Band 99, Heft 4

The issue of hypercoagulability in acute asthmatic attacks is controversial. Thismay be due to lack of an appropriate test to monitor overall coagulation. Currenthematologic tests do not account for the cellular fraction of blood that haspro coagulant activity. Our study uses a clotting assay called the modified recalcification time test that is performed with whole blood to ensure the contribution of all chemical and cellular mediators in the coagulation process, particularly tissue factor. Venous blood samples were obtained from 12 adult patients with acute exacerbation of asthma or chronic obstructive pulmonary disease andcompared with samples from 12 age-matched healthy control subjects. By use of the modified recalcification time, the presence of a relative hypercoagulable state was demonstrated in patients with acute bronchospasm. Furthermore, there is an identifiable difference in modified recalcification time value between the patients with acute attacks who required hospital admission versus those discharged from the emergency department.

International travel projections suggest that physicians will be increasingly involved in cotmseling their traveling patients on the prevention of health hazards. A mail survey of 121 returning international travelers indicated that their leading problems involved drinking water (odds ratio [OR], 19.4; 95% confidence interval [CI], 9.6 to 39.1), sanitation (OR, 13.8; 95% CI, 6.9 to 27.5), jet lag (OR, 12.4; 95% CI, 6.2 to 24.6), and food (OR, 9.5; 95% CI, 4.8 to 18.8). Medication for treatment of travelers' diarrhea and countermeasures for jet lag were not significantly associated with better outcomes. Compliance with malaria chemoprophylaxis was greater than previously reported.

A 17-year-old boy was seen in the emergency department with signs and symptoms of acute upper airway obstruction, closely resembling epiglottitis. Inunediate management consisted of induction of general anesthesia with spontaneous ventilation. Because no organic pathologic process was found, and in combination with subsequently known psychosocial stressors, a diagnosis of psychogenic stridor, a conversion disorder, was made. Conversion disorders may be seen by the busy family practitioner or pediatrician and are frequently underdiagnosed.

Visualization technology offers the possibility of profoundly changing the way in which osteopathic medical students assimilate basic osteopathic principles by giving them the ability to interactively explore biomechanical components of the musculoskeletal system, and to investigate the effects that changes in physical properties can have on functionality. The authors are developing a multiple-volume series of computer-assisted learning modules that use three-dimensional, visualization technology to enhance the acquisition of knowledge and skills necessary for clinical evaluation and treatment of the lumbar and cervical spines. These materials, designed to serve as an adjunct to teaching strategies that faculty are currendy using, are available to students on campus through the Kobiljak Resource Center at Michigan State University College of Osteopathic Medicine (MSUCOM) and via the Internet (http://hal.binl.msu.edulEdTech) to individuals and groups who are physically removed from the Michigan State University campus. In addition to addressing needs in undergraduate and graduate medical education, these osteopathic materials, delivered to users via CD-ROM, have been approved for obtaining Category 1-B CME credits (http://hal.bim.msu.edulcme).Itis anticipated that the use of these materials will facilitate understanding of static and dynamic relationships among physical components of the musculoskeletal system, thus contributing to ongoing efforts to develop and maintain physician, faculty, and student expertise in areas that are uniquely osteopathic. Although initial efforts were restricted to the cervical and lumbar spines, future modules will include other regions of the body. The ultimate goal is to enable students to visualize the effects of pathologic processes as they interactively control an articulation in three-dimensional space.

Incidental findings transcend medical practice. Two cases are discussed in which significant conditions were discovered during clinical examination for an unrelated disorder. The first case presents a disease reported for the first time in a male. Recent literature has alluded to missed diagnoses found only at autopsies With cost constraint as a national theme, the appropriate use of technology presents a challenge to the physician. The cases discussed raise questions about the process of diagnosis. Both situations bring to light the limitations of clinical investigation early in the pathologic process.