Volume 111, Issue 9

The prevalence of type 2 diabetes mellitus (T2DM) has reached epidemic proportions in the United States, the impact of which is seen in all medical practices. The tenets of osteopathic medicine are readily applicable to a proactive approach to patients with T2DM and are (1) the body is a unit; the person is a unit of body, mind, and spirit; (2) the body is capable of self-regulation, self-healing, and health maintenance; (3) structure and function are reciprocally interrelated; and (4) rational treatment is based upon an understanding of these basic principles. The authors examine the evidence that supports the application of these tenets to the prevention and management of T2DM and cover topics including the removal of noxious stimuli to help the body function optimally; the musculoskeletal system's role in disease prevention and management; the dynamic interaction of body, mind, and spirit, all 3 of which must be addressed to maintain health and limit disease; and intrinsic and extrinsic forces that can either promote or provoke a person's health.

Since its inception, osteopathic medicine has been concerned with the lymphatic system. Research has demonstrated the effectiveness of lymphatic osteopathic manipulative treatment (OMT) techniques in affecting fluid management and immune function. Many of the functions provided by the lymphatic system and augmented by OMT are necessary for proper wound healing. The authors highlight the unique contribution of the lymphatics to wound healing, as well as the unique contribution of OMT to lymphatic-directed treatment of patients with chronic wounds. The authors propose that this information be used as a basis for research into the effects of OMT on chronic wound healing in patients.

Patients with thoracic outlet syndrome can be treated with osteopathic manipulative treatment (OMT) to alleviate dysfunction and restriction of the pectoralis minor muscle (PMM) and the resulting compression of the brachial plexus. Neuromuscular ultrasonography (US) can demonstrate abnormalities in the thoracic outlet that are amenable to OMT and can be used to monitor intervention. The present report identifies PMM deformation and brachial plexus compression in a 32-year-old woman with thoracic outlet syndrome who was treated successfully with OMT. Neuromuscular US results were used to measure the degree of PMM deformation with the pectoral bowing ratio and confirm the diagnosis. Osteopathic manipulative treatment was applied and monitored using neuromuscular US to confirm that the operator's manipulating hand had direct contact with the PMM. Symptoms abated immediately after treatment. Results of a second neuromuscular US examination showed that the pectoral bowing ratio decreased into the normal range and thus confirmed that PMM deformation had resolved.

Chromium is a naturally occurring, toxic heavy metal used in many industrial processes. The US Department of Labor's Occupational Safety and Health Administration has established specific limits for occupational exposure levels of chromium and guidelines for medical surveillance of individuals who have been exposed to chromium. The author presents a case in which a 54-year-old man who had been working with chromium exhibited persistent elevations of urinary chromium levels after the cessation of occupational exposure. The author determined that the elevated chromium levels were caused by the patient's knee prostheses, which were made of cobalt-chromium alloy. The author also discusses mandates and screening guidelines for occupational chromium exposure and reviews the literature on chromium levels in individuals with prosthetic joint implants.