Volume 94, Issue 4

Conventional open carpal tunnel release effectively relieves symptoms, but involves pain and fairly long recovery time. A relatively new technique of endoscopic carpal tunnel release as described by Chow has been carried out on 20 hands in 16 patients. The endoscopic approach allows earlier return to normal activities with less postoperative pain than conventional or open release.

Many of the goals in caring for patients with non-life-threatening rheumatic conditions can be safely met with nonsteroidal anti-inflammatory drug (NSAID) therapy. These drugs relieve pain and stiffness and help to maintain joint mobility. However, no course of treatment can be successful without patient compliance. The difficulties of following dosage requirements and scheduling, together with the increased risk of adverse side effects, are particular problems for the elderly-the very patients who are the major consumers of NSAIDs. The key to successful NSAID therapy is maintaining patient comfort and function while using the simplest and safest medical regimen available. The author discusses ways in which these goals can be achieved.

Epithelial ovarian cancer is one of the more aggressive malignancies among American women today, and its incidence is increasing. The major obstacle in combatting ovarian cancer is the remarkable lack of symptoms in early-stage disease. Symptoms usually occur in advanced stages when tumor dissemination within the peritoneal cavity induces ascites with resultant increasing abdominal girth. Physicians have been unable to reach women who have early-stage ovarian cancer, a time when a high cure rate could be expected. However, during the past few years, significant developments in the areas of serum tumor markers, transvaginal ultrasonography with color flow Doppler analysis, immunodiagnostic techniques, and immunotherapy have been reported. These new modalities show promise for use in the early diagnosis and treatment of ovarian cancer. The authors review some of the new data and discuss patient outcomes when these new modalities are used.

Healthcare reform proposals introduced in the House and Senate, put forward by foundations, professional associations and study groups, all call for medical schools to train more generalists. As these agents make recommendations for change, they are studying the osteopathic medical education model with fresh interest because of its success in maintaining more than 60% of its graduates in primary care practice. Most students of reform place the blame for producing too many specialists and subspecialists squarely on the academic health centers. The authors trace the development of academic health centers and compare and contrast the models developed in the osteopathic and allopathic medical settings. They enumerate the strengths in the osteopathic education model which have contributed to our favorable balance of generalists to specialists. However, they argue that specific changes in the osteopathic academic health center are essential if we are to retain leadership in generalist education under healthcare reform.

Lecithin-cholesterol acyltransferase is responsible for the formation of most cholesteryl esters in plasma. Absence of this enzyme can result in a rare syndrome that includes diffuse corneal opacities, normocytic normochromic anemia, proteinuria, renal failure, and premature arteriosclerosis. The deficiency can be inherited in an autosomal recessive manner, or it can be acquired through liver disease. Diagnosis requires a high index of suspicion and documentation of impairment of enzyme mass or activity (or both). This article includes a case report of the first United States citizen known to have lecithin-cholesterol acyltransferase deficiency. The authors review the literature related to this disease.