Hypertension: the cause of the J-curve

Many studies have established that mortality from heart attacks is related to diastolic blood pressure in a J-curve with increased mortality at low as well as high pressures. This has been observed in untreated as well as treated patients and a similar phenomenon has been found in large population studies. Two hypotheses to account for this curve have been advanced. The direct causation hypothesis attributes the increased mortality at low pressures to low coronary perfusion. The reverse causation hypothesis attributes the curve to a subgroup of patients with low blood pressures as a result of pre-existing disease. This controversy is still unresolved and needs a prospective trial to decide the issue.     

Hemangiopericytoma of the colon:

A patient with a hemangiopericytoma of the colon is discussed. This is the second such case reported in the English medical literature. Soon after discovery of the tumor, the patient presented with a colonic intussusception with the tumor serving as the lead point. This was reduced by a hypaque enema, but the intussusception recurred twice more, being reduced again by hypaque enema and finally having to be reduced by colonoscopy. At surgery a left hemicolectomy with primary anastomosis was performed. The microscopic, ultrastructural, and pathologic aspects of hemangiopericytoma are discussed with special attention to lesions of the gastrointestinal tract.     

Editorial: taking FIT to the people: out of the office and into the mail

Colorectal cancer (CRC) screening is most commonly performed in the United States using an opportunistic approach: patients coming to a physician's office for other unrelated reasons are offered screening with either fecal occult blood tests or, more commonly, a referral for colonoscopy. This approach has been effective to a point. CRC screening rates are increasing, but are still suboptimal and vary across different regions of the United States. Mailed fecal immunochemical test (FIT) outreach has the potential to allow more consistent CRC screening, by moving beyond opportunistic, office visit-based screening, to an organized approach. The study by van Roon et al. in this issue of the American Journal of Gastroenterology demonstrates that mailing FIT collection devices will not result in decreased sensitivity for 10-14 days following the specimen collection.