September 1, 1999

Patients with many different types of medical conditions may require assessment and medical advice before they make the decision to travel by air.

Alternative clinical clues are presented that may help in the diagnosis of depression in older persons who deny feeling sad or “blue.”

HELLP syndrome, characterized by hemolysis, elevated liver enzyme levels and a low platelet count, is frequently misdiagnosed at initial presentation. The mainstay of therapy is supportive management.

Weight loss of as little as 5 percent in patients with human immunodeficiency virus (HIV) infection is associated with an increased risk of disease progression. Early identification and aggressive treatment of wasting syndrome in HIV disease can restore the patient to baseline…

The evaluation of dysuria requires a thorough history, a focused physical examination and urinalysis with both dipstick and microscopic assessment of the urine specimen. In most male patients, dysuria is caused by infection, with benign prostatic hyperplasia an important…

Many patients with gastroesophageal reflux disease have head and neck symptoms without heartburn. The head and neck manifestations can be diverse, and diagnosis of GERD in patients presenting with such symptoms requires a high index of suspicion.

The sideline physician should have a good understanding of concussion management—especially the assessment of injury severity and the risks associated with premature return to play.

Some antioxidant vitamins appear to be important in reducing the risk of coronary heart disease. Patients with coronary heart disease would probably benefit from taking vitamins E and C.

Vision problems in early childhood, such as amblyopia, strabismus and retinopathy of prematurity, are potentially treatable. Prompt detection and timely treatment require an effective screening program during early childhood.

This document has been endorsed by the American Academy of Family Physicians and was developed in cooperation with the Association of Departments of Family Medicine, the Association of Family Practice Residency Directors and the Society of Teachers of Family Medicine.

On page 865 of this issue, you'll find the first article in a new series appearing under the “Problem-Oriented Diagnosis” banner. The article “Evaluation of Dysuria in Men,” by Richard G. Roberts, M.D., J.D., and Paul P. Hartlaub, M.D., M.S.P.H., kicks off a series of diagnosis…

Selected policy and health issues news briefs from AAFP News Now.

How did you do on your last report card? It may not matter. An increasing number of health plans and hospitals write “report cards,” or physician profiles, for the physicians they employ. A new study by the U.S. Agency for Health Care Policy and Research (AHCPR) questions the…

In the article on concussion in sports in this issue of American Family Physician,1 Harmon highlights many important issues related to the evaluation and treatment of concussion (mild traumatic brain injury; MTBI) in young athletes. This injury, which is common in athletes…

In this issue of American Family Physician, Adams and colleagues discuss potential clinical uses of antioxidant vitamin supplementation. Interest in dietary antioxidant vitamins has been growing over the past few decades with the recognition that oxidative processes can damage…

As genetic testing for disease susceptibility is incorporated into clinical practice, family physicians will increasingly provide initial genetic counseling and referrals for testing. Genetic testing for disease susceptibility is associated with numerous social, ethical and…

WLL recently learned about a new digital camera device that can instantly identify eye problems in infants and toddlers. This camera may help detect conditions that are the most common causes of preventable blindness in children. The device, called EyeDx, works by using a lens…

Photo Quiz presents readers with a clinical challenge based on a photograph or other image.

(Great Britain—The Practitioner, March 1999, p. 164) Although elder abuse has only recently received recognition, it is estimated that a typical British family practice may have as many as 20 elderly patients who are victims of abuse. Definitions of elder abuse vary, but all…

Despite the frequency of mistakes in medical practice, there is no unequivocal formal guidance on how physicians should deal with medical errors.

The American College of Cardiology (ACC) and the American Heart Association (AHA) have updated their guidelines for coronary angiography. The executive summary and recommendations are published in the May 4, 1999, issue of Circulation. The entire guidelines are published in the…

The Task Force on Newborn and Infant Hearing of the American Academy of Pediatrics (AAP) has issued a new policy statement recommending development of universal newborn hearing screening programs nationwide. The statement, published in the February 1999 issue of Pediatrics…

The American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) have issued a joint statement in support of a recommendation from the Institute of Medicine for universal testing for human immunodeficiency virus (HIV) infection with…

Book Reviews | Also Received

Genes are long molecules called DNA that are present in every cell in your body. DNA controls growth and helps you stay healthy. If your DNA is abnormal or damaged, it may not work properly, which may lead to disease. Some genetic abnormalities, or “gene mutations,” may run in…

Most people don't have any problems when they fly, but it's possible to make airplane travel safer and more comfortable. Here are some tips:

HELLP syndrome is a rare but serious illness in pregnancy. This illness can start quickly, most often in the last three months of pregnancy (the “third trimester”). It can also start soon after you have your baby.

Even though you have HIV, you don't have to lose weight. Good nutrition and exercise can improve your health and slow down your HIV infection.

Gastroesophageal reflux disease (or GERD, for short) is what happens when liquids and food in your stomach go “the wrong way,” or back up into your throat. When this happens, the foods and liquids can irritate your throat.

A concussion is an injury to the brain. It's usually caused by a blow to the head. Most of the time it doesn't involve a loss of consciousness.

Several things can lower your risk of heart disease:

Amblyopia (say this: am-blee-oh-pee-ah) is an eye problem that causes poor vision in children. The problem starts when the pathways of vision in the brain don't develop, or grow, strong enough. Pathways are a little like roads—they carry vision messages from eye to brain…

Diabetes makes your blood sugar level higher than normal. High blood sugar levels can damage the nerves in your body. When diabetes damages the nerves, it's called diabetic neuropathy.

Diabetes makes your blood sugar level higher than normal. High blood sugar levels can weaken your blood vessels, including the small blood vessels in the retina. (The retina is the part of the eye that's sensitive to light and helps you see.) This damage is called diabetic…

Diabetes makes your blood sugar level higher than normal. A high blood sugar level can damage your blood vessels and nerves. Damage to the blood vessels in your feet may mean that your feet get less blood. Damage to the nerves may cause you to lose some of the feeling…

Gestational diabetes is a kind of diabetes that starts during pregnancy. (The word gestational means “during pregnancy.”) If you have gestational diabetes, your body isn't able to use the sugar (glucose) in your blood as well as it should, so the level of sugar in your blood…