Targeting bioterrorism.

Concerns about bioterrorism have grown in recent years. The fear of bioterrorism is as potent as the genuine risk. In this new age of potential biological warfare, emergency medical preparedness must be on target. Physicians must be ready to alert public health authorities.

Cystic fibrosis and chromosome abnormalities associated with echogenic fetal bowel.

OBJECTIVE: To determine the prevalence of cystic fibrosis mutations and chromosome abnormalities in the fetuses of a heterogeneous population of pregnant women referred for prenatal testing for echogenic fetal bowel. METHODS: Fetal or parental samples obtained after a second-trimester sonographic finding of echogenic fetal bowel were submitted to a referral diagnostic laboratory during a 2-year period. Results of DNA testing and karyotyping on these samples were analyzed to determine the prevalence of cystic fibrosis transmembrane reductase gene mutations and chromosome abnormalities. RESULTS: Of 244 cases tested, two fetuses were positive for two cystic fibrosis mutations. This rate (0.8% or two of 244) is 20 times higher than the general white population rate of one per 2500. In a third case, both parents were carriers but the fetus was not tested. Nine (8%) of 113 fetuses tested had one cystic fibrosis mutation. Of 106 fetuses for whom chromosome results were available, three (2.8%) fetuses had a chromosomal abnormality: two had trisomy 21 and one had Klinefelter syndrome. A fourth fetus carried a de novo, apparently balanced, 5;12 translocation. CONCLUSION: These laboratory results are representative of a broad spectrum of clinical settings and indicate a generalized increased risk associated with this sonographic finding. Therefore, when a second-trimester sonographic diagnosis of fetal echogenic bowel is made, fetal testing for both cystic fibrosis and chromosome abnormalities is warranted.

Steroids. Building a better you?

The use of anabolic steroids was first reported in the 1950s among weight lifters seeking to gain an edge in strength and muscle size. Since then, anabolic steroids have been used to augment strength and appearance. Today, steroids reach far beyond the world of professional athletes to high school locker rooms, neighborhood gyms, and suburban fitness centers. An estimated one million Americans use anabolic steroids for nonmedical purposes, supporting an illicit $400 million market.

Assessment of the feasibility and impact of shared decision making in prostate cancer.

OBJECTIVES: To assess the feasibility and patient impact of using standardized video presentations concerning alternative treatments for managing localized prostate cancer. METHODS: One hundred eleven men with newly diagnosed localized prostate cancer were shown a video tape concerning the risks and benefits of four treatment options: radical surgery, external beam radiation, hormonal therapy, and watchful waiting. The impact of the video presentation was assessed using a questionnaire completed by the patient before and after viewing the video and again following a discussion with his treating physician. RESULTS: Patients demonstrated significant increases in their understanding of treatment options to manage prostate cancer after viewing the video presentation. Treating physicians confirmed the increased sophistication of their patients' knowledge of their disease and the potential outcomes associated with alternative treatments. CONCLUSIONS: Standardized video presentations of treatment alternatives for prostate cancer can be incorporated into busy office practices. Both patients and physicians benefit from the increased level of understanding that allows physician/patient discussions to focus on the critical risk/benefit tradeoffs rather than simply describing treatment alternatives.

The race for governor: talking about health care.

During the 1989 gubernatorial race, Jim Florio liked to say that a political campaign is a conversation--a time for candidates and voters to communicate aspirations and concerns, an opportunity for political engagement and dialogue. An election campaign is a time when citizens pay more attention to politics, and candidates have more personal contact with voters. For both citizens and candidates, a campaign at its best is a time for education.

The debate over cardiac catheterization.

At first glance, there would seem to be little controversy over cardiac catheterization, a diagnostic procedure used to evaluate problems with heart function and blood supply. In a typical cardiac catheterization, a long thin tube is inserted through blood vessels into the heart to evaluate blood pressure, inject dye, and take x-rays.

Confronting AIDS in older adults.

A 57-year-old corporate executive, married with three grown children, began suffering from severe flu-like symptoms and weight loss. Hospitalized for a week, he was tested for chronic fatigue syndrome and mononucleosis. Finally, with no change in his symptoms, his physician recommended an HIV test. The results were positive.

Graduate medical education: where do we go from here?

The tremors that are shaking the world of medicine are reshaping the landscape of graduate medical education (GME), and along with it, the future of the medical profession in the United States. GME--essentially medical residencies and, to a lesser extent, research fellowships--is the crossroads where career aspirations become professional choices, and where decisions are made, both on a macro and micro level, that will shape medicine for years to come.