Volume 100, Issue 7

Travel medicine practice in the United States has not been extensively studied. This study included 1078 consecutive patients who presented to a university-based travel medicine clinic from 1990 through 1994. Analyses of patient demographics, clinic attendance, itineraries, and vaccinations were conducted. Mean patient age (+/- SD) was 37.4 +/- 16.2 years; 626 (58.1%) of the patients were male. Travel duration was 103.1 +/- 242.3 days (median, 21 days), and lead time (defined as the time between clinic presentation and departure for the purpose of this study) was 23.8 +/- 26.5 days (median, 16 days). Destination was the strongest independent factor affecting vaccination practices. A lead time of 31 or more days was associated with significantly elevated odds ratios for all immunobiologicals except immune globulin. These findings underscore the need to educate the traveling public, healthcare providers, and the travel industry about the benefits of seeking medical consultation at least 1 month prior to international travel.

Meckel's diverticulum is a common anomaly of the small intestine that occurs in approximately 2% of the population, often found incidentally at the time of abdominal exploration. Carcinoid tumors in a Meckel's diverticulum have been reported in only 111 cases. The author describes a patient who presented for elective cholecystectomy and who during laparoscopy was found to have an abnormal-appearing ileal diverticulum. The resected specimen contained a carcinoid tumor. The decision-making process in treating these patients is reviewed along with a discussion of the laparoscopic treatment of intra-abdominal pathologic conditions found incidentally at the time of elective surgery.

The authors report the case of a 60-year-old man with respiratory distress secondary to exacerbation of chronic obstructive pulmonary disease, right lower lobe pneumonia, and severe bronchospasm. High doses of lorazepam were given intravenously after failure to control bronchospasm and agitation with bronchodilators and mucolytic agents; the patient was unresponsive to all stimuli while receiving lorazepam. Electroencephalography revealed a profoundly suppressed pattern without accompanying low-voltage fast activity--this was reversible following withdrawal of the lorazepam.

Osteopathic medical students are future osteopathic physicians, and how they view the manipulative aspect of patient care will have an effect on the distinctiveness of osteopathic medicine. To encourage students' application of osteopathic principles and practice, a Web-based computer-assisted clinical case (CACC) was designed, for which students were required to submit a SOAP (Subjective, Objective, Assessment, Plan) note. Results from the CACC-SOAP note exercise indicate that the experience engages medical students and can determine the students' abilities to recognize osteopathic principles in patient care.