Volume 96, Issue 9

The purpose of this two-part study was to develop and test an instructional videotape for use in the osteopathic hospital setting; to standardize a procedure for documentation of palpatory and structural findings and diagnoses; and to examine the program's influence on the correlation of palpable and structural findings with a diagnostic impression of somatic dysfunction. To that end, the authors analyzed results of a survey of the medical records of 20 osteopathic training hospitals. Patients' charts were randomly pulled before and after house staff who performed admitting hospital examinations viewed an educational videotape. The videotape emphasized that the structural and palpatory screening examination should simply answer the question, "Is there a problem in the musculoskeletal system?" Chi-square analysis was used to evaluate the frequency of documentation of altered structural findings (structure, motion, tissue changes) and the diagnostic impression of somatic dysfunction and their correlation. Based on more than 300 reviewed charts, the authors found that the frequency of documentation of structural and palpatory examination was not significantly altered after house staff viewed the videotape. A sequence of hospital-based instruction in osteopathic principles and practices has been initiated at more than 50 osteopathic medical institutions, and the problems related to continuing medical education and clinical research in osteopathic medicine are discussed.

The federal Agency for Health Care Policy and Research has published its second set of guidelines in the field of internal medicine. These guidelines outline a comprehensive plan for the treatment of heart failure. They focus on the practical aspects of the management of patients with heart failure due to reduced left ventricular systolic performance (ejection fractions < 35% to 40%). They also offer expert opinion in the diagnosis and evaluation of heart failure and review clinical criteria for admission and discharge of these patients. Prevention of heart failure is a major focus of these current guidelines.

Avulsion fractures of the anterior inferior iliac spine are a relatively uncommon injury. Their diagnosis is usually made based on history, findings of the clinical examination, and standard roentgenograms. In the patient described, the diagnosis of avulsion of the anterior inferior iliac spine was made with the assistance of a single photon emission computed tomography scan, a relatively new diagnostic tool.

Presented is a case of a chest wall metastasis due to tumor seeding along the needle tract from a percutaneous fine-needle aspiration biopsy (FNAB) of a lung carcinoma. At thoracostomy, the patient was found to have a chest wall lesion at the site of the FNAB that had been performed 4 months earlier. This relatively uncommon complication has been reported elsewhere, but its significance with respect to the management of lung lesions suspected to be malignant has not been defined. The authors maintain that FNAB may not be indicated in select patients. The application of this diagnostic modality should be considered individually on the basis of the patient's operative risk as well as the risk for having a primary lung carcinoma develop.