From The Editor's Desk

Robert Perrillo

As with past issues, the feature articles in the April 2000 issue of The Ochsner Journal represent a broad spectrum. Several years ago, I had the distinct displeasure of passing a renal stone…a very humbling experience to say the least! Not surprisingly, I looked at the lead article by Dr. Jill Lindberg and associates with particular fascination. I am disappointed to know that Louisiana residents are living in a “stone belt” but encouraged by the finding that there are improved ways available at Ochsner to predict the likelihood of stone formation. As pointed out by the authors, the measurement of calcium oxalate stone agglomeration inhibition should lead to more cost-efficient care and obviate the need for less sensitive measurements such as 24 hour urine calcium, oxalate, and supersaturation measurements. This article is followed by a practice-oriented discussion on the management of depression. Depression is very common, and recent studies in the liver clinic have suggested that as many as 25% of our chronic viral hepatitis patients suffer from chronic depression. With a multitude of antidepressants available nowadays, the question often comes down to “Which one should I use?” Practicing clinicians should find Dr. Rouchell's article and algorithm particularly useful in this regard. From the extensive body of data on HIV pathogenesis and medical treatment, Dr. William Brandon has provided a concise and thoughtful summary on recent advances in the clinical features of the primary HIV syndrome and the impact that early appreciation has on the care of the infected individual. Dr. Steven Deitelzweig then discusses the medical management of venous thromboembolic disease. His review covers this relatively common disorder from the perspective of epidemiology, pathogenesis, prophylaxis, diagnosis, and treatment. The pros and cons of unfractionated and the newer low molecular weight heparins are discussed. In keeping with our interest in Basic Science, Drs. Janet Larson and Craig Cohen describe methods for in utero gene therapy. This is a newly developing and complex field with great potential to elucidate the pathogenesis of inheritable diseases and to find novel ways of treating disorders that are poorly manageable by more conventional treatments. This overview serves as an apt prelude to some of the fascinating work that these authors have done in the area of cystic fibrosis which will be discussed in a subsequent issue. The final article in the April issue focuses on how the reader can obtain current information from the Internet on primary care prevention strategies. Dr. Joseph Breault has made it easy for the reader to access the appropriate web sites so that he or she can glean the latest information about the utilities and pitfalls in patient screening.

Also in this issue, I have included a decision tree on how to evaluate patients with persistent low level ALT elevations. This area is of particular importance to me, since low level ALT elevations constitute 10% to 15% of my hepatology clinic consultations. It has been my observation that a good medical history and a few basic laboratory tests done early can substantially shorten the period of evaluation and avoid unnecessary and often costly testing. Please note that I have added the relative charges for the various means of diagnosis as part of this algorithm. Scanning the Literature has been a popular feature of the Journal. In this issue, we run the gamut of articles dealing with “Do Parents Expect Antibiotics for the Common Cold” to “Does Glaucoma Shorten Your Life.” We hope that you enjoy the articles and reviews contained within and, as always, we welcome your comments.