Painful red nodules in female patient with recent travel history: a case report.

INTRODUCTION: Dermatologic pathology can be both challenging and frustrating in the Family Practice setting. CASE PRESENTATION: We report the case of a 38-year-old female that presented initially with a few, small red nodules on both the upper and lower extremities, which were painful to touch. This patient had an extremely vague picture, which included recent upper respiratory infection and recent travel to Europe. Erythema Nodosum was suspected and work-up initiated to determine underlying cause. ASO titer ultimately confirmed recent Streptococcal infection. Although the primary diagnosis was not made until follow-up visit, treatment was started based on understanding of common causes of Erythema Nodosum. CONCLUSION: Using the patient's history, a differential diagnosis knowing the common causes of EN can help direct diagnostic evaluation.

Impact of osteopathic manipulative treatment on cost of care for patients with migraine headache: a retrospective review of patient records.

CONTEXT: Migraine headache is highly prevalent in the United States, resulting in large healthcare expenditures. OBJECTIVE: To determine whether the use of osteopathic manipulative treatment (OMT) at an osteopathic family practice residency clinic affected the cost of treating patients with migraine headache, compared with non-OMT care at the osteopathic clinic and care at an allopathic family practice residency clinic. METHODS: A retrospective review of electronic medical records from patients treated for migraine at two residency clinics within the Florida Hospital organization from July 1, 2002, to June 30, 2007. One of the clinics was osteopathic and offered OMT services, and the other clinic was allopathic and did not offer OMT. All costs compiled during the office visits and costs of prescribed medications were tabulated for each patient. Patients' pain-severity ratings, as reported in office visits in 2006 and 2007, were also tabulated. RESULTS: Electronic medical records from 631 patients, representing 1427 migraine-related office visits, were analyzed. Average cost per patient visit was approximately 50% less at the osteopathic clinic than at the allopathic clinic ($195.63 vs $363.84, respectively; P<.001). This observed difference was entirely attributable to the difference in the average number of medications prescribed per visit at the two clinics, with 0.696 prescriptions at the osteopathic clinic and 1.285 prescriptions at the allopathic clinic (P<.001). This difference in prescription number resulted in a lower average medication cost per visit at the osteopathic clinic than at the allopathic clinic ($106.94 vs $284.93, respectively; P<.001). Patients at the osteopathic clinic were 5 years younger on average than at the allopathic clinic (P<.001). No statistically significant difference was observed between the two practices in patients' ratings of pain severity. CONCLUSION: The inclusion of OMT in a treatment regimen for patients with migraine headache may lower the cost of the treatment regimen. However, further study is needed to confirm these results.

Estimating cost of care for patients with acute low back pain: a retrospective review of patient records.

CONTEXT: Low back pain (LBP) has a major economic impact in the United States, with total costs related to this condition exceeding $100 billion per year. OBJECTIVE: To estimate the cost of standard care compared to standard care plus osteopathic manipulative treatment (OMT) for acute LBP of less than 6 months' duration. METHODS: A retrospective review of electronic medical records from patients who visited Florida Hospital East Orlando in Orlando. All patients had LBP of less than 6 months' duration and had received care between January 1, 2002, and December 31, 2005. The control group comprised patients who received standard care; the study group consisted of patients who received OMT in addition to standard care. Healthcare utilization (eg, radiologic scans, prescriptions) was determined by "episodes of care," and costs were averaged per patient. RESULTS: A total of 1556 patients and 2030 episodes of care met inclusion criteria. Compared with subjects in the control group, individuals in the OMT group had an average of 0.5 more office visits per EOC, resulting in 38% more office visits. However, OMT patients had 18.5% fewer prescriptions written, 74.2% fewer radiographs, 76.9% fewer referrals, and 90% fewer magnetic resonance imaging scans. In the OMT group, total average costs were $38.26 lower (P=.02), and average prescription costs were $19.53 lower (P<.001). Patients in the OMT group also had $63.81 less average radiologic costs (P<.0001). CONCLUSION: Osteopathic manipulative treatment may reduce costs for the management of acute LBP. Further research in a prospective study is needed.

Osteopathic manipulative treatment of a 26-year-old woman with Bell's palsy.

Bell's palsy is caused by a lesion of the facial nerve and results in unilateral paralysis or paresis of the face. The condition affects approximately 23 in 100,000 persons, with onset typically occurring between the ages of 10 and 40 years. The authors report the case of a 26-year-old woman with Bell's palsy, whom they treated with osteopathic manipulative treatment that was focused on the enhancement of lymphatic circulation. The osteopathic manipulative procedures used involved reducing restrictions around four key diaphragms (thoracic outlet, respiratory diaphragm, suboccipital diaphragm, cerebellar tentorium), as well as applying the thoracic pump, muscle energy, primary respiratory mechanism, and osteopathy in the cranial field. The authors, who were guided by the four principles of osteopathic philosophy, report that the patient's symptoms resolved within 2 weeks, during which two sessions of osteopathic manipulative treatment, each lasting approximately 20 minutes, were held. Patient recovery occurred without the use of pharmaceuticals.

Presence of Chapman reflex points in hospitalized patients with pneumonia.

The authors undertook a case control study to determine whether hospitalized patients with pneumonia had reflex points in the anterior chest wall as described by Frank Chapman, DO, specifically those classified as relating to the lung. Sixty-nine hospitalized patients were enrolled in the study. Patients with an admitting diagnosis of pneumonia were compared to those without pneumonia as their admitting diagnosis. All patients were examined to determine if Chapman reflex points for the lungs were present. The study controlled for potential confounding diagnoses by excluding patients with lung pathology other than pneumonia. Results demonstrated a statistically significant relationship between the presence of Chapman reflex points and pneumonia in hospitalized patients.

If the bubble bursts.... EMS response to aortic aneurysms & dissections.

An aortic disease patient is typically an older male with a history of atherosclerosis and hypertension. He might have Marfanoid characteristics, a history of cocaine or methamphetamine abuse or history of syphilis. Alternatively, suspect dissection in a pregnant female with complaints consistent with possible aortic problems. During your assessment, zero in on the patient's anatomy. Include aortic phenomena in your differential for chest and back pain. Take blood pressures in both arms. Search the abdomen for pulsatile masses, and be wary of hoarseness and Horner's syndrome.