TABLE OF C O N T E N T S

H D E D I C A T E D T O L I F E L O N G L E A R N I N G

E D I T O R I A L C L I N I C A L R E V I E W S

Medical McCarthyism: 517 Medicare, teaching hospitals, and charges of health care fraud Real fraud cannot be tolerated, but spurious fraud charges are equally intolerable.

J.D. C L O U G H

I N T E R N A L M E D I C I N E B O A R D R E V I E W

Vancomycin-resistant 527 Staphylococcus aureus: An emerging public health threat Three reported cases of S aureus with intermediate susceptibility to vancomycin raise fears that high-level vancomycin resistance may soon be seen. Physicians need to limit their use of vancomycin, and hospitals need to intensify their infection-control efforts. P.A. FLORES AND S .M. G O R D O N

A 52-year-old woman 520 with skin lesions and liver function abnormalities The patient presents to her doctor with a pruritic rash of 6 weeks' duration. What is the diagnosis and treatment?

H. DAW AND J. H. I S A A C S O N

C L I N I C A L D E C I S I O N - M A K I N G

The uncertain role 523 of immunosuppressive agents in Sjogren's syndrome Although Sjogren's syndrome is an autoimmune disorder, immunosuppressive agents have yielded disappointing results in clinical trials.

Stress ulcer prophylaxis: 533 The case for a selective approach Although stress-related mucosal damage is common in critically ill patients, the risk of significant gastrointestinal bleeding appears to be confined to patients with certain risk factors. A full-color illustration explaining the pathogenesis of stress-related mucosal damage accompanies this article.

M.B . BOBEK AND A .C . A R R O L I G A

CONTINUED ON PAGE 513

G. U N A R D A K I AND H .M . M 0 U T S 0 P 0 U L 0 S

C L E V E L A N D C L I N I C J O U R N A L OF M E D I C I N E V O L U M E 6 4 • N U M B E R 10 N O V E M B E R / D E C E M B E R 1

TABLE OF CONTENTS

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Homocysteine: 543 Update on a new risk factor A high fasting plasma homocysteine level is an independent risk factor for atherosclerosis and venous thrombosis.

R S. BALLAL, D.W. JACOBSEN, AND K. ROBINSON

C A N C E R D I A G N O S I S A N D M A N A G E M E N T

Stereotactic breast biopsy: 550 A less-invasive option Percutaneous core needle biopsy, guided by digital three-dimensional x-ray imaging, offers a reasonable alternative to standard surgical biopsy. W.A. CHILCOTE AND C.A. QUINN

D E P A R T M E N T S

Dear Colleague 508

1997 Reviewers 519

Change of Address 532

Index to Volume 64 555

CME Credit Test 559

The Cleveland Clinic Journal of Medicine is peer reviewed and indexed in Index Medicus.

Update on JNC VI: Changes in hypertension management Highlights and commentary on the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

New hope for the impaired physician Prevention of alcohol and drug abuse is the best remedy for this difficult problem

Managing subclinical hyperthyroidism An approach to the workup for this ambiguous condition

What internists need to know about amiodarone As this potent antiarrhythmic drug is used more often, internists need know how to use it correctly

CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 64 • NUMBER 10 NOVEMBER / DECEMBER 1 997 5 1 3