Band 99, Heft 2

The chronic fatigue syndrome is an illness of unknown etiology characterized by severe fatigue, myalgias, lymphadenopathy, arthralgias, chills, fevers, and postexertional malaise. Recognizing chronic fatigue syndrome is primarily a method of exclusionwith no definitive diagnostic test or physical findings. As research continues to delve into the many possible etiologic agents for chronic fatigue syndrome-infectious, immunologic, neurologic, or psychiatric alone or in combination- the answer remains elusive. What is known is that chronic fatigue syndrome is a heterogeneous disorder very possibly involving an interaction of biological systems. Therefore, chronic fatigue syndrome may describe a large subset of patients, each exhibiting unique symptoms and serologic profiles dependent on the nature of the onset of illness and the genetic profile of individual patients.

Cystic fibrosis is a lethal genetic disorder whose victims currently have a median life span of approximately 30 years. With this increased life span, new aspects of the disease are identified in patients with cystic fibrosis, including chronic sinusitis. Sinusitis severely affects the quality of life of patients with sinusitis. This article discusses several aspects of sinusitis in patients with cystic fibrosis, including clinical presentation, radiologic findings, and treatment options. By recognizing and treating sinusitis in patients with cystic fibrosis, physicians may improve the quality of life of these patients.

Gastroesophageal reflux and asthma are common diseases in the developed world, and they often coexist in patients. Animal experiments, epidemiologic data, and clinical studies suggest that gastroesophageal reflux may contribute to the pathogenesis of asthma. In addition to classic reflux symptoms, such patients may notice nightly exacerbations of asthma or postprandial worsening of their pulmonary symptoms. Empiric treatment with an acid-suppressive regimen is the most cost-effective approach for asthmatic patients with classic gastroesophageal reflux symptoms, especially if the asthma remains poorly controlled despite conventional treatment. If patients have persistent problems after an adequate duration of acid-suppressive therapy or if they report symptoms indicating complicated reflux disease, such as dysphagia, additional diagnostic studies should be initiated. In most cases, medical therapy should be chosen for the long-term treatment of patients with asthma and gastroesophageal reflux. With the availability of less-invasive laparoscopic surgery, fundoplication may be an alternative in selected, mostly young individuals who have documented reflux and symptoms responsive to appropriate acid-suppressive regimens.

Multiple medications are available to treat asthma and other allergic diseases, making it difficult to determine which medications to use. The decision should be based on efficacy, cost, and other advantages and disadvantages. Comparative tables can help for rapid selection and can be used as a tool for enhancing prescribing practices. This article organizes this information into a tabular format, allowing for rapid review.