Volume 94, Issue 2

To provide information on how cervicothoracic pain responds to osteopathic manipulative treatment, five subjects with acute or chronic pain received appropriate medication and three osteopathic manipulative treatments by the principal investigator using thrust and nonthrust techniques. The mean number of findings by both investigators on structural examination decreased considerably immediately after each of the three treatments. The number of findings increased in week 2 and decreased in week 3. The prinicpal investigator observed a further decrease by the final session, but the coinvestigator reported an increase. The pain scale score improved an average of nearly 3Wo. Thermography showed cooling of the cervicothoracic region in all subjects and conversion to a normal pattern in four. Osteopathic manipulative treatment should be considered for patients with acute or chronic cervicothoracic pain. The use of thermographic analysis in clinical osteopathic research seems warranted.

In our highly active society, individuals and groups push their physical limits. Consequently, the incidence of whiplash injury is increasing. Patients may not recover rapidly or fully from a whiplash injury, thus leading to chronic neck and spinal symptoms and litigation. Physicians must recognize whiplash injury as a manifestation of total-body trauma and treat accordingly, with particular emphasis on alleviating abnormal tension of the fascia. Precise description of the accident, followed by healing methods tailored to well-defined bodily injury, aids in effective management. Whiplash injury poses a challenge to the osteopathic physician to sharpen skills in defining the injury based on the details of the accident and to incorporate myofascial release treatment into traditional modes of whiplash treatment. Fortunately, many highly respected osteopathic physicians have written extensively on the subject and the tools are at hand to refine treatment for both acute and chronic whiplash.

Managed care plans now enroll 38.6 million persons in the United States, and have increased their enrollment 14-fold in 5 years. The three major health reform proposals before Congress presently make managed care organizations, in one form or another, the linchpin of their reform plans. The authors trace the history of managed care leading to today's spectrum of plans from health maintenance organizations to preferred provider organizations with all their variants. They examine the government and insurance industry records of successes and failures and project the future for managed care with and without government-imposed healthcare reform. They unscramble the "alphabet soup" and detail the problems physicians have encountered in managed care settings. Given the key role of the primary care physician, the authors urge osteopathic physicians to take a proactive role in designing the shift to managed care. By supporting intelligent healthcare reform that brings physicians, hospitals, and insurers together in a practitioner-friendly system, the primary care physician can assume the leadership role in managed care and continue to serve as the patient advocate.

The peritoneal washings obtained at diagnostic laparoscopy of two women with suspected endometriosis contained cells with cytologic features of adenocarcinoma. Exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and pelvic washings confirmed endometriosis with no evidence of cancer. At 1.5-year and 4.0-year follow-up, respectively, cancer had not developed in either patient. The authors report what they were able to find in the literature regarding false-positive assessments of malignancy obtained by cytologic examination. They also outline steps to be taken should a diagnosis of malignancy arise in a woman with endometriosis who desires pregnancy.