578 AeroBid® (flunisolide) Effective asthma control BID For oral inhalation only CONTRAINDICATIONS AeroBid Inhaler is contraindicated in the primarytreatment of status asthmaticus or other acute episodes of asthma where intensive measures are required. Hypersensitivity to any ofthe ingredients of this preparation contraindicates its use. WARNINGS Particularcare is needed in patientswhoare transferred from systemicallyactivecorticosteroids to AeroBid Inhaler be- causedeaths duetoadrenal insufficiency have occurred in asthmatic patients duringand aftertransfer from systemic corticosteroidsto aerosol corticosteroids. Afterwithdrawal from systemic corticosteroids, a number of monthsare re- quiredfor recoveryof hypothalamic-pituitary-adrenal (HPA) function. During this period of HPAsuppression, patients mayexhibit signsand symptomsofadrenal insufficiencywhen exposed to trauma, surgery or infections, particularly gastroenteritis. Although AeroBid Inhalermayprovidecontrol ofasthmatic symptomsduring theseepisodes, it does NOTprovidethesystemic steroidthat isnecessary for coping with theseemergencies. During periods ofstress orasevereasthmaticattack, patientswwho have been withdrawn from systemiccorticosteroids should be instructed to resumesystemic steroids (in large doses) immediatelyand to contact their physician forfurther instruction. These patients shouldalso be instructed tocarryawarning card indicating that they may need supplemen- tarysystemic steroids during periods of stressorsevere asthma attack.Toassessthe risk ofadrenal insufficiency in emergencysituations, routine tests ofadrenal cortical function, including measurement ofearly morning resting cortisol levels, should beperformed periodically in all patients. An earlymorning resting cortisol level may beaccepted as nor- mal if itfallsatornearthenormal mean level. Localized infections with Candidaalbicans orAspergillus niger have occurred in the mouth and pharynxand occasionally in the larynx. Positive culturesfor oral Candida may be present in upto 34% of patients. Although thefrequency of clinically apparent infection isconsiderably lower, these infections may requiretreatment withappropriate antifungal therapy or dis- continuancewithAeroBid Inhaler. AeroBid Inhaler is not to be regarded as a bronchodilatorand is not indicated for rapid relief of bronchospasm. Patients should be instructed to contact their physician immediately when episodes of asthmathat are not responsive to bronchodilators occur duringthe course of treatment. During such episodes, patients may requiretherapy with systemic corticosteroids. There is no evidence that control of asthma can beachieved byadministration of thedrug in amounts greaterthan the recom- mended doses, which appear to bethe therapeutic equivalent of approximately 10 mg/day of oral prednisone. Theoretically, the use of inhaled corticosteroids with altemate day prednisone systemic treatment should beaccompanied by more HPA right oi TARGET suppression than a therapeutically equivalent regimen of eitheralone. Transfer of patients from systemic steroid therapyto AeroBid Inhaler may unmask allergic conditions previously suppressed by the systemic steroid therapy, e.g., rhinitis, conjunctivitis, and eczema. Consider a few features of The Western Journal of Medicine: PRECAUTIONS Advances in Clinical Medicine General: Because of the relatively high molar dose of flunisolide per activation in this preparation, and because of the * Epitomes-Important evidence suggesting higher levels of systemic absorption with flunisolide than with othercomparable inhaled cortico- Each month this selection highlights the major advances in a steroids, patients treated should carefully for any with AeroBid be observed evidence of systemic corticosteroid effect, in- different with 15 or 20 brief cluding suppression of bone growth in children. Particular care should betaken in observing patients post-operatively or specialty epitomes by experts during periods of stress for evidence of a decrease in adrenal function. During withdrawal from oral steroids, some patients in the field. may experience symptoms of systemically active steroid withdrawal, e.g., joint and/or muscular pain, lassitudeand depres- sion, despite maintenance or even improvement of respiratory function. * Biomedical Science In responsive patients, flunisolide may permit control of asthmatic symptoms without suppression of HPAfunction. Since flunisolide is absorbed into the circulation and can be systemically active, the beneficial effects ofAeroBid Inhaler in Five major clinical research societies coordinate important minimizing or preventing HPA dysfunction may be expected only when recommended dosages are not exceeded. new research findings, emphasizing clinical value. The long-term effects of the drug in human subjects are still unknown. In particular, the local effects of the agent on develop- mental or immunologic processes in the mouth, pharynx, trachea, and lung are unknown. There isalso no information aboutthe possible long-term systemic effects oftheagent. * Socioeconomics The potential effects of the drug on acute, recurrent, or chronic pulmonary infections, including active or quiescenttuber- WJM is often the first to predict. examine, and evaluate culosis, are not known. Similarly, the potential effects of long-term administration of the drug on lung or othertissues are unknown. socioeconomic changes and trends. Pulmonary infiltrates with eosinophilia may occur in patients on AeroBid Inhaler therapy. Although it is possible that in some patients this state may become manifest because of systemicsteroid withdrawal when inhalational steroids are * Yearly Special Issue administered, a causative role for thedrug and/or its vehicle cannot be ruled out. Each devoted to a topic vital tf physicians: cross-cultural Carcinogenesis: A 22-month study was conducted in Swissderived mice toevaluate the carcinogenic potential of the drug. There wasan increase in the incidence of pulmonary adenomas within the range ofadenomas previously reported in mceclicine (1983). AIDS-a global perspective (1987). the literaturefor untreated or control Swissderived mice. An additional study is being conducted in a species with a lower women mnedicine (1988). addiction meedicinie and the incidence of spontaneous pulmonary tumors. andl hab add - Impairmentof ferlillty: Female rats receiving high doses of flunisolide (200 mcg/kg/day) showed some evidenceof pri mary Care phys ician ( 1990). re litation medicine: impaired fertility. Reproductive performance in the low (8 mcg/kg/day) and mid-dose (40 mcg/kg/day) groupswas compar- into lite to vears (1991). abIeto controls. Pregnancy: Pregnancy Category C. Aswith othercorticosteroids, flunisolide has been shown to beteratogenic in rabbits and rats at doses of 40 and 200 mcg/kg/day respectively. It was also fetotoxic in theseanimal reproductive studies. There Enclosed is $ to cover subscriptions. are no adequate and well-controlled studies in pregnantwomen. Flunisolide should be used during pregnancy only if the potential benefit justifiesthe potential riskto thefetus. Subscription renewal Regular subscription Nursing Mothers: It is not known whetherthisdrug is excreted in human milk. Becauseothercorticosteroids are excreted Ll LI. in human milk, caution should beexercised when flunisolide isadministered to nursingwomen. Foreign subscription Bill me [- ADVERSE REACTIONS Adverseevents reported in controlled clinical trialsand long-term open studies in 514 patients treatedwithAeroBidare Student Resident described below. Of those patients, 463 were treated for3 months or longer, 407 for6 months or longer, 287 for 1 yearor longer, and 122 for2 years or longer. Musculoskeletal reactions were reported in 35% of steroid-dependent patients in whom the dose of oral steroid was being TO: tapered. This is a well-known effect ofsteroid withdrawal. Incidence 10% or grater Gastrointestinal: diarrhea (10%), nausea and/orvomiting (25%), upset stomach (10%); General: flu (10%); Mouth and Street Throat: sore throat (20%); Nervous System: headache (25%); Respiratory: cold symptoms (15%), nasal congestion (15%), upper respiratory infection (25%); Special Senses: unpleasant taste (10%). Incidence 3-9% (^itv I tttP /7 in Cardiovascular: palpitations; Gastrointestinal: abdominal pain, heartburn; General: chest pain, decreased appetite, edema, fever; Mouthand Throat: Candida infection; NervousSystem: dizziness, irritability, nervousness, shakiness; Reproductive: menstrual disturbances; Respiratory: chest congestion, cough,* hoarseness, rhinitis, runnynose, sinus congestion, sinus Specialty (If applicable) drainage, sinus infection, sinusitis, sneezing, sputum, wheezing*; Skin: eczema, itching (pruritus), rash; Special Senses: ear infection, loss of smell ortaste. Incidence 1-3% Student/Resident Completion Date (Year) General: chills, increased appetite andweight gain, malaise, peripheral edema, sweating, weakness; Cardiovascular: hyper- tension, tachycardia; Gastrointestinal: constipation, dyspepsia, gas; Hemic/Lymph: capillaryfragility, enlarged Iymph Please mail this with enclosed to: nodes; Mouthand Throat: dry throat, glossitis, mouth irritation, pharyngitis, phlegm, throat irritation; Nervous System: coupon payment anxiety, depression, taintness, fatigue, hyperactivity, hypoactivity, insomnia, moodiness, numbness, vertigo; Respiratory: bronchitis, chest tightness,* dyspnea, epistaxis, head stuffiness, laryngitis, nasal irritation, pleurisy, pneumonia, sinus Circulation Department discomfort; Skin: acne, hives, orurticaria; SpecialSenses: blurred vision, earache, eye discomfort, eye infection. P.O. Box 7602, San Francisco Incidences lessthan 1%, judged by investigators as possibly or probablydrug-related: abdominal fullness, shortness ofbreath. California 94120-7602 *The incidencesasshown of cough, wheezing, and chesttightnesswere judgedby investigators to be possiblyorprobablydrug- related. In placebos-controlledtrials, theoverall incidencesoftheseadverse evnts (regardlessof investigators' judgementof drug SuLbscr-iptions. 12 issues per catr weresimilarfordrug and placebo-treated groups.They may berelated to thevehicle or delivery system. relationship) U.S. and CanadaL: $40 yeatr. S70 2 yciars CAUTION: Federal law prohibits dispensingwithout prescription. Forfull prescribing information, pleasesee package insert. All other counLtries: $70 year. S120 2 years (NDC 0456-0672-99) Mfd by: Riker Laboratories Studcnt/Resident (USA and Canada): S15 per veiir Northridge, Calitornia 91324 For Foreut Pharmaceuticals, Inc. References: St. Louis, MO 63043-9979 1. National Heart, Lung, and BloodInstiute NationalAsthma Education Program Expert Panel Repolt-Guidelines for The Western Journal of Medicine the Diagnosis andManagement ofAsthma. Bethesda, Md: US Dept of Health and Human Services; 1991. 2. Physicians'DeskReference®. 45th ed. Oradell, NJ Medical Economics Co nc; 1991:955, 1862. 2026. P.O. Box 7602 San Francisco, California 94120-7602 (415) 882-5179 F3 FOREST PHARMACEUTICALS, INC. 1991 Forest Pharmaceuticals, Inc St. Louis, MIssoun 63043-9979 AER02591 580 The Western Journal of Medicine SINCE 1902 ISSN 0093-0415

PO BOX 7602 * SAN FRANCISCO, CALIFORNIA 94120-7602 * TELEPHONE (415) 882-5177 LINDA HAWES CLEVER, MD, Editor SALLY LINEBARGER, Assistant Managing Editor FRITZ C. HEATON, Advertising and Promotion Manager LLOYD H. SMITH, Jr, MD, Associate Editor SANDRA WILLETT, Editorial Assistant NILA J. NICHOLS, Circulation Coordinator DIANA L. McANINCH, Managing Editor JANICE ANDERSEN, Senior Copy Editor JACQUELINE BRAZIEAL, Classified Advertising editorial communications to DR CLEVER * business communications to MS McANINCH

Official Journal of the Alaska State Medical Association, the Arizona Medical Association, the California Medical Association, the Denver Medical Society, the Idaho Medical Association, the Nevada State Medical Association, the New Mexico Medical Society, the Utah Medical Association, the Washington State Medical Association, and the Wyoming Medical Society. Affiliated Clinical Investigation Societies: the Western Association of Physicians; the Western Society for Clinical Investigation; the Western Section, American Federation for Clinical Research; the Western Society for Pediatric Research; the Western Region, Society for Investigative Dermatology. SPECIAL EDITORS Primary Care Medicine General and Family Practice Pathology Stephen J. McPhee Charles W. Huff, Laramie, Wyo Roy 1. Davis, Phoenix, Ariz Special Editor for Arizona Terrie Mendelson Norman Kahn, Sacramento, Calif Marshall B. Block, Phoenix, Ariz J. Jerome Wildgen, Kalispell, Mont Pediatrics Epidemiology and Biostatistics Allen W. Mathies, Jr, Pasadena, Calif Special Editor for Denver B. Hulley David Shander, Denver, Colo Stephen Internal Medicine William 0. Robertson, Seattle, Wash Radiologic Cases Philip R. Alper, Burlingame, Calif Special Editor for Idaho Jonathan M. Levy Robert W. Burroughs, Spokane, Wash Pharmacology E. R. W. Fox, Coeur d'Alene, Idaho Rubin Bressler, Tucson, Ariz Poetry Patricia Gabow, Denver, Colo Special Editor for Nevada Leonard D. Hudson, Seattle, Wash Reno, Nev Margaret Kaufman Physical Medicine and Rehabilitation Anton P. Sohn, Harry R. Kimball, Philadelphia, Pa Julie G. Madorsky, Pomona, Calif Special Editor for New Mexico EDITORIAL BOARD Darwin Palmer, Albuquerque, NM 1. Brian Taylor, Carlsbad, NM Irwin J. Schatz, Honolulu, Hawaii Plastic Surgery Editor Emeritus Stephen 1. Wasserman, San Diego, Calif Santa Monica, Calif Special Editor for Utah Malcolm S. M. Watts, San Francisco, Calif Henry K. Kawamoto, Jr, Laurens R White, San Francisco, Calif John H. Holbrook, Salt Lake City, Utah Editor Emeritus Preventive Medicine and Public Health Special Editor for Washington Dwight L Wilbur, San Francisco, Calif Neurology Joseph L Lyon, Salt Lake City, Utah Baringer, Salt Lake City, Utah David Hopkins, Federal Way, Wash Allergy J. Richard Jonathan Mann, Boston, Mass Special Editor for Wyoming Don F. Seelinger, Albuquerque, NM Merle S. Scherr, Scottsdale, Ariz W. C. Wiederholt, La Jolla, Calif Psychiatry Joseph P. Murphy, Casper, Wyo Anesthesiology Ralph Crawshaw, Portland, Ore Ronald D. Miller, San Francisco, Calif Neurosurgery R. Bruce Sloane, Los Angeles, Calif George A. Ojemann, Seattle, Wash ASSISTANT EDITORS Biostatistics and Epidemiology Robert F. Spetzler, Phoenix, Ariz Radiology Clinical Investigation Virginia L Ernster, San Francisco, Calif Gary Glazer, Stanford, Calif Kenneth D. 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All other countries add stocks are available, missing issue requests from subscribers are honored for up to six months after the US $4.23 Air Printed Matter Postage. Address all subscription communications to: issue date. Thereafter, the single copy rate of $5.00 is applicable for each issue available. THE WESTERN JOURNAL OF MEDICINE Circulation, PO Box 7602 Chonge ofAddress-Requests for change of address should give both the old and new address. Allow San Francisco, CA 94120-7602 * Tel: (415) 882-5179 six weeks for changeover. SUBMITTING MANUSCRIPTS Manuscripts for consideration should be sent to the editor, Linda Hawes Clever, MD, PO Box 7602, San in most issues. Manuscripts may be prepared in accordance with the "Uniform Requirements for Manu- Francisco, CA 94120-7602; overnight mail, 221 Main St, San Francisco, CA 94105. scripts Submitted to Biomedical Journals" (Annals ofInternal Medicine, Feb 1988; The MedicalJoumal of "Instructions for Authors"-A complete guide to manuscript submission and WJM style appears Austrolia, Feb 1988). PUBLISHER The Western Journal of Medicine Copyright 1991 by the California Medical Association * Owned and Published by the California (ISSN 0093-0415/USPS 084 480) is published monthlyfor $35 peryear (USAand Canada) bythe California Medical Association. Medical Association, 221 Main Street, San Francisco, CA 94105. Second-class postage paid at San All material subject to this copyright appearing in THE WESTERN JOURNAL OF MEDICINE may be Francisco and additional mailing offices. photocopied for the noncommercial purpose of scientific or educational advancement. Volumes begin POSTMASTER: Send address changes to The Western Journol of Medicine, Circulation, PO Box 7602, with January and July. San Francisco, CA 94120-7602. 584 THE WESTERN JOURNAL OF MEDICINE BuSparr ol) Refrences: 1. Feighner JP, Cohn JB. Analysis of individual symptoms in generalized anxiety--a pooled, multistudy, dou- ble-blind evaluation of buspirone. Neuropsychobiology. 1989:21:124-130. 2. Newton RE, Marunycz JD, Alderdice MT, Napoliello MJ. Review of the side-effect profile of buspirone. Arn J Med. 1986;80 (suppl 3B):17-21. & Lader M. Assessing the potential for buspirone dependence or abuse and effects of its withdrawal. Am J Med. 1987;82 (suppl 5A):20-26. Contraindications: Hypersensitivity to buspirone hydrochloride. The Western Warnings: The administration of BuSpar to a patient taking a monoamine oxidase inhibitor (MAOI) may pose a hazard. Since blood pressure has become elevated when BuSpar was administered concomitantrywith an MAOI, such concomitant use is not recommended. BuSparshould not be employed in lieu of appropriate antipsychotic treatment. Journal ofMedicine Precautions: General-Interference with cognitiveandmotorperformance: Although buspirone is less sedating than other anxiolytics and does not produce significant tunctional impairment, its CNS effects in a given patient may not be predictable; therefore, patients should be cautioned about operating an automobile or using complex machinery until they are reasonably certain that buspirone does not affectthem adversely. (ISSN 0093-0415/USPS 084 480) is published Although buspirone has not been shown to increase alcohol-induced impairment in motor and mental per- formance, it is prudent to avoid concomitant use with alcohol. monthly for $40 per year (USA and Canada) by Potential for withdrawal reactions in sedativelhypnoticlanxiol'tic drug dependent patients: Because bu- spirone will not block the withdrawal syndrome often seen wit cessation of therapy with benzodiazepines the California Medical Association, 221 Main and other common sedative/hypnotic drugs, before starting buspirone withdraw patients gradually from their rior treatment, especially those who used a CNS depressant chronically. Rebound or withdrawal Street, San Francisco, CA 94105. Second-class symptoms may occur over varying time periods, depending in part on the type of drug and its elimination half-life. Thewithdrawal syndromecan appearasany combination of irritability, anxiety, agitation, insomnia, postage paid at San Francisco, CA and additional tremor, abdominal cramps, muscle cramps, vomiting, sweating, flu-like symptoms without fever, and occa- sionally, even as seizures. mailing offices. Possible concerns related to buspirone's binding to dopamine receptors: Because buspirone can bind to central dopamine receptors, a question has been raised about its potential to cause acute and chronic changes in dopamine mediated neurological tunction (eg, dystonia, pseudoparkinsonism, akathisia, and tardive dyskinesia). Clinical experience in controlled trials has tailed to identifyany significant neuroleptic- likeactivity; however, a syndrome of restlessness, appearing shortlyafter initiation of treatment, has been re- ported; the syndrome may be due to increased central noradrenergic activity or may be aftributable to POSTMASTER: dopaminer9ic effects (ie, represent akathisia). Intormation forPatients-Patients should be instructed to inform their physician about any medica- Send address changes to tions, prescription or nonprescription, alcohol or drugs they are now taking or plan to take during treatment with buspirone; to inform their physician if they are pregnant, are planning to become pregnant, or become The Western Journal ofMedicine pregnant while taking buspirone; to inform their physician if they are breasl feeding; and not to drive a car or operate potentially dangerous machinery until they experience how this medication affects them. Circulation, P.O. Box 7602 ODrg Interactions-Concomitant use with other CNS active drugs should be approached with caution (seeWarnings). Concomitant usewithtrazodone may havecaused 3- to6-foldelevations on SGPT (ALT) in San Francisco, CA 94120-7602 stew patients. Concomitant administration of BuSparand haloperidol resulted in increased serum haloperi- dot concentrations in normal volunteers. The clinical significance is not clear. Buspirone does not displace tightly bound drugs like phenytoin, propranolol, and wartarin from serum proteins, but may displace less firmly bound drugs like digoxin. However, there was one report of prolonaed prothrombin time when buspi- rone was given to a patient also treated with wartarin, phenytoin, phenobarbital, digoxin, and Synthroid. Carcinogenesis, Impairment offertility-No evidence of carcinogenic potential was observed in ratsMutapenesis,or mice; buspimone did not induce point mutations, nor was DNA damage observed; chromosomal aberrations or abnormalities did not occur. Pregnan Effects-Pregnancy Category B: Should be used during pregnancy only clearly neead Teratogenic if Nursing Mothers-Administration to nursing women should be avoided if clinically possible. Pediatric Use-The safety and effectiveness have not been determined in individuals below 18 years of age. lusein theElderly-No unusual, adverse, age-related phenomena have been identified in elderly patients receiving a total, modal daily dose of 15 mg. Use in Patients withImpairedHepatcorRenalFunction-Since buspirone is metabolized by the liver and excreted by the kidneys, it is not recommended in severe hepatic or renal impairment. Moving? Adverse Reactions (See also Precautions): Commonly Observed-The more commonly ob- served untoward events, not seen at an equivalent Incidence in placebo-treated patients, include dizziness, nausea, headache, nervousness, lightheadedness, and excitement. Associated withDiscontinuation otTreatment-The more common events causing discontinuation included: central nervous system disturbances (3.4%), primarily dizziness, insomnia, nervousness, drows- iness, lightheaded feeling; gastrointestinal disturbances (1.2%), primarily nausea; miscellaneous distur- bances (1.1% primarily headache and fatigue. In addition,3.4% of patients had multiple complaints, none Please give us six weeks of which could be characterized as primary. Incidence in ControlledClinical Trials-Adverse events reported by 1% or more of 477 patients who received buspirone in tour-week, controlled trials: Cardiovascular: Tachycardia/pa pitations1%. CNS: Diz- notice and supply your ziness 12%, drowsiness 10%, nervousness 5%, insomnia 3%, lightheadedness 3%, decreased concentra- tion 2%, excitement 2%, anger/hostility 2%, confusion 2%, depression 2%. EEN1: Blurred vision 2%. Gastrointestinal: Nausea8%, dry mouth 3%, abdominal/gastric distress 2%, diarrhea2%, constipation1%, personal reference number. vomiting 1%. Musculoskeletal: Musculoskeletal aches/pains 1%. Neurological: Numbness2%, paresthesia 1%, incoordination 1%, tremor 1%. Skin: Skin rash 1%. Miscellaneous: headache 6%, fatigue 4%, weak- ness 2%, sweating/clamminess 1%. OtherEventsObservedDuring theEntirePremarketingEvaluation-The relativefrequency ofall other undesirable events reasonably associated with the use of buspirone in approximately 3000 subjects who took multiple doses of the drug under well-controlled, open, and uncontrolled conditions is defined as follows: Frequent are those occurring in at least 1/100 patients; infrequent are those occurring in 1/100 to 111000 patients; and rare are those occurring in less than 111000 patients. Cardiovascular-frequent: non- specific chest pain; infrequent: syncope, hypotension, hypertension; rare: cerebrovascular accident, con- gestive heart failure, myocardial infarction, cardiomyopathy, bradycardia. Central Nervous System- frequent: dream disturbances; infrequent: depersonalization, dysphoria, noise intolerance, euphoria, aka- thisia, fearfulness, loss of interest, dissociative reaction, hallucinations, suicidal ideation, seizures; rare: ID No. feelings of claustrophobia, cold intolerance, stupor, slurred speech, psychosis. EENT-frequent: tinnitus, sore throat, nasal congestion; infrequent: redness and itching of the eyes, altered taste, altered smell, con- junctivitis; rare: inner ear abnormality, eye pain, photophobia, pressure on eyes. Endocrine-rare: galactor- rhea, thyroid abnormality. Gastrointestinal-infrequent: flatulence, anorexia, increased appetite, salivation, irritable colon, rectal bleeding; rare: burning of the tongue. Genitourinary-infrequent: urinary frequency, urinary hesitancy, menstrual irregularity and spoffing, aysuria, rare: amenorrhea, pelvic inflammatory dis- ease, enuresis, nocturia. Musculoskeletal-infrequent: muscle cramps, muscle spasms, rigid/stiff muscles, arthralgias. Neurological-infrequent: involuntary movements, slowed reaction time; rare: muscle weak- ness. Respiratory-infrequent: hyperventilation, shortness of breath, chestcongestion; rare: epistaxis. Sex- ual Function-infrequent: decreased or increased libido; rare: delayed ejaculation, impotence. Skin- infrequent: edema, pruritus, flushing, easy bruising, hair loss, dry skin, facial edema blisters; rare: acne, thinning of nails. Clinical Laboratory-infrequent: increases in hepatic aminotransferases (SGOT, SGPT); rare: eosinophilia, leukopenia, thrombocytopenia. Miscellaneous-infrequent: weight gain, fever, roaring sensation in the head, weight toss, malaise; rare: alcohol abuse, bleeding disturbance, loss of voice, hic- cou hs. PosClinicalgExphence-Rareintroduction occurrences ofallergic reactions, cogwheel rigidity, dys- tonic reactions, ecchymosis, emotional lability, tunnel vision, and urinary retention have been reported. Be- cause of the uncontrolled nature of these spontaneous reports, a causal relationship to BuSpar has not been determined. Drug Abuse and Dependence: Controlled Substance Class-Not a controlled substance. Physical andPsychologicalDependence-Buspirone has shown no potential forabuse or diversion and there is no evidence that it causes tolerance, or either physical or psychological dependence. However, since it is difficult to predict from experiments the extent to which a CNS-active drug will be misused, di- verted, and/or abused once marketed, physicians should carefully evaluate patients for a history of drug abuse and followsuch patientsclosely, observing them for signs of buspirone misuseor abuse (eg, develop- ment of tolerance, incrementation of dose, drug-seeking behavior). The Western Overdosage: SignsandSymptoms-At doses approaching 375 mg/daythe symptoms were observed: nausea, vomiting, dizziness, drowsiness, miosis, and gastric distress.followingNo deaths have been re- ported in humans either wilh deliberate or accidental overdosage. Journal of Medicine Recommended Overdose Treatment-General symptomatic and supportive measures should be used along with immediate gastric lavage. No specific antidote is known and dialyzability of buspirone has not been determined. P.O. Box 7602 For complete details, see Prescribing Information M or consultyour Mead Johnson Pharmaceuticals eaM0 San Francisco, CA 94120-7602 Representative. PHARMACEUTICALS_A_ U.S. Patent Nos. 3,717,634 and 4,182,763 S37 ABristol-MvasSQibbCo. MJL8-4270R2 US.A.PrinceonO New Jersey 08543 598 THE WESTERN JOURNAL OF MEDICINE Continuing Medical Education CALIFORNIA, HAWAII, NEVADA * COLORADO * IDAHO * NEW MEXICO * UTAH * WASHINGTON

