August 2005

Nephrotic syndrome is a common disease in children. Minimalchange disease remains the most frequent cause, but a careful evaluation to exclude other renal conditions is important, particularly to distinguish between isolated nephrotic syndrome and nephrotic syndrome with nephritis. Corticosteroids and sodium restriction form the mainstay of therapy. Although most patients with isolated nephrotic syndrome recover quickly without major sequelae, the physician must remain alert for signs and symptoms of serious complications. Detailed patient and family education, along with close follow-up and support, will help ensure the best outcomes.

Asthma is a chronic respiratory disease affecting 20 million people in the United States, including 6.1 million children. Allergies are among the most common risk factors for the development of asthma, and they often trigger acute episodes. Because the economic and health care burden of asthma has increased over the past 20 years, physicians should be familiar with current management guidelines, as well as with the many medications available. Early diagnosis and appropriate treatment can prevent asthma exacerbations and improve the quality of life of patients.

Too often, patients seek help and receive medical advice but return for follow-up with less-than-optimal improvement because they did not comply with recommended therapy. Costs of nonadherence add to the economic burden of health care in the United States and interfere with appropriate treatment. By discussing with the patient anticipated barriers, such as perceived side effects or regimen complexity, the physician can significantly improve outcomes. The authors outline ways to enhance patient compliance and improve the clinical picture while reducing costs.

Neuro-ophthalmic symptoms and signs are the key to diagnosing certain systemic conditions that are considered true emergencies, such as giant cell arteritis, increased intracranial pressure with papilledema, and acute third cranial nerve palsy secondary to intracranial aneurysm. These symptoms and signs may be first encountered by the primary care or emergency department physician; it is critical that they be recognized immediately upon presentation to facilitate expeditious management, which in some cases will save patients' lives and vision.