Volume 97, Issue 1

Chronic nonbacterial prostatitis is an ill-understood and difficult-to-diagnose disease. Symptoms of chronic nonbacterial prostatitis are similar to those of chronic prostatitis and include low back pain, frequency, dysuria, perineal discomfort, and painful ejaculation. In view of uncertainty about etiology, treatment of chronic nonbacterial prostatitis remains speculative. Most treatment is aimed at relieving symptoms and not at curing the disease. Because of the troublesome nature of chronic nonbacterial prostatitis and the poor results obtained from traditional treatment methods, a new modality of transurethral microwave hyperthermia was investigated. Six patients were treated from January 1994 through June 1995 by use of transurethral microwave hyperthermia. These men were treated four times during a 2-week period. Their average symptom score decrease was 74.9% and was associated with minimal morbidity. Based on this result, it is concluded that transurethral microwave hyperthermia is a safe and effective treatment modality for chronic nonbacterial prostatitis.

The adult patient who complains of anterior hip pain is a dilemma frequently encountered by the primary care physician. Detailed history taking, physical examination, and plain x-ray films are indicated for the initial evaluation. Anterior hip pain is often diagnosed as musculoskeletal strain/sprain and treated with a conservative regimen represented by the acronym NICER (nonsteroidal antiinflammatory drugs, ice, compression, elevation, and rest) with or without physical therapy. On occasion, this therapy fails to eradicate the symptoms. When these symptoms are refractory to diagnosis by conventional means, a more comprehensive evaluation of the etiology is warranted. Refractory pain is defined in the authors' practice as pain that persists after 4 weeks of initial conservative management. This subsequent evaluation includes the use of such laboratory tests as complete blood cell count with differential count, Chern 20 health profile, erythrocyte sedimentation rate, and an arthritic panel (assessment of rheumatoid factor, antinuclear antibody, C-reactive protein). Ancillary radiologic tests warranted include a nuclear bone scan, a magnetic resonance imaging scan, a computed tomography arthrogram with hip aspiration, and/or a scan of white blood cells labeled with indium 111. The test chosen depends on the etiology most suspected. A useful diagnostic algorithm for the investigation of anterior hip pain in the adult is provided. An illustrative case presentation of carcinoma of an unknown primary site presenting as anterior hip pain demonstrates the algorithm as it applies in the authors' practice.

Focal atrophy is a diagnosis of exclusion in nontraumatic cerebrospinal fluid rhinorrhea. It is most commonly associated with ethmoid or sphenoid sinus defects and is most prevalent in women between the ages of 30 and 40 years. In the unique case described, a 39-year old woman had focal atrophy and cerebrospinal fluid rhinorrhea secondary to a sphenoid sinus defect. The defect was diagnosed by computed tomography scans and repaired neurosurgically.

Interferon alia and its related compounds have been used for more than 10 years in the treatment of a number of conditions including viral illnesses, childhood hemangiomas, various cancers, and leukemia. The potential applications for this class of medication continue to grow. The use of interferon alia in experimental protocols has also increased, thus making it more likely that new indications will be discovered. It is probable that primary care physicians will be called on to initiate therapy or will see patients being treated with interferon in their practice. We report the development of interferon-related retinopathy in a 43-year-old man while he was receiving experimental treatment with interferon alfa for hepatitis B virus and hepatitis C virus infection. The vision loss was acute and only partially reversible. Interferon, its mechanism of action, and the past literature are briefly discussed.

The US Supreme Court addressed the issue of expert medical and scientific testimony in the 1993 case Daubert v Merrell Dow Pharmaceuticals, Inc. The guidelines to be used as a standard for expert medical witnesses under Daubert differ from earlier standards used by many courts for more than 70 years. This commentary reviews the history of previous and current standards used to determine admissibility of medical testimony in legal proceedings and discusses the ramifications of these standards for osteopathic physicians involved in the medical malpractice process.

Depression is one of the most common disorders in primary care patients. Yet, physicians fail to recognize it in most patients. One of the likely reasons for this problem may be that medical students and physicians have difficulty recalling pertinent psychiatric didactic information in a clinically usable form. To that end, the author presents three mnemonics as a means to help clinicians easily recall the information important to making an accurate diagnosis of depression in their patients.