Endoscopic management of colonic perforations: clips versus suturing closure (with videos).

Background And Aims: Perforation during colonoscopy remains the most worrisome adverse event and usually requires urgent surgical rescue. The aim of this study was to evaluate the feasibility and effectiveness of endoscopic closure of full-thickness colonic perforations.

Methods: We performed a retrospective analysis of all consecutive patients with endoscopically closed colonic perforations over the past 6 years (2009-2014).

Superior vena cava syndrome as a presentation of metastatic prostate cancer.

Superior vena cava (SVC) syndrome is an uncommon complication of malignant disease caused by the obstruction of venous blood flow in the SVC. When present, a diagnosis of lung cancer or lymphoma will be made in approximately 95% of cases. Although other malignant diseases are occasionally associated with SVC, its occurrence in patients with prostate cancer is rare.

Lost in the mist: acute adrenal crisis following intranasal fluticasone propionate overuse.

Introduction. Acute adrenal crisis in relation to nasal steroid overuse has been reported very scantly in English medical literature and remains an underdiagnosed condition. Case presentation.

Serum 25-hydroxyvitamin D and depressive symptoms in older women and men.

Context: Hypovitaminosis D and depressive symptoms are common conditions in older adults.

Objective: We examined the relationship between 25-hydroxyvitamin D [25(OH)D] and depressive symptoms over a 6-yr follow-up in a sample of older adults.

Design And Setting: This research is part of a population-based cohort study (InCHIANTI Study) in Tuscany, Italy.

The effects of age on medio-lateral stability during normal and narrow base walking.

We examined age-related differences in frontal plane stability during performance of narrow base (NB) walking relative to usual gait. A cross-sectional analysis of participants from the Baltimore Longitudinal Study of Aging (BLSA) was performed on data from the BLSA Motion Analysis Laboratory. Participants were 34 adults aged 54-92 without history of falls.

20-Hydroxyeicosatetraenoic acid is a potent dilator of mouse basilar artery: role of cyclooxygenase.

20-Hydroxyeicosatetraenoic acid (20-HETE), an arachidonic acid (AA) metabolite synthesized by cytochrome P-450 omega-oxidases, is reported to produce vasoconstriction in the cerebral circulation. However, we find that like 14,15-epoxyeicosatrienoic acid (14,15-EET), 20-HETE produces dilation of mouse basilar artery preconstricted with U-46619 in vitro. Indomethacin inhibited the vasodilation produced by 20-HETE but not by 14,15-EET, suggesting a cyclooxygenase (COX)-dependent mechanism.

Repeat needle biopsies combined with clinical observation are safe and accurate in the management of a solitary pulmonary nodule.

Background: Sixty percent of removed solitary pulmonary nodules (SPNs) are benign. An approach that reduces the unnecessary excision of benign nodules is consistent with the oncologic objective of organ preservation.

Methods: A prospective observational study was performed at a lung cancer referral center in which consecutive patients were evaluated who presented with SPNs measuring < 4 cm on computed tomography (CT) scans.

An approach to the diagnosis and treatment of cryofibrinogenemia.

Cryofibrinogenemia is a rarely symptomatic disorder that is underrecognized due to the infrequency with which it causes symptoms. Although completely reversible, this disorder can be life threatening when untreated. In this review, the classification, pathophysiology, and clinical presentation of cryofibrinogenemia are described, based on case reports and prospective observational data.

Residents' breast examination performance. How often? How well?

The American Cancer Society recommends annual clinical breast examination (CBE) for women with average risk of breast cancer beginning at age 40. The purpose of the current chart review study was to determine the adequacy of CBE performed by house officers in a community teaching hospital. A chart audit of 92 women aged 50 or older who were consecutively admitted to the medical service was used as a baseline measure of CBE documentation.

Transbronchial needle aspiration for cytology specimens.

Transbronchial needle aspiration (TBNA) for diagnosis and staging of bronchogenic carcinoma has evolved in the USA since the late 1970's. Initial reports advised that aspirated specimens be flushed into a container by normal saline or Hank's solution and processed in a cytology laboratory usually by Millipore filter and other techniques. A highly sophisticated cytology laboratory is the key to the success of this procedure.

Is routine fecal occult blood testing worthwhile in hospitalized patients?

As with other forms of cancer, early detection of colorectal cancer is associated with higher survival rates. Published reports indicate that 5% to 10% of positive fecal occult blood tests (FOBT) are due to cancer. This article describes a chart review study of 23 hospitalized patients with positive FOBT results, of whom seven (30.

Desquamative interstitial pneumonia: a case presentation.

A 25-year-old African-American woman presented in the emergency room of a community hospital complaining of shortness of breath. The patient was admitted with a diagnosis of atypical pneumonia. Her respiration worsened despite intravenous erythromycin, nebulized albuterol, 40% oxygen via ventimask, and guaifenesin.

Felty's syndrome: a case presentation.

A 64-year-old male patient with Felty's syndrome was treated with antibiotics, Plaquenil (hydroxychloroquine sulfate), and gold salts. In the fourth week of hospitalization, the patient died. Autopsy showed extensive bronchopneumonia, fibrous pleuritis, congestive splenomegaly, mild atherosclerosis, reactive lymphoid hyperplasia, congested passive liver, severe rheumatoid arthritis, and hypercellular bone marrow.

Ceftriaxone-induced acute pancreatitis.

Objective: To report a case probable ceftriaxone-induced acute pancreatitis.

Case Summary: A patient with a history of short-bowel syndrome on home total parenteral nutrition developed fever, chills, and right flank pain. She was diagnosed with gram-negative catheter sepsis and prescribed antibiotic therapy to be administered for four weeks.

Needle brush in the diagnosis of lung mass or nodule through flexible bronchoscopy.

Transbronchial needle aspiration (TBNA), in comparison with cytology brush and forceps biopsy, in the diagnosis of a pulmonary mass or coin lesions has been studied by Shure and Wang in the past. Both studies concluded that TBNA markedly increased the diagnostic yield. A new instrument, a "needle brush" (Mill Rose Lab), has been developed and compared with the following three instruments: a regular cytology brush was used first, followed by needle brush, TBNA, and forceps biopsy under fluoroscopy.