April 6-11-31st Annual Cardiology Retreat. Scripps Clinic and Research CALIFORNIA, HAWAII, AND Foundation at Rancho Santa Fe. Mon-Sat. Contact: Scripps Clinic, 10666 NEVADA N Torrey Pines Rd, La Jolla 92037. (619) 554-8556. April 21-23-2nd Annual Symposium on Coronary Stenting: A Live This listing of continuing education programs in California, Ha- Demonstration Course. Scripps Clinic and Research Foundation at waii, and Nevada is supplied by the Committee on Continuing Sheraton Grande Torrey Pines Hotel, La Jolla. Tues-Thurs. 18 hrs. Con- tact: Scripps Clinic, 10666 N Torrey Pines Rd, La Jolla 92037. (619) 554- Medical Education of the California Medical Association. All 8556. courses and meetings listed have been approved for Category I May 1-2-2nd International Symposium on Thrombolytic Therapy in credit toward the CMA Certificate in Continuing Medical Educa- Acute Ischemic Stroke. Scripps Clinic and Research Foundation at San tion. To have accredited courses listed here, please send infor- Diego Marriott, La Jolla. Fri-Sat. Contact: Scripps Clinic, Box 403C, mation at least two months in advance to Department of 10666 N Torrey Pines Rd, La Jolla 92037. (619) 554-8556. Continuing Medical Education, California Medical Association, P0 Box 7690, San Francisco 94120-7690; or phone (415) 541-0900. For more information on accreditation or certification, please CRITICAL CARE write to the above address. February 3-7-Critical Care Medicine. USC at Caesar's Palace, Las Vegas, Nevada. Mon-Fri. 33.5 hrs. $695. Contact: USC. ALLERGY DERMATOLOGY February 6-8-Allergy Diagnosis. UCSD at La Jolla Village Inn. Thurs-Sat. January 17-19-Practical Dermatology and Dermatologic Office Proce- 20 hrs. $290. Contact: Janice Turner, PO Box 2586, La Jolla 92038. (619) dures for the Primary Care Physician. UCSD at Hyatt Regency, La 459-1564. Jolla. Fri-Sun. 20 hrs. Contact: Jacqueline Shiller, Box 84296, San Diego March 27-28-Asthma and Allergy in the 1990s. Medical Education Re- 92138. (619) 223-2997. sources at Wyndham Hotel, Palm Springs. Fri-Sat. Contact: MER, 1500 January 31-February 2-Cutaneous Malignancies: 1992 Skin Cancer Up- W Canal Ct, Ste 500, Littleton, CO 80120. (800) 421-3756. date. Scripps Clinic and Research Foundation at Sheraton Grande Torrey Pines Hotel, La Jolla. Fri-Sun. 18 hrs. Contact: Susan Buntjer, Scripps Clinic and Research Foundation, 10666 N Torrey Pines Road, La Jolla ANESTHESIOLOGY 92037. (619) 554-8556. February 27-Problems ofthe Aging Skin. Stanford Medical Center at Palm January 9-12-UCSD Anesthesia Update: 1992. UCSD at Hotel del Cor- Springs. Thurs-Sun. Contact: Pamela Bain, R-144, Stanford 94305. (415) onado, San Diego. Thurs-Sun. Contact: UCSD. 723-7854. January 19-21 -Second America-Japan Anesthesia Congress. Interna- tional Anesthesia Research Society at Sheraton Waikiki Hotel, Honolulu, Hawaii. Sun-Tue. 14 hrs. $250. Contact: Vicky Larsen, University of Utah School of Medicine, 50 North Medical Drive, Salt Lake City, UT 84132. (801) 581-6115. KEY TO ABBREVIATIONS January 19-24-Hawaiian Seminar on Clinical Anesthesia. California So- CMA: California Medical Association ciety of Anesthesiologists at Westin Maui Hotel, Kaanapali Beach, Maui, Contact: Continuing Medical Education, California Medical Association, Hawaii. Sun-Fri. 20 hrs. Contact: California Society ofAnesthesiologists, PO Box 7690, San Francisco 94120-7690. (415) 541-0900. 1065 E Hillsdale Blvd, #410, Foster City 94404. (800) 345-3691. DREW: Charles R. Drew Postgraduate Medical School January 24-26-30th Clinical Conference in Pediatric Anesthesiology. Contact: Herbert M. Thomas, MD, MPH, Director of CME, Office of Children's Hospital of Los Angeles at Stouffer Concourse Hotel. Fri-Sun. Continuing Education, Charles R. Drew Postgraduate Medical School, 1621 15 hrs. Contact: Katherine Barky, MD, PO Box 54700, Los Angeles East 120th St, Los Angeles 90059. (213) 603-3183. 90054. (213) 669-2262. LLU: Loma Linda University March 13-17-66th Congress of the International Anesthesia Research Contact: James J. Couperus, MD, Associate Dean for Educational Affairs, Society. International Anesthesia Research Society at San Francisco Loma Linda University School of Medicine, Loma Linda 92350. Hilton & Towers. Fri-Tues. Contact: Anne Maggiore, IARS, 2 Summit PMC: Pacific Medical Center Park Dr, Ste 140, Cleveland, OH 44131. (216) 642-1124. Contact: Continuing Education, Pacific Medical Center, PO Box 7999, San March 21-22-Pbstgraduate Assembly. Los Angeles County Society of An- Francisco 94120. (415) 563-4321, ext 2761. esthesiologists at Sheraton Universal Hotel, Universal City. Sat-Sun. Con- STAN: Stanford University tact: Michael Carlson, 1903 Redondo Ave, Long Beach 90804. (213) Contact: Edward Rubenstein, MD, Associate Dean for Postgraduate Educa- 597-2661. tion, Medical School Office Building, Suite X-365, Stanford 94305-6114. March 21-26-20th Obstetric Anesthesia Conference. Ohio State Univer- (415) 723-5594. sity Hospitals at Sheraton Waikiki Hotel, Honolulu, Hawaii. Sat-Thurs. UCD: University of California, Davis Contact: Arlene Rogers, 410 W 10th Ave, Columbus, OH 43210. (614) Contact: Ruth Feryok, Director, Office of Continuing Medical Education, 293-8487. University of California, Davis, School of Medicine, 2701 Stockton Blvd, Sacramento 95817. (916) 734-5390. May 17-22-Anesthesiology Review Course. UCSD at San Diego Princess Resort. Contact: UCSD. UCI: University of California, Irvine Sun-Fri. Contact: Melvin I. Marks, MD, Director, Memorial/UCI Center for Health Education, Long Beach Memorial Medical Center, 2801 Atlantic Ave, PO Box 1428, Long Beach, California 90801-1428. (213) 595-3811. CARDIOLOGY UCLA: University of California, Los Angeles Extension Contact: Martin D. Shickman, MD, Director, Continuing Education in January 18-25-Cardiopulmonary Emergencies. UCSD at Kona, Hawaii. 1 Medicine and the Health Sciences, PO Box 24902, UCLA, Los Angeles week. Contact: UCSD. 90024. (213) 825-8423. February 14-16-Arrhythmias: Interpretation, Diagnosis and Manage- UCSD: University of California, San Diego ment. Medical Education Resources at Disneyland Hotel, Anaheim. Fri- Contact: Office ofContinuing Medical Education, University ofCalifornia, Sun. Contact: MER, 1500 W Canal Ct, Ste 500, Littleton, CO 80120. San Diego, School of Medicine (M-017), La Jolla 92093. (619) 534-3940. (800) 421-3756. UCSF: University of California, San Francisco March 20-21-Cardiac Diagnostic Methods & Risk Management. Medi- Contact: Janet Johnson, Administrative Director, Extended Programs in cal Education Resources at Caesars Palace, Las Vegas, Nevada. Fri-Sat. Medical Education, School of Medicine, University of California, San Fran- Contact: MER, 1500 W Canal Ct, Ste 500, Littleton, CO 80120. (800) cisco 94143. (415) 476-425 1. 421-3756. USC: University of Southern California April 4-Practical Cardiology for the '90s. Grossmont Hospital at La Mesa. Contact: Phil R. Manning, MD, Associate Dean, Postgraduate Division, Sat. Contact: Karen Hamilton, PO Box 158, La Mesa 91944-0158. (619) University of Southern California School of Medicine, 1975 Zonal Ave, 589-4168. KAM314, Los Angeles 90033. (800) 872-1119. (Continued on Page 600) 600 THE WESTERN JOURNAL OF MEDICINE

CONTINUING MEDICAL EDUCATION (Continued from Page 598) EMERGENCY MEDICINE GERIATRICS January 10-11-California Trauma Conference. UCD at Hyatt Regency, January 21-25-9th UCLA Intensive Course in Geriatric Medicine. Sacramento. Fri-Sat. Contact: UCD. UCLA at Beverly Hilton. Tues-Sat. 40 hrs. $600. Contact: UCLA. January 13-17-Emergency Medicine Symposia I. UCSD at San Diego January 24-25-Alzheimer's Disease: New Approaches to Treatment. Hilton Beach & Tennis Resort. Mon-Fri. Contact: UCSD. UCSD at Westgate Hotel, San Diego. Contact: Cass Jones, Professional 565- February 23-28-Emergency Medicine. UCD at Incline Village, Nevada. Conference Management, 7916 Convoy Ct, San Diego 92111. (619) Sun-Fri. Contact: UCD. 9921. March 6-8-Recent Advances in Geriatric Medicine-Healthy People 2000: March 8-13-13th Annual Mammoth Mountain Emergency Medicine Ski in the El- Conference. CAL/ACEP and Orange County Emergency Department at A New Look at Screening, Prevention and Rehabilitation Mammoth Lakes. Sun-Fri. 18 hrs. $395. Contact: Mark Song, Medical derly. UCSD at Pan Pacific Hotel, San Diego. Fri-Sun. Contact: Cass Beach 92662. (714) 552-0831. Jones, Professional Conference Management, 7916 Convoy Ct, San Diego Conferences, PO Box 52-B, Newport 92111. (619) 565-9921. March 16-20-Emergency Medicine Symposia II. UCSD at Basic Science UCSD. March 16-17-Exercise in Geriatric Care. VA Sepulveda Medical Center at Building. Mon-Fri. Contact: Burbank. Mon-Tues. Contact: Symposium Secretary, VA Medical Center, April 1-4-8th Annual Advances in Emergency Medicine. UCSF at Pan GRECC (I IE), 1611 1 Plummer St, Sepulveda 91343. (818) 895-931 1. Pacific Hotel, San Francisco. Wed-Sat. $455. Contact: UCSF. May 6-10-14th Biannual: Wound Management Workshop. UCSD at San Diego Hilton Beach & Tennis Resort. Wed-Sun. 18 hrs. $200-$435. Con- tact: UCSD. INFECTIOUS DISEASES May I1-15-Emergency Medicine Symposia I. UCSD at San Diego Hilton February 7-8-10th Annual Practical Update of Infectious Disease. UCD. Beach & Tennis Resort. Mon-Fri. Contact: UCSD. Fri-Sat. 12 hrs. $160. Contact: UCD. April 25-HIV Update. UCDMC at Cancer Center Auditorium. Sat. Con- tact: UCD. April 29-May 1-13th Annual Advances in Infectious Diseases. UCSF at ENDOCRINOLOGY AND METABOLISM San Francisco. Wed-Fri. $400. Contact: UCSF. March 4-5-Advances in Endocrinology and Metabolism. UCSF at Pan May 6-8-13th Annual Advances in Infectious Diseases. UCSF at Sheraton Pacific Hotel, San Francisco. Wed-Thurs. 14.5 hrs. $295. Contact: Palace Hotel, San Francisco. Wed-Fri. $400. Contact: UCSF. UCSF. March 6-18th Annual Diabetes Symposium. UCD at Sacramento. Fri. 6 hrs. $140. Contact: UCD. INTERNAL MEDICINE March 6-7-Diabetes Update. UCSF at Pan Pacific Hotel, San Francisco. Fri-Sat. 10 hrs. $245. Contact: UCSF. January 30-February 1-Advanced Nephrology: Nephrology for the Con- sultant. UCSD at La Jolla Marriott, San Diego. Thurs-Sat. 17 hrs. $350. Contact: UCSD. February 22-27-Topics and Advances in Internal Medicine. UCSD at FAMILY PRACTICE/PRIMARY CARE Sheraton Harbor Island, San Diego. Sat-Sun. Contact: UCSD. February 23-25-5th Annual Congress of the North American Society of February 9-15-UCI Family Practice Refresher Course. Memorial/UCI Phlebology on the Advances in Sclerotherapy and the Advances in Center for Health Education at Marriott Hotel, Newport Beach. Sun-Sat. Surgical and Medical Treatment of Venous Disease. North American Contact: UCI. Society of Phlebology and the American Academy of Dermatology at February 13-15-Current Concepts in Cancer Management: A Sympo- Grand Hyatt Union Square, San Francisco. Sun-Tues. 14 hrs. Contact: sium for Primary Care Physicians and Cancer Care Providers. Hoag NASP, 204 N El Camino Real, E-234, Encinitas 92024. (619) 942-8380. Memorial Center at Newport Beach Marriott. Thurs-Sat. $350. Contact: February 27-29-1992 Zimmerman Conference: Progress in Vascular Bi- Meeting Management, 5665 Oberlin, Ste 110, San Diego 92121. (619) ology, Hemostasis and Thrombosis. Scripps Clinic at Sheraton Grande 453-6222. Torrey Pines Hotel, LaJolla. Thurs-Sat. Contact: Scripps Clinic, 10666 N February 13-16-44th Annual Scientific Assembly. California Academy of Torrey Pines Rd, La Jolla 92037. (619) 554-8556. Family Physicians at Sheraton Harbor Island Hotel, San Diego. Thurs- March 20-26-Internal Medicine 1992: A Comprehensive Review. Sharp Sun. 26 hrs. $275. Contact: Robert Fagan, CAFP, 114 Sansome St, Ste Memorial Hospital at Hotel del Coronado. Fri-Thurs. 54 hours. Contact: 1305, San Francisco 94104. (415) 394-9121. Jacqueline Shiller, PO Box 84296, San Diego 92138. (619) 223-2997. February 14-16-Office Gynecology for the Primary Care Physician. May 11-15-20th Annual Advances in Internal Medicine. UCSF at Ritz- SDSU at Hyatt Islandia, San Diego. Fri-Sun. 20 hrs. Contact: Jacqueline Carlton Hotel, San Francisco. Mon-Fri. 33 hrs. $610. Contact: UCSF. Shiller, PO Box 84296, San Diego 92138. (619) 223-2997. February 17-19-Issues in Men's Health. SDSU at Hyatt Islandia, San Diego. Mon-Wed. 20 hrs. Contact: Jacqueline Shiller, PO Box 84296, San Diego 92138. (619) 223-2997. NEUROLOGY March 25-27-Annual Review in Family Medicine: Controversies and January 30-February 1-15th Annual: Neurology for Non-Neurologists. Challenges in Primary Care. UCSF. Wed-Fri. 15.5 hrs. Contact: UCSF. UCSD at Omni San Diego Hotel. Thurs-Sat. 21 hrs. $375. Contact: April 4-Cardiology for Primary Care. UCDMC at Cancer Center Audito- UCSD. rium. Sat. Contact: UCD. February 13-15-25th Annual Recent Advances in Neurology. UCSF at April 4-11-5th Annual Primary Care Medicine: Update 1992. UCSF at San Francisco. Thurs-Sat. 15 hrs. Contact: UCSF. Maui Intercontinental, Wailea, Maui, Hawaii. 1 week. $540. Contact: UCSF. April 9-1 1-Advances in Rheumatology for Primary Care Physicians. OB/GYN UCSF at Le Meridien Hotel, San Francisco. Thurs-Sat. $240. Contact: UCSF. January 16-19-OB/GYN and Ultrasound. UCSD at Hotel del Coronado, April 10-Office Orthopedics for the Primary Care Physician. Sharp San Diego. Thurs-Sun. 20 hrs. $450. Contact: Dawne Ryals, PO Box Memorial Hospital at San Diego Princess Vacation Village, San Diego. 1925, Roswell, GA 30077-1925. (404) 641-9773. Fri. 20 hrs. Contact: Jacqueline Shiller, PO Box 84296, San Diego 92138. February 2-6-Ambulatory Gynecology. UCD at Hyatt Lake Tahoe, Incline (619) 223-2997. Village, Nevada. Sun-Thurs. Contact: UCD. February 13-16-47th Annual Pbstgraduate Assembly. OB/GYN Assem- bly ofSouthern California at Beverly Hilton, Beverly Hills. Thurs-Sun. 28 hrs. Contact: OB/GYN Assembly, 5820 Wilshire Blvd, #500, Los GASTROENTEROLOGY Angeles 90036. (213) 937-5514. Soci- April 2-4-Gynecologic Surgery. Memorial/UCI Center for Health Educa- February 29-March 1-Endoscopy Update 1992. Southern California tion at Palm Springs. Thurs-Sat. Contact: UCI. ety for Gastroenterology at Century Plaza Hotel, Los Angeles. Sat-Sun. Marquis Hotel, Contact: Joyce Fried, University of California Brain Research Institute, April 2-4-Ultrasound Update. Memorial/UCI Center for Health Education Los Angeles 90024. at Bally's Hotel, Las Vegas. Thurs-Sat. Contact: UCI. (Continued on Page 602) 602 THE WESTERN JOURNAL OF MEDICINE

