Treating anxiety disorders in children with group cognitive-behaviorial therapy: a randomized clinical trial.

A randomized clinical trial evaluated the therapeutic efficacy of group cognitive-behavioral therapy (GCBT) versus a wait-list control (WLC) condition to treat anxiety disorders in children. Results indicated that GCBT, with concurrent parent sessions, was highly efficacious in producing and maintaining treatment gains. Children in GCBT showed substantial improvement on all the main outcome measures, and these gains were maintained at 3-, 6-, and 12-month follow-ups. Children in the WLC condition did not show improvements from the pre- to the postwait assessment point. These findings are discussed in terms of the need to continue to advance the development of practical, as well as conceptual, knowledge of efficacious treatment for anxiety disorders in children.

Bone metabolism and osteopenia in eating disorders.

Bone loss is a potentially debilitating condition in women with eating disorders. Complications may include failure to achieve peak bone mass, increased risk of premature fractures, and inability to reach the height potential. We therefore conducted a comprehensive evaluation of 58 women with anorexia nervosa (AN), bulimia (BUL) and anorexia/bulimia (AB), comparing bone mineral density (BMD) to physical parameters, biochemical indices, and markers for bone formation and resorption. BMDs were significantly lower in patients with AN than in those with AB and BUL, and overt osteopenia was uncommon in AB and BUL. Hypercortisolism was the best laboratory marker to assess the risk of osteopenia in patients with AN. However, there were no associated changes in bone formation or resorption parameters. No direct correlation was found between BMD and body mass index, estrogen deficiency, tubular reabsorption of phosphorus, serum vitamin D, PTH, BGP, or alkaline phosphatase levels. Although the prognosis for complete recovery to normal BMD is poor, treatment of the underlying depressive disorder, improvement in nutrition with increased weight, and spontaneous resumption of menses are associated with restoring bone health.

Epiploic disorders. Conditions of the epiploic appendages.

Disorders of the epiploic appendages are rarely diagnosed preoperatively and usually result from torsion with subsequent infarction. No diagnostic test or clinical symptoms are pathognomonic of this process, which is a disease of middle age and rarely life-threatening, and the most common preoperative diagnosis is acute appendicitis. An analysis of case information reported in the surgical literature has been combined with our recent experience involving ten cases. Fifty-eight percent of the patients in this collected series were male, and the average age in both sexes was 42 years. The sigmoid colon was the most frequent site of these disorders (41.5%), and acute appendicitis was the most common preoperative diagnosis (37.7%). The treatment is ligation, excision, and occasionally seromuscular inversion. When encountered at exploration, this entity may represent the sole etiology of the abdominal pain if exploration is otherwise negative.

Common bile duct stricture without obvious cause.

Common bile duct strictures without apparent cause are unusual, yet probably occur more often than has been recognized. Whether this condition represents a different cause of biliary stricture or is just a forme fruste of recognized injuries or causes is not clear. Nonetheless, the surgeon should be aware that such isolated strictures without obvious cause may occur. The common causes of biliary stricture should be ruled out for diagnostic and therapeutic reasons. The management of such strictures is the same as for strictures due to the generally recognized causes.

Difficulties in the diagnosis and treatment of pancreas divisum.

The anatomic variant pancreas divisum has been implicated as possibly playing a role in the development of idiopathic pancreatitis. A number of recent reports have supported the use of sphincteroplasty of the minor ampulla to treat pancreatitis associated with pancreas divisum. We reviewed the cases of five recent patients with this anomaly who had problems or complications associated with the operative treatment of their pancreatitis. One patient was subsequently found to have adenocarcinoma of the pancreas after pancreatic resection; one patient had restenosis of the minor ampulla; one patient had recurrent pancreatitis following sphincteroplasty; one patient died of pancreatic necrosis postoperatively; and in one patient, no minor ampulla could be identified. Awareness of these complications and the technique of sphincteroplasty are of critical importance to the surgeons caring for these patients.

Female inguinal hernias and testicular feminization.

Surgeons and clinicians should be aware of testicular feminization and its implications in performing inguinal hernia repairs on female patients of any age. Removal of the gonads is probably indicated only after pubertal growth is complete. Other intersex conditions usually require prepubertal gonadectomy, but in these patients diagnosis is often made before any planned hernia repair. Incisional biopsy of abnormal gonads is important, but the diagnosis of testicular feminization must be confirmed by appropriate laboratory tests. Corticosteroids should be given to cover the immediate postoperative period so that patients with biochemical defects will not have hypoadrenalism.

Avulsion of the common bile duct by blunt trauma.

Two cases of common bile duct avulsion by blunt trauma are presented. These injuries are rare and the treatment is controversial, but the better repairs are choledochoduodenostomy and choledochojejunostomy. Primary repair is not indicated.

Obstruction of the ureter due to a false aneurysm.

A false aneurysm arising from an aortofemoral bifurcation graft caused symptomatic ureteral obstruction in a 69-year-old woman. Following revision of the aortograft anastomosis, her symptoms and ureteral obstruction subsided. The prevention and treatment of ureteral complications following vascular surgery are discussed. Postoperative pyelograms may be indicated in the vascular bypass patient.