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Articles 
Nikolaus C. Netzer, Riccardo A. Stoohs, Cordula M. Netzer, Kathryn Clark, and Kingman P. Strohl Although sleep apnea is common, it often goes undiagnosed in primary care encounters. The Berlin Questionnaire was found to be a means of identifying patients who are likely to have sleep apnea.
Robert G. Hart, Oscar Benavente, Ruth McBride, and Lesly A. Pearce Adjusted-dose warfarin and aspirin reduce stroke in patients with atrial fibrillation, and warfarin is substantially more efficacious than aspirin. The benefit of antithrombotic therapy was not offset by the occurrence of major hemorrhage among participants in randomized trials.
Stephanie K. Brodine, Richard A. Shaffer, Monica J. Starkey, Sybil A. Tasker, Joyce L. Gilcrest, Mark K. Louder, Anthony Barile, Thomas C. VanCott, Maryanne T. Vahey, Francine E. McCutchan, Deborah L. Birx, Douglas D. Richman, and John R. Mascola The percentage of HIV-1 non–subtype B infection and mutations resistant to antiretroviral drugs was relatively high in U.S. military personnel with recently acquired HIV-1 infection.
Brief Communications
Geoff McColl, Hitoshi Kohsaka, Jeff Szer, and Ian Wicks A patient with severe, treatment-resistant rheumatoid arthritis received high-dose cyclophosphamide and antithymocyte globulin. Hemopoietic rescue was achieved with peripheral blood stem cells from the patient's identical twin brother.
Emmanuel Héron, Olivier Lozinguez, Joseph Emmerich, Claude Laurian, and Jean-Noël Fiessinger The overall clinical outcome of spontaneous axillary–subclavian venous thrombosis is good, and no relation exists between the severity of late symptoms and ultrasonographic sequelae.
Updates
Robert K. Schneider and James L. Levenson In covering the pertinent psychiatric literature published in 1998, this Update expands on and introduces information about psychiatry that may not be readily available to the general clinical internist.
Perspectives
Eric J. Cassell The diagnosis of suffering is often missed, even in severe illness and even when it stares physicians in the face. Knowing patients well enough to understand the origin of their suffering and its best treatment requires methods of empathic attentiveness and nondiscursive thinking that can be learned and taught. The relief of suffering depends on physicians acquiring these skills.
NIH Conferences
Lucien M. Levy, Marinos C. Dalakas, and Mary Kay Floeter The stiff-person syndrome is characterized by muscle rigidity and episodic spasms that involve axial and limb muscles. Although the cause is unknown, an autoimmune pathogenesis is suspected. The syndrome is potentially treatable by immunomodulatory agents.
Editorials
Richard P. Millman In this issue, Netzer and colleagues' well-designed study shows that a simple self-administered patient questionnaire is an excellent way of identifying patients at high risk for sleep apnea. The study also provides further evidence that physicians underrecognize sleep disorders.
Michael D. Ezekowitz Hart and colleagues' meta-analysis in this issue reemphasizes the value of anticoagulation in patients with atrial fibrillation, especially those at highest risk for stroke. These findings may lead to increased use of antithrombotic therapy in elderly patients, who have the greatest risk for stroke but also are a group for whom the fear of bleeding complications with anticoagulation is greatest.
On Being a Patient
Norman Epstein A dream—influenced by melatonin?—helps a physician put his father's spirit to rest.
Letters The 28th Amendment
The Hospitalist Movement
Physiologic Left Ventricular Cavity Dilatation in Elite Athletes
Hand Hygiene in Hospitals
Misdiagnosis of HIV Infection
Myocardial Infarction in HIV-Infected Men Receiving Protease Inhibitors
Ocular Venous Occlusion and Hyperhomocysteinemia
Cyclophosphamide-Associated Uroepithelial Toxicity
CD123 hiDendritic Cell Lymphoma: An Unusual Case of Non-Hodgkin Lymphoma
J. Willis Hurst The author shares 17 quotations that he has framed and placed on the wall of a teaching conference room. These quotations illustrate a few principles that should be considered as physicians move into the future.
Kevin W. Olden
Mark P. Seraly
David A. Horowitz
Douglas C. Bigelow
Paula Tatarunis
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