Jane F. Desforges

DESPITE early observations suggesting an inverse relation between serum levels of high-density lipoprotein (HDL) cholesterol and coronary disease,1 2 3 the possible protective role of HDL in atherogenesis received little attention until its "rediscovery" by Miller and Miller4 in 1975 and the publication of confirmatory results from the Honolulu,5 Framingham,6 and Tromsø7 heart studies in 1976 and 1977. In the ensuing decade, research into the biochemistry, metabolism, epidemiology, and genetics of HDL has expanded rapidly, but many questions remain unanswered. The recent publication of the results of the Helsinki Heart Study8 , 9 — in which simultaneous 11 percent increases in HDL and reductions . . .

The solitary thyroid nodule, defined as a palpably discrete swelling within an otherwise apparently normal gland, is usually a benign lesion. However, patient and physician alike are typically concerned about the possibility of thyroid cancer. This review describes a strategy for the treatment of clinically euthyroid patients who have a solitary thyroid nodule that prevents unnecessary testing while identifying the few patients who require therapy. Management has changed in recent years, but important differences of opinion remain over which nodules should be surgically excised. Several recent reviews address these issues comprehensively13.Prevalence of Thyroid Nodules and CancerThe . . .

THE development of molecular genetics, both as a self-contained field and as a body of techniques broadly useful in biologic investigation, has had a profound influence on medical research. The beneficiaries include every discipline in basic science and, at least indirectly, most clinical and applied medical disciplines. Certain technical milestones can be identified over the past several decades that have been particularly important in the progress of the field. One is the discovery of restriction endonucleases, which together with the development of DNA ligation and transformation procedures, led to the ability to clone and thus propagate genes of any organism . . .

ALTHOUGH osteonecrosis, the in situ death of a segment of bone, has been recognized since the early part of this century, it still presents challenges to the biologist, the physician in the applied sciences, and especially the clinician. Since the first descriptions,1 2 3 we have learned what to call it; at least for lesions of the hip, how to classify it4 , 5; and through advanced radiologic imaging, how to diagnose it with certainty.6 , 7 The pathogenesis of osteonecrosis has been partially elucidated,8 , 9 but its natural history and the effective management of it remain in some ways as confusing and shrouded in mystery . . .

THE annual incidence of falls among elderly persons living in the community increases from 25 percent at 70 years of age to 35 percent after 75 years of age.1 Fifty percent of elderly persons who fall do so repeatedly. Falls are even more common in nursing homes, where the average annual incidence of reported falls is 1600 per 1000 patients.2 Women fall more often than men until the age of 75 years, after which the frequency is similar in both sexes.1 In the statistics reported here, and in the field of geriatrics generally, "falls" excludes those that result from major . . .