Coronary artery disease is the cause of approximately two thirds of cases of systolic heart failure, although hypertension and diabetes are likely to be contributing factors in many cases. Dilated cardiomyopathy may also result from a genetic cause, previous viral infection, a

A 47-year-old man was admitted to this hospital because of abdominal pain of 5 weeks’ duration, which radiated to the flank. He had had intermittent abdominal pain and constipation for 15 years. He was born in Central America and lived in

A 75-year-old man was admitted to this hospital because of the recent onset of hypertension, hyperglycemia, and edema. 11 days earlier, at a routine visit to his internist, the blood pressure was 171/75 mm Hg. During the following week, the patient reported blood pressures from 160 to 186 systolic and from 79 to 82 diastolic, and a glucose level of 170 to 286 mg per deciliter. He noted ankle swelling, weight gain of 4.5 kg, pain in both calves tha

A 46-year-old woman was referred to this hospital because of swelling of the leg and skin changes. She had chronic kidney disease due to congenital ureteral reflux, with recent hemodialysis, and recurrent deep venous thrombosis of the left leg, beginning 2 years earlier. Swelling of the leg persisted, and thickening and erythema of the skin of both legs developed, leading to difficulty walking, sitting, and bending. A skin-biopsy specimen was thought to be consistent with a diagnosis of eosinophilic fasciitis. During the next 14 months, the skin of both legs and one arm became hardened, and difficulty swallowing developed.

On examination by a dermatologist, there was induration of the left leg, extending to

A 23-year-old man was transferred to this hospital because of cough, hoarseness, fever, and abnormalities on chest imaging. One month before admission, a nonproductive cough developed, followed by hoarseness, dyspnea on exertion, and fever. Imaging studies at another facility showed pulmonary and mediastinal masses and a lesion in the pelvis. CT of the abdomen and pelvis after the administration of contrast material showed a permeative, lytic, and destructive lesion in the posterior right iliac bone. Positron-emission tomographic scans obtained at this hospital showed 18F-fluorodeoxyglucose–avid lesions. The key features are large anterior mediastinal lymph nodes, multiple pulmonary masses, and a large destr

   This trial compared Gefitinib, an inhibitor of the tyrosine kinase of epidermal growth factor receptor (EGFR), with carboplatin plus paclitaxel紫杉醇as initial treatment of pulmonary adenocarcinoma in more than 1200 East Asian patients.

    The 12-month rates of progression-free survival were 24.9% with gefitinib and 6.7% with carboplatin–paclitaxel. The study met its primary objective of showing the noninferiority of gefitinib and also showed its superiority, as compared with carboplatin–paclitaxel, with respect to progression-free survival in the intention-to-treat population (hazard ratio for progression or

 A 27-year-old man was seen at the hospital because of progressive dyspnea and decreased exercise tolerance during the past 2 years. Imaging studies showed diffuse pulmonary fibrosis. The patient had lighter skin than many in his family, although he reported that several family members had light skin and respiratory problems. He had a history of easy bruising. On examination, his skin was pale, and there was clubbing of the fingers and toes, normal breath sounds, pigmented irises, and horizontal nystagmus. This young man has severe respiratory compromise marked by restri

    A 26-year-old man was admitted to the hospital because of abdominal distention and shock. He had been well until the previous evening, when mild abdominal pain developed, shortly after he had eaten five or six frankfurters; the next day, the pain became severe, and his parents found him unresponsive, with coffee-grounds material emanatin

   A 52-year-old man presented to the emergency department with abdominal discomfort. 5 weeks earlier, nonradiating discomfort developed in the epigastric region. The patient’s pain became more localized to the periumbilical area and was accompanied by early satiety and multiple episodes of vomiting. He had no fever, diarrhea,tenesmus, melena, or hematochezia.

   The medical history included mild intermittent asthma that was diagnosed 20 years earlier, obstructive sleep apnea, hypertension, dyslipidemia, type 2 diabetes mellitus, hypothyroidism, and gout. A diagnosis of chronic idiopathic angioedema–urticaria was establi

A 57-year-old teacher with a history of hypertension presented to an urgent care center with nonradiating chest pressure and light-headedness. Her chest pressure had begun soon after she had arrived at work that morning, when she was physically threatened by a parent of one of her fifth-grade students. Her symptoms improved with rest immediately after the event but then worsened by the end of the day. The patient had a history of well-c