HIV, highly active antiretroviral therapy and the heart: a cellular to epidemiological review.

The advent of potent highly active antiretroviral therapy (HAART) for persons infected with HIV-1 has led to a "new" chronic disease with complications including cardiovascular disease (CVD). CVD is a significant cause of morbidity and mortality in persons with HIV infection. In addition to traditional risk factors such as smoking, hypertension, insulin resistance and dyslipidaemia, infection with HIV is an independent risk factor for CVD. This review summarizes: (1) the vascular and nonvascular cardiac manifestations of HIV infection; (2) cardiometabolic effects of HAART; (3) atherosclerotic cardiovascular disease (ASCVD) risk assessment, prevention and treatment in persons with HIV-1 infection.

Flavobacterium meningosepticum bacteremia in an adult with acute leukemia. Use of rifampin to clear persistent infection.

A case of Flavobacterium meningosepticum bacteremia complicating the course of a patient with leukemia is described. The patient was treated successfully when rifampin was added to the antibiotic therapy. Unusual organisms should be considered as agents of infection in immunocompromised hosts and susceptibility testing with drugs not commonly employed for gram-negative rods should be performed in complicated cases.

Granular cell tumor: a great masquerader.

Granular cell tumor usually presents as an asymptomatic mass in the skin or subcutaneous tissue, yet it is rarely considered in the clinician's differential diagnosis of such masses. We present a case of granular cell tumor located on an extremity and discuss its characteristic histopathologic findings and aspects of its origin and management.

'Puffing' in medical advertising expands liability.

Advertising is nothing new to the medical profession, although for many years reputable doctors did not advertise their skills. In 1975, the Federal Trade Commission (FTC) successfully argued in a case that was appealed to the Supreme Court that the AMA had unlawfully restricted medical advertising. While the FTC usurped the job of policing medical advertising, it seems to regard medical adverstising as a local problem not worthy of FTC attention. It has avoided setting standards for medical advertising and has failed to initiate significant enforcement against deceptive medical advertising. This article briefly reviews the historical role of advertising in modern American medicine and discusses advertising in relation to risk management.

The medical liability insurance crisis: how it began.

Economic pressures, awareness that physicians can be sued, improved medical care, and increased patient expectations have led to the skyrocketing liability insurance costs physicians face today. In the early days when the doctor could offer hope but little medicine, patients were not inclined to sue for medical "failures." But with the Great Depression, World War II, more recent medical advances changed the patient-physician relationship. Patients had gained the expertise of specialists, but often lost the personal relationship they once shared with their primary physician. Thus, when treatments were unsuccessful, the patient often-times blamed the physician. Insurance premiums (and patient costs) increased, while patients became even more aware that physicians were covered by insurance. This article reviews key economic, medical, and social events that led to the present medical liability insurance crisis.

Medical experts compete to testify for malpractice plaintiffs.

This article describes the activities of physicians who offer their services for hire as witnesses and consultants to attorneys in malpractice litigation. Cases illustrating the extent of the problem are discussed along with legal and ethical restrictions on witnesses and contingent-fee payment of medicolegal consultants. A common belief is that the ever-present threat of malpractice litigation, which hangs over the heads of physicians like the sword of Damocles, is due to avaricious lawyers, unrealistic expectations of patients, and the reckless generosity of juries with other people's money. But physicians also have exacerbated a troublesome situation. Gone is the universal reluctance of doctors to testify against other doctors.

The patient's right to confidentiality.

Public policy dictates that physicians maintain confidentiality of their interchanges with their patients and of their records. Though few instances of litigation regarding breach of such confidence are recorded, physicians are well advised not to divulge information or acknowledge the doctor-patient relationship without a patient's consent. Under special circumstances where harm to the patient or the public may be inferred, the physician may have special obligations to contact and/or divulge information to appropriate parties. The special circumstances of AIDS and mental illness merit individual consideration.