Endoscopic removal of a bleeding colonic polypoid angiodysplasia: case report

Arteriovenous malformations are common causes of lower gastrointestinal bleeding in the elderly. Among them, angiodysplasia is one subtype that appears on endoscopy as red, flat superficial lesions, and sometimes slightly elevated. Colonic angiodysplasia is very rarely seen as a polypoid lesion. The present case describes a bleeding large polypoid colonic angiodysplasia in a 60-year-old man. It was removed endoscopically using a PolyLoop ligature device without complications.     

Endocrine incidentalomas

Objectives: Endocrine incidentalomas are very common in the practice of every physician, mostly primary care and family physicians. Incidentalomas are discovered in the thyroid, pituitary and adrenal glands during imaging studies performed for non‐endocrine reasons. The aim of this review article is to familiarise health professionals with all three endocrine incidentalomas, and give some guidance on how to initiate the right endocrine workup. Methods: We reviewed the most pertinent literature published on this topic through PubMed and Medline. We also discussed our own approach to incidentalomas in the endocrine clinic at Thomas Jefferson Hospital in Philadelphia. Results/conclusions: Thyroid incidentalomas are very common, with a prevalence close to 50% on imaging studies. Thyroid‐stimulating hormone (TSH) is the first test to obtain; if not suppressed, next step is fine‐needle aspiration biopsy of any nodule above 1 cm and/or with suspicious ultrasound characteristics. Adrenal incidentalomas have a prevalence of almost 5%. All adrenal nodules above 4 cm should be resected. Regardless of the size, a workup for pheochromocytoma should always be done. Only hypertensive patients should be screened for primary hyperaldosteronism. Pituitary incidentalomas are also common, with a prevalence of 10–20%. All patients with pituitary masses should have a workup for hormonal hypersecretion. Only patients with macroadenomas will have additional screening for hypopituitarism and visual field defects. All hyperfunctioning adenomas are resected except prolactinomas which are treated medically. Similarly, if a macroadenoma is causing hypopituitarism or visual deficit, surgery should also be considered.     

Effectiveness and tolerability of citalopram for the treatment of depression and anxiety disorders in children and adolescents: an open-label study

To assess the effectiveness and tolerability of citalopram for the acute treatment of children and adolescents suffering from depression and/or anxiety disorders. As much as 78 outpatients, aged 7–18 years with a diagnosis of depressive and/or anxiety disorder, completed an 8-week open trial with citalopram (20–40 mg/day). Outcome, side effects and suicidality were assessed weekly to bi-weekly using appropriate rating scales. At endpoint 56% of subjects were found to be responders (Clinical Global Impression-Improvement [CGI-I] Scale ≤ 2). Subjects with less severe psychopathology and subjects with anxiety disorders showed a more favorable response. As much as 43% of depressed and 51% of anxious subjects had a 50% or greater reduction in scores on our secondary outcome measures, Children’s Depression Rating Scale-Revised (CDRS-R) and Screen for Child Anxiety Related Emotional Disorders (SCARED). Most reported adverse events were mild to moderate and did not affect medication adherence. No increase in suicidality was observed during the study. Citalopram was moderately effective, generally well tolerated and safe for the acute treatment of depressed and anxious children and adolescents.     

The War Events Questionnaire

Background: The measurement of exposure to war in large epidemiological studies necessitates the use of easily administered and reliable questionnaires that cover a range of war events. The War Event Questionnaire (WEQ) was designed by our group to address these issues and has proved to be quite easy to administer. The aim of this study is to establish the inter-rater reliability of the WEQ. Method: Two trained interviewers alternated in administering parts I and II of the WEQ. Results: The Kappa statistics used to calculate the degree of agreement between the two raters ranged from 0.281 to 0.774 for part I events and from 0.189 to 1.000 for part II events. Conclusion: The WEQ has proved to be a useful instrument that addresses both objective and the subjective war experiences; it is a fairly reliable instrument and has helped us avoid tautological assessment of the mental health effects of war. Accepted: 28 May 1998     

Does nondipping of blood pressure at night reflect a trait of blunted cardiovascular responses to daily activities?

Background: Individuals who fail to show a decline in blood pressure (BP) when asleep or at night (labeled nocturnal nondippers) are at elevated risk for hypertension and associated targetorgan damage.Purpose: We tested whether the well-established changes in BP exhibited in response to daily activities are also blunted in nocturnal nondippers.Methods: Cross-sectional study of 41 women and 56 men, aged 27 to 71 years, residing in Benin, Nigeria, enrolled in a health survey of civil servants. Ambulatory 24-hr BP monitoring was performed with concurrent diary recordings of physical activity level, posture, location, state of mental activity, interpersonal interaction, and mood obtained during the waking hours.Results: Nocturnal nondippers exhibited smaller cardiovascular responses to changes in posture (from lying to sitting or to standing, ps <.02), location (from home to work or to driving/riding in a car, ps < .02), mental activity (from relaxed to active, p =. 02), and mood (from feeling mellow to feeling elated-happy, p = .05) than did dippers. Statistical controls for posture substantially reduced the effects of nondipping status on responses to other daily activities and mood. Lack of systolic BP responsiveness to postural changes during the day is a strong predictor of nondipping status.Conclusions: Nondipping at night appears to extend to decreased cardiovascular responses to changes in activities during daytime hours. This work was supported by National Institutes of Health Grants HL44413 andHL44413-S1.