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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. The most common cyanotic lesions are tetralogy of Fallot and transposition of the great arteries. In infants with cyanotic lesions, hypoxia is more of a problem than congestive heart failure. Suspicion of a congenital heart defect should be raised by the presence of feeding difficulties in association with tachypnea, sweating and subcostal recession, or severe growth impairment. Follow-up of infants with congenital heart disease should follow the schedule of routine care for healthy babies with some modifications, such as administration of influenza and pneumococcal vaccines. 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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Rape is a crime which occurs to over 12 million women. It has a substantial impact on the physical, psychological and social health of the victim. It is defined as the carnal knowledge of a person forcibly and against their will and includes successful and unsuccessful assaults. In this sense, the terms rape and sexual assault are used interchangeably. Physicians should responsibly counsel patients when appropriate concerning prevention of sexual assault and should be knowledgeable about the acute medical and psychological management of a sexual assault victim, including the collection of evidence. This article provides basic information regarding examination, evidence collection and treatment.

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Although halitosis is generally thought of as a social handicap related to poor oral hygiene or disease of the oral cavity, it may also indicate a serious systemic illness that requires diagnosis and treatment. Halitosis can be the result of pathologic or nonpathologic factors, both local systemic. A complete physical examination, with laboratory and radiographic studies as indicated by the history and physical examination, will generally identify a treatable cause for halitosis. Treatment is directed at the underlying cause. Simple measures, including careful oral hygiene, may be employed to lessen breath odor.

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Autosomal dominant polycystic kidney disease is one of the most commonly inherited diseases in the United States. It affects nearly 500,000 Americans and accounts for 5 to 10 percent of patients with end-stage renal disease. Diagnosis is usually made in middle age, when complications such as hypertension, pain and hematuria develop. Renal complications include hypertension, cyst infection and hemorrhage, hematuria and flank pain. Other manifestations and related conditions include polycystic liver disease, cerebral aneurysm, cardiac valve abnormalities and diverticulosis. The severity and course of the disease vary in individual patients. Management involves the control of hypertension and treatment of complications. Genetic counseling is important. Dialysis and renal transplantation often are successful treatments in patients who develop renal failure.

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Methamphetamine has long been a drug of abuse. The smokable form of methamphetamine hydrochloride, called "ice" on the street, is twice as toxic as amphetamine and has clinical effects similar to those of cocaine. In the United States, methamphetamine use has spread eastward from Hawaii and California. Ice is a strong central nervous system stimulant. Chronic use may result in serious psychiatric, cardiovascular, metabolic and neuromuscular changes. Generally, patients presenting with methamphetamine toxicity can be treated conservatively in the emergency department. Long-term treatment usually requires drug rehabilitation and inpatient counseling.

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Anxiety disorders affect 16 percent of the U.S. population. Family physicians treat 90 percent of patients presenting with one or more anxiety disorders. Common anxiety disorders include generalized anxiety disorder, panic disorder and social phobia. Differentiation among these disorders may be difficult, since symptoms and presentations are often similar. Underlying medical disorders and depressive illness may mimic or coexist with anxiety disorders. The chronic, remitting and relapsing nature of anxiety disorders requires the institution of a long-term plan of care. The integration of pharmacologic and psychotherapeutic interventions generally produces the greatest benefit to patients. Pharmacotherapeutic options frequently prescribed by family physicians include benzodiazepines, beta blockers, monoamine oxidase inhibitors, tricyclic antidepressants and azapirones. Useful psychotherapeutic models featuring brief interventions include supportive and cognitive approaches, and behavioral therapies, such as biofeedback, in vivo exposure and systematic desensitization.

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OBJECTIVE: This study assesses the prevalence and characteristics of sexual assault among women patients attending two family medicine residency training clinics. METHODS: Two hundred four consecutive women patients 18 years and older were asked to complete a questionnaire; one hundred eighty-eight (92.2%) agreed. RESULTS: Fifty-four (28.7%) of the 188 women patients reported some type of sexual assault. Approximately 15% of patients reported being victims of rape; 8% reported attempted rape, and 5.3% reported forced sexual contact. Twelve (41.4%) of the 29 rape victims indicated that they had been raped more than once. Only 24% of rape and attempted rape victims reported the incident to police, 18.2% sought medical attention, and 21% sought counseling. CONCLUSIONS: Family physicians should be aware of the prevalence of sexual assault in their practices and should understand proper questioning, management, counseling, and referral of patients.

