The natural history of Meckel's diverticulum and its relation to incidental removal: A study of 202 cases of diseased Meckel's diverticulum found in King County,Washington, over a fifteen year period

To determine the natural history of Meckel's diverticulum, 202 case records of proved disease of Meckel's diverticulum were retrieved, covering a fifteen year period, from all the hospitals of King County, Washington (population, 1,143,800). Using the figure of 2 per cent incidence of Meckel's diverticulum, we calculated that a Meckel's diverticulum has a 4.2 per cent likelihood of causing disease during a lifetime, decreasing to zero with old age. Using previously published mortality and morbidity figures, we calculated that to save one patient's life from the complications of Meckel's diverticulum, it would be necessary to remove approximately 800 asymptomatic Meckel's diverticula. This would be likely to incur a significant amount of postoperative morbidity from postoperative intestinal obstruction and infection. We suggest that the prophylactic removal of Meckel's diverticulum is rarely, if ever, justified.     

Central nervous system infections associated with hereditary hemorrhagic telangiectasia

The clinical courses of 31 episodes of brain abscess and one episode of meningitis occurring in patients with hereditary hemorrhagic telangiectasia are reviewed. Pulmonary arteriovenous malformations were demonstrable in all but two patients and presumably permitted septic microemboli to evade the normal pulmonary capillary filter and lodge in the brain. Obtundation, headache, visual disturbances, hemiplegia, and seizures were the most common presenting features. Cyanosis, clubbing, polycythemia, and hypoxemia were routinely encountered, but leukocytosis and fever were present in a minority of cases, and all blood cultures were sterile. Anaerobic and microaerophilic streptococci were the commonest pathogens found in the brain abscesses. Thirteen patients died, and patients without abscess drainage or with delayed diagnosis had a higher mortality rate. A brain abscess may develop in approximately 1 percent of patients with hereditary hemorrhagic telangiectasia, and awareness of this risk should lead to early investigation of any patient with hereditary hemorrhagic telangiectasia who has neurologic symptoms.     

The prevalence of somatization in primary care

The authors define somatization as an idiom of distress in which patients with psychosocial and emotional problems articulate their distress primarily through physical symptomatology. Studies are then reviewed to demonstrate the inordinate amount of time and energy these patients cost the health care practitioner as well as the frequency of misdiagnosis. Iatrogenic harm is a common problem in somatizing patients due to unnecessary tests, hospitalizations, surgeries as well as the development of chronic illness behavior. It is essential that psychiatrists working in consultationliaison begin to develop research in the area of somatization especially at the primary care level.     

Evidence for an accelerated adaptation to starvation in chronic uremia

During a 72-hr period of starvation plasma levels of glucose and immunoreactive insulin fell to a greater extent, and alanine, free fatty acid, and glycerol concentrations were higher in fasted chronically uremic rats than in nonuremic controls. These changes, in conjunction with a significant increase in the uremic group's activity of phosphoenolypyruvate-carboxykinase, the rate-limiting enzyme in hepatic gluconeogenesis, after only 12 hr of fasting suggest that alterations in glucose metabolism in uremia may contribute to an exaggeration and acceleration of the metabolic consequences of starvation.     

COPD: psychosocial and psychophysiological issues

The treatment of the patient with chronic obstructive pulmonary disease (COPD) described here is one in which psychosocial assets are increased, the effect of life change is minimized, and the emotional defenses are utilized to cope with the disease process. Problems in the patient's environment are surmounted when the patient maintains a therapy program that allows him or her to meet the requirements of daily living.     

Effect of fluoride therapy on nondialyzable urinary hydroxyproline,serum alkaline phosphatase,parathyroid hormone,and 25-hydroxyvitamin D

The effect of sodium fluoride therapy was studied in 40 osteoporotic male subjects, aged 50–80 yr. Twenty patients were treated with sodium fluoride (20–40 mg/day) and 20 received placebo for 107 wk. A marked increase (53%; p < 0.001) in the nondialyzable fraction of urinary hydroxyproline was found in the fluoridetreated group. Total urinary hydroxyproline levels were unchanged. The increased fraction of urinary hydroxyproline is suggestive of increased bone collagen synthesis and is consistent with the finding of a diminished rate of bone loss in the fluoride-treated group (per cent change in bone density after 107 wk was ?0.14 ± 5.28 versus ?5.24 ± 7.62 for the placebo-treated group; p < 0.02). Serum alkaline phosphatase levels were elevated in the fluoride-treated group (38%; p < 0.001) after 107 wk of treatment. This change, as well as the increased fraction of urinary hydroxyproline persisted for at least 6 mo after cessation of fluoride treatment and was not temporally related to serum fluoride levels. No significant changes in serum parathyroid hormone, 25-hydroxyvitamin D, serum calcium, and phosphorus were found after 1 yr of fluoride treatment. These findings suggest that fluoride does not alter serum 25-hydroxy-vitamin D and that the mechanism by which fluoride increases the rate of bone formation does not involve hyperparathyroidism.