Volume 99, Issue 3

To evaluate the benefit of osteopathic manipulative treatment in the elderly with pneumonia, the authors recruited 21 individuals older than 60 years whowere hospitalized with acute pneumonia. Eleven patients were randomly assigned to the treatment group and ten to the control group. The treatment groupreceived specific osteopathic manipulative treatment for somatic dysfunction and a standardized treatment protocol. Both groups received conventional therapy, and the attending physician was blind to group assignments. No significant difference existed between groups for age, sex, or severity of illness. Although the mean duration of leukocytosis, intravenous antibiotic treatment, and length of stay were shorter for the treatment group, these measures did not reach statistical significance. However, the mean duration of oral antibiotic use did reach statistical significance at 3.1 days for the treatment group and 0.8 day for the control group. Osteopathic manipulative treatment may reduce antibiotic use and length of stay; however, a larger study is needed to clarify this outcome.

A relatively common group of developmental anomalies of the posterior fossa and its contents make up the Chiari malformations. The most common of these anomalies are the Chiari malformations type I and type II. Many patients with these defects are asymptomatic, but many of them suffer from headaches. Although the prevalence of common primary headache disorders in patients with Chiari malformations is similar to that of the general population, a particular type of occipital headaches occurs more frequently in patients with a Chiari malformation. In the two patients described in the illustrative case presentations, the major complaint was headache. Both had Chiari malformation type I diagnosed. Chiari malformation should be considered in the differential diagnosis of patients who complain of exertional headache. Exertional headaches or worsening of pain during Valsalva's maneuver should prompt clinical suspicion of an underlying intracranial lesion and warrants further evaluation by appropriate neuroimaging studies.

Nausea and vomiting are common complaints in pregnancy, occurring in more than 50% of pregnant women. Occasionally, the vomiting becomes severe and persistent enough to develop into the syndrome called hyperemesis gravidarum and sometimes requires hospitalization. A 20-year-old woman presented with hyperemesis gravidarum, which was later found to be associated with a molarpregnancy. Hyperemesis gravidarum is reported to occur in as many as 26% of molar pregnancies. Increases in the level of serum [3-human chorionic gonadotropin may be the mechanism of hyperemesis gravidarum in molar pregnancy. Hyperthyroid states linked to molar pregnancy may further exacerbate hyperemesis gravidarum. Physicians should be aware of this possibility of molar pregnancy in all patients with hyperemesis gravidarum and be familiar with the appropriate management to monitor and prevent .an often-fatal trophoblastic neoplasm.

Charcot-Marie-Tooth disease type 1, also known as hereditary motor sensory neuropathy type 1, is an uncommon autosomal dominant disease that causes destruction of peripheral nerves with a varied clinical course, but often leads to muscle weakness. If the peroneal muscle is involved, the patient may develop a characteristic slapping gait. The dose-limiting side effect of the chemotherapeutic agentvincristine is usually its neurotoxicity. We report the case of a 5-year-old patient with leukemia who developed an acute polyneuropathy after treatment with vincristine. Charcot-Marie-Tooth disease type 1 was diagnosed in the patient and, subsequently, in his mother only after vincristine toxicity was observed.

The Osteopathic Approach Lecture Series (Osteopathic AppLeS) was created in response to both the current need in the osteopathic medical profession for a distinctive osteopathic identity and'lack of readily available information regarding an osteopathic approach. The series consisted of 16 lectures given to interns, extems, residents, and attendings at a community-based osteopathic hospital during a lO-month time span which emphasized and inculcated an osteopathic approach to patients with a variety of illnesses. Emphasis was placed on osteopathic manipulative treatment training throughout the series. Data were collected at individual presentations using a survey of participants and studied retrospectively. The results of the surveys indicated that using this type of presentation series may substantially increase confidence and knowledge in an osteopathic approach and osteopathic manipulative treatment skills.