Volume 96, Issue 3

The efficacy of combining preoperative autologous blood donation with the intraoperative use of an autotransfuser during radical retropubic prostatectomy was examined by retrospective analysis of the charts of 27 patients who underwent this procedure between February 1989 and August 1992. An intraoperative autotransfuser was combined with 2 units of pre donated autologous blood in 14 patients (group 1), with 4 (29%) of the 14 requiring homologous blood. In group 2, 5 (62%) of 8 patients required homologous blood. For the remaining 5 patients (group 3), no autologous blood was available, so all received homologous blood transfusion. Preliminary data suggest that ideally, patients scheduled for radical prostatectomy should attempt to store at least 2 units of autologous blood and have an autotransfuser available during surgery.

Although further research is needed with larger study groups and improved study designs, a review of the literature indicates that there are some scientific bases to suggest that heavy or exhaustive exercise may be predisposing to upper respiratory tract illness while moderate amounts may be protective. There exists no convincing evidence suggesting that moderate exercise poses a demonstrable negative influence on the frequency of common respiratory tract infections or adversely influences the course of certain chronic viral illnesses, including viral hepatitis and human immunodeficiency virus infection. Constitutional symptoms secondary to infectious diseases appear to compromise human performance. Exhaustive exercise appears to be a predisposing factor for the development of common respiratory tract infections and may potentially adversely affect the course of certain infectious diseases. Very limited data suggest an enhancement of resistance to respiratory tract infections from moderate exercise training. Although biologically plausible, data to support unequivocal exercise-induced enhancement or suppression of immunologic function are inconclusive at this time.

Sports medicine physicians treating race car drivers competing on the circuit are likely to encounter more than burns, contusions, and lacerations. Based on the author's 3-year experience as a member of a medical team on the motor sports circuit, this article outlines the various injuries and illnesses---many of which are seen in family practice medicine-that these physicians can encounter in crew members and spectators, as well as race car drivers.

The osteopathic family practitioner of the future will play a larger role in the delivery of healthcare under managed care. To prepare for this role, osteopathic family practice residents must develop skills in direct medical care, medical education, and healthcare administration. Likewise, these residents need to become familiar with the clinical setting in which these skills are needed, specifically, ambulatory, rural, hospital, and minor emergency care environments. We propose the development of a curriculum designed to promote these skills and clinical experiences. This curriculum would expand family practice experiences; replace the current required rotations in specialty medicine with longitudinal rotations designed to develop specific family practice skills; include block rotations in hospital care, minor emergency care, and rural medicine; develop model case assignments to teach residents. to integrate their roles as provider, educator, and administrator; and entail clinical experiences in medical administration and education. An evaluation process that reflects the goals of the family practice curriculum is key to the success of such a program.

A 46-year-old man was seen with a 2-month history of crampy abdominal pain and recent onset of hematochezia. Colonoscopic examination revealed a semiannular mass lesion in the descending colon which was thought to represent a near-obstructing neoplasm. A partial colon resection was performed. Gross inspection revealed a segment of bowel with focally necrotic mucosa but no mass lesion. Microscopic examination revealed deposits of amyloid infiltrating the muscularis propria, submucosal vessel walls, and lamina propria, with focal ischemic necrosis of mucosa. Special stains were positive for light chains, indicating primary amyloidosis. Follow-up studies for multiple myeloma and inflammatory disorders gave negative results. A diagnosis of isolated amyloidosis of the colon was rendered. Two months after surgery, the patient had a recurrence of symptoms and colon biopsy specimens revealed amyloidosis. The patient was given colchicine, with subjective and objective improvement. The various types of amyloidosis are discussed.