Abetalipoproteinemia is a rare genetic disease that has provided important new insights into the physiology of lipoprotein assembly and vitamin E metabolism. Forty-two years after its initial description, a molecular etiology of ABL has been reported to be a deficiency of a microsomal transfer protein, thus suggesting that this protein plays a key role in lipoprotein particle assembly and secretion both in the intestine and in the liver. Furthermore, studies in patients with ABL have established the critical role of hepatic secretion of VLDL in the delivery of vitamin E to peripheral tissues and the essential role of vitamin E in the maintenance of normal physiological function of multiple tissues. The systematic investigation of this rare genetic disease has provided insights that have substantially enhanced our understanding of human physiology.

Convulsive status epilepticus is an emergency that is associated with high morbidity and mortality. The outcome largely depends on etiology, but prompt and appropriate pharmacological therapy can reduce morbidity and mortality. Etiology varies in children and adults and reflects the distribution of disease in these age groups. Antiepileptic drug administration should be initiated whenever a seizure has lasted 10 minutes. Immediate concerns include supporting respiration, maintaining blood pressure, gaining intravenous access, and identifying and treating the underlying cause. Initial therapeutic and diagnostic measures are conducted simultaneously. The goal of therapy is rapid termination of clinical and electrical seizure activity; the longer a seizure continues, the greater the likelihood of an adverse outcome. Several drug protocols now in use will terminate status epilepticus. Common to all patients is the need for a clear plan, prompt administration of appropriate drugs in adequate doses, and attention to the possibility of apnea, hypoventilation, or other metabolic abnormalities.

To review the epidemiology of anxiety-related reactions during magnetic resonance imaging (MRI) examinations, the feasibility of identifying patients at risk, and the management strategies that have been applied.

These recommendations update previous CDC/American Thoracic Society (ATS) recommendations for the treatment of tuberculosis (TB) among adults and children. The most notable changes are in response to the increasing prevalence of drug-resistant TB in the United States. These recommendations include the need for a) in vitro drug susceptibility testing of Mycobacterium tuberculosis isolates from all patients and reporting of these results to the health department, b) initial four-drug regimens for the treatment of TB, and c) initial directly observed therapy for persons with TB. Adherence to these recommendations will help prevent the occurrence of more cases of drug-resistant TB, reduce the occurrence of treatment failure, and reduce the transmission of TB in the United States.

Acute ischemic stroke is a common, devastating disorder without beneficial therapy. Recent advances concerning the pathophysiology of ischemic brain injury have led to the development of rational pharmacological interventions. Thrombolytic and cytoprotective therapies may be useful and are being evaluated in clinical trials. The design of adequate clinical trials to evaluate these promising therapies has also evolved based on experience. Potential therapy for acute ischemic stroke must be assessed in a large number of patients who are given the intervention within hours of onset using a neurological scoring scale and a disability scale. Several new magnetic resonance imaging technologies are emerging that should allow the clinician to rapidly and accurately identify ischemic brain lesions and to evaluate cerebral perfusion. The availability of potentially efficacious therapies for ischemic stroke evaluated in well-designed clinical trials with magnetic resonance imaging technology, which can also assess therapeutic effects in vivo, should lead to the emergence of therapy to improve the outcome of patients with ischemic stroke in the near future.

To describe ways in which intuitive thought processes and feelings may lead patients to make suboptimal medical decisions.

To review the major forecasts of physician supply and physician requirements.

To review the evidence regarding indications for pulmonary artery catheterization (PAC) in critically ill patients, and to propose a guideline-generating process that would encourage randomized controlled trials of PAC.

A small group of editors of general medical journals met informally in Vancouver, British Columbia, in January 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group, now expanded and known as the International Committee of Medical Journal Editors (also known as the Vancouver Group), has met annually since then and its concerns have broadened. The committee has produced four editions of the Uniform Requirements for Manuscripts Submitted to Biomedical Journals; this fourth edition was revised slightly in January 1993. During discussions of manuscript requirements, questions have been raised about other issues surrounding publication, especially ethics. Some of these concerns are now covered in the Uniform Requirements; others are addressed in separate statements issued by the committee. The total content of this communication may be reproduced for educational, not-for-profit purposes without regard for copyright; the committee encourages distribution of the material, which we hope will be useful. Journals that agree to use the Uniform Requirements are asked to cite the document in their instructions to authors.

To determine whether over-the-counter cold medications have been shown to be effective in relieving symptoms in children, adolescents, and adults.

Further assessment of the long-term risk of breast cancer associated with diethylstilbestrol (DES) during pregnancy.