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A combination of manual physical therapy and supervised exercise yields functional benefits for patients with osteoarthritis of the knee and may delay or prevent the need for surgical intervention.
In a community with a high prevalence of HIV infection, much of the burden of pneumococcal disease was attributable to AIDS. Incidence rates were high in young adults and especially in black persons. Efforts to increase pneumococcal vaccination rates should target HIV-infected adults, particularly those living in poor urban areas.
In this observational study of patients hospitalized with congestive heart failure, cardiologist care was associated with greater costs and resource use and no difference in survival at 30 days of follow-up compared with generalist care. Whether the trend toward better survival at 1-year follow-up represents differences in care or unadjusted illness severity is uncertain.
Discontinuing prophylaxis against Pneumocystis carinii pneumonia may be appropriate for some HIV-infected ambulatory patients.
An immunocompromised woman who owned a pet cockatoo developed cryptococcal meningitis. The patient and the cockatoo had indistinguishable isolates and biochemical patterns, a finding suggesting that the patient's infection resulted from exposure to aerosolized cockatoo excreta.
Psychological distress often causes suffering in terminally ill patients and their families and poses challenges in diagnosis and treatment. This paper uses three cases to illustrate the assessment and management of normal distress and grieving, clinical depression, and the wish to hasten death in the presence of psychological distress.
Use of helical computed tomography (CT) in the diagnosis of pulmonary embolism has not been adequately evaluated. The safety of withholding anticoagulation in patients with negative findings on helical CT is uncertain. Definitive large, prospective studies should be conducted to assess the sensitivity, specificity, and safety of helical CT for diagnosing suspected pulmonary embolism.
Normal or low diastolic blood pressure is the characteristic that makes isolated systolic hypertension clinically different from essential hypertension. The elevated systolic pressure requires therapy, but large reductions in cuff diastolic pressures, especially in patients with known coronary artery disease, should probably be avoided.
In this issue, Auerbach and colleagues report that care by cardiologists may be associated with a marginal survival benefit but is also associated with higher costs and greater resource utilization. However, without information on appropriateness of care, the reason for cost differences and resource utilization cannot be attributed to overuse of resources by cardiologists or underuse of resources by generalists.
Rathbun and colleagues' systematic review in this issue evaluates prospective studies on helical computed tomography (CT) for diagnosing pulmonary embolism. The authors correctly conclude that helical CT has not been adequately assessed for the diagnosis of pulmonary embolism. The role of this new technology remains controversial, and further studies are needed.
Three CD-ROM versions of textbooks are reviewed: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, Topol's Cardiovascular Medicine, and Hurst's The Heart.
Areas explored in this Update are asthma, rhinitis treatment, allergen immunotherapy, epinephrine treatment of anaphylaxis, and the appropriate duration of prophylaxis against anaphylactic reactions to insect stings.
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