Open Access Published by De Gruyter

Volume 95 Issue 10

Issue of Journal of Osteopathic Medicine

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Editorial Comments

Open Access October 1, 1995

Working conditions can contribute to preterm births

Page range: 570A-570A

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Open Access October 1, 1995

Even persons of average weight may be at a greater risk of dying younger than their lighter counterparts.

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Letters to the Editor

Open Access October 1, 1995

Recount of prostaglandin E1 therapy in a patient with Raynaud's phenomenon

Robert L. DiGiovanni, Jerry M. Littlefield, Robert G. Good

Page range: 572A-572A

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Open Access October 1, 1995

Preventive medicine indoctrination must begin at undergraduate level

John Licciardone, DO, C. MBA

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Open Access October 1, 1995

Response: Preventive medicine indoctrination must begin at undergraduate level

Frank D. Winters, Samson A. Inwald

Page range: 574-574

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News

Open Access October 1, 1995

From the NIH: Safety of calcium channel blockers outlined

Page range: 581-581

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Editorials

Open Access October 1, 1995

Synergism strengthens osteopathic medical education programs

Thomas Wesley Allen

Page range: 586-586

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Original Contribution

Open Access October 1, 1995

Occurrence and impact of suspected delirium in hospitalized elderly patients

Thomas A. Cavalieri, Lloyd J. Forman, Thomas Galski, Steven Dinsmore, Patricia A.J. Kay, Sherry Pomerantz

Page range: 588-588

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Abstract

The records of 95 consecutive people older than 65 years and admitted to a community hospital were retrospectively reviewed to determine the prevalence of undiagnosed delirium in hospitalized elderly patients. Chart review focused on identification of patients with documented diagnosed delirium according to Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R) criteria and patients with unrecognized delirium. Unrecognized delirium was considered present when information contained in a patient's chart met some or all criteria for delirium as described in DSM-III-R, but the physician's progress notes failed to indicate delirium as a diagnosed clinical entity. The prevalence of diagnosed delirium was 2%. Thirty-six percent of the patients were suspected of having unrecognized delirium. The mean length of hospital stay and the rate of mortality were significantly higher for patients with suspected delirium than for nondelirious patients. The findings of this study suggest that unrecognized delirium in the hospitalized elderly may occur frequently and is associated with an increased length of hospital stay and increased mortality.

Review

Open Access October 1, 1995

Sickle cell disease: The clinical manifestations

Julianne Wilkens Childs

Page range: 593-593

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Abstract

In the United States, sickle cell disease primarily affects people of Mrican descent, and the multisystemic complications caused by the resultant vasoocclusive state create a multitude of diagnostic considerations. In the musculoskeletal system, likelihood is high for avascular necrosis of the femoral humeral head, as a consequence of skeletal infarcts, and also for leg ulceration and osteomyelitis; in the eyes, the incidence of proliferative retinopathy is high; in the urinary tract, dehydration is common, and causes for renal failure are many; in the pulmonary system, pneumonia is of prime concern, as are sickle cell chest syndrome (from occlusion within the microvasculature of the lung) and the deadly sickle cell chronic lung disease, for which pulmonary function tests are important in early asymptomatic stages. Cholelithiasis occurs in 40% of young adult patients with sickle cell disease and can be confused with sickle cell hepatopathy, and rheumatologic and immunologic diseases can occur concomitantly with sickle cell disease, with similar symptoms. The chance for stroke in patients with sickle cell disease is 25%, and early recurrence is common, although the pathogenesis has been more clearly elucidated through computed tomography and magnetic resonance imaging. Infection with Streptococcus pneumoniae has high mortality because of the asplenia associated with sickle cell disease.

Special Communication

Open Access October 1, 1995

Residents' performance before and after night call as evaluated by an indicator of creative thought

Craig S. Nelson, Kim Dell’Angela, Scott W. Jellish, Irwin E. Brown, Michael Skaredoff

Page range: 600-600

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Abstract

The effects of sleep deprivation on medical personnel have received much attention. This study evaluates the effects of sleep loss on divergent-thinking (creative or innovative) processes as measured by the Torrance Test of Creative Thinking (TTCT). Anesthesia residents who had approximately 30 minutes sleep while being on-call were evaluated. These physicians had similar caffeine and nicotine consumption before and after the test. The results reported here demonstrate that postcall residents had TTCT scores that were appreciably below those scores of rested residents. Postcall verbal fluency was less among the on-call group than among the rested group (94.0 ± 9.7 vs 101.8 ± 9.8) as was figural originality (89.9 ± 22.1 vs 113.3 ± 20.3). These study results suggest that sleep deprivation affects divergent, or creative, thinking. Divergent-thinking processes are usually innovative and are used during complex problem-solving tasks. Further studies are needed on the effects of sleep deprivation. This information can then be used to help improve residents' working conditions and patient care.

