American family physician
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American family physician · Apr 1999
ReviewInterventions to reduce cardiovascular risk factors in children and adolescents.
Certain modifiable risk factors for cardiovascular disease have their beginnings in childhood. Cigarette smoking, hypertension, physical inactivity, obesity, hypercholesterolemia, hyperinsulinemia, homocysteinemia and poor nutrition in childhood and adolescence may all contribute to the development of cardiovascular disease in adulthood. Identifying at-risk children and adolescents is the first step in modifying or preventing these risk factors. ⋯ The family should complete a questionnaire about the family's history and risk of cardiovascular disease. The child, along with other family members, should be given advice on dietary changes to reduce fat intake. Incorporating a cardiovascular health schedule into routine office visits is useful for monitoring the risk of cardiovascular disease and for reinforcing the need to maintain healthy habits.
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American family physician · Apr 1999
ReviewSpecial considerations in interpreting liver function tests.
A number of pitfalls can be encountered in the interpretation of common blood liver function tests. These tests can be normal in patients with chronic hepatitis or cirrhosis. The normal range for aminotransferase levels is slightly higher in males, nonwhites and obese persons. ⋯ Conversely, patients who present soon after passing common bile duct stones can be misdiagnosed with acute hepatitis because aminotransferase levels often rise immediately, but alkaline phosphatase and gamma-glutamyltransferase levels do not become elevated for several days. Asymptomatic patients with isolated, mild elevation of either the unconjugated bilirubin or the gamma-glutamyltransferase value usually do not have liver disease and generally do not require extensive evaluation. Overall hepatic function can be assessed by applying the values for albumin, bilirubin and prothrombin time in the modified Child-Turcotte grading system.
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American family physician · Apr 1999
ReviewCaring for infants with congenital heart disease and their families.
Congenital heart defects are classified into two broad categories: acyanotic and cyanotic lesions. The most common acyanotic lesions are ventricular septal defect, atrial septal defect, atrioventricular canal, pulmonary stenosis, patent ductus arteriosus, aortic stenosis and coarctation of the aorta. Congestive heart failure is the primary concern in infants with acyanotic lesions. ⋯ More frequent follow-up is required if congestive heart failure is present. Family psychosocial issues should also be addressed. One of the main roles for the family physician is to help the parents put the diagnosis in perspective by clarifying expectations and misconceptions, and answering specific questions.
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American family physician · Apr 1999
ReviewChronic critical limb ischemia: diagnosis, treatment and prognosis.
Chronic critical limb ischemia is manifested by pain at rest, nonhealing wounds and gangrene. Ischemic rest pain is typically described as a burning pain in the arch or distal foot that occurs while the patient is recumbent but is relieved when the patient returns to a position in which the feet are dependent. Objective hemodynamic parameters that support the diagnosis of critical limb ischemia include an ankle-brachial index of 0.4 or less, an ankle systolic pressure of 50 mm Hg or less, or a toe systolic pressure of 30 mm Hg or less. ⋯ Patients with diabetes are more likely than other patients to have distal disease that is less amenable to bypass grafting. Compared with amputation, revascularization is more cost-effective and is associated with better perioperative morbidity and mortality. Limb preservation should be the goal in most patients with critical limb ischemia.