CONTINUING MEDICAL EDUCATION (Continued from Page 600) April 8-12-Pacific Coast Fertility Society: Annual Scientific Program February 7-9-Current Concepts in Pediatric Medicine: 1992. Children's and Postgraduate Course. Pacific Coast Fertility Society at Stouffer Hospital San Diego at Hyatt Islandia Hotel, San Diego. Fri-Sun. 18 hrs. Esmeralda Resort, Indian Wells. Wed-Sun. 22 hrs. Contact: Director of Children's Hospital, (619) 576-4072. Medical Education, 12760 La Mirada Blvd, Ste 220, La Mirada 90638. Annual the Memorial/UCI Cen- (213) 947-7068. March 4-6-17th Care of Sick Newborn. ter for Health Education at Long Beach. Wed-Fri. Contact: UCI. May 14-16-25th Annual Advances and Controversies in Clinical Pediat- OCCUPATIONAL/ENVIRONMENTAL rics. UCSF at Fairmont Hotel, San Francisco. Thurs-Sat. Contact: UCSF. January 27-February 7-Occupational and Environmental Medicine Se- ries: Session I. UCSF at Miyako Hotel, San Francisco. Mon-Fri. 80 hrs. PSYCHIATRY $1200. Contact: UCSF. January 26-31-18th Annual Midwinter Program for Psychiatrists. UCD February 10-14-Occupational and Environmental Medicine: Session III. hrs. Contact: UCD. UCSF at Miyako Hotel Japan Center, San Francisco. Mon-Fri. 40 hrs. at Hyatt Lake Tahoe. Sun-Fri. 25 $395. $600. Contact: UCSF. February 1-3-West Coast Neuropsychological Assessment Conference: Boston to As- February 12-16-Team Physician Course. American College of Sports Recent Advances in the Approach Neuropsychological sessment. UCSD at Pan Pacific Hotel, San Diego. Sun-Mon. Contact: Medicine at Wyndham Hotel, Palm Springs. Wed-Sun. Contact: ACMS, Cass Jones, Professional Conference Management, 7916 Convoy Ct, San PO Box 1440, Indianapolis, IN 46202-1440. (317) 637-9200. Diego 92111. (619) 565-9921. February 8-9-Breakthroughs in Anxiety Disorders: Treating Anxiety, Panic and Obsessive-Compulsive Disorders and Depression. UCSD at ONCOLOGY Omni Hotel, San Diego. Sat-Sun. Contact: Cass Jones, Professional Con- ference Management, 7916 Convoy Ct, San Diego 92111. (619) 565- February 17-19-Clinical Hematology and Oncology: 1992. Scripps Clinic 9921. and Research Foundation at Sheraton Grande Torrey Pines Hotel, La February 15-16-Victims of Abuse: The Emotional Impact of Child and Jolla. Mon-Wed. 18 hrs. $385. Contact: Susan Buntjer, 10666 N Torrey Adult Trauma. San Diego Psychoanalytic Society and Institute at Hyatt Pines Rd, La Jolla 92037. (619) 554-8556. Regency La Jolla at Aventine. Sat-Sun. Contact: Cass Jones, Professional February 29-Neo Adjuvant Approach to Non-Small Cell Lung Cancer. Conference Management, 7916 Convoy Ct, San Diego 92111. (619) 565- UCD at Incline Village, Nevada. Sat. Contact: UCD. 9921. March 5-7-7th International Conference on Monoclonal Antibody Im- March 13-15-West Coast Psychiatry Board Review: Preparation for Part munoconjugates for Cancer. UCSD at San Diego Marriott. Thurs-Sat. II. UCSD at US Grant Hotel, San Diego. Fri-Sun. Contact: Cass Jones, Contact: UCSD. Professional Conference Management, 7916 Convoy Ct, San Diego April 30-May 3-Breast Cancer Conference. Memorial/UCI Center for 92111. (619) 565-9921. Health Education at Hyatt Regency, Long Beach. Thurs-Sun. Contact: April 10-11-The Cutting Edge 1992: Erotic Mysteries-Intimacy, Sexu- UCI. ality and Gender in the '90s. UCSD at Omni Hotel, San Diego. Fri-Sat. Contact: Cass Jones, Professional Conference Management, 7916 Convoy OPHTHALMOLOGY Ct, San Diego 92111. (619) 565-992 1. April 10-14-The Power of the Art-Suggestive Therapeutics: An Intro- January 31-February 4-11th Annual Squaw Valley Retina Symposium. duction to Medical Hypnosis. UCSD at Mission Bay Hilton, San Diego. Alta-California Ophthalmological Society at Resort at Squaw Creek, Fri-Tues. Contact: UCSD. Olympic Valley. Fri-Tues. 16 hrs. Contact: Richard Murray, 2701 Eye St, on Abuse and Sacramento 442-4975. April 23-24-11th Annual Conference Child Neglect. 95816. (916) UCDMC at Radisson Hotel, Sacramento. Thurs-Fri. 12 hrs. $175. Con- May 15-16-Pearls of Ocular Therapy. Scripps Clinic and Research Foun- tact: UCD. dation at LaJolla. Fri-Sat. Contact: Scripps Clinic, 403C, 10666 N Torrey Pines Rd, La Jolla 92037. (619) 554-8556. RADIOLOGY January 10-12-Advanced Seminars in Diagnostic Imaging. UCSD at Ritz- ORTHOPEDICS Carlton Resort Hotel, Laguna Niguel. Fri-Sun. 15 hrs. $400. Contact: January 23-25-Orthopaedic Update II: Current Concepts and Advances. Dawne Ryals, PO Box 1925, Roswell, GA 30077-1925 (404) 641-9773. UCSD at Hyatt Islandia Hotel, San Diego. Thurs-Sat. Contact: UCSD. January 12-16-Diagnostic Imaging Update: Body Imaging, Mammog- Medical 23-26-Fracture UCD at Resort at raphy, Neuroradiology and Pediatrics. Stanford University January Management. Squaw Creek, Center at Ritz-Carlton Palm Beach. Sun-Thurs. 23.5 hrs. $550. Contact: Squaw Valley. Thurs-Sun. Contact: UCD. Dawne Ryals, PO Box 1925, Roswell, GA 30077-1925. (404) 641-9773. March 15-20-The Spine: Current Concepts ofDiagnosis and Treatment. 2-44th Annual Midwinter Confer- Vanderbilt University Medical Center Department of Orthopaedics at January 31-February Radiological ence. Los Angeles Radiological Society at Century Plaza Hotel, Los Grand Hyatt Wailea, Maui, Hawaii. Sun-Fri. $575. Contact: The Spine/ Box Los Current Concepts, c/o Unconventional Inc, 3960 Park Blvd, Ste E, San Angeles. Fri-Sun. 17.25 hrs. $425. Contact: LARS, PO 91215, Diego 92103. (619) 692-9115. Angeles 90009-1215. (213) 827-9078. February 4-7-Advanced Seminars in Diagnostic Imaging. UCSD at Le Meridien Hotel, Coronado. Tues-Fri. 20 hrs. $500. Contact: Dawne PAIN MANAGEMENT Ryals, PO Box 1925, Roswell, GA 30077-1925. (404) 641-9773. February 4-8-18th Annual Mid-Pacific Radiological Conference. Los February 19-22-The Practicing Physician's Approach to the Difficult Angeles Radiological Society at Hyatt Regency Waikoloa, Hawaii. Tues- Headache Patient. University of Chicago School of Medicine at Wynd- Sat. 18.5 hrs. $550. Contact: LARS, POBox 91215, Los Angeles 90009- ham Hotel, Palm Springs. Wed-Sat. 15 hrs. Contact: Idell Applebaum, 1215. (213) 827-9078. Diamond Headache Clinic, 5252 N Western Ave, Chicago, IL 60625. Breast Cancer. Uni- 878-0396. February 10-13-Mammographically Detected Early (312) versity of Alabama at Birmingham at Ritz-Carlton, Rancho Mirage. Mon- Thurs. 18 hrs. $450. Contact: Dawne Ryals, PO Box 1925, Roswell, GA PATHOLOGY 30077-1925. (404) 641-9773. January 10-1 1-Pathology Update. UCD at Cancer Center Auditorium. Fri- February 24-28-Diagnostic Imaging Update: Body Imaging, Mammog- raphy, MRI and Interventional. Stanford University Medical Center at Sat. Contact: UCD. Ritz-Carlton Mauna Lani, Hawaii. Mon-Fri. 23.5 hrs. $550. Contact: April 11-7th Annual Conference: New Treatment in Chronic Liver Dis- Dawne Ryals, PO Box 1925, Roswell, GA 30077-1925. (404) 641-9773. ease. Scripps Clinic and Research Foundation at La Jolla. Sat. 6 hrs. Contact: Scripps Clinic, 10666 N Torrey Pines Rd, La Jolla 92037. (619) February 27-30-Advanced Seminars in Diagnostic Imaging. UCSD at 554-8556. Ritz-Carlton, Laguna Niguel. Thurs-Sun. 20 hrs. $500. Contact: Dawne Ryals, PO Box 1925, Roswell, GA 30077-1925. (404) 641-9773. March 2-6-Magnetic Resonance Imaging. UCSD at Hotel del Coronado, PEDIATRICS San Diego. Mon-Fri. 27.25 hrs. $540. Contact: Dawne Ryals, PO Box GA 30077-1925. 641-9773. January 22-25-San Diego Conference on Responding to Child Maltreat- 1925, Roswell, (404) ment. Children's Hospital at Hyatt Regency Hotel, La Jolla. Wed-Sat. March 11-13-12th Annual Current Approaches to Radiation Oncology, Contact: Children's Hospital, 8001 Frost St, San Diego 92123. (619) 495- Biology, and Physics. UCSF at Hotel Nikko, San Francisco. Wed-Fri. 18 4940. hrs. $325. Contact: UCSF. (Continued on Page 680) 667 CONSULTANTS FOR The Western Journal of Medicine The editors wish to acknowledge with appreciation the valued services given by the following persons to thejournal during the past year. They are not members of the Editorial Board, yet provide immeasurable help to the journal and our readers.

Amend, William J. C., Jr Brownstein, Harold Deedwania, Prakash C. Garrick, James Aminoff, Michael J. Brunn, Ruth Dowling del Banco, Tom Gayle, Helene D. Andereck, William S. Burack, Robert Dement, William C. Gaynor, Ellen R. Anderson, Carolyn S. Burrow, Gerald N. Detmer, William Geehr, E. C. Anderson, James W. Busuttil, Ronald W. Dobkin, Bruce H. Gelber, Robert H. Anderson, Thomas P. Butler, Thomas Dobs, Adrian S. Genant, Harry K. Appenzeller, Otto Dodge, Harold Geokas, Michael C. Arevalo, Jose A. Calenoff, Leonid Donin, Jerry F. Gerberding, Julie L. Arieff, Allen I. Calkins, David Douglass, Harold O., Jr Gerich, John E. Arnaud, Claude D. Cannon, W. Dilworth, Jr Downing, Michael Gerin, John Aron, David C. Cello, John P. Drew, W. Lawrence Gharib, Hossein Arsham, Gary Chabon, Ada B. Dull, H. Bruce Gilbert, Robert Augustyn, Caroline Chaisson, Richard E. Dunn, Frederick L. Gillum, Richard F. Challenor, Yasoma B. Easton, Jessie Ginsberg, Michele M. Bacchetti, Peter Chalmers, Thomas C. Eddy, David M. Glantz, Stanton A. Bachulis, Ben L. Chamberlain, Robert M. Edes, Thomas E. Gleich, Sheldon Backer, Howard D. Chang, Albert Edmondson, Alan Glenn, Anne Marie Baker, Bruce Chasnoff, Ira J. Edwards, Tony Goetzl, Edward J. Baldessarini, Ross J. Chatterjee, Kanu Eickhoff, Theodore C. Goldbloom, David S. Ballard, Roberta A. Chawluk, John B. Elsner, Robert H. Golden, Jeffrey A. Barag, Steven Chazotte, Cynthia Enthoven, Alain C. Goldenberg, Don L. Barker, Judith C. Chen, Valentina Epstein, Arnold M. Goldman, Mervin J. Barnes, Mary Anne Child, John S. Epstein, Charles J. Goldschlager, Nora F. Barrios, Xavier 0. Christensen, Linda Epstein, Ervin H., Jr Goldsmith, Robert S. Baskin, David S. Churg, Andrew Epstein, Joel B. Gomez, Gerardo A. Bass, Nathan M. Cimo, Philip L. Erickson, Roy V. Goodstein, George Bauer, Douglas C. Clarfield, A. M. Eschbach, Joseph W. Gordin, Fred M. Bayley, Stephen Clark, William D. Ettinger, Bruce Gostout, Christopher J. Becker, Charles E. Clever, James Evans, Martin E. Graffis, Linda Becker, Thomas M. Coates, Thomas J. Everhart, James Granoff, Dan M. Benner, Gordon Cochi, Stephen L. Grayston, J. Thomas Benowitz, Neal L. Cogan, Martin G. Falk, Rodney Greene, Harry Benz, Christopher C. Cohen, Alan S. Fallat, Robert J. Greenspan, Francis S. Bergsagel, Daniel E. Cohen, Neal H. Feigenbaum, Lawrence Z. Griffin, Jerry C. Bero, Lisa Cohen, Ronald Fields, Howard L. Grillo, Hermes C. Berrol, Sheldon Cohn, Bradford P. Fishbain, David Grim, Clarence E. Bersot, Thomas P. Collin, Jack Fisher, Delbert A. Griner, Paul F. Blaisdell, F. William Conte, Felix A. Fitz, Gregory Groffen, John Blanc, Paul Conte, John E., Jr Fitzgerald, Faith Grosfeld, Jay L. Blankenhorn, David H. Cook, Joseph V. Flamm, Bruce L. Grossman, Moses Blaser, Martin J. Cooper, Allen D. Fleischer, David E. Grumbach, Melvin M. Block, Marshall B. Cooper, Joel D. Fletcher, C. D. M. Grundy, Scott M. Blossom, John Corash, Laurence M. Foster, Lawrence R. Grunfeld, Carl Boland, C. Richard Corey, Lawrence Fotheringham, Mark Guilleminault, Christian Boles, Roger Corlin, Richard F. Fox, E. R. W. Guze, Lucien B. Borison, Richard L. Cornfield, Joel Z. Fox, Sarah A. Boushey, Homer A. Cosentino, Anthony Franzi, Loretta Hahn, Robert A. Bozzette, Samuel A. Coulehan, John L. Franzi, Lou Hales, Robert E. Bradley, T. Douglas Croce, Carlo M. Freeman, Richard Halfin, Vivian Bredfeldt, Raymond C. Csaky, Karl G. Frey, Charles Hall, Thomas L. Bressman, Paul Cummings, Steven R. Frieden, Thomas R. Halstead, Lauro Bristow, J. David Currey, Charles J. Frierson, John Gordon Hamsten, Lauro Broelsch, Christoph E. Cutler, Robert W. P. Froelicher, Victor F. Hamsten, Anders Brown, Gary C. Frost, Philip H. Hanson, Catherine I. Brown, James K. Davidson, Dennis M. Fujimoto, Wilfred Y. Hardt, Eric Brown, Jeanette S. Davis, Harold Harley, Naomi Brown, Stuart T. Davis, Maradee Gadacz, Thomas R. Harrington, Donald C. Brown, Susan Dean, Joseph Galgiani, John N. Harris, Hank Browner, Warren S. DeBusk, Robert Gardner, Kenneth D., Jr Harris, Steven T. 6686 6C OS UT AT CONSULTANTS

Harsh, Griffith R. Kassler, William J. Lipavsky, Aja Murphy, Joseph P. Haskell, William L. Katz, Ben Z. Lipinski, Joseph F., Jr Murphy, Raymond L. H., Jr Hattner, Robert S. Katz, Michael Lipton, Helene L. Murphy, Trudy V. Hayes, F. Ann Kaufman, Margaret Litt, Iris F. Murray, Robert Hayward, Rodney A. Kaufman, Michael H. Ljung, Britt-Marie E. Mustacchi, Piero 0. Haywood, L. Julian Keane, Gerald Lo, Bernard Myers, John R. Hearst, Norman G. Kelly, Gerard R. Lopp, Ron Mylotte, Joseph M. Heimburger, Douglas C. Kennedy, Charles A. Lothman, Eric Henderson, John C. Kennedy, Robert L. Lotze, Michael T. Nakamura, Jeffrey Herington, Thomas Kerner, John A. Lowenstein, Daniel H. Nayberg, Irina Herman, John B. Kilbourne, Edwin M. Luce, John M. Nelson, Richard L. Hernandez, Sandra R. King, E. Gamer Lyssy, Robert J. Neuhaus, John Hirsch, Irl King, Eileen Nevitt, Michael C. Hoang, Giao N. Kiraly, Laszlo McCaughan, James S., Jr Newman, Thomas B. Hoar, Shelia K. Kirk, Allan D. McCorkell, Scott J. Nicoll, C. Diana Hochman, Frank Kishi, Donald T. McDougall, I. Ross Nolte, Martha S. Hodis, Howard N. Kizer, Kenneth W. McFadden, Charles Northfelt, Donald W. Hoffman, Richard E. Klatchko, Barbara A. MacGregor, Scott N. Norton, Jeffrey A. Holbrook, John H. Kleeman, Charles McKee, Ann C. Hollander, Harry Knaus, William MacKenzie, Malcolm R. O'Connor, Gerald T. Hollenberg, Milton Knochel, James P. McLellan, Robert O'Donnell, James J. Holley, David R. Koenig, Harold G. McLoughlin, Helen O'Donoghue, Gerard M. Holman, Susan Kolb, Felix 0. McMahon, Brian J. Older, Chic Holmes, David R., Jr Komaroff, Anthony L. McPhee, Stephen J. O'Reilly, Robert A. Holmes, Gary P. Korn, David McSherry, Charles K. Ockner, Robert K. Hopewell, Philip Kosatsky, Tom Madorsky, Arthur Ogrod, Eugene S. II Hopkins, David S. Kozarek, Richard A. Magruder-Habib, Kathryn Okamoto, Gary Horner, Ronnie D. Krasinski, Keith Mahoney, Martin C. Olden, Kevin W. Hornick, Richard B. Krieger, John Malloy, Mary J. Oldridge, Neil B. Howe, Roger K. Krom, Ruud A. F. Mann, Stephan C. Orcutt, Fred V. Hricak, Hedvig Kryger, Meir H. Margolin, Kim Orlowski, James P. Hughes, James P. Kumar, Mary L. Margolis, Alan J. Osterholm, Michael T. Hulley, Stephen B. Marin, Barbara Hultgren, Herbert N. La Dou, Joseph Markowitz, Lauri E. Paluba, Verna Hummel, Linda LaForce, F. M. Marshall, Randy Panzer, Robert J. Hurt, Richard D. Lake, John R. Marton, Keith I. Pappagianis, Demosthenes Husson, Robert N. Landin, Kerstin Massie, Barry M. Pappas, S. C. Hutchins, Edwin B. Landrigan, Philip J. Matheis, Larry Parmer, William B. Lane, Steven R. Mathisen, Glenn Parmley, William W. Illingworth, Roger Lang, Howard L. Matthay, Michael A. Parsons, Kenneth Lange, W. Robert Matthews, Richard L. Pastor, Patricia Jackson, Robert M. Langenberg, Andria Maurer, Richard C. Patterson, Chris Jacobs, Charlotte Laros, Russell K., Jr Mead, Alice Paul, Richard H. Jacobs, Richard A. Lawrence, H. Jeffrey Meloy, J. Reid Peiris, Alan N. Jaffe, Richard B. Laxer, Kenneth D. Melvin, John Pelletier, Lawrence L., Jr Jagelman, David G. Lazan, Myron Mendelson, Terrie Pennington, James E. Jamal, Ijazz Lear, James L. Mentzer, William C. Perez-Stable, Eliseo J. Janoff, Edward N. Lee, Helen Merchant, James A. Perkins, Herbert A. Jenkins, Ronald D. Lee, Marion Merigan, Thomas C. Perloff, Dorothee Jergesen, Harry E. Lee, Philip R. Mertz, Gregory J. Petrakis, Nicholas L. Johansen, Kaj Leeds, Andrew L. Miles, Steven H. Petty, Thomas L. Johns, Carol Johnson Lemp, George F. Minkoff, Howard L. Phillips, Theodore L. Johnson, Herbert Leppik, Ilo E. Mitchell, Mack C. Plenk, Henry Johnson, Joseph E. III Levenson, Alan I. Modic, Michael T. Pont, Allan Johnson, Richard W., Jr Levey, Andrew S. Montaner, Julio S. G. Popper, Robert W. Jones, Robert Levin, Jack Montgomery, A. Bruce Porter, George A. Jonsen, Albert R. Levine, Jon Moody, Frank G. Posner, Jerome B. Judson, Franklyn N. Levison, Sandra P. Moore, James E. Price, R. Arlen Levy, Jonathan M. Moore, Richard D. Kagawan, Butch Levy, Warren S. Moreno, Paul Quinn, Michael F. Kaltreider, H. Benfer Lewis, Charles Morris, Chris Quinn, Thomas C. Kamerow, Douglas B. Lewis, Frank R., Jr Morris, J. Glenn, Jr Kaplan, Marc S. Lien, Howard Morris, John C. Radany, Eric H. Kaplan, Selna L. Lifson, Alan R. Morris, R. Curtis, Jr Raffin, Thomas A. Kapp, Marshall B., Jr Lilly, Debra Moseley, Richard H. Rahl, Robert Karam, John H. Lindan, Krysia Moser, Kenneth M. Ramoska, Edward A. Karandikar, Alka Lindquist-Kleissler, Kathy Moss, Gerald Ramsey, Linda Kardos, Thomas F. Linker, Charles A. Mullins, William Ramsey, Paul G. Kaslow, Richard A. Linn, Lawrence S. Murphy, Edward L. Raskin, Neil H. e o e THE WESTERN JOURNAL OF MEDICINE * DECEMBER 1991 * 155 * 6 669

Rebhun, Joseph Schachter, Julius Slade, John Trunkey, Donald Rechenmacher, Judy Schaffner, William Slap, Gail S. Tucker, Samuel M. Reddick, Eddie J. Schallow, Ray Smith, Bonnie Reeves, William C. Schambelan, Morris A. Smith, David E. Underwood, Robert Regala, Carlos Schiedermayer, David L. Smith, Kenneth Unger, Kathleen Reilly, Joseph M. Schiff, Eugene R. Smith, Mark D. Reisberg, Irwin R. Schmittling, Gordon Smith, Stephen D. Van Dyke, Craig Remington, Jack S. Schnaper, H. William Smith, Teresa Van Dyke, Rebecca Rennie, Drummond Schnapp, Lynn M. Smith, W. McFate Van Voorhis, Wesley Reus, Victor I. Schneiderman, Lawrence J. Sohn, Anton P. Velji, Anvar Reynolds, Arden Schoenberg, Janet B. Solanki, Dilip L. Victor, Bruce Reynolds, Telfer B. Schouten, Ronald Solomon, David H. Rhame, Frank S. Wagner, Willis H. Schuchter, Lynn M. Somogyi, Anthony A. Wallerstein, Ralph 0. Richardson, Jean L. Schuckit, Marc A. Sorenson, J. Leon Wang, Anne Riddle, Matthew C. Schultz, Alvin L. Sox, Harold M. Wara, Diane W. Ries, Curt A. Schulz, Jerry Sparacino, Robert Ward, Paul H. Rimer, Barbara K. Schwartz, Allen D. Spickard, Andy Washington, A. Eugene Risse, Guenter B. Schwartz, Seymour I. Stall, Ron Way, Lawrence W. Roach, Mack Ill Schwarz, M. Roy Stamm, Walter E. Webb, Karen B. Rodnick, Jonathan E. Seah, K. K. K. Stavros, Becky Weber, Barrett Rokeach, Michael H. Sears, David A. Steele-Rosonoff, Renee Wedgewood, Ralph Rolfs, Robert T. Sebastian, Anthony Stenchever, Morton A. Weigelt, John A. Roll, Frederick J. Seehusen, Robert K. Stone, Lance Weinstein, Harvey Rose, John Sees, Karen Lea Stovall, Thomas G. Rose, Weiss, Arthur Steven C. Segal, Jonathan H. Strober, Warren Wells, Kenneth B. Rosenberg, Jon Segal, Mark Stulbarg, Michael Whinnery, Fred Rosenstein, Alan Selby, Joseph V. Sublet, Virginia H. Williams, Hibbard E. Ross, Allan M. Service, F. John Summers, Paul R. Williams, Karen Rowley, Diane L. Settlage, Robert Hurd Syme, S. Leonard Winkelstein, Warren Russell, Thomas R. Severinghaus, John W. Wise, Gilbert J. Shander, David Talal, Norman Woeber, Kenneth Sack, Kenneth E. Shane, Stanley R. Tassen, Cathy Wofsy, Constance B. Sadana, Gurbinder Shapiro, Martin F. Taylor, Glenn Wolfe, Frederick Sagar, Stephen M. Shapiro, R. S. Taylor, I. Brian Wrensch, Margaret Sahn, Stephen Sharma, Om P. Tecoma, Evelyn S. Wyler, Allen R. Saibil, Fred Shaw, Kathryn Telzak, Edward E. Salvatierra, Oscar Shepard, John W., Jr Terr, Lenore Yarnell, Stanley Sams, Bruce Shepherd, Rodger Tesch, Bonnie J. Yoshida, Jrenichi Samuelson, Cecil 0. Showstack, Jonathan A. Thickman, David Young, Clinton Sandblom, Philip Shwachman, Benjamin Thorp, James A. Young, Lowell S. Sande, Merle A. Sichi, Andy Tobis, Jerome Sanders, Charles V. Siegel, David Travis, William D. Zasler, Nathan Sandler, Robert S. Simon, Roger P. Tremper, Kevin K. Zippin, Calvin Saunders, David R. Siperstein, Marvin Trieschmann, Roberta Ziring, Philip R. 670