Medical Education

Open Access October 1, 1995

Female enrollment in colleges of osteopathic medicine: Five years and five percentage points behind

Helen H. Baker

Page range: 604-604

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Abstract

An estimated one fifth of graduates of the colleges of osteopathic medicine (COMs) before 1910 were women. However, the proportion of women declined after 1900, so that by 1969, less than 3% of osteopathic medical students were women. Dramatic gains have been made in the past 25 years: for the 1993-1994 academic year, women made up 35% of all osteopathic medical students. Although these gains seem impressive, allopathic medical school enrollment comprised 400/0 women during the same academic year (5 percentage points higher than in osteopathic medical schools). Allopathic medical schools have had significantly more women enrolled every year between academic years 1969-1970 and 1993-1994. In. academic year 1985-1989, allopathic medical schools already had an enrollment that consisted of 35% female students, a percentage that COMs would first reach 5 years later. Based on these findings, enrollment of women in COMs is 5 years and 5 percentage points behind that of allopathic medical schools.

Case Report

Open Access October 1, 1995

Adult Arnold-Chiari malformation: a postpartum case presentation

Gilbert J. Toffol., Siobhan A. O’Reilly,

Page range: 607-607

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Abstract

Adult Arnold-Chiari malformation, also known as Chiari malformation type I, typically occurs in women during early adulthood and can be a cause of unexplained headaches, as well as associated syringomyelocele. In this unique case report, a 32-yearold, postpartum woman with posturally induced headache from Chiari malformation type I had symptoms occur for the first time during pregnancy. Magnetic resonance imaging of the brain confirmed the diagnosis and is the neuroimaging study of choice in such cases. Neurosurgical decompression, when performed early, is highly successful in symptomatic individuals.

Open Access October 1, 1995

Massive tissue necrosis after hydroxyzine injection

George Tokodi, Frank C. Huber

Page range: 609-609

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Abstract

A 47-year-old man hospitalized for disk surgery received a preoperative injection of hydroxyzine hydrochloride in the upper outer quadrant of the gluteal region. The immediate pain decreased after 3 days but later became incapacitating. Substantial tissue necrosis in the region of the injection was confirmed 4 weeks after the injection, and 100 g of necrotic tissue was excised, leaving the patient with lost muscle mass and a definite limp 2 years later. During the injection of hydroxyzine, the needle penetrated through the gluteal muscle and entered the gluteal artery, causing thrombosis of the artery and necrosis of the gluteus maximus muscle. This case and other reported cases indicate that the use of intramuscular hydroxyzine is contraindicated.

Open Access October 1, 1995

Transitional cell carcinoma of the distal portion of ureter protruding into the sigmoid conduit six years after cystoprostatectomy

Leonard H. Finkelstein, Anthony Elisco

Page range: 613-613

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Abstract

Bladder tumors develop after the diagnosis of upper urinary tract carcinoma in approximately 20% of cases, whereas the incidence of upper urinary tract tumor after the diagnosis of bladder cancer is low, approximately 2%. In a 64-year-old man who had undergone cystoprostatectomy treatment of bladder carcinoma 6 years previously, with the sigmoid conduit used for supravesicle diversion, a transitional cell carcinoma that developed in the conduit was not revealed with intravenous pyelography at regular follow-up intervals. The patient had only hematuria. After an obstructed left kidney, left ureteral stricture, and a filling defect in the conduit were observed radiologically and biopsy revealed a transitional cell cacinoma at the ureterosigmoid junction, the patient underwent left nephroureterectomy, partial resection of a third of the sigmoid conduit, and right ureteral reimplantation. The occurrence of upper urinary tract carcinoma after treatment of bladder cancer should be considered even in light of intravenous pyelography that shows no abnormality; and when such carcinomas occur in this situation, disease involving the conduit should be ruled out.

CME Quiz

Open Access October 1, 1995

CME Quiz

Page range: 617-617

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About this journal

The Journal of Osteopathic Medicine, founded in 1901 and known for 119 years as the Journal of the American Osteopathic Association, is the premier scholarly, peer-reviewed publication of the osteopathic medical profession. The mission of JOM is to serve as an international forum for the dissemination of scientific literature that incorporates an integrative, comprehensive, patient-centered approach to clinical care and improving health. JOM conducts double-blind peer review of academic research manuscripts from a wide variety of medical specialties, covering the full spectrum of clinical settings in which osteopathic physicians practice. All submissions are vetted by a distinguished group of Section Editors led by Editor-in-Chief Ross Zafonte, DO, and supported by a full Editorial Board.

JOM publishes original research, narrative and systematic review articles (including meta-analyses), clinical practice descriptions, and a very limited number of case reports, all of which are described fully in our Instructions for Authors. JOM is particularly interested in original scientific research that provides quantitative analysis of and contributes significantly to the evidence base underpinning current practices in osteopathic medicine, including but not limited to neuromusculoskeletal medicine. We also accept research submissions documenting trends and changes in education for osteopathic medical students. The ultimate focus of all material published in JOM is to support, enhance, and advance patient care through evidence.