Volume 94, Issue 5

A level sacral base plane is necessary to allow normalization of complex lumbosacral mechanics. Palpatory examinations are often used to evaluate for leg length discrepancy and pelvic obliquity despite improved accuracy and consistency of radiographic techniques. Treatment based on palpatory examinations suppose a direct and consistent relationship between the pelvic bones (innominates) and the sacral base. 1b evaluate the relationship between iliac crest levelness and sacral base levelness, a radiographic postural survey in the upright, weight-bearing position was performed on 358 men and women thought to have pelvic obliquity. Of these subjects, 293 demonstrated unlevel iliac crest heights or sacral base ~3'16 inch (4.76 mm), with iliac crest heights accurately predicting sacral base position 62% of the time. At ~3/8 inch (9.53 mm), 68% of the cases were accurately predicted. When the criterion for unlevelness was increased to ~ 112 inch (12.70 mm), the predictive accuracy improved to 83%. Radiographic findings in this study demonstrate a significant difference between iliac crest heights and sacral base position. In cases of mild to moderate short leg syndromes, the iliac crest height is an unreliable predictor of the direction or degree of sacral base levelness.

Two preliminary evaluations were conducted by surveying the charts of 15 chronically disturbed adolescents and young adult patients (ages 15 to 30 years) and 23 chronically disturbed adolescents (ages 12 to 18 years) treated in a tertiary surrogate family model hospital. Drug and alcohol use of patients and their parents was assessed in the first patient population. Results indicate that 40% of the patients had at least one parent who formerly used or is still addicted to drugs or alcohol (or both). The second survey examined the Global Assessment Functioning (GAF) scale administered to 23 adolescents on admission and at discharge from the hospital. Scores on the GAF had improved at discharge in 19 of21 patients whose length of stay ranged from 2 to 12 months. The information gathered from the retrospective surveys of the medical charts of these two patient populations helps to better understand multigenerational influence as a probable factor in the development of the chronically disturbed adolescent. Also, it shows how small psychiatric hospitals may conduct ongoing outcome studies that could be useful to improve staff morale and produce evidence to case managers and third-party payers that their treatment programs provide both positive patient care and positive results.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the centerpiece of pharmacologic therapy for most rheumatic disorders and related conditions, and as such are used in great numbers. These drugs are relatively safe and effective, but the pharmacokinetics of NSAIDs can be substantially altered in certain groups of patients, including the elderly and patients with renal and hepatic disease. In these patients, the risk of NSAID toxicity is increased. An understanding of NSAID pharmacokinetics in these groups can help physicians to adjust therapeutic regimens in order to limit the potentially serious complications of long-term NSAID therapy. The author discusses the age-related physiologic changes that may affect the various areas of drug pharmacokinetics and ways in which NSAIDs may interact with other drugs. Risk assessment and monitoring methods are also discussed.

While healthcare reform proposals are debated at the national level, states continue to propose and implement reform measures to address Medicaid, health insurance, universal coverage and access, medical liability, and cost-containment. The authors examine the shared responsibility of the federal and state governments for healthcare regulation and the surprising number of powers that reside with the states. They review the major barriers to state reform represented by restrictions within Medicaid and the Employee Retirement Income Security Act of 1974 (ERISA) legislation. Established state programs in Maryland, Hawaii, and Arizona are revisited, and innovative reforms in Oregon, Tennessee, and Washington are examined. Finally, the authors concentrate on the reform measures under way in the five most heavily DO-populated states, pointing out the potential for one of the big three (Michigan, Pennsylvania, and Ohio) to emerge as a model for the larger states. They urge osteopathic physicians to exert influence, based on their record of serving the Medicaid and other underserved populations, in state settings where they can be most effective.

Systemic lupus erythematosus is a relatively common autoimmune disease in the United States. Hyposplenism is infrequently described in patients with systemic lupus erythematosus. It is seen in up to 5% of patients and is thought to be caused by vasculitic changes within the spleen. The diagnosis of hyposplenism can be made easily by identifying Howell-Jolly bodies on a peripheral blood smear. The authors describe a patient with systemic lupus erythematosus associated with hyposplenism and discuss possible diagnostic and treatment implications.