Osteopathic Family Physician RSS feed: Current Issue. Osteopathic Family Physician , the official journal of the American College of Osteopathic Family Physicians, is a peer-reviewed publication whose purpose to deliver information that helps osteopathic family physicians care for their patients, improve their practices, and better understand the activities ACOFP is taking on their behalf. The content areas of the journal reflect the interests of Association members and other health professionals. These areas include such diverse topics as preventive medicine, managed care, osteopathic principles and practices, pain management, public health, medical education, and practice management. The journal's particular emphases include an active forum for the presentation of family medicine research in diverse settings, involving medical students, residents, fellows, and practicing professionals. Osteopathic Family Physician provides a forum for careful systematic reviews of primary care. As the official journal of the American College of Osteopathic Family Physicians, Osteopathic Family Physician publishes policy statements, communications from the Board of Governors, and notices of important Committee and Special Interest Group projects. http://www.osteopathicfamilyphysician.org/?rss=yesElsevier Inc.en © 2012 Elsevier Inc. All rights reserved. Osteopathic Family Physician1877-573X41January 2012 © 2012 Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.osteopathicfamilyphysician.org/article/PIIS1877573X1100219X/abstract?rss=yesOsteopathic medicine has made great strides in modern medicine. Once we struggled for acceptance; now we strive for distinctiveness. Many features make osteopathic medicine unique, but one of the clearest areas of distinctness is the integration of osteopathic diagnosis and treatment in the overall patient evaluation and treatment.Attaining distinctiveness as a professionJay H. Shubrook10.1016/j.osfp.2011.11.003Osteopathic Family Physician 4, 1 (2012)2012-01-01Osteopathic Family Physician2012-01-0141S1877-573X(11)X0006-0Editor’s Message11http://www.osteopathicfamilyphysician.org/article/PIIS1877573X11001365/abstract?rss=yes Several studies have assessed interexaminer correlation of diagnosis of somatic dysfunction (SD). This study looks at the simple task of palpating the anterior superior iliac spine (ASIS) of both a live and a fixed plastic model to determine whether examination results are reliable. It is expected that osteopathically trained individuals would be able to do this with reasonable accuracy. However, we tested the results of 151 examiners and found low levels of agreement on diagnosis. Furthermore, the fixed models ‘ASIS’ were set at equal, yet most examiners (89.2%) chose either left or right. Based on these statistically significant results, we can conclude that palpation for symmetry of two paired structures (such as ASIS') is not an accurate way to assess for SD. It is important to have a standardized approach to diagnosis, because comparing one ASIS with the other does not seem to be the best way to teach students how to diagnose. Reliability of diagnosis of somatic dysfunction among osteopathic physicians and medical studentsKatrine Bengaard, Richard J. Bogue, W. Thomas Crow10.1016/j.osfp.2011.08.003Osteopathic Family Physician 4, 1 (2012)2012-01-01Osteopathic Family Physician2012-01-0141S1877-573X(11)X0006-0Research Article27http://www.osteopathicfamilyphysician.org/article/PIIS1877573X11002188/abstract?rss=yes Osteopathic manipulative treatment (OMT) is a unique aspect of osteopathic medicine that has served as a useful adjunct to traditional surgical and pharmacological treatment of medical conditions for more than 100 years. Using an approach based on five basic body functions, as well as traditional modern medical and surgical therapeutics, OMT enhances the body's innate ability to fight inflammation and other systemic results of disease states. OMT has been shown to be a safe and cost-effective treatment for back pain, in particular for patients who have continued pain despite standard treatments and for those who are unable or unwilling to take pain relievers. For patients with pneumonia, OMT can reduce the need for potentially dangerous antibiotics and reduce the length of a patient's hospital stay. In addition, in children with otitis media, OMT can be used as an adjunct to antibiotic and surgical treatment to decrease morbidity, reduce antibiotic usage, and decrease the discomfort associated with the symptoms of a middle ear infection. Evidence-based osteopathic manipulative treatment for common conditionsLuis Liu Perez, Jason A. Sneed, David Eland10.1016/j.osfp.2011.11.002Osteopathic Family Physician 4, 1 (2012)2012-01-01Osteopathic Family Physician2012-01-0141S1877-573X(11)X0006-0Review Articles812http://www.osteopathicfamilyphysician.org/article/PIIS1877573X11001766/abstract?rss=yes Cutaneous metastasis is a rare occurrence but may be the presenting sign of a primary internal malignancy. Skin, breast, lung, gastrointestinal, and kidney are the most common primary malignancies to metastasize to skin. Common regions for cutaneous metastasis include the scalp, abdomen, chest, back, and extremities. The appearance of cutaneous metastasis is a preterminal occurrence and clinically a very poor prognostic sign. Skin cancer was the topic chosen, but it was decided to explore skin as a site of metastasis rather than primary melanoma, squamous cell, or basal cell carcinoma. A search and review of the literature on PubMed was performed to identify cases of cutaneous metastasis caused by a variety of primary sources in adults—mainly breast, lung, skin, gastrointestinal, genitourinary, renal, and thyroid. Inclusion criteria