JOEL J. HEIDELBAUGH, M.D., and MICHAEL BRUDERLY, M.D.

Most patients with cirrhosis remain asymptomatic until the occurrence of decompensation, characterized by ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, or variceal bleeding from portal hypertension. Liver biopsy should be considered only after serologic and radiographic evaluation has failed to confirm the diagnosis.

JOEL J. HEIDELBAUGH, M.D., and MARYANN SHERBONDY, M.D.

Major complications of cirrhosis include ascites, hepatic encephalopathy, portal hypertension, and variceal bleeding. Therapy includes sodium restriction, diuretics, and abstention from alcohol, with empiric prophylaxis against spontaneous bacterial peritonitis and variceal bleeding in certain patients. Survival rates for liver transplants have improved as a result of advances in immunosuppression and risk-stratification scoring systems.

GREGORY JUCKETT, M.D., M.P.H.

Although avian influenza A (H5N1) is not yet capable of efficient human-to-human transmission, it could become the source of the next human influenza pandemic. Pandemic preparedness involves increasing global influenza surveillance and developing strategies for containing outbreaks at the source. Prompt case recognition, isolation, and treatment, including pharmacologic and nonpharmacologic interventions, are crucial for disease control.

Editorial: "Keeping Up to Date on Avian Influenza," p. 719

PAULA GARDINER, M.D., and LANA DVORKIN, PHARM.D.

Ensuring adherence to a medication regimen is difficult, especially when the patients are children. Simple strategies can be used by family physicians and parents to encourage adherence in young and school-age children and in teenagers.

Patient information: "Getting Your Child to Take Medicine," p. 800