning to compromise their triple mission of teaching, research, and clinical care. This squeeze reflects competitive pressures ...