Volume 101, Issue 8

This article describes the authors' first experience using the EMS Swiss LithoClast pneumatic lithotriptor in the management of middle and distal ureteral calculi. Also presented is a review of the literature comparing different modalities of intracorporeal lithotripsy. A retrospective analysis was performed on 11 patients treated with the Swiss LithoClast using the Circon ACMI MR6 Rigid Mini-ureteroscope (7 patients with distal calculi and 4 patients with midureteral calculi). The lithotriptor successfully fragmented 91% of the calculi, independent of stone composition. Complete failure of fragmentation was only encountered in one patient, and this was secondary to the lithotriptor's inherent ballistic force causing retrograde passage of the calculus. One patient had postoperative radiographic evidence of stone fragments along the ureteral stent. There was no intraoperative morbidity or long-term complications encountered with use of the pneumatic lithotriptor. Additionally, patients' overall satisfaction was 91% with respect to the procedure itself and relief of preoperative pain. The only significant postoperative complaint was ureteral stent discomfort in one patient. The authors conclude that the EMS Swiss LithoClast pneumatic lithotriptor is a safe and effective tool in the management of middle and distal ureteral calculi. However, as noted with one patient, there is always a risk of stone push from the ballistic force of the lithotriptor.

Recent studies published in leading medical journals have concluded that chiropractic treatment is not particularly helpful for relieving asthma and migraine symptoms because even though study participants showed notable improvement in symptoms, those subjects who received sham manual medicine treatments also showed improvement. Yet the sham treatment received by control groups in these studies is reminiscent in many ways of traditional osteopathic manipulation. This seems to represent not only a failure to recognize the value of many manual medicine techniques but also an ignorance of the broad spectrum of manual medicine techniques used by various practitioners, from osteopathic physicians to chiropractors to physical therapists. Such blind spots compromise research methodology with regard to manual medicine studies, which could, in turn, diminish the role of manual medicine in clinical practice. Osteopathic manipulative treatment provides an excellent model for recognizing and integrating the full range of manual medicine techniques into research and clinical applications because of the wide range of techniques employed. The potential exists for these techniques to contribute much to medical research and clinical practice--provided that osteopathic physicians and other manual medicine practitioners work to alleviate ignorance about the efficacy of various forms of manipulation.

Herbal dietary supplements are often considered by patients to be safe and free from side effects. The case described here shows digoxin toxicity in a patient taking a dietary supplement not normally considered to contain digoxin. In addition to highlighting the risks of herbal supplements, this case also demonstrates the concept that digoxin equivalents are not picked up by the standard digoxin assay.

Osteopathic manipulation has been used to treat a wide range of diseases in largely outpatient settings. The authors describe the emergent use of osteopathic manipulative treatment to improve respiratory mechanics in a critically ill patient with acute respiratory failure. High-velocity mobilization of cervical and thoracic dysfunctions resulted in a decreased work of breathing, improved arterial oxygenation, resolution of tachycardia, and an overall improvement in the patient's clinical condition.

Anal duct carcinoma, also known as anal gland carcinoma or adenocarcinoma of the anal canal, is an unusual anal cancer that accounts for approximately 0.1% of all gastrointestinal cancers. Delays in diagnosis most likely account for the poor prognosis associated with this cancer. Presenting symptoms often mimic those of more common benign anorectal pathologic processes. Multimodality treatment that includes surgery, chemotherapy, and radiation therapy is often recommended. The authors describe a typical case of anal duct carcinoma and its management. They also discuss the findings of a survey of the combined experience of members of the American Osteopathic College of Proctology and review the literature.