Volume 106, Issue 10

Objective: To evaluate the gross external characteristics of the coronal, lambdoid, and sagittal sutures in human cadaver skulls and determine if a difference exists in terms of patency, sex, and age. Methods: The coronal, lambdoid, and sagittal sutures were described using a modified grading scale to quantify sutural patency. An open suture was graded as 0, a fused suture as 1, and an obliterated suture as 2, 3, or 4, depending on the extent of obliteration. Results: Thirty-six skulls were examined, including 17 female and 19 male (age range, 56–101 y). When compared with the sagittal suture, the lambdoid suture was significantly more likely to be patent and least likely to be obliterated. No significant difference in suture grades was found between female and male skulls, and no significant difference was found between age and suture grade. Conclusion: The prolonged patency of the lambdoid suture may be due to external forces, such as the greater number of muscles affecting the lambdoid suture when compared with the sagittal suture.

Context: Although studies have been published documenting the safety and efficacy of osteopathic manipulative treatment (OMT) in adults, no studies exist documenting the safety of OMT in pediatric patients. Objective: To determine the incidence of iatrogenesis (ie, aggravations and complications) derived from OMT in the pediatric patient population. Design: A retrospective review of medical records was conducted looking for documentation of aggravations or complications subsequent to OMT. Treatment-associated aggravations were defined as worsening of symptoms or complaints after treatment. Treatment complications were defined as cerebrovascular accidents, dislocation, fracture, pneumothorax, sprains and strains, or death as a treatment outcome. The authors documented all occurrences of treatment-associated aggravations or complications recorded at each office visit, as well as the timing of an aggravation between office visits. Setting: Medical records of pediatric patients receiving OMT and being seen more than twice at osteopathic manipulative medicine offices in Pennsylvania and Virginia were reviewed. Patients: Of 502 pediatric patients' medical records reviewed, 346 met the inclusion criteria of two or more office visits for which adequate follow-up data were available. Results: No treatment-associated complications were documented. Thirty-one (9%) patients had documented treatment-associated aggravations. There was no significant difference between the proportion of male and female patients considered in the study, relative to a 50/50 distribution (females, 48%; males, 52%). Conclusions: Osteopathic manipulative treatment appears to be a safe treatment modality in the pediatric population when administered by physicians with expertise in OMT. Future studies should be prospective and include larger numbers of patients to document the safety of OMT in this clinical application.

Clostridium botulinum , a gram-positive anaerobic bacterium, produces a potent neurotoxin that causes muscle paralysis. The therapeutic use of botulinum toxin was discovered in the 1970s and has since been used to treat patients with a broad range of medical complaints. Botulinum toxin (BTX) is used in the primary care setting to treat conditions such as allergic rhinitis, hyperhidrosis, lichen simplex chronicus, migraine, myofascial pain syndrome, and certain task-specific idiopathic focal dystonias (eg, writer's cramp)—in addition to its more publicized use for cosmetic enhancement of the face. The expanding range of therapeutic applications for BTX make it necessary for primary care physicians to understand the biochemistry, preparation, indications, and interactions of BTX.

Background: As the field of genetic medicine advances andmore tests for genetic diseases become available, a dilemma of legal and ethical importance will be increasingly encountered by family physicians. Protecting the confidentiality of a patient with a genetic disease when the patient's family is at risk for inheriting the disease is a conflict that more and more physicians will be forced to address. Methods: In March 2003, osteopathic family physicians in New Jersey were given a vignette in which a patient reveals that he has a genetic disease and demands that the information be kept confidential. The physicians were then given a 33-item questionnaire asking their opinions about disclosing an untreatable and a treatable disease to each of the patient's children and their mother, a former spouse. Also, physicians' opinions on larger issues were gathered, such as potential legal consequences of their actions and state laws in this area. Correlations between physicians' opinions and their demographic characteristics were also explored. Data were analyzed using Pearson product moment correlations and repeated-measures analyses of variance. Results: Physicians tended to agree that adult children should be told if the disease were treatable, and these physicians were willing to accept responsibility for deciding whom to tell. With regard to the characters in the vignette, physicians felt comfortable telling the 22-year-old daughter, were unsure about telling the 17-year-old son, and would not tell either a former spouse or the 12-year-old son. The respondents agreed that state laws should permit disclosure rather than require it, and they did not think state laws should forbid it. Conclusion: The authors recommend that states draft a definitive public policy about when, how, and whether to disclose pertinent medical information to those at risk for inheriting a genetic disease.

The prophylactic use of vena cava filters (VCFs) remains controversial. Class I data supporting the placement of prophylactic VCFs are lacking. In addition, there are concerns regarding the long-term effects of permanent VCF placement in patients with a relatively brief period of thromboembolic risk. Venous thromboembolism can be a lethal event, occurring without a prodrome. Yet, this condition is potentially preventable. The efficacy of VCFs is difficult to determine, as it is likely that when a VCF actually traps a thrombus, the event is clinically asymptomatic. We present three cases of asymptomatic thrombus trapping in VCFs, recognized through incidental radiographic studies.