Volume 155 INDEX-v July-December 1991

AUTHOR INDEX

Agnew, David C., Santa Barbara, Calif ...... (Jul) 66 Eckenfels, Edward J., Chicago, III ...... (Aug) 140 Alexander, Eben, Jr, Winston-Salem, NC ...... (Oct) 430 Elder, John P., San Diego, Calif ...... (Nov) 548 Anders, Gregg T., Fort Sam Houston, Tex ...... (Oct) 373 Emmons, Richard W., Berkeley, Calif ...... (Aug) 136 Ardalan, Bach, Miami, Fla ...... (Aug) 176 Eng, Thomas R., Washington, DC ...... (Dec) 613 Aslamy, Wazhma, Scottsdale, Ariz ...... (Sep) 301 Espina, Byron, Los Angeles ...... (Dec) 610 Esquivel, Carlos O., San Francisco, Calif ...... (Nov) 494 Evans, Gary W., Bemidji, Minn ...... (Nov) 549 Bacon, George E., Grand Rapids, Mich ...... (Oct) 428 Bailey, Steven R., Fort Sam Houston, Tex ...... (Oct) 373 Farber, Debora B., Los Angeles, Calif ...... (Oct) 388 Calif...... 171 Baird, Robert, Orange, (Aug) Fedoruk, M. Joseph, Anaheim, Calif ...... (Dec) 663 Bal, Dileep G., Sacramento, Calif ...... (Nov) 548 Ferdman, Ronald M., Los Angeles, Calif ...... (Nov) 547 Baldwin, DeWitt C., Jr, Chicago, III ...... (Aug) 140 Fink, Max, Stony Brook, NY ...... (Nov) 515 J. Baringer, Richard, Salt Lake City, Utah ...... (Nov) 528 Fischer, David J., Boise, Idaho ...... (Oct) 410 Barnard, John A., Tenn ...... 189 Nashville, (Aug) Fogelson, David L., Santa Monica, Calif...... (Nov) 522 J. Los Calif ...... Bateman, Bronwyn, Angeles, ...... (Oct) 388 Friedman, Ira M., San Francisco, Calif ...... (Aug) 136 Anna Salt Lake Utah ...... Beck, C., City, ...... (Sep) 293 Frost, Philip H., San Francisco, Calif...... (Oct) 424 John Calif ...... Benfield, R., Sacramento, ...... (Oct) 407 Fye, Kenneth H., San Francisco, Calif...... (Dec) 642 Benjamin, Harold H., Santa Monica, Calif ...... (Jul) 86 Berman, Arnold C., San Francisco, Calif...... (Oct) 415 Berman, Stephen, Denver, Colo ...... (Dec) 649 Gadde, Hari, Brooklyn, NY...... (Oct) 419 Berrios, Daniel C., San Francisco, Calif ...... (Aug) 133 Gardner, Vance O., Irvine, Calif...... (Aug) 169 Berry, Roy A., Sacramento, Calif...... (Nov) 531 Gasman, John D., Stanford, Calif ...... (Oct) 412 Beuhler, Stephanie Pershing, Big Horn, Wyo...... (Nov) 504 Gelb, Alan, San Francisco, Calif...... (Sep) 289 Binder, Louis S., El Paso, Tex ...... (Sep) 284 Geller, Richard J., Fresno, Calif ...... (Dec) 639 Bishai, David, Los Angeles, Calif ...... (Oct) 429 Gelpi, Armand P., Palo Alto, Calif ...... (Sep) 260 Bishop, F. Marian, Salt Lake City, Utah ...... (Oct) 426 Gerner, Robert, Los Angeles, Calif ...... (Nov) 518 Blanton, Herman M., Fort Sam Houston, Tex ...... (Oct) 373 Gibbons, Harry L., Salt Lake City, Utah ...... (Dec) 658 Blinder, Barton J., Newport Beach, Calif...... (Nov) 520 Gibbons, Robert P., Seattle, Wash ...... (Jul) 43 Bodenheimer, Thomas, San Francisco, Calif ...... (Aug) 192 Gilbert, Fred I., Jr, Honolulu, Hawaii ...... (Jul) 61 Boly, Lawrence R., San Francisco, Calif ...... (Oct) 415 Gitlin, Michael J., Los Angeles, Calif ...... (Nov) 521 Borges, Mary L., Olympia, Wash ...... (Dec) 613 Golden, Alice M., Worcester, Mass ...... (Oct) 384 Bosser, Sonya K., Bethesda, Md ...... (Jul) 47 Goldstein, Mary Kane, Palo Alto, Calif ...... (Sep) 263 Boushey, Homer A., San Francisco, Calif ...... (Jul) 72 Goldstein, Michael S., Los Angeles, Calif...... (Jul) 86 Brosman, Stanley A., Santa Monica, Calif...... (Dec) 633 Gordon, Gilad S., Seattle, Wash ...... (Dec) 616 Burian, Pam, Los Angeles, Calif ...... (Dec) 610 Grady, Deborah, San Francisco, Calif ...... (Aug) 133 Burrow, Gerard N., La Jolla, Calif...... (Jul) 80 Gray, Gary M., Stanford, Calif ...... (Dec) 660 Bush, Thomas M., San Jose, Calif ...... (Jul) 39 Greer, Monte A., Portland, Ore ...... (Jul) 83 Grimm, Susan, Denver, Colo ...... (Dec) 649 Grindlinger, Howard M., Sacramento, Calif...... (Oct) 431 Caiozzo, Vince, Irvine, Calif ...... (Aug) 169 Call, Gregory K., Salt Lake City, Utah ...... (Jul) 70 Haber, Richard J., San Francisco, Calif ...... (Aug) 146 Callaham, Michael, San Francisco, Calif ...... (Sep) 289 Halsted, Charles H., Davis, Calif (Dec) 605 Salt Lake Utah ...... Callister, Cyril Bruce, City, ...... (Sep) 299 Hamilton, Maurice E., Sacramento, Calif ...... (Aug) 174 Los Calif ...... 416 Campofiori, Gail, Angeles, ...... (Oct) Hammond, Elizabeth H., Salt Lake City, Utah ...... (Sep) 293 Peter San Calif ...... 527 Carroll, R., Francisco, ...... (Nov) Hammons, Laura, Gallup, NM ...... (Dec) 663 Carvalho, Paula G., Boise, Idaho ...... (Nov) 525 John Wash ...... 365 SD Harlan, M., Seattle, (Oct) Cash, Joseph M., Rapid City, ...... (Dec) 644 Harlin, Vivian K., Wash ...... (Dec) 613 Nev Olympia, Caudill, Timothy G., Reno, ...... (Sep) 292 Harris, Cheryl P., Salt Lake City, Utah ...... (Nov) 528 James Tex ...... 284 Chappell, A., Lubbock, (Sep) Hebdon, C. Kent, Sandy, Utah ...... (Dec) 658 Chen, Valentina N., Calif...... 421 Stanford, (Oct) Heckenlively, John R., Los Angeles, Calif ...... (Oct) 388 Chin of ...... 186 Chew, Hin, Republic Singapore (Aug) Lisa San Calif ...... 72 Chin, Marshall H., Mass 553 Helfend, K., Francisco, ...... (Jul) Boston, ...... (Nov) Henderson, Vernon, Oakland, Calif ...... (Sep) 253 Church, Joseph A., Los Angeles, Calif ...... (Nov) 547 Robert NM ...... 522 Linda San Calif Hendren, L., Albuquerque, (Nov) Clever, Hawes, Francisco, ..... (Sep) 306, (Oct) 421, Hessel, Samuel J., Scottsdale, Ariz ...... (Sep) 301 (Nov) 540 Hoch, Dana Frederich, San Jose, Calif ...... (Nov) 551 Robert Tenn Coffey, J., Nashville, ...... (Aug) 189 Hoffman, Jerome R., Los Angeles, Calif ...... (Sep) 290 Concepcion, Waldo, San Francisco, Calif ...... (Nov) 494 Hori, Michael K., Sacramento, Calif ...... (Nov) 525 John Fla ...... Connolly, P., Pensacola, (Jul) 78 Howard, P. Holbrook, Sacramento, Calif...... (Jul) 33 San Calif...... 72 Conrad, Douglas J., Francisco, (Jul) Howell, Lydia P., Sacramento, Calif...... (Jul) 33 Los Calif ...... Coppola, Carl, Angeles, (Aug) 193 Shaun S. Fla ...... 176 Wash Hung, J., Miami, ...... (Aug) Correa, Roy J., Jr, Seattle, ...... (Jul) 43 Hunter, Ripley H., San Francisco, Calif...... (Dec) 642 Cox, Ken, San Francisco, Calif ...... (Nov) 494 Crade, Michael, Long Beach, Calif...... (Sep) 287 Craig, Timothy J., San Diego, Calif ...... (Jul) 78 Imai, Kent, San Jose, Calif ...... (Jul) 39 Crawford, Stephen W., Seattle, Wash ...... (Nov) 488 Crooks, Catherine, San Diego, Calif ...... (Nov) 548 Jacobs, Michael B., Stanford, Calif ...... (Aug) 178 Curtis, Jeffrey L., Ann Arbor, Mich ...... (Jul) 72 Los Calif ...... 610 Cutler, Robert W. P., Stanford, Calif...... (Oct) 421 Jamin, Denise, Angeles, (Dec) J. Calif ...... 421 Cuttitta, Frank, Bethesda, Md...... (Aug) 152 Janda, Michael, Berkeley, (Oct) Johnson, James E., Fort Sam Houston, Tex ...... (Oct) 373 Johnson, Michael, Sacramento, Calif ...... (Nov) 548 Daniels, George, Jr, Stanford, Calif ...... (Dec) 634 Danielson, Kelvin, Scottsdale, Ariz...... (Sep) 301 Kabalin, John N., Palo Alto, Calif ...... (Dec) 632, 635 Daugherty, Steven R., Chicago, Ill ...... (Aug) 140 Kahn, Douglas, Newport Beach, Calif ...... (Nov) 517 de Guzman, Nelson, Los Angeles, Calif ...... (Dec) 610 Kahn, Norman B., Davis, Calif...... (Dec) 653 Denny, Christopher, Los Angeles ...... (Nov) 505 Kane, John P., San Francisco, Calif ...... (Oct) 424 Dhar, Santi R., Brooklyn, NY ...... (Aug) 181 Kanel, Gary, Los Angeles, Calif ...... (Oct) 416 Dieckmann, Ronald A., San Francisco, Calif...... (Sep) 287 Karnes, William E., Rochester, Minn ...... (Aug) 152 Dor-Ner, Alexandra Dane, Boston, Mass ...... (Nov) 555 Karolewski, Alice N., Sacramento, Calif ...... (Dec) 647 Drakes, Thomas P., Redding, Calif ...... (Jul) 76 Kasdorf, Julia, Brooklyn, NY ...... (Nov) 539 THE WESTERN JOURNAL OF MEDICINE 9 DECEMBER 1991 * 155 * 6 ~~~~~~~~671671

Katzman, Debra K., Stanford, Calif ...... (Aug) 136 Osborn, Robin E., San Diego, Calif...... (Jul) 78 Kavanaugh, Anne, Crozet, Va ...... (Oct) 369 O'Toole, David M., Worcester, Mass ...... (Oct) 384 Keeffe, Emmet B., Portland, Ore ...... (Nov) 541 Keepers, George A., Portland, Ore...... (Nov) 516 Keesey, John C., Long Beach, Calif ...... (Jul) 69 Padmanabhan, Krishnan, Brooklyn, NY ...... (Aug) 181, (Oct) 419 Kenney, Erin, San Diego, Calif...... (Nov) 548 Panacek, Edward A., Cleveland, Ohio ...... (Sep) 286 Kingsley, Paul L., Ross, Calif ...... (Jul) 87 Pane, Gregg A., Irvine, Calif ...... (Sep) 285 Kirkman-Liff, Bradford L., Tempe, Ariz ...... (Sep) 269 Pascoe, Dennis C., Palo Alto, Calif ...... (Sep) 263 Kizer, Kenneth W., Davis, Calif ...... (Oct) 430 Peck, Magda G., Omaha, Neb ...... (Sep) 303 Knight, Lawrence L., Boise, Idaho ...... (Oct) 410, (Nov) 525 Poirier, Virginia C., Sacramento, Calif...... (Dec) 647 Kobayashi, John M., Seattle, Wash ...... (Dec) 613 Presti, Joseph C., Jr, New York, NY ...... (Nov) 527 Koeffler, H. Phillip, Los Angeles, Calif...... (Nov) 505 Prochazka, Allan V., Denver, Colo ...... (Sep) 256 Koenig, Kristi L., Orange, Calif ...... (Oct) 400 Pultz, Constance, Charleston, SC ...... (Oct) 432, (Nov) 537 Koo, John Y. M., San Francisco, Calif ...... (Nov) 523 Korula, Jacob, Los Angeles, Calif...... (Oct) 416 Radany, Eric, San Francisco, Calif ...... (Nov) 544 Raffin, Thomas A., Stanford, Calif...... (Sep) 307 Laine, Loren, Los Angeles, Calif ...... (Sep) 274 Ramsey, Linda L., San Francisco, Calif...... (Aug) 183 Lane, Richard D., Tucson, Ariz ...... (Nov) 521 Ramsey, Paul G., Seattle, Wash ...... (Oct) 380 Lardinois, Claude K., Reno, Nev ...... (Sep) 292 Rappaport, Maurice, San Jose, Calif ...... (Nov) 516 Latham, Ricky D., Fort Sam Houston, Tex ...... (Oct) 373 Rarick, Mark U., Los Angeles, Calif ...... (Dec) 610 Lee, Loretta, Santa Ana, Calif ...... (Dec) 663 Reed, Antoinette, Palo Alto, Calif ...... (Jul) 46 Le Mauviel, Laurie, Minneapolis, Minn ...... (Sep) 280 Reiner, Robert J., Lompoc, Calif ...... (Dec) 664 Levengood, Gary, San Francisco, Calif ...... (Aug) 172 Rice, Charles L., Seattle, Wash ...... (Oct) 365 Levin, Barry, San Francisco, Calif ...... (Nov) 494 Rickman, Leland S., San Diego, Calif ...... (Jul) 47 Levine, Alexandra M., Los Angeles, Calif...... (Dec) 610 Riley, Katherine, Seattle, Wash ...... (Nov) 500 Levy, Jonathan M., Scottsdale, Ariz ...... (Sep) 301 Rodrigo, Juan J., Sacramento, Calif ...... (Aug) 169 Lew, Chris, Honolulu, Hawaii ...... (Jul) 61 Rose, Theodore, Oakland, Calif ...... (Oct) 400 Lewis, Janet, Los Altos, Calif...... (Jul) 38, (Aug) 194 Rubin, Haya R., Baltimore, Md ...... (Nov) 550 Lewis, Jerry P., Sacramento, Calif ...... (Nov) 531 Russell, Liisa A., Sacramento, Calif ...... (Jul) 33 Litt, Iris F., Stanford, Calif...... (Aug) 136 Loeb, John M., Castro Valley, Calif ...... (Sep) 296 Lo Gerfo, James P., Seattle, Wash ...... (Dec) 616 Sabella, Joseph D., Napa, Calif ...... (Oct) 428 Lombard, Charles M., Mountain View, Calif...... (Sep) 296 Sageman, W. Scott, San Diego, Calif ...... (Jul) 78 Loosli, Alvin R., Walnut Creek, Calif ...... (Aug) 191 Sainsbury, Steven J., Templeton, Calif ...... (Dec) 637 Louie, Kevin W., San Francisco, Calif...... (Aug) 170 Salpeter, Shelley R., San Jose, Calif ...... (Oct) 412 Lyons, Stephen, Moscow, Idaho ...... (Dec) 620 Salva, Paul S., Indianapolis, Ind ...... (Oct) 428 Samlowski, Wolfram E., Salt Lake City, Utah ...... (Sep) 293 Sanchez, Ram6n M., San Diego, Calif...... (Jul) 78 McAllister, C. Kenneth, Fort Sam Houston, Tex ...... (Oct) 373 Sandblom, Philip, Lausanne, Switzerland ...... (Dec) 660 McCormick, Frank, Emeryville, Calif ...... (Nov) 505 Sato, Judith K., Los Angeles, Calif ...... (Nov) 547 MacFarlane, Michael T., Los Angeles, Calif ...... (Dec) 634 Schachter, Julius, San Francisco, Calif...... (Aug) 136 Mackersie, Robert C., San Diego, Calif ...... (Oct) 405 Schaffenburg, Carlos A., Chevy Chase, Md...... (Sep) 312 Malloy, Mary J., San Francisco, Calif...... (Oct) 424 Scherger, Joseph E., Davis, Calif ...... (Aug) 191, (Dec) 653 Manfred, Freya, Bloomington, Minn ...... (Dec) 615 Schmidt, Joseph D., San Diego, Calif...... (Dec) 633 Mann, Eberhard M., Honolulu, Hawaii ...... (Nov) 520 Schneeweiss, Ronald, Seattle, Wash ...... (Nov) 500 Marcus, Robert, Palo Alto, Calif ...... (Jul) 53 Schneider, Philip D., Sacramento, Calif ...... (Dec) 621 Marder, Richard A., Sacramento, Calif ...... (Aug) 172 Sefcik, Stephan E., Seattle, Wash ...... (Dec) 616 Marra, Christina, Seattle, Wash ...... (Jul) 65 Senecal, Pierre E., San Francisco, Calif ...... (Dec) 639 Mascola, Laurene, Los Angeles, Calif ...... (Nov) 547 Shapiro, Richard M., Stanford, Calif ...... (Oct) 412 Meals, Roy A., Los Angeles, Calif...... (Aug) 170 Shlotzhauer, Tammi L., San Jose, Calif ...... (Jul) 39 Menninger, John A., Denver, Colo ...... (Nov) 519 Sibley, William A., Tucson, Ariz ...... (Jul) 65 Merrell, Steven W., Rochester, Minn ...... (Dec) 621 Silberman, Howard, Los Angeles, Calif ...... (Oct) 405 Meyer, Thomas J., Denver, Colo ...... (Sep) 256 Slife, David M., Fort Sam Houston, Tex...... (Oct) 373 Miller, Scott R., Irvine, Calif ...... (Oct) 404 Smith, Elizabeth Spencer, Santa Rosa, Calif ...... (Jul) 82 Mitchell, Connie, Sacramento, Calif...... (Sep) 285 Smith, Lloyd H., Jr, San Francisco, Calif...... (Sep) 306 Montgomery, Terri, Los Angeles, Calif ...... (Dec) 610 Smith, Michael E., Oakland, Calif ...... (Sep) 253 Mooney, Vert, San Diego, Calif ...... (Aug) 173 Sowa, Marian V., Long Beach, Calif ...... (Jul) 64 Moore, Wesley S., Los Angeles, Calif ...... (Oct) 407 Sparkes, Robert S., Los Angeles, Calif ...... (Oct) 388 Morris, James M., San Francisco, Calif ...... (Aug) 172 Stabile, Bruce E., San Diego, Calif...... (Oct) 408 Mower, William, Los Angeles, Calif...... (Sep) 290 Starkman, Elaine, Walnut Creek, Calif ...... (Oct) 432 Mueller, Juergen, Oakland, Calif...... (Oct) 400 Stevens, Dennis L., Boise, Idaho ...... (Nov) 525 Murdock, Margie A., Orange, Calif ...... (Oct) 370 Stewart, William B., San Francisco, Calif ...... (Nov) 538 Murphey, William H., Portland, Ore ...... (Oct) 423 Stone, James, Stanford, Calif...... (Oct) 406 Murray, Ronald S., Englewood, Colo...... (Jul) 68 Sutton, Mark A., Seattle, Wash ...... (Jul) 43 Myers, Wayne, Hazard, Ky ...... (Nov) 500 Sutton, Roger A. L., Vancouver, BC ...... (Sep) 249 Myers, Woodrow A., Jr, New York, NY ...... (Jul) 83 Szpakowski, Jean-Luc, Richmond, Calif ...... (Nov) 494

Nakazato, Paul, San Francisco, Calif ...... (Nov) 494 Tang, Eddie, Los Angeles, Calif...... (Aug) 164 Nambisan, Raman, Oakland, Calif ...... (Sep) 253 Tanji, Jeffrey L., Davis, Calif ...... (Dec) 653 Nathan, Julia, San Francisco, Calif ...... (Sep) 290 Teplitz, Raymond L., Sacramento, Calif ...... (Jul) 33 Nesbitt, Thomas S., Davis, Calif ...... (Dec) 653 Tipton, Ann C., Stanford, Calif ...... (Aug) 136 Nichols, Peter, Los Angeles, Calif...... (Oct) 416 Tompkins, Pendleton, San Mateo, Calif...... (Nov) 549 Nickens, Herbert W., Jr, Washington, DC ...... (Jul) 27 Truong, Daniel D., Orange, Calif ...... (Jul) 69 Nightingale, Elena O., Washington, DC ...... (Sep) 303 Tucker, Elizabeth D., Salt Lake City, Utah ...... (Sep) 299 Nordyke, Robert A., Honolulu, Hawaii ...... (Jul) 61 Tunis, Sean, Baltimore, Md ...... (Nov) 550 Norman, Lee A., Seattle, Wash ...... (Oct) 413 Tunzi, Marc, Twin Falls, Idaho ...... (Nov) 548 Notkin, Herbert, Arcata, Calif ...... (Jul) 86, (Aug) 191 Nudleman, Kenneth L., Orange, Calif ...... (Jul) 67, 70 Nuwer, Marc R., Los Angeles, Calif ...... (Jul) 67 Vallone, Robert P., Palo Alto, Calif...... (Sep) 263 Van Brunt, Edmund, Berkeley, Calif...... (Jul) 88 Vedder, Nicholas B., Seattle, Wash ...... (Oct) 365 Oboler, Sylvia K., Denver, Colo ...... (Sep) 256 Velji, Anvar, Sacramento, Calif ...... (Sep) 308 Odumakinde, Elizabeth A., Sacramento, Calif ...... (Nov) 531 Vestal, Robert E., Boise, Idaho ...... (Oct) 410 Olson, Kent R., San Francisco, Calif ...... (Dec) 639 Volberding, Paul A., San Francisco, Calif ...... (Nov) 540 Organ, Claude H., Jr, Oakland, Calif ...... (Sep) 253 Vora, Samir, Brooklyn, NY ...... (Oct) 419 672 VOLUME INDEX

