Spinal cord injuries predispose patients to numerous complications. The care of such patients requires attention to multiple bodily systems, sensitivity to the effects of interventions on function and lifestyle, and a special vigilance because of the tendency of spinal cord injuries to mask problems. Improved clinical care, however, has increased the life expectancy of people with spinal cord injuries and therefore the prevalence of such injuries. The Americans with Disabilities Act should make people with spinal injuries more visible, as they participate in and contribute to society in greater numbers. Maintenance of health brings greater opportunities for self-care and mobility through rehabilitation and may allow people with spinal cord injuries to take advantage of future opportunities for neurologic improvement or cure.

The practitioner should attempt to identify the infant and young child with developmental delay as early as possible, so that appropriate services can be provided. Ongoing surveillance is required, rather than one-time screening. The practitioner should also serve as an advocate for children with developmental delay. He or she should ensure that appropriate services exist within the child's community and that they are readily accessible. This requires ongoing communication not only with the child and the family, but also with schools and community agencies.

The oral azole drugs--ketoconazole, fluconazole, and itraconazole--represent a major advance in systemic antifungal therapy. Among the three, fluconazole has the most attractive pharmacologic profile, including the capacity to produce high concentrations of active drug in cerebrospinal fluid and urine. Ketoconazole, the first oral azole to be introduced, is less well tolerated than either fluconazole or itraconazole and is associated with more clinically important toxic effects, including hepatitis and inhibition of steroid hormone synthesis. However, ketoconazole is less expensive than fluconazole and itraconazole--an especially important consideration for patients receiving long-term therapy. All three drugs are effective alternatives to amphotericin B and flucytosine as therapy for selected systemic mycoses. Ketoconazole and itraconazole are effective in patients with the chronic, indolent forms of the endemic mycoses, including blastomycosis, coccidioidomycosis, and histoplasmosis; itraconazole is also effective in patients with sporotrichosis. Fluconazole is useful in the common forms of fungal meningitis--namely, coccidioidal and cryptococcal meningitis. In addition, fluconazole is effective for selected patients with serious candida syndromes such as candidemia, and itraconazole is the most effective of the azoles for the treatment of aspergillosis.

The three syndromes described in this article were chosen from about a dozen nerve-compression disorders that affect the arm from scapula to digits. They illustrate the range of problems encountered. None of the other syndromes are as common, and in some instances (pronator syndrome and anterior interosseous syndrome), localized inflammation is at least as common a cause of neuropathy as is compression. Some syndromes of nerve compression have important implications for musicians, athletes, and those who place stress on the upper limbs through heavy or repeated use. Well-designed prospective trials are clearly needed to expand our knowledge of the prevention and treatment of the entrapment neuropathies. Much more needs to be known about the long-term natural history of these disorders, since prevention is usually possible.

The development of antiemetic drugs has been one of the most rewarding areas of oncologic research, since therapeutic advances in this area can result in immediate improvement in the quality of life for patients undergoing chemotherapy. Antiemetic therapy has progressed dramatically during the past decade and a half. Fifteen years ago, patients receiving cisplatin for the first time had a median of 12 vomiting episodes within the first 24 hours, whereas now more than 50 percent of such patients have no vomiting episodes at all. Theoretical and clinical challenges remain, however, in the effort to control chemotherapy-induced emesis. The mechanisms of anticipatory vomiting and delayed vomiting are still not understood, and consistently effective therapeutic approaches to these problems have yet to be developed.