The Comprehensive Osteopathic Medical Licensing Examination, COMLEX-USA: a new paradigm in testing and evaluation.

Medical licensure in the United States demands a dynamic and current means to evaluate the competency of physicians seeking to practice medicine. A systematic measuring tool is required--one that is based on actual patient encounters and how physicians should apply their knowledge and skills to the clinical setting according to their level of training and professional development. Osteopathic physicians have a distinctive approach to healthcare, applying the biopsychosocial model with emphasis on the neuromusculoskeletal system. A component of this distinctive approach is a high level of knowledge and skill in the application of osteopathic manipulative treatment. Developed by the National Board of Osteopathic Medical Examiners, COMPLEX-USA is the new sequential three-level examination process for osteopathic medical licensure in the United States. The examination process is interdisciplinary and highly clinical, with even basic science components tested within a clinical context. Examination content is based on wide expert consensus and data consistent with osteopathic medical education, training, and practice. Its design is a novel multidimensional structure that emphasizes clinical problem-solving skills and osteopathic principles and practice within the context of life cycle, gender, ethnicity, and points of service. Design schemata and blueprints are included along with descriptions of strategic research and development. COMPLEX-USA represents the most appropriate pathway for initial licensure for a distinctive and unique professional: the osteopathic physician in the United States.

Male breast carcinoma: clinical experience in a suburban community.

Male breast cancer is difficult to study because it occurs infrequently, accounting for 1% of all breast carcinoma. Breast cancer occurs 10 years later in men than in women, and its presentation parallels that in women. The authors retrospectively review 13 cases of male breast cancer occurring over a 20-year period in four community hospitals. Treatment methods paralleled those used for female cancer patients. Surgery, primarily radical mastectomy, was performed in all patients. In the eight patients in whom hormone receptor assays were obtained, all tests were positive for estrogen receptors, progesterone receptors, or both. Metastases were diagnosed in five patients during follow-up. The longest disease-free survival has been 10 years. Similarities and differences regarding male and female breast cancer are discussed as are the diagnosis and management of men with this disease.

Hemangiopericytoma of the breast.

Hemangiopericytoma is an extremely rare soft tissue tumor of the pericytes that surround the walls of blood vessels. The lesion is characterized by proliferation of the pericytes above the basement membrane. The microscopic features of the hemangiopericytoma can often be demonstrated by reticulin staining. Clinical presentation can vary. The lesion has been found in any number of anatomic locations. Occurrence in breast tissue, however, has been strikingly rare. Most lesions are benign. However, they can be aggressive and can recur at distant sites. Malignant varieties have been reported. In breast tissue, the most difficult aspect of the diagnosis appears to be that the tumor grossly, and to some extent microscopically, resembles cystosarcoma phylloides, particularly in the malignant degenerative form of the latter disease. Most diagnostic methods for evaluating the tumor fail to produce a definitive diagnosis. Microscopic confirmation is perhaps the only method by which definitive diagnosis can be made. Treatment consists of wide excision and careful clinical follow-up. A case history and a review of the literature concerning this lesion are included here.