for the review was most common types of cancer in adults, appearance of lesions, and cutaneous metastasis to distant regions rather than direct extension with the exception of breast cancer. Primary malignancies found in children, lymphomas, and leukemias were not included in this review. Skin as a site of metastasisStephanie Aldret, Lora Cotton10.1016/j.osfp.2011.09.005Osteopathic Family Physician 4, 1 (2012)2012-01-01Osteopathic Family Physician2012-01-0141S1877-573X(11)X0006-0Review Articles1317http://www.osteopathicfamilyphysician.org/article/PIIS1877573X11002139/abstract?rss=yes Toenail removal is a common procedure that family physicians routinely perform in the office. This article highlights the acute and chronic indications for toenail removal and its contraindications, potential complications, and procedural details including digital block anesthesia. A sample consent form and patient educational handout are provided as well as the current diagnostic International Classification of Diseases, 9th revision, and current procedural terminology codes for the clinician to use. Procedural review of toenail excisionScott Klosterman, Candace Prince10.1016/j.osfp.2011.11.001Osteopathic Family Physician 4, 1 (2012)2012-01-01Osteopathic Family Physician2012-01-0141S1877-573X(11)X0006-0Review Articles1823http://www.osteopathicfamilyphysician.org/article/PIIS1877573X11001250/abstract?rss=yes Background: Hereditary angioedema (HAE) is a rare autosomal dominant genetic disorder characterized by localized or diffuse swelling of an affected patient's face, neck, larynx, visceral organs, extremities, and trunk. There is also an acquired form of angioedema that has been described in patients with malignancies (i.e., lymphocytic leukemia) or collagen vascular disease, or in those who have developed C1 esterase inhibitor (C1-INH) autoantibodies. However, HAE is rarely associated with urticaria. Clinical case: A 19-year-old Caucasian woman was admitted to our hospital with five days of burning and pruritic whole-body erythematous rash, facial and eyelid swelling, sore throat, and abdominal pains. She was taking Yaz, an oral birth control pill (Bayer HealthCare Pharmaceuticals, Wayne, NJ). She was started on Benadryl 50 mg intravenously every six hours, famotidine 40 mg by mouth every 12 hours, doxepin 75 mg by mouth at bedtime as needed, and methylprednisolone 125 mg intravenously every six hours without clinical improvement. Extensive laboratory testing was performed and she had a low C4 level 15mg/dL (16-47 mg/dL), a low C1-INH level 6 mg/dL (10-25 mg/dL), and an elevated CRP level 1.6 mg/dL (0-0.9 mg/dL). Because of the relatively low levels of C4, low C1-INH levels, increased CRP, use of oral contraceptive pills, abdominal symptoms, and poor response to high dose steroid therapy, a provisional diagnosis of HAE was made and she was treated with intravenous infusion of C1-INH (Berinert, CSL Behring GmbH, Marburg, Germany) at a dose of 20 U/kg of body weight for one dose at a rate of 4 mL/min. Her symptoms completely resolved with this medication. Conclusion: This is one of only a few case reports that demonstrates HAE presenting initially as refractory urticaria. Hereditary angioedema presenting as refractory urticaria: a case reportMatthew Wall10.1016/j.osfp.2011.06.001Osteopathic Family Physician 4, 1 (2012)2012-01-01Osteopathic Family Physician2012-01-0141S1877-573X(11)X0006-0Case Reports2428http://www.osteopathicfamilyphysician.org/article/PIIS1877573X11001717/abstract?rss=yes Nonmelanoma skin cancer, consisting of squamous and basal cell carcinoma, is the most common malignancy in the United States. The most common risk factor is exposure to ultraviolet radiation; however, these malignancies have also developed at sites of exposure to industrial agents, ionizing radiation, and areas of chronic inflammation. This case details an 85-year-old white male who presented with a squamous cell carcinoma that developed proximate to a subcutaneous metallic foreign body. The lesion was successfully excised with negative margins. We review the literature and discuss potential mechanisms of foreign body carcinogenesis. Case of a squamous cell carcinoma associated with a subcutaneous foreign bodyEric M. Neverman, Craig A. Canby, Edward D. Shuherk, Rebecca S. Frisch10.1016/j.osfp.2011.09.002Osteopathic Family Physician 4, 1 (2012)2012-01-01Osteopathic Family Physician2012-01-0141S1877-573X(11)X0006-0Case Reports2932http://www.osteopathicfamilyphysician.org/article/PIIS1877573X11002371/abstract?rss=yesBruising10.1016/S1877-573X(11)00237-1Osteopathic Family Physician 4, 1 (2012)2012-01-01Osteopathic Family Physician2012-01-0141S1877-573X(11)X0006-0Patient Education Handout3333http://www.osteopathicfamilyphysician.org/article/PIIS1877573X11002395/abstract?rss=yesCalender of Events10.1016/S1877-573X(11)00239-5Osteopathic Family Physician 4, 1 (2012)2012-01-01Osteopathic Family Physician2012-01-0141S1877-573X(11)X0006-03434http://www.osteopathicfamilyphysician.org/article/PIIS1877573X11002255/abstract?rss=yesGuide for Readers10.1016/S1877-573X(11)00225-5Osteopathic Family Physician 4, 1 (2012)2012-01-01Osteopathic Family Physician2012-01-0141S1877-573X(11)X0006-0FrontmatterA1A1http://www.osteopathicfamilyphysician.org/article/PIIS1877573X11002267/abstract?rss=yesEditorial Board10.1016/S1877-573X(11)00226-7Osteopathic Family Physician 4, 1 (2012)2012-01-01Osteopathic Family Physician2012-01-0141S1877-573X(11)X0006-0FrontmatterA2A2http://www.osteopathicfamilyphysician.org/article/PIIS1877573X11002279/abstract?rss=yesTable of contents10.1016/S1877-573X(11)00227-9Osteopathic Family Physician 4, 1 (2012)2012-01-01Osteopathic Family Physician2012-01-0141S1877-573X(11)X0006-0FrontmatterA3A3