Dispelling the myths about omega-3 fatty acids.

Although there is an enormous amount of information available on omega-3 fatty acids, it is sometimes misleading, contradictory, and unsupported by scientific fact. Consumers and medical professionals may be confused regarding the potential value of omega-3 fatty acid supplements, despite having either read or heard about fi sh oil consumption and/or omega-3 fatty acid benefits and risks. The availability of a prescription formulation of omega-3-acid ethyl esters (P-OM3) has provided important new information that helps to dispel the myths and alleviate concerns surrounding the use of omega-3 fatty acids in clinical practice.

Patient use of dietary supplements: a clinician's perspective.

Background: The estimated prevalence of dietary-supplement use among US adults was 73% in 2002. Appropriate use of dietary supplements within the paradigm of evidence-based medicine may be a challenge for medical doctors and non-physician clinicians. Randomized, controlled, clinical trial data, which are considered the gold standard for evidence-based decision making, are lacking.

Hypertension-related disease in African Americans. Factors underlying disparities in illness and its outcome.

African Americans have a higher prevalence of hypertension, diabetes, cardiovascular disease (CVD), stroke, and renal disease than white Americans. The high rates of diabetes and hypertension in children and of type 2 diabetes, stroke, and CVD in women are particularly striking. In this article, Drs Sowers, Ferdinand, Bakris, and Douglas examine the biologic, social, and genetic factors that contribute to these health disparities, the risk for which appears in early childhood.

Evaluation of constipation.

Constipation is the reason for 2.5 million physician visits per year in the United States, with more than one half of these visits to primary care physicians. Patients and physicians frequently define constipation differently.

Evaluation of dysuria in adults.

Dysuria, defined as pain, burning, or discomfort on urination, is more common in women than in men. Although urinary tract infection is the most frequent cause of dysuria, empiric treatment with antibiotics is not always appropriate. Dysuria occurs more often in younger women, probably because of their greater frequency of sexual activity.

Recognizing spinal cord emergencies.

Physicians who work in primary care settings and emergency departments frequently evaluate patients with neck and back pain. Spinal cord emergencies are uncommon, but injury must be recognized early so that the diagnosis can be quickly confirmed and treatment can be instituted to possibly prevent permanent loss of function. The differential diagnosis includes spinal cord compression secondary to vertebral fracture or space-occupying lesion, spinal infection or abscess, vascular or hematologic damage, severe disc herniation and spinal stenosis.

Hypertension in patients with diabetes. Strategies for drug therapy to reduce complications.

Hypertension in diabetic patients must be treated aggressively if patients are to benefit from reduced risk of morbidity and mortality. Diabetes itself must be diagnosed promptly, particularly in at-risk patients, so appropriate lifestyle modifications can be made at the earliest opportunity. Although this may reduce or delay onset of hypertension, antihypertensive drug treatment should be initiated in the diabetic patient with even high-normal blood pressure.

Sternocleidomastoid tumor of infancy: two cases of an interesting entity.

Sternocleidomastoid tumor of infancy (SCMTI), also known as fibromatosis colli or muscular torticollis, is the most common cause of congenital torticollis. It is present in approximately 0.4% of live births, and usually 90% of patients will have a good prognosis if therapy is initiated and continued for the appropriate period of time.

Anaerobic lung infections.

Aspiration is the leading cause of anaerobic lung infections. Risk factors for these infections include a depressed level of consciousness, a history of seizure, general anesthesia, central nervous system or neuromuscular disease, cerebrovascular accident, impaired swallowing and use of a tracheal or nasogastric tube. Clinical presentation includes fever, weight loss, malaise and cough productive of foul-smelling sputum.

Pediatric maxillofacial trauma.

The accurate diagnosis and timely, appropriate treatment of soft-tissue and bony maxillofacial injuries in children are of critical importance due to the potential adverse impact of maxillofacial trauma on subsequent facial growth and development. Guidelines are provided to assist the pediatrician in the evaluation and treatment of minor and major facial injuries.

Cervical spondylotic myelopathy. A diagnostic challenge in aging patients.

Cervical spondylotic myelopathy remains a diagnostic and therapeutic challenge to physicians in a number of specialties. The diagnostic evaluation consists of a comprehensive neurologic and orthopedic examination supplemented by appropriate neurophysiologic and neuroradiologic studies. Currently, magnetic resonance imaging and myelography with computed tomography are the imaging methods of choice.