Primary aldosteronism--actual epidemics or false alarm?

The prevalence of "primary aldosteronism" (PAL) cannot be precisely determined at this time, given 1) lack of a universally accepted definition, and 2) normotensive as well as normokalemic phases in the evolutionary development of a disease eventually characterized by hypertension and hypokalemia. The exception is fully genetically characterised forms such as glucocorticoid-suppressible hyperaldosteronism, the true prevalence of which could be proven today by universal screening using a single blood sample, but this is neither practical nor appropriate. Controversy has arisen regarding the rareness, or otherwise, of PAL because of 1) rediscovery in the last 12 years of the normokalemic phase described by Conn, 2) application of widely available methods for measurement of aldosterone and renin to "screening", 3) variable quality of these methods, and of their application, and 4) lack of the necessary "diagnostic", in addition to "screening", tests in some studies. PAL is significantly more common than previously thought, and a very important potentially curable form of hypertension. Early diagnosis and specific treatment avoids morbidity. The current focus on increased detection is essential, and will help to resolve the question of prevalence.     

Biological false reactive VDRL tests: when to re-test?

Syphilis serology is a basic screening test for the workers who want to go abroad. Many countries reject migrant workers who have reactive syphilis serology. Biological false reactives warrant repeated syphilis serology. We prospectively studied 30 patients (25 males and 5 females) who had biological false reactive VDRL tests (VDRL reactive, confirmatory TPHA negative). Affirmative tests for syphilis serology for all cases were performed every two weeks. On follow-up, the expected range (95% CI) for seroconversion was between 9.25 and 10.49 weeks. Most cases (25 cases) completely returned to the VDRL non-reactive stage within 10 weeks; three cases completely returned within 6 weeks; 2 cases completely returned within 14 weeks. It is recommended that repeat syphilis serology be conducted 10 weeks after an initial biological false reactive VDRL test.     

True or false? The hygiene hypothesis for Crohn's disease

The "hygiene hypothesis" for Crohn's disease postulates that multiple childhood exposures to enteric pathogens protect an individual from developing Crohn's disease later in life, while individuals raised in a more sanitary environment are more likely to develop Crohn's disease. In this issue of the American Journal of Gastroenterology, two Canadian case-control studies come to diametrically opposed conclusions regarding the hygiene hypothesis for Crohn's disease. This difference may be partially related to differences in study population (population based vs hospital based), age of onset, different genetic determinants, urban/rural residence (40% rural vs principally urban), or different exposures from the putative causative agent. As of now, the veracity of the hygiene hypothesis for Crohn's disease is not confirmed.     

A “false positive” octreoscan in ileal Crohn’s disease

We present a case report of a patient with a suspicious ileal carcinoid tumour. Clinical examination as well as computer tomograghy （CT） scan suggested a tumour. Octeotride scan showed uptake in the same bowel loop reported as pathological in CT. The patient underwent surgery and biopsy which reported Crohn’s disease （CD）. The interest in the case is due to the fact that this is, to the best of our knowledge, the second report of Crohn’sdisease as a cause of false positive octeotride scan. Unfortunately, no somatostatin recptors could be found in the sample, so further studies should be performed.