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THE CLASSICAL form of ventricular preexcitation associated with the Wolff-Parkinson-White syndrome1 is manifested on the surface electrocardiogram by a short P-R interval (0.12 seconds or less) and a wide QRS complex (more than 0.11 seconds) with a slurred initial deflection, the δ-wave, in at least some leads. This electrocardiographic abnormality may be persistent, intermittent, or phasic. Its reported incidence ranges from 0.1 to 3.1/1,000 apparently healthy adults and from 0.8 to 4.8/1,000 children.2 Uncomplicated preexcitation has no subjective manifestations. Paroxysmal tachyarrhythmias, however, occur at some time in 40% to 80% of those with abnormal ECGs. Although most patients with arrhythmias have a benign course, in some life-threatening arrhythmias develop, which may result in sudden death.MechanismsWhereas detailed consideration of electrophysiologic mechanisms is inappropriate here, an understanding of certain features of the syndrome is essential for rational therapy. Present evidence strongly suggests that, in the great majority of

Over the last ten years, we have kept an eye on the possible role of technology and of a different mix of health professionals on the delivery of personal health services. Seven years ago we decided that the day of technology had not arrived and we elected to diversify the manpower mix. This led to the development of the Duke physician's assistant or associate program. We never lost our interest in the machines, however, and today we believe their time has come. We are on the brink of a major technological breakthrough in the practice of complex medicine. This technological revolution will change the educational patterns in medical schools, will have far-reaching effects on patterns of practice in the medical centers, and will give the medical centers the leverage in community hospitals to set up a reasonable regionalization program.Before proceeding with our thesis, we must acknowledge that many prophets

In recent years a number of reports concerning congenital, complete heart block have appeared. Although this electrophysiological abnormality is often associated with congenital malformations of the heart, it may occur as an isolated entity. When heart block is not an isolated entity, the prognosis is determined primarily by the severity of associated anatomic abnormalities, or the presence or absence of Stokes-Adams attacks, or congestive heart failure.1 If the QRS duration is normal and if the ventricular rate is not excessively slow, the outlook for children with isolated congenital heart block appears to be good.2Much less information is available in the literature concerning the natural history of congenital partial heart block, perhaps because a congenital basis often is difficult to prove. The patient described in this report has congenital, first degree heart block with an unusually long PR interval. Her problem represents an interesting therapeutic challenge and a

INTRODUCTION Acute hemolytic anemia with hemoglobinuria is an unusual complication of infectious mononucleosis.1-18 It is most often secondary to the production of high titers of cold agglutinins and hemolysins and usually occurs between the second and third week of illness.19,20 Aregenerative crises have occurred during the course of certain chronic hemolytic anemias and have been considered to result from "relative folie acid deficiency."21-23 The patient described here illustrated the development of megaloblastic marrow arrest during an acute episode of massive hemolysis associated with infectious mononucleosis. REPORT OF A CASE A 15-year-old white schoolboy entered the hospital complaining of weakness and fever. Except for the usual childhood diseases, he had been in excellent health until this illness. Three weeks prior to admission he developed a nonproductive eough, coryza, and malaise without fever. Despite persistent fatigue, he went on a camping trip two weeks prior to admission. Generalized malaise increased and he