February 2005

Venous thromboembolism is a spectrum of diseases that includes deep vein thrombosis and pulmonary embolism. It is a common source of morbidity and an avoidable cause of mortality that typically occurs in high-risk persons or in specific clinical situations. The diagnosis of deep vein thrombosis or pulmonary embolism can be challenging because of their nonspecific signs and symptoms. As a result, they are underdiagnosed and undertreated. Over the past decade, new diagnostic tools have been developed that obviate the need for invasive pulmonary angiography. Concurrently, new treatment paradigms have become available since the introduction of low-molecular-weight heparin for initial therapy. Long-term warfarin anticoagulation guidelines tailored to specific clinical situations have been developed by expert consensus.

Posttraumatic stress disorder is the fourth most common psychiatric condition, affecting about 1 in 10 people at some point during their lifetime. The principal cause is exposure to an extremely traumatic event. The individual's unique biologic or psychosocial character and previous exposure, along with the personal significance of the trauma, shape the intensity of the response. Early recognition of trauma symptoms and signs and prompt intervention are important in the prevention of acute stress disorder and the subsequent development of posttraumatic stress disorder. Obtaining a trauma history during a routine medical examination can lead to the diagnosis and help initiate treatment. In addition to being distressing, symptoms also diminish quality of life, impair psychosocial adjustment, and worsen overall health.

Investigation of the small intestine or the esophagus with conventional diagnostic and imaging modalities can be challenging. Video capsule endoscopy is a relatively new and noninvasive technique that allows direct visualization of the small bowel or the esophagus and can obviate the need for or guide the use of more invasive procedures. The capsule contains a miniature camera that takes pictures of the lining of the small intestine or the esophagus. Unlike conventional diagnostic procedures, video capsule endoscopy can often successfully identify the source of the problem quickly and painlessly. It is also useful in assessing patients with a variety of other conditions affecting the small intestine or the esophagus, including Crohn's disease, celiac disease, tumors, reflux disease, esophagitis, and Barrett's esophagus.

Several case reports published since the introduction of atypical antipsychotics suggest an association between these medications and both new-onset diabetes mellitus and diabetic ketoacidosis. The latter is a potentially life threatening medical emergency. We report the case of a 41-year-old African American woman with schizophrenia who developed type 2 diabetes and ketoacidosis 7 months after commencing olanzapine therapy. This case adds to the evidence in the literature that patients who develop ketoacidosis while taking antipsychotic medications tend to be female and relatively young, a disproportionate number of whom are African American. The frequency of these reports suggests that clinicians should monitor serum glucose levels periodically in all patients treated with atypical antipsychotics, particularly in those at increased risk for diabetes.