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Articles 
Florence Lot, Jean-Christophe Séguier, Sophie Fégueux, Pascal Astagneau, Philippe Simon, Michèle Aggoune, Patrice van Amerongen, Martine Ruch, Mireille Cheron, Gilles Brücker, Jean-Claude Desenclos, and Jacques Drucker In October 1995, the French Ministry of Health offered HIV testing to patients who had been operated on by an orthopedic surgeon in whom AIDS was recently diagnosed. The one HIV-positive patient identified was HIV-negative before surgery and had viral sequences closely related to those obtained from the surgeon. This finding suggests that the surgeon may have transmitted HIV to this patient during surgery.
Ja-Liang Lin, Huei-Huang Ho, and Chun-Chen Yu Chelation therapy appears to slow the progression of renal insufficiency in patients with mildly elevated body lead burden. This implies that long-term exposure to low levels of environmental lead may be associated with impaired renal function in patients with chronic renal disease.
George W. Petty, Robert D. Brown, Jr., Jack P. Whisnant, JoRean D. Sicks, W. Michael O'Fallon, and David O. Wiebers In this study, complication rates for warfarin and intravenous heparin given for secondary stroke prevention were lower than rates reported from earlier trials and observational studies. For warfarin, however, these rates were higher than those found in more recent randomized trials. Rates were higher for heparin than for aspirin and warfarin. These rates can be used to judge the applicability of complication rates derived from ongoing clinical trials.
Antonio Pelliccia, Franco Culasso, Fernando M. Di Paolo, and Barry J. Maron In a sample of highly trained athletes, left ventricular cavity dimension varied widely but was strikingly increased to a degree compatible with primary dilated cardiomyopathy in almost 15% of patients. When systolic dysfunction is absent, this dilatation is probably an extreme physiologic adaptation to intensive athletic conditioning.
Brief Communications
Franc Strle, Robert B. Nadelman, Joze Cimperman, John Nowakowski, Roger N. Picken, Ira Schwartz, Vera Maraspin, Maria E. Aguero-Rosenfeld, Shobha Varde, Stanka Lotric-Furlan, and Gary P. Wormser Erythema migrans caused by Borrelia afzelii in Slovenia and erythema migrans caused by B. burgdorferi in New York have distinct clinical presentations. Caution should be used when clinical and laboratory experience from one side of the Atlantic is applied to patients on the other side.
Josiah D. Rich, Nathan A. Merriman, Eleftherios Mylonakis, Thomas C. Greenough, Timothy P. Flanigan, Brian J. Mady, and Charles C.J. Carpenter The availability of sensitive assays for plasma HIV viral load and the trend toward earlier and more aggressive treatment of HIV infection have led to the inappropriate use of these assays as primary tools for the diagnosis of acute HIV infection. Physicians should be cautious when using these assays to detect primary HIV infection, especially when the pretest probability of infection is low.
Akihiro Matsumoto, Shin-ichi Momomura, Seiryo Sugiura, Hideo Fujita, Teruhiko Aoyagi, Masataka Sata, Masao Omata, and Yasunobu Hirata In this study, nitric oxide inhalation improved gas exchange in patients with congestive heart failure. This treatment may be useful as supportive therapy when other conventional vasodilators worsen gas exchange.
Academia and Clinic
Emilie H.S. Osborn, Maxine A. Papadakis, and Julie Louise Gerberding Medical students may be at high risk for occupational exposures to blood. This study found that instruction in universal precautions is not sufficient to prevent exposures to blood during medical training. Medical schools must assume greater responsibility for ensuring that students are proficient in the safe conduct of clinical procedures and must develop systems so that students can report and learn from their mistakes.
Updates
Eugene R. Schiff Among the many topics related to hepatology that gained attention in 1997, this Update focuses on viral hepatitis, other types of liver disease, complications of cirrhosis, and liver transplantation.
History of Medicine
Charles B. Upshaw, Jr. and Mark E. Silverman In 1899, Karel F. Wenckebach unraveled the complicated arrhythmia that bears his name. He is remembered for his insight into atrioventricular circulation, which is as valid today as it was a century ago.
Editorials
Julie Gerberding In this issue, Lot and colleagues report what they believe to be the first case of HIV transmission from an infected surgeon to a patient during a surgical procedure. It is reassuring that this is only the second reported instance of an infected health care provider transmitting HIV to a patient. Rational prevention policies will further reduce this very small risk.
Daniel D. Federman Medical students participate actively in patient care and thus incur some of the risks of experienced physicians, especially the risk for exposure to bloodborne viruses. As a result, schools must train their students in safe procedures and establish response capacities for any break in technique that leads to a possible exposure to bloodborne pathogens. In this issue, Osborn and colleagues describe an outstanding approach to this problem.
Richard E. Sampliner Our understanding of the molecular biology of adenocarcinoma of the esophagus and gastric cardia and of Barrett esophagus is increasing. However, the cause of the increasing incidence of adenocarcinoma is not yet known, and this limits our ability to intervene to reduce the incidence.
On Being a Doctor
Faith T. Fitzgerald What is the relation between "humaneness" and curiosity? How is curiosity suppressed in medical students and physicians?
On Being a Patient
Keith Luther After hospitalization for pancreatitis, Henry returns to the hotel where he lives and faces the challenge not to drink.
Letters Appropriateness of Spinal Manipulation
The Medical Consultant's Role in Caring for Patients with Hip Fracture
Low-Molecular-Weight Heparin for Treating Venous Thromboembolism
Static Electricity Stops a Recalcitrant Arrhythmia
Ocular Venous Occlusion and Hyperhomocysteinemia
Giant-Cell Arteritis Presenting as Mondor Disease
AIDS Exceptionalism
Characteristics of Primary HIV Infection
The Death of House Officers
Annette T. Carron, Joanne Lynn, and Patrick Keaney Improvement in end-of-life care has become a demand of the public and a priority for health care professionals. Medical textbooks could support this improvement by functioning as educational resources and reference material. This paper evaluates four widely used general internal medicine textbooks for their coverage of the clinical management of patients in advanced stages of fatal illnesses.
Ruric Anderson
Robert M. Arnold
Monty M. Bodenheimer
Karen B. Kreiner
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