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Methamphetamine has long been a drug of abuse. Recently, a resurgence of its use has spread across the country. A smokable form of methamphetamine hydrochloride with the street name "ice" has spread eastward from Hawaii and California. It has strong stimulant properties, is twice as toxic as amphetamine, is associated with multiple system effects similar to cocaine. Treatment of acute intoxication is symptomatic and may include hydration, temperature regulation, seizure management, control of agitation, and monitoring for cardiac arrhythmias. Long-term treatment of addiction requires drug rehabilitation and inpatient counseling.

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Diarrhea is a common gastrointestinal problem in diabetes, and its prevalence has been underestimated. The cause of diabetic diarrhea is unknown, but it is probably related to gastrointestinal motility disturbances secondary to diabetic autonomic neuropathy. Other causes (especially primary malabsorption syndromes and islet cell tumors) must be excluded. Treatment of diabetic diarrhea is largely symptomatic and only moderately effective. Antidiarrheal agents may ameliorate acute episodes. Broad-spectrum antibiotics and clonidine hydrochloride (Catapres) have had some success in long-term control. Most recently, subcutaneous administration of somatostatin analogues has been shown to be helpful, the main side effects being drowsiness and vomiting.

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Women differ from men in their drinking patterns and in the biologic consequences of alcohol use. Women more often drink at home and conceal their drinking behavior. Because women have a higher percentage of body fat and a lower percentage of body water than men, the same amount of alcohol causes more severe toxic effects in women than in men. Heavy alcohol consumption in women is associated with gynecologic dysfunction and fetal alcohol syndrome. Depression, anxiety or other psychiatric illness is also common in women alcoholics. Family physicians should be alert to the subtle behaviors that suggest alcoholism and be familiar with the available community resources and treatment options.

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Hypertension is a chronic problem commonly seen by primary care physicians. Inadequate treatment may result in significant morbidity and even death. Therefore, all patients with hypertension or at risk for hypertension should be educated about nonpharmacologic measures to control blood pressure. Weight reduction and sodium restriction are cornerstones of nonpharmacologic management of hypertension. Although studies of the effects of aerobic exercise on blood pressure are not well designed, data confirm the value of such exercise. Relaxation therapy has been shown to lower blood pressure, but effects may be transient. Potassium and calcium supplementation has lowered blood pressure, but because study results are contradictory, the exact clinical criteria for use of such supplements have not been determined. Vegetarians have lower blood pressure than nonvegetarians, but no specific dietary components (eg, fiber, fat) have been documented as the beneficial factors. Because of its significant pressor effect, alcohol should be avoided by hypertensives. A low-fat diet is recommended to decrease cardiovascular risk and assist in weight control.

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Estimates are that one in every six women is raped during her lifetime. The family physician must be able to evaluate and treat the rape victim in the emergency setting. A detailed history, careful physical examination, collection of medical specimens for legal purposes, assessment of the patient's psychologic state, prophylaxis of venereal disease and pregnancy counseling are required.

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Designer drugs, chemically altered compounds derived from federally controlled substances, have become a major cause of addiction and overdose deaths. These drugs include mescaline analogs, synthetic opioids, arylhexylamines, methaqualone derivatives and crack, a new form of cocaine. Sudden changes in mood, weight loss, depression, disturbed sleep patterns, deteriorating school or work performance, marital problems, and loss of interest in friends and social activities may be signs of drug addiction. Life-threatening complications of acute intoxication, such as hyperthermia, seizures, combative and psychotic behavior, and cardiorespiratory collapse, require prompt diagnosis and supportive intervention.

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Drug abuse is on the rise in Mississippi. Treatment centers across the state report significant increases in substance abuse cases. Consequently, family physicians must have the most current, accurate information available and the skills with which to treat either an acute crisis or the chronic problems related to drug abuse. The authors present an overview of the clinical presentations and management of some of the most widely used designer drugs: crack, ecstasy and PCP.

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