Maternal serum biochemical screening at 15 to 20 weeks of gestation is increasingly being used to identify fetal abnormalities such as neural-tube defects, Down's syndrome, and other chromosomal abnormalities. In California, maternal serum alpha-...

Nearly 129,000 patients are given a diagnosis of colorectal cancer each year in the United States, and hepatic metastases develop in 60 percent of these patients.¹ Of these 77,400 patients, 15 to 25 percent have metastatic liver disease when the primary ...

Currently, organ transplantation is limited by the availability of donor organs. In the United States, there have been small increases in the number of donor organs available. Nonetheless, since 1994, a rapid rise in the number of patients awaiting ...

Since echocardiography became a routine diagnostic tool, pericardial effusion has been a common clinical finding. In most instances, the cause of pericardial effusion can be determined; however, in some cases the cause is not apparent even after a ...

Figure 1. A 42-year-old woman who had a six-year history of breast cancer and bony metastasis, which had been treated with surgery, adjunctive chemotherapy, and radiation to the thoracic spine, presented with a two-week history of progressive dyspnea on ...

In the late 1980s and early 1990s, federal agencies established requirements that women and members of minority groups be adequately represented in clinical trials of treatment for cancer.¹–⁵ This mandate is crucial in oncology, because with many types of ...

Autoimmune disease is the consequence of an immune response against self-antigens that results in the damage and eventual dysfunction of target organs. Although the triggering event in most autoimmune diseases is unknown, an infectious cause has long been ...

Presentation of Case

A four-month-old girl was admitted to another hospital because of cyanosis.

The patient had been well until two months earlier, when she began to require up to 45 minutes for her feedings. Three weeks before admission, acral and ...

Five times during the past year, the Journal has released articles early by posting them on our site on the World Wide Web (http://www.nejm.org). The decision to release an article early is made together with the authors and in accordance with our policy ...

In recent years maternal serum screening in the second trimester of pregnancy has become a routine part of prenatal care in the United States and other industrialized nations. Maternal serum screening is designed to identify women whose fetuses are at ...

The care of patients in teaching hospitals presents a persistent challenge: a primary commitment to the health of patients must be combined with the educational goals of the teaching institution. These goals include the mastery of procedural skills by ...

To the Editor: Alter et al. (Aug. 19 issue)¹ present valuable data on the prevalence of hepatitis C virus (HCV) infection in the United States. However, their analyses of risk factors for HCV infection are flawed because the third National Health and ...

To the Editor: Hochman et al. (Aug. 26 issue)¹ reported the results of a randomized clinical trial in which they compared early revascularization with medical management in patients who had cardiogenic shock after an acute myocardial infarction. They did ...

To the Editor: Norton et al. (Aug. 26 issue)¹ report 10-year surgical-cure rates of 34 percent in 123 patients with sporadic gastrinomas and 0 percent in 28 patients with multiple endocrine neoplasia type 1. The authors' objective was limited to the ...

To the Editor: Willett et al. (Aug. 5 issue)¹ have highlighted the importance of taking early action to prevent increases in measures of obesity and the associated risks, including type 2 diabetes, hypertension, and dyslipidemia. The data to which they ...

To the Editor: In their review of the mechanisms that control labor (Aug. 26 issue),¹ Norwitz et al. assert that magnesium sulfate is both safe and efficacious for the management of preterm labor. They also state that it has become the first-line ...

To the Editor: In a Clinical Problem-Solving article by Fisk et al. (Sept. 2 issue),¹ a 34-year-old man with paraplegia was admitted because of fever and abdominal pain. The clinician-discussant noted, “It is of interest that palpation of the left lower ...

To the Editor: Indirect evidence suggests that gum chewing may have greater metabolic effects than has been appreciated. The thermic effect of food is reduced when nutrition bypasses the mouth.¹ In cows, chewing increases energy expenditure by ...

This group of 13 very thoughtful essays addresses the difficult question of just how we should think about using — or refrain from using — our radically enhanced abilities in molecular biology and genetic engineering to improve the lot of current and ...

Enhancing Human Traits consists of 12 articles derived from a series of discussions at the Hastings Center and an essay by the editor reviewing these 12 articles. Most of the contributors are philosophers, with a smattering of theologians and lawyers, and ...

Perhaps no field of scientific inquiry is as likely to be misunderstood and abused as genetics. Part of the misunderstanding arises from archaic views about what genes are and how they are expressed during development. The extreme abuse of genetic ...