Atrial fibrillation is the most common sustained arrhythmia encountered in clinical practice, with an overall prevalence of 0.4 percent in the general population¹–⁴; it affects 2.2 million people in the United States.³,⁵ Electrical cardioversion is often ...

In children, peak blood lead levels as low as 10 to 20 μg per deciliter (0.5 to 1.0 μmol per liter) are associated with reduced scores on developmental tests at 4 to 10 years of age.¹–⁵ Such blood lead levels occur in tens of thousands of children in the ...

During the past decade, vancomycin-resistant enterococci have emerged and become endemic at many health care facilities in the United States.¹–⁶ A major impediment to control is the large, unrecognized population of patients who are colonized with ...

Treatments for postmenopausal women with osteoporosis include estrogens, selective estrogen-receptor modulators, bisphosphonates, calcitonin, vitamin D, and calcitriol. These treatments reduce bone resorption (and formation) and moderately increase bone ...

Figure 1. A 21-year-old woman presented with a two-month history of gradual loss of vision in both eyes and increasing headaches. A ventriculoperitoneal shunt had been inserted when she was one year old. Funduscopic examination demonstrated marked ...

Numerous studies have reported that black patients with coronary artery disease are less likely than white patients to undergo cardiac catheterization.¹–⁹ Many aspects of the physician–patient relationship that may account for treatment decisions have ...

Nontraumatic intracerebral hemorrhage is bleeding into the parenchyma of the brain that may extend into the ventricles and, in rare cases, the subarachnoid space. Each year, approximately 37,000 to 52,400 people in the United States have an intracerebral ...

Presentation of Case

A 47-year-old woman was admitted to the hospital for the third time because of a painful, red swelling of the right foot.

Nine months before the third admission, the patient had awoken during the night because of pain in the lower ...

Dating back to the 17th-century observation that cinchona bark could correct an irregular heartbeat in patients with malaria,¹ cardioversion of atrial fibrillation is one of the oldest therapies in cardiovascular medicine. In 1962, Lown et al. reported ...

Lead poisoning in children was first recognized in its severe acute form, known as lead encephalopathy.¹ This condition is characterized by seizures, coma, and — not infrequently — death, and it is associated with severe neurologic sequelae in survivors. ...

Many studies have shown that black Americans are less likely than whites to receive a wide range of medical services, including potentially lifesaving surgical procedures.¹,² Despite these data, which span two decades, there is little evidence that racial ...

At the end of outpatient clinic, I asked my four medical students to share something new that they had learned that day. “I learned that I need to see my patients actually walk.” “How to prioritize treatment of chest pain.” “When to use metformin.”

“I ...

To the Editor: The article by Mechanic et al. (Jan. 18 issue)¹ challenges the prevailing wisdom that the increased penetration of managed care is associated with a decrease in the length of patients' office visits with physicians. The data to support ...

To the Editor: A decision on whether to recommend population screening for hereditary hemochromatosis requires information on disease penetrance — that is, the fraction of persons with a hemochromatosis genotype who will develop clinical symptoms of the ...

To the Editor: With regard to our article on the transmission of hepatitis C virus from a patient to an anesthesiology assistant and subsequently to five other patients (Dec. 21 issue),¹ we wish to clarify two points. First, the anesthesiology assistant ...

To the Editor: DeAngelis, in her review article on brain tumors (Jan. 11 issue),¹ emphasizes that “irradiation of the cranium, even at low doses, can increase the incidence of meningiomas by a factor of 10 and the incidence of glial tumors by a factor of ...

To the Editor: In his review of the diagnosis and treatment of acute pharyngitis in primary care (Jan. 18 issue),¹ Bisno assigns surprisingly little importance to the assessment and management of the substantial pain associated with this condition. ...

To the Editor: In the presidential candidates' discussion of their vision of health care (Oct. 19 issue),¹ George W. Bush refers to the concealment of medical errors due to the perceived risk of litigation and calls for research on why errors occur and ...

To the Editor: We describe a patient who had polyarteritis nodosa associated with parvovirus B19 infection that regressed completely with intravenous immune globulin therapy.

A 33-year-old woman was seen because of asthenia, fever (temperature, 40°C), ...

John McDonough's Experiencing Politics is a brilliant book. McDonough provides a fascinating account of the high stakes, the drama, and the excitement involved in making laws. This is an enlightening and entertaining book that offers an inside, real-life ...

During India's struggle to gain independence from British rule, a reporter asked Mohandas Gandhi, “What do you think of Western civilization?” Gandhi replied, “I think it would be a very good idea.” In The Economic Evolution of American Health Care, David ...

In 1997, guns claimed the lives of more than 32,000 Americans, and another 81,000 suffered serious nonfatal injuries. Yet these figures fail to reveal the full toll of firearm violence. Not included, for example, are the costs of personal efforts to ...