The clinical diagnosis of Ehlers–Danlos syndrome type IV, the vascular type, is made on the basis of four clinical criteria: easy bruising, thin skin with visible veins, characteristic facial features, and rupture of arteries, uterus, or intestines.¹ The ...

The incidence of invasive pneumococcal disease is highest among young children and the elderly. Although the rates are lower among nonelderly adults, the absolute numbers of infections are highest in these adults, who may be at increased risk if they have ...

Lymphocytic myocarditis remains a poorly characterized disorder. Approximately 10 percent of patients with cardiomyopathy of recent onset who undergo endomyocardial biopsy have this condition, which is presumed to be caused by viral infection.¹,² The ...

Factor XI is a component of the intrinsic pathway of coagulation. It can be activated in vitro by contact with a thrombogenic surface, such as glass. Whether surface contact contributes to the activation of factor XI in vivo, however, is uncertain. Factor ...

Figure 1. Left flank pain and hypotension developed in a 62-year-old woman during treatment with intravenous heparin (900 U per hour) and warfarin (7.5 mg per day) for deep venous thrombosis. Coagulation studies showed a prothrombin time of 15.5 seconds, ...

Bradycardia is a common finding during the clinical evaluation of both healthy patients and those who are ill. Bradycardia may be caused either by intrinsic dysfunction of or damage to the conduction system or by the response of normal tissues to ...

Enterococci are best known as antibiotic-resistant opportunistic pathogens that are commonly recovered from patients who have received multiple courses of antibiotics and have been hospitalized for prolonged periods.¹–⁶ These organisms were well ...

Presentation of Case

A 23-year-old man was examined because of severe anemia, low-grade fever, and bloody diarrhea.

The patient had been well until two months earlier, when fatigue developed. Three weeks later he came to this hospital because of ...

The first comprehensive description of a syndrome comprising laxity and fragility of the skin associated with hypermobility of the large joints was published in 1892 by Tschernogobow¹ in Moscow. With remarkable insight, he interpreted the cause of the ...

Smoking kills. Tobacco use was responsible for approximately one fifth of all deaths in the United States in 1990, with deaths due to cardiovascular diseases, cancer (especially of the lung), and chronic obstructive pulmonary disease among those ...

“Sick patients die” is a refrain familiar to all clinicians. It can easily be applied to patients with severe congestive heart failure or cardiogenic shock resulting from an acute inflammatory process involving the myocardium. In this issue of the Journal,...

To the Editor: Like Fenlon et al. (Nov. 11 issue),¹ we undertook a prospective study to establish the sensitivity, specificity, and accuracy of virtual colonoscopy. Of 25 patients (median age, 71 years) with large-bowel symptoms (mainly rectal bleeding) ...

To the Editor: Determining the risk of rupture of an intracranial aneurysm solely on the basis of a single radiologic measurement of an aneurysm in a first-degree relative of a patient with spontaneous subarachnoid hemorrhage and the statistical annual ...

To the Editor: The medical mystery in the January 20 issue¹ involved a 79-year-old woman who presented to the emergency department with a several-hour history of facial swelling (Figure 1A). She had chronic obstructive pulmonary disease. The swelling of ...

To the Editor: The article by Armstrong et al. (Oct. 28 issue)¹ highlights the use of the Internet to bypass traditional safeguards imposed by Congress and state legislatures to protect patients from dangerous drugs and the improper practice of medicine ...

To the Editor: In his article on the use of physical restraints in medical emergencies, Annas (Oct. 28 issue)¹ describes an egregious violation of a patient's right to provide informed consent and summarizes new federal regu-lations regarding the use of ...

To the Editor: Viral hepatitis is an important public health threat. In the United States the prevalence of chronic hepatitis C infection is approximately 1.5 percent and that of chronic hepatitis B infection is 5.5 percent.¹ The viruses that cause these ...

This is an American book for American readers, written mainly for physicians and associated professionals, but also for interested lay readers. The author, Stephen Kliadman, is a journalist with a remarkable knowledge of medicine — in particular, ...

Obesity is now a pandemic in industrialized societies. Who can feel confident that health care professionals have adequately met the needs of patients or communities with regard to this problem? By what measure do we know what these needs are? Obese ...

In our modern world, overweight is becoming the norm and frank obesity commonplace, but the problem of obesity is not new. In the 17th century, obesity was recognized as a cause of death and disability, and obese persons were ridiculed in some societies. ...

Behind the straightforward and simplistic title of this slim book lies comprehensive and up-to-date information regarding an important and unresolved problem: the high incidence of stroke in black persons. The subtitle, A Guide to Management and ...

Case Records of the Massachusetts General Hospital (Case 4-2000) Case Records of the Massachusetts General Hospital, N Engl J Med 2000:342;414-420.. On page 418, the sentence that begins 26 lines from the bottom of the right-hand column should have read, “...

Effects of an Angiotensin-Converting–Enzyme Inhibitor, Ramipril, on Cardiovascular Events in High-Risk Patients Original Article, N Engl J Med 2000:342;145-153.. On page 145, in line 16 of the Results paragraph of the Abstract, the relative risk of ...