Anal fissure, a split in the skin of the distal anal canal, is a common problem that causes substantial morbidity in people who are otherwise healthy. The incidence of anal fissure is similar in men and women.¹,² The majority of fissures occur in the ...

Coronary revascularization by percutaneous techniques is widely used in the treatment of patients with stable angina pectoris, inducible myocardial ischemia, or both. Studies comparing medical treatment and percutaneous revascularization suggested that ...

Although numerous epidemiologic, pathological, and in vitro molecular studies have implicated cytomegalovirus (CMV) as a cofactor in the pathogenesis of the acquired immunodeficiency syndrome (AIDS), a direct causal relation has been difficult to document,...

The placenta is an organ of embryonic origin that supports the growing fetus by facilitating the transfer of nutrients from the mother. It is not well understood how the allogeneic fetus thrives and avoids immune rejection in an environment where only ...

Figure 1. A six-year-old girl underwent successful allogeneic bone marrow transplantation for severe β-thalassemia in 1985. Before transplantation, the serum ferritin concentration was 4044 μg per liter and the serum aspartate aminotransferase and alanine ...

For many causes of death, there are regular changes in mortality rates, with systematically recurring periods of increased and decreased risk. For example, deaths from influenza peak in the winter,¹ deaths from motor vehicle accidents peak on long holiday ...

In 1925, Thomas Cooley and Pearl Lee described a form of severe anemia, occurring in children of Italian origin and associated with splenomegaly and characteristic bone changes.¹ Over the next decade, a milder form was described independently by several ...

Presentation of Case

A 16-year-old girl was admitted to the hospital because of fever, rash, and severe ocular disease.

The patient had been in good health until three months earlier, when small, painful, mildly pruritic vesicles appeared on her left ...

Botulinum toxin is one of the deadliest poisons known, causing death by muscle paralysis. As a poison, it is most commonly encountered as a source of food poisoning, and there are shivers around the world when it surfaces as a possible biologic weapon. ...

Cancer is rare during pregnancy, occurring in only about 1 per 1000 live births. More than half the cases are tumors of the uterine cervix, breast, or thyroid, which can metastasize to the placenta but not the fetus.¹ Melanoma and hematologic tumors, ...

To the Editor: In their multicenter trial of transfusion requirements in critical care, Hébert et al. (Feb. 11 issue)¹ demonstrate that, in the case of red-cell transfusion, the adage “more is better” is not always true. However, their recommendation of ...

To the Editor: The article on transfusion medicine by Goodnough and associates (Feb. 11 and Feb. 18 issues)¹ raises two important issues: the physiologic significance of the peripheral hematocrit measurement and the hemostatic defect caused by acute ...

To the Editor: In patients infected with hepatitis B virus (HBV), the disappearance of circulating antigens and the development of antibodies to these antigens have traditionally meant that the infection has cleared. Subsequent immunity has been believed ...

To the Editor: In their report on the treatment of infertility with follicle-stimulating hormone and intrauterine insemination, Guzick et al. (Jan. 21 issue)¹ did not state in their discussion that a more cost effective and safer method, administration ...

To the Editor: In the commentary of their Clinical Problem-Solving article “A Balancing Act” (Feb. 4 issue),¹ Saha and colleagues emphasize the importance of clinical examination in assessing the safety of lumbar puncture. In particular, the presence of ...

To the Editor: The study by Gasner et al. (Feb. 4 issue)¹ of the detention of patients with tuberculosis in New York City — like recent evaluations of detention in other areas²,³ — was conducted exclusively by officials running the program. One of us ...

To the Editor: The report by LeLorier et al. (Aug. 21, 1997, issue) indicated that the results of meta-analyses frequently conflict with those of large randomized, controlled trials.¹ An editorial suggested that some of these discrepancies may arise when ...

Henk ten Have and Jos Welie have brought together an admirable collection of essays about the ways in which people have ownership rights to their bodies. Traditionally, the common law defined ownership as the rights of persons to control the use of ...

The concept of an unconscious mind is an old one, going back to speculations in the 12th century and articulated clearly by a Professor W.B. Carpenter of London in his lectures 25 years before Freud ever wrote his papers on the topic. Without reading a ...

The recent publication of superb fiction by contemporary physicians — Richard Selzer, Ethan Canin, Susan Mates, and Ferrol Sams, among others — suggests that physicians are granted, by their medicine, a privileged view of human events, and that doctors ...