Medical Progress

PATIENTS who have a first myocardial infarction deserve consideration as a special group. For the most part, the early mortality rate from a first infarction is roughly half the rate found in patients with a second or third infarction,^1,2 and the long-term survival is considerably better...

Neurologic DisordersThe tendency of certain workplace toxins, including organic solvents such as n-hexane, metals such as lead and arsenic, and certain organophosphate compounds, to cause profound and occasionally irreversible damage to the axons of peripheral nerves has been known for several decades.¹³³ The irreversible central...

THE clinical discipline of occupational medicine, largely unstudied, untaught, and unpracticed in major medical centers as recently as a decade ago, underwent unprecedented rejuvenation in the 1980s. Spurred by national regulatory programs and requirements, widespread litigation concerning toxic injury, and an altered public perception of environmental risks, the demand for...

PERIODONTAL disease is a general term used to describe specific diseases that affect the gingiva and the supporting connective tissue and alveolar bone, which anchor the teeth in the jaws. The periodontal diseases are among the most common chronic disorders that have plagued humans for centuries. The ancient writings of...

IMPOTENCE is a common disorder that in many people has a profound effect on their well-being. Recently, the field of erectile dysfunction has undergone considerable change. There is now an improved understanding of the physiologic mechanisms of penile erection and how these can be altered to cause impotence. New diagnostic...

THE hematopoietic growth factors are glycoprotein hormones that regulate the proliferation and differentiation of hematopoietic progenitor cells and the function of mature blood cells.^{1 2 3} The recognition that circulating factors regulate red-cell production was derived from the work of Carnot and Deflandre, who...

(Second of Two Parts)Rejection and HistocompatibilityAlthough the possibility of rejection is always present, nonimmunologic causes of early hepatic dysfunction must be ruled out systematically. The differential diagnosis can include suboptimal revascularization; defects in biliary reconstruction that cause obstruction or bile fistula; opportunistic infection with cytomegalovirus,^119,120

(First of Two Parts) ADVANCES in the management of both chronic and acute hepatic disease have been made possible and even mandated by the development of liver transplantation. The clinical use of transplantation has proceeded at a rapid pace since a Consensus Development Conference of the National Institutes of Health...

LYME disease was described as a separate entity in 1977 because of a geographic clustering of children in Lyme, Conn., who were thought to have juvenile rheumatoid arthritis.¹ The rural setting of the case clusters and the identification of erythema migrans (Fig. 1) as a feature of the...

ALCOHOLISM is a major social, economic, and public health problem throughout much of the world. In the United States alone, the annual cost of lost productivity and health expenses related to alcoholism is estimated to be $117 billion.¹ Ethanol-related neurologic disorders constitute a particularly large, diverse, and devastating...

(Second of Two Parts)Another clinical syndrome for which a putative anaerobic pathogen has been tentatively identified is nonspecific vaginitis, now often referred to as anaerobic vaginosis. In the past this condition was thought to be caused by Gardnerella vaginalis , but more recently by abnormal anaerobic vaginal flora,...

(First of Two Parts)ANAEROBIC bacteria constitute a prominent part of the abundant microbial flora of the human body. The oropharynx, skin, colon, and vagina harbor up to 10¹¹ anaerobes per cubic centimeter.¹ Because of their fastidious growth requirements and ubiquity as commensals, the pathogenic role...

YERSINIA ENTEROCOLITICA is rapidly emerging worldwide as an enteric pathogen associated with a wide spectrum of clinical and immunologic manifestations. The clinical illness caused by this pathogen ranges from self-limited enterocolitis to potentially fatal systemic infection; post-infection manifestations include erythema nodosum and reactive arthritis. The organism was first described by...

ASBESTOS is a mineral causing much controversy in today's society. Before the passage and enactment of the Occupational Safety and Health Act of 1970, millions of Americans were exposed to relatively high concentrations of airborne asbestos in the work-place. Other citizens — including insulation installers, shipyard workers, and manufacturers of...

PATIENTS with portal hypertension and esophageal varices are grouped in one of two categories when long-term care is being considered: those who have had variceal bleeding, in whom the treatment is considered therapeutic and the aim is to prevent recurrent bleeding, and those with varices that have not yet bled,...

THIS two-part article briefly presents the current understanding of both emergency management of actively bleeding esophageal varices and long-term care of varices that have bled and those that have never bled. Esophageal varices result from portal hypertension, which in turn has a number of possible causes. Their prevalence varies geographically....

STAPHYLOCOCCUS AUREUS is one of the most versatile human pathogens. In the late 1930s, sulfonamides offered the first challenge to S. aureus, but they failed because of their poor clinical performance in the presence of pus and the acquisition of resistance by the bacteria.¹ In the...

The secosteroid hormone 1,25-dihydroxyvitamin D₃ (1,25(OH)₂D₃) is the major biologically active metabolite of vitamin D₃. (Secosteroids are those in which one of the rings has undergone fission; in vitamin D, this is ring B.) 1,25(OH)₂D₃ is recognized as...

THE latest published survey of contraceptive use in the United States was conducted in 1987. Of the 57.4 million women in the reproductive age group (15 to 44 years), 16.1 million (28 percent) were not exposed to unwanted pregnancy.¹ Of the remaining 41.3 million women who were exposed,...

EXTRAORDINARY progress in the understanding of the structure and function of human genes has been made in the past 25 years. Techniques have been developed for the manipulation and study of genes in both normal and abnormal states. Many of these achievements have been extremely important to medicine, and they...