Wagner, Sheldon L., Corvallis, Ore...... (Oct) 430 Winograd, Carol Hutner, Palo Alto, Calif...... (Sep) 263 Walker, Ameae, Riverside, Calif...... (Aug) 152 Wise, Philip, San Diego, Calif ...... (Dec) 635 Walsh, John H., Los Angeles, Calif ...... (Aug) 152 Wong-Staal, Flossie, La Jolla, Calif ...... (Nov) 481 Ward, John H., Salt Lake City, Utah ...... (Sep) 293 Wood, Stephen Daniel, Salt Lake City, Utah ...... (Sep) 299 Warnock, Martha L., San Francisco, Calif ...... (Jul) 72 Wray, Robert B., Salt Lake City, Utah...... (Sep) 293 Wasserman, Stephanie, Denver, Colo...... (Dec) 649 Wu, Albert W., Baltimore, Md ...... (Nov) 550 Wasserstein, Philip H., Stanford, Calif...... (Aug) 178 Wurlitzer, Fred, Burlingame, Calif ...... (Oct) 429 Waters, Cheryl H., Los Angeles, Calif...... (Jul) 68 Wyrebek, Michele, Sterling, Mass ...... (Dec) 662 Watson, Craig, Sacramento, Calif...... (Dec) 626 Waxman, Kenneth, Orange, Calif...... (Oct) 370, 404 Joel, Los Angeles, Calif...... (Nov) 523 Thomas NC ...... 538 Yager, Weil, P., Asheville, (Nov) Yang, Jack C., San Diego, Calif ...... (Jul) 47 Weiss, Eric, Woodside, Calif ...... (Sep) 288 Yellin, Albert, Los Angeles, Calif ...... (Oct) 416 Welch, Richard B., San Francisco, Calif ...... (Aug) 172 Yeo, Kiat, Brooklyn, NY...... (Aug) 181 Weleber, Richard G., Portland, Ore ...... (Oct) 423 Yim, Kenneth K., Oakland, Calif ...... (Sep) 253 Wenrich, Marjorie D., Seattle, Wash ...... (Oct) 380 Young, Russell L., San Diego, Calif...... (Nov) 548 White, George L., Jr, Hattiesburg, Miss ...... (Sep) 299 Whitman, Neal A., Salt Lake City, Utah...... (Oct) 426 Williams, Hibbard E., Davis, Calif ...... (Aug) 183 Zawada, Edward T., Jr, Sioux Falls, SD ...... (Dec) 644 Winn, Robert K., Seattle, Wash ...... (Oct) 365 Zucconi, George, La Mesa, Calif ...... (Dec) 664

IN MEMORIAM California Medical Association: Mason, Charles E., Apr 9, 1991 ...... (Sep) 222 Jul 1991 ...... 461 Adams, Deane T., Jun 30, 1991 ...... (Sep) 222 Massengill, James B., 1, ...... (Nov) Matychowiak, Francis A., May 25, 1991 ...... (Aug) 117 Aycinena, Juan, Jul 6, 1991 ...... (Nov) 461 1991 ...... 117 Baker, Stephen T., May 19, 1991 ...... (Aug) 109 Maxson, Eugene S., Apr 23, ...... (Aug) Meador, James H., Sep 1, 1991 ...... (Nov) 463 Banta, Edwin, Jr, Apr 3, 1991 ...... (Aug) 109 463 Barnett, Clair B., Sep 1, 1991 ...... (Nov) 461 Menda, Kishen B., Jul 11, 1991 ...... (Nov) Merrill, Robert L., Aug 31, 1991 ...... (Nov) 463 Bartlett, John C., Jun 13, 1991 ...... (Nov) 461 Mar 1991 ...... 117 Batten, Douglas H., Aug 14, 1991 ...... (Nov) 461 Miller, Earl M., 27, ...... (Aug) James Mar 1991 ...... 117 Berner, Richard A., Jun 10, 1991 ...... (Sep) 222 Milton, T., 12, (Aug) Laurl 1991 ...... 222 Bertero, Jules, Apr 19, 1991 ...... (Nov) 461 Moffitt, W., May 25, (Sep) Momary, Hassan M., Mar 29, 1991 ...... (Aug) 117 Bescoby, Felix J., Jul 11, 1991 ...... (Nov) 461 Mootoo, Siegfried A., Apr 10, 1991 ...... (Aug) 117 Blaufuss, Arnold, May 5, 1991 ...... (Aug) 109 Mosso, James A., Mar 23, 1991 ...... (Aug) 117 Boomer, Joseph M., May 12, 1991 ...... (Nov) 461 Nemeth, Laslo Jeno, Apr 24, 1991 ...... (Aug) 117 Borkovic, Steven P., Mar 27, 1991 ...... (Aug) 109 Jerrold 1991 ...... 461 Bramham, James C., Mar 17, 1991 ...... (Aug) 109 Nesselrod, Peerman, Sep 6, (Nov) Howard Jul 1991 ...... 222 Cable, Sheldon, Mar 20, 1991 ...... (Aug) 109 Nudelman, Lee, 1, (Sep) Olmstead, Luke R., Feb 9, 1991 ...... (Sep) 222 Callahan, Rosemarie, Jun 13, 1991 ...... (Sep) 222 1991 ...... 222 Calvy, William J., Sep 1991 ...... (Nov) 461 Paxson, Jane T., May 1, ...... (Sep) Peck, Samuel G., Sep 1, 1991 ...... (Nov) 463 Campion, Gwendolyn, May 9, 1991 ...... (Aug) 109 Phillips, R. E., Jul 19, 1991 ...... (Nov) 463 Casberg, Melvin A., Mar 27, 1991 ...... (Sep) 222 Jul 1991 ...... 463 Chandler, Arthur L., Apr 23, 1991 ...... (Nov) 461 Potter, George V., 13, (Nov) Jul 1991 ...... 463 Chennell, Bruce A., Mar 30, 1991 ...... (Sep) 222 Ray, Leighton W., 28, (Nov) 1991 ...... 463 Cronenwett, Paul H., Apr 25, 1991 ...... (Aug) 109 Richmond, Robert A., Aug 18, ...... (Nov) Rixford, Henry C., May 13, 1991 ...... (Aug) 117 Dakin, Richard L., Mar 3, 1991 ...... (Aug) 109 Helen Mar 1991 ...... 117 Dowdy, Kemp, Aug 11, 1991 ...... (Nov) 461 Robertson, R., 12, (Aug) 1991 ...... 222 Draper, Oliver D., Apr 13, 1991 ...... (Sep) 222 Robley, Wendell W., May 21, ...... (Sep) 1991 ...... 222 Drapkin, Harold, Apr 30, 1991 ...... (Aug) 109 Rubens, Mark Kenneth, May ...... (Sep) John 1991 ...... 117 Edwards, Bob, Jul 12, 1991 ...... (Aug) 117 Rydell, R., May 13, (Aug) Schmela, Woodrow W., May 28, 1991 ...... (Sep) 222 Fitch, William M., Mar 9, 1991 ...... (Aug) 109 1991 ...... 117 Florin, Alvin C., Jul 29, 1991 ...... (Nov) 461 Sokhos, Dimitri, Apr 21, (Aug) Jun 1991 ...... 463 Foley, Robert D., Jun 8, 1991 ...... (Sep) 222 Spaur, R. Craig, 8, ...... (Nov) Jun 1991 222 Gerlach, Richard D., Jun 27, 1991 ...... (Sep) 222 Splithoff, Clarence A., 17, ...... (Sep) Strange, Gerald, Mar 5, 1991 ...... (Aug) 117 Giberson, A. F., May 5, 1991 ...... (Aug) 109 1991 117 Gibson, George C., Apr 18, 1991 ...... (Aug) 109 Taboada, Jose, May 6, ...... (Aug) Howard Mar 1991 ...... 117 Gilmore, William M., Jul 11, 1991 ...... (Nov) 461 Terry, R., 29, (Aug) Robert 1991 ...... 117 Ginsberg, Robert L., May 22, 1991 ...... (Aug) 109 Wade, M., Apr30, (Aug) Waldron, Melvin C., Jan 13, 1991 ...... (Sep) 222 Goodson, Samuel B., Jan 21, 1991 ...... (Sep) 222 1991 117 Gould, Lloyd E., Sep 9, 1991 ...... (Nov) 461 Walter, Norman T., Mar 28, ...... (Aug) Jun 222 Gray, Richard, Apr 28, 1991 ...... (Aug) 109 Weiler, Philip G., 14, 1991 ...... (Sep) White, Edward D., Jun 2, 1991 ...... (Sep) 222 Greenlaw, Colin T., Jun 16, 1991 ...... (Sep) 222 117 Gull, Reuben, Apr 21, 1991 ...... (Nov) 461 Wood, Paul E., Apr 1991 ...... (Aug) Woodruff, Nathan H., Jr, Apr 25, 1991 ...... (Aug) 117 Hack, Rudolf W., Jul 10, 1991 ...... (Sep) 222 117 Hamilton, James J., Apr 11, 1991 ...... (Aug) 109 Zeigler, Paul, Mar 1991 ...... (Aug) Hanigan, Thomas E., Apr 1991 ...... (Aug) 109 Hartzman, Robert, Jun 20, 1991 (Nov) 461 Denver Medical Society: Feb 1991 109 Haskins, George W., 19, ...... (Aug) Blaney, Loren F., Aug 14, 1991 ...... (Nov) 463 Hastings, Orville L., Jan 30, 1991 ...... (Aug) 109 Hannum, John N., Apr 19, 1991 ...... (Aug) 117 Hawk, Walter D., Jul 21, 1991 ...... (Nov) 461 Lubchenco, Michael A., Aug 11, 1991 ...... (Nov) 463 Hayes, Donald Murray, Aug 17, 1991 ...... (Nov) 461 Meister, Edward J., Apr 28, 1991 ...... (Aug) 117 Huffer, Richard L., May 18, 1991 ...... (Aug) 109 Musman, David J., Jun 17, 1991 ...... (Sep) 222 Humber, John Davis, May 20, 1991 ...... (Aug) 109 Schonebaum, Robert M., Jul 17, 1991 ...... (Nov) 463 Johnson, Allen R., May 1, 1991 ...... (Sep) 222 Johnson, David A., Jul 27, 1991 ...... (Nov) 461 Idaho Medical Association: Jules, Philip, Mar 28, 1991 ...... (Aug) 109 Goates, Gregory L., Jul 26, 1991 ...... (Nov) 463 Klein, Russell R., Apr 1, 1991 ...... (Aug) 109 Wehler, Andrew J., Aug 26, 1991 ...... (Nov) 463 Koch, Fremont P., Sep 27, 1991 ...... (Nov) 461 Lane, Robert D., May 15, 1991 ...... (Aug) 109 Leonard, Carl D., May 24, 1991 ...... (Aug) 109 New Mexico Medical Society: Lewis, William B., Jr, Mar 14, 1991 ...... (Aug) 109 Blake, Henry W., Jun 23, 1991 ...... (Sep) 222 McCarty, Kevin, Aug 8, 1991 ...... (Nov) 461 Farid, Sada, Mar 1991 ...... (Sep) 222 McPharlin, James H., Apr 20, 1991 ...... (Aug) 109 Gutowski, Franz, Aug 4, 1991 ...... (Nov) 463 Alan 1991 461 McPherson, Given, May 10, ...... (Nov) Smith, George L., Jun 12, 1991 ...... (Sep) 222 Mar 1991 117 Martin, Frank H., 12, ...... (Aug) Spining, William D., Jun 23, 1991 ...... (Nov) 463 THE WESTERN JOURNAL OF MEDICINE * DECEMBER 1991 * 155 * 6 673

SUBJECT INDEX A Abortion 'Gag' Rule (Correspondence), California Primary Care Physicians, see Smoking Cessation Herbert Notkin...... (Aug) 191 Attitudes, Practices, and Policies Among Laura Hammons...... (Dec) 663 Cancer, see Molecular Mechanisms of Acid-Base Disorders, see Practical Approach to Cancer, see Numb Chin in Metastatic Acute Mediastinal Widening Following Endotracheal Intubation and Cancer Patients and Support Groups (Correspondence), Gastric Lavage (Radiologic Case), Krishnan Padmanabhan, Harold H. Benjamin, Michael S. Goldstein ...... (Jul) 86 Hari Gadde, Samir Vora ...... (Oct) 419 Cancer Patients for Rehabilitation Potential, see Evaluating [AIDS], see Cardiac Dysfunction in Patients Seropositive for the Cardiac Dysfunction in Patients Seropositive for the Human Human Immunodeficiency Virus Immunodeficiency Virus, James E. Johnson, David M. Slife, The AIDS Virus-What We Know and What We Can Do About It Gregg T. Anders, Steven R. Bailey, Herman M. Blanton, (Biomedical Science), Flossie Wong-Staal ...... (Nov) 481 C. Kenneth McAllister, Ricky D. Latham ...... (Oct) 373 Alcohol, see Menace of Cardiac Tamponade, and Cutaneous Vasculitis, see Idiopathic Amnesiac, see Memoirs of an Mediastinitis With Superior Vena Cava Obstruction, Angiographic Yield in Penetrating Extremity Trauma, Cardiomyopathy Associated With High-Dose Interleukin-2 Therapy, Vernon Henderson, Raman Nambisan, Michael E. Smith, Anna C. Beck, John H. Ward, Elizabeth H. Hammond, Kenneth K. Yim, Claude H. Organ, Jr...... (Sep) 253 Robert B. Wray, Wolfram E. Samlowski ...... (Sep) 293 Animal Rights and Animal Experimentation-Implications for Causes and Prevention of Calcium-containing Renal Calculi Physicians, Armand P. Gelpi ...... (Sep) 260 (Biomedical Science), Roger A. L. Sutton ...... (Sep) 249 Editorial, Thomas A. Raffin ...... (Sep) 307 Editorial, Lloyd H. Smith, Jr ...... (Sep) 306 Anti-inflammatory Drugs-Proposed Guidelines for Monitoring Central Nervous System, see Sarcoidosis of Toxicity, see Nonsteroidal Central Nervous System Sarcoidosis, see Intractable Hiccups as a Antiphospholipid Syndrome, see Superior Mesenteric Artery Presentation of Thrombosis Associated With Charges for Comprehensive Obstetric Care at Teaching and Arizona, see Public Perceptions ofHealth Care Problems-An Nonteaching Hospitals-A Comparison, Gilad S. Gordon, Analysis From Stephan E. Sefcik, James P. Lo Gerfo ...... (Dec) 616 Aspergillar Myocarditis and Acute Coronary Artery Occlusion in an Children Who Received Transfusions in Mexico, see Human Immunocompromised Patient, Michael K. Hori, Immunodeficiency Virus Infection in Lawrence L. Knight, Paula G. Carvalho, Chin, see Numb Dennis L. Stevens ...... (Nov) 525 Chlamydia Pneumoniae Lower Respiratory Tract Infections Among Autocrine Growth Factors and Solid Tumor Malignancy University Students in Northern California, see Incidence of (Conferences and Reviews), Moderator: John H. Walsh; Ciguatera Fish Poisoning in San Francisco, California, Caused by Discussants: William E. Karnes, Frank Cuttitta, Imported Barracuda, Richard J. Geller, Kent R. Olson, 639 Ameae Walker ...... (Aug) 152 Pierre E. Sendcal ...... (Dec) Editorial, Robert J. Coffey, John A. Barnard ...... (Aug) 189 Ciliary Dyskinesia, see Primary Cisplatin Therapy-Associated Recurrent Toxic Shock Syndrome, Arnold C. Berman, Lawrence R. Boly ...... (Oct) 415 B Clinical Diagnosis of Splenomegaly (Conferences and Reviews), Jack C. Yang, Leland S. Rickman, Sonya K. Bosser ...... (Jul) 47 Betamix, see Toxic Exposure to in the Medicaid Bilateral Spontaneous Renal Hemorrhage Due to Polyarteritis Colorado Pediatricians and Family Physicians see Nodosa, Joseph C. Presti, Jr, Peter R. Carroll ...... (Nov) 527 Program, Participation of Biomedical Science: Commentary: Health The AIDS Virus-What We Know and What We Can Do About It, Managed-Care Plans-Their Future Under National Thomas P. Weil ...... (Nov) 533 Flossie Wong-Staal ...... (Nov) 481 Insurance, ...... Care Services in the Causes and Prevention of Calcium-containing Renal Calculi, Medical Education, Training, and Health Republic of Singapore, Chin Hin Chew ...... (Aug) 186 Roger A. L. Sutton ...... (Sep) 249 for Border Health, Elena 0. Editorial, Lloyd H. Smith, Jr ...... (Sep) 306 Partnerships Improving Nightingale, Magda G. Peck...... (Sep) 303 Intravenous Immune Globulin Use in Patients With Human 306 Immunodeficiency Virus-Related Thrombocytopenia Who Need Editorial, Linda Hawes Clever ...... (Sep) Perils of Providing Medical Opinion-A State Medical Association's Dental Extraction, Mark U. Rarick, Pam Burian, Linda L. 183 Nelson de Guzman, Byron Espina, Terri Montgomery, Experience, Hibbard E. Williams, Ramsey ..... (Aug) Physician, Heal Thy Planet, William B. Stewart ...... (Nov) 538 Denise Jamin, Alexandra M. Levine ...... (Dec) 610 Historical Jejunal Brush-Border Folate Hydrolase-A Novel Enzyme, Teething as a Cause of Death-A Review, L. C. Kent Hebdon ...... (Dec) 658 Charles H. Halsted ...... 605 Harry Gibbons, (Dec) Trial and Tribulation of Yorrick Davis, Editorial, Gary M. Gray ...... (Dec) 660 Egerton Gerard N. Burrow ...... (Jul) 80 Mechanisms and Consequences of Leukocyte-Endothelial Interaction, John M. Harlan, Nicholas B. Vedder, Robert K. Winn, Charles L. Rice ...... (Oct) 365 Concerned Patient (Lessons From the Practice), Edmund Van Brunt ...... (Jul) 88 Biopsy of Superficial Masses in Children, see Fine Needle Conferences and Reviews: Aspiration Autocrine Growth Factors and Solid Tumor Malignancy, Moderator: Bismuth Subsalicylate, see Fatal Salicylate Toxicity From John H. Walsh; Discussants: William E. Karnes, Frank Cuttitta, Border Health, see Partnerships for Improving Ameae Walker ...... (Aug) 152 Bowel Obstruction Due to Newly Diagnosed Inoperable Advanced Editorial, Robert J. Coffey, John A. Barnard...... (Aug) 189 Ovarian Cancer With Medical Therapy, see Resolution of Clinical Diagnosis of Splenomegaly, Jack C. Yang, Boy With Neck Pain After Motor-Vehicle Accident, see 3-Year-Old Leland S. Rickman, Sonya K. Bosser ...... (Jul) 47 Brain Cancer, see Memoirs ofan Amnesiac-Two Years With Hemobilia-Evolution of Current Diagnosis and Treatment, Breast, see Sarcoidosis of the Steven W. Merrell, Philip D. Schneider ...... (Dec) 621 Editorial, Philip Sandblom ...... (Dec) 660 Hepatitis C Virus-A Review, Eddie Tang ...... (Aug) 164 C Molecular Genetics of Retinitis Pigmentosa, Moderator: Calcium-containing Renal Calculi, see Causes and Prevention of Debora B. Farber; Discussants: John R. Heckenlively, Calf Deep Venous Thrombosis, see Home Treatment of Robert S. Sparkes, J. Bronwyn Bateman...... (Oct) 388 674 VOLUME INDEX

