[Hamartoma of the duodenum: a rare cause of gastrointestinal bleeding]. / Hamartom des Duodenums: Seltene Ursache einer gastrointestinalen Blutung.

We report on a 34-year-old man who was admitted to our hospital with melena and hematemesis. Endoscopy showed a giant pedunculated polyp of the duodenum as the source of bleeding. The 10 cm long tumor was resected transduodenally by open surgery and the histological examination revealed it to be a hamartoma. This case demonstrates a very rare benign tumor of the duodenum, its possible clinical manifestation and treatment options.

Bagh regrows - earthquake survivors as catalysts of community and personal reconstruction.

In our age of frequent natural disasters in this increasingly interdependent world, there is a pressing need to understand better the processes of societal adjustment. The Kashmir earthquake of 8 October 2005 brought human suffering on a massive scale. High rates of psychiatric morbidity have been reported (Niaz et al, 2006; see also http://emdrpakistan.com). Whereas the relevance of the application of Western, secularised, psychological treatment models to this group is outside the scope of this paper, survivors have faced catastrophe and destruction of both their internal and external realities.

Status and development of critical incident stress management services in the United Kingdom National Health Service and other emergency services combined: 1993-1996.

Surveys conducted amongst members of the Association of NHS Occupational Physicians indicate few changes in the status and development of Critical Incident Stress Management Services (CISMS) in the United Kingdom National Health Service between 1993 and 1996. Limited CISMS are confirmed by the majority of respondents in the two surveys with developments having typically occurred within long-established staff care services such as counselling. In 1996 NHS provision is typically based on the independent use of own resources. A 1996 comparison of NHS with pooled returns from Ambulance Services, Fire Brigades and Social Services Departments indicates few variations in status, provision and levels of expertise in the delivery of CISMS. Other emergency services co-operate to a greater extent with each other than does the health care sector. Occupational Health Department responders confirm availability of expertise resources to provide CISMS, but low priority status frustrates delivery of CISMS. Survey results indicate the NHS is at risk of not fulfilling its duty to care for staff after major incidents. The establishment of regional centres of CISMS excellence with local and national responsibilities is advocated.

Long-term traumatic stress reactions in British Falklands War veterans.

This brief report summarizes the first available findings on long-term traumatic stress syndromes among ex-servicemen who are veterans of the Falklands War. The results reveal a correlation between physical injury during the War and post-traumatic stress disorder, indicating the need for a long-term follow-up survey incorporating treatment evaluations and welfare rights.

Post-traumatic stress disorders and European war veterans.

After tracing the history of PTSD as a diagnosis and exemplifying its use among non-European war veteran groups, this review article documents the size and characteristics of European war veteran populations and the known psychological, social and medical sequelae of war experience since 1918. Models of psychopathology vary markedly over time and between countries. Treatment practices owe more to sociopolitical and military expediency than systematic assessment of European veterans' needs and treatment outcomes. PTSD has not yet attained the pivotal status it enjoys in studies of American war veterans. Reasons for this are offered along with a proposal that recent European studies rightly highlight a broad spectrum of post-war adjustment difficulties in which PTSD emerges as a process phenomenon with implications for prognosis and future care planning.

The Lincolnshire Joint Emergency Services Initiative for staff at risk following critical incidents.

This article is based on a paper presented by Roderick J. Orner at the Annual Conference of the National Association for Health Service Personnel Officers, Bristol, 20-21 September 1991. The scheme won the Prize for Innovation in HRM at the National Healthcare Awards for Excellence in Human Resource Management 1991.