Five to 25 percent of nulliparous pregnant women have operative vaginal delivery.¹ Although forceps have been used in obstetrics since the early 19th century, vacuum extraction was not widely used until the 1950s. The popularity of vacuum extraction has ...

Dilated cardiomyopathy, a myocardial disorder characterized by dilatation of the cardiac chambers and impaired systolic contraction, is a major cause of congestive heart failure worldwide. Despite advances in therapy, mortality due to dilated ...

In patients with end-stage renal disease, successful renal allotransplantation improves the quality of life and increases survival, as compared with long-term dialysis treatment.¹–³ The survival advantage of renal transplantation varies among patients,⁴–⁷ ...

The receptor for luteinizing hormone and chorionic gonadotropin plays a major part in normal and abnormal reproductive function.¹–⁴ In males, activation of the receptor regulates the development and function of Leydig cells.⁵ Testosterone secreted by ...

Figure 1. A 22-year-old man presented with a six-month history of severe epigastric and periumbilical hunger pangs, diarrhea, and a weight loss of 8 kg. Ultrasonographic abdominal examination showed normal findings, as did examination of a stool specimen ...

The rapid development of high-technology procedures has come at a time when the ability of the U.S. health care system to provide expensive services to all patients is increasingly constrained. The inverse relation between expanding medical achievement ...

Gestational diabetes mellitus is defined as glucose intolerance that is first detected during pregnancy.¹ This simple definition belies the complexity of a condition that spans a spectrum of glycemia, pathophysiology, and clinical effects and for which ...

In May 1998, the Food and Drug Administration (FDA) issued a public health advisory to all practitioners who deliver babies. The advisory, entitled “Need for Caution When Using Vacuum Assisted Delivery Devices,”¹ was based on reports to the FDA of 12 ...

In 1990, Geisterfer-Lowrance et al. reported the first evidence of a gene defect underlying a form of intrinsic heart-muscle disease. They found that a mutation in the gene encoding the contractile protein β-myosin heavy chain results in familial ...

There is virtual unanimity that the optimal treatment for most patients with end-stage renal disease is renal transplantation. However, unlike the case for liver, heart, and lung transplantation, for which no long-term successful alternative is available, ...

Normal puberty starts when pulsatile release of gonadotropin-releasing hormone (GnRH) from the hypothalamus begins. This triggers the release of luteinizing hormone and follicle-stimulating hormone from the pituitary. In both sexes, these pituitary ...

To the Editor: Tazarotene is a novel receptor-selective retinoid originally developed for the topical treatment of mild-to-moderate plaque psoriasis.¹ On the basis of recent hypotheses about the effects of this agent on the differentiation and ...

To the Editor: I salute Silverman et al. (Aug. 5 issue)¹ for their article on the association between for-profit hospital ownership and increased Medicare spending, which drives home the obvious fact that for-profit businesses attempt to optimize ...

To the Editor: As an investigator in four initial studies of active compression–decompression cardiopulmonary resuscitation (CPR), including a large randomized trial,¹ I would like to comment on the report by Plaisance et al. (Aug. 19 issue).² All ...

To the Editor: Aggressive angiomyxoma is a rare myofibroblastic tumor that arises mainly in the perineum and genitalia in premenopausal women. Histologically, the tumor has a monomorphic pattern, with small, spindle-shaped mesenchymal cells dispersed in ...

To the Editor: Niewoehner et al. (June 24 issue)¹ reported the effects of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease (COPD). They designed their study to evaluate clinical outcomes and found that patients treated ...

To the Editor: Patients in whom sepsis develops, particularly those who also have cirrhosis, are prone to the development of renal failure secondary to peripheral vasodilatation and subsequent renal arterial vasoconstriction. Sort et al. (Aug. 5 issue)¹ ...

To the Editor: Table 3 and Table 4 of Case 20-1999 (July 8 issue)¹ are entitled “Criteria for the Diagnosis of Systemic Lupus Erythematosus” and “Criteria for the Diagnosis of Wegener's Granulomatosis,” respectively. However, both these lists from the ...

To the Editor: Dissection of the aorta involves a tear of the aortic intima with separation of the aortic wall and formation of two perfused channels. There are two generally accepted classifications of aortic dissection: the De Bakey classification (...

The study of medical history has vanished from most U.S. medical schools. Is this a surprise? The number of discoveries in molecular biology has exploded. The field of biochemistry grows relentlessly. Newly defined diseases are described in detail. ...

Louis Pasteur is one of the secular saints of France, as well as a hero of medicine and science of mythic stature. Books, plays, and poems have been written about him, and yet it is only recently that a critical historical appraisal of Pasteur and his ...

The 1990s have seen an outpouring of exceptional literature about the history of public health. Survey books have provided outstanding coverage of the broad scope of the growth of public health, and numerous scholars have published fascinating biographies ...