Internet-based cognitive behavior therapy for major depressive disorder: A randomized controlled trial.

Background: Prior research has shown that the Sadness Program, a technician-assisted Internet-based cognitive behavioral therapy (iCBT) intervention developed in Australia, is effective for treating major depressive disorder (MDD). The current study aimed to expand this work by adapting the protocol for an American population and testing the Sadness Program with an attention control group.

Methods: In this parallel-group, randomized controlled trial, adult MDD participants (18-45 years) were randomized to a 10-week period of iCBT (n = 37) or monitored attention control (MAC; n = 40).

Microstructure of frontoparietal connections predicts individual resistance to sleep deprivation.

Sleep deprivation (SD) can degrade cognitive functioning, but growing evidence suggests that there are large individual differences in the vulnerability to this effect. Some evidence suggests that baseline differences in the responsiveness of a fronto-parietal attention system that is activated during working memory (WM) tasks may be associated with the ability to sustain vigilance during sleep deprivation. However, the neurocircuitry underlying this network remains virtually unexplored.

The design organization test: further demonstration of reliability and validity as a brief measure of visuospatial ability.

Neuropsychological assessments are frequently time-consuming and fatiguing for patients. Brief screening evaluations may reduce test duration and allow more efficient use of time by permitting greater attention toward neuropsychological domains showing probable deficits. The Design Organization Test (DOT) was initially developed as a 2-min paper-and-pencil alternative for the Block Design (BD) subtest of the Wechsler scales.

Sleep difficulties are associated with increased symptoms of psychopathology.

Sleep problems often co-occur with psychopathological conditions and affective dysregulation. Individuals with mood disorders have significantly higher rates of sleep disturbances than healthy individuals, and among those with mood disorders, sleep problems are associated with lower rates of remission and response to treatment. Sleep disruption may itself be a risk factor for various forms of psychopathology, as experimental sleep deprivation has been found to lead to increased affective, cognitive, and somatic symptoms within healthy volunteers.

Physical exercise and brain responses to images of high-calorie food.

Physical exercise has many health benefits, including improved cardiovascular fitness, lean muscle development, increased metabolism, and weight loss, as well as positive effects on brain functioning and cognition. Recent evidence suggests that regular physical exercise may also affect the responsiveness of reward regions of the brain to food stimuli. We examined whether the total number of minutes of self-reported weekly physical exercise was related to the responsiveness of appetite and food reward-related brain regions to visual presentations of high-calorie and low-calorie food images during functional MRI.

Translating vague complaints into precise symptoms: the implications of a poor medical history.

A medical history serves to record the patient's complaints and translate them into clear-cut, medically defined symptoms. A poorly defined symptom loses most of its discriminative power as a diagnostic test for a medical work-up. If physicians are uncertain about the exact meaning of a symptom, they have to account for the possibility of multiple competing interpretations for the identical set of complaints.

The pitted duodenal bulb.

The radiologic, endoscopic, and histologic findings in two patients with flaskshaped or collar-button collections of barium in the duodenum are presented. These abnormal mucosal depressions, which may be related to inflammation, were seen endoscopically and identified radiographically and have not been reported previously.

Substances that interfere with guaiac card tests: implications for gastric aspirate testing.

Previous studies have shown that acidic pH and several ingestible substances can cause misleading guaiac tests of gastric aspirates. In this in vitro study, over 100 foods, beverages, and drugs were diluted to concentrations potentially present in the stomachs of outpatients being evaluated for gastrointestinal bleeding. These were mixed with known concentrations of blood and tested with different brands of guaiac cards.

Large colorectal polyps: colonoscopy, pathology, and management.

Between 1984 and 1987, we reviewed all large (greater than or equal to 3.0 cm) colorectal polyps to determine the efficacy of colonoscopic polypectomy from both an oncologic and technical viewpoint. Forty-eight polyps greater than or equal to 3.

Familial achalasia in two siblings: significance of possible hereditary role.

Familial achalasia in siblings has been reported previously. We describe the clinical and radiographic findings in two siblings with achalasia. A discussion of the possible hereditary influence in achalasia is presented as well as a pertinent review of the literature.

Esophageal carcinoma multiplex with gastric metastasis.

We describe here the radiographic findings in a patient with multiple synchronous squamous carcinomas of the esophagus with a large metastasis to the gastric cardia. Radiographic documentation of this constellation of tumor involvement has not previously been reported. The mechanisms of esophageal metastasis are reviewed.

Lymphomatous polyposis of the colon.

Lymphoma of the colon is rare and has different radiographic presentations. The least common of these presentations is diffuse polyposis. Here we describe 4 cases of diffuse lymphomatous polyposis of the colon, each having a distinct radiographic appearance.

Intussusception secondary to squamous carcinoma of the lung.

This report describes unusual radiologic and pathologic findings in a patient with multiple small bowel metastases from squamous cell carcinoma of the lung. The diagnostic work-up revealed a large, pleural-based, right lung mass, a large left adrenal mass, two ulcerated small bowel masses, and a unique giant peduncular mass that caused intermittent intussusception. A pertinent review of the literature is presented.

Horse pill ("bute") hemorrhage.

Phenylbutazone (PBZ) is a nonsteroidal antiinflammatory drug (NSAID) that is not commonly prescribed due to the high incidence of serious adverse reactions. However, it is still used extensively in equine medicine, and is readily available to those employed in the care and management of horses. Such persons may take the drug indiscriminately, without medical supervision.

Intramural hemorrhage simulating gastric neoplasm.

We report a case of benign gastric ulcer with secondary extensive intramural hemorrhage causing a radiographic appearance consistent with a large ulcerated gastric neoplasm. This is the second such case reported and the first studied with sonography and computed tomographic scan. A brief review of the literature on intramural gastric hematoma is presented.

Acute suppurative obstructive cholangitis due to stones: treatment by urgent endoscopic sphincterotomy.

Endoscopic sphincterotomy is an accepted treatment for retained common bile duct stones, but there is little specific information available regarding its application in acute suppurative obstructive cholangitis with sepsis due to choledocholithiasis. Thirteen patients with this condition were referred to the authors for consideration of urgent endoscopic common bile duct decompression. All had been judged to be poor surgical candidates.

Processing of aspiration cytology samples. An alternative method.

Cytotechnologists usually assist in smear preparation during radiologic fine needle aspiration (FNA) procedures. An alternative technique is presented that requires neither cytotechnologist participation nor immediate processing. In 111 consecutive patients undergoing FNA procedures, the aspirate was immediately fixed in 50% ethanol.

Colonoscopy after Golytely preparation in acute rectal bleeding.

Thirty-five consecutive patients with acute hematochezia, negative gastric aspirates, and negative sigmoidoscopy underwent urgent colonoscopy after Golytely purgation. Mucosal visualization was excellent. Colonic bleeding lesions were identified in 24 of 35 patients, and hemorrhage originating proximal to the ileoceal valve was documented in three of these 35 patients.