March 2005

Prevention has become an important component in the management of cardiovascular disease, a leading cause of death in the United States. Success with modification of traditional risk factors?hypertension, diabetes, dyslipidemia, smoking, and obesity?has led researchers to investigate additional factors that may identify people at risk for a coronary event. C-reactive protein, the most studied and valuable nonlipid serum marker identified thus far, has shown to predict risk for cardiovascular events. Other risk factors studied include homocysteine, fibrinogen, and low-density lipoprotein oxidation; these have shown some clinical benefit in the early phases of research. Interventions that modify these markers, including statin therapy, may need to be considered. Exciting research is ongoing that may crystallize the role of these novel factors in the management of coronary artery disease.

Lemierre's syndrome is characterized by oropharyngeal infection, usually by Fusobacterium necrophorum, followed by septic thrombophlebitis of the internal jugular vein with embolization to the lungs and other organs. Since the introduction of antibiotics, Lemierre's syndrome has become relatively rare and is usually unsuspected until blood culture results are available. In the preantibiotic era, ligation of the internal jugular vein on the affected side to prevent septicemia was the only recognized treatment. Current therapy is a 4- to 6-week course of antibiotics, such as penicillin G, clindamycin, or metronidazole, directed against F necrophorum. The use of anticoagulation is still controversial.

There is considerable anecdotal evidence that teaching ward rounds has deteriorated. This article discusses current impediments to the performance of teaching ward rounds and what the attending physician teacher and trainee can contribute simultaneously to improve patient care and teaching. Patients, who are the center of activity, gladly participate in teaching ward rounds and, when carried out properly, enjoy and profit from it. Because this teaching patient care exercise is extremely important, considerable effort must be expended to create an environment that exudes excellence.