Volume 93, Issue 4

Flow cytometry was used to measure the DNA content in paraffin-embedded archival specimens of prostatic adenocarcinoma. The specimens were from 49 patients who were found to have adenocarcinoma of the prostate at the time of transurethral resection of the prostate for bladder outlet obstruction. At initial presentation, 34 of these patients had clinically localized disease and 15 had metastatic disease. The authors studied the relationship of DNA ploidy to clinical stage, histologic grade, disease progression, and duration of survival. Their results indicate that regardless of the clinical stage at presentation, the mean time to disease progression is longer in a patient with a DNA diploid tumor when compared with that in a patient with a DNA aneuploid tumor (18.1 months vs 6.5 months, respectively). Additionally, mean time of survival was longer in a patient with a diploid tumor than in a patient with an aneuploid tumor (31.6 months vs 9.6 months, respectively).

During the past 40 years, the osteopathic medical profession has undergone a transformation from "osteopathy" to "osteopathic medicine." The former was characterized by manipulative treatment; the latter, by full-service healthcare. During this transformation, the profession has won acceptance from the government, the military, and MDs. These changes in status have resulted in new problems for the profession because DO graduates are increasingly turning toward allopathic programs for residency training. Thus, osteopathic medicine's primary care orientation is being replaced by an emphasis on specialty training. The authors propose that osteopathic medicine return to its original mission of primary care, abandon or restrict specialty training to those who have completed primary care residencies, and rethink its separate-but-equal posture. They also propose that osteopathic medicine establish lines of communication with allopathic medicine, the American Medical Association, and the government to facilitate the development of a rational national policy for primary care that considers the potential osteopathic medicine has to offer in meeting the nation's primary care needs.

Shame is a powerful negative emotion that motivates much intrapersonal and interpersonal conflict. The relationship between patient and physician can turn to conflict if the medical environment elicits shame in the patient; conflict arises when the patient externalizes the cause and blames the physician for negative feelings. Patients who suffer from hyperactive and reactive shame responses may require particularly sensitive care. Including the assessment of shame reactivity in the medical history can help identify such persons. Measures that reduce shame should improve compliance and reduce the incidence of malpractice suits.

Affiliation agreements are necessary when a sponsoring institution makes arrangements for all or part of the education elements of an internship or residency program to be delivered at another hospital. The sponsoring institution may be a college of osteopathic medicine or an osteopathic hospital. Some basic considerations, which are outlined herein, should be reviewed when the sponsoring institution enters such agreements. Some of these considerations are requirements of the American Osteopathic Association, while others are necessary to avoid later complications. Agreement should be reached on negotiable factors, accepted by both institutions, and then referred for legal review by appropriate authorities.

Tuberculous meningitis usually results from hematogenous seeding of the central nervous system from a primary pulmonary source of infection. Initially, the meningitic process can mimic a flu-like syndrome, followed rapidly by the development of profound neurologic deficits. Computed tomography scanning or magnetic resonance imaging of the head often demonstrates a characteristic pattern of basal cistern involvement with Mycobacterium tuberculosis. The incidence of tuberculous meningitis in the more developed countries has increased during the past 5 years because of the growing number of cases in patients with acquired immunodeficiency syndrome, the spread among the homeless, and the expanding immigrant population. The significant morbidity and mortality rates associated with tuberculous meningitis-generally considered to be a disease of the past emphasize the need for greater clinical awareness, early diagnosis, and .prompt treatment.

Ovarian dysgerminoma is the most common ovarian malignancy in young women. Conservative treatment is indicated in the reproductive-age woman who wishes to preserve childbearing capacity. This case report describes a patient with ovarian dysgerminoma who underwent chemotherapy with a cisplatinvinblastine-bleomycin regimen that resulted in serious toxic complications-including cortical blindness and seizures that were transient in nature. Although current chemotherapy regimens have dramatically improved the overall survival of women with germ-cell tumors, there are toxic complications such as those demonstrated in this report, and toxicity must be balanced against presumed benefit.

Septic arthritis is a common disorder that is rarely caused by group C streptococci. This infectious process usually occurs in patients with a preexisting rheumatologic condition. Treatment consists of intravenous antibiotics, joint aspiration, and physical therapy. Prolonged recovery and septic complications are expected. This report describes a case typical of group C streptococcal arthritis.