Editorial, Richard G. Weleber, William H. Murphey ..... (Oct) 423 Reply, Thomas Bodenheimer ...... (Aug) 192 Molecular Mechanisms of Cancer, Moderator: H. Phillip Koeffler; Drug Screen Caused by Foreign-Manufactured Vitamin Discussants: Frank McCormick, Christopher Denny ..... (Nov) 505 Formulation, see Positive Preemployment Urine Editorial, Eric H. Radany ...... (Nov) 544 Durable Power of Attorney for Health Care-Are We Ready for It?, Painful Subacute Thyroiditis in Hawaii, Robert A. Nordyke, Mary Kane Goldstein. Robert P. Vallone, Dennis C. Pascoe, Fred I. Gilbert, Jr, Chris Lew ...... (Jul) 61 Carol Hutner Winograd ...... (Sep) 263 Editorial, Monte A. Greer ...... (Jul) 83 Dyskinesia, see Primary Ciliary Practical Approach to Acid-Base Disorders, Discussant: Richard J. Haber ...... (Aug) 146 E Primary Ciliary Dyskinesia, Laurie Le Mauviel ...... (Sep) 280 Status Epilepticus-Clinical Features, Pathophysiology, and Editorials: Treatment, Craig Watson...... (Dec) 626 Border Health the Linda Hawes Clever .... 306 Understanding Osteoporosis, Robert Marcus ...... (Jul) 53 Spans Continent, (Sep) Upper Gastrointestinal Tract Hemorrhage, Discussant: Dietary Folate-The Digestible Vitamin, Gary M. Gray ..... (Dec) 660 How We Get H. Jr ...... 306 Loren Laine ...... (Sep) 274 Stoned, Lloyd Smith, (Sep) Vibrio vulnificus-Hazard on the Half Shell, Kristi L. Koenig, International Health, Anvar Velji ...... (Sep) 308 Lethal Leviathan-Vibrio J. Michael Janda...... (Oct) 421 Juergen Mueller, Theodore Rose ...... (Oct) 400 vulnificus, Liver for the Editorial, J. Michael Janda...... (Oct) 421 Transplantations-Challenges Future, Emmet B. Keeffe ...... (Nov) 541 Medical Student Section, Valentina N. Chen, Coronary Artery Occlusion, see Aspergillar Mvocarditis and Acute Robert W. P. Cutler ...... (Oct) 421 Correspondence: Molecular Advances in Retinitis Pigmentosa, Richard G. Weleber, William H. Murphey ...... (Oct) 423 Abortion 'Gag' Rule, Herbert Notkin ...... (Aug) 191 Molecular Genetics in the Cancer Clinic, Eric Radany ...... (Nov) 544 Laura Hammons ...... (Dec) 663 More Great News for Readers ...... (Oct) 421 Cancer Patients and Support Groups, Harold H. Benjamin, Niacin-The Long and the Short of It, Mary J. Malloy, Michael S. Goldstein (Jul) 86 ...... Philip H. Frost, John P. Kane ...... (Oct) 424 The Digital Rectal Examination in Women, Physicians and Animal Experimentation, Thomas A. Raffin. . (Sep) 307 Pendleton Tompkins ...... (Nov) 549 Physicians and the Human Immunodeficiency Virus, Do We Need Warning Labels on Food?, Alvin R. Loosli .... (Aug) 191 Paul A. Volberding ...... (Nov) 540 Joseph E. Scherger ...... (Aug) 191 Preceptorships in the 21st Century-The Return of the Apprentice, Reply, Thomas Bodenheimer ...... (Aug) 192 F. Marian Bishop, Neal A. Whitman ...... (Oct) 426 Human Immunodeficiency Virus Infection in Children Who Subacute Thyroiditis, Monte A. Greer...... (Jul) 83 Received Transfusions in Mexico, Ronald M. Ferdman, There's a Long, Long Trail A-winding ...... (Nov) 540 Joseph A. Church, Laurene Mascola, Judith K. Sato ..... (Nov) 547 Two Medical Worlds-Separate and Unequal, Inexpensive, Convenient Adjunct for the Treatment of Diabetes, Woodrow A. Myers, Jr ...... (Jul) 83 Gary W. Evans...... (Nov) 549 Understanding Autocrine Growth Regulation, Robert J. Coffey, Medical Tourists, David Bishai ...... (Oct) 429 John A. Barnard ...... (Aug) 189 Reply, Fred Wurlitzer ...... (Oct) 429 Why Should Every Physician Know About Hemobilia?, Menace of Alcohol, Eben Alexander, Jr ...... (Oct) 430 Philip Sandblom...... (Dec) 660 Reply, Kenneth W. Kizer ...... (Oct) 430 Perspectives on 'Impairment,' Sheldon L. Wagner ...... (Oct) 430 Positive Preemployment Urine Drug Screen Caused by Egerton Yorrick Davis, see Trial and Tribulation of Foreign-Manufactured Vitamin Formulation, M. Joseph Fedoruk, Emergency Medicine, see Epitomes Loretta Lee...... (Dec) 663 Endotracheal Intubation and Gastric Lavage, see Acute Mediastinal Public Interest in Human Growth Hormone Therapy, Paul S. Salva, Widening Following George E. Bacon ...... (Oct) 428 Epilepticus, see Status Redwood Medicare Assignment Program, Herbert Notkin .... (Jul) 86 Smoking Cessation Attitudes, Practices, and Policies Among Epitomes: California Primary Care Physicians, Russell L. Young, Emergency Medicine: Catherine Crooks, John P. Elder, Erin Kenney, Dileep G. Bal, Zidovudine for Prophylaxis of Human Immunodeficiency Virus After Accidental Louis S. Michael Johnson ...... (Nov) 548 Infection Exposure, Binder, James A...... 284 Tort Reform Works, Joseph D. Sabella ...... (Oct) 428 Chappell (Sep) and Acute Toxic Exposure to Betamix, Marc Tunzi ...... (Nov) 548 Magnesium Myocardial Infarction, Connie Mitchell ...... 285 The Value of Defiance, Howard M. Grindlinger ...... (Oct) 431 ...... (Sep) WARNING-Inhaling Tabasco Products Can Be Hazardous to Your Preventing and Controlling Violence in Emergency Departments, Health, Haya R. Rubin, Albert W. Wu, Sean Tunis ...... (Nov) 550 Gregg A. Pane ...... (Sep) 285 Neuromuscular Blockage in Emergency Medicine, Edward A. Panacek ...... (Sep) 286 Transvaginal Imaging of Ectopic Pregnancy, Michael Crade. . (Sep) 287 Rectal Diazepam Therapy for Prehospital Pediatric Status D Epilepticus, Ronald A. Dieckmann ...... (Sep) 287 Decision Making in Critically Ill Patients With Hematologic Bacterial Meningitis in Emergency Departments, Malignancy, Stephen W. Crawford ...... (Nov) 488 Eric Weiss ...... (Sep) 288 Deep Venous Thrombosis, see Home Treatment of Calf Human Immunodeficiency Virus Precautions in Emergency Dental Extraction, see Intravenous Immune Globulin Use in Patients Departments, Alan Gelb ...... (Sep) 289 With Human Imunodeficiency Virus-Related Thrombocytopenia High-Dose Epinephrine in Cardiac Arrest, Michael Callaham (Sep) 289 Who Need When to Image Cervical Spine Injuries, Jerome R. Hoffman, Desperately Seeking Primary Prevention (Lessons From the William Mower ...... (Sep) 290 Practice), Anonymous ...... (Sep) 310 Terminating Paroxysmal Supraventricular Tachycardias With Diabetes, see Inexpensive, Convenient Adjunctfor the Treatment of Adenosine, Julia Nathan ...... (Sep) 290 Dietary Folate-The Digestible Vitamin (Editorial), Gary M. Gray ...... (Dec) 660 General Surgery: Domestic Violence-Risk Factors and Outcomes, Advances in the Management of Hemorrhagic Shock, Daniel C. Berrios, Deborah Grady ...... (Aug) 133 Scott R. Miller, Kenneth Waxman...... (Oct) 404 Do We Need Warning Labels on Food? (Correspondence), Use and Abuse of Parenteral Nutrition, Howard Silberman. . . (Oct) 405 Alvin R. Loosli ...... (Aug) 191 Procuring Donor Organs for Transplantation, Joseph E. Scherger ...... (Aug) 191 Robert C. Mackersie ...... (Oct) 405 THE WESTERN JOURNAL OF MEDICINE o DECEMBER 1991 o 155 o 6 675

Surgical Treatment of Chronic Ulcerative Colitis, Exocrine Glands, see Sarcoidosis of the Breast, Central Nervous James Stone ...... (Oct) 406 System, and Efficacy of Carotid Endarterectomy in Randomized Trials, Experimentation-Implications for Physicians, see Animal Rights Wesley S. Moore ...... (Oct) 407 and Animal Surgical Treatment of Hemoptysis, John R. Benfield ...... (Oct) 407 Laparoscopic Cholecystectomy, Bruce E. Stabile ...... (Oct) 408 Neurology: F Use of Antiepileptic Drugs in Pregnancy, Marian V. Sowa.... (Jul) 64 Family Physicians, see Obstetric Care, Medicaid, and Human T-cell Leukemia Virus Myelopathy, William A. Sibley (Jul) 65 Fatal Salicylate Toxicity From Bismuth Subsalicylate, Acquired Immunodeficiency Syndrome Dementia, Steven J. Sainsbury ...... (Dec) 637 Fever of Unknown see Gastric Tuberculosis as Christina Marra ...... (Jul) 65 Origin, Presenting Fine Needle of Masses in Treatment of Cluster Headaches, David C. Agnew ...... (Jul) 66 Aspiration Biopsy Superficial Children, Pleotis Liisa A. P. Holbrook Electroencephalographic Brain Mapping, Marc R. Nuwer .... (Jul) 67 Lydia Howell, Russell, Howard, Transcranial Doppler Study, Kenneth L. Nudleman ...... (Jul) 67 Raymond L. Teplitz (Jul) 33 Myth of the Chronic Fatigue Syndrome, Ronald S. Murray ... (Jul) 68 Folate, see Dietary Selegiline (Eldepryl) for Parkinson's Disease, Food, see Do We Need Warning Labels on Cheryl H. Waters...... (Jul) 68 Fulminant Hepatic Failure Following Low-Dose Sustained-Release Intravenous -y-Globulin for Chronic Inflammatory Demyelinating Niacin Therapy in Hospital, David J. Fischer, Polyneuropathy and Myasthenia Gravis, John D. Keesey ... (Jul) 69 Lawrence L. Knight, Robert E. Vestal ...... (Oct) 410 J. H. John P. 424 Botulinum Toxin Therapy, Daniel D. Truong ...... (Jul) 69 Editorial, Mary Malloy, Philip Frost, Kane.. (Oct) Preventing Chemotherapy-induced Neuropathy, Kenneth L. Nudleman ...... (Jul) 70

Carotid Endarterectomy, Gregory K. Call ...... (Jul) 70 G Gastric Lavage, see Acute Mediastinal Widening Following Orthopedics: Endotracheal Intubation and Tissue Banking, Juan J. Rodrigo...... (Aug) 169 Gastric Tuberculosis Presenting as Fever of Unknown Origin, Medical Management of Spinal Cord Injury, Vance 0. Gardner, Shelley R. Salpeter, Richard M. Shapiro, John D. Gasman (Oct) 412 Vince Caiozzo ...... (Aug) 169 Gastrointestinal Tract Hemorrhage, see Upper Ilizarov Method, Kevin W. Louie ...... (Aug) 170 General Surgery, see Epitomes Update on the Diagnosis and Treatment of Scaphoid Fractures, Genetics of Retinitis Pigmentosa, see Molecular Roy A. Meals...... (Aug) 170 Open Reduction of Pelvic Fractures, Robert Baird ...... (Aug) 171 Bearing Surfaces in Total Joint Replacement, Richard B. Welch, Gary Levengood ...... (Aug) 172 H Arthroscopic-Assisted Reconstruction of the Anterior Cruciate Headache, see Spontaneous Intracranial Hypotension-An Ligament, Richard A. Marder ...... (Aug) 172 Uncommon and Underrecognized Cause of Percutaneous Discectomy, James M. Morris ...... (Aug) 172 [Health Care], see Two Medical Worlds-Separate and Unequal Objective Measurements for Rehabilitation After Back Injury, Health Care Problems-An Analysis From Arizona, see Public Vert Mooney ...... (Aug) 173 Perceptions of Health Status of Minority Populations in the United States,

Psychiatry: Herbert W. Nickens ...... (Jul) 27

Electroconvulsive Therapy, Max Fine ...... (Nov) 515 Editorial, Woodrow A. Myers, Jr ...... (Jul) 83 Electrophysiologic Evaluation for Brain Dysfunction, Heart and Mind (Lessons From the Practice), Maurice Rappaport ...... (Nov) 516 Marshall H. Chin ...... (Nov) 553 Prophylaxis of Antipsychotic Drug-Induced Extrapyramidal Helmet Use Improves Outcomes After Motorcycle Accidents, Syndromes, George A. Keepers ...... (Nov) 516 Margie A. Murdock, Kenneth Waxman ...... (Oct) 370 Panic Disorder, Douglas Kahn ...... (Nov) 517 Hematologic Malignancy, see Decision Making in Critically Ill Rational Polydrug Use in Psychiatry, Robert Gerner ...... (Nov) 518 Patients With Tobacco Dependence and Smoke-free Psychiatric Units, Hemobilia-Evolution of Current Diagnosis and Treatment John A. Menninger ...... (Nov) 519 (Conferences and Reviews), Steven W. Merrell, Eating Disorders in Psychiatric Illness, Barton J. Blinder (Nov) 519 Philip D. Schneider ...... (Dec) 621 Nocturnal Enuresis, Eberhard M. Mann ...... (Nov) 520 Editorial, Philip D. Sandblom ...... (Dec) 660 Treatment-Resistant Depression, Michael J. Gitlin ...... (Nov) 521 [Hemochromatosis], see Vibrio vulnificus-Hazard on the Half Antidepressant Treatment in Patients With Heart Disease, Shell Richard D. Lane ...... (Nov) 521 Hemodialysis, see Isoniazid Overdose-Successful Treatment with Obsessive-Compulsive Disorder, David L. Fogelson...... (Nov) 522 Pyridoxine and Brain Imaging and Neurodevelopmental Psychiatry, Hemoptysis in a Patient With Tuberculosis, see Lung Mass and Robert L. Hendren ...... (Nov) 522 Hemorrhage, see Upper Gastrointestinal Tract Treating Compulsive Behaviors in Dermatology, Hepatic Failure Following Low-Dose Sustained-Release Niacin John Y. M. Koo...... (Nov) 523 Therapy in Hospital, see Fulminant Bulimia Nervosa, Joel Yager ...... (Nov) 523 Hepatitis B, see Screening for During Pregnancy Hepatitis C Virus-A Review (Conferences and Reviews),

Urology: Eddie Tang ...... (Aug) 164 Prostate-Specific Antigen, John N. Kabalin ...... (Dec) 632 Hepatocellular Carcinoma Coexisting With Hepatic BCG Vaccine in Urinary Bladder Cancer, Adenoma-Incidental Discovery After Long-Term Oral Stanley A. Brosman...... (Dec) 633 Contraceptive Use, Jacob Korula, Albert Yellin, Gary Kanel,

Medical Treatment of Benign Prostatic Hyperplasia, Gail Campofiori, Peter Nichols ...... (Oct) 416 Joseph D. Schmidt ...... (Dec) 633 Hiccups as a Presentation of Central Nervous System Sarcoidosis, Screening for Prostate Cancer, Michael T. MacFarlane ..... (Dec) 634 see Intractable Laparoscopy in Urology, George Daniels, Jr ...... (Dec) 634 Home Treatment of Calf Deep Venous Thrombosis, Extracorporeal Shock-Wave Lithotripsy With Minimal or No Cyril Bruce Calliser, Stephen Daniel Wood, Anesthesia, John N. Kabalin ...... (Dec) 635 George L. White, Jr, Elizabeth D. Tucker ...... (Sep) 299 Male Infertility Update, Philip Wise...... (Dec) 635 How We Get Stoned (Editorial), Lloyd H. Smith, Jr ...... (Sep) 306 Human Growth Hormone Therapy, see Public Interest in Evaluating Cancer Patients for Rehabilitation Potential, Human Immunodeficiency Virus, see Cardiac Dysfunction in David M. O'Toole, Alice M. Golden ...... (Oct) 384 Patients Seropositivefor the 676 VOLUME INDEX

Human Immunodeficiency Virus, see Intravenous Immune Globulin Routine Gone Awry, Carl Coppola ...... (Aug) 193 Use in Patients With Sailor Who Couldn't Play Pool, Paul L. Kingsley ...... (Jul) 87 Human Immunodeficiency Virus, see Patterns ofPrimary Care of Patients Infected With Lethal Leviathan-Vibrio vulnificus (Editorial), Human Immunodeficiency Virus Infection in Children Who J. Michael Janda ...... (Oct) 421 Received Transfusions in Mexico (Correspondence), Leukocyte-Endothelial Interaction, see Mechanisms and Ronald M. Ferdman, Joseph A. Church, Laurene Mascola, Consequences of Judith K. Sato ...... (Nov) 547 [Liver Disease], see Vibrio vulnificus-Hazard on the HalfShell Hypercalcemia, see Intravascular (Angiotropic) Large-Cell Liver Transplantation-Experience With 100 Cases, Lymphoma ('Malignant Angioendotheliomatosis') With Jean-Luc Szpakowski, Ken Cox, Paul Nakazato, Small-Vessel Pulmonary Vascular Obstruction and Waldo Concepcion, Barry Levin, Carlos 0. Esquivel ..... (Nov) 494 Editorial, Emmet B. Keeffe ...... (Nov) 541 Lung Mass and Hemoptysis in a Patient With Tuberculosis (Radiologic Case), Krishnan Padmanabhan, Santi R. Dhar, Idiopathic Mediastinitis With Superior Vena Cava Obstruction, Kiat Yeo ...... (Aug) 181 Cardiac Tamponade, and Cutaneous Vasculitis, John M. Loeb, Charles M. Lombard ...... (Sep) 296 The Ill-Fated Child (Lessons From the Practice), M George Zucconi ...... (Dec) 664 ('Malignant Angioendotheliomatosis') With Small-Vessel Pulmonary Immune Globulin Use, see Intravenous Vascular Obstruction and Hypercalcemia, see Intravascular 'Impairment,' see Perspectives on (Angiotropic) Large-Cell Lymphoma Incidence of Chlamydia pneumoniae Lower Respiratory Tract Managed-Care Plans-Their Future Under National Health Infections Among University Students in Northern California, Insurance (Commentary), Thomas P. Weil ...... (Nov) 533 Debra K. Katzman, Ann C. Tipton, Iris F. Litt, Massive Splenic Infarction in Doubly Abnormal Heterozygous Ira M. Friedman, Richard W. Emmons, Julius Schachter (Aug) 136 Sickling Disorders-A New Complication of Acute Splenic Inexpensive, Convenient Adjunct for the Treatment of Diabetes Sequestration Syndrome, Roy A. Berry, W. Evans ...... (Nov) 549 (Correspondence), Gary Elizabeth A. Odumakinde, Jerry P. Lewis...... (Nov) 531 Interleukin-2 Therapy, see Cardiomyopathy Associated With Mechanisms and Consequences of Leukocyte-Endothelial Interaction High-Dose (Biomedical Science), John M. Harlan, Nicholas B. Vedder, International Health (Editorial), Anvar ...... (Sep) 308 Velji Robert K. Winn, Charles L. Rice ...... (Oct) 365 Intracranial Hypotension-An Uncommon and Underrecognized Mediastinal Widening Following Endotracheal Intubation and Cause of Headache, see Spontaneous Gastric Lavage, see Acute Intractable Hiccups as a Presentation of Central Nervous System Mediastinitis With Superior Vena Cava Obstruction, Cardiac Sarcoidosis, John P. Connolly, Timothy J. Craig, Tamponade, and Cutaneous Vasculitis, see Idiopathic Ram6n M. Sanchez, W. Scott Sageman, Robin E. Osborn.. (Jul) 78 Medicaid, see Obstetric Care, Intravascular (Angiotropic) Large-cell Lymphoma ('Malignant Medicaid, see Participation of Colorado Pediatricians and Family Angioendotheliomatosis') With Small Vessel Pulmonary Vascular Physicians in Obstruction and Hypercalcemia, Jeffrey L. Curtis, Medical Education, Training, and Health Care Services in the Martha L. Warnock, Douglas J. Conrad, Lisa K. Helfend, Republic of Singapore (Commentary), Chin Hin Chew ... (Aug) 186 Homer A. Boushey ...... (Jul) 72 Medical Opinion-A State Medical Association's Experience, see Intravenous Immune Globulin Use in Patients With Human Perils ofProviding Immunodeficiency Virus-Related Thrombocytopenia Who Need Medical School, see Student Perceptions ofMistreatment and Dental Extraction (Biomedical Science), Mark U. Rarick, Harassment During Pam Burian, Nelson de Guzman, Byron Espina, [Medical Students], see Preceptorships in the 21st Century-The Terri Montgomery, Denise Jamin, Alexandra M. Levine .. (Dec) 610 Return ofthe Apprentice Is Deleting the Digital Rectal Examination a Good Idea?, Medical Student Section (Editorial), Valentina N. Chen, Mark A. Sutton, Robert P. Gibbons, Roy J. Correa, Jr .... (Jul) 43 Robert W. P. Cutler ...... (Oct) 421 Correspondence, Pendelton Tompkins ...... (Nov) 549 Medical Tourists (Correspondence), David Bishai ...... (Oct) 429 Isoniazid Overdose-Successful Treatment With Pyridoxine and Reply, Fred Wurlitzer ...... (Oct) 429 Hemodialysis, Joseph M. Cash, Edward T. Zawada, Jr ... (Dec) 644 Medicare Assignment Program, see Redwood Medicine and Society: J Obstetric Care, Medicaid, and Family Physicians-How Policy Jejunal Brush-Border Folate Hydrolase-A Novel Enzyme Changes Affect Physicians' Attitudes, Thomas S. Nesbitt, (Biomedical Science), Charles H. Halsted ...... (Dec) 605 Jeffrey L. Tanji, Joseph E. Scherger, Norman B. Kahn ... (Dec) 653 Participation of Colorado Pediatricians and Family Physicians in the Medicaid Program, Stephen Berman, Stephanie Wasserman, K Susan Grimm ...... (Dec) 649 [Kidney Stones], see How We Get Stoned Memoirs of an Amnesiac-Two Years With Brain Cancer, or The Outer Space of Living With Brain Tumors, L Alexandra Dane Dor-Ner ...... (Nov) 555 Large-cell Lymphoma ('Malignant Angioendotheliomatosis') Menace of Alcohol (Correspondence), Eben Alexander, Jr ... (Oct) 430 With Small-Vessel Pulmonary Vascular Obstruction and Reply, Kenneth W. Kizer ...... (Oct) 430 Hypercalcemia, see Intravascular (Angiotropic) Metastasis-Induced Acute Pancreatitis, Shaun S. J. Hung, Leg Symptoms in Outpatient Veterans, Sylvia K. Oboler, Bach Ardalan ...... (Aug) 176 Allan V. Prochazka, Thomas J. Meyer ...... (Sep) 256 Metastatic Cancer, see Numb Chin in Mexico, see Human Immunodeficiency Virus Infection in Children Lessons From the Practice: Who Received Transfusions in Concerned Patient, Edmund Van Brunt ...... (Jul) 88 Minority Populations in the United States, see Health Status of Desperately Seeking Primary Prevention, Anonymous ...... (Sep) 310 Molecular Genetics of Retinitis Pigmentosa (Conferences and Heart and Mind, Marshall H. Chin ...... (Nov) 553 Reviews), Moderator: Debora B. Farber; Discussants: The Ill-Fated Child, George Zucconi ...... (Dec) 664 John R. Heckenlively, Robert S. Sparkes, My Jogging Partner, Dana Frederick Hoch ...... (Nov) 551 J. Bronwyn Bateman ...... (Oct) 388 Own Robert J. Reiner 666 My Awakening, ...... (Dec) Editorial, Richard G. Weleber, William H. Murphey ..... (Oct) 423 THE WESTERN JOURNAL OF MEDICINE * DECEMBER 1991 * 155 6 677

