Standards of education, regulation, and market control: perspectives on complementary and alternative medicine in Ontario, Canada

This paper provides a contemporary analysis of the issues and questions surrounding the regulation and standardization of education with respect to two complementary and alternative medicine (CAM) professions, namely Chinese traditional medicine and homeopath in Ontario, Canada. Rather than taking a standard of education for granted, the assumption that standardizing professional education is a positive move is critiqued because it is claimed to ensure public safety and uniformity within the profession. It is argued that such an assumption fails to deconstruct the power relations involved with setting a standard of education and continues to ignore the fact that setting a standard of education in CAM is part and parcel of biomedical dominance, competition, turf wars and survival. At the end of this paper, some critical questions regarding setting standards of education by the health professions in general are raised.     

Airway stenting for malignant and benign tracheobronchial stenosis

BACKGROUND: Patients with benign and malignant central airway obstruction suffer from disabling dyspnea, obstructive pneumonia, and impending suffocation. Therapeutic bronchoscopy provides immediate and gratifying palliation. Airway stenting is the principal modality used to manage intrinsic tracheobronchial pathology and extrinsic airway compression. This report provides the details of the indications, techniques, and results of airway stenting in our practice. METHODS: University of Washington patients undergoing bronchoscopy with stent placement or revision from May 1992 through December 2001 were extracted from a prospective patient database. Details of the stent procedure were obtained from the medical records and office charts. Early outcomes were assessed by patient symptoms and signs, and late outcomes were assessed by patient follow-up visits, follow-up bronchoscopy, or discussions, or a combination of these with the patient, patient's family, or referring physician. RESULTS: One hundred forty-three patients underwent 309 stent procedures of which 67% were for malignant disease. Eighty-two percent required urgent or emergent intervention, and 77% had compromise of more than three fourths of the airway lumen. Eighty-seven percent of stents placed were silicone rubber and 15% of patients required multiple stents to achieve airway palliation. Significant improvement was achieved in 94% of patients but required multiple endoscopies to maintain improvement in 41%. There was no stent-related mortality and only one major complication required surgery. CONCLUSIONS: Airway stenting provides prompt and durable palliation in unresectable patients with central airway obstruction. Frequently multiple stents and multiple procedures will be necessary to maintain a satisfactory airway.     

Gastric and duodenal cutaneous fistulas

Forty-seven patients, 18 with gastric and 29 with duodenal cutaneous fistulas, managed at the Cleveland Clinic Foundation between 1956 and 1976 are analyzed. This is done with the intention of defining factors responsible for increased rates of morbidity and mortality. The location and number, output, associated sepsis, and nutritional status are reviewed. Treatment modalities ranged from nonsurgical medical treatment to conservative surgical and radical surgical treatment. Overall mortality rate was 29.8% with a 34.5% mortality rate from duodenal fistulas and 22.2% from gastric fistulas. A review of the literature and guidelines for management of gastric and duodenocutaneous fistulas are presented.     

Aseptic necrosis following slipped capital femoral epiphysis

Sixty-five patients with slipped capital femoral epiphysis were studied retrospectively for the development of aseptic necrosis. Seven (11%) patients developed segmental or total aseptic necrosis of the capital femoral epiphysis. Radiographically the changes of aseptic necrosis were detectable as early as four months. The cause for the aseptic necrosis is thought to be due to interruption of the blood supply to the capital femoral epiphysis at the time of slippage or during surgical manipulation.     

Focal fibrocartilaginous dysplasia: curettage as an alternative to conservative management or more radical surgery

We describe two cases of focal fibrocartilaginous dysplasia, one treated conservatively while the other underwent curettage of the lesion. Resolution of tibia vara and healing of the focal fibrocartilaginous dysplasia was noted at 6 months in the patient who underwent curettage while the conservatively managed patient required 8 years of follow-up. Of the 17 cases of conservatively followed tibial focal fibrocartilaginous dysplasia described in the literature, 11 showed complete recovery after a median interval of 57 months. We believe that curettage may result in rapid healing by removing the persistent mesenchymal anlage which can interfere with the normal growth of the tibia. Received: 15 January 2001 Accepted: 16 February 2001