Band 96, Heft 2

The literature suggests that the extent to which osteopathic physicians actually use osteopathic manipulative treatment (OMT) and the factors that predict the use of OMT remain virtually unexplored. A mailed survey of practicing osteopathic physicians was used to query respondents about their use of OMT and about the effects of a number of factors on use of OMT. The survey showed that 71% of 100 practicing physicians used OMT with 5% or more of their patients, and 14% in 50% or more of their patients. Multivariate statistical procedures revealed that a physician's having learned a new OMT format since graduation from medical school was the primary predictor of the use of OMT, followed by interest in OMT during internship. The other predictor was whether the respondent had a family member who was also a DO. Physician's specialty, emphasis on OMT during graduate and postgraduate training, and the era during which DOs received their training were not significant predictors of OMT use. These results indicate a need for further research on OMT use and the variables examined in this study.

The osteopathic medical profession has long recognized the importance of the lymphatic system in maintaining health. A review of scientific studies shows much information on the mechanisms and importance of lymph circulation. Many osteopathic manipulative techniques designed to treat patients with tissue congestion are based on early research recognizing that lymph flow is influenced by myofascial compression. Osteopathic manipulative treatment of the diaphragm was substantiated when pressure differentials created by the thoracic diaphragm were shown to influence lymph flow. Current research demonstrates that autonomically mediated, intrinsic lymphatic contractility plays a significant role in lymph propulsion, supporting the use of osteopathic manipulative techniques directed at influencing the autonomic nervous system to improve lymphatic circulation. Although research provides an explanation of how osteopathic manipulative techniques influence the lymphatic system, experimentation to test the direct influence of manipulation on lymph circulation is needed. Clinical outcomes studies are also necessary to substantiate the clinical efficacy of osteopathic manipulative techniques.

Women have been entering the physician workforce in ever-increasing numbers since the 1970s, and women are expected to reach numeric parity with men early in the next century. In an effort to predict changes in the physician workforce, analysts have relied primarily on data collected in the allopathic medical profession. Documented differences in practice characteristics between osteopathic and allopathic physicians make current workforce projections–based heavily on assumptions rooted in the allopathic medical profession–nonrepresentative of the osteopathic medical profession. The authors attempt to identify the impact of increasing numbers of women physicians on the osteopathic medical profession. They trace the historical presence of women in medicine and explore speculations concerning the continued growth in the numbers and percentage of women in medicine. The authors analyze data from the 1992 AOA census in search of identifiable trends in practice location and specialty choice based on gender, marital status, and dual-osteopathic physician couples. Finally, they discuss the need for complete and accurate data collection for the profession as data-driven workforce policy decisions ultimately affect the entire profession.

Many osteopathic medical students and physicians have an inherent fear of injuring patients when they perform osteopathic manipulative treatment (OMT). Based on the estimated several hundred million treatments performed each year in the United States as well as a review of the literature over the past six decades, only 185 reports of injury were found. However, besides good training in these techniques, the key to the safety of OMT is the taking of a thorough patient history and performing a thorough physical examination before the application of any manipulative procedure.

Diabetes insipidus together with acute myelogenous leukemia has rarely been seen. Still rarer is the occurrence of monosomy 7 with the two diseases (only six cases reported). A patient who had diabetes insipidus develop before the diagnosis of acute myelogenous leukemia was found at karyotyping to have monosomy 7. Although a specific mechanism whereby monosomy 7 would cause diabetes insipidus has been proposed, some have suggested that monosomy 7 may have its effect by altering cell wall membranes. Others have suggested that acute myelogenous leukemia causes diabetes insipidus by causing infiltrates in the hypothalamus or posterior lobe of the pituitary gland. Magnetic resonance imaging of the patient's brain showed no abnormalities of the hypothalamus or pituitary gland. Lumbar puncture revealed no leukocytes in the cerebrospinal fluid. The authors believe that the cause of diabetes insipidus can be explained in patients with acute myelogenous leukemia by checking for monosomy 7 during karyotyping. Because karyotyping is now more frequently performed in evaluation of patients for chemotherapy or bone marrow transplantation, genetic abnormalities such as monosomy 7 will become increasingly apparent.

A patient with diffuse intestinal pseudo-obstruction consisting of gastric paresis and impaired small and large bowel motility, mononeuropathy multiplex, and sensory neuropathy/neuronopathy was found to have small-cell carcinoma of the lung. The clinical symptoms were thought to be consistent with paraneoplastic neuropathy, and high antineuronal and anti-calcium channel antibodies led to the diagnosis of small-cell carcinoma of the lung. Identification of paraneoplastic neuropathy is important, because early treatment may halt the progression of the underlying carcinoma.