Molecular Mechanisms of Cancer (Conferences and Reviews), Poems: Moderator: H. Phillip Koeffler; Discussants: Frank McCormick, Aneurysm, Stephen Lyons...... (Dec) 620 ...... 505 Christopher Denny (Nov) Case Histories-Oncology, Anne Kavanaugh ...... (Oct) 369 Eric H...... 544 Editorial, Radany (Nov) Doctor's Wife, Constance Pultz ...... (Nov) 537 Motorcycle Accidents, see Helmet Use Improves Outcomes After Ear, Freya Manfred ...... (Dec) 615 Motor-Vehicle Accident, see 3-Year-Old Boy With Neck Pain After Eleventh Hour, Constance Pultz ...... (Oct) 432 Mouse Joint-Another Manifestation of an Occupational Epidemic?, In a Convalescent Hospital, Janet Lewis ...... (Aug) 194 Lee A. Norman ...... (Oct) 413 In Praise of Old Men's Pee, Elaine Starkman ...... (Oct) 432 My Jogging Partner (Lessons From the Practice), Inserting a Chest Tube Without Anesthesia, Dana Frederick Hoch ...... (Nov) 551 Michele Wyrebek ...... (Dec) 662 Myocarditis, see Aspergillar Older Julia Kasdorf ...... 539 My Own Awakening (Lessons From the Practice), Brother, ...... (Nov) On an Old Woman Dying, Janet Lewis ...... (Jul) 38 Robert J. Reiner ...... 666 (Dec) Out in the Trenches, Elizabeth Spencer Smith...... (Jul) 82 Sick Child, Stephanie Pershing Buehler ...... (Nov) 504 The Toronto Dogs, Carlos A. Schaffenburg ...... (Sep) 312 N To Pronounce the Dead, Antoinette Reed...... (Jul) 46 National Health Insurance, see Managed-Care Plans-7hreir Future Under Poisoning, see Ciguatera Fish Neck Pain After Motor-Vehicle Accident, see 3-Year-Old Boy With Positive Preemployment Urine Drug Screen Caused by Neurology, see Epitomes Foreign-Manufactured Vitamin Formulation (Correspondence), Niacin Therapy in Hospital, see Fulminant Hepatic Failure M. Joseph Fedoruk, Loretta Lee ...... (Dec) 663 Following Low-Dose Sustained-Release Practical Approach to Acid-Base Disorders (Conferences and Nonsteroidal Anti-inflammatory Drugs-Proposed Guidelines for Reviews), Discussant: Richard J. Haber ...... (Aug) 146 Monitoring Toxicity, Thomas M. Bush, Tammi L. Shlotzhauer, Preceptorships in the 21st Century-The Return of the Apprentice Kent Imai ...... (Jul) 39 (Editorial), F. Marian Bishop, Neal A. Whitman...... (Oct) 426 The Numb Chin in Metastatic Cancer, Cheryl P. Harris, Preemployment Urine Drug Screen Caused by J. Richard Baringer ...... (Nov) 528 Foreign-Manufactured Vitamin Formulation, see Positive Pregnancy, see Screeningfor Hepatitis B During Primary Care Physicians, see Smoking Cessation Attitudes, 0 Practices, and Policies Among California Obstetric Care, Medicaid, and Family Physicians-How Policy Primary Ciliary Dyskinesia (Conferences and Reviews), Changes Affect Physicians' Attitudes (Medicine and Society), Laurie Le Mauviel ...... (Sep) 280 Thomas S. Nesbitt, Jeffrey L. Tanji, Joseph E. Scherger, Psychiatry, see Epitomes Psychosis, see Severe Thyrotoxicosis Presenting as Acute Norman B. Kahn ...... (Dec) 653 Obstetric Care at Teaching and Nonteaching Hospitals, Public Interest in Human Growth Hormone Therapy see Charges for (Correspondence), Paul S. Salva, George E. Bacon...... (Oct) 428 Occupational Epidemic?, see Mouse Joint-Another Manifestation Public Perceptions of Health Care Problems-An Analysis From ofan Arizona, Bradford L. Kirkman-Liff ...... (Sep) 269 Oral Contraceptive Use, see Hepatocellular Carcinoma Coexisting Pulmonary Vascular Obstruction and Hypercalcemia, see With Hepatic Adenoma-Incidental Discovery After Long-Term Intravascular (Angiotropic) Large-Cell Lymphoma ('Malignant Orthopedics, see Epitomes Angioendotheliomatosis') With Small-Vessel Osteoporosis, see Understanding Pyridoxine, see Isoniazid Overdose: Successful Treatment With Ovarian Cancer With Medical Therapy, see Resolution of Bowel Radiologic Cases: Obstruction Due to Newly Diagnosed Inoperable Advanced Acute Mediastinal Widening Following Endotracheal Intubation and Gastric Lavage, Krishnan Padmanabhan, Hari Gadde, Samir Vora ...... (Oct) 419 P Lung Mass and Hemoptysis in a Patient With Tuberculosis, Painful Subacute Thyroiditis in Hawaii (Conferences and Reviews), Krishnan Padmanabhan, Santi R. Dhar, Kiat Yeo ...... (Aug) 181 Robert A. Nordyke, Fred I. Gilbert, Jr, Chris Lew ...... (Jul) 61 3-Year-Old Boy With Neck Pain After Motor-Vehicle Accident, Editorial, Monte A. Greer ...... (Jul) 83 Wazhma Aslamy, Kelvin Danielson, Samuel J. Hessel, Pancreatitis, see Metastasis-Induced Acute Jonathan M. Levy ...... (Sep) 301 Participation of Colorado Pediatricians and Family Physicians in the 2-Year-Old Girl With Seizures and Fever, Alice N. Karolewski, Medicaid Program (Medicine and Society), Stephen Berman, Virginia C. Poirier ...... (Dec) 647 Stephanie Wasserman, Susan Grimm ...... (Dec) 649 Partnerships for Improving Border Health (Commentary), Recruiting Physicians to Rural Practice-Suggestions for Success, Elena 0. Nightingale, Magda G. Peck ...... (Sep) 303 Katherine Riley, Wayne Myers, Ronald Schneeweiss ..... (Nov) 500 Editorial, Linda Hawes Clever ...... (Sep) 306 Rectal Examination a Good Idea?, see Is Deleting Patterns of Primary Care of Patients Infected With Human Redwood Medicare Assignment Program (Correspondence), Immunodeficiency Virus, Marjorie D. Wenrich, Herbert Notkin...... (Jul) 86 Paul G. Ramsey ...... (Oct) 380 Rehabilitation Potential, see Evaluating Cancer Patientsfor Penetrating Extremity Trauma, see Angiographic Yield in Renal Calculi, see Causes and Prevention of Calcium-containing Perils of Providing Medical Opinion-A State Medical Association's Renal Hemorrbage, see Bilateral Spontaneous Experience (Commentary), Hibbard E. Williams, [Residents], see Preceptorships in the 21st Century-The Return of Linda R. Ramsey ...... (Aug) 183 the Apprentice Perspectives on 'Impairment' (Correspondence), Resolution of Bowel Obstruction Due to Newly Diagnosed Sheldon L. Wagner...... (Oct) 430 Inoperable Advanced Ovarian Cancer With Medical Therapy, Physician, Heal Thy Planet (Commentary), Thomas P. Drakes ...... (Jul) 76 William B. Stewart ...... (Nov) 538 Retinitis Pigmentosa, see Molecular Genetics of Physicians and Animal Experimentation (Editorial), Routine Gone Awry (Lessons From the Practice), Thomas A. Raffin ...... (Sep) 307 Carl Coppola ...... (Aug) 193 Physicians and the Human Immunodeficiency Virus (Editorial), Rural Practice-see Recruiting Physicians to Paul A. Volberding ...... (Nov) 540 Planet, see Physician, Heal Thy Polyarteritis Nodosa, see Bilateral Spontaneous Renal Hemorrhage s Due to Sailor Who Couldn't Play Pool (Lessons From the Practice), 678 VOLUME INDEX

Paul L. Kingsley ...... (Jul) 87 Thrombosis, see Home Treatment of CalfDeep Venous Salicylate Toxicity, see Fatal Thombosis Associated With Antiphospholipid Syndrome, see Sarcoidosis, see Intractable Hiccups as a Presentation of Central Superior Mesenteric Artery Nervous System Thyroiditis, see Subacute Sarcoidosis of the Breast, Central Nervous System, and Exocrine Thyroiditis in Hawaii, see Painful Subacute Glands in a Patient With Sicca Symptoms, Kenneth H. Fye, Thyrotoxicosis Presenting as Acute Psychosis, see Severe Ripley H. Hunter ...... (Dec) 642 Tort Reform Works (Correspondence), Joseph D. Sabella .... (Oct) 428 Screening for Hepatitis B During Pregnancy-Awareness of Current Toxic Exposure to Betamix (Correspondence), Marc Tunzi . (Nov) 548 Recommendations Among Washington Hospitals, Toxic Shock Syndrome, see Cisplatin Therapy-Associated Recurrent Thomas R. Eng, Mary L. Borges, Vivian K. Harlin, Training, and Health Care Services in the Republic of Singapore, John M. Kobayashi ...... (Dec) 613 see Medical Education, Training, and Severe Thyrotoxicosis Presenting as Acute Psychosis, Transfusions in Mexico, see Human Immunodeficiency Virus Timothy G. Caudill, Claude K. Lardinois ...... (Sep) 292 Infection in Children Who Received Sicca Symptoms, see Sarcoidosis ofthe Breast, Central Nervous Transplantation, see Liver System, and Exocrine Glands in a Patient With Trauma, see Angiographic Yield in Penetrating Extremity Sickling Disorders, see Massive Splenic Infarction in Doubly Trial and Tribulation of Egerton Yorrick Davis (Commentary), Abnormal Heterozygous Gerard N. Burrow ...... (Jul) 80 Singapore, see Medical Education, Training, and Health Care Tuberculosis, see Lung Mass and Hemoptysis in a Patient With Services in Tuberculosis Presenting as Fever of Unknown Origin, see Gastric Smoking Cessation Attitudes, Practices, and Policies Among Tumor Malignancy, see Autocrine Growth Factors and Solid California Primary Care Physicians (Correspondence), Two Medical Worlds-Separate and Unequal (Editorial), Russell L. Young, Catherine Crooks, John P. Elder, Erin Kenney, Woodrow A. Myers, Jr ...... (Jul) 83 Dileep G. Bal, Michael Johnson...... (Nov) 548 2-Year-Old Girl With Seizures and Fever (Radiologic Case), Special Article: Alice N. Karolewski, Virginia C. Poirier...... (Dec) 647 Memoirs of an Amnesiac-Two Years With Brain Cancer, or The Outer Space of Living With Brain Tumors, Alexandra Dane Dor-Ner ...... (Nov) 555 U Understanding Autocrine Growth Regulation (Editorial), Splenic Infarction, see Massive Robert J. Coffey, John A. Barnard ...... (Aug) 189 Splenic Sequestration Syndrome, see Massive Splenic Infarction in Understanding Osteoporosis (Conferences and Reviews), Doubly Abnormal Heterozygous Sickling Disorders-A New Robert Marcus ...... (Jul) 53 Complication ofAcute United States, see Health Status ofMinority Populations in Splenomegaly, see Clinical Diagnosis of Upper Gastrointestinal Tract Hemorrhage (Conferences and Spontaneous Intracranial Hypotension-An Uncommon and Reviews), Discussant: Loren Laine ...... (Sep) 274 Underrecognized Cause of Headache, Michael B. Jacobs, Urine Drug Screen Caused by Foreign-Manufactured Vitamin Formulation, see Positive Preemployment Philip H. Wasserstein ...... (Aug) 178 Status Epilepticus-Clinical Features, Pathophysiology, and Urology, see Epitomes Treatment (Conferences and Reviews), Craig Watson ..... (Dec) 626 Student Perceptions of Mistreatment and Harassment During Medical School-A Survey of Ten United States Schools, V DeWitt C. Baldwin, Jr, Steven R. Daugherty, Value of Defiance (Correspondence), Howard M. Grindlinger (Oct) 431 Edward J. Eckenfels ...... (Aug) 140 Vasculitis, see Idiopathic Mediastinitis With Superior Vena Cava Subacute Thyroiditis (Editorial), Monte A. Greer ...... (Jul) 83 Cardiac Subsalicylate, see Fatal Salicylate Toxicity From Bismuth Obstruction, Tamponade, and Cutaneous Mesenteric Venous Thrombosis, see Home Treatment of CalfDeep Superior Artery Thrombosis Associated With Vibrio vulnificus-Hazard on the Half Shell and Antiphospholipid Syndrome, Maurice E. Hamilton ...... (Aug) 174 (Conferences Superior Vena Cava Obstruction, Cardiac Tamponade, and Reviews), Kristi L. Koenig, Juergen Mueller, Cutaneous Vasculitis, see Idiopathic Mediastinitis With Theodore Rose ...... (Oct) 400 Editorial, J. Michael Janda ...... (Oct) 421 Surgery, General, see Epitomes Violence-Risk Factors and Outcomes, see Domestic Vitamin, see Dietary Folate Vitamin Formulation, see Positive Preemployment Urine Drug T Screen Caused by Foreign-Manufactured Tabasco Products Can Be Hazardous to Your Health, see WARNING-Inhaling Taxes and Abortion (Correspondence), Laura Hammons .... (Dec) 663 Teething as a Cause of Death-A Historical Review (Commentary), w Harry L. Gibbons, C. Kent Hebdon ...... (Dec) 658 WARNING-Inhaling Tabasco Products Can Be Hazardous to Your There's a Long, Long Trail A-winding (Editorial) ...... (Nov) 540 Health (Correspondence), Haya R. Rubin, Albert W. Wu, 3-Year-Old Boy With Neck Pain After Motor-Vehicle Accident Sean Tunis ...... (Nov) 550 (Radiologic Case), Wazhma Aslamy, Kelvin Danielson, Warning Labels on Food, see Do We Need Samuel J. Hessel, Jonathan M. Levy ...... (Sep) 301 Washington Hospitals, see Screening for Hepatitis B During Thrombocytopenia, see Intravenous Immune Globulin Use in Pregnancy-Awareness of Current Recommendations Among Patients With Human Immunodeficiency Virus-Related tWomen Physicians], see There's a Long, Long Trail A-winding 680 THE WESTERN JOURNAL OF MEDICINE

CONTINUING MEDICAL EDUCATION (Continued from Page 602) March 22-27-MRI Workshop in Hawaii: 1992. Queens Medical Center at February 28-29-Nutrition: A Key Partner in the Treatment of Fre- Kea Lani Hotel, Wailea, Hawaii. Sun-Fri. 37 hrs. $595. Contact: Susan quently Encountered Medical Problems. UCD at Walnut Creek. Fri- Block, Queens Medical Ctr, 1301 Punchbowl St, Honolulu, HI 96813. Sat. Contact: UCD. (808) 547-4544. March 12-13-Dimensions of Caring 1992: Enhancing Quality of Life in April 5-10-General Radiology Review Course. UCLA at Miramar Shera- Palliative Care. Scripps Clinic and Research Foundation at Omni Hotel, ton Hotel, Santa Monica. Sun-Fri. 40 hrs. $425. Contact: UCLA. San Diego. Thurs-Fri. Contact: Scripps Clinic, 10666 N Torrey Pines Rd, April 19-24-Residents Radiology Review Course. UCSD at Hotel del La Jolla 92037. (619) 554-8556. Coronado, San Diego. Sun-Fri. 39 hrs. $470. Contact: Dawne Ryals, PO April 2-4-Medicine Today. UCSD at Price Center. Thurs-Sat. Contact: Box 1925, Roswell, GA 30077-1925. (404) 641-9773. UCSD. April 25-Interventional Radiology. UCSD at Hotel del Coronado, San April 9-13-Lactation Educator Training Programs. UCLA at Westwood. Diego. Sat. 8 hrs. $125. Contact: Dawne Ryals, PO Box 1925, Roswell, 22.5 hrs. $725. Contact: UCLA. GA 30077-1925. (404) 641-9773. May 4-8-MRI: A State of the Art Clinical Review. Stanford University Medical Center at Ritz-Carlton, San Francisco. Mon-Fri. 23.5 hrs. $540. Contact: UCSD. May 8-10-Advanced Seminars in Diagnostic Imaging. UCSD at Ritz- COLORADO Carlton, Laguna Niguel. Fri-Sun. 15 hrs. $400. Contact: UCSD. This medical in May 21-24-Doppler and Duplex Imaging. UCSD at Le Meridien Hotel, listing of continuing education programs Colorado San Diego. Thurs-Sun. 21.5 hrs. Contact: UCSD. is compiled by the Denver Medical Society. To list CME programs here, please send information at least two months in advance to: Mr Robert L. Kennedy, Denver Medical Society, 1850 Williams REHABILITATIVE/THERAPEUTIC Street, Denver, CO 80218; or telephone (303) 377-1850. March 5-7-Rehabilitation: Science, Technology, Quality and Costs- Brochures, course information, and registration forms are availa- Present and Future. Scripps Memorial Hospital at La Jolla Marriott. ble from the contact person or organization. 18.5 hrs. $395. Contact: Meeting Management, 5665 Oberlin Dr, Ste 10, San Diego 92121. (619) 453-6222. December 21-April 11, 1992 (17 Weekly Meetings)-Second Annual Vail Computers in Medicine Conference. Rose Medical Center atL' Ostello SLEEP MEDICINE Lodge, Vail. One week. Contact: David R. Scott, (800) 525-5810. January 30-31-New Horizons in Sleep Disorders Medicine. California January 9-11-Twenty-Seventh Annual Conference on Occupational Thoracic Society at Doubletree Resort, Palm Springs. Thurs-Fri. Contact: Medicine & Colorado/AMA Guides to Evaluation of Permanent Im- California Thoracic Society, 202 Fashion Ln, #219, Tustin 92680. (714) pairment Course. The Rocky Mountain Academy of Occupational Medi- 730-1944. cine and Colorado State Association of Occupational Health Nurses at Hyatt Regency Tech Center, Denver. Thurs-Sat. Contact: Douglas Scott, April 3-4-Pharmacotherapeutics in Clinical Sleep Medicine. Scripps MD, (303) 782-9129. Clinic and Research Foundation at La Jolla. Fri-Sat. Contact: Scripps Clinic, 10666 N Torrey Pines Rd, La Jolla 92037. (619) 554-8556. January 25-February 1-Reconstructive Surgery of the Hip and Knee. University of Colorado School of Medicine at Snowmass Conference Center, Snowmass Village. One week. Contact: Joann Bauer, (303) 270- 5195 or (800) 882-9153. SURGERY January 25-February 1-15th Annual Infectious Diseases in Clinical Prac- January-May 1992-Temporal Bone Surgical Dissection Courses. House tice. UCSF at Beaver Run Resort and Conference Center, Breckenridge. Ear Institute at Los Angeles. 6 days each. 53 hrs. $1 100. Contact: Antonio Sat-Sat. 24 hrs. Contact: UCSF. De la Cruz, House Ear Institute, 2100 W 3rd St, Los Angeles 90057. (213) February 8-15-Seventeenth Annual Vail Psychiatry Conference. Rose 483-4431, ext 7079. Medical Center and University of Colorado School of Medicine at Lion January 17-18-What's New in General Surgery. UCD at Radisson Hotel, Square Lodge, Vail. One week. Contact: David R. Scott, (800) 525-5810. Sacramento. Fri-Sat. 16 hrs. $295. Contact: UCD. February 8-15-Sixth Annual Duke Symposium on Dermatologic and February 8-1 1-International Symposium on Hair Replacement Surgery. Rheumatic Diseases. Duke University Medical Center at Marriott Mark American Academy of Facial Plastic and Reconstructive Surgery at Cen- Resort, Vail. One week. Contact: Symposium Coordinator, Duke Univer- tury City J W Marriott, Los Angeles. Sat-Tues. Contact: Sharon Clawson, sity, (800) 457-1125. (213) 278-8823. February 8-15-Fourteenth Annual Vail Emergency Medicine Confer- ence. Rose Medical Center and University of Colorado School of Medi- February 9-14-15th Annual San Diego Postgraduate Assembly in Sur- cine at Marriott Mark Resort, Vail. One week. Contact: David R. Scott, gery. UCSD at Hotel del Coronado, San Diego. Sun-Fri. Contact: UCSD. (800) 525-5810. February 12-14-2nd International Lung Transplant Symposium: Up- date 1992. Cedars-Sinai Medical Center at Ritz-Carlton, Laguna Niguel. February 10-14-Family Practice Review, University of Colorado School of Wed-Fri. 6.5 hrs. $500. Contact: Carolyn Lavitt, Continuing Education, Medicine, Denver. Mon-Fri. Contact: Joann Bauer, (303) 270-5195 or 8700 Beverly Blvd, Los Angeles 90048. (213) 855-5547. (800) 882-9153. February 14-16-Advanced Laparoscopy for the General Surgeon. Rose March 18-21-Surgical Challenges in the Head and Neck: A Dissection Medical Center and University of Colorado School of Medicine at Loew's Course Emphasizing Contemporary Strategies. UCSD at Basic Sci- Giorgio Hotel and University of Colorado Health Sciences Center, Den- ence Bldg, La Jolla. Wed-Sat. Contact: UCSD. ver. Fri-Sun. Contact: David R. Scott, (800) 525-5810. March 19-22-42nd Annual Surgical Forum. Society of Graduate Surgeons February 15-22-Eighteenth Annual Vail Obstetrics and Gynecology at Beverly Hilton, Beverly Hills. Thurs-Sun. Contact: SGS, 5820 Wilshire Conference. Rose Medical Center and University of Colorado School of Blvd, Ste 500, Los Angeles 90036. (213) 937-5514. Medicine at Marriott Mark Resort, Vail. One week. Contact: David R. April 2-4-12th Annual Meeting and Scientific Sessions of the Interna- Scott, (800) 525-5810. tional Society for Heart Transplantation. UCSD at San Diego Marriott. Thurs-Sat. Contact: UCSD. February 15-22-Seventeenth Annual Vail Internal Medicine Conference. Rose Medical Center and University of Colorado School of Medicine at Lion Square Lodge, Vail. One week. Contact: David R. Scott, (800)525- 5810. GENERAL/MULTI DISCI PLI NARY February 22-29-Seventeenth Annual Vail General and Vascular Surgery Conference. Rose Medical Center and University of Colorado School of December 24-30-Advances in Medicine. Hawaii Medical Association at Medicine at Marriott Mark Resort, Vail. One week. Contact: David R. Royal Lahaina Resort, Kaanapali Beach. Thurs-Wed. 16 hrs. $475. Con- Scott, (800) 525-5810. tact: Symposium Maui, PO Box 833, Makawao, Maui, HI 96768. (808) 878-6757. February 22-29-Neurology for the Primary Care Physician. Rose Medi- cal Center and University of Colorado School of Medicine at The Antlers January 25-27 and March 1-2-Lactation Educator Training Programs. at Vail. One week. Contact: David R. Scott, (800) 525-5810. UCLA at Loma Linda. 22.5 hrs. $725. Contact: UCLA. February 28-March 2-Principles of Anesthesia Technology. University of February 24-28-Physician Heal Thyself. UCSD at San Diego Princess Colorado School of Medicine at Marriott Mark Resort, Vail. Fri-Mon. Resort. Mon-Fri. Contact: UCSD. Contact: Joann Bauer, (303) 270-5195 or (800) 882-9153. (Continued on Page 682) DECEMBER 1991 * 155 * 6 681

YOHIMBINE HOI..~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~,FIjtO I m r I Description: Yohimbine is a 3a-15a-20B-17a-hydroxy Yohimbine-16a-car- boxylic acid methyl ester. The alkaloid is found in Rubaceae and related trees. Also in Rauwolfia Serpentina (L) Benth. Yohimbine is an indolalkylamine alkaloid with chemical similarity to reserpine. It is a crystalline powder. odorless. Each compressed tablet contains (1/12 gr.) 5.4 mg of Yohimbine Hydrochloride. Action: Yohimbine blocks presynaptic alpha-2 adrenergic receptors. Its action on peripheral blood vessels resembles that of reserpine, though it is weaker and of short duration. Yohimbine's peripheral autonomic nervous system effect is to increase parasympathetic (cholinergic) and decrease sympathetic (adrenergic) activity. It is to be noted that in male sexual 0 performance, erection is linked to cholinergic activity and to alpha-2 ad- renergic blockade which may theoretically result in increased penile inflow, decreased penile oufflow or both. Yohimbine exerts a stimulating action on the mood and may increase anxiety. Such actions have not been adequately studied or related to dosage althoughtheyappeartorequire highdosesofthedrug. Yohimbinehasa mild

