Volume 92, Issue 6

For 3 years, children between 18 months and 12 years of age with and without recognized neurologic deficits were studied at the Osteopathic Center for Children. Their response to 6 to 12 osteopathic manipulative treatments directed to all areas of impaired inherent physiologic motion was estimated from changes in three sensory and three motor areas of performance. Houle's Profile of Development was used to compare neurologic with chronologic age and rate of development, and scores were age-adjusted. Results in children after treatment were compared with those following a waiting period without treatment. Neurologic performance significantly improved after treatment in children with diagnosed neurologic problems and to a lesser degree in children with medical or structural diagnoses. The advances in neurologic development continued over a several months' interval. The results support the use of osteopathic manipulative treatment as part of pediatric healthcare based on osteopathic medical philosophy and principles.

Lyme disease, a multisystem disorder, has now been reported to the Centers for Disease Control from 43 states of the United States. The disease is a ticktransmitted infectious disorder caused by the spirochete bacterium Borrelia burgdorferi. Lyme disease typically begins with the symptoms of flu associated with a characteristic skin rash, erythema chronicum migrans. The diagnosis of Lyme disease is best made by clinical examination and epidemiologic history, with serologic studies supporting the clinical diagnosis. Prompt diagnosis and early treatment with antibiotics will often lead to the resolution of symptoms and the prevention of late complications, Lyme carditis, neurologic manifestations, and arthritis.

Avascular necrosis of the hip is a serious clinical problem encountered by primary care physicians. It requires early detection for proper management and treatment. The clinician should be aware of the imaging modalities available for evaluation of patients with suspected avascular necrosis. Traditional studies include plain-film radiography, computed tomography, and planar bone scintigraphy. Magnetic resonance imaging and singlephoton emission computed tomography bone scanning have been developed to such an extent that they are now the most sensitive indicators of early avascular necrosis. The authors review currently available imaging modalities and provide a practical approach to the assessment of patients with suspected avascular necrosis of the hip.

Scientific developments in molecular biology enable clinical laboratory testing to directly examine genetic information coded in biologic specimens. These efforts, accomplished by the use of DNA probe technology in the in situ hybridization and other tests will allow for the specific identification of pathogens; recognition of genetic diseases; and the critical evaluation of the genetic basis of cancer. The authors discuss the concepts and uses of DNA testing.

This monthly series was developed from the AOA Task Force on AIDS Writers' Workshop, held August 16 to 18, 1991, in New York. The workshop was sponsored by an education grant from Burroughs Wellcome. It will provide brief clinical updates and perspectives on the human immunodeficiency virus (HIV). Readers may request tear sheets from the AOA editorial offices.

A well-designed rating form provides one means to evaluate a resident's clinical performance. A clear perception of the program's goals is the foundation on which an original-or-revised design should rest. Suggestions for three different types of rating forms are presented here.

A 29-year-old woman presented with progressive dyspnea, fever, cough, and weight loss. A chest roentgenogram revealed bilateral peripheral infiltrates suggestive of chronic eosinophilic pneumonia. Bronchoscopic evaluation, as well as a therapeutic trial of corticosteroids, was nondiagnostic. Open lung biopsy revealed findings consistent with a diagnosis of sarcoidosis. Roentgenographically, differentiating between sarcoidosis and chronic eosinophilic pneumonia can be difficult. A diagnostic approach, as well as the differential diagnosis of bilateral peripheral pulmonary infiltrates, is discussed.

Choriocarcinoma is a malignant germ cell tumor that usually arises from a previous gestation, but may also arise from germ cells anywhere along their known migratory pathway during fetal development. Gestational choriocarcinoma is highly sensitive to chemotherapy. This malignancy is known to undergo spontaneous regression of the primary tumor, which, in the face of metastases, may obscure the primary tumor site. The authors report the case of a patient with choriocarcinoma who was seen with pulmonary metastases and a single large lesion in the kidney 5 years posthysterectomy. The problems in resolving the primary site and the importance of a tissue diagnosis before nephrectomy are discussed.