Volume 93, Issue 2

Previous studies have shown that dysmenorrhea produces low-back pain and an electromyographic (EMG) pattern typical of trauma-induced low-back pain. To determine the effects of high-velocity low-amplitude osteopathic manipulative treatment (OMT) on this type oflowback pain, 12 dysmenorrheic subjects were assigned to a group receiving OMT or to a group not receiving OMT (or both). Eight subjects participated in both groups, the other four being equally distributed between groups. Osteopathic manipulative treatment significantly decreased EMG activity during extension of the lumbar spinae erector muscles and abolished the spontaneous EMG activity. These EMG changes coincided with the patient's report of alleviated low-back pain and menstrual cramping. Osteopathic manipulative treatment did not change the creatinine kinase, lactate dehydrogenase or lactate dehydrogenase isoenzyme activity, or myoglobin concentration.

Alcohol and other drug abuse is the leading cause of physician impairment. Prompt identification and early intervention by colleagues are the most effective ways of dealing with this problem in hospital residents. The author offers guidelines for recognizing the progressive signs of trouble inadvertently sent out by abusers, as well as effective ways in which colleagues can intervene. Also offered are steps in evaluation and treatment that can effectively address these illnesses and prevent compromising patient care.

The incidence of the acquired immunodeficiency syndrome (AIDS) is rising at an alarming rate. Usually, the first clue that a patient has human immunodeficiency (HIV) infection is the emergence of a skin disease. Early diagnosis and aggressive therapy are vital in the management of these conditions. In Part 1 of this article, the author discussed AIDS-related infectious diseases of the skin. In Part 2, he discusses noninfectious inflammatory diseases, malignant cutaneous neoplasms, and nonclassified skin changes found in mvoinfected individuals, as well as their optimal management.

As more instruction takes place in an outpatient setting, clinicians must become adept at teaching in this ambulatory care setting. This article suggests ways in which instructors can "seize the moment" by taking advantage of learning opportunities inherent in such an environment.

In human beings, the function of the immune system and of inflammation is to protect the individual against invading organisms such as bacteria, viruses, parasites, and fungi as well as thermal and mechanical injuries. The inflammatory process, initiated to destroy foreign organisms or an inappropriate immune response/target tissue, may lead to injury, the destruction of host tissue, and the development of the disease process. This article describes the history of a patient with four disorders of unknown cause, all of which may have evolved from one immunologic aberration.

The diagnosis of delayed rupture of the spleen may be difficult to make because of the presumed triviality of the precipitating injury, an unpredictable time lag between the injury and the development of symptoms, and the possibility of atypical signs and symptoms remote from the bleeding spleen. The clinician may confuse the signs and symptoms with those of acute appendicitis or with some other cause. The authors present two case histories to illustrate the diagnostic difficulties caused by delayed rupture of the spleen. Whenever the acute surgical abdomen is present with concomitant anemia, the diagnosis of delayed rupture of the spleen should be considered.

Cancer of the paranasal sinuses and nasal cavity is an uncommon disease accounting for less than 0.2% of all malignancies. Lymphoma of the paranasal sinuses is a rare clinical entity representing less than 100 cases a year. In most cases, tumors arising in the paranasal sinuses are of the non-Hodgkin's variety. Most of these tumors are asymptomatic in the early stages and are diagnosed only after invasion of adjacent structures with local bone destruction. Computed tomography is essential for staging. The prognosis and treatment of lymphoma of the paranasal sinuses are based on the anatomic staging and histologic subtype. The prognosis is favorable for patients with localized disease. The authors describe a malignant lymphoma of the maxillary sinus in a 44-year-old man.