Consider a few features of The Western of anti-diuretic action, probably via stimulation of hypothalmic centers and Journal Medicine: release of posterior pituitary hormone. * Epitomes-Important Advances in Clinical Medicine Reportedly, Yohimbine exerts no significant influence on cardiac stimula- Each month this selection highlights the major advances in a tion and other effects mediated by 8-adrenergic receptors. its effect on blood different specialty with 15 or 20 brief epitomes by experts pressure, if any, would be to lower it; however no adequate studies are at hand in the field. to quantitate this effect in terms of Yohimbine dosage. Indications: Yocon' is indicated as a sympathicolytic and mydriatric. it may * Biomedical Science have activity as an aphrodisiac. Five major clinical research societies coordinate important Contraindicalions: Renal diseases. and patient's sensitive to the drug. In new research findings, emphasizing clinical value. view of the limited and inadequate information at hand, no precise tabulation can be offered of additional contraindications. * Socioeconomics Warning: Generally. this drug is not proposed for use in females and certainly WJM is often the first to predict, examine, and evaluate must not be used during pregnancy. Neither is this drug proposed for use in socioeconomic changes and trends. pediatric, geriatric or cardio-renal patients with gastric or duodenal ulcer history. Nor should it be used in conjunction with mood-modifying drugs * Yearly Special Issue such as antidepressants, or in psychiatric patients in general. Each devoted to a topic vital to physicians: cross-cultural Adverse Reactions: Yohimbine readily penetrates the (CNS) and produces a medicine (1983), AIDS-a global perspective (1987), complex pattern of responses in lower doses than required to produce periph- women and medicine (1988), addiction medicine and the eral a-adrenergic blockade. These include, anti-diuresis, a general picture of primary care physician (1990), rehabilitation medicine: add- central excitation including elevation of blood pressure and heart rate, in- ing life to years (1991). creased motor activity, irritability and tremor. Sweating. nausea and vomiting are common after parenteral administration of the drug.1 .2 Also dizziness, headache, skin flushing reported when used orally.1 3 Enclosed is $ to cover subscriptions. Dosage and Administration: Experimental dosage reported in treatment of Subscription renewal Regular subscription El erectile impotence.1.3.4 1 tablet (5.4 mg) 3 times a day. to adult m ales taken O orally. Occasionalsideeffectsreportedwiththisdosagearenausea. dizziness Foreign subscription O Bill me O or nervousness. In the event of side effects dosage to be reduced to " tablet 3 Student Resident times a day, followed by gradual increases to 1 tablet 3 times a day. Reported O O therapy not more than 10 weeks.3 TO: How Supplied: Oral tablets of Yocon* 1/12 gr. 5.4 mg in bottles of 100ls NDC 53159-001-01 and 1000's NDC Q9treet 53159-001-10. References: 1. A. Morales et al., New England Journal of Medi- City/State/Zip cine: 1221. November 12, 1981. 2. Goodman, Gilman - The Pharmacological basis Specialty (If applicable) of Therapeutics 6th ed.. p. 176-188. YOo McMillan December Rev. 1/85. Student/Resident Completion Date (Year) 3. Weekly Urological Clinical letter. 27:2, July 4, 1983. Please mail this with enclosed to: 4 A. Moraleset al., TheJournalof Urology 128: coupon payment 45-47. 1982. Circulation Department Rev. 1/85 P.O. Box 7602, San Francisco California 94120-7602 AVAILABLE AT PHARMACIES NATIONWIDE Subscriptions, 12 issues per year U.S. and Canada: $40 1 year, $70 2 years PALISADES All other countries: $70 1 year, $120 2 years PHARMACEUTICALS, INC Student/Resident (USA and Canada): $15 per year 219 County Road Tenafly. New Jersey 07670 The Western Journal of Medicine (201) 569-8502 1-800-237-9083 P.O. Box 7602 * San Francisco, California 94120-7602 L (415) 882-5179 682 THE WESTERN JOURNAL OF MEDICINE

CONTINUING MEDICAL EDUCATION (Continued from Page 680) February 29-March 7-Colorado Review ofAnesthesia. University ofColo- February 28-29-20th Annual New Mexico Thoracic Society Lung Disease rado School of Medicine at Marriott Mark Resort, Vail. One week. Con- Conference. El Dorado Hotel, Santa Fe. Contact: Billie Dytzel, 216 tact: Joann Bauer, (303) 270-5195 or (800) 882-9153. Truman, NE, Albuquerque 87108. (505) 265-0732. February 29-March 7-Horizons in Surgery. University of Colorado School of Medicine at Beaver Run Resort, Breckenridge. One week. Contact: Joann Bauer, (303) 270-5195 or (800) 882-9153. February 29-March 7-Third Annual Vail Infectious Disease Conference. Rose Medical Center and University of Colorado School of Medicine at UTAH The Antlers at Vail. One week. Contact: David R. Scott, (800) 525-5810. This listing of continuing medical education courses in Utah is February 29-March 7-Fourteenth Annual Vail Pediatrics Conference. compiled and edited by the CME office of the Utah Medical Asso- Rose Medical Center and University of Colorado School of Medicine at ciation. All courses listed have been certified by CME accredited Marriott Mark Resort, Vail. One week. Contact: David R. Scott, (800) institutions as meeting the criteria for Category 1 of the Physi- 525-5810. cian's Award of the American Medical Association. March 7-14-Seventeenth Annual Vail Primary Care Conference. Rose Recognition Medical Center and University of Colorado School of Medicine at Mar- Accredited institutions wishing to list AMA Category 1 CME riott Mark Resort, Vail. One week. Contact: David R. Scott, (800) 525- courses here should send information at least two months in 5810. advance to the Office of Continuing Medical Education, 540 East March 7-14-"Minding the Body, Mending the Mind": Influencing Fifth South, Salt Lake City, UT 84102; or phone (801) 355-5290. Health and Healing. Rose Medical Center and University of Colorado For information on CME accreditation, please write the CME office School of Medicine at The Antlers at Vail. One week. Contact: David R. Scott, (800) 525-5810. at the above address. March 7-14-Fifteenth Annual Vail Cancer Treatment Conference. Rose NOTE: Course information in the following listing is subject to Medical Center and University of Colorado School of Medicine at The change on occasion. Check with the sponsoring institution. Antlers at Vail. One week. Contact: David R. Scott, (800) 525-5810. March 14-21-Fifteenth Annual Vail Urology Conference. Rose Medical Center and University of Colorado School of Medicine at Marriott Mark MEDICAL GRAND ROUNDS Resort, Vail. One week. Contact: David R. Scott, (800) 525-5810. March 14-21-Fourteenth Annual Vail Sports Medicine Conference. Rose Each Wed-8:00-9:00 a.m. Alternating between University of Utah Medical Medical Center and University of Colorado School of Medicine at Mar- Center and VA Medical Center, Salt Lake City. Contact: William D. Odell, riott Mark Resort, Vail. One week. Contact: David R. Scott, (800) 525- MD, PhD, Professor and Chairman, Dept of Internal Medicine, Univ of 5810. Utah, (801) 581-7606. March 16-19-Nineteenth Annual Neonatal and Infant Respiratory Sym- January 8-1 1-Arthritic Hip, Knee and Shoulder (Sponsor: UUSM). Wed- posium. Ohio State University Hospitals at Marriott Mark Resort, Vail. Mon-Thurs. Contact: Arlene Rogers, Ohio University Hospitals, (614) Sat. Snowbird. Contact: UUSM. 293-8487. January 15-18-Craniofacial/Oculoplastic Surgery (Sponsor: UUSM). March 21-28-Headache and Facial Pain Conference. Rose Medical Cen- Wed-Sat. Snowbird. Contact: UUSM. ter and University of Colorado School of Medicine at The Antlers at Vail. January 26-30-Pediatric Critical Care Colloquium (Sponsor: UUSM). One week. Contact: David R. Scott, (800) 525-5810. Sun-Thurs. Snowbird. Contact: UUSM. March 21-28-Fourth Annual Colorado Geriatrics Overview/Board Re- February 3-7-Surgical Pathology (Sponsor: UUSM). Mon-Fri. Park City. view. University of Colorado School of Medicine at Iron Horse Resort, Contact: L. Larsen, (801) 581-5854. Winter Park. One week. Contact: Joann Bauer, (303) 270-5195 or (800) February 9-14-Interventional Radiology (Sponsor: UUSM). Sun-Fri. 882-9153. Park City. Contact: Judy Gallegos, (801) 581-8188. First Wednesday of Each Month-Various Topics in Neurology. Sponsored February 10-14-Eleventh Annual Dermatology Seminar (Sponsor: by the Colorado Society ofClinical Neurologists. Contact: Colorado Soci- UUSM). Mon-Fri. Park City. Contact: Rosalie Lammle, (801) 581-8664. of 449-3566. ety Neurologists, (303) February 14-15-1992 Winter Ski Meeting (Sponsor: Utah Ophthalmologi- cal Society). Fri-Sat. Prospector Square Hotel, Park City. Contact: Mark CONTACT INFORMATION Fotheringham, (801) 355-7477. U of Colo-Contact: University of Colorado School of Medicine, Office of Continuing Medical Education, 4200 E 9th Ave, Denver, CO. (303) 270-5195. SPONSORS OF COURSES-ABBREVIATIONS AHA: American Heart Association, Utah Affiliate, 645 E 400 South, Salt Lake City 84102. (801) 322-5601. IDAHO CH: Castleview Hospital (formerly Carbon Hospital), RFD 2, Box 46, Price 84501. (801) 637-4800. HCH: Holy Cross Hospital, 1045 E First South, Salt Lake City 84102. (801) 350-4744. February 21-23-33rd Annual Medical Winter Clinics-Wilderness and ITS: Intermountain Thoracic Society, 1616 S 11th East, Salt Lake City Travel Medicine. Ada County Medical Society at Shore Lodge, McCall. 84105. (801) 484-4456. Fri-Sun. 9 hrs. Cat. 1. $100 for Idaho Medical Association members; LDSH: LDS Hospital, 8th Ave and "C" St, Salt Lake City 84143. (801) 321- $150, nonmembers. Contact: Judy Barningham, Ada County Medical 1100. Society, PO Box 2668, Boise 83701. (208) 336-2930. LRH: Logan Regional Hospital, 1400 N 5th East, Logan 84321. (801) 752- 2050. MDH: McKay-Dee Hospital Center, 3939 Harrison Blvd, Ogden 84409. (801) 399-4141. MVH: Mountain View Hospital, 1000 E Highway 6, Payson 84651. (801) 465- 9201. NEW MEXICO 144: 144th Evacuation Hospital, PO Box 8000, Salt Lake City 84108. (801) Information, requests for accreditation, and items to be listed 524-3924. OSS: Ogden Surgical Society, PO Box 931 1, Ogden 84409. should be sent to the chair of the CME Committee, New Mexico PVH: Pioneer Valley Hospital, 3460 S 4155 West, West Valley City 84120. Medical Society, 7770 Jefferson, Suite 400, Albuquerque, NM (801) 968-9061. 87109, at least two months in advance. For information on CME UOS: Utah Ophthalmological Society, 540 E 500 South, Salt Lake City accreditation or on the CME requirements of the New Mexico 84102. (801) 355-7477. USH: Utah State Hospital, PO Box 270, Provo 84603-0270. (801) 373-4400. Board of Medical Examiners, please write to the above address or UUSM: University of Utah School of Medicine, Office of Continuing Medical call (505) 828-0237. Education, 50 N Medical Dr, Salt Lake City 84132. (801) 581-8664. VAMC: Veterans Administration Medical Center, 500 Foothill Dr, Salt Lake NOTE: Course information in the following listing is subject to City 84148. (801) 582-1565. change on occasion. Check with the sponsoring institution for VVMC: Valley View Medical Center, 595 S 75 East, Cedar City 84720. (801) current details. 586-6587. WRI: Westem Rehabilitation Institute, 8074 S 1300 East, Sandy 84094. (801) 561-3400. (Continued on Page 684) 684 THE WESTERN JOURNAL OF MEDICINE

CONTINUING MEDICAL EDUCATION (Continued from Page 682) February 14-18-Syncope (Sponsor: UUSM). Fri-Tues. Olympia Hotel, April 30-May 2-Musculoskeletal Disease. Seattle. Thurs-Sat. Contact: Park City. Contact: UUSM. U/W. February 15-22-Update in Clinical Microbiology and Immunology May 8-Office Procedures. Tacoma. Fri. Contact: PCMS. (Sponsor: UUSM). Sat-Sat. Park City. Contact: Midge Beckman, (801) May 13-15-Fifth Conference on Occupational Hazards to Health Care 581-7480. Workers. Seattle. Wed-Fri. Contact: NW Center for Occupational Health February 17-21-Pediatric Emergency Medicine (Sponsor: UUSM). Mon- and Safety, (206) 543-1069. Fri. The Marriott, Salt Lake City. Contact: UUSM. May 21-22-Cardiology Conference. Tacoma. Thurs-Fri. Contact: Multi- February 19-24-Physical Medicine and Rehabilitation Update (Sponsor: care, (206) 594-1221. UUSM). Wed-Mon. Radisson Inn, Park City. Contact: UUSM. May 27-Pesticide Medicine. Eastern Washington. Wed. Contact: NW Cen- February 20-21-Protecting Your Right to Prescribe (Sponsor: UUSM). ter for Occupational Health and Safety, (206) 543-1069. Thur-Fri. University Park Hotel, Salt Lake City. Contact: Sharon Thomp- May 30-The Fetal Patient. Seattle. Sat. Contact: VMMC. sen, (801) 355-7477. June 22-23-Advanced Cardiac Life Support. Tacoma. Mon-Tues. Con- February 23-26-The 32nd Annual OB/GYN Update (Sponsor: UUSM). tact: PCMS. Sun-Wed. Yarrow, Park City. Contact: S. Martin, (801) 581-5501. June 26-Sports Medicine. Tacoma. Fri. Contact: Multicare, (206) 594- February 26-29-Infertility and Endocrinology Update (Sponsor: 1221. UUSM). Wed-Sat. Yarrow, Park City. Contact: S. Martin, (801) 581- 5501. September 9-12-Washington State Medical Association Annual Meeting. February 28-Mar 3-The 36th Anesthesiology Update (Sponsor: UUSM). Jantzen Beach, Oregon. Thurs-Sun. Contact: WSMA. Fri-Tue. Snowbird. Contact: V. Larsen, (801) 581-6393. September 23-24-Critical Care. Tacoma. Thurs-Fri. Contact: Multicare, (206) 594-1221.

WASHINGTON COURSE SPONSORS AND CONTACT INFORMATION The listing of continuing medical education programs in Washing- ton state is compiled by the Washington State Medical Associa- CME HARBORVIEW-Contact: Gayle Splater, Cytology Continuing Education, Dept. of Pathology, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104. (206) tion. To list Category 1 programs here, please send information at 223-5953. least two months in advance to Continuing Medical Education, PCMS CME-Contact: Mrs Maxine Bailey, Executive Director, College of Medical Washington State Medical Association, 2033 Sixth Avenue, Suite Education, 705 South Ninth, No. 203, Tacoma, WA 98405. (206) 627-7137. 900, Seattle, WA 98121; or phone (206) 441-WSMA. U/W (UNIVERSITY OF WASHINGTON)-Contact: U/W School of Medicine, Div. of CME, SC-50, Seattle, WA 98195. (206) 543-1050. Brochures and registration forms are available from the contact WSMA-Washington State Medical Association, Continuing Medical Education, 2033 person or organization listed at the end of each course or in the list Sixth Ave, Suite 900, Seattle, WA 98121. (206) 441-9762. of course sponsors and contact information. VMMC (VIRGINIA MASON MEDICAL CENTER)-Contact: Linda Orgel, Division of Continuing Medical Education, Virginia Mason Medical Center, PO Box 900, Seattle, WA 98111. (206) 223-6898. January 16-Law and Medicine Symposium. Tacoma. Thurs. Contact: PCMS. January 16-17-Alzheimers Update. Seattle. Thurs-Fri. Contact: U/W. January 24-25-WTS Chest Conference. Seattle. Fri-Sat. Contact: Wash- ington Thoracic Society, (206) 441-5100. January 31-Vascular Surgery Update for Primary Care Providers. Seat- tle. Fri. Contact: VMMC. February 6-7-A Day in the Office: Problems in Pediatric Practice 1992. This Publication Seattle. Thurs-Fri. Contact: Group Health, (206) 326-3441. is available in Microform. February 7-Review of HIV Infections. Tacoma. Fri. Contact: PCMS. February 14-Cancer and the Nervous System. Seattle. Fri. Contact: VMMC. February 28-Office Intervention: Alcohol and Substance Abuse. Ta- coma. Fri. Contact: PCMS. March 9-13-Geriatric Board Review. Seattle. Mon-Fri. Contact: U/W. March 9-19-Physical Medicine and Rehabilitation. Bellevue. Mon-Thurs. Contact: U/W. March 12-13-Internal Medicine Review-1992. Tacoma. Thurs-Fri. Con- tact: PCMS. March 20-Integrated Approach to the Dizzy Patient. Seattle. Fri. Con- tact: VMMC. March 22-25-Urgent Problems in Primary Care. Bend, Oregon. Sun- Thurs. Contact: Group Health, (206) 326-3441. March 25-Ethics Conference. Seattle. Wed. Contact: VMMC. March 23-26-Death Investigations. Seattle. Mon-Thurs. Contact: U/W. March 25-27-Spirometry Training for Worker Screening. Seattle. Wed- Fri. Contact: NW Center for Occupational Health and Safety, (206) 543- 1069. University Microfilms International March 30-April 3-Hawaii and CME. Kauai, Hawaii. Mon-Fri. Contact: PCMS. Please send additional information for April 10-Recent Developments in Occupational Medicine. Seattle. Fri. (na.ilv o* publipna1lonn Contact: NW Center for Occupational Health and Safety, (206) 543-1069. April 10-Gastro-Esophageal Reflux: A Multi-faceted Disease. Seattle. Fri. Contact: VMMC. April 17-18-Tacoma Surgical Club. Tacoma. Fri-Sat. Contact: PCMS. City April 24-Annual Day of Pediatrics. Tacoma. Fri. Contact: Multicare, (206) 594-1221. State Zip April 24-25-Diabetes of the Eye. Seattle. Fri-Sat. Contact: U/W. 300 North Zeeb Road. Dept. P.R.. Ann Arbor. Mi. 48106 April 24-25-Low-Back Pain. Seattle. Fri-Sat. Contact: VMMC. 685 THE WESTERN JOURNAL OF MEDICINE INSTRUCTIONS FOR AUTHORS Our readership represents all specialties of medicine. We wish to receive and The permission ofthe authors should also be obtained. The Editors discourage the publish manuscripts that are valid, important, lively, well-written, and succinct. use of borrowed figures or tables. They should be of interest to a broad range of busy practitioners, students, re- All manuscripts will be subject to peer review to determine the originality, searchers, and scholars who have a clinical orientation. The purpose ofa paper or validity, and importance ofcontent and conclusions. Reviewers' comments will be letter may be to alert, review, discuss-above all, to teach. Titles should be short returned with rejected manuscripts at the discretion of the Editors. All reviewers and intriguing. Avoid jargon, the overuse of abbreviations and acronyms, sexist will remain anonymous. Any conflict of interest, actual or potential, will have language, redundancies, or expendable words and phrases (see AMA Manual of been revealed to the Editors. Style, 8th Edition). All accepted manuscripts are subject to copy editing, and the corresponding author is sent edited galley proofs for approval and necessary minor changes. Manuscript Information Excessive changes at this stage may result in a delay of publication or withdrawal Manuscripts should be sent to the Editor, Linda Hawes Clever, MD, The of the paper. No changes will be made after the final, edited version has been Western Journal ofMedicine, 221 Main Street, San Francisco, California 94105. approved by the corresponding author without notifying the author. It is the Manuscripts must be original, not previously published, and not under consider- corresponding author's responsibility to clear all corrections and changes with his ation by another publication. Ifpreliminary data were included in another presen- or her coauthors. tation or publication, that should be noted in the cover letter and a copy of that publication should be included. 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Oth- results, and conclusions. ers-newspapers, magazines, etc-should be kept to a minimum and included in Letters to the Editor must be double-spaced and will be published at the the text.) discretion of the Editors. They may be edited for style and brevity. Those of a scientific nature may be subject to peer review. They should be no more than 500 Journal Articles words in length. Authors will be sent galley proofs before publication. Abbreviations ofjournal titles should conform to those used in Index Medicus. List up to six authors; for seven or more, use et al after listing the first three. Letter of Transmittal 1. Jones JS, Anderson HW Jr, Johnson DW, et al: The athletic heart revis- All authors must sign the letter of transmittal, with one author designated ited-Sudden death of a 28-year-old athlete. JAMA 1978; 292:444-456 as correspondent and his or her name, address, and telephone number included. 2. Berman SM, Shah B, Wyle FA, Dacosta-Iyer M, McRae DM: Dissemi- The order ofauthorship is determined by the authors. All authors should meet nated Pneumocystis carinii in a patient receiving aerosolized pentamidine prophy- the basic criteria for authorship (as stated below). Because order of authorship is laxis. West J Med 1990; 153:82-86 assigned in different ways its meaning cannot be inferred accurately unless it is Books stated by the authors. Authors may wish to add an explanation of the order of 3. Berne EJ: Role playing in therapy, chap 2, Principles of Group Therapy. authorship in a footnote. In deciding on order, authors should be aware that many New York, NY, Oxford University Press, 1966, pp 35-51 (author of book is same journals limit the number of authors listed in the table of contents and that the as author of chapter) National Library of Medicine lists in MEDLINE only the first 10 authors. 4. 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EDITED BY JULIE G. MADORSKY, MD > REHABILITATION IN RHEUMATIC DISEASES Mary L. Jurisson > REHABILITATION OF OCCUPATIONAL Low BACK PAIN Gerald P Keane > HIV INFECTION: IMPLICATIONS FOR REHABILITATION MEDICINE Jon A. Mukand > PAIN CENTERS: ORGANIZATION AND OUTCOME Sridhar V Vasudevan and N. Timothy Lynch > USE IT OR LOSE IT: THE HAZARDS OF BED REST AND INACTIVITY Paul J. Corcoran > CEREBRAL PALSY Gabriella E. Molnar REHABMLITATION MEDICINE > REVERSING DISABILITY OF IRREVERSIBLE LUNG DISEASE Brian L. Tiep MAY7..!e1991wv > SEX AND DISABILITY ARE NoT MUTUALLY EXCLUSIVE George Szasz MAY 1991 > WORKER REHABILITATION PROGRAMS: SEPARATING FACT FROM FICTION Andrew J. Haig and Suzanne Penha

Addiction Medicine and the Primary Care Physician (3RD PRINTING) > OVERVIEW OF ADDICTION MEDICINE David Smith, Editor/Founder, Haight-Ashbury Free Clinic > CHEMICAL DEPENDENCE AND THE WORK PLACE John Osterloh and Charles Becker > THE DISEASE CONCEPT OF ALCOHOLISM John Wallace > COGNITIVE IMPAIRMENTS IN RECOVERING ALCOHOLICS George Fein > SUBSTANCE ABUSE AND PULMONARY PATHOLOGY Donald Tashkin > SPECIAL POPULATIONS: THE ADOLESCENT Martha Morrison > METHADONE MAINTENANCE IN THE TREATMENT OF OPIOID DEPENDENCE Joan Zweben > TREATMENT OF NICOTINE DEPENDENCE IN THE CHEMICALLY DEPENDENT PATIENT Karen Sees > PHARMACOLOGIC APPROACHES TO THE TREATMENT OF COCAINE DEPENDENCE Wanda A. Taylor and Mark S. Gold

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