Volume 97, Issue 4

Unilateral arthritis was produced in rats by use of methylated bovine serum albumin in a model of antigen-induced arthritis. The progression of arthritis was measured by computerized motion analysis, bilateral joint circumference, voluntary extension force of the hindlegs, and length of ankle extension. Animals with induced arthritis were assigned to treated and untreated groups on the basis of approximately equal deficits by the parameters measured. A third group of rats, which did not have arthritis induced and received no treatment, served to establish mean normal parameters. Modified techniques of muscle energy, passive movement of the ankle and knee, and passive myofascial stretch were applied to the animals, and the animals were exercised in a mechanized exercise wheel. Parameters associated with gait were examined by computerized motion analysis of walking. Animals treated with manipulation and exercise improved significantly relative to untreated animals with . antigen-induced arthritis in vertical ankle lift, ankle-based and foot-based stride lengths, knee circumference, and normalized extension of the ankle. The results demonstrate that the parameters identified can be used to detect functional deficits and significant improvement from those deficits can be derived from a nonpharmacologic treatment paradigm that includes osteopathic manipulation and exercise in an animal model of arthritis. These parameters may be useful in the identification of the relative benefits of independent treatment variables including frequency of osteopathic manipulation and exercise and the relative benefits of each in this model. Also, they may elucidate how these treatments produce their beneficial effects clinically.

In the United States, approximately 1.5 million to 2 million persons practice the martial arts. It is the general belief that martial arts are safe, with little thought given to the physical forces involved. Some enthusiasts gravitate to the martial arts to learn self-defense, whereas others participate to improve cardiovascular fitness, flexibility, and self-esteem. Some join for the structured exercise programs, whereas others desire the artistic expression or have a need to compete. Injuries involve the head and neck region, trunk, and extremities. Soft tissue trauma, hematomas, and lacerations are some of the most common injuries. Occasionally fractures occur, most often involving the hands and digits. The neurosurgical literature indicates that wearing headgear increases the shearing injury to nerve fibers and neurons in the brain in proportion to the degree of acceleration to the head. Three case presentations illustrate death resulting from anterior chest trauma.

A retrospective review was done on the medical records (March 1986 through December 1989) of patients referred to Pittsburgh Children's Hospital with the presumptive diagnosis of epiglottitis. Data obtained included age, final diagnosis, referring physician's radiographic evaluation/interpretation, procedures (intubation, IV administered, aerosol, cultures obtained), transport times, and long-term morbidity and mortality. The diagnostic value of lateral neck radiographs was analyzed. Lateral neck radiographs were found to be of little value in the primary evaluation of epiglottitis. Rather, skilled personnel, using an established protocol, did limit morbidity and mortality in patients with symptoms consistent with epiglottitis. All medical centers should develop a protocol for management of patients presenting with symptoms suggestive of epiglottitis.

A case of somatic delusional disorder with a severe secondary eating disorder is described. The patient's psychotic symptoms and emaciation were markedly improved with separate trials of antipsychotic and antiobsessional medications. Further epidemiologic studies of eating disorders with coexisting psychotic disorders are suggested. Classification of eating disorders to include a subset with psychotic or obsessional features (or both) may prove useful in future diagnoses. Pharmacotherapy may be a beneficial therapeutic modality in treating eating disorders with concurrent psychotic features.

With a few exceptions, laparoscopic cholecystectomy has rapidly supplanted open cholecystectomy as the operation of choice for symptomatic cholelithiasis. The risk of bile duct injury using the laparoscopic technique is almost twice that of the open technique (0% to 1 % vs 0% to 0.5%). There appears to be a direct correlation between the number of cases an individual surgeon performs and the frequency of bile duct injury. The nature of bile duct injuries following the laparoscopic technique tends to be more serious than those seen following the open prodecure. In addition, more than 50% of bile duct injuries go undetected at the time of operation. A number of technical steps can be taken to help prevent bile duct injuries when using the laparoscopic technique. This article reports two such cases to alert the surgeon that a high index of suspicion must always be maintained concerning the possibility of bile duct injury following laparoscopic cholecystectomy.