Cover	1257	1316

	Articles
1309	Sickle Cell Disease in Childhood: Part II. Diagnosis and Treatment of Major Complications and Recent Advances in Treatment DORIS L. WETHERS, M.D. Early diagnosis and aggressive management of the complications of sickle cell disease, including infections, acute splenic sequestration and acute chest syndrome, are important. Complications can progress quickly and become life-threatening.
1316	Cover Article Assisted Vaginal Delivery Using the Vacuum Extractor LAKSHMIDEVI V. PUTTA, M.D., and JEANNE P. SPENCER, M.D. Forceps are being replaced by vacuum extractors for many situations in which assistance is required to achieve vaginal delivery. Vacuum extractors should be used when indicated, usually for a nonreassuring fetal heart tracing or failure to progress in the second stage of labor.
1325	Alternative Therapies: Part II. Congestive Heart Failure and Hypercholesterolemia VINCENT MORELLI, M.D., and ROGER J. ZOOROB, M.D., M.P.H. Certain natural supplements may be helpful in the management of common medical conditions, but careful selection of patients and knowledge of side effects are critical components in effective use. The second part of this two-part article discusses the role of natural supplements in the management of congestive heart failure and hypercholesterolemia.
1333	Problem-Oriented Diagnosis Proteinuria in Adults: A Diagnostic Approach MICHAEL F. CARROLL, M.D., and JONATHAN L. TEMTE, M.D., PH.D. Primary care physicians need to differentiate the patient who has a common benign cause of proteinuria from one who has a more serious cause, such as glomerulonephritis or multiple myeloma, and who may need referral for further evaluation.
1343	Management of Bipolar Disorder KIM S. GRISWOLD, M.D., M.P.H., and LINDA F. PESSAR, M.D. Collaboration between the patient's family physician and psychiatrist is important. The use of tricyclic antidepressants should be avoided in these patients because they may induce a rapid cycling of symptoms.
	Patient information: "Bipolar Disorder," p. 1357
1359	Practical Therapeutics Update on Vitamin Supplements for the Prevention of Coronary Disease and Stroke KEVIN A. PEARCE, M.D., M.P.H., MARIA G. BOOSALIS, PH.D., M.P.H., R.D., L.D., and BRYAN YEAGER, PHARM.D. This article reviews patient-oriented evidence on the role that dietary and supplemental antioxidants and folic acid may play in the prevention of coronary disease and stroke.

Cover Illustration © 2000 Floyd E. Hosmer, Birmingham, Ala.
Copyright © 2000 by the American Academy of Family Physicians.
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