Band 108, Heft 11

Context : The synthetic, tension-free midurethral sling was introduced in the 1990s as a surgical treatment for women with stress urinary incontinence (SUI). Several similar products are now available. The authors generated data comparing clinical outcomes of two midurethral sling procedures. Objective : To compare clinical outcomes of two midurethral sling procedures currently used for the treatment of women with SUI: Gynecare Tension-free Vaginal Tape (TVT; Ethicon Women's Health & Urology, Somerville, NJ) and Uretex Self-Anchoring Urethral Support System (CR Bard Inc, Covington, Ga). Methods : A nonrandomized, prospective study was conducted at a urogynecology practice with women who had preoperative urodynamically proven SUI. The study consisted of two phases: 100 consecutive cases using the TVT midurethral sling, then 100 consecutive cases using the Uretex midurethral sling. Symptom improvement was evaluated at 12-month postoperative follow-up by measuring rates of prolonged intermittent self-catheterization, urinary tract infection, urinary retention requiring urethrolysis, and new-onset urge incontinence. Results : The TVT and Uretex groups were similar with respect to age, parity, and incidence of prior anti-incontinence surgery. There was no significant difference in outcomes measured between the two groups in symptom improvement at 12-month follow-up. Conclusion : The TVT and Uretex midurethral slings demonstrate similar short-term improvement and complication rates in a nonrandomized population of women with SUI.

Context : Research into the physiologic effects of osteopathic lymphatic techniques has been somewhat limited. Objective : To assess the short-term hematologic and hemodynamic effects of a comprehensive lymphatic treatment protocol. Methods : Randomized crossover design that included 10-minute lymphatic treatment and rest (control) protocols delivered 1 week apart for a small pilot group of healthy men (N=15). At baseline, albumin, hematocrit, hemoglobin, platelet count, total protein, and white blood cell count were measured, as were systolic and diastolic blood pressure. All measures were repeated 20, 50, and 80 minutes after baseline data were gathered. Results : Significant condition × time interaction effects were observed, indicating a decrease in platelet counts and an increase in diastolic blood pressure after the lymphatic treatment protocol. Statistically significant differences by time were observed in all hemotologic measures and in systolic blood pressure. No adverse events or complications from the treatment protocol were observed in this population. Conclusion : Lymphatic techniques may decrease platelet counts and increase diastolic blood pressure during the first hour after treatment. (ClinicalTrials.gov number NCT 00742989)

Context: Research studies have associated cranial strain patterns with a variety of neurologic disorders. However, baseline data on the prevalence of such patterns in a healthy population is lacking. Objective: To determine the prevalence of cranial strain patterns in healthy subjects. Methods: A retrospective analysis of cranial strain findings from healthy subjects who participated in two previous research projects. Data were collected for the following cranial strain patterns: torsion (left or right), sidebending rotation (left or right), lateral (left or right), and vertical (superior or inferior). Results: Data from 142 healthy subjects—119 women and 23 men with a mean age of 24.5 years—were analyzed. Torsion and sidebending rotation were the most common cranial strain patterns observed, comprising 72% of all identified patterns. The most prevalent patterns when stratified by the side of dysfunction were right torsion (31%), left sidebending rotation (23%), and left lateral (19%). Left sidebending rotation with right torsion (17%); left lateral, left sidebending rotation, and right torsion (14%); and right sidebending rotation with right torsion (11%) were the most common combinations of cranial stain patterns. Conclusion: Although the present study identified common cranial strain patterns in a healthy population, future studies with broader patient populations and multiple observers are needed to confirm and further define these findings.

Piriformis syndrome is a neuromuscular condition characterized by hip and buttock pain. This syndrome is often overlooked in clinical settings because its presentation may be similar to that of lumbar radiculopathy, primary sacral dysfunction, or innominate dysfunction. The ability to recognize piriformis syndrome requires an understanding of the structure and function of the piriformis muscle and its relationship to the sciatic nerve. The authors review the anatomic and clinical features of this condition, summarizing the osteopathic medical approach to diagnosis and management. A holistic approach to diagnosis requires a thorough neurologic history and physical assessment of the patient based on the pathologic characteristics of piriformis syndrome. The authors note that several nonpharmacologic therapies, including osteopathic manipulative treatment, can be used alone or in conjunction with pharmacotherapeutic options in the management of piriformis syndrome.

Context: Although many studies on the effects of osteopathic manipulative treatment (OMT) have been published, few examine its role in treating hospitalized patients. Objective: To determine patient perception of receiving OMT while hospitalized. Methods: Patients were referred to receive OMT through a consultation service and were separated into four groups: medical, musculoskeletal, obstetric, or postsurgical. The same osteopathic physician treated each patient and used various OMT techniques as needed. High-velocity, low-amplitude was not used. Patient perceptions were assessed 24 hours after treatment using a 10-question survey. Main outcome measures included pain, need for pain medication, anxiety about hospitalization, and overall comfort level. Results: Of the 195 hospitalized patients who received OMT, 160 (82%) returned the survey. Of these patients, 43% reported a decreased need for pain medication, 74% indicated a decrease in pain, 90% had reduced anxiety, and 98% reported that OMT improved their overall comfort level. In addition, 94% of patients felt OMT was helpful for their recovery, and 98% would recommend OMT for other hospitalized patients. Conclusion: Osteopathic manipulative treatment may be of tremendous benefit to hospitalized patients, regardless of their diagnoses.